RESUMO
Murine typhus is a febrile, fleaborne disease caused by infection with Rickettsia typhi bacteria. Cases can range from mild and nonspecific to fatal. We report 2 cases of murine typhus in Costa Rica, confirming the presence and circulation of R. typhi causing severe disease in the country.
Assuntos
Rickettsia , Tifo Endêmico Transmitido por Pulgas , Animais , Camundongos , Humanos , Tifo Endêmico Transmitido por Pulgas/diagnóstico , Tifo Endêmico Transmitido por Pulgas/epidemiologia , Tifo Endêmico Transmitido por Pulgas/microbiologia , Costa Rica/epidemiologia , Rickettsia typhi/genéticaRESUMO
Ovule formation is a complex developmental process in plants, with a strong impact on the production of seeds. Ovule primordia initiation is controlled by a gene network, including components of the signaling pathways of auxin, brassinosteroids and cytokinins. By contrast, gibberellins (GAs) and DELLA proteins, the negative regulators of GA signaling, have never been shown to be involved in ovule initiation. Here, we provide molecular and genetic evidence that points to DELLA proteins as novel players in the determination of ovule number in Arabidopsis and in species of agronomic interest, such as tomato and rapeseed, adding a new layer of complexity to this important developmental process. DELLA activity correlates positively with ovule number, acting as a positive factor for ovule initiation. In addition, ectopic expression of a dominant DELLA in the placenta is sufficient to increase ovule number. The role of DELLA proteins in ovule number does not appear to be related to auxin transport or signaling in the ovule primordia. Possible crosstalk between DELLA proteins and the molecular and hormonal network controlling ovule initiation is also discussed.
Assuntos
Proteínas de Arabidopsis/metabolismo , Arabidopsis/embriologia , Giberelinas/metabolismo , Óvulo Vegetal/embriologia , Arabidopsis/citologia , Óvulo Vegetal/citologiaRESUMO
The controlled release of functionally active compounds is important in a variety of applications. Here, we have synthesized, characterized, and studied the magnetic properties of three novel metal-metal-bonded tris(formamidinato) Ru25+ complexes. We have used different auxin-related hormones, indole-3-acetate (IAA), 2,4-dichlorophenoxyacetate (2,4-D), and 1-naphthaleneacetate (NAA), to generate [Ru2Cl(µ-DPhF)3(µ-IAA)] (RuIAA), [Ru2Cl(µ-DPhF)3(µ-2,4-D)] (Ru2,4-D), and [Ru2Cl(µ-DPhF)3(µ-NAA)] (RuNAA) (DPhF = N,N'-diphenylformamidinate). The crystal structures of RuIAA, RuIAA·THF, Ru2,4-D·CH2Cl2, and RuNAA·0.5THF have been determined by single-crystal X-ray diffraction. To assess the releasing capacity of the bound hormone, we have employed a biological assay that relied on Arabidopsis thaliana plants expressing an auxin reporter gene and we demonstrate that the release of the phytohormones from RuIAA, Ru2,4-D, and RuNAA is pH- and time-dependent. These studies serve as a proof of concept showing the potential of these types of compounds as biological molecule carriers.
Assuntos
Arabidopsis/química , Complexos de Coordenação/química , Ácidos Indolacéticos/química , Reguladores de Crescimento de Plantas/química , Rutênio/química , Arabidopsis/metabolismo , Complexos de Coordenação/síntese química , Complexos de Coordenação/metabolismo , Concentração de Íons de Hidrogênio , Ácidos Indolacéticos/metabolismo , Fenômenos Magnéticos , Estrutura Molecular , Reguladores de Crescimento de Plantas/síntese química , Reguladores de Crescimento de Plantas/metabolismo , Temperatura , Fatores de TempoRESUMO
PURPOSE: Participation in medical decisions and taking into account patients' values and preferences are especially important for psychiatric patients who may be treated against their will. The increasing rates of coercive measures and the underlying clinical, ethical, and legal issues highlight the need to examine their use in psychiatry. Although limited congruence in decision-making preferences may be on the basis of these coercive practices, this issue has not been adequately addressed. We explore the relationship between compulsory admissions and congruence in decision-making preferences in mental health settings. METHODS: Cross-sectional study among 107 outpatients with DSM diagnoses of schizophrenia of bipolar disorder using the Control Preference Scale to assess congruence in decision-making experienced and preferred style. History of compulsory admissions was obtained through review of available records. Descriptive statistics and multivariate analyses were used. RESULTS: 70% of patients reported experiencing their preferred style of decision-making and 44% patients had history of compulsory admissions. These patients were more autonomous and preferred to take a more active role. The degree of congruence was lower in patients with previous compulsory admissions. The best predictors of compulsory admissions were not having a regular doctor and the unmatched participation preferences. CONCLUSIONS: Patients who experienced a different level of participation in decision-making than desired more frequently had compulsory admissions. We propose to assess participation preferences each time a relevant treatment decision is about to be made and tailor care accordingly. We identified several factors leading to compulsory admissions that can be modified to prevent further coercive measures.
Assuntos
Transtorno Bipolar/terapia , Hospitalização , Participação do Paciente , Transtornos Psicóticos/terapia , Transtorno Bipolar/psicologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Psicóticos/psicologia , EspanhaRESUMO
Greater attention is focusing on the motivations of subjects recruited for research protocols, especially in vulnerable populations. Although addiction is a highly stigmatized condition, very little research has focused on the factors influencing the decision to participate of patients with an addiction. Our aim is to gather further evidence in relation to the motivations of people with Substance Use Disorders (SUD), comparing their reasoning and willingness to participate in a hypothetical research study of 53 subjects with DSM-5 diagnoses of SUD and 50 controls. Responses on the MacArthur Competence Assessment Tool for Clinical Research were documented and correlated with several variables. There were no significant differences in willingness to participate in research and reasons for doing so between SUD and controls. Among SUD subjects, 59% mentioned altruism, 53.8% expected therapeutic benefits, and 43.6% desired to help others; none mentioned money. Of those patients with SUD who refused to participate in research, 69.2% cited aversion and 46.2% mentioned risk. Willingness to participate was correlated with higher computer literacy and better cognitive performance. In the multivariate analysis, aversion was a significant predictor of willingness to participate in research. When research is not related to their diagnosis, the motivations of SUD and controls are similar and ï¬owed logically from the study. However, elements associated with therapeutic misconceptions were also evident. Therefore, negative views about the motivations of SUD subjects' participation in research are unfounded. Consequently, to improve study recruitment, assessments may be targeted to speciï¬c vulnerabilities rather than to diagnoses.
Cada vez se presta más atención a las motivaciones de las personas reclutadas para ensayos clínicos, especialmente si pertenecen a colectivos vulnerables. Aunque la participación en investigación de las personas con trastorno por uso de sustancias (TUS) suscita estereotipos negativos, muy pocos estudios se han centrado en los factores que influyen en la misma. Nuestro objetivo es analizar sus motivaciones comparando las razones y la disposición a participar en un ensayo hipotético de 53 pacientes con diagnósticos DSM-5 de TUS y 50 controles. Las respuestas que dieron a la entrevista MacArthur Competence Assessment Tool for Clinical Research se correlacionaron con diversas variables. No encontramos diferencias significativas entre ambas poblaciones en términos de motivaciones y disposición a participar. El 59% de la población TUS mencionó altruismo, un 53,8% esperaba beneficio terapéutico, y el 43,6% deseaba ayudar a otros. De los pacientes con TUS que rechazaron participar, el 69,2% alegó miedo y el 46,2% incomodidad por los riesgos. La disposición a participar se relacionó con un mayor nivel cognitivo y de alfabetización informática. En el análisis multivariante, la aversión a la investigación permaneció como factor predictivo significativo de la disposición a participar. Cuando la investigación no está relacionada con su diagnóstico, las motivaciones de la población TUS son similares a las de los controles y se deducen lógicamente del estudio, aunque también se evidenciaron elementos de "error terapéutico". Por consiguiente, las visiones negativas sobre las motivaciones de los TUS como participantes en investigación son infundadas. Para mejorar el reclutamiento, las valoraciones deben dirigirse a vulnerabilidades especificas en lugar de al diagnóstico.
Assuntos
Pesquisa Biomédica , Competência Mental , Motivação , Participação do Paciente/psicologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adulto , Estudos de Casos e Controles , Tomada de Decisões , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Participação do Paciente/estatística & dados numéricosRESUMO
AIM: To test the hypothesis that fluid adherence in patients on haemodialysis can be improved through nurses' solution-focused communication with patients on issues of adherence. BACKGROUND: Adherence to fluid-intake restrictions is low in patients on haemodialysis, creating serious health risks. Psychosocial interventions to increase adherence have typically focused on patients and ignored patient/staff interactions. DESIGN: This is a single-group, pre-post pilot study registered in ClinicalTrials.gov (identifier: NCT03432988). METHOD: A 1-month baseline of interdialytic weight gain was taken in April 2016 for a group of 36 adult patients in a hospital haemodialysis unit. Then, the nurses of the unit received a 4 hr training in solution-focused communication on issues of fluid adherence and applied it with the patients of the sample. Interdialytic weight gains were measured during another month. One month after the training, in October 2016, interdialytic weight gains were measured for another month. RESULTS: After introducing solution-focused communication on fluid adherence, patients' average interdialytic weight gains decreased significantly, below the level considered indicative of problematic adherence. These results were maintained at follow-up. CONCLUSIONS: Our results suggest that a novel approach to adherence, nurses' solution-focused communication with patients on haemodialysis, may improve patients' adherence to fluid restriction. More rigorous, controlled studies are required to confirm long-term benefits and to understand the causal mechanisms that may underlie the effectiveness of this intervention.
Assuntos
Comunicação , Falência Renal Crônica/terapia , Relações Enfermeiro-Paciente , Cooperação do Paciente/psicologia , Educação de Pacientes como Assunto/métodos , Diálise Renal/enfermagem , Diálise Renal/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos PilotoRESUMO
Letter to the editor.
Resumen: el consentimiento informado constituye un elemento clave para una investigación ética. La población adicta puede tener deteriorada su capacidad para consentir por varios motivos. Las drogodependencias representan un campo idóneo para un análisis bioético porque implican conflictos de valores a diversos niveles. Constituyen un problema complejo en el que interaccionan intereses económicos, políticos, sociales, y sanitarios. Analizamos las implicaciones de estas cuestiones para la práctica clínica y la investigación con personas con trastornos adictivos y damos unas directrices sobre cuándo, cómo y por qué llevar a cabo valoraciones de la capacidad para participar en investigación.
Assuntos
Pesquisa Biomédica , Tomada de Decisões , Competência Mental , Sujeitos da Pesquisa , Transtornos Relacionados ao Uso de Substâncias/psicologia , HumanosRESUMO
BACKGROUND: Informed consent is a key element of ethical clinical research. Addicted population may be at risk for impaired consent capacity. However, very little research has focused on their comprehension of consent forms. The aim of this study is to assess the capacity of addicted individuals to provide consent to research. METHODS: 53 subjects with DSM-5 diagnoses of a Substance Use Disorder (SUD) and 50 non psychiatric comparison subjects (NPCs) participated in the survey from December 2014 to March 2015. This cross-sectional study was carried out at a community-based Outpatient Treatment Center and at an urban-located Health Centre in Spain. A binary judgment of capacity/incapacity was made guided by the MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR) and a clinical interview. Demographics and clinical characteristics were assessed by cases notes and the Mini-Mental State Examination, the Global Assessment Functional Scale and the Clinical Global Impression Scale. RESULTS: NPCs performed the best on the MacCAT-CR, and patients with SUD had the worst performance, particularly on the Understanding and Appreciation subscales. 32.7% SUD people lacked research-related decisional capacity. There were no statistically significant differences between the groups in terms of capacity to consent to research. CONCLUSIONS: The findings of our study provide evidence that a large proportion of individuals with SUD had decisional capacity for consent to research. It is therefore inappropriate to draw conclusions about capacity to make research decisions on the basis of a SUD diagnosis. In the absence of advanced cognitive impairment, acute withdrawal or intoxication, we should assume that addicted persons possess decision-making capacity. Thus, the view that people with SUD would ipso facto lose decision-making power for research consent is flawed and stigmatizing.
Assuntos
Pesquisa Biomédica/ética , Tomada de Decisões , Consentimento Livre e Esclarecido/psicologia , Competência Mental , Sujeitos da Pesquisa/psicologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adulto , Estudos Transversais , Feminino , Humanos , Consentimento Livre e Esclarecido/ética , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
Mental capacity is an emerging ethical legal concept in psychiatric settings but its relation to clinical parameters remains yet uncertain. The aim of this study is to evaluate the association between capacity to consent research and different psychiatric disorders and to characterize predictors of impairments in research decision-making capacity across diagnostic groups in a cross-sectional study. 139 consecutively referred outpatients with DSM-IV TR diagnoses of psychotic, mood and anxiety disorders were interviewed and a binary judgment of incapacity was made guided by the MacArthur competence assessment tool for consent research (MacCAT-CR). Demographics and clinical information were assessed by cases notes. Patients with anxiety disorders performed the best on the MacCAT-CR, and patients with psychotic disorders had the worst performance, however, there was considerable heterogeneity within each group. Cognitive impairment and global functioning were strongly correlated with MacCAT-CR subscales scores. 30.6% participants lacked research-related decisional capacity. Low Understanding score OR 0.07 (IC 95% 0.01-0.32) and Low Reasoning score OR 0.30 (IC 95% 0.11-0.82) were the factors most closely associated with lack of capacity. No absolute statements about decisional capacity can be driven merely due to the diagnosis. We found several risk factors which may be considered to decide which populations may require more thorough capacity assessments. The issues under consideration in the present study are by no means unique to people with psychiatric conditions. Ignoring this caveat, risks further inappropriate stigmatization of those with serious mental illness.
Assuntos
Transtornos de Ansiedade/psicologia , Consentimento Livre e Esclarecido/psicologia , Competência Mental/psicologia , Transtornos do Humor/psicologia , Pacientes Ambulatoriais/psicologia , Pacientes Ambulatoriais/estatística & dados numéricos , Transtornos Psicóticos/psicologia , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , PrevalênciaRESUMO
OBJECTIVES: To determine the test-retest reliability of a questionnaire, with a validation preliminary, to assess knowledge of cardiovascular risk (CVR) and cardiovascular disease in patients attending community pharmacies in Spain. To complement the external validity, establishing the relationship between an educational activity and the increase in knowledge about CVR and cardiovascular disease. DESIGN: Sub-analysis of a controlled clinical study, EMDADER-CV, in which a questionnaire about knowledge concerning CVR was applied at 4 different times. LOCATION: Spanish Community Pharmacies. PARTICIPANTS: There were 323 patients in the control group, from the 640 who completed the study. MAIN MEASUREMENTS: Intraclass correlation coefficient to assess the reliability in 3 comparisons (post-educational activity with week 16, post-educational activity with week 32, and week 16 with week 32); and the non-parametric Friedman test to establish the relationship between an oral and written educational activity with increasing knowledge. RESULTS: For the 323 patients in the 3 comparisons, the intraclass correlation coefficient values were 0.624; 0.608 and 0.801, respectively (fair-good to excellent reliability). So, the Friedman test showed a statistically significant relationship between educational activity and increased knowledge (p < .0001). CONCLUSIONS: According to the intraclass correlation coefficient, the questionnaire aimed at assessing the knowledge on CVR and cardiovascular disease has a reliability between acceptable and excellent, which added to the previous validation, shows that the instrument meets the criteria of validity and reliability. Furthermore, the questionnaire showed the ability to relate an increase in knowledge with an educational intervention, feature that complements its external validity.
Assuntos
Doenças Cardiovasculares , Conhecimentos, Atitudes e Prática em Saúde , Educação de Pacientes como Assunto , Farmácias , Humanos , Reprodutibilidade dos Testes , Fatores de Risco , Espanha , Inquéritos e QuestionáriosRESUMO
OBJECTIVES: Elafin, an endogenous serine protease inhibitor, modulates colonic inflammation. We investigated the role of elafin in celiac disease (CD) using human small intestinal tissues and in vitro assays of gliadin deamidation. We also investigated the potential beneficial effects of elafin in a mouse model of gluten sensitivity. METHODS: Epithelial elafin expression in the small intestine of patients with active CD, treated CD, and controls without CD was determined by immunofluorescence. Interaction of elafin with human tissue transglutaminase-2 (TG-2) was investigated in vitro. The 33-mer peptide, a highly immunogenic gliadin peptide, was incubated with TG-2 and elafin at different concentrations. The degree of deamidation of the 33-mer peptide was analyzed by liquid chromatography-mass spectrometry. Elafin was delivered to the intestine of gluten-sensitive mice using a recombinant Lactococcus lactis vector. Small intestinal barrier function, inflammation, proteolytic activity, and zonula occludens-1 (ZO-1) expression were assessed. RESULTS: Elafin expression in the small intestinal epithelium was lower in patients with active CD compared with control patients. In vitro, elafin significantly slowed the kinetics of the deamidation of the 33-mer peptide to its more immunogenic form. Treatment of gluten-sensitive mice with elafin delivered by the L. lactis vector normalized inflammation, improved permeability, and maintained ZO-1 expression. CONCLUSIONS: The decreased elafin expression in the small intestine of patients with active CD, the reduction of 33-mer peptide deamidation by elafin, coupled to the barrier enhancing and anti-inflammatory effects observed in gluten-sensitive mice, suggest that this molecule may have pathophysiological and therapeutic importance in gluten-related disorders.
Assuntos
Doença Celíaca/metabolismo , Elafina/metabolismo , Mucosa Intestinal/metabolismo , Intestino Delgado/metabolismo , Adulto , Animais , Biomarcadores/metabolismo , Estudos de Casos e Controles , Doença Celíaca/dietoterapia , Cromatografia Líquida , Desaminação , Dieta Livre de Glúten , Feminino , Proteínas de Ligação ao GTP/metabolismo , Gliadina/metabolismo , Humanos , Masculino , Espectrometria de Massas , Camundongos , Camundongos Endogâmicos NOD , Pessoa de Meia-Idade , Permeabilidade , Proteína 2 Glutamina gama-Glutamiltransferase , Transglutaminases/metabolismo , Proteína da Zônula de Oclusão-1/metabolismoRESUMO
PURPOSE OF REVIEW: To provide an update of research findings on the mechanisms underlying respiratory complications after cardiac surgery, especially acute respiratory distress syndrome, transfusion-related lung injury and ventilation-associated pneumonia. The article will review some of the preventive and therapeutic measures that can be implemented to reduce these complications, focusing on the use of protective invasive ventilation and postextubation noninvasive ventilation. RECENT FINDINGS: The development of postoperative pulmonary complications is related to various perioperative factors. The most effective preventive measures are a correct preoperative preparation and an uneventful surgery. The implementation of nosocomial pneumonia prevention bundles, or early extubation in a fast-track program, has proven to be effective in reducing the complication rate. The application of protective invasive ventilation, with low tidal volumes, has been found to reduce lung injury and mortality in patients with lung injury or healthy lungs. The use of noninvasive ventilation as a preventive postextubation approach in patients at risk and rescue noninvasive ventilation in those developing respiratory failure remains under debate and is subject to ongoing research. SUMMARY: Postoperative pulmonary complications are common, but severe complications are infrequent. Their reduction requires measures to prevent infection and mechanical ventilation-associated lung injury through the use of low tidal volumes and early extubation. Noninvasive ventilation after extubation can be utilized to avoid reintubation and the associated increased morbidity and mortality. However, noninvasive ventilation should be done under rigorous conditions and by following strict criteria.
Assuntos
Lesão Pulmonar Aguda/prevenção & controle , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Pneumonia Associada à Ventilação Mecânica/prevenção & controle , Respiração Artificial/métodos , Síndrome do Desconforto Respiratório/prevenção & controle , Lesão Pulmonar Aguda/terapia , Extubação , Humanos , Modalidades de Fisioterapia , Pneumonia Associada à Ventilação Mecânica/terapia , Síndrome do Desconforto Respiratório/terapia , Reação TransfusionalRESUMO
Older patients have been remarkably underrepresented in bleeding risk cohorts. Thus, the PRECISE-DAPT (Derivation and validation of the predicting bleeding complications in patients undergoing stent implantation and subsequent dual antiplatelet therapy) and Academic Research Consortium for High Bleeding Risk (ARC-HBR) scores are not validated in older adults. Therefore, we sought to evaluate the PRECISE-DAPT and ARC-HBR scores in an exclusively older population and assess the prognostic value of a truly simplified clinical evaluation (SCE), consisting of only 3 binary clinical variables (hemoglobin <11 g/100 ml, previous bleeding, and anticipated use of anticoagulants). This is a retrospective analysis of the prospective single-center older-HCD registry. Consecutive patients aged ≥75 years who underwent percutaneous coronary intervention from 2012 to 2019 were included. The primary end point was postdischarge bleeding at 12 months of follow-up, defined according to the Bleeding Academic Research Consortium 3 or 5 criteria. A total of 693 patients with a mean age of 81 (±4.4) years were included in the study and 60 patients (6.8%) met the primary end point. The PRECISE-DAPT and ARC-HBR scores did not significantly predict postdischarge bleeding in the Cox regression models (hazard ratio 1.65 [0.78 to 3.42] and 1.46 [0.72 to 4.24], respectively), whereas the SCE outperformed both scores (hazard ratio 2.47, 1.34 to 4.49). All 3 scores exhibited a moderate discriminatory potential, as determined by a receiver-operating characteristic curve analysis (areas under the curve 0.601, 0.621, and 0.616, respectively), with no significant differences between them. The SCE showed an Integrated Discrimination Improvement of 0.25, p = 0.02 (SCE vs ARC-HBR) and 0.24, p = 0.01 (SCE vs PRECISE-DAPT), with an Net Reclassification Improvement of 6.54%, p = 0.37 and 7.12%, p = 0.43, respectively. In conclusion, the PRECISE-DAPT score and ARC-HBR criteria showed insufficient predictive value in older adults. A truly SCE consisting of 3 easily accessible variables not only provides equal discriminatory potential but also demonstrates superior predictive value, as determined by Cox regression models. This makes it a highly appealing tool for risk stratification, pending its evaluation in larger prospective studies.
Assuntos
Intervenção Coronária Percutânea , Humanos , Masculino , Feminino , Idoso , Estudos Retrospectivos , Idoso de 80 Anos ou mais , Medição de Risco/métodos , Terapia Antiplaquetária Dupla/métodos , Hemorragia/epidemiologia , Inibidores da Agregação Plaquetária/uso terapêutico , Sistema de Registros , Hemorragia Pós-Operatória/epidemiologia , Fatores de RiscoRESUMO
BACKGROUND: Primary Health Care (PHC) has been key element in detection, monitoring and treatment of COVID-19 cases in Spain. We describe how PHC practices (PCPs) organized healthcare to guarantee quality and safety and, if there were differences among the 17 Spanish regions according to the COVID-19 prevalence. METHODS: Cross-sectional study through the PRICOV-19 European Online Survey in PCPs in Spain. The questionnaire included structure and process items per PCP. Data collection was due from January to May 2021. A descriptive and comparative analysis and a logistic regression model were performed to identify differences among regions by COVID-19 prevalence (low < 5% or high ≥5%). RESULTS: Two hundred sixty-six PCPs answered. 83.8% of PCPs were in high prevalence regions. Over 70% PCPs were multi-professional teams. PCPs attended mainly elderly (60.9%) and chronic patients (53.0%). Regarding structure indicators, no differences by prevalence detected. In 77.1% of PCPs administrative staff were more involved in providing recommendations. Only 53% of PCPs had a phone protocol although 73% of administrative staff participated in phone triage. High prevalence regions offered remote assessment (20.4% vs 2.3%, p 0.004) and online platforms to download administrative documents more frequently than low prevalence (30% vs 4.7%, p < 0.001). More backup staff members were hired by health authorities in high prevalence regions, especially nurses (63.9% vs 37.8%, p < 0.001. OR:4.20 (1.01-8.71)). 63.5% of PCPs provided proactive care for chronic patients. 41.0% of PCPs recognized that patients with serious conditions did not know to get an appointment. Urgent conditions suffered delayed care in 79.1% of PCPs in low prevalence compared to 65.9% in high prevalence regions (p 0.240). A 68% of PCPs agreed on having inadequate support from the government to provide proper functioning. 61% of high prevalence PCPs and 69.5% of low ones (p: 0.036) perceived as positive the role of governmental guidelines for management of COVID-19. CONCLUSIONS: Spanish PCPs shared a basic standardized PCPs' structure and common clinical procedures due to the centralization of public health authority in the pandemic. Therefore, no relevant differences in safety and quality of care between regions with high and low prevalence were detected. Nurses and administrative staff were hired efficiently in response to the pandemic. Delay in care happened in patients with serious conditions and little follow-up for mental health and intimate partner violence affected patients was identified. Nevertheless, proactive care was offered for chronic patients in most of the PCPs.
Assuntos
COVID-19 , Atenção Primária à Saúde , Humanos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Espanha/epidemiologia , Atenção Primária à Saúde/organização & administração , Estudos Transversais , Masculino , Feminino , Qualidade da Assistência à Saúde , Adulto , Pessoa de Meia-Idade , SARS-CoV-2 , Inquéritos e Questionários , Pandemias , Segurança do PacienteRESUMO
BACKGROUND: National physical activity (PA) policy processes are only beginning to be studied in Latin America, and little attention has focused at the subnational level. This study examined national-subnational relations in the policy process (agenda setting, policy formulation, adoption, implementation, and evaluation) in selected Latin American countries. METHODS: The Global Observatory for Physical Activity's (GoPA!) INTEGRATE-PA-Pol tool was applied in Colombia, Costa Rica, Ecuador, and Mexico. Data were collected in matched pairs of the capital plus one noncapital city among national and subnational policymakers (n = 27), previously identified by the GoPA! Country Contacts. PA policy development and implementation were assessed using descriptive statistics. RESULTS: Twenty-three (response rate = 85.2%) informants provided data, mainly from the health sector (52.2%), followed by the sport (26.1%), transport (13.0%), and education (8.7%) sectors. Most informants reported that their countries had a current PA policy embedded within noncommunicable diseases prevention plans (46.2%), other plans (46.2%), or obesity prevention/management/control plans (7.7%). Respondents at the subnational level rated PA promotion as central (64.3%), while the national-level role was important but not central (75.0%). National and subnational policymakers indicated low-to-little involvement in the other level's PA policy processes across the 5 policy stages. CONCLUSIONS: This study demonstrated that collecting national and subnational PA policy data across countries with the active collaboration of the GoPA! network was feasible. We also successfully identified governmental interactions throughout the PA policy process, suggesting suboptimal engagement between national and subnational levels.
Assuntos
Exercício Físico , Política de Saúde , Humanos , Costa Rica , Equador , Colômbia , México , Formulação de Políticas , Promoção da Saúde/organização & administração , EsportesRESUMO
Research on eco-friendly bioremediation strategies for mitigating the environmental impact of toxic metals has gained attention in the last years. Among all promising solutions, bentonite clays, to be used as artificial barriers to isolate radioactive wastes within the deep geological repository (DGR) concept, have emerged as effective reservoir of microorganisms with remarkable bioremediation potential. The present study aims to investigate the impact of bentonite fungi in the speciation and mobility of selenium (Se) and tellurium (Te), as natural analogues 79Se and 132Te present in radioactive waste, to screen for those strains with bioremediation potential within the context of DGR. For this purpose, a multidisciplinary approach combining microbiology, biochemistry, and microscopy was performed. Notably, Aspergillus sp. 3A demonstrated a high tolerance to Te(IV) and Se(IV), as evidenced by minimal inhibitory concentrations of >16 and >32 mM, respectively, along with high tolerance indexes. The high metalloid tolerance of Aspergillus sp. 3A is mediated by its capability to reduce these mobile and toxic elements to their elemental less soluble forms [Te(0) and Se(0)], forming nanostructures of various morphologies. Advanced electron microscopy techniques revealed intracellular Te(0) manifesting as amorphous needle-like nanoparticles and extracellular Te(0) forming substantial microspheres and irregular accumulations, characterized by a trigonal crystalline phase. Similarly, Se(0) exhibited a diverse array of morphologies, including hexagonal, irregular, and needle-shaped structures, accompanied by a monoclinic crystalline phase. The formation of less mobile Te(0) and Se(0) nanostructures through novel and environmentally friendly processes by Aspergillus sp. 3A suggests it would be an excellent candidate for bioremediation in contaminated environments, such as the vicinity of deep geological repositories. It moreover holds immense potential for the recovery and synthesis of Te and Se nanostructures for use in numerous biotechnological and biomedical applications.
Assuntos
Resíduos Radioativos , Selênio , Selênio/química , Telúrio , Bentonita , Biodegradação AmbientalRESUMO
Cardiovascular risk factors and established cardiovascular disease (CVD) increase the risk of suffering dementia of the Alzheimer's type (DAT). Here, we set out to define specific molecular profiles of CVD in patients with DAT to better understand its relationship, to unravel the mechanisms underlying the high risk of developing DAT in CVD patients and to define new markers of early disease. Plasma samples from patients with DAT, with and without CVD, were analyzed through a multiomics approach, with integration of metabolomics and proteomics datasets using the OmicsNet web-based tool. Metabolomics results showed an enrichment in lipids and lipid-like molecules. Similarly, the most significant cluster identified through proteomics was formed by 5 proteins related to lipoprotein and cholesterol metabolism. After integration and functional enrichment, glycerolipid metabolism, fatty acid degradation and sphingolipid metabolism were among the most significant functions. Finally, differential expression of ABCA1 and APOH proteins was verified, in an independent cohort also including controls and patients with CVD alone. Both proteins positively correlated with phospho-Tau (181), a classical hallmark of DAT. Different molecular profiles exist in patients with DAT, with and without CVD, with exacerbated alterations in patients in which DAT and CVD co-exist. This information may help to define biomarkers like ABCA1 and APOH that identify patients with cardiovascular dysfunction that are at high risk of developing DAT. Such markers will allow more personalized interventions to be selected, a further step towards precision medicine for individuals whose molecular profiles indicate a distinct response to the same management strategies.
RESUMO
Calcific aortic valve disease (CAVD) and coronary artery disease (CAD) are related cardiovascular diseases in which common mechanisms lead to tissue calcification. Oxidative stress plays a key role in these diseases and there is also evidence that the redox state of serum albumin exerts a significant influence on these conditions. To further explore this issue, we used multimarker scores (OxyScore and AntioxyScore) to assess the global oxidative status in patients with CAVD, with and without CAD, also evaluating their plasma thiol levels. In addition, valvular interstitial cells were treated with reduced, oxidized, and native albumin to study how this protein and its modifications affect cell calcification. The differences we found suggest that oxidative status is distinct in CAVD and CAD, with differences in redox markers and thiol levels. Importantly, the in vitro interstitial cell model revealed that modified albumin affects cell calcification, accelerating this process. Hence, we show here the importance of the redox system in the development of CAVD, emphasizing the relevance of multimarker scores, while also offering evidence of how the redox state of albumin influences vascular calcification. These data highlight the relevance of understanding the overall redox processes involved in these diseases, opening the door to new studies on antioxidants as potential therapies for these patients.
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OBJECTIVE: To characterize recorded trichinosis cases and outbreaks in Santa Fe Province, Argentina, from 1998 to 2009 from epidemiological, clinical, and laboratory viewpoints. METHODS: An analysis was conducted of 1 519 epidemiological records of persons who had signs and symptoms compatible with trichinosis in Santa Fe Province in the period 1998-2009. A descriptive statistical analysis of information in epidemiological records and of clinical and laboratory results, as well as a bifactorial analysis of possible associations with epidemiological and environmental factors were also carried out. RESULTS: Trichinosis symptoms were found in 1 276 cases; 372 met the clinical case definition and 224 samples were positive by indirect immunofluorescence, independent of their clinical case classification. There were 27 outbreaks that involved 1 157 cases identified in eight departments, with greater frequency in the province's center and south. Annual distribution of epidemiologically associated cases was heterogeneous, with greater frequency in the period 2000-2003 and in the months of August to October. Probability of becoming sick was greater with consumption of products from informal sources (OR = 3.69; P = 0.014) and in rural areas (OR = 1.799; P = 0.011). Disease incubation period (median) was 12 days. The risk of becoming sick was 2.06 times greater in persons who ate meat or ate pork by-products than in those who did not. CONCLUSIONS: The greatest number of outbreaks occurred in departments that were more populous and where pork production was greater. Specific actions should be designed for prevention and control of the disease in those departments. Epidemiological risk analysis should be considered in evaluating, managing, and communicating trichinosis health risks.
Assuntos
Surtos de Doenças , Triquinelose/epidemiologia , Adolescente , Adulto , Argentina/epidemiologia , Criança , Pré-Escolar , Estudos Epidemiológicos , Humanos , Pessoa de Meia-Idade , Fatores de Tempo , Triquinelose/diagnóstico , Adulto JovemRESUMO
The gut microbiota is increasingly recognized as a key environmental factor that shapes host development and physiology, including neural circuits formation and function. Concurrently, there has been growing concern that early-life antibiotic exposure may alter brain developmental trajectories, increasing the risk for neurodevelopmental disorders such as autism spectrum disorder (ASD). Here, we assessed whether perturbation of the maternal gut microbiota in mice during a narrow critical perinatal window (last week of pregnancy and first three postnatal days), induced by exposure to a commonly used broad-spectrum oral antibiotic (ampicillin), influences offspring neurobehavioral outcomes relevant to ASD. Our results demonstrate that neonatal offspring from antibiotic-treated dams display an altered pattern of ultrasonic communication, which was more pronounced in males. Moreover, juvenile male, but not female, offspring from antibiotic-treated dams showed reduced social motivation and social interaction, as well as context-dependent anxiety-like behavior. However, no changes were observed in locomotor or exploratory activity. This behavioral phenotype of exposed juvenile males was associated with reduced gene expression of the oxytocin receptor (OXTR) and several tight-junction proteins in the prefrontal cortex, a key region involved in the regulation of social and emotional behaviors, as well as a mild inflammatory response in the colon. Further, juvenile offspring from exposed dams also showed distinct alterations in several gut bacterial species, including, Lactobacillus murinus, and Parabacteroides goldsteinii. Overall, this study highlights the importance of the maternal microbiome in early-life, and how its perturbation by a widely used antibiotic could contribute to atypical social and emotional development of offspring in a sex-dependent manner.