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In the last 2 decades, clinical genetics on hereditary colorectal syndromes has shifted from just a molecular characterization of the different syndromes to the estimation of the individual risk of cancer and appropriate risk reduction strategies. In the last years, new specific therapies for some subgroups of patients have emerged as very effective alternatives. At the same time, germline multigene panel testing by next-generation sequencing (NGS) technology has become the new gold standard for molecular genetics.

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Resumen Introducción: En Chile, la prevalencia de tabaquismo es cercana al 40%. En la actualidad, a pesar que los tratamientos de cesación de tabaquismo son costo-efectivos, sólo el 14% de la población tiene acceso. El objetivo de esta revisión es describir la evidencia actual que existe en Chile en relación a los programas de cesación tabáquica. Metodología: Se realizó una revisión bibliográfica en las bases de datos Scielo y Pubmed. Los criterios de inclusión fueron artículos desde 2009 a 2015 que presentaran información acerca de programas de cesación del tabaquismo. Se seleccionaron cuatro estudios. Se analizaron los diseños y metodologías de trabajo, la tasa de éxito, seguimiento y los profesionales que participaron en los programas. Resultados: Se encontraron tres programas en el sistema público y uno de una clínica privada. Las tasas de éxito fueron similares en tres de ellos, fluctuando entre 37% a los 12 meses y 48% en otro estudio, y 34% a los 6 meses, y otro grupo que tuvo sólo un 14% de éxito al año. Todos realizaron seguimientos hasta el año de completado el tratamiento, y los profesionales involucrados en los programas fueron médico, psicólogo y enfermera, agregándose kinesiólogo en uno. Conclusiones: A nivel nacional, actualmente la información disponible sobre los programas de cesación de tabaquismo es escasa. La metodología de trabajo es similar en los estudios encontrados, pero no existe un consenso a nivel nacional como una guía clínica, para el tratamiento del tabaquismo, por lo que es necesario desarrollarlas para poder implementar estos programas en diversas instituciones de salud de nuestro país.

Introduction: In Chile, the prevalence of smoking is close to 40%. At present, even though smoking cessation treatments are cost-effective, only 14% of the population has access to them. The objective of this review is to describe the current evidence that exists in Chile in relation to smoking cessation programs. Methodology: A literature review was made in the Scielo and Pubmed databases. The inclusion criteria were articles from 2009 to 2015 that presented information about smoking cessation programs. Four studies were selected. We analyzed the design of cessation therapy programs, success rates, follow-up and the professionals who participated. Results: Three programs were found in the public system and one in a private clinic. The success rates were similar in three of them, ranging from 37% at 12 months and 48% in another study, and 34% at 6 months, and another group that had only 14% success at one year. All carried out follow-ups until the year of completion of the treatment, and the professionals involved in the programs were physician, psychologist and nurse, adding the kinesiologists in one. Conclusions: At the national level, information on smoking cessation programs is currently scarce. The design and methodology of programs were similar among studies, but there was no consensus at the national level as a clinical guide for the treatment of smoking, so it is necessary to develop them in order to implement these programs in different health institutions in our country.

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Resumen Se describe la metodología utilizada en el Instituto Nacional del Tórax para el tratamiento del tabaquismo, modalidad grupal. Se realizan 7 sesiones semanales, donde se utilizan los principios de la Entrevista Motivacional. Hay una primera etapa de preparación (3 sesiones), se fija día D y luego 4 sesiones de acompañamiento, manejo del síndrome de privación, prevención de recaídas y mantención de la abstinencia.

We describe the methodology used at the Instituto Nacional del Tórax for smoking cessation, group therapy. We carried out 7 weekly sessions, where the principles of the Motivational Interview are used. There is a first stage of preparation (3 sessions), fixed D-day and then 4 sessions of follow up, for the management of deprivation syndrome, relapse prevention and maintenance of abstinence.

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The aim of this article was to present an update of the theorical and methodological foundations of counseling and evidence of their effectiveness, relating to the practice of health teams and analyzing future challenges. It is described, the theorical basis, the policy directions of the Chilean Ministry of Health, the international recommended strategies and the contributions of the participants in a training program conducted by INTA with 312 professionals (nutritionists, physiotherapists and dentists mostly). The analysis of the conditions in the Primary Health Care, to implement systematically nutrition, physical activity and tobacco counseling is presented. The need to improve the practice and its contribution to a preventive approach to serious problems of physical inactivity, obesity and smoking in the Chilean population is discussed.

El objetivo de este artículo es presentar una actualización de los fundamentos teóricos y metodológicos de la consejería y la evidencia sobre su eficacia, relacionándola con la práctica de los equipos de salud y analizando los desafíos futuros. Se describen las bases teóricas, las orientaciones de política del Ministerio de Salud de Chile, las estrategias recomendadas a nivel internacional y los aportes de los participantes de un programa de capacitación realizado por el INTA con 312 profesionales (nutricionistas, kinesiólogos y odontólogos en su mayoría). Se presenta el análisis de las condiciones en la Atención Primaria de Salud para implementar la consejería en alimentación, actividad física y tabaco en forma sistemática. Se discute la necesidad de adoptar medidas para el mejoramiento de la práctica y su contribución a un abordaje preventivo de los graves problemas de sedentarismo, obesidad y tabaquismo en la población chilena.

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This work reports the preparation of molecularly imprinted polymers (MIPs) selective to cephalosporin (CF) antibiotics, and their application as molecularly imprinted solid-phase extraction (MISPE) sorbents for the determination of these antimicrobials in milk samples. Several functional monomers and cross-linkers have been screened to select the best combination that provides high selectivity for the simultaneous multiresidue extraction of cefthiofur (THIO), cefazolin (AZO), cefquinome (QUI), cephapirin (API), cephalexin (ALE) and cephalonium (ALO) from the samples. The novel MIPs were prepared by a non-covalent imprinting approach in the form of spherical microparticles using the synthetic surrogate molecule sodium 7-(2-biphenylylcarboxamido)-3-methyl-3-cepheme-4-carboxylate, N-3,5-bis(trifluoromethyl)phenyl-N'-4-vinylphenyl urea (VPU) as functional monomer, and divinylbenzene (DVB) as crosslinking agent in a 1:2:20 molar ratio. The optimized MISPE method allowed the extraction of the target antimicrobials from raw cow milk samples using a selective washing with 5mL methanol/2-[4-(2-hydroxyethyl)-1-piperazinyl]ethanesulfonic acid (HEPES) buffer (0.1M, pH 7.5) (2:98, v/v) to remove the non-specifically retained compounds, followed by elution with 1mL of trifluoroacetic acid (TFA) in methanol (0.1:99.9, v/v). The extracts have been analysed by UHPLC-MS/MS and the analytical method has been validated according to EU guideline 2002/657/EC. The limits of quantification (S/N=10) were in the 1.7-12.5µgkg-1 range, well below the maximum residue limits (MRLs) currently established for the quantified cephalosporins in milk samples. The developed MIP allows mutiresidual determination of the six cephalosporin antibiotics mentioned above, significantly broadening the application to food analysis of MISPE methods.

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Background: Tobacco use is one of the main preventable causes of morbidity and mortality in the world. This report presents the experience of the smoking cessation team from the National Thorax Institute (Instituto Nacional del Tórax-Chile). Patients and Method: A clinical series of patients treated between April 2013 and March 2014, with one-year follow-up was studied. Intervention was based on seven group sessions, with a cognitive behavioral viewpoint and pharmacological treatment (mainly varenicline). Follow-up was done through telephone calls at 1, 3, 6 and 12 months. Descriptive statistics and X² test were used. Results: Eighty-seven patients were treated, mean age 54 years, 63% women; 79% had a pack year index over 20; 28% had depression and 16% had COPD. 59% received varenicline. Self-reported abstinence for 12 months was 37%. No significant differences between high risk groups were found. Conclusion: The smoking cessation program done at the National Thorax Institute shows that it is feasible to implement this type of programs in the public health system of Chile with results comparable to those internationally published.

Introducción: El tabaco es uno de los principales factores de morbimortalidad prevenible en el mundo. En este artículo se presenta la experiencia del equipo de tratamiento del tabaquismo en el Instituto Nacional del Tórax (INT). Método: Se analizaron los pacientes tratados entre abril de 2013 y marzo de 2014, con seguimiento a un año. La intervención consistió en 7 sesiones grupales con enfoque cognitivo conductual y terapia farmacológica (principalmente vareniclina). El seguimiento fue telefónico al mes 1, 3, 6 y 12. Se utilizó estadística descriptiva y test de X². Resultados: Se sometieron a tratamiento 87pacientes, edad promedio 54 años, 63% mujeres; tienen índice paquete año sobre 20 el 79%, depresión 28% y Enfermedad Pulmonar Obstructiva Crónica 16%. El 59% recibió vareniclina. La abstinencia autoreportada a 12 meses fue de 37%. No se encontraron diferencias significativas en grupos de riesgo. Conclusión: La experiencia de tratamiento anti-tabaco realizada en el INT muestra que es factible implementar este tipo de programas en el sistema público de salud chileno con resultados comparables a las publicaciones internacionales.

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OBJECTIVE: Epidemiological evidence shows an inverse relationship between sleep duration and overweight/obesity risk. However, there are few polysomnographic studies that relate the organization of sleep stages to pediatric overweight (OW). We compared sleep organization in otherwise healthy OW and normal-weight (NW) 10-year-old children. SUBJECTS: Polysomnographic assessments were performed in 37 NW and 59 OW children drawn from a longitudinal study beginning in infancy. Weight and height were used to evaluate body mass index (BMI) according to international criteria. Non-rapid eye movement (NREM) sleep (stages N1, N2 and N3), rapid eye movement (REM) sleep (stage R) and wakefulness (stage W) were visually scored. Sleep parameters were compared in NW and OW groups for the whole sleep period time (SPT) and for each successive third of it using independent Student's t-tests or nonparametric tests. The relationship between BMI and sleep variables was evaluated by correlation analyses controlling for relevant covariates. RESULTS: The groups were similar in timing of sleep onset and offset, and sleep period time. BMI was inversely related to total sleep time (TST) and sleep efficiency. OW children showed reduced TST, sleep efficiency and stage R amount, but higher stage W amount. In analysis by thirds of the SPT, the duration of stage N3 episodes was shorter in the first third and longer in the second third in OW children as compared with NW children. CONCLUSIONS: Our results show reduced sleep amount and quality in otherwise healthy OW children. The lower stage R amount and changes involving stage N3 throughout the night suggest that OW in childhood is associated with modifications not only in sleep duration, but also in the ongoing night time patterns of NREM sleep and REM sleep stages.

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Tobacco dependence is an addictive chronic disease, characterized by its trend to the recurrence, in which the relapses are part of the process of smoking cessation. It is recommended a complete clinical evaluation, including the application of certain tests that can allow level of dependence, motivation and psychiatric comorbidities evaluation. The current treatment of smoking has two pillars: psycho-social intervention and pharmacological therapy. The current interventions are based on two theoretical models that try to understand changes of smoking behavior: The Stages of Change and PRIME Theory. Brief intervention is a strategy internationally approved because of its population impact on smoking cessation. The methodology used is named "5A's": Ask, Advise, Asses, Assist and Arrange follow-up. For not motivated patients at the intervention time it can be used the "5R 's" methodology: Relevance, Risks, Rewards, Roadblocks and Repetition. The actual approach used in smokers management, is Motivational Interview, which tries to produce the behavioral change from inside and not imposing it. Its four tools are: express empathy, develop discrepancy, roll with resistance and support self efficacy. The useful psychosocial strategies, in which exists consensus, are: 1) Give practical counseling of problem solving and skills training to face risky situations; 2) Intra-treatment support, encouraging attempts of smoking cessation and communicate caring and concern.

El tabaquismo es una enfermedad crónica adictiva, caracterizada por su tendencia a la recurrencia, en que las recaídas son parte del proceso de dejar de fumar. Se recomienda una evaluación clínica completa de los fumadores, incluyendo la aplicación de algunos tests que permitan evaluar nivel de adicción, motivación y comorbilidad psiquiátrica. El tratamiento actual del tabaquismo tiene dos pilares: intervención psicosocial y terapia farmacológica. las intervenciones actuales, se basan en dos modelos teóricos que intentan comprender los cambios de la conducta de fumar de las personas: las Etapas de Cambio y la Teoría PRIME. la Consejería Breve es una estrategia aprobada internacionalmente por su impacto poblacional en dejar de fumar. la metodología que utiliza se denomina las 5 A: Averiguar, Aconsejar, Acordar, Ayudar y Acompañar. Para los pacientes no motivados al momento de la intervención se utiliza la metodología de las 5 R: Relevancia, Riesgos, Recompensas, Resistencias y Repetición. El enfoque actualmente utilizado en el manejo de los fumadores, es la Entrevista Motivacional, que intenta producir el cambio conductual desde dentro y no imponiéndolo. Sus cuatro herramientas son: expresar empatia, desarrollar las discrepancias, lidiar con las resistencias y mejorar la autoeficacia. Hay consenso en que las estrategias psicosociales útiles son: 1) la entrega de consejos prácticos para resolución de problemas y desarrollo de habilidades para enfrentar situaciones de riesgo; 2) el apoyo intratratamiento, incentivando los intentos por dejar de fumar y trasmitiendo preocupación y apoyo.

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Objetivos: Evaluar la eficacia y aceptabilidad del microdosificador de cloro como sistema de tratamiento de agua para consumo humano en localidades rurales en la Región San Martín, Perú. Materiales y métodos: Estudiorealizado en cinco localidades rurales (cuatro intervenidas y una de control). Se realizaron reuniones de sensibilización, capacitación en el manejo y uso del sistema de microdosificación de cloro y se entregaron los materiales necesarios para la implementación de la intervención. El seguimiento se realizó mediante la evaluación de la cantidad de cloro residual en el agua de consumo humano, y se midieron también los niveles de contaminación del agua. Resultados: Luego de un período de 17 semanas de seguimiento, 75,9 por ciento de los 1281 participantes usaban el sistema, la contaminación de agua antes de la intervención era > 800UFC/50mL de coliformes en las cinco localidades, luego de la intervención se redujo a cero en tres de las cuatro localidades intervenidas. Las concentraciones decloro residual en el agua de consumo de las localidades intervenidas se encontraron en rangos adecuados. Conclusiones: El uso del microdosificador de cloro y el sistema de participación comunitaria para lograr el consumo de agua de calidad son aceptados satisfactoriamente en las comunidades rurales estudiadas, y reducen significativamentela contaminación del agua para consumo humano.

Objectives: To assess efficacy and acceptability of a chloride microdosing device as a drinking water treatment system in rural communities in San Martin region, Peru. Materials and methods: This is a study performed in five rural communities (four underwent the intervention and one served as control). Meetings were held in order to make people aware with respect to handling and use of the chloride microdosing system, and materials necessary for implementing the intervention were given to the population. Follow-up was performed measuring the amount of residual chloride in drinking water, and also water contamination levels were measured. Results: After a 17-week follow up period, 75.9% of 1281 participants were using the system. Water contamination before the intervention was >800 CFU (colony-forming units) of coliform bacteria/50 mL in all five communities. The coliform CFU count was reduced to zero in three of the four communities undergoing the intervention. Residual chloride concentrations in drinking water in the communities were within the normal range. Conclusions: The use of chloride micro-dosing system and community participation in order to have good quality in drinking water are satisfactorily accepted in rural communities assessed, and there is a significant reduction in drinking water contamination.

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OBJECTIVE: This quantitative study examined the relationship between acculturation and disordered eating patterns among different generations of Mexican American women. METHOD: Participants included 139 Mexican American women (mean age = 29.1) drawn from local undergraduate courses and community agencies. The posttest-only design included a demographic measure, Acculturation Rating Scale for Mexican Americans (ARSMA), and the Eating Attitudes Test (EAT-26). RESULTS: Of the five generations studied, second-generation women endorsed the most disordered eating patterns and the highest degrees of concurrent acculturation. Moreover, there was a significant, positive correlation between acculturation and Factor III of the EAT which highlights control of eating and perceived pressure from others to gain weight. Participants scoring beyond the EAT cut-off score endorsed bulimic symptoms. DISCUSSION: Differing intergenerational ideals regarding weight may create special strains for second-generation Mexican American women. Criteria for disordered eating in a population previously not considered at risk should be further assessed and clinicians should be careful not to underdiagnose among this group.

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