RESUMO
Chronic noncancer pain (CNCP) is, and continues to be, a global problem that affects people with multimorbidity. The objective is to comment on the gap in Chile in integrating multimorbidity and CNCP in the real practice context despite the advances in public policies and local evidence revealed. Therefore, a pilot is responding to this problem by implementing an approach to incorporate into a multimorbidity comprehensive approach the assessment of CNCP and adding nonmedical services. It is expected to evaluate its impact on the performance of the health system, as well as on people.
Assuntos
Dor Crônica , Humanos , Dor Crônica/epidemiologia , Dor Crônica/terapia , Analgésicos Opioides , Multimorbidade , Chile/epidemiologia , Política PúblicaRESUMO
RESUMEN Introducción: La nefrolitotomía percutánea es la primera opción terapéutica para la litiasis renal coraliforme. Objetivo: Caracterizar a los pacientes con complicaciones de la nefrolitotomía percutánea para el tratamiento de la litiasis renal coraliforme. Método: Se estudió una serie de 191 pacientes, operados mediante nefrolitotomía percutánea. Variables estudiadas: tipo de litiasis coraliforme, posición para la técnica, condición de libre de litiasis después de la operación, presencia de complicaciones, momento, tipo y grado según clasificación de Clavien-Dindo. Se hallaron frecuencias absolutas, relativas y se utilizó el test de ji cuadrado para determinar asociación entre variables. Resultados: El 86,9 % tenía menos de 60 años, 67,0 % eran masculinos, 61,7 % presentaba comorbilidades. La litiasis coraliforme era parcial o total (30,3 % y 46,5 %, respectivamente). En 60,2 % afectaba el riñón izquierdo; 58,1 % se operaron en supino y 70,2 % quedaron libre de litiasis con la nefrolitotomía percutánea monoterapéutica. Ocurrieron complicaciones en 19,9 %; 16,2 % fueron postoperatorias, 14,1 % infecciosas, 7,8 % Clavien-Dindo I y 5,2 % IIIb. El tipo de litiasis y la posición de la nefrolitotomía percutánea no se asociaron con las complicaciones (p> 0,05). El grado de la complicación no se relacionó con el tipo de litiasis (p> 0,05). Conclusiones: Las complicaciones postoperatorias más frecuentes son las relacionadas con la infección y el sangrado; predominan ligeramente en los pacientes con litiasis coraliformes parcial, total y en los operados en supino; el grado Clavien-Dindo de las complicaciones, es mayor en las litiasis coraliformes más complejas.
ABSTRACT Introduction: Percutaneous nephrolithotomy is the first therapeutic option for staghorn kidney stones. Objective: To characterize patients with complications of percutaneous nephrolithotomy for the treatment of staghorn renal lithiasis. Method: A series of 191 patients, operated by percutaneous nephrolithotomy, was studied. Variables studied: type of staghorn lithiasis, position for the technique, stone-free condition after the operation, presence of complications, time, type and grade according to the Clavien-Dindo classification. Absolute and relative frequencies were found and the chi-square test was used to determine the association between variables. Results: 86.9 % were less than 60 years old, 67,0 % were male, 61,7 % had comorbidities. The staghorn lithiasis was partial or total (30,3 % and 46,5 %, respectively). In 60,2 % it affected the left kidney; 58.1 % underwent supine surgery and 70,2 % were stone free with monotherapeutic percutaneous nephrolithotomy. Complications occurred in 19,9 %; 16,2 % were postoperative, 14,1 % infectious, 7,8 % Clavien-Dindo I, and 5,2 % IIIb. The type of lithiasis and the position of the percutaneous nephrolithotomy were not associated with complications (p> 0,05). The degree of complication was not related to the type of lithiasis (p> 0,05). Conclusions: The most frequent postoperative complications are those related to infection and bleeding; they slightly predominate in patients with partial and total staghorn stones and in those operated on in the supine position; the Clavien-Dindo grade of complications is higher in the more complex staghorn stones.
RESUMO
Ralstonia pseudosolanacearum GMI1000 (Rpso GMI1000) is a soil-borne vascular phytopathogen that infects host plants through the root system causing wilting disease in a wide range of agro-economic interest crops, producing economical losses. Several features contribute to the full bacterial virulence. In this work we study the participation of light, an important environmental factor, in the regulation of the physiological attributes and infectivity of Rpso GMI1000. In silico analysis of the Rpso genome revealed the presence of a Rsp0254 gene, which encodes a putative blue light LOV-type photoreceptor. We constructed a mutant strain of Rpso lacking the LOV protein and found that the loss of this protein and light, influenced characteristics involved in the pathogenicity process such as motility, adhesion and the biofilms development, which allows the successful host plant colonization, rendering bacterial wilt. This protein could be involved in the adaptive responses to environmental changes. We demonstrated that light sensing and the LOV protein, would be used as a location signal in the host plant, to regulate the expression of several virulence factors, in a time and tissue dependent way. Consequently, bacteria could use an external signal and Rpsolov gene to know their location within plant tissue during the colonization process.
Assuntos
Proteínas de Bactérias/genética , Interações Hospedeiro-Patógeno/fisiologia , Ralstonia/fisiologia , Solanum lycopersicum/microbiologia , Aderência Bacteriana/fisiologia , Proteínas de Bactérias/metabolismo , Biofilmes/crescimento & desenvolvimento , Regulação Bacteriana da Expressão Gênica , Luz , Polissacarídeos Bacterianos/genética , Polissacarídeos Bacterianos/metabolismo , Ralstonia/patogenicidadeRESUMO
Coral reef health depends on an intricate relationship among the coral animal, photosynthetic algae, and a complex microbial community. The holobiont can impact the nutrient balance of their hosts amid an otherwise oligotrophic environment, including by cycling physiologically important nitrogen compounds. Here we use 15N-tracer experiments to produce the first simultaneous measurements of ammonium oxidation, nitrate reduction, and nitrous oxide (N2O) production among five iconic species of reef-building corals (Acropora palmata, Diploria labyrinthiformis, Orbicella faveolata, Porites astreoides, and Porites porites) in the highly protected Jardines de la Reina reefs of Cuba. Nitrate reduction is present in most species, but ammonium oxidation is low potentially due to photoinhibition and assimilatory competition. Coral-associated rates of N2O production indicate a widespread potential for denitrification, especially among D. labyrinthiformis, at rates of ~1 nmol cm-2 d-1. In contrast, A. palmata displays minimal active nitrogen metabolism. Enhanced rates of nitrate reduction and N2O production are observed coincident with dark net respiration periods. Genomes of bacterial cultures isolated from multiple coral species confirm that microorganisms with the ability to respire nitrate anaerobically to either dinitrogen gas or ammonium exist within the holobiont. This confirmation of anaerobic nitrogen metabolisms by coral-associated microorganisms sheds new light on coral and reef productivity.
Assuntos
Antozoários , Microbiota , Anaerobiose , Animais , Recifes de Corais , NitrogênioRESUMO
Las capacidades prácticas de los padres para cuidar, proteger y educar a sus hijos, asegurándoles un desarrollo sano, son los aspectos centrales de las competencias parentales. La intervención del Programa de Prevención Focalizada en Chile (PPF) y de Triple P en su 4to nivel (grupal) -de origen Australiano- tiene entre sus propósitos, fortalecer las competencias parentales en personas que tengan a cargo un niño/a. La presente investigación de diseño cuasi experimental, de tipo pre-post con grupo control equivalente, comparó la eficacia de ambos programas en la intervención de competencias parentales, en una muestra de 15 padres y cuidadores de niños/as entre 2 y 12 años. Los resultados muestran que no hay diferencias significativas en las variables estilos de crianza, autoeficacia parental y dificultades de ajuste en la infancia entre las intervenciones realizadas a través del modelo Triple P versus PPF, así como tampoco en la evaluación de estas variables pre y post intervención en ninguna de las dos estrategias. Aunque los resultados resultan interesantes en términos de discusión sobre la efectividad de estas estrategias de intervención en las variables descritas, las dificultades asociadas a la adherencia de las familias a las citaciones y el bajo número de sujetos con el que contó la investigación deben tomarse en cuenta al analizar nuestros resultados. Se recomienda incluir análisis cualitativos e investigaciones con un N mayor que permitan comparar los resultados y mejorar la evidencia sobre la efectividad de estos programas de intervención.
The practical abilities of parents to care for, protect and educate their children, ensuring their healthy development, are the central aspects of parental competencies. The intervention of the Chilean Focused Prevention Programme (PPF) and Triple P in its 4th level (group) - of Australian origin - has, among its purposes, to strengthen parental competencies in people who are in charge of a child. The present research of quasi-experimental design, of pre-post type with an equivalent control group, compared the effectiveness of both programmes in parenting skills in a sample of 15 parents and caregivers of children between 2 and 12 years old. The results show no significant differences in the variables of parenting styles, parental self-efficacy, and adjustment difficulties in childhood between the interventions carried out through the Triple P model versus PPF, nor in assessing these variables pre and post intervention in either of the two strategies. Although the results are interesting as a discussion of the effectiveness of these intervention strategies on the variables described, the difficulties associated with families' adherence to the citations and the low number of subjects in the research should be considered when analysing our results. It is recommended to include qualitative analyses and research with a higher N to compare the results and improve the evidence on the effectiveness of these intervention programmes.
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Pais/psicologia , Educação Infantil , Poder Familiar , Adaptação Psicológica , Chile , Inquéritos e Questionários , Resultado do Tratamento , AutoeficáciaRESUMO
Introducción: El complejo enzimático emisor de luz de las bacterias luminiscentes es una poderosa herramienta bioquímica, con una amplia variedad de aplicaciones, incluyendo el control de la calidad ambiental. Objetivos: Identificar taxonómicamente dos bacterias luminiscentes de las aguas de la plataforma cubana, así como seleccionar los medios de cultivo que favorezcan su crecimiento y luminiscencia. Métodos: La identificación taxonómica de las bacterias luminiscentes se llevó a cabo utilizando métodos tradicionales y moleculares. Cuatro medios de cultivo (LM, Boss, Chalk, ZoBell) fueron evaluados en función de la tasa de crecimiento específico (μ) y la luminiscencia utilizando un espectrofotómetro Genesys 10UV y un espectro fluorómetro Shimadzu RF-5301pc, respectivamente. Resultados: La caracterización bioquímica y fisiológica de los aislamientos de CBM-976 y CBM-992 mostró similitudes con las especies de Vibrio harveyi. El análisis del posicionamiento taxonómico confirmó una alta correspondencia con las cepas de V. harveyi aisladas de entornos acuáticos, utilizando secuencias parciales de los genes 16S rRNA, gyrB y pyrH. Se seleccionaron los medios de cultivo LM y ZoBell por tener una alta tasa de crecimiento específico de las cepas CBM-976 y CBM-992; así como por mostrar altos valores de luminiscencia. Los resultados permitirán profundizar en la caracterización fisiológica y son el punto de partida para el desarrollo de métodos de detección de contaminantes. Conclusiones: La combinación de las características fisiológicas y bioquímicas, así como las técnicas de biología molecular contribuyeron a determinar la posición taxonómica de las cepas CBM-976 y CBM-992 aisladas de las aguas marinas cubanas como Vibrio harveyi. Además, se seleccionaron los medios de cultivo LM y ZoBell como los más adecuados para el crecimiento y la emisión de luminiscencia de ambas cepas.
Introduction: The light-emitting enzyme complex of luminescent bacteria is a powerful biochemical tool, with a wide variety of applications including environmental quality monitoring. Objectives: To identify taxonomically two luminescent bacteria from Cuban shelf waters, as well as select the culture media that favor their growth and luminescence. Methods: The taxonomic location of the luminescent bacteria was carried out using traditional and molecular methods. Four culture media (LM, Boss, Chalk, ZoBell) were evaluated as a function of specific growth rate (μ) and luminescence, using a Genesys 10UV spectrophotometer and a Shimadzu RF-5301pc spectrofluorometer, respectively. Results: Biochemical and physiological characterization of CBM-976 and CBM-992 isolates showed similarities with Vibrio harveyi species. Phylogenetic positioning analysis confirmed a high correspondence with V. harveyi strains isolated from aquatic environments, using partial sequences of 16S rRNA, gyrB and pyrH genes. LM and ZoBell culture media were selected for having a high specific growth rate of CBM-976 and CBM-992 strains, as well as for showing high luminescence values. The results will allow deepening the physiological characterization and are the starting point for the development of contaminant detection methods. Conclusions: The rational combination of physiological and biochemical characteristics, as well as the molecular approach, contributed to determine the taxonomic position of CBM-976 and CBM-992 strains isolated from Cuban marine waters as Vibrio harveyi. Furthermore, LM and ZoBell culture media were selected as the most suitable for growth and luminescence emission for both strains.
Assuntos
Animais , Bactérias/química , Medições Luminescentes , DNA , Cuba , Meios de Cultura/análiseRESUMO
BACKGROUND: Clinical practice guidelines (CPGs) promote better quality and equity in health care and potentially they could improve patients' outcomes. However, their implementation is hindered by a number of factors including some related to health care professionals. AIM: To assess the perceptions and attitudes of primary care physicians regarding CPGs developed by the Chilean Ministry of Health in the context of the Health Sector Reform. MATERIAL AND METHODS: An adaptation of the survey "Knowledge, perceptions and attitudes towards Clinical Practice Guidelines" was sent to 1,264 primary care physicians in Chile and answered completely by 354. The analysis assessed the attitudes towards CPG, their use in primary care and their relationship with socio demographic features of respondents. RESULTS: Eighty two percent of respondents reviewed the flowcharts of the guidelines, 85% consulted their online version. The classification of evidence levels and the strength of recommendations generated a high level of confidence with the guidelines in 70 and 64% of respondents. Eighty five percent considered that CPG could help to standardize clinical practice. The most relevant barrier hindering CPG use was the lack of a brief, simple and easy to access format in 63% of respondents. The three dimensions of the theory of planned behavior (attitude toward behavior, subjective norms, and perceived behavioral control) were associated with a greater frequency of guideline use. A higher age and not being Chilean were associated with a lower frequency of use. CONCLUSIONS: The identified factors associated with CPG use should be considered in future guideline design.
Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Médicos de Atenção Primária/normas , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Atenção Primária à Saúde/normas , Adulto , Atitude do Pessoal de Saúde , Chile , Estudos Transversais , Feminino , Fidelidade a Diretrizes/normas , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Masculino , Médicos de Atenção Primária/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Inquéritos e QuestionáriosRESUMO
Background: Clinical practice guidelines (CPGs) promote better quality and equity in health care and potentially they could improve patients' outcomes. However, their implementation is hindered by a number of factors including some related to health care professionals. Aim: To assess the perceptions and attitudes of primary care physicians regarding CPGs developed by the Chilean Ministry of Health in the context of the Health Sector Reform. Material and Methods: An adaptation of the survey "Knowledge, perceptions and attitudes towards Clinical Practice Guidelines" was sent to 1,264 primary care physicians in Chile and answered completely by 354. The analysis assessed the attitudes towards CPG, their use in primary care and their relationship with socio demographic features of respondents. Results: Eighty two percent of respondents reviewed the flowcharts of the guidelines, 85% consulted their online version. The classification of evidence levels and the strength of recommendations generated a high level of confidence with the guidelines in 70 and 64% of respondents. Eighty five percent considered that CPG could help to standardize clinical practice. The most relevant barrier hindering CPG use was the lack of a brief, simple and easy to access format in 63% of respondents. The three dimensions of the theory of planned behavior (attitude toward behavior, subjective norms, and perceived behavioral control) were associated with a greater frequency of guideline use. A higher age and not being Chilean were associated with a lower frequency of use. Conclusions: The identified factors associated with CPG use should be considered in future guideline design.
Assuntos
Humanos , Masculino , Feminino , Adulto , Atenção Primária à Saúde/normas , Padrões de Prática Médica/normas , Conhecimentos, Atitudes e Prática em Saúde , Guias de Prática Clínica como Assunto , Médicos de Atenção Primária/normas , Padrões de Prática Médica/estatística & dados numéricos , Atitude do Pessoal de Saúde , Chile , Estudos Transversais , Inquéritos e Questionários , Fidelidade a Diretrizes/normas , Fidelidade a Diretrizes/estatística & dados numéricos , Médicos de Atenção Primária/estatística & dados numéricosRESUMO
The brief intervention is a therapeutic strategy suggested to address behavioral changes associated with risk factors for chronic non-communicable diseases and there is ample evidence of its effectiveness. However, this evidence is sustained by various definitions of brief intervention, a fact that makes the clinical application of this strategy difficult. This literature review article aimed to conduct a search for systematic reviews in the Epistemonikos database in order to identify common factors in the definition of brief intervention and summarize some brief intervention strategies frequently used in primary health care. It also seeks to describe their effectiveness, for three risk factors: tobacco, alcohol and physical activity, within this clinical context.
La intervención breve en salud es una estrategia terapéutica, sugerida para abordar cambios conductuales asociados a factores de riesgo de enfermedades crónicas no transmisibles. Existe amplia evidencia sobre su efectividad. Sin embargo, esta evidencia se sustenta en distintas definiciones de intervención breve, lo que dificulta su aplicación clínica. Este artículo de revisión de literatura, se propuso realizar una búsqueda de revisiones sistemáticas en la base de datos Epistemonikos con el fin de identificar factores comunes en su definición y resumir algunas estrategias de intervención breve usadas con frecuencia en la atención primaria de salud. Asimismo, se busca describir su efectividad en este contexto clínico, para tres factores de riesgo: tabaco, alcohol y actividad física.