Impacto de un Programa de Capacitación en la práctica profesional de médicos del Primer Nivel de Atención : El caso del Programa en Terapéutica Racional en Atención Primaria de la Salud

El Ministerio de Salud, a través del Programa Remediar y con la participación de 24 Facultades de Medicina, implementa un Programa de Capacitación en Terapéutica Racional de Atención Primaria de la Salud (TRAPS) destinado a médicos/as que se desempeñan en el primer nivel de atención (PNA). En el Curso sobre Riesgo Cardiovascular Global (RCVG) se promueve la utilización de la Guía de la OMS adaptada para Argentina para la estimación del riesgo. Objetivo. Presentar los resultados de un estudio cualitativo que indaga, entre los profesionales que habían asistido al curso, el conocimiento y la utilización de la Guía. Material y Método. Entrevistas en profundidad semiestructuradas a través de las cuales se exploran dimensiones tales como la relación médico paciente, el abordaje de personas con riesgo cardiovascular y los factores institucionales que intervienen en el proceso de atención. Los profesionales sostienen que la capacitación recibida impactó en la práctica clínica y que el uso de la Guía simplifica y mejora el tratamiento de personas con factores de riesgo otorgándoles seguridad y reduciendo la variabilidad en la práctica clínica. También señalaron que el uso de la Guía facilita la comunicación y contribuye a que el paciente se involucre en su propio tratamiento. Conclusiones. El Curso motivó a los profesionales en el uso de la Guía en su práctica clínica cotidiana. No obstante, se identificaron matices en la utilización de la herramienta. En este sentido, la utilización de la Guía también puede verse incentivada u obstaculizada por factores que van más allá de la capacitación, entre los que se destacan los factores institucionales. Sería conveniente ampliar el estudio incluyendo profesionales de otras jurisdiccione

PAX4 preserves endoplasmic reticulum integrity preventing beta cell degeneration in a mouse model of type 1 diabetes mellitus

[Aims/hypothesis]: A strategy to enhance pancreatic islet functional beta cell mass (BCM) while restraining inflammation, through the manipulation of molecular and cellular targets, would provide a means to counteract the deteriorating glycaemic control associated with diabetes mellitus. The aims of the current study were to investigate the therapeutic potential of such a target, the islet-enriched and diabetes-linked transcription factor paired box 4 (PAX4), to restrain experimental autoimmune diabetes (EAD) in the RIP-B7.1 mouse model background and to characterise putative cellular mechanisms associated with preserved BCM. [Methods]: Two groups of RIP-B7.1 mice were genetically engineered to: (1) conditionally express either PAX4 (BPTL) or its diabetes-linked mutant variant R129W (mutBPTL) using doxycycline (DOX); and (2) constitutively express luciferase in beta cells through the use of RIP. Mice were treated or not with DOX, and EAD was induced by immunisation with a murine preproinsulin II cDNA expression plasmid. The development of hyperglycaemia was monitored for up to 4 weeks following immunisation and alterations in the BCM were assessed weekly by non-invasive in vivo bioluminescence intensity (BLI). In parallel, BCM, islet cell proliferation and apoptosis were evaluated by immunocytochemistry. Alterations in PAX4- and PAX4R129W-mediated islet gene expression were investigated by microarray profiling. PAX4 preservation of endoplasmic reticulum (ER) homeostasis was assessed using thapsigargin, electron microscopy and intracellular calcium measurements. [Results]: PAX4 overexpression blunted EAD, whereas the diabetes-linked mutant variant PAX4R129W did not convey protection. PAX4-expressing islets exhibited reduced insulitis and decreased beta cell apoptosis, correlating with diminished DNA damage and increased islet cell proliferation. Microarray profiling revealed that PAX4 but not PAX4R129W targeted expression of genes implicated in cell cycle and ER homeostasis. Consistent with the latter, islets overexpressing PAX4 were protected against thapsigargin-mediated ER-stress-related apoptosis. Luminal swelling associated with ER stress induced by thapsigargin was rescued in PAX4-overexpressing beta cells, correlating with preserved cytosolic calcium oscillations in response to glucose. In contrast, RNA interference mediated repression of PAX4-sensitised MIN6 cells to thapsigargin cell death. [Conclusions/interpretation]: The coordinated regulation of distinct cellular pathways particularly related to ER homeostasis by PAX4 not achieved by the mutant variant PAX4R129W alleviates beta cell degeneration and protects against diabetes mellitus. The raw data for the RNA microarray described herein are accessible in the Gene Expression Omnibus database under accession number GSE62846

Long-term effects of intermittent adolescent alcohol exposure in male and female rats

Alcohol is a serious public health concern that has a differential impact on individuals depending upon age and sex. Patterns of alcohol consumption have recently changed: heavy episodic drinking—known as binge-drinking—has become most popular among the youth. Herein, we aimed to investigate the consequences of intermittent adolescent alcohol consumption in male and female animals. Thus, Wistar rats were given free access to ethanol (20% in drinking water) or tap water for 2-h sessions during 3 days, and for an additional 4-h session on the 4th day; every week during adolescence, from postnatal day (pnd) 28–52. During this period, animals consumed a moderate amount of alcohol despite blood ethanol concentration (BEC) did not achieve binge-drinking levels. No withdrawal signs were observed: no changes were observed regarding anxiety-like responses in the elevated plus-maze or plasma corticosterone levels (pnd 53–54). In the novel object recognition (NOR) test (pnd 63), a significant deficit in recognition memory was observed in both male and female rats. Western Blot analyses resulted in an increase in the expression of synaptophysin in the frontal cortex (FC) of male and female animals, together with a decrease in the expression of the CB2R in the same brain region. In addition, adolescent alcohol induced, exclusively among females, a decrease in several markers of dopaminergic and serotonergic neurotransmission, in which epigenetic mechanisms, i.e., histone acetylation, might be involved. Taken together, further research is still needed to specifically correlate sex-specific brain and behavioral consequences of adolescent alcohol exposure

A comprehensive review on sub-zero temperature cold thermal energy storage materials, technologies, and applications:state of the art and recent developments

The energy industry needs to take action against climate change by improving efficiency and increasing the share of renewable sources in the energy mix. On top of that, refrigeration, air-conditioning, and heat pump equipment account for 25-30% of the global electricity consumption and will increase dramatically in the next decades. However, some waste cold energy sources have not been fully used. These challenges triggered an interest in developing the concept of cold thermal energy storage, which can be used to recover the waste cold energy, enhance the performance of refrigeration systems, and improve renewable energy integration. This paper comprehensively reviews the research activities about cold thermal energy storage technologies at sub-zero temperatures (from around 270 ◦C to below 0 ◦C). A wide range of existing and potential storage materials are tabulated with their properties. Numerical and experimental work conducted for different storage types is systematically summarized. Current and potential applications of cold thermal energy storage are analyzed with their suitable materials and compatible storage types. Selection criteria of materials and storage types are also presented. This review aims to provide a quick reference for researchers and industry experts in designing cold thermal energy systems. Moreover, by identifying the research gaps where further efforts are needed, the review also outlines the progress and potential development directions of cold thermal energy storage technologies.The authors would like to acknowledge the funding support from SJ-NTU Corporate Lab. This work was partically funded by the Ministerio de Ciencia, Innovación y Universidades de España (RTI2018-093849-B-C31 - MCIU/AEI/FEDER, UE), and the Ministerio de Ciencia, Innovación y Universidades - Agencia Estatal de Investigación (AEI) (RED2018-102431-T). The authors at the University of Lleida would like to thank the Catalan Government for the quality accreditation given to their research group (2017 SGR 1537). GREiA is certified agent TECNIO in the category of technology developers from the Government of Catalonia. This work is partially supported by ICREA under the ICREA Academia program

Long-Term Effects of Intermittent Adolescent Alcohol Exposure in Male and Female Rats

Alcohol is a serious public health concern that has a differential impact on individuals depending upon age and sex. Patterns of alcohol consumption have recently changed: heavy episodic drinking¿known as binge-drinking¿has become most popular among the youth. Herein, we aimed to investigate the consequences of intermittent adolescent alcohol consumption in male and female animals. Thus, Wistar rats were given free access to ethanol (20% in drinking water) or tap water for 2-h sessions during 3 days, and for an additional 4-h session on the 4th day; every week during adolescence, from postnatal day (pnd) 28¿52. During this period, animals consumed a moderate amount of alcohol despite blood ethanol concentration (BEC) did not achieve binge-drinking levels. No withdrawal signs were observed: no changes were observed regarding anxiety-like responses in the elevated plus-maze or plasma corticosterone levels (pnd 53¿54). In the novel object recognition (NOR) test (pnd 63), a significant deficit in recognition memory was observed in both male and female rats. Western Blot analyses resulted in an increase in the expression of synaptophysin in the frontal cortex (FC) of male and female animals, together with a decrease in the expression of the CB2R in the same brain region. In addition, adolescent alcohol induced, exclusively among females, a decrease in several markers of dopaminergic and serotonergic neurotransmission, in which epigenetic mechanisms, i.e., histone acetylation, might be involved. Taken together, further research is still needed to specifically correlate sex-specific brain and behavioral consequences of adolescent alcohol exposure

Impacto de un programa de capacitación en la práctica profesional de médicos del Primer Nivel de Atención : El caso del Programa en Terapéutica Racional en Atención Primaria de la Salud. Programa Remediar. Ministerio de Salud

El Ministerio de Salud, a través del Programa Remediar y con la participación de 24 Facultades de Medicina, implementa un Programa de Capacitación en Terapéutica Racional de Atención Primaria de la Salud (TRAPS) destinado a médicos/as que se desempeñan en el primer nivel de atención (PNA). En el Curso sobre Riesgo Cardiovascular Global (RCVG) se promueve la utilización de la Guía de la OMS adaptada para Argentina para la estimación del riesgo. Objetivo. Presentar los resultados de un estudio cualitativo que indaga, entre los profesionales que habían asistido al curso, el conocimiento y la utilización de la Guía. Material y Método. Entrevistas en profundidad semiestructuradas a través de las cuales se exploran dimensiones tales como la relación médico paciente, el abordaje de personas con riesgo cardiovascular y los factores institucionales que intervienen en el proceso de atención. Los profesionales sostienen que la capacitación recibida impactó en la práctica clínica y que el uso de la Guía simplifica y mejora el tratamiento de personas con factores de riesgo otorgándoles seguridad y reduciendo la variabilidad en la práctica clínica. También señalaron que el uso de la Guía facilita la comunicación y contribuye a que el paciente se involucre en su propio tratamiento. Conclusiones. El Curso motivó a los profesionales en el uso de la Guía en su práctica clínica cotidiana. No obstante, se identificaron matices en la utilización de la herramienta. En este sentido, la utilización de la Guía también puede verse incentivada u obstaculizada por factores que van más allá de la capacitación, entre los que se destacan los factores institucionales. Sería conveniente ampliar el estudio incluyendo profesionales de otras jurisdicciones.Mesa 19: Evaluar para la transformación. Evaluación de políticas sociales en Argentina.Facultad de Humanidades y Ciencias de la Educació

Testing the efficacy of INtegral Cognitive REMediation (INCREM) in major depressive disorder : study protocol for a randomized clinical trial

Given the limitation of pharmacological treatments to treat cognitive symptoms in patients with Major Depressive Disorder (MDD), cognitive remediation programs has been proposed as a possible procognitive intervention but findings are not conclusive. This study investigates the efficacy of an INtegral Cognitive REMediation (INCREM) that includes a combination of a Functional Remediation (FR) strategy plus a Computerized Cognitive Training (CCT) in order to improve not only cognitive performance but also the psychosocial functioning and the quality of life. A single blind randomized controlled clinical trial in 81 patients with a diagnosis of MDD in clinical remission or in partial remission. Participants will be randomized to one of three conditions: INCREM (FR + CCT), Psychoeducation plus online games and Treatment As Usual (TAU). Intervention will consist in 12 group sessions, of approximately 110 min once a week. The primary outcome measure will be % of change in psychosocial functioning after treatment measured by the Functional Assessment Short Test (FAST); additionally, number of sick leaves and daily activities will also be recorded as pragmatic outcomes. To our knowledge, this is the first randomized controlled clinical trial using a combination of two different approaches (FR + CCT) to treat the present cognitive deficits and to promote their improvements into a better psychosocial functioning. Clinical Trials . Date registered 10th of August 2018 and last updated 24th August 2018

Testing the efficacy of INtegral Cognitive REMediation (INCREM) in major depressive disorder: study protocol for a randomized clinical trial

Background: Given the limitation of pharmacological treatments to treat cognitive symptoms in patients with Major Depressive Disorder (MDD), cognitive remediation programs has been proposed as a possible procognitive intervention but findings are not conclusive. This study investigates the efficacy of an INtegral Cognitive REMediation (INCREM) that includes a combination of a Functional Remediation (FR) strategy plus a Computerized Cognitive Training (CCT) in order to improve not only cognitive performance but also the psychosocial functioning and the quality of life. Methods: A single blind randomized controlled clinical trial in 81 patients with a diagnosis of MDD in clinical remission or in partial remission. Participants will be randomized to one of three conditions: INCREM (FR + CCT), Psychoeducation plus online games and Treatment As Usual (TAU). Intervention will consist in 12 group sessions, of approximately 110 min once a week. The primary outcome measure will be % of change in psychosocial functioning after treatment measured by the Functional Assessment Short Test (FAST); additionally, number of sick leaves and daily activities will also be recorded as pragmatic outcomes. Discussion: To our knowledge, this is the first randomized controlled clinical trial using a combination of two different approaches (FR + CCT) to treat the present cognitive deficits and to promote their improvements into a better psychosocial functioning. Trial registration: Clinical Trials NCT03624621 . Date registered 10th of August 2018 and last updated 24th August 2018

Disrupted network switching in euthymic bipolar disorder: Working memory and self-referential paradigms

Background: Patients with bipolar disorder (BD) frequently suffer from neurocognitive deficits that can persist during periods of clinical stability. Specifically, impairments in executive functioning such as working memory and in self-processing have been identified as the main components of the neurocognitive profile observed in euthymic BD patients. The study of the neurobiological correlates of these state-independent alterations may be a prerequisite to develop reliable biomarkers in BD. Methods: A sample of 27 euthymic BD patients and 25 healthy participants (HC) completed working memory and self-referential functional Magnetic Resonance Imaging (fMRI) tasks. Activation maps obtained for each group and contrast images (i.e., 2-back > 1-back/self > control) were used for comparisons between patients and HC. Results: Euthymic BD patients, in comparison to HC, showed a higher ventromedial prefrontal cortex activation during working memory, a result driven by the lack of deactivation in BD patients. In addition, euthymic BD patients displayed a greater dorsomedial and dorsolateral prefrontal cortex activation during self-reference processing. Limitations: Pharmacotherapy was described but not included as a confounder in our models. Sample size was modest. Conclusion: Our findings revealed a lack of deactivation in the anterior default mode network (aDMN) during a working memory task, a finding consistent with prior research in BD patients, but also a higher activation in frontal regions within the central executive network (CEN) during self-processing. These results suggest that an imbalance of neural network dynamics underlying external/internal oriented cognition (the CEN and the aDMN, respectively) may be one of the first reliable biomarkers in euthymic bipolar patients

Características fonológicas en población escolar con dislexia: Un modelo de ecuaciones estructurales: Phonological features in a school population with dyslexia: A structural equation model

Objective: To analyze the relationship between phonological fluency, repetition, naming and verbal comprehension in children diagnosed with dyslexia. Method: A sample of (N=114) school patients with dyslexia diagnosis between the ages of 7 and 16 years, selected by non-probability sampling, was used. We built a structural equation model (SEM) in RCran 4.0.4 software, to analyze the relationship between the latent variables (phonological fluency, semantic fluency, pseudoword repetition, sentence repetition, language naming and verbal comprehension), through the results of standardized psychometric tests; Verbal Fluency Test, Boston Test, Child Neuropsychological Assessment and Weschler Intelligence Scale IV. Results: Covariances between phonological fluency and all language components were positive; semantic fluency (σxy=0.55), pseudoword repetition (σxz=0.53), sentence repetition (σxw=0.64), LG naming (σxv=0.60), verbal comprehension (σxy=0.57), indicating a direct relationship. In people with dyslexia, the lower the phonological fluency the greater the language deficits. Conclusion: In dyslexia, phonological and semantic fluency is limited and is directly related to the clinical manifestations of this neurodevelopmental disorder.Introducción: El trastorno específico del aprendizaje es una entidad nosológica del neurodesarrollo, las manifestaciones clínicas se hacen evidentes en la etapa escolar y son persistentes en el transcurso de la vida. La dislexia (DS) se caracteriza por una afectación en la comprensión y fluidez del proceso lector, asociada a déficits neurocognitivos. Objetivo: Analizar. la relación existente entre fluidez fonológica, repetición, denominación y comprensión verbal en niños con diagnóstico de DS. Método: Se empleó una muestra de N=114 personas con diagnóstico de DS escolarizados, en edades entre 7 y 16 años y un. muestreo no probabilístico. Construimos un modelo de ecuaciones estructurales (MEE) en el software RCran 4.0.4, para analizar la relación entre las variables latentes (fluidez fonológica, fluidez semántica, repetición de pseudopalabras, repetición de frases, denominación y comprensión verbal), a través de los resultados de pruebas psicométricas estandarizadas; Test de Fluencia Verbal, Test de Boston, Evaluación Neuropsicológica Infantil y Escala Weschler IV de Inteligencia. Resultados: Las covarianzas entre fluidez fonológica y todos los componentes del lenguaje (LG) fueron positivas; fluidez semántica (σxy=0,55), repetición de pseudopalabras (σxz=0,53), repetición de frases (σxw=0,64), denominación del LG (σxv=0,60), comprensión verbal (σxy=0,57), lo que indica una relación directa. En las personas con DS, a menor fluidez fonológica mayores deficiencias del LG. Conclusión: En la DS la fluidez fonológica y semántica es limitada y se relaciona de manera directa conlas manifestaciones clínicas de este trastorno del neurodesarrollo (TN)