Opiniones, prácticas, barreras y predisposición al cambio, a la hora de dar consejo para dejar de fumar

ObjetivoConocer las opiniones, las prácticas actuales, las barreras percibidas y la predisposición al cambio con respecto al consejo para dejar de fumar (CF) ofertado a los pacientes por los diferentes profesionales sanitarios (PS) de atención primaria.DiseñoEstudio descriptivo, transversal.EmplazamientoCentros de salud del Área Sanitaria 9, de Madrid.ParticipantesParticiparon 480 PS, entre médicos de familia, pediatras, residentes de medicina familiar y comunitaria, y enfermería.MedicionesMediante cuestionario autocumplimentado y anónimo se recogen variables sociodemográficas, sobre actitudes, creencias y utilización de estrategias en CF y sobre barreras percibidas para darlo, así como la predisposición al cambio.ResultadosContestó al cuestionario el 75,2% (el 94,2, 61,1, 51,6 y 88% de los médicos, enfermeros, pediatras y residentes, respectivamente). El 72% pregunta de manera habitual, con un incremento hasta el 92,4% en las enfermedades relacionadas con el tabaquismo, sin diferencias respecto al sexo, el PS, el hábito tabáquico y la formación previa. El 85,8% ofrece realizar un seguimiento y el 63,5% proporciona consejos escritos. El 75% de los no fumadores se considera modelo social, frente al 40% de los fumadores. Las principales barreras son la falta de tiempo y la baja motivación en los pacientes. El 93,5% cree que es necesaria una formación específica para proporcionar CF.ConclusionesSe pregunta y se ofrece CF, independientemente del hábito tabáquico del PS. A pesar de las barreras, hay una adecuada utilización de las estrategias para proporcionar CF. Hay buena predisposición al cambio para optimizar el CF.ObjectiveTo get to know the opinions, current practices, perceived barriers and stage of change in respect to the smoking cessation advice (SCA) offered to patients by the different health professionals (HP) from primary care.DesignDescriptive cross-sectional study.LocationÁrea Sanitaria 9’s Health Centers, inMadrid, Spain.Participants480 HPs, including primary care doctors, pediatricians, primary care residents, and nursery staff.MeasurementsUsing a self-filled and anonymous questionnaire, we will gather sociodemographic variables and from the HP’s office, regarding the attitudes towards tobacco, efficiency beliefs and use of strategies in the advice, and the perceived barriers to give it, as well as the state of change.Results75.2% of the HPs filled the questionnaire (94.2%, 61.1%, 51.6%, and 88% by doctors, nurses, pediatricians, and residents respectively). 72% ask regularly, this rate increasing to 92.4% over tobacco-related diseases. No differences were made between sexes, professional types, tobacco habits, or previous attendance to courses. 85.8% offers tracing and 63.5% give written advices. Nearly 75% of non-smokers are considered social role models, that against only 40% of smokers. The main barriers found were lack of time and low motivation from the patients. 93.5% consider an specific education necessary to give efficient SCA.ConclusionsInquiries are made and SCA is given, independently of the smoking habits of the SCA. Likewise, there is a good state of change by the HPs to optimize the treatment of tobacco dependency

Impact of Daily Thermocycles on Hatching Rhythms, Larval Performance and Sex Differentiation of Zebrafish

In the wild, water temperature cycles daily: it warms up after sunrise, and cools rapidly after sunset. Surprisingly, the impact of such daily thermocycles during the early development of fish remains neglected. We investigated the influence of constant vs daily thermocycles in zebrafish, from embryo development to sexual differentiation, by applying four temperature regimens: two constant (24°C and 28°C) and two daily thermocycles: 28:24°C, TC (thermophase coinciding with daytime, and cryophase coinciding with night-time) and 24:28°C, CT (opposite to TC) in a 12:12 h light:dark cycle (LD). Embryo development was temperature-dependent but enhanced at 28°C and TC. Hatching rhythms were diurnal (around 4 h after lights on), but temperature- and cycle-sensitive, since hatching occurred sooner at 28°C (48 hours post fertilization; hpf) while it was delayed at 24°C (96 hpf). Under TC, hatching occurred at 72 hpf, while under CT hatching displayed two peaks (at 70 hpf and 94 hpf). In constant light (LL) or darkness (DD), hatching rhythms persisted with tau close to 24 h, suggesting a clock-controlled "gating" mechanism. Under 28°C or TC, larvae showed the best performance (high growth and survival, and low malformations). The sex ratio was strongly influenced by temperature, as the proportion of females was higher in CT and TC (79 and 83% respectively), contrasting with 28°C and 24°C, which led to more males (83 and 76%). Ovarian aromatase (cyp19a) expression in females was highest in TC and CT (6.5 and 4.6 fold higher than at 28°C, respectively); while anti-müllerian hormone (amh) expression in males increased in testis at 24°C (3.6 fold higher compared to TC) and particularly at 28°C (14.3 fold increase). Taken together, these findings highlight the key role of environmental cycles during early development, which shaped the daily rhythms in fish embryo and larvae, and ultimately influenced sex differentiation

Retention and diffusion of radioactive and toxic species on cementitious systems: Main outcome of the CEBAMA project

Cement-based materials are key components in radioactive waste repository barrier systems. To improve the available knowledge base, the European CEBAMA (Cement-based materials) project aimed to provide insight on general processes and phenomena that can be easily transferred to different applications. A bottom up approach was used to study radionuclide retention by cementitious materials, encompassing both individual cement mineral phases and hardened cement pastes. Solubility experiments were conducted with Be, Mo and Se under high pH conditions to provide realistic solubility limits and radionuclide speciation schemes as a prerequisite for meaningful adsorption studies. A number of retention mechanisms were addressed including adsorption, solid solution formation and precipitation of radionuclides within new solid phases formed during cement hydration and evolution. Sorption/desorption experiments were carried out on several anionic radionuclides and/or toxic elements which have received less attention to date, namely: Be, Mo, Tc, I, Se, Cl, Ra and 14C. Solid solution formation between radionuclides in a range of oxidation states (Se, I and Mo) with the main aqueous components (OH−, SO4 −2, Cl−) of cementitious systems on AFm phases were also investigated

From Passive to Radical Revolution in Venezuela’s Populist Project

In December 2001, Hugo Chávez and others changed Venezuela’s Bolivarian revolutionary project, which consisted of replacing a corrupt and elitist constitution with a fair and popular one, into a radical one. In its early stages the project corresponded to what Gramsci called a “passive revolution.” Attempts by opposition forces to crush the construction of a new populist hegemony (a coup in April 2002 and an indefinite strike in December 2002) were met with popular mobilization that reaffirmed Chávez’s hegemonic project. The radical revolution consisted of social programs designed to alleviate the suffering of the poor and consolidated a new hegemonic structure among Venezuela’s lower classes. The concept of “radical revolution” provides a theoretical alternative for assessing the extent to which a political project can be described as populist

International nosocomial infection control consortium (INICC) report, data summary of 36 countries, for 2004-2009

The results of a surveillance study conducted by the International Nosocomial Infection Control Consortium (INICC) from January 2004 through December 2009 in 422 intensive care units (ICUs) of 36 countries in Latin America, Asia, Africa, and Europe are reported. During the 6-year study period, using Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN; formerly the National Nosocomial Infection Surveillance system [NNIS]) definitions for device-associated health care-associated infections, we gathered prospective data from 313,008 patients hospitalized in the consortium's ICUs for an aggregate of 2,194,897 ICU bed-days. Despite the fact that the use of devices in the developing countries' ICUs was remarkably similar to that reported in US ICUs in the CDC's NHSN, rates of device-associated nosocomial infection were significantly higher in the ICUs of the INICC hospitals; the pooled rate of central line-associated bloodstream infection in the INICC ICUs of 6.8 per 1,000 central line-days was more than 3-fold higher than the 2.0 per 1,000 central line-days reported in comparable US ICUs. The overall rate of ventilator-associated pneumonia also was far higher (15.8 vs 3.3 per 1,000 ventilator-days), as was the rate of catheter-associated urinary tract infection (6.3 vs. 3.3 per 1,000 catheter-days). Notably, the frequencies of resistance of Pseudomonas aeruginosa isolates to imipenem (47.2% vs 23.0%), Klebsiella pneumoniae isolates to ceftazidime (76.3% vs 27.1%), Escherichia coli isolates to ceftazidime (66.7% vs 8.1%), Staphylococcus aureus isolates to methicillin (84.4% vs 56.8%), were also higher in the consortium's ICUs, and the crude unadjusted excess mortalities of device-related infections ranged from 7.3% (for catheter-associated urinary tract infection) to 15.2% (for ventilator-associated pneumonia). Copyright © 2012 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved

Adecuación de las derivaciones desde atención primaria al servicio de urgencias hospitalario en el Área 9 de Madrid

Objetivo: Conocer la adecuación de las derivaciones desde atención primaria (AP) al servicio de urgencias hospitalario en el Área 9 de Madrid. Objetivos secundarios: - Descripción de las patologías derivadas. - Grado de información clínica presente en los volantes de derivación. Métodos: Diseño: Estudio descriptivo transversal. Participantes: Pacientes atendidos en el Hospital Severo Ochoa (Leganés), remitidos con volante de derivación por médicos de AP, entre el 1 de marzo y el 10 de abril del 2003. Mediciones: Se recogieron variables sociodemográficas (edad, género), variables sobre temporalidad (día de la semana, hora de llegada), variables sobre información en los volantes de derivación (motivo de la misma, historia clínica, exploración física, juicio clínico), variables sobre la atención en urgencias (descripción de la patología, requerimiento de pruebas diagnósticas, pertinencia de la derivación). Resultados: Se consideraron adecuadas el 49,4% de las derivaciones. El grupo de edad de 0-30 años fue el más derivado y el viernes el día más frecuentado. El 64% fue dado de alta en menos de 3 horas. Ingresó el 2,7%. Los mejor derivados fueron los mayores de 65 años y en turno de noche. En los volantes constaba el juicio clínico solo en el 60,7% y el motivo de derivación más frecuente fue la demanda de valoración (89,2%). Conclusiones: La mitad de las derivaciones fueron adecuadas. Los pacientes de mayor edad y con patologías potencialmente más graves son los mejor derivados. El volante de derivación es mejorable