Orientación hacia la salud y consumo de drogas en la población juvenil ¿Es realmente eficaz la prevención actual?

A pesar de los esfuerzos realizados en materia de prevención, las cifras de consumo de drogas en nuestro país siguen siendo preocupantes, revelando edades de consumo cada vez más precoces. A día de hoy las explicaciones son muy diversas, aunque no suelen traducirse en soluciones realmente efectivas. El presente trabajo, planteado desde la perspectiva del Marketing Sanitario, intenta encontrar algunas de las claves de esta situación. El trabajo empírico ha consistido en la realización de 683 entrevistas a jóvenes de ambos sexos, de entre 18 y 30 años, residentes en la comunidad gallega. Además de actualizar los datos disponibles referidos a hábitos y prácticas de riesgo, se ha analizado la relación entre ambos tipos de variables, en un intento de alcanzar nuevas explicaciones y claves para una mejor prevención del consumo de drogas en esta población. Los resultados obtenidos ponen en entredicho la eficacia de las actuales políticas de prevenciónIn last two decades a big effort has been made in order to prevent drug use, and the number of studies related to consumption of these substances among young people has increased. Nevertheless, the figures are still high, revealing both an increasingly shorter age of initiation. Nowadays, the number of possible explanations for this is large, but they are not targeted towards real solutions. The present study, departing from a Health Marketing perspective, tries to find some key aspects of this situation. The empirical work, consisting of 683 interviews with young men and women, among 18 and 30 years, residents in Galicia, apart from updating the available data about habits and risk behaviors, linking both types of variables in an attempt to reach new plausible explanations and keys, in order to a better prevention of drug use in young people. The results call into question the effectiveness of current prevention policiesS

Relationship between perceived health care quality and attitude toward substance abuse treatment

A pesar de la considerable inversión realizada en los últimos años en España en la asistencia a las drogodependencias, la adherencia al tratamiento sigue siendo uno de los elementos que condicionan de forma clara la efi cacia de los diferentes programas que se ponen en marcha. Diferentes autores han advertido la importancia de la calidad percibida del servicio en este contexto. Este trabajo se plantea con el doble objetivo de remarcar el papel que una adecuada gestión de la calidad de la atención al drogodependiente posee, tanto como modulador de las actitudes y percepciones de los usuarios respecto al tratamiento, como fi losofía de trabajo en sí misma, propia de una organización sanitaria comprometida con la mejora continua. La realización de una entrevista personal a 670 usuarios de la Red Asistencial del Plan de Galicia sobre Drogas (PGD) y la posterior utilización del análisis de estructuras de covarianza ha permitido constatar la estrecha relación entre ambos elementos (calidad percibida del servicio y percepción del tratamiento), al mismo tiempo que se pone a disposición de profesionales e investigadores una nueva escala para su evaluación, breve, sencilla, de fácil aplicación y con propiedades psicométricas adecuadasDespite the considerable investment made in recent years in Spain in substance abuse care, treatment adherence remains one of the aspects that determine the effectiveness of programs. Several authors have noted the importance of perceived service quality in this context. This paper is presented with dual purpose of highlighting the role that management of the quality of care for drug addicts has, both as a modulator of users’ attitudes and perceptions about the treatment, and as a work philosophy, typical of an organization committed to continuous improvement. Conducting personal interviews with 670 users of drug abuse care services in Galicia and through the application of covariance structure analysis, the close relationship between two factors (perceived quality and attitude toward treatment) was revealed. This research also provides professionals and researchers with a new scale for service evaluation that is short, easy to use and with adequate psychometric propertiesS

Optimization of xylanase production by filamentous fungi in solid state fermentation and scale-up to horizontal tube bioreactor

Five microorganisms, namely Aspergillus niger CECT 2700, A. niger CECT 2915, A. niger CECT 2088, Aspergillus terreus CECT 2808, and Rhizopus stolonifer CECT 2344, were grown on corncob to produce cell wall polysaccharide-degrading enzymes, mainly xylanases, by solid-state fermentation (SSF). A. niger CECT 2700 produced the highest amount of xylanases of 504±7 U/g dry corncob (dcc) after 3 days of fermentation. The optimization of the culture broth (5.0 g/L NaNO3, 1.3 g/L (NH4)2SO4, 4.5 g/L KH2PO4, and 3 g/L yeast extract) and operational conditions (5 g of bed loading, using an initial substrate to moistening medium of 1:3.6 (w/v)) allowed increasing the predicted maximal xylanase activity up to 2,452.7 U/g dcc. However, different pretreatments of materials, including destarching, autoclaving, microwave, and alkaline treatments, were detrimental. Finally, the process was successfully established in a laboratory-scale horizontal tube biore- actor, achieving the highest xylanase activity (2,926 U/g dcc) at a flow rate of 0.2 L/min. The result showed an overall 5.8-fold increase in xylanase activity after optimization of culture media, operational conditions, and scale-up.We are grateful to the Spanish Ministry of Science and Innovation for the financial support of this work (project CTQ2011-28967), which has partial financial support from the FEDER funds of the European Union; to the Leonardo da Vinci Programme for founding the stay of Felisbela Oliveira in Vigo University; to MAEC-AECID (Spanish Government) for the financial support for Perez-Bibbins, B. and to Spanish Ministry of Education, Culture and Sports for Perez-Rodriguez's FPU; and to Solla E. and Mendez J. (CACTI-University of Vigo) for their excellent technical assistance in microscopy

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Expansion of Pathogen-Specific Mono- and Multifunctional Th1 and Th17 Cells in Multi-Focal Tuberculous Lymphadenitis

BACKGROUND: Th1 and Th17 responses are known to play an important role in immunity to pulmonary tuberculosis (PTB), although little is known about their role in extrapulmonary forms of tuberculosis (TB). METHODS: To identify the role of Th1, Th17, and Th22 cells in multi-focal TB lymphadenitis (TBL), we examined mycobacteria–specific immune responses in the whole blood of individuals with PTB (n = 20) and compared them with those with TBL (n = 25). RESULTS: Elevated frequencies of CD4(+) T cells expressing IFN- γ, TNF-α, and IL-2 were present in individuals with TBL compared with those with PTB at baseline and in response to ESAT-6 and CFP-10. Similarly, increased frequencies of CD4(+) T cells expressing IL-17A, IL-17F, and IFN-γ were also present in individuals with TBL at baseline and following ESAT-6 and CFP-10 stimulation although no significant difference in frequency of Th22 cells was observed. Finally, frequencies of Th1 (but not Th17) cells exhibited a significantly negative correlation with natural regulatory T cell frequencies at baseline. CONCLUSIONS: Multi-focal TB lymphadenitis is therefore characterized by elevated frequencies of Th1 and Th17 cells, indicating that Th1 and Th17 responses in TB disease are probably correlates of disease severity rather than of protective immunity