Venous Thromboembolism Risk and Adherence to Pharmacological Thromboprophylaxis in Hospitalized Patients in Uruguay: First Nationwide Study.

INTRODUCTION: Venous thromboembolism (VTE) is a serious, frequent, and preventable medical complication in hospitalized patients. Although the efficacy of prophylaxis (pharmacological and/or mechanical) has been demonstrated, compliance with prophylaxis is poor at international and national levels. AIM: To determine the indication and use of pharmacological thromboprophylaxis in hospitalized patients in Uruguay. METHODS: An observational, descriptive, cross-sectional, multicentre study involving 31 nationwide healthcare facilities was conducted. Baseline characteristics associated with hospital admission, the percentage of the population with an indication for thromboprophylaxis, and the percentage of patients receiving pharmacological thromboprophylaxis were assessed. The VTE risk was determined using the Padua score for medical patients; the Caprini score for surgical patients; the Royal College of Obstetricians and Gynaecologists (RCOG) guidelines for pregnant-postpartum patients. RESULTS: 1925 patients were included, representing 26% of hospitalized patients in Uruguay. 71.9% of all patients were at risk of VTE. Of all patients at risk of VTE, 58.6% received pharmacological thromboprophylaxis. The reasons for not receiving thromboprophylaxis were prescribing omissions in 16.1% of cases, contraindication in 15.9% and 9.4% of patients were already anticoagulated for other reasons. Overall, just 68% of patients were "protected" against VTE. Recommendations of major thromboprophylaxis guidelines were followed in 70.1% of patients at risk. CONCLUSIONS: Despite the progress made in adherence to thromboprophylaxis indications, nonadherence remains a problem, affecting one in six patients at risk of VTE in Uruguay.

Propiedades psicométricas de la versión en español del instrumento Health-Promoting Lifestyle Profile-II en universitarios mexicanos / Psychometric properties of the Spanish version of the Health-Promoting Lifestyle Profile-II instrument in Mexican university students

Introducción: El instrumento Health-Promoting Lifestyle Profile II fue desarrollado en inglés y español para examinar perfiles de estilo de vida promotores de salud. Existen varios reportes que cuestionan la validez de su versión en español, se piensa que la traducción utilizada requiere modificaciones de acuerdo con el contexto cultural en el que desee utilizarse. Se propuso evaluar las propiedades psicométricas de las seis dimensiones que propone la versión original del instrumento en universitarios mexicanos. Método: Diseño ex post facto con 478 estudiantes de una universidad pública del noreste de México. Análisis con LISREL 8.1 y SPSS 21.0. Se realizó análisis psicométrico de las seis dimensiones con índices de homogeneidad factorial, índices de validez y confiabilidad en dos modelos.Resultados: Se presentan datos descriptivos y resultados de análisis factoriales con modelo de ajuste moderado y una distribución que explica el 49.93% de la varianza. La versión de 52 ítems presentó valores bajos de validez convergente y discriminante, con la eliminación de seis ítems estos valores se normalizaron para cinco de las seis dimensiones. En contraste, la fiabilidad de las puntuaciones fue buena. Conclusiones: En esta muestra del contexto mexicano, se confirman algunas problemáticas de la solución factorial de la versión en español con un modelo que presenta ajuste moderado ante la estructura de seis dimensiones. Sin embargo, la estructura predicha muestra valores de fiabilidad acepTables. A juicio de expertos, la estructura de seis dimensiones parece ser la más adecuada para utilizarse en universitarios mexicanos. (AU)

Introduction: The Health-Promoting Lifestyle Profile-II instrument was developed in English and in Spanish to examine health-promoting lifestyle profiles. Several reports question the validity of its Spanish version; it is thought that the translation employed requires changes according to the cultural context in which it is intended to be used. The proposal was to evaluate the psychometric properties of the six dimensions proposed by the original version of the instrument in Mexican university students. Method: Ex post facto design with 478 students from a public university in northeastern Mexico. The analysis was performed in LISREL 8.1 and in SPSS 21.0. A psychometric analysis was performed of the six dimensions with factor homogeneity, validity, and reliability indices in two models. Results: Descriptive data and results of the factor analysis are presented with a moderate fit model and a distribution that explains 49.93% of the variance. The 52-item version presented low convergent and discriminant validity values; by removing six items, these values reached normalization for five of the six dimensions. In opposition to that, reliability of the scores was good. Conclusions: In this sample from the Mexican context, some problems of the Spanish version's factor solution are confirmed with a model that presents moderate fit given the six-dimension structure. However, the predicted structure shows accepTable reliability values. In the experts' opinion, the six-dimension structure seems to be the most adequate to be used in Mexican university students. (AU)

Elaboração e análise de indicadores sociais para o apoio à tomada de decisão no processo de despoluição da Baía de Guanabara / Elaboration and analysis of social indicators as an instrument to support decision making in the process of depollution of the Guanabara Bay

Resumo Apesar dos esforços de despoluição desde os anos 1990, não houve percepção, por parte da opinião pública, de que houve evolução do deteriorado quadro social da região da bacia da Baía de Guanabara (RJ). A importância dos indicadores sociais emerge em um momento em que se faz necessário prestar contas à população quanto aos investimentos e resultados obtidos, direcionar as ações às questões sociais e locais em situação de maior urgência e acompanhar os resultados para a identificação de ajustes nas ações para o alcance de melhores resultados. A atual agenda de discussão das questões sociais do entorno da baía configurou a base para a elaboração de um sistema de indicadores sociais. Três bacias hidrográficas em processo de despoluição também foram estudadas, com foco em suas abordagens quanto às questões sociais. Um modelo teórico de indicadores foi elaborado e testado em um recorte da bacia da Baía de Guanabara, por intermédio da utilização de dados públicos disponíveis. O modelo se mostrou ferramenta útil para uma abordagem holística da bacia ao informar sobre o melhor direcionamento de ações de despoluição para resultados mais efetivos em ambas as questões, sociais e ambientais.

Abstract Despite the efforts in the depollution since the 1990s, evolution of the damaged social scenario in the region of the watershed of the Guanabara Bay is not perceived by the public opinion. The importance of social indicators emerges in a moment in which rendering account to the population regarding investiments and results obtained, orienting actions for emergency social and local issues and monitoring results for identification of adjustments to the actions for the achievement of better results is necessary. The current agenda for debating social issues of the region of the bay represented the basis for the creation of a system of social indicators. Three watersheds in depollution process were also studied, focusing on their approaches regarding social issues. A theoretical model of indicators was developed and tested in a draft of the Guanabara Bay watershed, using the public data available. The model proved to be a useful tool for an holistic approach of the bay by providing information on the better orientation of depollution actions for more effective results in both social and environmental issues.

Moderate hyperprolactinemia is associated with survival in patients with acute graft-versus-host disease after allogeneic stem cell transplantation.

Fasting serum prolactin (PRL) levels in response to metoclopramide (MCP) and lymphocyte cytokine profiles was studied in patients given allografts and their donors. Thirty normoprolactinemic volunteers (12-59 years) were studied: group 1, 10 healthy men; group 2, 8 males and 2 females with various hematologic diseases; and group 3, 3 males and 7 females HLA-identical sibling donors: PRL and cytokines were measured. Four surviving recipients developed acute graft-versus-host disease (GVHD) (+), and six did not. Before transplant Fasting PRL concentrations were higher in 'future' GVHD(+) recipients than in their donors (P < 0.001). The opposite was seen in response to MCP (P = 0.01). Donors had a predominant T-helper type 1 (Th1) cytokine profile compared with recipients (P ≤ 0.02), and GVHD(+) recipients had a greater tumor necrosis factor (TNF) value than GVHD(-) (P = 0.05). After transplant On days +30 and +100, a mild sustained rise in fasting PRL levels occurred only in GVHD(+) recipients (P ≤ 0.05) simultaneously with a transient rise in Th1 cytokines. GVHD(-) recipients had no changes. Donors with a Th1 cytokine profile might be more prone to induce GVHD in their recipients, and a mild sustained rise in PRL concentrations after transplantation in recipients GVHD(+) might participate in the amelioration of the severity of GVHD.

Mutation in mce operons attenuates Mycobacterium tuberculosis virulence.

On the Mycobacterium tuberculosis genome there are four mce operons, all of which are similar in sequence and organization, and code for putatively exported proteins. To investigate whether Mce proteins are essential for virulence, we generated knock-out mutants in mce1, mce2 and mce3 operons of M. tuberculosis and evaluated their ability to multiply in a mammalian host. The allelic replacement was confirmed in each mutant strain by Southern blotting. RT-PCR experiments demonstrated the lack of in vitro expression of mutated genes in Deltamce1 and Deltamce2 mutants. On the other hand, no expression of mce3 was detected in either the wild-type or mutant strains. Similar doubling time and growth characteristics in in vitro culture were observed for mutants and parental strains. The intratracheal route was used to infect BALB/c mice with the Deltamce3, Deltamce2 and Deltamce1 mutants. Ten weeks after infection, all mice infected with the Deltamce mutants survived, while those infected with the wild-type strain died. This long survival correlated with very low counts of colony-forming units (CFU) in the lungs. Deltamce1-infected mice developed very few and small granulomas, while animals infected with Deltamce3 or Deltamce2 mutants showed delayed granuloma formation. Mice infected with Deltamce1 did not develop pneumonia, while animals infected with Deltamce3 and Deltamce2 mutants showed small pneumonic patches. In spleens, bacterial counts of mutant strains were less reduced than in lungs, compared with those of wild-type. In contrast, no such attenuation was observed when the intraperitoneal route was used for infection. Moreover, Deltamce1 mutants appear to be more virulent in lungs after intraperitoneal inoculation. In conclusion, mce operons seem to affect the virulence of M. tuberculosis in mice, depending on the route of infection. Hypotheses are discussed to explain this last issue. Thus, mutants in these genes seem to be good candidates for vaccine testing.