Improving tobacco cessation interventions in hospitals: Pre-post evaluation of an innovative health systems intervention in Catalonia (Spain).

This study measured changes in healthcare professionals' (HCPs) performance in tobacco cessation intervention before and 6 months after a health system intervention. The intervention involved exposure to online training for staff and the implementation of a structured organizational change-level practice model that included some strategies, comprising establishing tobacco cessation steering groups with champions in each hospital, developing tailored protocols and guidelines within each organization, conducting on-site workshops for clinicians, and creating posters and pocket materials summarizing the intervention. Pre-post evaluation in four hospitals in Barcelona province (Catalonia, Spain). We assessed the knowledge, attitudes, behaviors, and organizational factors (KABO) and the performance of each of the components of the 5As Model for Treating Tobacco Use according to a scale from 0 ("Never") to 10 ("Always") among HCPs. We performed Wilcoxon signed-rank tests for paired samples and assessed changes in performance by performing linear regression. A total of 255 HCPs completed the pre-post evaluation. All components of the 5As Model increased, with "Assist" and "Arrange a follow-up" showing the greatest improvement. Several KABO dimensions significantly increased, including individual skills (mean score: 3.3-5.7, P < .001), attitudes and beliefs (4.8-5.4, P < .001), individual commitment (5.9-6.6, P < .001), and perception of having positive organizational support (4.3-4.7, P < .001). An increase in each point in individual skills and support of the organization was associated with increased rates of 5As delivery, with the greatest associations found for "Assist" (0.60 and 0.17, respectively) and "Arrange a follow-up" (0.71 and 0.18, respectively). The intervention was successful in increasing HCPs individual skills, attitudes and beliefs, individual commitment, and perception of having positive organizational support and the performance of all components of the 5As. Future research should focus on strategies that promote organizational support, a dimension that is essential to increasing Assist and Arrange, which were less implemented at baseline.

This study aimed to assess the impact of a health system intervention on healthcare professionals' (HCPs) ability to help patients quit tobacco use. The intervention involved exposure to online training for staff and the implementation of a structured organizational change-level practice model that included some strategies, comprising establishing tobacco cessation steering groups with champions in each hospital, developing tailored protocols and guidelines within each organization, conducting on-site workshops for clinicians, and creating posters and pocket materials summarizing the intervention. The study took place in four hospitals in Barcelona province. We measured changes in HCPs' knowledge, attitudes, behaviors, and organizational factors related to tobacco cessation interventions. We also evaluated the performance of different components of the 5As Model, which guides tobacco cessation interventions (Ask, Advise, Assess, Assist, and Arrange a follow-up). The results showed significant improvements in all components of the 5As Model, with "Assist" and "Arrange a follow-up" showing the most substantial enhancement. Several key dimensions, including individual skills, attitudes, commitment, and perception of organizational support, also improved significantly. Furthermore, we found that increased individual skills and organizational support were associated with higher rates of delivering the 5As components, particularly "Assist" and "Arrange a follow-up." In conclusion, the health system intervention successfully enhanced HCPs' skills, attitudes, commitment, and perception of organizational support, leading to improved performance in helping patients quit tobacco use. Future research should explore strategies to further promote organizational support, especially for components like "Assist" and "Arrange a follow-up" that were less commonly implemented initially.

Accuracy of Modified Blue-Dye Testing in Predicting Dysphagia in Tracheotomized Critically Ill Patients.

(1) Background: Diagnosis of dysphagia in critically ill patients with a tracheostomy is important to avoid aspiration pneumonia. The objective of this study was to analyze the validity of the modified blue-dye test (MBDT) on the diagnosis of dysphagia in these patients; (2) Methods: Comparative diagnostic test accuracy study. Tracheostomized patients admitted to the Intensive Care Unit (ICU) were studied with two tests for dysphagia diagnosis: MBDT and fiberoptic endoscopic evaluation of swallowing (FEES) as the reference standard. Comparing the results of both methods, all diagnostic measures were calculated, including the area under the receiver-operating-characteristic curve (AUC); (3) Results: 41 patients, 30 males and 11 females, mean age 61 ± 13.9 years. The prevalence of dysphagia was 70.7% (29 patients) using FEES as the reference test. Using MBDT, 24 patients were diagnosed with dysphagia (80.7%). The sensitivity and specificity of the MBDT were 0.79 (CI95%: 0.60-0.92) and 0.91 (CI95%: 0.61-0.99), respectively. Positive and negative predictive values were 0.95 (CI95%: 0.77-0.99) and 0.64 (CI95%: 0.46-0.79). AUC was 0.85 (CI95%: 0.72-0.98); (4) Conclusions: MBDT should be considered for the diagnosis of dysphagia in critically ill tracheostomized patients. Caution should be taken when using it as a screening test, but its use could avoid the need for an invasive procedure.

Factors associated with changes in inpatients' smoking pattern during hospitalization and one month after discharge: A cohort study.

INTRODUCTION: Smokers are frequent users of healthcare services. Admissions to hospital can serve as a "teachable moment" for quitting smoking. Clinical guidelines recommend initiating smoking cessation services during hospitalization; however, in Southern European countries less than 5% of inpatients receive a brief intervention for smoking cessation. OBJECTIVES: The aims of this study were (i) to examine rates of smoking abstinence during and after hospitalization; (ii) to measure changes in smoking patterns among persons who continued smoking after discharge; and (iii) to identify predictors of abstinence during hospitalization and after discharge. METHODS: A cohort study of a representative sample of current adult smokers hospitalized in two Spanish and two Portuguese hospitals. We surveyed smokers during hospitalization and recontacted them one month after discharge. We used a 25-item ad hoc questionnaire regarding their smoking pattern, the smoking cessation intervention they have received during hospitalization, and hospital and sociodemographic characteristics. We performed a descriptive analysis using the chi-square test and a multivariate logistic regression to characterize the participant, hospital, and smoking cessation intervention (5As model) characteristics associated with smoking abstinence. RESULTS: Smoking patients from both countries presented high abstinence rates during hospitalization (Spain: 76.4%; Portugal: 70.2%); however, after discharge, their abstinence rates decreased to 55.3% and 46.8%, respectively. In Spain, smokers who tried to quit before hospital admission showed higher abstinence rates, and those who continued smoking reduced a mean of five cigarettes the number of cigarettes per day (p ≤ 0.001). In Portugal, abstinence rates were higher among women (p = 0.030), those not living with a smoker (p = 0.008), those admitted to medical-surgical wards (p = 0.035), who consumed their first cigarette within 60 min after waking (p = 0.006), and those who were trying to quit before hospitalization (p = 0.043). CONCLUSIONS: Half of the smokers admitted into the Spanish hospitals are abstinent one month after discharge or have reduced their cigarettes per day. Nevertheless, success rates could be increased by implementing evidence-based tobacco cessation programs at the organizational-level, including post-discharge active quitting smoking support. CLINICAL RELEVANCE: Three-quarters of the inpatients who smoke remain abstinent during hospitalization and over half achieve to maintain their abstinence or at least reduce their consumption one month after discharge, proving that admission to hospitals is an excellent teachable moment to quit smoking.

A white circular-spot pattern of iridian atrophy associated with Varicella-zoster virus and Toxoplasma gondii coinfection: a case report.

BACKGROUND: We report a case of white circular spots of iridian atrophy, which we will call "polka dots" pattern, as a rare ophthalmological finding associated with uveitis secondary to varicella-zoster virus and Toxoplasma gondii coinfection in a male patient in Bogotá, Colombia. CASE PRESENTATION: We present de case of a 53-year-old Colombian male patient with a diagnosis of anterior uveitis in his left eye due to varicella-zoster virus and Toxoplasma gondii coinfection documented by polymerase chain reaction analysis. He presented with multiple areas of superficial white circular spots of iridian atrophy in 360º, some with deeper atrophy where the stroma fibers were visualized and only a small punctate defect of transillumination was evident. This rare pattern of iridian atrophy has not been previously described in cases of uveitis in the literature. CONCLUSIONS: This is the first case reporting the findings of superficial "polka dots" pattern iridian atrophy in 360° secondary to anterior uveitis due to the coinfection of a virus and a parasite. The identification of similar clinical cases may lead to early initiation of systemic treatment in these patients.

DNA Topology and the Initiation of Virus DNA Packaging.

During progeny assembly, viruses selectively package virion genomes from a nucleic acid pool that includes host nucleic acids. For large dsDNA viruses, including tailed bacteriophages and herpesviruses, immature viral DNA is recognized and translocated into a preformed icosahedral shell, the prohead. Recognition involves specific interactions between the viral packaging enzyme, terminase, and viral DNA recognition sites. Generally, viral DNA is recognized by terminase's small subunit (TerS). The large terminase subunit (TerL) contains translocation ATPase and endonuclease domains. In phage lambda, TerS binds a sequence repeated three times in cosB, the recognition site. TerS binding to cosB positions TerL to cut the concatemeric DNA at the adjacent nicking site, cosN. TerL introduces staggered nicks in cosN, generating twelve bp cohesive ends. Terminase separates the cohesive ends and remains bound to the cosB-containing end, in a nucleoprotein structure called Complex I. Complex I docks on the prohead's portal vertex and translocation ensues. DNA topology plays a role in the TerSλ-cosBλ interaction. Here we show that a site, I2, located between cosN and cosB, is critically important for an early DNA packaging step. I2 contains a complex static bend. I2 mutations block DNA packaging. I2 mutant DNA is cut by terminase at cosN in vitro, but in vivo, no cos cleavage is detected, nor is there evidence for Complex I. Models for what packaging step might be blocked by I2 mutations are presented.

Manejo de desechos en: Hospital Escuela Universitario, San Felipe e Instituto Hondureño de Seguridad Social / Management of waste in the Hospital Escuela, San Felipe and Instituto Hondureño de Seguridad Social

El manejo de los residuos intrahospitalarios es un aspecto que forma parte de la gestión hospitalaria, cuya finalidad es preservar la bioseguridad de los empleados y pacientes en las diferentes áreas, así como la protección del medio ambiente. Objetivo: caracterizar el manejo intrahospitalario de los desechos generados en diferentes áreas de los hospitales: Escuela Universitario, San Felipe y el Instituto Hondureño de Seguridad Social (IHSS). Material y Métodos: estudio descriptivo sobre el manejo de desechos intrahospitalarios, realizado durante el mes de marzo del año 2014 en las instituciones mencionadas. Se evaluaron las áreas: quirófano, sala de oncología, sala de cirugía, servicio de rayos x y servicio de laboratorio. Se recopilaron los datos mediante la anotación de observaciones hechas por los empleados y los investigadores. Resultados: en las salas de cirugía general se observó inadecuada segregación de los desechos bioinfecciosos. En cada centro hospitalario existen áreas específicas destinadas y señalizadas para el almacenamiento de los desechos previo a su eliminación. En las áreas de rayos x, laboratorio y sala de oncología, se observó inadecuada segregación de los desechos a pesar de existir recipientes rotulados y afiches que brindan ejemplos de segregación adecuada; en el área de quirófano en los tres hospitales, existe una adecuada segregación de los desechos. El transporte interno de los desechos es realizado incorrectamente, no cuenta con un número adecuado de carros especiales para su transporte, de manera que los empleados encargados lo hacen manualmente, exponiéndose a enfermarse, a sí mismo, otros empleados, pacientes y público en general. Conclusión: el personal está segregando inadecuadamente los desechos, a pesar que cada hospital cuenta con un reglamento establecido para su manejo...(AU)

La formación del género: el impacto de la socialización a través de la educación / The formation of the gender: the impact of the socialization across the education

"Se hace un análisis de la formación del género, como una construcción social que define lo masculino y lo femenino, lo que deriva en los llamados roles de género. Tal dicotomía masculino-femenino marca estereotipos las más de las veces rígidos, condicionando roles, limitando las potencialidades humanas de las personas, pues la norma dicta que hay que ajustarse a comportamientos 'adecuados' al género respectivo. Se discute la dicotomía masculino-femenino y la polarización de los géneros, así como el modelo de la androginia, planteándose algunos cuestionamientos en torno a la misma. Se analiza la socialización como el proceso por el cual los individuos adquieren conductas y valores asociados a sus roles culturalmente asignados. Se discute y analiza la educación como una instancia de socialización, destacándose el sexismo que existe en la misma y en todos los niveles, desde el preescolar hasta el universitario. Se sostiene que el sexismo no se manifiesta únicamnete en los contenidos de los textos, sino también por medio del curriculum oculto, es decir, del trato diferencial (en detrimento de las mujeres) a mujeres y hombres mediante el lenguaje, los gestos, el tono de voz, la atención proporcionada a mujeres y hombres, así como la calidad de ésta. En este sentido, sigue existiendo discriminación en el sistema educativo, pero esta discriminación no incide tanto en los niveles de éxito escolar (generalmente las niñas obtienen mejores calificaciones que los niños), como en el nivel de formación de los géneros. De acuerdo con Subirats (1991), la transmisión del género femenino, en las aulas, pasa precisamente por la creación de una actitud dependiente en las mujeres, así como la transmisión del género masculino pasa por la creación de personalidades capaces de mayor autonomía. Tomando en cuenta las cifras proporcionadas por ANUIES (1992), respecto a la proporción de mujeres y hombres en la educación superior (43 y 57 por ciento respectivamente), el argumento que se plantea es que se debe trascender el dato cuantitativo y pasar al cualitativo. Para tal efecto, se requiere analizar los siguientes aspectos: a) eficiencia terminal en hombres y mujeres; b) distribución de porcentajes por sexo, y c) inserción en el mercado laboral. Se mencionan algunas experiencias en otros países, como Puerto Rico y España, que han puesto en práctica programas alternativos dentro de la educación formal, libres de sexismo. Se bosquejan cuatro elementos de una propuesta alternativa que procure eliminar el sexismo de la escuela. Finalmente, se concluye señalando que los cambios y las transformaciones en la polarización de los géneros deben orientarse al cambio en la estructura social androcéntrica, más que impulsar cambios a nivel individual"