Retrospective registry of patients with locally advanced/metastatic HR+/HER2- breast cancer treated in clinical practice in Andalusia.

BACKGROUND: Limited data are available regarding the real-world effectiveness and safety of Cyclin Dependent Kinase 4/6 inhibitor (CDK4/6i) (palbociclib/ribociclib) just as a first-line treatment for patients with hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR + /HER2‒) metastatic breast cancer (MBC). OBJECTIVE: To assess whether clinical or demographic characteristics limit access to first-line CDK4/6i treatment in clinical practice in the Autonomous Community of Andalusia (Spain) between November 2017 and April 2020. In addition, effectiveness will be described in an exploratory analysis. METHODS: Physicians from 12 centers participated in selecting demographic and clinical characteristics, treatment, and outcome data from women with HR + /HER2- MBC treated with or without CDK4/6i in addition to hormonal in the first-line setting, in a 3:1 proportion. Kaplan-Meier analysis estimated progression-free rates (PFRs) and survival rates (SRs). RESULTS: A total of 212 patients were included, of whom 175 (82.5%) were in the CDK4/6i treatment group and 37 (17.5%) were in the non-CDK4/6i treatment group (control group). Patients in the CDK 4/6i treatment group were younger (p = 0.0011), the biopsies of the metastatic site at the moment of the relapse were most commonly performed (p = 0.0454), and had multiple metastatic sites (p = 0.0025). The clinical benefit rate (CBR) was 82.3% in the CDK4/6i group and 67.8% in the control group. Median time to a progression event or death (PFS) was 20.4 months (95%CI 15.6-28) in the CDK4/6i group and 12.1 months (95%CI 7.9-not reached) in the control group. CONCLUSIONS: Younger patients, biopsies of metastatic disease and with multiple metastatic sites were more frequently treated with CDK4/6i in our daily clinical practice.

La teoría de las transiciones como paradigma de apoyo al automanejo en personas con condiciones crónicas / Transitions theory as a paradigm for supporting self-management in people with chronic conditions / A teoria das transições como paradigma para apoiar a autogestão em pessoas com condições crónicas

Resumen Introducción: La experiencia de vivir con una enfermedad crónica no es una tarea sencilla, se requiere de herramientas que permitan aumentar el grado de conciencia para enfrentar las necesidades y superar desafíos sobre el estado de salud y enfermedad. En los últimos años, se ha instaurado el apoyo al automanejo, con la finalidad de potenciar las habilidades en personas con este tipo de afecciones. Resulta trascendental considerar como desde enfermería se puede contribuir al logro de aquello. El objetivo del presente ensayo es reflexionar acerca de la teoría de las transiciones de Meléis como paradigma de apoyo al automanejo en personas con condiciones crónicas. Desarrollo: La teoría de las transiciones de Meléis establece que las personas están en constante cambio, tal como ocurre en el proceso de transición de salud-enfermedad. Recibir el diagnóstico de una enfermedad crónica, conlleva una serie de procesos complejos para la persona, debido a la multiplicidad de variables que ello implica. La teoría de Meléis entrega lineamientos para orientar a la persona profesional de enfermería sobre elementos claves e interrelacionados, como la concepción previa de la naturaleza de la transición y sus condiciones, lo que servirá para la planificación de modalidades de intervención congruentes con las experiencias de la persona y su evaluación en el transcurso del proceso de salud y enfermedad. Conclusión: El paradigma ofrecido por Meléis puede ser considerado un enfoque clave para emprender el proceso de cuidado de enfermería tendiente a apoyar a las personas con enfermedad crónica en el logro del automanejo.

Abstract Introduction: The experience of living with a chronic disease is not a simple task, since it requires tools that allow increasing the degree of awareness to face the needs and overcome challenges about the state of health and disease. In recent years, support for self-management has been established, with the aim of enhancing the skills of people with this type of condition. It is important to consider how the nursing discipline can contribute to achieve this. The aim of this paper is to reflect on Meléis' theory of transitions as a paradigm to support self-management in people with chronic conditions. Development: Meléis' theory of transitions establishes that people are in constant change, as occurs in the health-illness transition process. Receiving the diagnosis of a chronic disease involves a series of complex processes for the person, due to the multiplicity of variables involved. Meléis' theory provides guidelines to orient the nursing professional on key and interrelated elements, such as the previous conception of the nature of the transition and its conditions, which will serve for the planning of intervention modalities congruent with the person's experiences and their evaluation in the course of the health and disease process. Conclusion: The paradigm offered by Meléis can be considered a key approach to undertake the nursing care process aimed at supporting people with chronic illness in achieving self-management.

Resumo Introdução: A experiênca de viver com uma doença crônica não é uma tarefa simple, pois requer ferramentas que permitam aumentar o nível de consciência para enfrentar as necessidades e superar desafios relativos ao estado de saúde e doença. Nos últimos anos, foi estabelecido o apoio à autogestão, com o objetivo de melhorar as habilidades das pessoas com este tipo de condições. É transcendental considerar como a disciplina de Enfermagem pode contribuir para isso. O objetivo deste ensaio é refletir sobre a teoria das transições de Meleis como paradigma de apoio à autogestão em pessoas com condições crônicas. Desenvolvimento: A teoria das transições de Meléis estabelece que as pessoas estão em constante mudança, como acontece no processo de transição saúde-doença. Receber o diagnóstico de uma doença crónica implica uma série de processos complexos para a pessoa, devido à multiplicidade de variáveis envolvidas. A teoria de Meléis fornece directrizes para orientar o profissional de enfermagem sobre elementos-chave e inter-relacionados, como a conceção prévia da natureza da transição e das suas condições, que servirão para o planeamento de modalidades de intervenção congruentes com as experiências da pessoa e a sua avaliação no decurso do processo saúde-doença. Conclusão: O paradigma oferecido por Meleis pode ser considerado uma abordagem chave para empreender o processo de cuidado de enfermagem que visa apoiar as pessoas com doenças crônicas no alcance do autogerenciamento.

How effective are mobile apps in managing people with type 2 diabetes mellitus? A systematic literature review protocol.

INTRODUCTION: The rise of new technologies in the field of health is yielding promising results. In certain chronic conditions such as type 2 diabetes mellitus, which ranks among the top five causes of global mortality, it could be useful in supporting patient management. MATERIALS AND METHODS: A systematic review will be conducted on scientific publications from the last 5 years (January 2019 to October 2023) to describe the effect of mobile app usage on glycated hemoglobin for the management of adult patients with type 2 diabetes mellitus who participated in randomized controlled clinical trials. The search will be carried out in the databases of MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCOhost), CENTRAL, WoS, Scopus, Epistemonikos, and LILACS. The search strategy will be constructed using both controlled and natural language. Additionally, the Cochrane filter will be applied to identify randomized controlled trials. The review will include scientific articles reporting studies that present results from randomized controlled trials, with texts in Spanish, English, or French, utilizing mobile applications for the management of adult individuals (over 18 years) with type 2 diabetes mellitus, and whose outcomes report the effects on glycated hemoglobin. The Cochrane Risk of Bias Tool will be used to assess the quality of the studies, and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology will be implemented to evaluate the certainty of the evidence. RESULTS: The analysis will be conducted by observing the value of the glycated hemoglobin levels of the participants. Given that this data is a quantitative and continuous value, it facilitates the identification of the effects of the mobile applications used for the management of type 2 diabetes mellitus (T2DM) in adults. Furthermore, if sufficient data are available, a meta-analysis will be conducted using IBM-SPSS. The effect of the intervention will be estimated by the mean difference. All point estimates will be accompanied by 95% confidence intervals. A random effects model will be used. The heterogeneity of the results will be assessed using Cochrane's Q and I2 statistics. DISCUSSION: Considering that the quality of content and functionality of certain applications in the healthcare field is highly variable, it is necessary to evaluate the scientific evidence reported on the effect of the use of this type of technology in people with T2DM.

Update on the management of elderly patients with colorectal cancer.

Colorectal cancer (CRC) is one of the most common tumours worldwide, and 70% of CRC patients are over 65 years of age. However, the scientific evidence available for these patients is poor, as they are underrepresented in clinical trials. Therefore, a group of experts from the Oncogeriatrics Section of the Spanish Society of Medical Oncology (SEOM), the Spanish Cooperative Group for the Treatment of Digestive Tumours, (TTD) and the Multidisciplinary Spanish Group of Digestive Cancer (GEMCAD) have reviewed the scientific evidence available in older patients with CRC. This group of experts recommends a multidisciplinary approach and geriatric assessment (GA) before making a therapeutic decision because GA predicts the risk of toxicity and survival and helps to individualize treatment. In addition, elderly patients with localized CRC should undergo standard cancer resection, preferably laparoscopically. The indication for adjuvant chemotherapy (CT) should be considered based on the potential benefit, the risk of recurrence, the life expectancy and patient comorbidities. When the disease is metastatic, the possibility of radical treatment with surgery, radiofrequency (RF) or stereotactic body radiation therapy (SBRT) should be considered. The efficacy of palliative CT is similar to that seen in younger patients, but elderly patients are at increased risk of toxicity. Clinical trials should be conducted with the elderly population and include GAs and specific treatment plans.

The differential sensitivity of the hypothalamic-hypophysial-ovarian axis to 5-hydroxytryptophan alters the secretion of estradiol.

Serotonin [5-hydroxytryptamine (5-HT)] modulates ovarian function. The precursor of 5-HT, 5-hydroxytryptophan (5-HTP), has been used to treat depression. However, the effects of 5-HTP on ovarian and reproductive physiology remain unknown. In this research, we analysed the impact of 5-HTP on the monoaminergic system and its interactions with the reproductive axis and ovarian estradiol secretion when administered by distinct routes. Female rats 30 days of age were injected with 5-HTP i.p. (100 mg/kg), into the ovarian bursa (1.5 µg/40 µL) or into the median raphe nucleus (20 µg/2.5 µL) and were killed 60 or 120 min after injection. As controls, we used rats of the same age injected with vehicle (0.9% NaCl). Monoamine, gonadotrophin and steroid ovarian hormone concentrations were measured. The injection of 5-HTP either i.p. or directly into the ovarian bursa increased the concentrations of 5-HT and the metabolite 5-hydroxyindole-3-acetic acid in the ovary. For both routes of administration, the serum concentration of estradiol increased. After i.p. injection of 5-HTP, the concentrations of luteinizing hormone were decreased and follicle-stimulating hormone increased after 120 min. Micro-injection of 5-HTP into the median raphe nucleus increased the concentrations of 5-HT in the anterior hypothalamus and dopamine in the medial hypothalamus after 120 min. Our results suggest that the administration of 5-HTP either i.p. or directly into the ovarian bursa enhances ovarian estradiol secretion.

El Modelo Transteórico y la Teoría del Automanejo Individual y Familiar como paradigma para comprender el cambio de comportamiento y el automanejo en personas con enfermedades crónicas / The Transtheoretical Model and the Individual and Family Self-Management Theory as a paradigm to understand behavior change and self-management in people with chronic diseases

INTRODUCCIÓN: El automanejo y el cambio de conducta siguen siendo retos para quienes padecen enfermedades crónicas. Para su abordaje existen modelos y estrategias que orientan a alcanzar mejores resultados en salud. OBJETIVO: Analizar la Teoría del Automanejo Individual y Familiar junto con el Modelo Transteórico como paradigmas para comprender los desafíos e identificar factores involucrados en el cambio conductual y el automanejo de personas con enfermedades crónicas. DESARROLLO: El Modelo Transteórico comprende cinco etapas que explican el proceso cíclico de cambio. Por otro lado, la Teoría del Automanejo Individual y Familiar se distingue por tres dimensiones: contexto, proceso y resultados. Al interrelacionar ambos modelos, se observa que el contexto dado por la Teoría del Automanejo Individual y Familiar puede determinar la etapa del cambio. Los procesos, como la autoeficacia, la facilitación social o la autorregulación, son implementados de formas distintas según la etapa del cambio en la que la persona se encuentre. CONCLUSIÓN: La integración de ambos modelos potencia la comprensión acerca del cambio de conducta en personas con enfermedades crónicas. Esta articulación favorece enfoques más personalizados, lo que permitiría que los profesionales de enfermería reconocer la etapa de cambio en la que se encuentra la persona y, con base en la Teoría del Automanejo, atender las necesidades del individuo y familia, propiciando un cuidado integral.

INTRODUCTION: Self-management and behavioral change continue to be challenges for those suffering from chronic diseases. There are models and strategies for approaching them that aim to achieve better health outcomes. OBJECTIVE: Analyze the Individual and Family Self-Management Theory together with the Transtheoretical Model as paradigms to understand the challenges and identify factors involved in behavioral change and self-management of people with chronic diseases. DEVELOPMENT: The Transtheoretical Model comprises five stages that explain the cyclical process of change. On the other hand, the Individual and Family Self-Management Theory is distinguished by three dimensions: context, process and outcomes. By interrelating both models, it is observed that the context given by the Individual and Family Self-Management Theory can determine the stage of change. Processes, such as self-efficacy, social facilitation or self-regulation, are implemented in different ways depending on the stage of change the person is in. Finally, outcomes, such as self-management, emerge from the effective joint application of both models. CONCLUSION: The integration of both models enhances the understanding of behavior change in people with chronic diseases. This articulation favors more personalized approaches, which would allow nursing professionals to recognize the stage of change in which the person is and, based on the Self-Management Theory, address the needs of the individual and family, promoting comprehensive care.

MELD 3.0 adequately predicts mortality and renal replacement therapy requirements in patients with alcohol-associated hepatitis.

Background & Aims: Model for End-Stage Liver Disease (MELD) score better predicts mortality in alcohol-associated hepatitis (AH) but could underestimate severity in women and malnourished patients. Using a global cohort, we assessed the ability of the MELD 3.0 score to predict short-term mortality in AH. Methods: This was a retrospective cohort study of patients admitted to hospital with AH from 2009 to 2019. The main outcome was all-cause 30-day mortality. We compared the AUC using DeLong's method and also performed a time-dependent AUC with competing risks analysis. Results: A total of 2,124 patients were included from 28 centres from 10 countries on three continents (median age 47.2 ± 11.2 years, 29.9% women, 71.3% with underlying cirrhosis). The median MELD 3.0 score at admission was 25 (20-33), with an estimated survival of 73.7% at 30 days. The MELD 3.0 score had a better performance in predicting 30-day mortality (AUC:0.761, 95%CI:0.732-0.791) compared with MELD sodium (MELD-Na; AUC: 0.744, 95% CI: 0.713-0.775; p = 0.042) and Maddrey's discriminant function (mDF) (AUC: 0.724, 95% CI: 0.691-0.757; p = 0.013). However, MELD 3.0 did not perform better than traditional MELD (AUC: 0.753, 95% CI: 0.723-0.783; p = 0.300) and Age-Bilirubin-International Normalised Ratio-Creatinine (ABIC) (AUC:0.757, 95% CI: 0.727-0.788; p = 0.765). These results were consistent in competing-risk analysis, where MELD 3.0 (AUC: 0.757, 95% CI: 0.724-0.790) predicted better 30-day mortality compared with MELD-Na (AUC: 0.739, 95% CI: 0.708-0.770; p = 0.028) and mDF (AUC:0.717, 95% CI: 0.687-0.748; p = 0.042). The MELD 3.0 score was significantly better in predicting renal replacement therapy requirements during admission compared with the other scores (AUC: 0.844, 95% CI: 0.805-0.883). Conclusions: MELD 3.0 demonstrated better performance compared with MELD-Na and mDF in predicting 30-day and 90-day mortality, and was the best predictor of renal replacement therapy requirements during admission for AH. However, further prospective studies are needed to validate its extensive use in AH. Impact and implications: Severe AH has high short-term mortality. The establishment of treatments and liver transplantation depends on mortality prediction. We evaluated the performance of the new MELD 3.0 score to predict short-term mortality in AH in a large global cohort. MELD 3.0 performed better in predicting 30- and 90-day mortality compared with MELD-Na and mDF, but was similar to MELD and ABIC scores. MELD 3.0 was the best predictor of renal replacement therapy requirements. Thus, further prospective studies are needed to support the wide use of MELD 3.0 in AH.

Aislamiento enzimático de protoplastos a partir del mesófilo de vitroplantas de Gynerium sagittatum Aubl. Beauv. cv. "Criolla"

Gynerium sagittatum es una gramínea ampliamente utilizada en la costa Caribe colombiana como fuente de fibra natural para la elaboración de artesanías, particularmente por la comunidad Zenú. En la presente investigación se evaluó el efecto de diferentes concentraciones de enzimas: celulasa y macerozima a diferentes tiempos de incubación y sus interacciones en el aislamiento de protoplastos. Los protoplastos se obtuvieron del mesófilo foliar de vitroplantas de G. sagittatum expuesto a combinaciones enzimáticas de celulasa (1.5 y 2.0%), con macerozima (0.3, 0.6 y 0.9%), durante 3, 6 y 9 horas de incubación, para un total de 18 tratamientos con 5 réplicas cada uno. Los mayores números de protoplastos aislados correspondieron a T18 (2.0% celulasa, 0.9% macerozima), T12 (2.0% de celulasa, 0.3% macerozima), T3 (1.5% de celulasa, 0.3% de macerozima) y T6 (1.5% de celulasa, 0.6% de macerozima) por 9 horas de incubación cada uno, con valores de 88.625, 83.000, 75.000 y 53.375 protoplastos/mL respectivamente. El tiempo de incubación fue significativo en el aislamiento de los protoplastos (p<0.05). Las predicciones entre factores mostraron que una interacción de 2.0% de celulasa y 0.9% de macerozima permite obtener 44.302 protoplastos/mL, mientras que las interaciciones tiempo de incubación-celulasa y tiempo de incubación-macerozima mostraron que es posible obtener 72.073 y 71.212 protoplastos/mL con 2.0% de celulasa y 0.9% macerozima por 9 horas de incubación cada una respectivamente. Los resultados indican que la aplicación de estas enzimas permite obtener cantidades considerables de protoplastos de G. sagittatum a partir de explantes cultivados in vitro.

Gynerium sagittatum is a graminaceous plant widely used in the Caribbean coast of Colombia as a natural fiber source for the elaboration of handicrafts, particularly by the Zenú community. In the present investigation, the effect of different concentrations of cellulase and macerozyme enzymes at different incubation times and their interaction in the isolation of protoplasts was evaluated. Protoplasts were obtained from leaf mesophyll of G. sagittatum vitroplants exposed to enzymatic combinations of cellulase (1.5 and 2.0%), with macerozyme (0.3, 0.6 and 0.9%), for 3, 6 and 9 hours of incubation, for a total of 18 treatments with 5 replicates each. The highest numbers of isolated protoplasts corresponded to T18 (2.0% cellulase, 0.9% macerozyme), T12 (2.0% cellulase, 0.3% macerozyme), T3 (1.5% cellulase, 0.3% macerozyme) and T6 (1.5% cellulase, 0.6% macerozyme); at 9 hours incubation. The protoplast number for these treatments were: 88.625, 83.000, 75.000 and 53.375 protoplasts/mL respectively. Incubation time was significant in the isolation of protoplasts (p<0.05). The predictions between the factors showed that with an interaction of 2.0% cellulase and 0.9% macerozyme it is possible to obtain 44.302 protoplasts/mL, likewise, the incubation time-cellulase and incubation time-macerozyme interactions showed that it is possible to obtain 72.073 and 71.212 protoplasts/mL with 2.0% cellulase and 0.9% macerozyme for 9 hours of incubation respectively. The results indicate that the use of these enzymes and time, allows the isolation of of protoplasts from G. sagittatum in vitro plants.

Current and novel approaches in the pharmacological treatment of hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) is one of the most lethal malignant tumours worldwide. The mortality-to-incidence ratio is up to 91.6% in many countries, representing the third leading cause of cancer-related deaths. Systemic drugs, including the multikinase inhibitors sorafenib and lenvatinib, are first-line drugs used in HCC treatment. Unfortunately, these therapies are ineffective in most cases due to late diagnosis and the development of tumour resistance. Thus, novel pharmacological alternatives are urgently needed. For instance, immune checkpoint inhibitors have provided new approaches targeting cells of the immune system. Furthermore, monoclonal antibodies against programmed cell death-1 have shown benefits in HCC patients. In addition, drug combinations, including first-line treatment and immunotherapy, as well as drug repurposing, are promising novel therapeutic alternatives. Here, we review the current and novel pharmacological approaches to fight HCC. Preclinical studies, as well as approved and ongoing clinical trials for liver cancer treatment, are discussed. The pharmacological opportunities analysed here should lead to significant improvement in HCC therapy.

Efecto del compuesto N-2,6-dicloro-aralquil-2-Aminoindano en la conducta estereotipada de ratas. Acción dopaminérgica selectiva central sobre los ganglios basales más que en las estructuras límbicas / Effect of the compound N-2,6-dichloro-aralkyl-2-aminoindane on the stereotyped behavior of rats. Selective action on the central dopaminergic system in the basal ganglia over limbic structures

Resumen La dopamina 1, está implicada en trastornos neurodegenerativos que afectan al sistema nervioso central (SNC) tales como la enfermedad de Parkinson, entre otros. Aunque no se dispone aún de ningún fármaco capaz de prevenir, detener o curar la progresión de estas enfermedades, son numerosos los compuestos que han sido diseñados, sintetizados y evaluados farmacológicamente, que han aportado las generalizaciones farmacofóricas del receptor dopaminérgico, necesarias para la búsqueda de un fármaco capaz de mejorar o curar estas patologías. Los derivados 2-aminoindano-N-aralquílicos han mostrado tener actividad selectiva en el sistema dopaminérgico central, de modo tal que los compuestos clorhidratos de N-[(2,4-diclorofenil)-1-metil- etil]-2-aminoindano 2 y N-[(3,4-diclorofenil)-1-metil-etil]-2-aminoindano 3 demostraron tener actividad agonística mediada por mecanismos dopaminérgicos centrales. Con el propósito de contribuir en la búsqueda de nuevos fármacos que permitan restablecer la homeostasis de la transmisión dopaminérgica en la enfermedad de Parkinson, el compuesto N-2,6-dicloro-aralquil-2-aminoindano 4 fue diseñado a través de estrategias de la química medicinal, que contienen las aproximaciones farmacofóricas de los profármacos. La evaluación farmacológica del compuesto 4, en la conducta estereotipada en ratas macho de la cepa Sprague Dawley, demostró tener actividad agonística a través de la activación de los mecanismos dopaminérgicos centrales y mostró mayor selectividad en las respuestas de conductas estereotipadas propias de los ganglios basales sobre las respuestas conductuales propias de las estructuras límbicas.

Abstract Dopamine 1 is involved in neurodegenerative disorders affecting the central nervous system (CNS), such as Parkinson's disease. Despite the absence of some available drugs capable of preventing, stopping or curing the progression of such diseases, there are numerous compounds designed, synthesized, and pharmacologically tested which give rise to pharmacophoric generalizations about the dopaminergic receptor required for the search of a drug able to improve or cure those pathologies. N-aralkyl-2-aminoindane derivatives have shown selective activity in the central dopaminergic system. Both the N-[(2,4-dichlorophenyl)-1-methyl-ethyl]-2-aminoindane hydrochloride 2 and N-[(3,4-dichlorophenyl)-1-methyl-ethyl]-2-aminoindane hydrochloride 3 showed an agonistic activity mediated by central dopaminergic mechanisms. To contribute to the search of new drugs able to re-establish homeostasis in the dopaminergic transmission in Parkinson's disease, the compound N-2,6- dichloro-aralkyl-2-aminoindane 4 was designed through medicinal chemistry strategies that contain pharmacophoric approximations of prodrugs. The pharmacological evaluation of compound 4 in the stereotyped behavior of male Sprague Dawley rats showed agonistic activity through the activation of central dopaminergic mechanisms and a higher selectivity in the responses of stereo- typed behavior characteristic of the basal ganglia over the typical responses from limbic structures.

Transitando desde las fases de cambio de comportamiento hacia el automanejo de personas con condiciones crónicas / Transiting from phases of behavior change to the self-management of people with chronic conditions

Introducción: A nivel mundial existe una constante preocupación debido a que cada día proliferan más personas con enfermedades crónicas. Para su abordaje, se han propuesto una serie de medidas que enfatizan el rol preponderante que tiene la persona en el logro del automanejo de su salud y enfermedad. El objetivo de este trabajo fue reflexionar acerca de elementos que favorecen el avance desde las etapas de cambio hacia el automanejo de personas con condiciones crónicas. Desarrollo: Para lograr el automanejo, resulta trascendental considerar en la atención a la persona con enfermedades crónicas, entre otros aspectos, el proceso de cambio de comportamiento y el grado de autoeficacia percibida. Asimismo, el personal profesional de la atención primaria de salud y enfermería requieren desarrollar habilidades específicas y de alta idoneidad para una atención integral, oportuna y continuada. Todos estos aspectos se interrelacionan para converger juntos en un plan de atención de salud colaborativo, consensuado y centrado en la persona. Conclusión: Para favorecer el avance del automanejo existen elementos tanto de la persona con enfermedad crónica como de la profesional que se articulan. Entre estas personas se dan relaciones de bidireccionalidad, que han de ser vistas como un proceso funcional continuo y no como elementos discretos en el cuidado en salud.

Introdução: Em todo o mundo existe uma preocupação constante, pois a cada dia proliferam mais pessoas com doenças crônicas. Para sua abordagem, foi proposta uma série de medidas que enfatizam o papel preponderante que a pessoa tem na realização do autogerenciamento de sua saúde e doença. O objetivo deste trabalho foi refletir sobre elementos que favorecem a passagem das etapas de mudança para a autogestão de pessoas com condições crônicas. Desenvolvimento: A fim de alcançar a autogestão, é crucial considerar, entre outros aspectos, o processo de mudança de comportamento e o grau de auto-eficácia percebido no cuidado da pessoa cronicamente doente. Do mesmo modo, os profissionais de cuidados de saúde primários e de enfermagem precisam desenvolver competências específicas e altamente qualificadas para cuidados abrangentes, atempados e contínuos. Todos estes aspectos se inter-relacionam para convergir em um plano de cuidados de saúde colaborativo, consensual e centrado na pessoa. Conclusão: Para favorecer o avanço da autogestão, há elementos tanto da pessoa quanto do profissional que se articulam, existindo relações bidirecionais entre eles, que devem ser vistos como um processo funcional contínuo e não como elementos discretos no cuidado à saúde.

Introduction: There is worldwide constant concern because of the increasing number of people with chronic diseases every day. When it comes to approaching this situation, a series of measures have been proposed to emphasize the preponderant role that the people have has in achieving the self-management of their health and disease. The objective of this work was to reflect on the elements that favor progress from the stages of change towards self-management in people with chronic conditions. Development: To achieve self-management, it is essential to consider - among other aspects - the process of behavioral change and the degree of perceived self-efficacy in the care of chronically ill people. Likewise, primary healthcare and nursing professionals need to develop specific and highly suitable skills for comprehensive, timely, and continuous care. All these aspects interrelate to converge together in a collaborative, consensual, and person-centered healthcare plan. Conclusion: To favor the advancement of self-management, there are elements that both the person and the professional need to articulate, for instance, the existing bidirectional relationships between them must be seen as a continuous functional process and not as discrete elements in healthcare.

Intervención dirigida al equipo de salud para fortalecer la implementación del Modelo de Cuidados Crónicos / Training of health care workers on the Chronic Care Model

BACKGROUND: The Chronic Care Model promotes the link between informed, activated patients with proactive and prepared health care teams. AIM: To evaluate the effect of an intervention aimed at strengthening the implementation of the Chronic Care Model in the care provided by health teams to users with chronic diseases. MATERIAL AND METHODS: Quasi-experiment study. Four health centers were randomly selected, divided into intervention and control groups, with 86 participants who met the selection criteria and agreed to participate in the study. A blended learning training program, lasting six months, was applied in intervened centers to incorporate the elements of the Chronic Care Model. The results were assessed using the questionnaire "Assessment of chronic illness care, internal client version 3.5" adapted to Chilean Spanish. RESULTS: A significant post-intervention improvement in the global score of attention evaluation was observed in the group that received the intervention, changing from basic su- pport to reasonably good support. Also, specific improvements were seen in five sections of the attention assessment. CONCLUSIONS: This intervention improved the evaluation of chronic disease care in the intervention group.

[Training of health care workers on the Chronic Care Model]. / Intervención dirigida al equipo de salud para fortalecer la implementación del Modelo de Cuidados Crónicos.

BACKGROUND: The Chronic Care Model promotes the link between informed, activated patients with proactive and prepared health care teams. AIM: To evaluate the effect of an intervention aimed at strengthening the implementation of the Chronic Care Model in the care provided by health teams to users with chronic diseases. MATERIAL AND METHODS: Quasi-experiment study. Four health centers were randomly selected, divided into intervention and control groups, with 86 participants who met the selection criteria and agreed to participate in the study. A blended learning training program, lasting six months, was applied in intervened centers to incorporate the elements of the Chronic Care Model. The results were assessed using the questionnaire "Assessment of chronic illness care, internal client version 3.5" adapted to Chilean Spanish. RESULTS: A significant post-intervention improvement in the global score of attention evaluation was observed in the group that received the intervention, changing from basic su- pport to reasonably good support. Also, specific improvements were seen in five sections of the attention assessment. CONCLUSIONS: This intervention improved the evaluation of chronic disease care in the intervention group.

Fortalecimiento del recurso humano para la atención de personas con enfermedades crónicas / Strengthening Human Resources for Providing Care to People with Chronic Diseases

Introducción: Las enfermedades crónicas implican un reto sanitario e intersectorial. Por ello, los prestadores requieren adquirir competencias específicas según estándares nacionales e internacionales para implantar una atención primaria de salud que provea acceso y cobertura universal. Objetivo: Reflexionar sobre elementos relevantes vinculados a las competencias de los proveedores de salud para la atención de personas con condiciones crónicas, en el contexto de la atención primaria de salud. Métodos: Se discuten estrategias, la implementación del Modelo de Cuidados Crónicos y la adquisición de competencias, analizando aspectos de la formación profesional, el aseguramiento de la educación continua y la disposición de los proveedores para estar a la vanguardia de los cuidados. Conclusiones: Para proveer una atención integral a personas con enfermedades crónicas es necesario el fortalecimiento del capital humano y la instalación de relaciones coproductivas entre el equipo multidisciplinario. Además, es fundamental que los equipos conozcan e incorporen estrategias con demostración de eficacia a nivel internacional, entre ellos se encuentra el Modelo de Cuidados Crónicos, cuya implementación ha sido lenta y con desarrollo parcial(AU)

Introduction: Chronic diseases represent a health and intersectoral challenge. Therefore, providers need to acquire specific competences according to national and international standards, in order to implement primary healthcare providing universal access and coverage. Objective: To reflect on the relevant elements related to the competences of healthcare providers for the care of people with chronic conditions in the context of primary healthcare. Methods: Strategies are discussed, together with the implementation of the chronic care model and the acquisition of competences, analyzing aspects of professional training, the assurance of continuing education and the willingness of providers to be at the forefront of care. Conclusions: In order to provide comprehensive care to people with chronic diseases, it is necessary to strengthen human capital and create coproductive relationships among the multidisciplinary team. In addition, it is essential that the teams be aware of and incorporate strategies that have been shown to be effective at the international level, including the chronic care model, whose implementation has been slow and only partially developed(AU)

Trabajo en equipo y calidad de la atención en salud

RESUMEN Todas las organizaciones aspiran a alcanzar resultados funcionales e integrales para dar respuesta a las necesidades del medio interno y externo en el que se encuentran inmersas. La organización sanitaria no ha sido la excepción, por lo que proveer una atención con altos estándares de calidad se ha transformado en una prioridad a nivel mundial. En este sentido, se precisa poner en práctica una serie de elementos que confluyan funcionalmente para avanzar hacia la calidad de la atención en salud, en donde el trabajo en equipo, sus integrantes, el compromiso y la confianza entre las personas son claves para el logro de esta meta, especialmente para enfermería. El objetivo de este trabajo es describir la importancia del trabajo en equipo para la calidad de la atención en salud.

ABSTRACT All organizations aspire to achieve functional and comprehensive results in order to meet the needs of the internal and external environment in which they are immersed. The healthcare organization has been no exception, and providing high quality care has become a worldwide priority. In this sense, it is necessary to put into practice a series of elements that functionally converge to move towards the quality of health care, where teamwork, team members, commitment and trust between people are keys to achieving this goal, especially for nursing. The objective of this work is to describe the importance of teamwork for the quality of health care.

RESUMO Todas as organizações aspiram a resultados funcionais e abrangentes para responder às necessidades do ambiente interno e externo em que estão inseridas. A organização de saúde não tem sido exceção, portanto, prestar cuidados com elevados padrões de qualidade tornou-se uma prioridade em todo o mundo. Nesse sentido, é necessário colocar em prática uma série de elementos que convergem funcionalmente para caminhar rumo à qualidade da assistência à saúde, onde o trabalho em equipe, seus integrantes, o compromisso e a confiança entre as pessoas são fundamentais para o alcance desse objetivo, especialmente para enfermagem. O objetivo deste documento é descrever a importância do trabalho de equipa para a qualidade dos cuidados de saúde.

Photodynamic activity of Tagetes minuta extracts against superficial fungal infections.

Candida and dermatophyte species are the most common causes of superficial mycoses because their treatment can be difficult due to limitations of current antifungal drugs in terms of toxicity, bioavailability, interactions, narrow-spectrum activity, and development of resistance. Photodynamic therapy (PDT) involves the topical administration of a photosensitizer in combination with light of an appropriate wavelength and molecular oxygen that produces reactive oxygen species (ROS), which promote damage to several vital components of the microorganism. Tagetes species are known as a source of thiophenes, biologically active compounds whose antifungal activity is enhanced by irradiation with UVA. The present investigation evaluated Tagetes minuta extracts as a photosensitizer on growth of Candida and dermatophytes and their effect on Candida virulence factors. T. minuta root hexane and dichloromethane extracts demonstrated high photodynamic antifungal activity. Bioautographic assays and chromatographic analysis revealed the presence of five thiophenes with reported photodynamic antifungal activities under UVA. Analysis of ROS production indicated that both type I and II reactions were involved in the activity of the extracts. In addition, the extracts inhibited virulence factors of Candida, such as adherence to epithelial surfaces and germ tube formation and showed efficacy against different Candida morphologies: budding cells, cells with germ tube and biofilms. Results suggested that PDT with T. minuta extracts might become a valuable alternative to the already established antifungal drugs for the treatment of superficial fungal infections.

Physiological changes of growth hormone during lactation in pup rats artificially reared.

During the lactation period, rat pups are fed by the dam, and the patterns of mother-pup interaction change during this period. Additionally, there are changes in feeding; first, mother´s milk is the only food needed for sustenance, and later, it is combined with solid food and water. GH serum concentrations depend on both maternal-pup interaction and energy metabolism. In the artificial rearing (AR) procedure, pups are deprived of mother-pup interaction, and the feeding pattern is controlled. This rearing paradigm has been used in rats to analyze the effects of maternal deprivation on social behavior. In the present study, we analyzed the variation in GH, acylated ghrelin and IGF-1 serum concentrations throughout the lactation period in AR pups. At pnd7, the maternal rearing (MR) pups responded to a 4 h fast with a drop in GH serum concentration, which is a well-known response to maternal deprivation. GH serum levels in the AR pups did not change, suggesting an adaptation phenomenon. A dopamine inhibitory effect of GH secretion was observed in pnd7 cultured somatotropes, suggesting dopamine regulation of GH secretion at this age. Acylated ghrelin serum levels in the AR pups showed an inverted pattern compared to that in the MR pups, which was related to the artificial feeding pattern. IGF-1 serum levels were lower in the AR pups than in MR pups, which was associated with hepatic GH resistance and with low Igf1 mRNA expression at pnd7. Interestingly, at pnd14, both pup groups showed high hepatic Igf1 mRNA expression but low IGF-1 serum levels, and this was inverted at pnd21. However, serum glucose levels were lower in the AR pups at pnd14 but reached the same levels as the MR pups at pnd21. Moreover, hepatomegaly and higher hepatic GH-receptor levels were observed in the AR pups at pnd21, which was in agreement with an absence of a solid food meal. During AR, the pups lost the maternal interaction-stimulated GH secretion, which correlated with lower IGF-1 serum levels during the first week of postnatal development. Later, the AR pups exhibited hepatic responses, in order to satisfy the metabolic demand for the normal weaning, with low carbohydrates levels in their meal.

Psychometric properties of the Brief Symptom Inventory-18 in a heterogeneous sample of adult cancer patients / Propiedades psicométricas del Inventario Breve de Síntomas-18 en una muestra heterogénea de pacientes de cáncer adulto

Abstract The Brief Symptom Inventory-18 (BSI-18) is a self-reporting screening instrument that is widely used to assess global psychological distress and three kinds of symptoms: anxiety, depression, and somatization. The present study tests the factor structure of the BSI-18 using confirmatory factor analysis (CFA), its reliability, convergent validity, and invariance for both sexes. A heterogeneous sample of 1183 cancer patients completed the BSI 18 and the NCCN Problem List. Hierarchical models of three and four subscales with GSI as a main factor provided an adequate and similar model fit. Nonetheless, the hierarchical three-factor model (the theoretical proposal) was selected for methodological and theoretical reasons. Reliability indexes (Cronbach's alpha and Composite Reliability) were satisfactory. The positive significant associations between BSI-18 (GSI and subscales) and emotional and physical categories of the Problem List showed the suitable convergent validity of the instrument. Finally, multigroup CFA revealed an essentially invariant structure of the BSI-18 for both sexes. The BSI-18 is a short instrument that can be used by researchers and health professionals to assess the psychological distress of cancer survivors.

Resumen El Inventario Breve de Síntomas-18 (BSI-18) es un instrumento de cribado ampliamente utilizado para evaluar distrés emocional (GSI) y tres tipos de síntomas: ansiedad, depresión, y somatización. Este trabajo estudia la estructura factorial del BSI-18, utilizando análisis factorial confirmatorio (AFC), su fiabilidad y validez convergente, así como su invarianza factorial a través del sexo. Una muestra de 1183 pacientes de cáncer completó el BSI 18 y la lista de problemas de la NCCN. Los modelos jerárquicos de tres y cuatro factores proporcionaron ajustes adecuados y similares. Sin embargo, el modelo de tres factores (propuesta teórica) fue seleccionado por razones metodológicas y teóricas. Los índices de fiabilidad (alfa de Cronbach y fiabilidad compuesta) fueron satisfactorios y las correlaciones positivas y significativas entre el BSI-18 (GSI y subescalas) y las categorías emocionales y físicas del listado de problemas evidenciaron la adecuada validez convergente del instrumento. Finalmente, el AFC multigrupo reveló una estructura básicamente invariante del BSI-18 a través del sexo. El BSI-18 es un instrumento breve que puede ser utilizado por investigadores y profesionales de la salud para evaluar el malestar psicológico en la población con cáncer.