Actitud de los fisioterapeutas acerca del acceso directo y su implementación a través de un cambio en la política pública en Puerto Rico / Attitude of physiotherapists about direct access and its implementation through a change in public policy in Puerto Rico

Objetivos: Explorar las actitudes de los fisioterapeutas de Puerto Rico: 1) hacia el acceso directo (AD), 2) las implicaciones para la profesión, la práctica y los servicios de salud, y 3) la implementación del AD a través de un cambio en política pública. Métodos: El diseño fue exploratorio transversal, no experimental y con un enfoque cuantitativo. Los participantes eran fisioterapeutas con licencia vigente, mayores de 21 años de edad, con cualquier grado académico en fisioterapia y que actualmente ejercen la práctica en Puerto Rico. Fueron excluidos fisioterapeutas sin experiencia clínica, que estaban completando un grado doctoral transicional o con experiencia ejerciendo con AD. Para abordar los objetivos de investigación, se construyó un cuestionario, cuyo contenido fue validado por 4 fisioterapeutas expertos utilizando el modelo de Lawshe modificado por Tristán. Resultados: Participaron de este estudio 100 fisioterapeutas. El 96% de los participantes estuvo de acuerdo con la implementación del AD en Puerto Rico. El 83% indicó estar preparado para ejercer la profesión por AD. El 55% entienden que fisioterapeutas con grado doctoral están más preparados para ejercer por AD. El 59% indicó que el AD debe estar restringido por nivel educativo y/o experiencia. Conclusión: La actitud de los fisioterapeutas en Puerto Rico respecto al AD resultó ser favorable, independientemente del grado académico, ya que están a favor con incorporar el AD a la fisioterapia, se sienten preparados para ejercer por AD y consideran el AD beneficioso para los pacientes, la práctica y la profesión. (AU)

Objectives: To explore the attitudes of physiotherapists in Puerto Rico: (1) towards direct access (DA), (2) the implications for the profession, practice, and health services, and (3) the implementation of DA through a change in public policy. Methods: The design was cross-sectional exploratory, non-experimental, and quantitative in nature. Participants were licensed physiotherapists, over 21 years old, with any academic degree in physiotherapy, currently practicing in Puerto Rico. Physiotherapists without clinical experience, those completing a transitional doctoral degree, or with experience practicing with DA were excluded. To address the research objectives, a questionnaire was constructed, whose content was validated by 4 expert physiotherapists using the Lawshe model modified by Tristán. Results: One hundred physiotherapists participated in this study. 96% of participants agreed with the implementation of DA in Puerto Rico. However, only 83% indicated being prepared to practice the profession through DA. 55% understood that physiotherapists with doctoral degrees were better prepared to practice through DA. 59% indicated that DA should be restricted based on educational level and/or experience. Conclusion: The attitude of physiotherapists in Puerto Rico towards DA was favorable regardless of academic degree. They are in favor of incorporating DA into physiotherapy, feel prepared to practice through DA, and consider it beneficial for patients, practice, and the profession. (AU)

Modulation of CYP2E1 metabolic activity in a cohort of confirmed caffeine ingesting pregnant women with preterm offspring.

BACKGROUND: To ascertain interactions of caffeine ingestion, food, medications, and environmental exposures during preterm human gestation, under informed consent, we studied a cohort of Mexican women with further preterm offspring born at ≤ 34 completed weeks. At birth, blood samples were taken from mothers and umbilical cords to determine caffeine and metabolites concentrations and CYP1A2 (rs762551) and CYP2E1 (rs2031920, rs3813867) polymorphisms involved in caffeine metabolism. RESULTS: In 90 pregnant women who gave birth to 98 preterm neonates, self-informed caffeine ingestion rate was 97%, laboratory confirmed rate was 93 %. Theobromine was the predominant metabolite found. Consumption of acetaminophen correlated significantly with changes in caffeine metabolism (acetaminophen R2 = 0.637, p = 0.01) due to activation of CYP2E1 alternate pathways. The main caffeine source was cola soft drinks. CONCLUSION: Environmental exposures, especially acetaminophen ingestion during human preterm pregnancy, can modulate CYP2E1 metabolic activity.

[Effect of a high glucose load on serum concentrations of C-reactive protein and alpha1-antitrypsin in obese women]. / Evaluación del efecto de la ingesta de una sobrecarga de glucosa sobre los niveles séricos de la proteína C reactiva y de la alpha1-antitripsina en mujeres obesas.

UNLABELLED: Obesity is associated with increased inflammation. C-reactive protein (CRP) is a proinflammatory molecule, and alpha1-antitrypsin is an inflammation-sensitive plasma protein. Proinflammatory process may be influenced by postprandial hyperglycemia. OBJECTIVE: The aim of the present study was to evaluate the role of high-glucose load on postprandial circulating levels of PCR and alpha1-antitrypsin in obese women with normal glucose tolerance. DESIGN: A total of 15 obese women (age=34.4+/-4.3 years, BMI=35.5+/-5.3 kg/m2) and 15 lean controls women (age=33.9+/-2.9 years, BMI=21.8+/-1.9 kg/m2) were recruited for this study. After and overnight fast subjects underwent a 2 h-75 g oral glucose tolerance test. Preprandial and postprandial CRP and alpha1-antitrypsin were measured. Anthropometry and blood biochemical parameters were measured in both groups. RESULTS: The obese women had fasting serum PCR levels higher (P=or<0.001) than those of control women. There weren't differences in fasting serum alpha1-antitrypsin levels in obese group in comparison to lean control group (P=0.26). Serum PCR and alpha1-antitrypsin did not change postprandially (P=or>0.05 difference to fasting levels). Serum CRP levels was positively related to body mass index (BMI) in obese group. Serum alpha1-antitrypsin was not related to BMI in both groups. CONCLUSION: A high glucose load is not associated with serum PCR and alpha1-antitrypsin levels increase. Serum alpha1-antitripsin levels are not increased in obese women. Serum PCR levels are increased in obese women, and are positively related to BMI.

Faculty development for family medicine: a status report.

Stability in family medicine residency program growth has resulted in a trend to redefine faculty development in terms of changing needs. Recent literature has indicated these needs to be in the areas of increased research, improved clinical skills, reassessment of content and methods of faculty development, and changes in educational methods. To identify the status of faculty development programs in 1985, 126 family medicine university-based programs were surveyed. Data were obtained regarding the content of faculty development programs, the perceived competence of faculty in six clinical teaching areas and three academic areas, and the importance of eight areas of faculty development. The most frequent activity reported by the 74 respondents was in the area of teaching and evaluation. Research was the academic area listed in which directors noted a particular lack of competence. In the clinical content area, both procedural skills and critical care stood out as areas of faculty needs. Results suggested that more than one track of faculty development should be provided to meet complex and changing faculty development needs.

Reaccion inmunoblastica difusa secundaria a picadura de abeja (reporte de un caso). / Secondary diffuse immunoblastic reaction to bee sting (report of a case)

Paciente masculino de 75 anos, presenta linfadenopatia generalizada gammapatia policlonal, aumento de linfocitos B y linfocitos T disminuidos. La biopsia de ganglio linfatico demuestra proliferacion inmunoblastica difusa secundaria a la estimulacion antigenica constante por picadura de abeja. La prueba cutanea con veneno purificado de abeja fue positiva. Se hace un llamado de atencion sobre esta alteracion ganglionar linfatica, ya que es frecuente su confusion con linfoma