Quality assessment of orthopedic surgery referral request letters from primary care consultation: Evaluation of a Spanish healthcare area.

BACKGROUND: One of the most requested referrals for specialist consultations from primary care (PC) is orthopedic surgery (OS). The purpose of this work was to analyze the number, characteristics, and quality of PC referral request letters in a Spanish healthcare area to their OS reference department. MATERIALS AND METHODS: The referral rates for 10 years were collected, and a total of 6,225 referral letters issued during the first half of 2019 were analyzed in detail. Gender, age, patient provenance, as well as priority and other process descriptors (type of pathology, suspected diagnosis, exploratory signs, imaging tests) were assessed. A scoring system was developed to evaluate the quality of the referral to an OS consultation: Quality evaluation in OS (QEOS) model. RESULTS: The rate of referral to OS is rising. The mean age of the referred patient was 53 years and 59.3% were women. Degenerative pathologies justified most referral requests (65.7%), most of which related to the spine (24.2%) or the knee (23.2%). In the QEOS analysis of the referral request letters, we noted that only 36.5% described some physical exploration, 32.9% image tool request, 25.8% indicated the pharmacological treatment, and 11.2% subsequent physiotherapy, resulting in a poor average quality of PC to OS patient referral. CONCLUSION: There is a growing demand for patient referral from PC to OS, however, the number, content, and quality of referral request letters varies greatly. The QEOS tool can be the germ of a simple evaluation system that would help in the improvement of the process of continuous care.

Estudio de la edad biológica en atletas del sexo masculino de la categoría escolar / Estudo da idade biológica em atletas do sexo masculino da categoria escolar / Study of the biological age in male athletes of the school category

RESUMEN Se realizó un estudio de la edad biológica de los deportistas escolares del sexo masculino. Como objetivo de este trabajo se declaró caracterizar el comportamiento de la edad biológica de los atletas escolares del sexo masculino, de 13 y 14 años de los deportes de tenis, balonmano, atletismo, judo y levantamiento de pesas en la Eide (Escuela de Iniciación Deportiva) "Julio Díaz González" de la provincia Artemisa, Cuba. En este diseño no experimental, se emplearon métodos de investigación, tanto de carácter teórico como del nivel empírico. Entre los empíricos, se encuentran la revisión de documentos, la observación, la entrevista y la medición. Estos permitieron constatar información relacionada con la edad biológica de los atletas y su integración a la planificación del proceso de entrenamiento deportivo que se desarrolla a largo plazo. Fue esencial en este estudio la aplicación del método de Tanner y Whitehouse, ajustado por Jordán, de la radiografía de la mano izquierda (mano total). Como resultado se identifica el comportamiento de la maduración ósea de los atletas escolares participantes en la investigación.

RESUMO Foi realizado um estudo sobre a idade biológica dos atletas da escola masculina. O objectivo deste trabalho era caracterizar o comportamento da idade biológica dos atletas escolares masculinos, de 13 e 14 anos, nos desportos de ténis, handebol, atletismo, judô e halterofilismo, na Eide (Escola de Iniciação ao Desporto) "Julio Díaz González", na província de Artemisa, Cuba. Neste desenho não experimental, foram utilizados métodos de investigação tanto teóricos como empíricos. Entre os empíricos, há a revisão de documentos, observação, entrevista e medição. Estes permitiram apurar informações relacionadas com a idade biológica dos atletas e a sua integração no planeamento do processo de treino desportivo que é desenvolvido a longo prazo. Foi essencial neste estudo a aplicação do método de Tanner e Whitehouse, ajustado por Jordán, da radiografia da mão esquerda (mão total). Como resultado, é identificado o comportamento da maturação óssea dos atletas escolares que participam na investigação.

ABSTRACT A study of the biological age of male school athletes was carried out. It was declared as an objective to characterize the behavior of the biological age of male school athletes, 13-14 years of age in tennis, handball, athletics, judo and weightlifting sports, at the EIDE (Sports Initiation School) Julio Diaz Gonzalez from Artemisa. In this non-experimental design some methods of investigation were used as well Empiric and Theoretical methods. The Empiric ones are: document review, observation, interview and measurement which allowed verifying information related to the biological age of the athletes and their integration to the planning of the sport training process that is developed to long term. The application of the method of Tanner Whitehouse, adjusted by Jordan of the radiograph of the left hand, total hand, was essential in this study. As a result is identified the athletes `bone maturation behavior that participated in this investigation.

Condiciones de trabajo asociadas a síntomas respiratorios por exposición a residuos de plaguicidas / Working conditions associated with respiratory symptoms due to exposure to pesticide residues

INTRODUCCIÓN. La exposición a plaguicidas de trabajadores agrícolas y productores ha sido causal de aparición de síntomas respiratorios teniendo el Ecuador el 62% de población rural dedicada a esta actividad. OBJETIVO. Identificar y evaluar las condiciones de trabajo asociadas a síntomas respiratorios por exposición a residuos de plaguicidas. MATERIALES Y MÉTODOS. Estudio analítico transversal. Población de 140 y muestra de 102 trabajadores de la empresa Condimensa. Los datos fueron recolectados mediante el cuestionario de salud respiratoria de la European Comunity Respiratory Health Survey en Latinoamérica segunda versión, en septiembre de 2020. RESULTADOS. Se encontró una relación estadísticamente significativa entre flema crónica y sexo con unA Prueba Exacta de Fisher (p=0,015), la manipulación de sustancias nocivas o toxicas (p=0,001), y la condición de exposición química (p=0,0006). Mediante análisis de regresión logística se determinó que la manipulación de sustancias nocivas o tóxicas (Odds Ratio 5.50, Intervalo de Confianza 95% 1.58 ­ 19.17), y estar expuesto a químicos (Odds Ratio 7.00, Intervalo de Confianza 95% 2.11 ­ 23.22), fueron factores de riesgo para el desarrollo de síntomas respiratorios: flema crónica, tos crónica, sibilancia, opresión en el pecho, disnea crónica, bronquitis crónica. CONCLUSIÓN. Se registró y evaluó las condiciones de trabajo asociadas a síntomas respiratorios por exposición a residuos; y, la evidencia fue fuerte para la exposición residual a plaguicidas.

INTRODUCTION.Worldwide Exposure to pesticides in agricultural workers and producers has been the cause of the appearance of respiratory symptoms. Ecuador having 62% of the rural population dedicated to this activity. OBJETIVE. Identify and evaluate the working conditions associated with respiratory symptoms due to exposure to pesticide residues. MATERIALS AND METHODS. Cross-sectional analytical study. Population of 140 and sample of 102 workers of the Condimensa company. The data were collected using the respiratory health questionnaire of the European Community Respiratory Health Survey in Latin America, second version, in september 2020. RESULTS. A statistically significant relationship between chronic phlegm and sex type was found with a Fisher exact (p=0,015), the handling of harmful or toxic substances Fisher exact (p = 0.001), and the condition of chemical exposure a Fisher Exact Test (p=0,0006). Through logistic regression analysis, it was determined that the handling of harmful or toxic substances (Odds Ratio 5.50, Confidence Interval 95% 1.58 - 19.17), and being exposed to chemicals (Odds Ratio 7.00, Confidence Interval 95% 2.11 - 23.22), were risk factors for the development of respiratory symptoms: chronic phlegm, chronic cough, wheezing, chest tightness, chronic dyspnea, chronic bronchitis. CONCLUSION. The working conditions associated with respiratory symptoms due to exposure to residues associated with chronic phlegm were recorded and evaluated; and the evidence was strong for residual pesticide exposure.

An mHealth Workplace-Based "Sit Less, Move More" Program: Impact on Employees' Sedentary and Physical Activity Patterns at Work and Away from Work.

BACKGROUND: Most workplace interventions that aim to reduce sedentary behaviour have 38 focused on employees' sedentary patterns at-work but less have focused on understanding the 39 impact beyond working time. The aim of this study was to evaluate the impact of a 13-week m-40 health workplace-based 'sit less, move more' intervention (Walk@WorkApp; W@W-App) on 41 physical activity (PA) and sitting in desk-based employees at-work and away from work. METHODS: Participants (n = 141) were assigned by hospital to an intervention group (IG; used the W@W-App; n = 90) or an active comparison group (A-CG; monitored occupational activity; n = 51). The W@W-App, installed on the participants´ own smartphones, provided real-time feedback for occupational sitting, standing, and stepping, and gave access to automated strategies to sit less and move more at work. Changes between groups were assessed for total sitting time, sedentary bouts and breaks, and light and moderate-to-vigorous PA (activPAL3TM; min/day) between the baseline and after program completion. RESULTS: Compared to the A-CG, employees that used the W@W-App program increased their number of daily breaks and the time spent on short sedentary bouts (<20 min, p = 0.047) during weekends. Changes in shortest sedentary bouts (5-10 min) during weekends were also statistically significant (p < 0.05). No changes in workday PA or sitting were observed. CONCLUSION: Desk-based employees seemed to transfer the W@W-App program knowledge outside of work. Evaluating the impact of workplace (mHealth-based or not) interventions at work but also away from work would provide a better understating of the impact of such interventions.

Efectividad de las estrategias de transferencia de conocimiento en lenguaje audiovisual comparadas con otras para mejorar desenlaces en la salud individual y de la población general: revisión sistemática / Effectiveness of Knowledge Translation Strategies in Audiovisual Language Compared With Other Languages to Improve Health Outcomes in Individuals and the General Population: Systematic Review

RESUMEN Introducción: La transferencia del conocimiento (KT) corresponde no solo a una serie de accio nes finales en áreas de divulgación, sino a la identificación de estrategias para la realización de este proceso. Objetivo: Evaluar la efectividad de estrategias de KT en lenguaje audiovisual comparadas con otros lenguajes para mejorar los desenlaces en salud de la población general. Métodos: Se realizó una búsqueda en MEDLINE, CENTRAL, PsycARTICLES, WHO International Clinical Trials Registry Platform, EMBASE y LILACS. Resultados: Se incluyeron 63 estudios; se observó gran variabilidad en las poblaciones de estudio, así como en los lenguajes comparados con el lenguaje audiovisual y los instru mentos de medición. Los estudios tienen alto riesgo de sesgo y la calidad de la evidencia identificada no permite llegar a una conclusión respecto a la efectividad de los lenguajes evaluados en KT. Conclusiones: Se identifican diferentes lenguajes que pueden emplearse para transferir cono cimientos. Se evidencia que el conocimiento y los efectos producidos por la intervención disminuyen a medida que avanza el tiempo, independientemente del tipo de lenguaje empleado. Por lo tanto, es el tiempo es un punto importante a tener en cuenta en este tipo de intervenciones.

ABSTRACT Background: Knowledge translation (KT) not only encompasses a series of final actions in areas of dissemination, but also the identification of strategies for the implementation of this process. Objective: To evaluate the effectiveness of KT strategies in audiovisual language compared with other languages to improve health outcomes in the general population. Methods: We performed a search in MEDLINE, CENTRAL, PsycARTICLES, the WHO Interna tional Clinical Trials Registry Platform, EMBASE and LILACS. Results: We included 63 studies encompassing a broad range of study populations, languages that were compared to audiovisual language and measurement scales for outcomes. These studies presented a high risk of bias and the quality of evidence was not sufficient to draw conclusions about the effectiveness of the evaluated languages for knowledge translation. Conclusions: We identified different languages that could be used in knowledge translation. The knowledge and the effects produced as a result of the strategy diminish as time pro gresses, regardless of the type of language used. This is an important point to consider when implementing this type of strategy.

Effectiveness of Knowledge Translation Strategies in Audiovisual Language Compared With Other Languages to Improve Health Outcomes in Individuals and the General Population: Systematic Review. / Efectividad de las estrategias de transferencia de conocimiento en lenguaje audiovisual comparadas con otras para mejorar desenlaces en la salud individual y de la población general: revisión sistemática.

BACKGROUND: Knowledge translation (KT) not only encompasses a series of final actions in areas of dissemination, but also the identification of strategies for the implementation of this process. OBJECTIVE: To evaluate the effectiveness of KT strategies in audiovisual language compared with other languages to improve health outcomes in the general population. METHODS: We performed a search in MEDLINE, CENTRAL, PsycARTICLES, the WHO International Clinical Trials Registry Platform, EMBASE and LILACS. RESULTS: We included 63 studies encompassing a broad range of study populations, languages that were compared to audiovisual language and measurement scales for outcomes. These studies presented a high risk of bias and the quality of evidence was not sufficient to draw conclusions about the effectiveness of the evaluated languages for knowledge translation. CONCLUSIONS: We identified different languages that could be used in knowledge translation. The knowledge and the effects produced as a result of the strategy diminish as time progresses, regardless of the type of language used. This is an important point to consider when implementing this type of strategy.

Recomendaciones de uso de everolimus en el trasplante hepático / Recommendations of everolimus use in liver transplant

Los fármacos inhibidores de la mTOR, everolimus (EVL) y sirolimus, son inmunosupresores con muy poco efecto nefrotóxico, limitado al desarrollo de proteinuria en algunos casos. En la prevención del rechazo agudo EVL combinado con tacrolimus a dosis reducidas tiene una eficacia y seguridad comparables a la inmunosupresión estándar con tacrolimus. La aplicación temprana de una inmunosupresión basada en EVL con minimización de la exposición al inmunosupresor calcineurínico en trasplantados hepáticos permite mejorar los resultados de la función renal, con tasas similares de eficacia y seguridad, tanto en el período de novo como de mantenimiento. En pacientes con disfunción renal establecida la introducción de EVL permite minimizar la exposición al inmunosupresor calcineurínico, con la consiguiente mejoría en la función renal. Aunque no hay evidencia suficiente para recomendar su uso para prevenir la recurrencia del hepatocarcinoma y la progresión de tumores de novo, es práctica clínica habitual utilizarlos en este contexto (AU)

Mammalian target of rapamycin (mTOR) inhibitors, everolimus (EVL) and sirolimus are immunosuppressive agents with a minor nephrotoxic effect, limited to the development of proteinuria in some cases. The combination of EVL and low-dose tacrolimus has proven to be as safe and effective as standard therapy with tacrolimus for the prevention of acute cellular rejection. Early initiation of EVL-based immunosuppressive regimens with reduced exposure to calcineurin inhibitors has been shown to significantly improve renal function of LT recipients during induction and maintenance phases, with comparable efficacy and safety profiles. In patients with established kidney failure, initiating EVL may enable clinicians to reduce calcineurin inhibitors exposure, thereby contributing to the improved renal function of these patients. Although there is not sufficient evidence to recommend their use to prevent the recurrence of hepatocellular carcinoma and the progression of de novo tumours, they are used in this context in routine clinical practice (AU)

Can a workplace 'sit less, move more' programme help Spanish office employees achieve physical activity targets?

We evaluated the impact of a workplace 'sit less, move more' programme (Walk@WorkSpain, W@WS, 19-week) on self-reported activity-related energy expenditure (AREE) in Spanish office employees (n = 264; 42 ± 10 years; 171 female) randomly assigned to Intervention (IG; used W@WS; n = 129) or comparison groups (CGs; n = 135). A linear mixed model assessed changes in METs-min/wk of total, vigorous, moderate and light physical activity (IPAQ short form) between baseline and 2 months follow-up. Over the CG, IG significantly increased light intensity AREE (P = 0.027). W@WS secured sustained increases on AREE-but not on achieving PA recommendations-providing translational evidence that active living in office employees can be increased.

Recommendations of everolimus use in liver transplant. / Recomendaciones de uso de everolimus en el trasplante hepático.

Mammalian target of rapamycin (mTOR) inhibitors, everolimus (EVL) and sirolimus are immunosuppressive agents with a minor nephrotoxic effect, limited to the development of proteinuria in some cases. The combination of EVL and low-dose tacrolimus has proven to be as safe and effective as standard therapy with tacrolimus for the prevention of acute cellular rejection. Early initiation of EVL-based immunosuppressive regimens with reduced exposure to calcineurin inhibitors has been shown to significantly improve renal function of LT recipients during induction and maintenance phases, with comparable efficacy and safety profiles. In patients with established kidney failure, initiating EVL may enable clinicians to reduce calcineurin inhibitors exposure, thereby contributing to the improved renal function of these patients. Although there is not sufficient evidence to recommend their use to prevent the recurrence of hepatocellular carcinoma and the progression of de novo tumours, they are used in this context in routine clinical practice.

Impact of a workplace 'sit less, move more' program on efficiency-related outcomes of office employees.

BACKGROUND: Few studies have examined the impact of 'sit less, move more' interventions on workplace performance. This study assessed the short and mid-term impacts of and patterns of change within, a 19-week workplace web-based intervention (Walk@WorkSpain; W@WS; 2010-11) on employees´ presenteeism, mental well-being and lost work performance. METHODS: A site randomised control trial recruited employees at six Spanish university campuses (n = 264; 42 ± 10 years; 171 female), assigned by worksite and campus to an Intervention (IG; used W@WS; n = 129; 87 female) or an active Comparison group (A-CG; pedometer, paper diary and self-reported sitting time; n = 135; 84 female). A linear mixed model assessed changes between the baseline, ramping (8 weeks), maintenance (11 weeks) and follow-up (two months) phases for the IG versus A-CG on (i) % of lost work productivity (Work Limitations Questionnaire; WLQ); (ii) three scales for presenteeism (WLQ) assessing difficulty meeting scheduling demands (Time), performing cognitive and inter-personal tasks (Mental-Interpersonal) and decrements in meeting the quantity, quality and timeliness of completed work (Output); and (iii) mental well-being (Warwick-Edinburgh Mental Well-being Scale). T-tests assessed differences between groups for changes on the main outcomes. In the IG, a multivariate logistic regression model identified patterns of response according to baseline socio-demographic variables, physical activity and sitting time. RESULTS: There was a significant 2 (group) × 2 (program time points) interaction for the Time (F [3]=8.69, p = 0.005), Mental-Interpersonal (F [3]=10.01, p = 0.0185), Output scales for presenteeism (F [3]=8.56, p = 0.0357), and for % of lost work performance (F [3]=10.31, p = 0.0161). Presenteeism and lost performance rose significantly in both groups across all study time points; after baseline performance was consistently better in the IG than in the A-CG. Better performance was linked to employees being more active (Time, p = 0.041) and younger (Mental-interpersonal, p = 0.057; Output, p = 0.017). Higher total sitting time during nonworking days (Mental-interpersonal, p = 0.019) and lower sitting time during workdays (WLQ Index, p = 0.013) also improved performance. CONCLUSION: Versus an active comparison condition, a 'sit less, move more` workplace intervention effectively reduced an array of markers of lost workday productivity. TRIAL REGISTRATION: NCT02960750 ; Date of registration: 07/11/2016.

The effectiveness of a basic exercise intervention to improve strength and balance in women with osteoporosis.

OBJECTIVE: To determine the effects of a simple exercise program on the balance and strength of postmenopausal women with osteoporosis. METHODS: This program was based on low intensity strength and balance exercises, and was carried out with simple, readily available equipment. Sixty five women were randomly assigned to either the experimental group (EG; n=33, age: 57.4±4.8 years) or the control group (CG; n=32, age: 58.8±4.5 years). Participants in the EG underwent balance and strength training for 60 min, three times/week for 6 months. Each session consisted of warm-up exercises (10 min), balance training (20 min), strength training (20 min), and cooldown (10 min). Participants from the CG were asked not to modify their usual habits during the course of the study. Static balance was evaluated using the blind monopodal stance static balance test. In contrast, dynamic balance was assessed using the "8-foot up and go" test, whereas the strength of the upper and lower limbs was measured using the "arm curl" and "30 s chair stand" tests, respectively. All these variables were assessed at baseline and upon program completion. RESULTS: The EG showed significant improvements (P<0.001) in static balance (21%), dynamic balance (36%), and in the strength of the upper (80%) and lower (47%) limbs in comparison to the CG after the sixth month. Participants in the CG showed significantly lower values (P<0.001) in the four tests. In addition, a significant inverse relationship between static balance and the strength of the upper (r=-0.390; P=0.001) and lower (r=-0.317; P=0.01) limbs was found. CONCLUSION: The present study demonstrates that a physical exercise program based on balance and strength exercises, carried out with simple and readily available equipment, is capable of significantly improving the strength and balance of women with osteoporosis.

Patterns of impact resulting from a 'sit less, move more' web-based program in sedentary office employees.

PURPOSE: Encouraging office workers to 'sit less and move more' encompasses two public health priorities. However, there is little evidence on the effectiveness of workplace interventions for reducing sitting, even less about the longer term effects of such interventions and still less on dual-focused interventions. This study assessed the short and mid-term impacts of a workplace web-based intervention (Walk@WorkSpain, W@WS; 2010-11) on self-reported sitting time, step counts and physical risk factors (waist circumference, BMI, blood pressure) for chronic disease. METHODS: Employees at six Spanish university campuses (n=264; 42±10 years; 171 female) were randomly assigned by worksite and campus to an Intervention (used W@WS; n=129; 87 female) or a Comparison group (maintained normal behavior; n=135; 84 female). This phased, 19-week program aimed to decrease occupational sitting time through increased incidental movement and short walks. A linear mixed model assessed changes in outcome measures between the baseline, ramping (8 weeks), maintenance (11 weeks) and follow-up (two months) phases for Intervention versus Comparison groups. RESULTS: A significant 2 (group) × 2 (program phases) interaction was found for self-reported occupational sitting (F[3]=7.97, p=0.046), daily step counts (F[3]=15.68, p=0.0013) and waist circumference (F[3]=11.67, p=0.0086). The Intervention group decreased minutes of daily occupational sitting while also increasing step counts from baseline (446±126; 8,862±2,475) through ramping (+425±120; 9,345±2,435), maintenance (+422±123; 9,638±3,131) and follow-up (+414±129; 9,786±3,205). In the Comparison group, compared to baseline (404±106), sitting time remained unchanged through ramping and maintenance, but decreased at follow-up (-388±120), while step counts diminished across all phases. The Intervention group significantly reduced waist circumference by 2.1cms from baseline to follow-up while the Comparison group reduced waist circumference by 1.3cms over the same period. CONCLUSIONS: W@WS is a feasible and effective evidence-based intervention that can be successfully deployed with sedentary employees to elicit sustained changes on "sitting less and moving more".

Self-reported sitting time and physical activity: interactive associations with mental well-being and productivity in office employees.

BACKGROUND: Little is known about how sitting time, alone or in combination with markers of physical activity (PA), influences mental well-being and work productivity. Given the need to develop workplace PA interventions that target employees' health related efficiency outcomes; this study examined the associations between self-reported sitting time, PA, mental well-being and work productivity in office employees. METHODS: Descriptive cross-sectional study. Spanish university office employees (n = 557) completed a survey measuring socio-demographics, total and domain specific (work and travel) self-reported sitting time, PA (International Physical Activity Questionnaire short version), mental well-being (Warwick-Edinburg Mental Well-Being Scale) and work productivity (Work Limitations Questionnaire). Multivariate linear regression analyses determined associations between the main variables adjusted for gender, age, body mass index and occupation. PA levels (low, moderate and high) were introduced into the model to examine interactive associations. RESULTS: Higher volumes of PA were related to higher mental well-being, work productivity and spending less time sitting at work, throughout the working day and travelling during the week, including the weekends (p < 0.05). Greater levels of sitting during weekends was associated with lower mental well-being (p < 0.05). Similarly, more sitting while travelling at weekends was linked to lower work productivity (p < 0.05). In highly active employees, higher sitting times on work days and occupational sitting were associated with decreased mental well-being (p < 0.05). Higher sitting times while travelling on weekend days was also linked to lower work productivity in the highly active (p < 0.05). No significant associations were observed in low active employees. CONCLUSIONS: Employees' PA levels exerts different influences on the associations between sitting time, mental well-being and work productivity. The specific associations and the broad sweep of evidence in the current study suggest that workplace PA strategies to improve the mental well-being and productivity of all employees should focus on reducing sitting time alongside efforts to increase PA.

Uptake and factors that influence the use of 'sit less, move more' occupational intervention strategies in Spanish office employees.

BACKGROUND: Little is known about the types of 'sit less, move more' strategies that appeal to office employees, or what factors influence their use. This study assessed the uptake of strategies in Spanish university office employees engaged in an intervention, and those factors that enabled or limited strategy uptake. METHODS: The study used a mixed method design. Semi-structured interviews were conducted with academics and administrators (n = 12; 44 ± 12 mean SD age; 6 women) at three points across the five-month intervention, and data used to identify factors that influenced the uptake of strategies. Employees who finished the intervention then completed a survey rating (n = 88; 42 ± 8 mean SD age; 51 women) the extent to which strategies were used [never (1) to usually (4)]; additional survey items (generated from interviewee data) rated the impact of factors that enabled or limited strategy uptake [no influence (1) to very strong influence (4)]. Survey score distributions and averages were calculated and findings triangulated with interview data. RESULTS: Relative to baseline, 67% of the sample increased step counts post intervention (n = 59); 60% decreased occupational sitting (n = 53). 'Active work tasks' and 'increases in walking intensity' were the strategies most frequently used by employees (89% and 94% sometimes or usually utilised these strategies); 'walk-talk meetings' and 'lunchtime walking groups' were the least used (80% and 96% hardly ever or never utilised these strategies). 'Sitting time and step count logging' was the most important enabler of behaviour change (mean survey score of 3.1 ± 0.8); interviewees highlighted the motivational value of being able to view logged data through visual graphics in a dedicated website, and gain feedback on progress against set goals. 'Screen based work' (mean survey score of 3.2 ± 0.8) was the most significant barrier limiting the uptake of strategies. Inherent time pressures and cultural norms that dictated sedentary work practices limited the adoption of 'walk-talk meetings' and 'lunch time walking groups'. CONCLUSIONS: The findings provide practical insights into which strategies and influences practitioners need to target to maximise the impact of 'sit less, move more' occupational intervention strategies.

T-tube or no T-tube in cadaveric orthotopic liver transplantation: the eternal dilemma: results of a prospective and randomized clinical trial.

OBJECTIVE: To compare the incidence and severity of biliary complications due to liver transplantation after choledochocholedochostomy with or without a T-tube in a single-center, prospective, randomized trial. SUMMARY BACKGROUND DATA: The usefulness of the T-tube for end-to-end biliary anastomosis to reduce the incidence of biliary complications in patients undergoing liver transplantation has been controversial. METHODS: A per-protocol analysis was designed for liver recipients, who were randomly assigned to choledochocholedochostomy with (n = 95) or without (n = 92) a T-tube. RESULTS: The overall biliary complication rate was 22.5% (n = 42), with no difference between groups (P = 0.35). The majority (66.7%) of complications in the T-tube group were types I and II, whereas 50% were type IIIa and 44% were type IIIb in the non-T-tube group (P < 0.0001). Fewer anastomotic strictures were found in the T-tube group (n = 2, 2.1%) than in the non-T-tube group (n = 13, 14.1%; P = 0.002). No difference in anastomotic biliary leakage was observed between groups. Biliary complication-free survival rates showed that complications appeared earlier in the T-tube group. Graft and patient survival rates were similar in both groups. CONCLUSIONS: Complications in the T-tube group were less severe and required less aggressive treatment. The incidence of anastomotic strictures was higher in patients with no T-tube. We recommend conducting choledochocholedochostomy with a rubber T-tube during liver transplantation in risky anastomosis and when the bile duct diameter is less than 7 mm. This study is registered at http://www.clinicaltrials.gov: Clinical trial ID# NCT01546064.

Información y soporte emocional a las mujeres con resultado anormal en papanicolaou: una guía de comunicación / Information and emotional support for women with abnormal pap test results

El presente trabajo tuvo por objetivo desarrollar y evaluar una guía de comunicación de la presencia y tratamiento de alteraciones en el Papanicolau, sugestivas de displasias o cáncer cervical. Método: Se entrevistó a una muestra de 97 mujeres con resultado citológico anormal que fueron referidas a diagnóstico y tratamiento a un hospital de especialidad,para comparar el grado de información acerca de su condición y tratamiento, así como su percepción de soporte emocional por parte de los profesionales de salud, antes y después de una sesión informativa sistematizada en la guía de comunicación propuesta. Resultados: La comunicación con las pacientes (y la guía correspondiente) se desarrolló a la luz del modelo de tratamiento basado en evidencias. Se documentó una diferencia clínica y estadísticamente signifi cativa antes y después de la sesión con el especialista que usó la guía en el nivel de información sobre la condición y su tratamiento (3,97 + 3,15 vs. 8,15 + 2,65; t= -7,27, gl= 53, p≤ ,0001), y una tendencia al incremento del porcentaje de pacientes que percibieron soporte emocional por parte del profesional de la salud en cuestión (62,3% vs. 100%; chi cuadrada=31,18, gl=1, p=,07) (AU)

The aim of the present study was to develop and to evaluate a guide to communicate the presence and treatment of Papanicolaou alterations that suggest dysplasia or cervical cancer. Method: A sample of 97 women with abnormal smear test referred to diagnosis and treatment at a third level hospital were interviewed pre and post an informative session systematized in the proposed guide, to compare the degree of information about their condition and treatment and their perception of emotional support from health professionals. Results: The communication guide were developed according evidence based treatment model. We documented a pre-post clinical and statistical difference in the level of information about their condition and treatment (3.97 + 3.15 vs. 8.15 + 2.65; t= -7.27, df= 53, p≤.0001), and a tendency of increment in the percentage of patients that perceived emotional support from health professionals (62.3% vs. 100%; chi square=31.18, df=1, p=.07). Conclusions: The guide presented here constitutes a useful material to improve communication of these conditions and its treatment among Hispanic women with low level of education (AU)

Factors influencing histological response after neoadjuvant chemoradiation therapy for rectal carcinoma.

Neoadjuvant chemoradiation therapy is one of the standard therapeutic regimens for rectal carcinoma. Nevertheless, chemoradiation therapy is not completely devoid of adverse effects, and it would be interesting to try to predict which patient will respond to neoadjuvancy. This study aimed at analyzing factors influencing pathological response after therapy. We reviewed the clinical and morphological data of 39 patients after neoadjuvant chemoradiation therapy. We performed immunohistochemistry for p53, cyclin D1, MIB-1 (Ki67), and bcl-2 protein in paraffin-embedded tissue. In our series, 12 patients did not respond to neoadjuvant therapy, 12 showed a complete response, and 15 a partial response. There was a statistically significant association between response and cardiomyopathy (p=0.02) and tenesmus (p=0.02) and a trend towards significance for age (p=0.08), preoperative TNM (p=0.08), peritumoral inflammatory response (p=0.07), and preoperative CEA (p=0.08). As for immunohistochemistry, we only found a trend towards significance for cyclin D1 (p=0.08). In our series of patients with rectal carcinoma receiving preoperative chemoradiation therapy, few factors were predictive of a histological response. The histological response seems to improve survival and reduce relapses.

Vaginosis bacteriana: aspectos colposcópicos / Bacterial vaginosis: colposcopic aspects

Determinar mediante los criterios de Amsel, la vaginosis bacteriana en las pacientes estudiadas y definir los aspectos colposcópicos más frecuentes asociados a esta patología. Estudio descriptivo y transversal de pacientes que acudieron a la consulta de ginecología por leucorrea. A las pacientes que presentaron vaginosis bacteriana, se les realizó la evaluación colposcópica. Para el análisis estadístico de variables no paramétricas se aplicó la prueba de hipótesis de proporción. Departamento de Obstetricia y Ginecología, Hospital Universitario “Antonio Patricio de Alcalá ”, Cumaná. Se encontraron 65 pacientes con vaginosis bacteriana y en la evaluación colposcópica de la misma, lo más frecuente fue la colpitis a puntos finos rojos, difusa, con un patrón vascular de capilar simple y a la prueba de lugol, la imagen colposcópica fue el caoba irregular con 82 por ciento (P<0,05), estadísticamente significativo. El aspecto colposcópico característico de la vaginosis bacteriana con un patrón vascular capilar simple es la colpitis a puntos finos rojo difusa y a la prueba de lugol caoba irregular.

Uso de métodos anticonceptivos en un centro de planificación familiar / Use of contraceptive methods in a family planning clinic

Objetivo: Conocer los métodos anticonceptivos que eligen las usuarias, la adhesión al tratamiento tras un año y los motivos del cambio. Material y métodos: Estudio retrospectivo, mediante revisión de historias clínicas en el Centro de Planificación Familiar de Oviedo de usuarias que acudieron por primera vez entre enero de 2005 y enero de 2006. La muestra final fue de 585 pacientes. Se analizó la edad, el método usado antes de la consulta, el método elegido, el usado al año y el motivo de abandono o cambio. Resultados: El 61% de las usuarias estaba usando el preservativo y un 22% usaba la píldora combinada. Tras la primera consulta y al año, los métodos hormonales combinados eran usados por el 75% de las jóvenes menores de 30 años (píldora combinada el 41%, anillo vaginal el 11% y parche el 7%). A partir de los 40 años elegían como método el dispositivo intrauterino (DIU). El 82% continuó con el método tras el año. Del 18% que cambió, un 8% lo hizo por presentar efectos secundarios y un 6% por comodidad. Los cambios fueron más frecuentes entre las jóvenes menores de 20 años y por razones de comodidad. Conclusiones: Cada edad tiene sus métodos, dadas las características de éstos. La píldora combinada sigue siendo el método más usado de los anticonceptivos hormonales combinados. El DIU de levonorgestrel tiende a igualarse en uso con el DIU de cobre en las usuarias mayores de 40 años. La información recibida acerca de la anticoncepción a usar es la clave de la adhesión al tratamiento

Objective: To identify the contraceptive methods chosen by users, treatment adherence after 1 year, and the reasons for changing methods. Material and methods: We performed a retrospective study through a review of the clinical histories in the Family Planning Clinic of Oviedo (Spain). Users who attended for the first time between January 2005 and January 2006 were included. The final sample consisted of 585 users. The main measurements were age, the method used before the consultation, the method chosen, the method used 1 year later, and the reason for discontinuance or changing method. Results: Sixty-one percent of users were using the contraceptive sheath and 22% used the combined pill. After the first consultation and 1 year later, combined hormonal contraception was used by 75% of the users younger than 30 years (pill in 41%, vaginal ring in 11%, patch in 7%). Users aged more than 40 years old chose the intrauterine device. Eighty-two percent of the users continued with the same method after 1 year. Among the 18% that changed methods, 8% did so due to adverse effects and 6% for reasons of convenience. Changes were more frequent among users aged less than 20 years and were due to convenience. Conclusions: Each age has its own methods, because each method has its characteristics. The combined pill continues to be the most widely used method within the group of combined hormonal contraceptives. Among users aged more than 40 years, the levonorgestrel intrauterine device (IDU) and the copper IDU are equally used. The information received on the contraception to be used is the key to treatment adherence

Adenomiomas de la vía biliar. Presentación de once casos / Adenomyomas of the bile duct. Report of eleven cases

Presentamos los adenomiomas encontrados en nuestro servicio tras una cirugía de las vías biliares. Pacientes y método. Se trata de 11 pacientes intervenidos entre 1990 y 2002, 5 varones y 6 mujeres de 44-71 años (media de edad, 53,3 años). Las pruebas de imagen previas a la cirugía se basan en la ecografía, la tomografía computarizada (TC) abdominal y la colangiopancreatografía retrógrada endoscópica (CPRE). Los tumores se localizaron en el fondo de la vesícula biliar en 9 casos, en el colédoco distal en 1 caso y en el conducto cístico en otro; esta última localización es extremadamente rara y no hemos encontrado ningún caso descrito en la bibliografía. Clínicamente, cursa con dolor tipo cólico y se observa un hídrops vesicular en las pruebas de imagen. En algunos pacientes, los adenomiomas se asociaban a otra enfermedad biliopancreática: colelitiasis en 8, coledocolitiasis en 2, colecistitis en 8, colesterolosis en 2, hepatocolangiocarcinoma en 1 e historia de pancreatitis aguda por asociación a colelitiasis en 2 pacientes. Resultados. Todos los pacientes fueron intervenidos quirúrgicamente realizando una duodenopancreatectomía cefálica debido a las dudas en cuanto a la malignidad del tumor; asimismo, se efectuaron 10 colecistectomías, simples en 7 casos, ampliada a la totalidad del conducto cístico y tejido linfograso adyacente en un paciente, asociada a una hepatectomía izquierda por hepatocolangiocarcinoma en un caso y asociada a coledocotomía y extracción de cálculos por coledocolitiasis en otro caso. Conclusiones. Los adenomiomas que se localizan en la vesícula biliar se asocian a colelitiasis y colecistitis crónica. Se presentan como formas localizadas y difusas. Si se localizan en el resto de la vía biliar cursan con cuadro de ictericia obstructiva, y si se localizan en el conducto cístico presentan dolor tipo cólico e hídrops, aunque esta localización es excepcional (AU)