Chloride Conductance,Nasal Potential Difference and Cystic Fibrosis Pathophysiology

Purpose

Cystic fibrosis (CF) is a multisystem genetic disease caused by dysfunction of the epithelial anionic channel Cystic Fibrosis Transmembrane conductance Regulator (CFTR). Decreased mucociliary clearance because of thickened mucus is part of the pulmonary disease pathophysiology. It is controversial if the thickened airway surface liquid (ASL) is caused by the deficient chloride secretion and excessive sodium (through ENaC) and water hyperabsorption from the periciliar fluid or by the lack of bicarbonate secretion with relative acidification of the ASL. Correlations between the magnitude of in vivo chloride conductance with phenotypic characteristics and CF genotype can help to elucidate these mechanisms and direct to new treatments.

Methods

Nasal potential difference was measured in 28 CF patients (age from 0.3 to 28 year) and correlated with pulmonary function, pancreatic phenotype, pulmonary colonization and genotype severity.

Results

The CFTR-chloride conductance was better in older patients (r = 0.40; P = 0.03), in patients with better pulmonary function (r = 0.48; P = 0.01), and was associated with genotype severity. Higher chloride diffusion in the presence of a favorable chemical gradient was associated with Pseudomonas aeruginosa negativity (P < 0.05). More negative NPDmax was associated with pancreatic insufficiency (P < 0.01) as well with genotype severity, but not with the pulmonary function.

Conclusions

The anion permeability through CFTR, mainly chloride, but bicarbonate as well, is the most critical factor in CF airway pathophysiology. Treatments primarily directed to correct CFTR function and/or airway acidity are clearly a priority.

     

Efficacy of Glutamine in the Prevention of Acute Radiation Enteritis

Background: Acute radiation enteritis is a common adverse effect related to radiotherapy (RT). Glutamine is an immune modulator and antioxidant amino acid that can exert a protective role in patients receiving abdominal or pelvic radiation. The aim of this study was to test if glutamine prevents radiation enteritis during RT. Materials and Methods: Double‐blind, randomized, controlled trial including 69 patients who needed RT because of pelvic or abdominal malignancies and received glutamine (30 g/d) or placebo (casein, 30 g/d). Enteritis was evaluated according to the Radiation Therapy Oncology Group scale, intestinal inflammation using fecal calprotectin, and gut integrity with citrulline. The incidence of enteritis was analyzed by Kaplan‐Meier curves, and the hazard ratio (HR) was calculated using Cox regression. Results: Patients were predominantly male (65.2%), with an average (SD) age of 66.6 (9.9) years, with urologic (44.9%), rectal (24.6%), or gynecological cancer (23.1%). More patients developed enteritis with glutamine than with the placebo (55.9% vs 22.0%; P = .002), with an HR of 1.59 (95% confidence interval, 0.62–4.05). There were no differences in final calprotectin levels (glutamine, 57.9 [85.8] mg/kg vs placebo, 54.0 [57.7] mg/kg; P = .182) or the number of patients with values >50 mg/kg (glutamine, 58.1% vs placebo, 54.6%; P = .777). Final citrulline levels were similar between groups (glutamine, 26.31 [10.29] mmol/L vs placebo, 27.69 [12.31] mmol/L; P = .639), without differences in the number of patients with <20 mmol/L (glutamine, 24.1% vs placebo, 25.0%; P = .938). Citrulline concentration was reduced during RT with placebo but remained unchanged with glutamine. Conclusion: Glutamine does not prevent the development of enteritis during RT.     

Efectividad de un programa multicomponente para dejar de fumar aplicado en atención primaria

Objective

To evaluate the effectiveness of a multicomponent program applied by nurses in primary care.

Method

A non-experimental pre-post study was carried out in 145 smokers from Area V of Asturias (Spain). The intervention consisted of a multicomponent group treatment program, applied for 7 weeks by primary care nurses.

Results

The mean age was 52 years. Men accounted for 39.73% of the study population. The abstinence rate at post-treatment was 51.1% (95% CI: 42.4 to 59.6). At 12 months, the abstinence rate was 41.1% (95% CI: 32.6 to 49.6). The change between the end of the intervention and follow-up at 6 and 12 months was statistically significant at both time points (p = 0.035 and p = 0.013, respectively). Among participants who had stopped smoking, there was a statistically significant decline in daily cigarette consumption. Factors that were statistically significantly associated with continued smoking at 12 months were heavier smoking before the intervention, higher scores on the Fagerström test, and a lower number of sessions attended.

Conclusions

The multicomponent treatment program was highly effective. The results suggest the desirability of specific training for health professionals to implement this type of intervention in primary care as an alternative to medical advice for smokers who need it.     

Percepción de las trabajadoras inmigrantes del servicio doméstico sobre los efectos de la regulación del sector en España

Objective

To examine the perceptions of female immigrant domestic workers of the effect of Royal Decree 1620/2011, which regulates the relationship of domestic workers in the family home and their employment conditions in Spain.

Methods

An exploratory study was performed using qualitative content analysis of three focus group discussions with immigrant women from Colombia, Ecuador and Morocco.

Results

Immigrant women positively assessed the theoretical benefits of the new regulation, but identified legal and economic barriers to obtaining a contract and being registered in the social security system by their employers, and to employers accepting the cost of these measures, especially for workers hired by the hour. These difficulties affected their possibilities of legalizing their status. The economic crisis posed a serious challenge to compliance with the new regulation.

Conclusions

Although the new regime encourages job creation with stronger working rights for these workers, immigrant women perceived that its implementation has been hampered by the current financial crisis and has not, therefore, improved their employment conditions.     

Diseño y características de los participantes de un programa para el desarrollo positivo de escolares (Medellín,Colombia)

The design of the program for the promotion of personal potential and prevention of risky health behaviors in school-aged children, PILAS! Better Adults, Better Kids, was based on local and international evidence on programs for the prevention of school-based violence. The program offers a training process for parents and teachers through active methodologies and advice (provided for 10 months) based on topics that encourage individual child development and the delegitimization of violence in everyday interactions. A total of 306 teachers, 800 parents and 12,800 children benefited from the program. An initial measurement was conducted using a scale ranging from 0 to 100 in a sample of 1751 children. The results showed an average of 80 in the children's social skills, but caregivers reported high levels of aggression. Communication and supervision failures were found among parents, as well as punishment practices through psychological and physical aggression. Another finding was low social cohesion in the neighborhood.     

Risk factors for absenteeism due to sick leave in the petroleum industry

OBJECTIVE

To identify risk factors for absenteeism among workers with sick leave in an oil company.

METHODS

A case-control study (120 cases and 656 controls) nested in a retrospective cohort study following up all employees of an oil company in the North-Northeast of Brazil from 2007 to 2009. The response variable used to represent absenteeism with sick leave was the average incidence of sick leave, defined as the ratio between total sick days and potential working days in the period. Logistic regression techniques were used to investigate the association between average incidence of sick leave > 5.0% over the period and the variables sex, position, age, time at work, shift work, smoking, arterial hypertension, body mass index, physical activity, coronary risk, sleep, glycemia, non-managed diabetes, cardiovascular, digestive, musculoskeletal, neurological and neoplastic diseases, straining body positioning during work, satisfaction at work, relationship with management, and concentrated attention at work.

RESULTS

Average incidence of sick leave higher than 5.0% in the cohort period was 15.5%. The logistic model revealed that workers with average incidence of sick leave higher than 5.0% were 2.6 times more likely to be female; 2.0 time more likely to be smokers; 1.8 time more likely to be former smokers; 2.2 times more likely to report abnormal sleep and 10.5 times more likely to report dissatisfaction with their than workers with average incidence of sick leave ≤ 5.0% in the period.

CONCLUSIONS

In this population, female gender, being a smoker or a former smoker, reporting dissatisfaction with the job and reporting abnormal sleep are good predictors of occupational absenteeism with sick leave.     

Model for the evaluation of drug-dispensing services in primary health care

OBJECTIVE

To develop a model for evaluating the efficacy of drug-dispensing service in primary health care.

METHODS

An efficacy criterion was adopted to determine the level of achievement of the service objectives. The evaluation model was developed on the basis of a literature search and discussions with experts. The applicability test of the model was conducted in 15 primary health care units in the city of Florianópolis, state of Santa Catarina, in 2010, and data were recorded in structured and pretested questionnaires.

RESULTS

The model developed was evaluated using five dimensions of analysis for analysis. The model was suitable for evaluating service efficacy and helped to identify the critical points of each service dimension.

CONCLUSIONS

Adaptations to the data collection technique may be required to adjust for the reality and needs of each situation. The evaluation of the drug-dispensing service should promote adequate access to medications supplied through the public health system.     

Immunogenicity and protective efficacy of yeast extracts containing rotavirus-like particles: A potential veterinary vaccine

Rotavirus is the most common cause of severe diarrhea in many animal species of economic interest. A simple, safe and cost-effective vaccine is required for the control and prevention of rotavirus in animals. In this study, we evaluated the use of Saccharomyces cerevisiae extracts containing rotavirus-like particles (RLP) as a vaccine candidate in an adult mice model. Two doses of 1 mg of yeast extract containing rotavirus proteins (between 0.3 and 3 μg) resulted in an immunological response capable of reducing the replication of rotavirus after infection. Viral shedding in all mice groups diminished in comparison with the control group when challenged with 100 50% diarrhea doses (DD₅₀) of murine rotavirus strain EDIM. Interestingly, when immunizing intranasally protection against rotavirus infection was observed even when no increase in rotavirus-specific antibody titers was evident, suggesting that cellular responses were responsible of protection. Our results indicate that raw yeast extracts containing rotavirus proteins and RLP are a simple, cost-effective alternative for veterinary vaccines against rotavirus.