Evaluation of the new advanced 15-loci MIRU-VNTR genotyping tool in Mycobacterium tuberculosis molecular epidemiology studies

Background. During the last few years, PCR-based methods have been developed to simplify and reduce the time required for genotyping Mycobacterium tuberculosis (MTB) by standard approaches based on IS6110-Restriction Fragment Length Polymorphism (RFLP). Of these, MIRU-12-VNTR (Mycobacterial interspersed repetitive units- variable number of tandem repeats) (MIRU-12) has been considered a good alternative. Nevertheless, some limitations and discrepancies with RFLP, which are minimized if the technique is complemented with spoligotyping, have been found. Recently, a new version of MIRU-VNTR targeting 15 loci (MIRU-15) has been proposed to improve the MIRU-12 format. Results. We evaluated the new MIRU-15 tool in two different samples. First, we analyzed the same convenience sample that had been used to evaluate MIRU-12 in a previous study, and the new 15-loci version offered higher discriminatory power (Hunter-Gaston discriminatory index [HGDI]: 0.995 vs 0.978; 34.4% of clustered cases vs 57.5%) and better correlation (full or high correlation with RFLP for 82% of the clusters vs 47%). Second, we evaluated MIRU-15 on a population-based sample and, once again, good correlation with the RFLP clustering data was observed (for 83% of the RFLP clusters). To understand the meaning of the discrepancies still found between MIRU-15 and RFLP, we analyzed the epidemiological data for the clustered patients. In most cases, splitting of RFLP-clustered patients by MIRU-15 occurred for those without epidemiological links, and RFLP-clustered patients with epidemiological links were also clustered by MIRU-15, suggesting a good epidemiological background for clustering defined by MIRU-15. Conclusion. The data obtained by MIRU-15 suggest that the new design is very efficient at assigning clusters confirmed by epidemiological data. If we add this to the speed with which it provides results, MIRU-15 could be considered a suitable tool for real-time genotyping.

Influencia de sobrepeso y obesidad sobre la infertilidad: Plan de cuidados y programa educacional

The scientific evidence, demonstrates that the obesity reduces the possibility that a woman, conceive naturally and diminishes the success of the treatment for the fertility. Nurses of the Unit of Attended Reproduction and of the Units of Nutrition and Dietary, they consider necessary to design an educational program of Formation and Information, to change attitudes related with the overweight and the obesity, in even not fertile. The strategy of this Program is based in the control and reduction of the weight, assuring the adhesion to the treatment of fertility, with interactive works shops for the change of alimentary habits, giving emotional support and indications to practice adapted physical exercise. This Nursing Intervention is applied like one tool that develops abilities for the learning and training; never using diets or products of the denominated miracle. The narrow collaboration and investigating participation among the nurses of these Units, bear the design of a methodology channeled to the obtaining of some prospective results that can be evaluated regarding the obtained results.

Construcción y validación de un cuestionario para medir conductas, conocimientos y actitudes sobre la higiene de las manos en personal sanitario en formacion.

Background: Hand hygiene in the health context is a complex behaviour. There have been rarely given the role of the knowledge and attitudes as predictors of hand hygiene behaviour. The main objective of this work is the description of the development of a questionnaire on hand hygiene and the analysis of their measurement properties. Method: An instrument which was designed and validated a questionnaire. It was held in January 2009. It finally has had 50 items that assess risk behaviour intention before and after contact with the patient, declarative knowledge and attitudes about hand hygiene. It has been applied to 431 students of health sciences at the University of Granada. Results: There were three factor analysis, ultimately obtaining a general convergence value that explains 46.01% of the total variance and high reliability (a=0,843). There is correlation between knowledge and behavior intentions before and after patient contact (p <0.01).In turn, the attitude correlates only with behavioral intention before (p <0.05). The hand hygiene behavior refers to a higher mean after the completion of various health activities before the same (4.26 and 3.96 respectively). Both declarative knowledge and attitudes significantly predict behavioral intention, in particular the conduct before the contact with the patient (R2 = 0.100, standardized Beta 0.256 for knowledge and 0.145 for attitudes). Conclusions: The questionnaire shows high internal consistency. We have obtained a valid tool for assessing risk behavior, knowledge and attitudes about students’ hand hygiene in health sciences. The tool detects deficiencies in basic skills in students.

8-weeks training program attenuates mitochondrial oxidative stress in the liver of emotionally stressed rats

In recent years it has been shown that emotional stress induced by immobilization may change the balance between pro-oxidant and antioxidant factors inducing oxidative damage. On the other hand, contradictory views exist concerning the role of physical activity on redox metabolism. Consequently, the present work was designed to assess the influence of an 8-week moderate swimming training program in emotionally stressed rats. Sixty 1-month-old male albino Wistar rats weighing 125-135 g were used in this experimental study. They were divided into three groups, as Control (lot A; n=20), Stressed (lot B; n=20) and Stressed & Exercised (lot C; n=20). Rats were stressed by placing the animals in a 25 x 7 cm plastic bottle 1 h/day, 5 days a week for 8 weeks. Protein carbonyl content values in liver homogenates were significantly increased in stressed animals (0.58+/-0.02 vs 0.86+/-0.03; p=0.018) which clearly indicated that emotional stress was associated with oxidative stress. Ultrastructural alterations, predominantly mitochondrial swelling and the decrease of cristae number observed by electron microscopy represented direct evidence of membrane injury. The most striking feature of our study was that we also found differences between stressed rats and stressed rats that performed our 8 week training program. Consequently our results highlight the potential benefit of a moderate training program to reduce oxidative damage induced by emotional stress since it attenuated protein oxidation and mitochondrial alterations.

Validation of a new tool to assess health-related quality of life in psoriasis: the PSO-LIFE questionnaire.

BACKGROUND Several questionnaires have been used to measure health related quality of life (HRQoL) in patients with psoriasis, few have been adapted for use in Spain; none of them was developed specifically for the Spanish population. The purpose of the study was to validate and assess the sensitivity to change of a new questionnaire to measure HRQOL in patients with psoriasis (PSO-LIFE). METHODS Observational, prospective, multicenter study performed in centers around Spain. Patients with active or inactive psoriasis completed the PSO-LIFE together with other Dermatology Quality of Life Index (DLQI) and Psoriasis Disability Index (PDI). A control group of patients with urticaria or atopic dermatitis was also included. Internal consistency and test-retest reliability of the PSO-LIFE were assessed by calculating Cronbach's alpha and Intraclass Correlation Coefficient (ICC). Validity was assessed by examining factorial structure, the capacity to discriminate between groups, and correlations with other measures. Sensitivity to change was measured using effect sizes. RESULTS The final sample included for analysis consisted of 304 patients and 56 controls. Mean (SD) age of psoriasis patients was 45.3 (14.5) years compared to 38.8 (14) years for controls (p < 0.01). Cronbach's alpha for the PSO-LIFE was 0.95 and test-retest reliability using the ICC was 0.98. Factor analysis showed the questionnaire to be unidimensional. Mean (SD) PSO-LIFE scores differed between patients with psoriasis and controls (64.9 [22.5] vs 69.4 [17.3]; p < 0.05), between those with active and inactive disease (57.4 [20.4] vs 76.4 [20.6]; p < 0.01), and between those with visible and non-visible lesions (63.0 [21.9] vs. 74.8 [23.9]; p < 0.01). The correlation between PSO-LIFE and PASI scores was moderate (r = -0.43) while correlations with DLQI and PDI dimensions ranged from moderate to high (between 0.4 and 0.8). Effect size on the PSO-LIFE in patients reporting 'much improved' health status at study completion was 1.01 (large effect size). CONCLUSIONS The present results provide substantial support for the reliability, validity, and responsiveness of the PSO-LIFE questionnaire in the population for which it was designed.

Graph based study of allergen cross-reactivity of plant lipid transfer proteins (LTPs) using microarray in a multicenter study.

The study of cross-reactivity in allergy is key to both understanding. the allergic response of many patients and providing them with a rational treatment In the present study, protein microarrays and a co-sensitization graph approach were used in conjunction with an allergen microarray immunoassay. This enabled us to include a wide number of proteins and a large number of patients, and to study sensitization profiles among members of the LTP family. Fourteen LTPs from the most frequent plant food-induced allergies in the geographical area studied were printed into a microarray specifically designed for this research. 212 patients with fruit allergy and 117 food-tolerant pollen allergic subjects were recruited from seven regions of Spain with different pollen profiles, and their sera were tested with allergen microarray. This approach has proven itself to be a good tool to study cross-reactivity between members of LTP family, and could become a useful strategy to analyze other families of allergens.

Expectations, experiences and attitudes of patients and primary care health professionals regarding online psychotherapeutic interventions for depression: protocol for a qualitative study.

BACKGROUND In the year 2020, depression will cause the second highest amount of disability worldwide. One quarter of the population will suffer from depression symptoms at some point in their lives. Mental health services in Western countries are overburdened. Therefore, cost-effective interventions that do not involve mental health services, such as online psychotherapy programs, have been proposed. These programs demonstrate satisfactory outcomes, but the completion rate for patients is low. Health professionals' attitudes towards this type of psychotherapy are more negative than the attitudes of depressed patients themselves. The aim of this study is to describe the profile of depressed patients who would benefit most from online psychotherapy and to identify expectations, experiences, and attitudes about online psychotherapy among both patients and health professionals that can facilitate or hinder its effects. METHODS A parallel qualitative design will be used in a randomised controlled trial on the efficiency of online psychotherapeutic treatment for depression. Through interviews and focus groups, the experiences of treated patients, their reasons for abandoning the program, the expectations of untreated patients, and the attitudes of health professionals will be examined. Questions will be asked about training in new technologies, opinions of online psychotherapy, adjustment to therapy within the daily routine, the virtual and anonymous relationship with the therapist, the process of online communication, information necessary to make progress in therapy, process of working with the program, motivations and attitudes about treatment, expected consequences, normalisation of this type of therapy in primary care, changes in the physician-patient relationship, and resources and risks. A thematic content analysis from the grounded theory for interviews and an analysis of the discursive positions of participants based on the sociological model for focus groups will be performed. DISCUSSION Knowledge of the expectations, experiences, and attitudes of both patients and medical personnel regarding online interventions for depression can facilitate the implementation of this new psychotherapeutic tool. This qualitative investigation will provide thorough knowledge of the perceptions, beliefs, and values of patients and clinicians, which will be very useful for understanding how to implement this intervention method for depression.

Development of a new tool for assessing health-related quality of life in patients with primary hyperparathyroidism.

BACKGROUND Several studies in recent years have evaluated Health Related Quality of Life (HRQoL) of patients with primary hyperparathyroidism (PHPT). No disease specific questionnaires are available to assess the impact of the disease. The aim of this research is to describe the development of a new disease specific Quality of Life (QoL) questionnaire for use specifically with PHPT patients. METHODS A conceptual model was developed describing the impact of the disease and its symptoms on QoL domains. A literature review was conducted to identify the most relevant domains. A focus group with experts was used to validate the domains; 24 patients were also interviewed to complement the information from the patient's perspective. A content analysis of the interviews was performed to identify items related with the impact of the disease, leading to PHPQoL-V.1 which was presented to a sample of 67 patients. Reliability was assessed by Cronbach's coefficient alpha and item-total score correlations. Validity was assessed by a factor analysis performed to determine the number of domains. Rasch analysis was carried out in order to refine the questionnaire items. RESULTS 259 items were extracted from the interviews that were subsequently reduced to 34 items. Cronbach's coefficient alpha was 0.92. The factor analysis extracted two domains (physical and emotional). After Rasch analysis the questionnaire PHPQoL-V.2 kept 16 items (9 physical and 7 emotional). The questionnaire was developed in a Spanish population and the final version was translated to English through translation and back-translation. CONCLUSION The first disease specific HRQoL questionnaire for PHPT patients (PHPQoL-16) has been developed. Validation studies designed to assess measurement properties of this tool are currently underway.

El blog y otras herramientas comunicativas de la biblioteca del Área de Gestión Sanitaria Este de Málaga - Axarquía

In 2006 the Library of the Andalusian Public Health System (BVSSPA) is constituted as a Virtual Library which provides Resources and Services that are accessed through inter-hospital local area network (corporate intranet) and Internet. On the other hand, the Hospital de la Axarquia still did not have any institutional or self-presence on the Internet and the librarian ask the need to create a space for communication with the "digital users" of the Library of the area through a website. MATERIALS AND METHODS. The reasons why we opted for a blog were: -It was necessary to make no financial outlay for its establishment. It allowed for great versatility, both in its administration and in its management by users. -The ability to compile on the same platform different Web 2.0 communication tools. Between different options available we chose Blogger Google Inc. The blog allowed entry to the 2.0 services or Social Web in the library. The benefits offered were many, especially the visibility of the service and communication with the user. 2.0 tools that have been incorporated into the library are: content syndication (RSS) which allowed users to stay informed about updates to the blog. Share documents and other multimedia as presentations through SlideShare, images through Flickr or Picasa, or videos (YouTube). And the presence on social network like Facebook and Twitter. RESULTS. The analysis of the activity we has been traking by Google Analytics tool, helping to determine the number of blog visits. Since its stablishment, on November 17th 2006, until November 29th 2010 the blog has received 15,787 visitors, 38,422 page views were consulted, at each visit on average 2.4 pages were consulted and each visit has an average stay at the site of 4'31''. DISCUSSION. The blog has served as a communication and information tool with the user. Since the creation of the blog we have incorporated technologies and tools to interact with the user. With all the tools used we have applied the concept of "open source" and the contents were generated from the activities organized in the Knowledge Management Unit from the anatomo-clinical sessions, the training activities, dissemination events, etc. The result has been the customization of library services, contextualized in the Knowledge Management Unit - Axarquia. In social networks we have shared information and files with the professionals and the community. CONCLUSIONS. The blog has allowed us to explore technologies that allow us to communicate with the user and the community, disseminate information and documents with the participation of users and become the "Interactive Library" we aspire to be.