Usefulness of vancomycin treatment individualization via Bayesian algorithms: a 5-year study in critical patients.

Aim: Compare two vancomycin dosing strategies in critical patients with methicillin-resistant Staphylococcus aureus (MRSA) infections, considering the heterogeneity of the dosing regimens administered and their implications for toxicity and efficacy. Materials & methods: Longitudinal retrospective observational study in two patient cohorts (standard dosing vs dosing via Bayesian algorithms). Results: The group of Bayesian algorithms received substantially higher and significantly heterogeneous doses, with an absence of nephrotoxicity. The speed of decrease observed in CRP and PCT was greater for the Bayesian strategy (p = 0.045 and 0.0009, respectively). Conclusion: Applying Bayesian algorithms to vancomycin dosage individualization allows for administering much higher doses than with standard regimens, facilitating a quicker clinical response in the absence of nephrotoxicity.

[Box: see text].

Brain lesions associated with eosinophilia. A useful clue for neurotoxocariasis. Report of one case / Lesiones cerebrales asociadas con eosinofilia. Una clave útil en neurotoxocariasis

ABSTRACT Neurotoxocariasis is uncommon. Its manifestations include events of meningitis, encephalitis and less frequently vasculitis, which manifest as headache, seizures, focalization, confusion, cognitive alterations and /or fever. Peripheral eosinophilia with clinical and neurological imaging elements, allow its early suspicion. We report a 48-year-old agricultural worker, admitted in our hospital for one week of gastrointestinal complaints, headache, progressive left hemiparesis and impaired consciousness. He had leukocytosis (13,530/μL) with peripheral eosinophilia (25%, absolute count 3,400 /μL). CSF analysis revealed no abnormalities and brain CT showed poorly defined hypodense lesions on subcortical areas and semioval centers. Magnetic resonance imaging showed multiple foci with increased signals predominantly in the white matter in both hemispheres, especially at frontal and occipital regions and at semioval centers. Lesions reinforced after paramagnetic contrast. Serological studies found specific IgG antibodies by ELISA against antigens of the genus Toxocara, which were confirmed by a positive IgG Western Blot. The patient was treated with albendazole (800 mg/d) for 14 days associated with parenteral and then oral corticosteroids with a favorable response and gradual complete recovery.

La neurotoxocariasis es infrecuente. Sus manifestaciones incluyen eventos de meningitis, encefalitis y con menor frecuencia vasculitis, que se manifiestan como cefalea, convulsiones, focalización, confusión, alteraciones cognitivas o fiebre. La eosinofilia periférica, junto a elementos clínicos e imágenes compatibles, permiten su sospecha. Informamos el caso de un trabajador agrícola de 48 años que ingresó por una semana de molestias gastrointestinales, cefalea, hemiparesia izquierda progresiva y deterioro de conciencia. Los exámenes revelaron leucocitosis (13.530/μL) con eosinofilia periférica (25%, recuento absoluto 3.400/μL). El análisis del LCR sin anomalías y la tomografía computada cerebral mostró lesiones hipodensas mal definidas en áreas subcorticales y centros semiovales. La resonancia magnética mostró múltiples focos con aumento de la señal predominantemente en la sustancia blanca en ambos hemisferios. Las lesiones presentaron refuerzo tras contraste paramagnético. Los estudios serológicos indicaron anticuerpos IgG específicos por ELISA contra antígenos del género Toxocara. El paciente fue tratado con albendazol (800 mg /día) durante 14 días asociado a corticoides con respuesta favorable y una recuperación gradual completa.

Improving the sensitivity of gastrointestinal helminth detection using the Mini-FLOTAC technique in wild birds.

High-performance-validated tests are essential for successful epidemiological monitoring, surveillance of parasitic infections, and comparative studies in wildlife populations. The Mini-FLOTAC is a novel flotation-based technique for the sensitive detection and quantification of gastrointestinal parasites that is recently being explored for use in wildlife. A limitation of any flotation-based copromicroscopic method is the selection of the flotation solution (FS), which might influence the performance of the test. However, no study has compared the influence of using different FS in the Mini-FLOTAC technique for parasite detection in wild birds. Here, we evaluated the diagnostic performance of the Mini-FLOTAC in three waterbird host species using two widely used FS: saturated salt (NaCl; specific gravity 1.20) and saturated zinc sulfate (ZnSO4; specific gravity 1.35). One hundred fresh fecal samples were analyzed for parasite fecal egg counts (FEC). Regardless of the host species, fecal samples evaluated with the Mini-FLOTAC method using ZnSO4 resulted in a significantly higher detection rate and higher FEC of strongylid, capillarid, cestode, and trematode parasites, than samples analyzed with the NaCl solution. Our concise study demonstrated the importance of using an appropriate FS for the identification of parasite eggs in wildlife species, especially in hosts with an expected aggregated distribution and low parasite load such as waterbird hosts. The higher analytical sensitivity of the Mini-FLOTAC technique achieved with ZnSO4, and its applicability to fieldwork, highlights this method as a promising tool for the quantitative surveillance of parasite infections in wild bird populations.

Parental Stress and Satisfaction in Parents With Pre-school and School Age Children.

Parenting is a transforming experience for the life of parents that brings joy and satisfaction as well as challenges, frustration, and demands. The aim of this study was to determine the relationship between "parental stress and satisfaction" and work-home conflict, perceived social support, and global satisfaction with life, and to determine the moderating role of the parent's gender. A sample of 244 participants was studied: 49.6% (121) mothers and 50.4% (123) fathers with children between 2 and 12 years of age. The data was analysed by means of multiple linear regression models and Beta regression for stress and parental satisfaction, respectively, and they were complemented with general and conditional dominance analyses to estimate the relevance of the predictors. Mothers presented higher levels of parental stress and satisfaction than fathers. Being female, having two children, and home-work conflict were predictors of a higher parental stress. Age was also a predictor, as younger parents and also those older than 37 years of age showed more parental stress. Having no partner and being male was associated to lower parental satisfaction. In conclusion, parental stress and satisfaction emerge as clearly differentiated dimensions of parenting experience. The gender gap in parental stress could be linked to the persistence of traditional roles regarding the care of the children, in agreement with the findings in other research.

Professors' Expectations About Online Education and Its Relationship With Characteristics of University Entrance and Students' Academic Performance During the COVID-19 Pandemic.

Due to COVID-19, universities have been facing challenges in generating the best possible experience for students with online academic training programs. To analyze professors' expectations about online education and relate them to student academic performance during the COVID-19 pandemic, and considering the socio-demographic, entry, and prior university performance variables of students. A prospective longitudinal design was used to analyze the expectations of 546 professors (54.8% male) in T1. In T2, the impact of the expectations of 382 of these professors (57.6% men) was analyzed, who taught courses during the first semester to a total of 14,838 university students (44.6% men). Professors' expectations and their previous experience of online courses were obtained during T1, and the students' academic information was obtained in T2. A questionnaire examining the Expectations toward Virtual Education in Higher Education for Professors was used. 84.9% of the professors were considered to have moderate to high skills for online courses. Differences in expectations were found according to the professors' training level. The professors' self-efficacy for online education, institutional engagement, and academic planning had the highest scores. The expectations of professors did not directly change the academic performance of students; however, a moderating effect of professor's expectations was identified in the previous student academic performance relationship on their current academic performance.

International Delphi Expert Consensus on Safe Return to Surgical and Endoscopic Practice: From the Coronavirus Global Surgical Collaborative.

OBJECTIVE: The aim of this work is to formulate recommendations based on global expert consensus to guide the surgical community on the safe resumption of surgical and endoscopic activities. BACKGROUND: The COVID-19 pandemic has caused marked disruptions in the delivery of surgical care worldwide. A thoughtful, structured approach to resuming surgical services is necessary as the impact of COVID-19 becomes better controlled. The Coronavirus Global Surgical Collaborative sought to formulate, through rigorous scientific methodology, consensus-based recommendations in collaboration with a multidisciplinary group of international experts and policymakers. METHODS: Recommendations were developed following a Delphi process. Domain topics were formulated and subsequently subdivided into questions pertinent to different aspects of surgical care in the COVID-19 crisis. Forty-four experts from 15 countries across 4 continents drafted statements based on the specific questions. Anonymous Delphi voting on the statements was performed in 2 rounds, as well as in a telepresence meeting. RESULTS: One hundred statements were formulated across 10 domains. The statements addressed terminology, impact on procedural services, patient/staff safety, managing a backlog of surgeries, methods to restart and sustain surgical services, education, and research. Eighty-three of the statements were approved during the first round of Delphi voting, and 11 during the second round. A final telepresence meeting and discussion yielded acceptance of 5 other statements. CONCLUSIONS: The Delphi process resulted in 99 recommendations. These consensus statements provide expert guidance, based on scientific methodology, for the safe resumption of surgical activities during the COVID-19 pandemic.

Brain lesions associated with eosinophilia. A useful clue for neurotoxocariasis. Report of one case.

Neurotoxocariasis is uncommon. Its manifestations include events of meningitis, encephalitis and less frequently vasculitis, which manifest as headache, seizures, focalization, confusion, cognitive alterations and /or fever. Peripheral eosinophilia with clinical and neurological imaging elements, allow its early suspicion. We report a 48-year-old agricultural worker, admitted in our hospital for one week of gastrointestinal complaints, headache, progressive left hemiparesis and impaired consciousness. He had leukocytosis (13,530/µL) with peripheral eosinophilia (25%, absolute count 3,400 /µL). CSF analysis revealed no abnormalities and brain CT showed poorly defined hypodense lesions on subcortical areas and semioval centers. Magnetic resonance imaging showed multiple foci with increased signals predominantly in the white matter in both hemispheres, especially at frontal and occipital regions and at semioval centers. Lesions reinforced after paramagnetic contrast. Serological studies found specific IgG antibodies by ELISA against antigens of the genus Toxocara, which were confirmed by a positive IgG Western Blot. The patient was treated with albendazole (800 mg/d) for 14 days associated with parenteral and then oral corticosteroids with a favorable response and gradual complete recovery.

Recovery of endoscopy services in the era of COVID-19: recommendations from an international Delphi consensus.

The COVID-19 pandemic has had a profound impact on provision of endoscopy services globally as staff and real estate were repurposed. As we begin to recover from the pandemic, a cohesive international approach is needed, and guidance on how to resume endoscopy services safely to avoid unintended harm from diagnostic delays. The aim of these guidelines is to provide consensus recommendations that clinicians can use to facilitate the swift and safe resumption of endoscopy services. An evidence-based literature review was carried out on the various strategies used globally to manage endoscopy during the COVID-19 pandemic and control infection. A modified Delphi process involving international endoscopy experts was used to agree on the consensus statements. A threshold of 80% agreement was used to establish consensus for each statement. 27 of 30 statements achieved consensus after two rounds of voting by 34 experts. The statements were categorised as pre-endoscopy, during endoscopy and postendoscopy addressing relevant areas of practice, such as screening, personal protective equipment, appropriate environments for endoscopy and infection control precautions, particularly in areas of high disease prevalence. Recommendations for testing of patients and for healthcare workers, appropriate locations of donning and doffing areas and social distancing measures before endoscopy are unique and not dealt with by any other guidelines. This international consensus using a modified Delphi method to produce a series of best practice recommendations to aid the safe resumption of endoscopy services globally in the era of COVID-19.

Impacto del maltrato infantil en la prevalencia de trastornos mentales en niños y adolescentes chilenos

RESUMEN Introducción: La mala salud mental está fuertemente asociada con la violencia interpersonal. El maltrato infantil es un problema cultural y global de salud pública que atenta contra los derechos de los niños. Objetivo: Examinar la asociación entre la experiencia de maltrato y presentación de trastornos mentales en niños y adolescentes. Material y Método: Estudio cuantitativo, no experimental, analítico de corte transversal, dirigido a niños y adolescentes chilenos. La muestra estuvo compuesta por 1558 participantes entre 4 y 18 años, el instrumento recolector de datos estuvo compuesto por la entrevista diagnóstica estructurada para niños, versión computarizada DISC-IV, un cuestionario de maltrato infantil y datos sociodemográficos. El análisis estadístico se realizó mediante regresión logística con el programa R versión 3. Resultados: En el grupo de los niños, los trastornos ansiosos y disruptivos prevalentes y subumbral se relacionaron con abuso sexual, maltrato psicológico y físico. En el grupo de los adolescentes, los trastornos del ánimo se asociaron con maltrato psicológico y abuso sexual, los trastornos disruptivos prevalentes y subumbrales se asociaron con todos los tipos de maltrato, y el trastorno por consumo de drogas se asoció con abuso sexual. Conclusión: Existe relación significativa entre el maltrato en sus diferentes categorías, especialmente abuso sexual con la expresión de trastornos mentales en niños y adolescentes. Es importante detectar tempranamente los niveles subumbrales para tratar de reparar el problema, educar a la población, procurar comunidades menos violentas y ambientes tranquilos para el crecimiento de niños y adolescentes.

ABSTRACT Introduction: Poor mental health is strongly associated with interpersonal violence. Child abuse is a cultural and global public health problem that violates children's rights. Objective: To examine the relation between experience of abuse and presence of mental disorders in children and adolescents. Materials and methods: Quantitative, non-experimental, cross-sectional analytical study, aimed at Chilean children and adolescents. The sample consisted of 1558 participants who were between 4 and 18 years old. The data-collection instrument included the Structured Diagnostic Interview for Children, computerized version DISC-IV, a child abuse questionnaire and sociodemographic data. Statistical analysis was performed by logistic regression using the R program version 3. Results: In the group of children, prevalent and sub-threshold anxiety and disruptive disorders were related to sexual abuse, psychological and physical abuse. In the adolescent group, mood disorders were associated with psychological and sexual abuse; prevalent and sub-threshold disorders were associated with all types of abuse, and drug use disorder was associated with sexual abuse. Conclusion: There is a significant relationship between abuse in its different categories, especially sexual abuse, and the occurrence of mental disorders in children and adolescents. It is important to detect early sub-threshold levels in order to try to solve the problem, educate the population, and have less violent communities and quiet environments for the growth of children and adolescents.

RESUMO Introdução: A saúde mental precária está fortemente associada à violência interpessoal. O abuso infantil é um problema cultural e global de saúde pública que compromete os direitos da criança. Objetivo: Examinar a associação entre a experiência de abuso e a apresentação de transtornos mentais em crianças e adolescentes. Material e Método: Estudo analítico quantitativo, não experimental, transversal, destinado a crianças e adolescentes chilenos. A amostra foi composta por 1558 participantes, entre 4 e 18 anos, o instrumento de coleta de dados foi composto pela Entrevista Diagnóstica Estruturada para Crianças, versão computadorizada DISC-IV, questionário de abuso infantil e dados sociodemográficos. A análise estatística foi realizada por meio de regressão logística com o programa R versão 3. Resultados: No grupo de crianças, os transtornos ansiosos e disruptivos prevalentes e abaixo do limiar estavam relacionados ao abuso sexual, psicológico e físico. No grupo de adolescentes, os transtornos do humor foram associados a abuso psicológico e abuso sexual, os transtornos disruptivos predominantes e inferiores ao limiar foram associados a todos os tipos de abuso, e o transtorno por uso de drogas foi associado ao abuso sexual. Conclusão: Existe uma relação significativa entre os abusos em suas diferentes categorias, principalmente o abuso sexual com a expressão de transtornos mentais em crianças e adolescentes. É importante detectar precocemente níveis inferiores ao limiar para tentar solucionar o problema, educar a população, para conseguir comunidades menos violentas e ambientes calmos para o crescimento de crianças e adolescentes.

Treatment of post-cholecystectomy biliary strictures with fully-covered self-expanding metal stents - results after 5 years of follow-up.

BACKGROUND: Endoscopic treatment of post-cholecystectomy biliary strictures (PCBS) with multiple plastic biliary stents placed sequentially is a minimally invasive alternative to surgery but requires multiple interventions. Temporary placement of a single fully-covered self-expanding metal stent (FCSEMS) may offer safe and effective treatment with fewer re-interventions. Long-term effectiveness of treatment with FCSEMS to obtain PCBS resolution has not yet been studied. METHODS: In this prospective multi-national study in patients with symptomatic benign biliary strictures (N = 187) due to various etiologies received a FCSEMS with scheduled removal at 6-12 months and were followed for 5 years. We report here long-term outcomes of the subgroup of patients with PCBS (N = 18). Kaplan Meier analyses assessed long-term freedom from re-stenting. Adverse events were documented. RESULTS: Endoscopic removal of the FCSEMS was achieved in 83.3% (15/18) of patients after median indwell of 10.9 (range 0.9-13.8) months. In the remaining 3 patients (16.7%), the FCSEMS spontaneously migrated and passed without complications. At the end of FCSEMS indwell, 72% (13/18) of patients had stricture resolution. At 5 years after FCSEMS removal, 84.6% (95% CI 65.0-100.0%) of patients who had stricture resolution at FCSEMS removal remained stent-free. In addition, at 75 months after FCSEMS placement, the probability of remaining stent-free was 61.1% (95% CI 38.6-83.6%) for all patients. Stent or removal related serious adverse events occurred in 38.9% (7/18) all resolved without sequalae. CONCLUSIONS: In patients with symptomatic PCBS, temporary placement of a single FCSEMS intended for 10-12 months indwell is associated with long-term stricture resolution up to 5 years. Temporary placement of a single FCSEMS may be considered for patients with PCBS not involving the main hepatic confluence. TRIAL REGISTRATION NUMBERS: NCT01014390; CTRI/2012/12/003166; Registered 17 November 2009.

Servicios de salud mental en contexto escolar / Health mental services within educational process

RESUMEN Introducción: Son escasos los servicios en salud mental dentro del contexto escolar que permitan una integración intersectorial para superar la brecha de falta de asistencia en salud mental en la población infanto - juvenil, aun cuando, es en la escuela donde se detectan mayoritariamente los problemas de salud mental. Objetivo: Comentar el uso de servicios de salud mental en el ambiente escolar en relación con los trastornos mentales y trastornos subumbrales. Método: El presente resultado se obtiene a partir del "Estudio de Prevalencia Comunitaria de Trastornos Psiquiátricos y Utilización de Servicios de la Población Infanto-Juvenil Chilena". La muestra estuvo representada por sujetos entre 4 y 18 años (N=1556). La información sobre el uso de servicio de salud mental se recogió con una versión modificada de la Escala Service Assesment for Children and Adolescent (SACA). Se realizó un modelo de regresión logística para analizar cinco áreas del uso de servicios en el ambiente escolar, las cuales se correlacionaron con diagnósticos de trastorno mentales y trastorno subumbral de ansiedad, disruptivo y depresión en el último año. Resultados: Las escuelas se enfrentan a grandes desafíos sobre cómo proporcionar apoyo efectivo de salud mental para los estudiantes, que presentan algún tipo de trastorno mental o trastorno subumbral. Discussión: Las instituciones educativas requieren ser visualizadas como una entidad que podría satisfacer las necesidades que se advierten de manera urgente en atención, prevención y promoción de problemas mentales en la población infanto- juvenil, si se vinculan de forma más directa con los servicios de salud mental.

ABSTRACT Introduction: Mental health services are scarce within the school context that allow intersectoral integration to overcome the gap in mental health care in the child and adolescent population, being the school where mental health problems are mostly detected. Objective: to know the use of mental health services in the school environment in relation to mental disorders and subthreshold disorders. Method: The present secondary study is carried out from the "Study of Community Prevalence of Psychiatric Disorders and Utilization of Services of the Chilean Child-Youth Population". The sample was represented by subjects between 4 and 18 years old (N = 1556). Information on the use of mental health service was collected with a modified version of the Service Assessment Scale for Children and Adolescents (SACA). A logistic regression model was performed to analyze five areas of the use of services in the school environment, which were correlated with diagnoses of mental disorders and subthreshold anxiety, disruptive and depression disorder in the last year. Results: Schools face great challenges on how to provide effective mental health support for students, who present some type of mental disorder or subthreshold disorder. Discusion: Educational institutions need to be visualized as an entity that could meet the needs that are urgently noticed in attention, prevention and promotion of mental problems in the child and adolescent population, if it is linked more directly with health services.

Child-to-parent Violence Questionnaire (CPV-Q): Validation among Spanish adolescents.

Background/Objective: Child-to-parent violence has generated great interest on the part of professionals and researchers in recent years. Consequently, there is a need to provide an assessment instrument that includes a wide range of child-to-parent violence behaviours and all of elements that define this type of violence. Thus, the purpose of the current study was to analyse the structure, reliability and validity of the CPV-Q, an instrument to assess child-to-parent violence behaviours, including the reasons for aggression against parents. Method: A total of 1,386 Spanish adolescents (55.2% females; M age = 14.7, SD = 1.7) were assessed using the CPV-Q. We obtained descriptive statistics of the items, the internal structure of the scale using both exploratory and confirmatory factor analysis, its reliability, and external evidence of its validity. Results: Data indicated a matrix of 4 factors with 14 parallel items (for the father and for the mother). Reasons for child-to-parent violence were grouped into instrumental and reactive reasons. Conclusion: The CPV-Q presents adequate psychometric properties; thus, it is proposed as a useful instrument to assess child-to-parent violence in both professional and research settings.

Antecedentes/Objetivo: La violencia filio-parental ha generado un gran interés por parte de profesionales e investigadores en los últimos años. En consecuencia, es necesario contar con un instrumento de evaluación que incluya un amplio rango de conductas de violencia filio-parental y todos los elementos que definen este tipo de violencia. De esta forma, el objetivo del presente estudio fue analizar la estructura, fiabilidad y validez del C-VIFIP, un instrumento para evaluar conductas de violencia filio-parental, incluyendo los motivos de las agresiones. Método: Se evaluó a un total de 1.386 adolescentes españoles (55,2% chicas; M edad = 14,7; DT = 1,7) con el C-VIFIP. Se obtuvieron los estadísticos descriptivos de los ítems, la estructura interna de la escala mediante análisis factorial exploratorio y confirmatorio, fiabilidad y evidencias externas de validez. Resultados: Los resultados indicaron una matriz de cuatro factores con 14 ítems paralelos (para el padre y para la madre). Los motivos de las agresiones se agruparon en instrumentales y reactivos. Conclusión: El C-VIFIP presenta adecuadas propiedades psicométricas, de forma que se propone como un instrumento útil para evaluar la violencia filio-parental, tanto en contextos profesionales como de investigación.

Cross-Cultural Adaptation of the Children's Emotion Regulation Processes Survey (CERP) in Chilean Preschoolers / Adaptação Transcultural do Questionário de Processos de Regulação Emocional (CERP) em Pré-Escolares Chilenos / Adaptación Transcultural del Cuestionario de Procesos de Regulación Emocional (CERP) en una Muestra de Preescolares Chilenos

Abstract Emotion regulation is an important aspect for the adaptation of human beings that influences their development and mental health. In actuality, it is an important challenge to have culturally valid instruments that allow to evaluate this construct. In this study, an analysis of the psychometric properties of the Children's Emotion Regulation Processes Survey (CERP) in a sample of Chilean preschoolers is presented. CERP is a third-party report questionnaire that assesses the strategies of emotion regulation in children, providing a vision based on development. The instrument was applied to mothers and fathers of 483 children, between the ages of 4 and 6 that attended preschool. Factorial structure, internal consistency and the relation with the Child Behavior Checklist (CBCL) as indicator of convergent validity was analyzed. The results showed a four factor structure, coherent with the empirical evidence. Also, all of the factors presented adequate reliability indexes and correlation with the internalization and externalization scales of CBCL. It is concluded that CERP exhibits positive reliability and validity indicators to be used in this population.

Resumo A regulação emocional é um aspecto de relevância para a adaptação dos indivíduos que influencia em seu desenvolvimento e saúde mental. Na atualidade, um desafio importante é contar com instrumentos válidos culturalmente que permitam avaliar este constructo. Neste estudo se apresenta a análise das propriedades psicométricas do Questionário de Processos de Regulação Emocional Infantil (CERP) em uma amostra de pré-escolares chilenos. O CERP é um questionário de relatórios de terceiros que avaliam estratégias de regulação emocional em crianças, entregando uma visão baseada no desenvolvimento. O instrumento foi aplicado a pais e mães de 483 crianças, entre 4 e 6 anos que cursavam a educação pré-escolar. Foi analisada a estrutura fatorial, consistência interna e o relacionamento com o Inventario de Condutas Infantis (CBCL) como indicador de validade convergente. Os resultados evidenciaram uma estrutura de quatro fatores, coerentes com a evidencia empírica. Além disso, todos os fatores apresentaram índices adequados de confiabilidade e correlações com as escalas de internalização e terceirização do CBCL. Se conclui que o CERP mostra indicadores de confiabilidade e validez positivos para serem usados nesta população.

Resumen La regulación emocional es un aspecto de relevancia para la adaptación de los individuos que influye en su desarrollo y salud mental. Actualmente, es un desafío contar con instrumentos válidos culturalmente para evaluar este constructo. En este estudio, se presenta el análisis de las propiedades psicométricas del Cuestionario de Procesos de Regulación Emocional Infantil (CERP) en una muestra de preescolares chilenos. El CERP es un cuestionario de reporte de terceros que evalúa las estrategias de regulación emocional en niños/as, entregando una visión basada en el desarrollo. Se aplicó el instrumento a padres y madres de 483 niños/as de edades entre 4 y 6 años que cursaban educación preescolar. Se analizó la estructura factorial, consistencia interna y relación con el Inventario de Conductas Infantiles (CBCL) como indicador de validez convergente. Los resultados evidenciaron una estructura de cuatro factores, coherentes con la evidencia empírica. Además, todos los factores presentaron adecuados índices de confiabilidad y correlaciones con las escalas de internalización y externalización del CBCL. Se concluye que el CERP muestra indicadores de confiabilidad y validez positivos para ser usado en esta población.

Variables asociadas al funcionamiento social en usuarios de hogares y residencias protegidas / Variables associated with the social performance of users in supported housing

RESUMEN Objetivo: Determinar las variables asociadas al funcionamiento social de usuarios que viven en hogares y residencias protegidas, en particular las características personales y clínicas de los residentes, factores del dispositivo residencial y de las áreas de salud a las que pertenecen. Material y método: Estudio descriptivo y correlacional cuya muestra estuvo compuesta por 122 residentes y 30 cuidadores de 15 hogares y 6 residencias protegidas. Se evaluó el desempeño social usando la Escala de Habilidades Básicas de la Vida Diaria que consta de 4 subescalas: autocuidado, habilidades domésticas, habilidades comunitarias, actividad y relaciones sociales. Para analizar los datos se utilizó un modelo lineal mixto. Resultados: En las subescalas de autocuidado, habilidades comunitarias y actividades y relaciones sociales, la varianza depende fundamentalmente de las características personales, en tanto en las habilidades domésticas el 47,6% corresponde a características del dispositivo y del área sanitaria. El nivel de restrictividad, el tiempo de permanencia en el dispositivo, el diagnóstico, la edad de los residentes y el apoyo social percibido fueron variables predictoras del funcionamiento social. Conclusión: El funcionamiento social de usuarios que viven en hogares y residencias está determinado, principalmente, por características individuales, sin embargo, variables del dispositivo y del área sanitaria tienen influencia dependiendo del tipo de habilidad social.

ABSTRACT Objective: Determine the variables associated with the social performance of users living in supported housing, in particular the personal and clinical characteristics of the residents, factors of the centre and of the health areas to which they belong. Method: Descriptive and correlational study whose sample consisted in 122 residents and 30 caregivers of 15 supported housing and 6 residential housing. Social performance was assessed through the Basic Everyday Living Skills Scale, which consisted of four sub-scales: self-care, domestic skills, community skills and activity and social relationships. In order to analyze the data, a mixed linear model was used. Results: In the sub-scales of self-care, community skills and activities and social relations the variance depends primarily on the personal characteristics. On the other hand, in the domestic skills 47.6% corresponds to centre characteristics and health area. The level of restrictiveness, time of residence in the facility, diagnosis of the users, age of residents and social support received corresponded to the statistically significant variables on the prediction of the social performance. Conclusion: Social performance of the users who live in supported housing is mainly determined by individual characteristics. However, variables of the centre and health area have a different weight depending on the type of social skill.

Autoeficacia cuestionario de autorregulación de estudio readiness / Questionário de autoeficácia para a autorregulação para estudar (readiness) / Self-efficacy questionnaire of the self-directed-learning readiness

La investigación ha demostrado la importancia de los instrumentos que miden la autoeficacia ligada a áreas de funcionamiento diferenciado, como el aprendizaje autorregulado. El objetivo de este trabajo fue proyectar y estudiar el comportamiento psicométrico del Cuestionario de Autoeficacia para la Autorregulación de la Disposición al Estudio. Se aplicó el instrumento, compuesto por nueve ítems, a una muestra por conveniencia de 695 estudiantes, en cinco universidades de la provincia de Concepción, CHILE. Mediante análisis factorial exploratorio, fue encontrada una estructura con un factor general (M=3.87; DE=0.65) y tres sub-factores, que fue demostrada en un análisis factorial confirmatorio. El instrumento muestra niveles adecuados de confiabilidad (α=0.84), una estructura latente con buen ajuste para los datos y correlaciones leves, pero estadísticamente significativas, con clasificaciones autoreferidas. Por lo tanto, el instrumento presenta propiedades psicométricas adecuadas para ser aplicadas en formato de auto-informe a distintos grupos de estudiantes. (AU)

A investigação tem demonstrado a importância dos instrumentos que medem a autoeficácia ligada às áreas de funcionamento diferencial, como a aprendizagem autorregulada. O objetivo deste trabalho é projetar e estudar o comportamento psicométrico do Questionário de Autoeficácia para a Autorregulação da Disposição para Estudar. O instrumento, composto por nove itens, foi aplicado em uma amostra por conveniência de 695 estudantes de cinco universidades da Província de Concepción, Chile. Por meio de análise fatorial exploratória, foi encontrada uma estrutura com um fator geral (M=3,87; DE=0,65) e três subfatores, a qual foi provada em uma análise fatorial confirmatória. O instrumento mostra níveis adequados de confiabilidade (α=0,84), uma estrutura latente com bom ajuste para os dados e as correlações leves, mas estatisticamente significativas, com classificações autorreferidas. Portanto, o instrumento apresenta propriedades psicométricas adequadas para serem aplicadas em formato de autorrelato, para diferentes grupos de alunos. (AU)

The investigation has demonstrated the importance of instruments that measure self-efficacy linked to areas of differential functioning, such as self-directed learning. The objective of this work is to design and study the psychometric behavior of the SelfEfficacy Questionnaire for Self-Directed-Learning. The instrument, composed of nine items, was applied to a convenience sample of 695 students from five universities in the province of Concepción, Chile. Through exploratory factor analysis, a structure with one general factor (M=3.87, SD=0.65) and three sub-factors was found, which was proved through confirmatory factor analysis. The instrument shows adequate levels of reliability (α=0.84), a latent structure with good fit for the data, and slight but statistically significant correlations with self-reported classifications. Therefore, the instrument has adequate psychometric properties to be applied in a self-report format for different groups of students. (AU)

Construcción y características psicométricas de la escala de estrategias de estimulación del autoconcepto académico / Escala de estratégias de estimulação do autoconceito acadêmico / Scale of strategies for stimulating academic self-concept

Se elaboró y se evaluó el comportamiento psicométrico de una escala de estrategias de estimulación del autoconcepto académico, asociada a comportamientos observados en la interacción profesor-alumno. Participaron del estudio 819 estudiantes de Eseñanza Primaria, de 16 escuelas de alta vulnerabilidad social, de la ciudad de Concepción, en Chile. La escala fue construída después de una revisión teórica, aplicación de dos pilotos con los alumnos y una validación interjueces. Los resultados del análisis factorial exploratorio indican que la escala final, con 15 preguntas, tiene una estructura de tres factores de primer orden (estrategias de capacidad, procedimientos de trabajo y de participación), que explican 66% de la varianza, con un factor de segundo orden con un omega jerárquico de 0,89. Esta estructura es corroborada por medio de un análisis factorial confirmatorio. Se observa validez concurrente con la subescala de autoestima escolar del Inventario de Autoestima de Coopersmith. (AU)

Elaborou-se e avaliou-se o comportamento psicométrico de uma escala de estratégias de estimulação do autoconceito acadêmico associada a comportamentos observáveis da interação professor-aluno. O estudo contou com a participação de 819 alunos do ensino fundamental de 16 escolas de alta vulnerabilidade social na cidade chilena de Concepción. A escala foi construída após uma revisão teórica, a aplicação de dois pilotos com os alunos e uma validação interjuízes. Os resultados de uma análise exploratória indicam que a escala final, com 15 perguntas, tem uma estrutura de três fatores de primeira ordem (estratégias de capacidade, de procedimentos de trabalho e de participação), que explicam 66% da variância, com um fator de segunda ordem com um ômega hierárquico de 0,89. Esta estrutura é corroborada por uma análise fatorial confirmatória. Observa-se validade concorrente com a subescala de autoestima escolar do Inventário de Autoestima de Coopersmith. (AU)

The objective of this study was to elaborate and evaluate behavioral psychometrics of a scale for stimulating academic self-concept strategies associated with observable teacher-student interaction behaviors. A total of 819 elementary students from 16 schools with high social vulnerability in the Chilean city of Concepción. The scale was constructed after a theoretical revision, the application of two pilot studies with the students, and an inter-judicial validation. Exploratory analysis results indicate that the final scale, with 15 questions, has a structure of three first-order factors (capacity, work procedures and participation strategies), which explain 66% of the variance, with a factor of second-order with a hierarchical omega of 0.89. This structure is corroborated by a confirmatory factor analysis. Concurrent validity is observed with the school self-esteem subscale of Coopersmith's Self-Esteem Inventory. (AU)

Cobertura de material de osteosíntesis interno expuesto en fracturas de pierna. Serie de casos / Cover of internal osteosynthesis material exposed in leg fractures: a series of cases

Introducción: Debido a factores intrínsecos y extrínsecos al paciente, las fracturas expuestas de las piernas son comunes y a menudo presentan lesiones de tejidos blandos complejas. Casos: Presentamos siete casos de pacientes masculinos, de los cuales seis sufrieron accidentes de tránsito y uno como secuela de herida por arma de fuego. Un paciente sufrió fractura en tercio proximal, cubierto con colgajo muscular de gemelo medial; cuatro en tercio medio, de los cuales en tres se usaron colgajos musculares hemisóleo y uno con colgajo fasciocutáneo sural inverso y por último dos de tercio distal que se cubrieron con colgajo sural. Discusión: En dos casos hubo necrosis parcial de colgajos que no requirieron cirugías complementarias. La consolidación de fracturas, en aquellas con tiempo de exposición corto, fue buena, mientras que en las de tiempo prolongado fue necesario recambio de material de fijación interna. En fracturas de pierna con material de fijación interna expuesto, se debe considerar tiempo menor a 15 días y conservar este material, siempre y cuando dispongan un protocolo de antibioticoterapia, limpieza quirúrgica y cobertura adecuada.

Introduction: Due to intrinsic and extrinsic factors to the patient, exposed leg fractures are common, and they are often accompanied by complex soft tissue injuries. Case report: We present seven cases of male patients, six injured in road traffic accidents and one with a gun shot trauma sequel. One had a fracture in the proximal third and coverage was made with medial gastrocnemius muscle flap; four had lesions in the middle third, three were treated with hemisoleus muscle flap and one with a reverse sural fasciocutaneous flap. The last two patients had compromised the distal third of their legs, both were covered with sural flap. Discusion: Two cases had partial flap necrosis but they did not require another surgery. Regarding fractures consolidation, outcome depended on exposure time, having better outcomes those with shorter times. Those with longer times required more often internal bone fixation procedures. Conclusions: In case of leg fractures with internal fixation material, exposed time should be taken into account. Patients with lap times shorter than 15 days could keep the material, as long as, an antibiotic prophylaxis scheme is followed. Otherwise, fixation material replacement is warranted.

Evaluación de la restrictividad de dispositivos residenciales para personas con un diagnóstico psiquiátrico en el modelo de Salud Mental Comunitaria en Chile / Assessment of the Restrictiveness of Supported Housing Services for People with Psychiatric Diagnosis in the Model of Community Mental Health in Chile

Los hogares y residencias protegidas son elementos centrales de la red asistencial que atiende a personas con un diagnóstico de trastorno mental severo, dentro del modelo de salud mental comunitaria. Este modelo tiene como uno de sus propósitos centrales estimular la autonomía y participación social de los usuarios. Se evaluó la restrictividad presente en estos dispositivos y factores asociados a su predicción. Se evaluaron 21 servicios residenciales mediante la escala de prácticas restrictivas, que se aplicó a un cuidador por lugar. Se observó que estos dispositivos poseen un nivel de restrictividad que limita la capacidad de los residentes para tomar decisiones en aspectos de su vida. Esta situación dificulta el empoderamiento y la participación de las personas en la comunidad.

Supported housing services are key elements of the healthcare network that serves people with a diagnosis of severe mental illness, within the community mental health model. This model has as a central purpose to stimulate both autonomy and social participation of users. The restrictiveness present in these centers and factors associated to their prediction was assessed. A total of 21 residential services were assessed by means of the scale of restrictive practices applied to one caregiver per place. It was observed that these services have a level of restrictiveness that limits the ability to make decisions of the residents respect to their lives. This situation hinders both empowerment and participation of people in their communities.

Construction and psychometric characteristics of the self-concept scale of interaction in the classroom.

BACKGROUND: Both construction and psychometric characteristics of a self-concept scale associated with observable behaviors by students and teacher, useful to guide a pedagogic intervention in the classroom are presented. METHOD: A total of 1,385 primary school students, aged between 8 and 12 years, from 24 high-social vulnerability schools of the Province of Concepción, Chile, participated in the study. The scale was constructed, including a theoretical review of the construct, pilot application with students and interjudge reliability. For the study of psychometric characteristics, exploratory factorial analysis (EFA), confirmatory factorial analysis (CFA), factorial invariance and recurrent validity were performed. RESULTS: A self-report instrument with 22 items shows a three-factor structure, with an explained variance of 44.71% and a high level of fi t for the model. CFA in two different samples showed fi t indicators for configural invariance. It also has concurrent validity. CONCLUSIONS: The scale has good psychometric properties to assess the academic self-concept in the dimensions of Capacity, Work Procedure, and Participation in class. This can be useful to guide an educational intervention in the context of the teacher-student interaction in the classroom, in primary schools with high socio-economic vulnerability.

Análisis psicométrico y adaptación de la Escala de Distancia Social (DS) en una muestra chilena / Psychometric analysis and adaptation of the Social Distance Scale (DS) in a Chilean sample

Antecedentes El estigma es uno de los obstáculos principales para la integración social de las personas con trastornos mentales. Objetivo Estudiar las propiedades psicométricas y adaptar la Escala de Distancia Social de Link (DS) en una muestra chilena. Ésta evalúa las actitudes públicas hacia personas con trastornos mentales mediante una viñeta seguida de un grupo de preguntas. Método Se tomaron dos muestras por conveniencia: la primera estuvo compuesta por 399 personas y la segunda por 350. La confiabilidad se evaluó por medio del coeficiente alfa de Cronbach. Para valorar su estructura factorial, se realizó un análisis factorial exploratorio con la primera muestra y uno confirmatorio con la segunda. Finalmente, se utilizó el coeficiente de correlación de Pearson para estudiar la validez concurrente con la Escala de Orientación a la Dominancia Social. Resultados Los resultados indican que el instrumento final posee dos factores "cercanía e interacción social", compuesto por tres reactivos, e "intimidad y confianza", compuesto por dos. A pesar de que las muestras tenían distinto nivel educativo, los índices de ajuste del modelo obtenido en el análisis factorial confirmatorio, así como la consistencia interna del instrumento, fueron adecuados. Discusión y conclusión La existencia de dos factores puede estar relacionada con el crecimiento del modelo de salud mental comunitaria en Chile, lo que ha impactado en la cantidad de dispositivos sanitarios y por tanto en la cercanía que se tiene sobre el tema. Los resultados obtenidos avalan la posibilidad de usar este instrumento en distintos grupos sociales.

Background Stigma is one of the major impairments to social integration of people with mental disorders. The present research was aimed to study the psychometric properties and adapt the Link's Social Distance Scale (SD) in a sample from Chile. This scale assessed the public attitudes toward people with mental disorders by means of a vignette, followed by a set of questions. Method A total of two samples by convenience were taken. The first sample consisted of 399 people and the second of 350. Reliability was assessed by means of the Cronbach's alpha coefficient. In order to validate its structure, an exploratory factor analysis of the first sample was conducted. Like waise, a confirmatory analysis was conducted with the second sample. Finally, the Pearson correlation coefficient was used to study the concurrent validity of the Orientation Scale to Social Dominance. Results Results indicate that the final instrument has two factors "proximity and social interaction," composed by three items, and "intimacy and confidence," composed by two. Despite the fact that the samples had different educational level, the adjustment indixes obtained from the confirmatory analyses, as well as the internal consistency of the instrument, were appropriate. Discussion and conclusion The existence of two factors can be related to the growth of the community mental health model in Chile. This has produced an impact on the amount of community centers and, therefore on the closeness on the subject. The results obtained support the possibility of using this instrument in different social groups.