Vacuna contra la COVID-19 y menstruación, desde el desconocimiento a la información: revisión sistemática / Vaccine against COVID-19 and menstruation, from ignorance to information: a systematic review

La creación de una vacuna para enfrentar la pandemia de COVID-19 conllevó un vacío de información sobre las posibles alteraciones del ciclo menstrual. El objetivo fue verificar las posibles alteraciones que se pudiesen haber generado en el ciclo menstrual de las mujeres posterior a la inoculación de la vacuna contra la COVID-19. Se realizó una revisión sistemática en las bases bibliografías Medline, Medline Complete, LILACS, CINAHL y ScIELO, utilizando los descriptores “Women”, “Woman”, “Fertile period”, “Vaccination”, “Mass vaccination”, “Immunization”, “COVID-19 vaccines”, “SARS-CoV-2 infection”, “COVID-19”, “Menstrual cycle”, “Menstruation”, “Endometrial cycle”, “Dysmenorrhea” y “Menstruation disturbances”. Mediante la utilización del protocolo PRISMA, de los 319 artículos localizados, 17 fueron incluidos en el análisis. La mayoría de los estudios incluyeron, principalmente, las vacunas Pfizer, Moderna, AstraZeneca y Johnson&Johnson/Janssen con una a tres dosis administradas. El porcentaje de ciclos menstruales alterados fue del 8,0% al 77,8%, y la alteración con mayor frecuencia referida fue la duración del ciclo menstrual, que fue desde 0,3 hasta 12 días de retraso de la menstruación. Todos los estudios refieren cambios en el ciclo menstrual con diversas prevalencias, con y sin significación estadística; sin embargo, también concluyen que estas alteraciones son reversibles y en un corto periodo de tiempo.

The creation of a vaccine to face the COVID-19 pandemic, led to an information gap on possible alterations of the menstrual cycle. The objective was to verify the possible alterations that could have been generated in the menstrual cycle of women, after the inoculation of the vaccine against COVID-19. A systematic review was carried out in the Medline, Medline Complete, LILACS, CINAHL and ScIELO bibliographic databases, using the descriptors “Women”, “Woman”, “Fertile period”, “Vaccination”, “Mass vaccination”, “Immunization”, “COVID-19 vaccines”, “SARS-CoV-2 infection”, “COVID-19”, “Menstrual cycle”, “Menstruation”, “Endometrial cycle”, “Dysmenorrhea” and “Menstruation disturbances”. Using the PRISMA protocol, of the 319 articles located, 17 were included in the analysis. Most of the studies mainly included the Pfizer, Moderna, AstraZeneca and Johnson&Johnson/Janssen vaccines with one to three doses administered. The percentage of altered menstrual cycles ranged from 8.0% to 77.8%, and the most frequently reported alteration was the length of the menstrual cycle, which occurred from 0.3 to 12 days late in menstruation. All the studies refer to changes in the menstrual cycle with different prevalences, with and without statistical significance; however, the same studies also conclude that these alterations are reversible and in a short period of time.

Influencia de la salud oral en la calidad de vida de los adultos mayores: una revisión sistemática

Objetivo: analizar cómo interfieren las diversas dimensiones de la salud oral en la calidad de vida de las personas mayores. Método: se realizó una revisión sistemática en las bases bibliográficas Medline, LILACS, SciELO y EBSCO Dentistry & Oral Sciences, para ello se utilizó la estrategia de búsqueda: aged OR aging AND "oral health" OR dentistry OR "geriatric dentistry" OR "dental care" OR "dental care for aged" OR "mouth diseases" OR "tooth diseases" OR "tooth loss" OR "facial pain" OR "oral hygiene" AND "quality of life" OR "health status" OR "self concept" OR "health services needs and demand" OR "personal satisfaction" OR "attitude to health" OR "risk factors" OR "age factors" OR "health status indicators" AND "sickness impact profile" OR "health surveys" OR "need essessment" OR "surveys and questionnaires" OR "reproducibility of results". Resultados: De los 1.356 registros identificados 14 artículos fueron incluidos para el análisis. Se evidenció, mediante la evaluación bucal clínica y las encuestas de autopercepción de la salud oral, que existe una asociación entre la salud oral y la calidad de vida de las personas mayores. Conclusiones: el deterioro de la calidad de vida de las personas mayores es causado, principalmente, por la pérdida de dientes.

Objective: To analyze how the various dimensions of oral health interfere with the quality of life of older adults. Method: a systematic review was carried out in the bibliographic databases Medline, LILACS, SciELO and EBSCO Dentistry & Oral Sciences using the search strategy: aged OR aging AND "oral health" OR dentistry OR "geriatric dentistry" OR "dental care" OR "dental care for aged" OR "mouth diseases" OR "tooth diseases" OR "tooth loss" OR "facial pain" OR "oral hygiene" AND "quality of life" OR "health status" OR "self concept" OR "health services needs and demand" OR "personal satisfaction" OR "attitude to health" OR "risk factors" OR "age factors" OR "health status indicators" AND "sickness impact profile" OR "health surveys" OR "need assessment" OR "surveys and questionnaires" OR "reproducibility of results". Results: Of the 1,356 records identified, 14 articles were included for the analysis. Clinical oral evaluation and oral health self-perception surveys demonstrated the association between oral health and quality of life in older adults. Conclusions: the deterioration of the quality of life of older adults is mainly caused by the loss of teeth.

Intervenciones efectivas para aumentar la duración y la exclusividad de la lactancia materna: una revisión sistemática / Effective interventions to increase the duration and exclusivity of breastfeeding: a systematic review

INTRODUCCIÓN: La lactancia materna según las recomendaciones de la Organización Mundial de la Salud, debería ser exclusiva por al menos los primeros 6 meses de vida del lactante. OBJETIVO: Evaluar la efectividad de las estrategias e intervenciones disponibles en la literatura científica actual, para aumentar la duración y exclusividad de la lactancia materna durante los primeros seis meses de vida del lactante. MÉTODO: Se realizó una revisión sistemática en las bases bibliografías CINAHL, Medline y Clinical Key, utilizando la estrategia de búsqueda "Mother-child relations" OR "Infant" OR "Newborn" AND "Lactation" AND "Breast feeding" OR "Breastfeeding duration" OR "Breastfeeding exclusive" OR "Interventions" AND "Best practices" OR "Evidence-based practice" OR "Evaluation of results of therapeutic interventions". RESULTADOS: De los 749 artículos localizados, 22 fueron incluidos en el análisis. Las estrategias identificadas para promover la lactancia materna se dividieron en 3 categorías según su entorno: las realizadas en los sistemas de salud, entornos domésticos o comunitarios y entornos múltiples. CONCLUSIÓN: Las estrategias e intervenciones que demostraron ser efectivas para aumentar la duración y exclusividad de la lactancia materna fueron las intervenciones multicomponentes, las iniciativas para capacitación de los profesionales de la salud y la estrategia "Hospital Amigo".

INTRODUCTION: Breastfeeding according to the recommendations of the World Health Organization, should be exclusive for at least the first 6 months of the nursling. OBJECTIVE: to evaluate the effectiveness of the strategies and interventions available in the current scientific literature, to increase the duration and exclusivity of breastfeeding during the first six months of the nursling. METHOD: A systematic review was carried out in the CINAHL, Medline and Clinical Key bibliography databases, using the search strategy "Mother-child relations" OR "Infant" OR "Newborn" AND "Lactation" AND "Breast feeding" OR "Breastfeeding duration" OR "Breastfeeding exclusive" OR "Interventions" AND "Best practices" OR "Evidence-based practice" OR "Evaluation of results of therapeutic interventions". RESULTS: Of the 749 articles found, 22 were included in the analysis. The strategies identified to promote breastfeeding were divided into 3 categories according to their setting: those carried out in health systems, home or community settings, and multiple settings. CONCLUSION: The strategies and interventions that proved to be effective in increasing the duration and exclusivity of breastfeeding were the multicomponent interventions, the initiatives for training health professionals and the "Friendly Hospital" strategy.

Obesidad pediátrica y aparición precoz de síndrome cardiometabólico: Revisión sistemática

RESUMEN Introducción: en las últimas décadas la obesidad pediátrica ha adquirido niveles epidémicos a nivel mundial. Objetivo: identificar evidencias científicas respecto de la obesidad pediátrica y su relación con la aparición precoz del síndrome cardiometabólico. Método: la investigación fue realizada mediante una revisión sistemática, entre enero y febrero de 2020, de las bases bibliografías MEDLINE, LILACS y ScIELO, utilizando los descriptores: "Child*", "Teen*", "Adolescent", "Pediatric Obesity", "Metabolic syndrome", "Cardiovascular diseases", "Arterial hypertension", "Insulin resistance", "dyslipidemias", "Glycosylated hemoglobin A", "HbA1". Resultados: de los 2.604 artículos localizados, 32 fueron incluidos en el análisis. La población de estudio fue de 56.761 niños y adolescentes entre 2 y 18 años. Más de la mitad de los estudios se realizaron en el continente americano y fueron principalmente de tipo transversal. En varias de estas investigaciones, los participantes o datos formaban parte de proyectos o encuestas de salud. La medición de los componentes del síndrome metabólico fue realizada, esencialmente, según la definición de la Organización Mundial de la Salud e International Diabetes Federation. Las variables más alteradas en niños y adolescentes con sobrepeso y obesidad fueron los parámetros antropométricos, bioquímicos y hemodinámicos. Conclusión: los estudios muestran la consolidación de la obesidad como factor de riesgo adquirido para la aparición de enfermedades metabólicas, pero lo más trascendental es la sólida evidencia encontrada de estudios de intervención, sobre la reversibilidad de las alteraciones patológicas como producto de una práctica de estilos de vida saludables.

ABSTRACT Introduction: In recent decades, pediatric obesity has reached epidemic levels worldwide. Objective: To identify scientific evidence regarding pediatric obesity and its relationship with early onset of cardiometabolic syndrome. Method: Research was carried out through a systematic review, between January and February 2020, of the MEDLINE, LILACS and ScIELO bibliographic databases, using the descriptors: "Child*", "Teen*", "Adolescent", "Pediatric Obesity", "Metabolic syndrome", "Cardiovascular diseases", "Arterial hypertension", "Insulin resistance", "dyslipidemias", "Glycosylated hemoglobin A", "HbA1". Results: Of the 2,604 articles located, 32 were included in the analysis. The study population was 56.761 children and adolescents between 2 and 18 years of age. More than half of the studies were carried out in the American continent and were mainly cross-sectional. In several articles, participants or data were part of health projects or surveys. The measurement of the components of the metabolic syndrome was carried out, essentially, according to the definition of the World Health Organization and the International Diabetes Federation. The most altered variables in overweight and obese children and adolescents were anthropometric, biochemical, and hemodynamic parameters. Conclusion: Studies show the consolidation of obesity as an acquired risk factor for the appearance of metabolic diseases, but the most important thing is the solid evidence found from intervention studies, on the reversibility of pathological alterations as a product of a practice of healthy lifestyles.

Factors associated with academic performance in undergraduate health sciences students enrolled in the human anatomy course / Factores asociados al rendimiento académico en la asignatura de anatomía humana en estudiantes de pregrado de ciencias de la salud

Abstract Introduction: Human anatomy is a core subject that poses a great academic challenge for students who are admitted to the health sciences undergraduate degree programs. Objective: To know the socio-academic profile of first-year students of several health sciences undergraduate programs and to assess the association between, on the one hand, academic performance during secondary education, study habits and performance in the university admission science test, and, on the other, academic performance in the human anatomy course. Materials and methods: Cross-sectional correlational study conducted in 2018. The study population consisted of 306 first-year students enrolled in 7 health sciences undergraduate programs offered by the Faculty of Medical Sciences of a public university in Santiago de Chile, Chile. The Pearson correlation coefficient was used to determine the correlation between the variables of interest. Also, a multiple linear regression analysis was performed to establish the factors significantly associated with the final grade obtained in the course. A level of significance of p<0.05 was considered. Results: The mean age of the participants was 19.8 years, 98.6% were single, and 65.3% were female. A significant association was observed between the final grade obtained in the course and the score obtained in the university admission test (p=0.000) and the high school grade point average (p=0.001); however, this association was not significant with the variables considered as study habits. Conclusion: Academic performance in the human anatomy course was associated with the students' prior knowledge, but not with their study habits. Thus, educational interventions in this university should focus more on leveling students' knowledge, rather than on optimizing their study habits.

Resumen Introducción. Anatomía humana es una asignatura básica que representa un gran desafío académico para los estudiantes que ingresan a programas de pregrado en ciencias de la salud. Objetivos. Conocer el perfil socioacadémico de los estudiantes de primer año de varios programas de ciencias de la salud y evaluar la asociación entre, por un lado, el desempeño académico en la enseñanza media, los hábitos de estudio y el desempeño en la prueba de selección universitaria de ciencias y, por el otro, el rendimiento académico en la asignatura de anatomía humana. Materiales y métodos. Estudio transversal correlacional realizado en 2018. La población de estudio consistió de 306 estudiantes de primer año de 7 programas de pregrado de ciencias de la salud ofrecidos por la Facultad de Ciencias Médicas de una universidad pública en Santiago de Chile, Chile. La correlación entre las variables de interés se determinó mediante el coeficiente de correlación de Pearson. Además, se realizó un análisis de regresión lineal múltiple para establecer los factores asociados significativamente con la nota final de la materia. Se consideró un nivel de significancia de p<0.05. Resultados. La edad promedio de los participantes fue 19.8 años, 98.6% eran solteros y 65.3% eran mujeres. Se observó una asociación significativa entre la nota final de la asignatura y el puntaje de la prueba de selección universitaria de ciencias (p=0.000) y el promedio de notas de enseñanza media (p=0.001), pero no con las variables consideradas como hábitos de estudio. Conclusiones. El rendimiento académico en la asignatura de anatomía humana se asoció con los conocimientos previos de los estudiantes, pero no con sus hábitos de estudio. Por tanto, se recomienda que las intervenciones educativas en esta universidad se centren más en la nivelación de los conocimientos de los estudiantes, que en la optimización de sus hábitos de estudio.

[Workplace violence against emergency service nurses: an integrative reviewViolência no trabalho contra os profissionais de enfermagem em serviços de emergência: revisão integrativa]. / Violencia en el trabajo hacia los profesionales de enfermería en los servicios de emergencias: revisión integrativa.

OBJECTIVE: Learn the worldwide frequency of physical and verbal violence against emergency service nurses, and its health and occupational impact. METHODS: An integrative review study was conducted in February 2020 of the MEDLINE, LILACS, CINAHL, and SciELO bibliographic databases, using the descriptors "Nurses," "Workplace Violence," "Physical Aggression," "Psychological Aggression," "Stress, Psychological," "Psychological Trauma," "Aggression," "Health Impact Assessment," "Health Impact," "Impacts on Health," "Impact Assessment, Health," and "Occupational Health." RESULTS: Of the articles located, 18 were included in the analysis. The studies confirmed that the health workers most affected by violence were nurses, and the most common types of violence were verbal aggression, followed by physical violence. In the hospital, these assaults most often occurred in the emergency service. The correlated impact on nurses' health included stress, emotional exhaustion, anxiety, and fear, among other symptoms. With regard to occupational impact, significant indirect accounts related to the reduction in productivity were evident. All these aspects led nurses to consider leaving their jobs in emergency services. CONCLUSIONS: The results enabled identifying a risk profile for violence against nurses in emergency services, seen in the high incidence of physical and verbal violence that led to reduced productivity on the job and the onset of symptoms of burnout syndrome.

OBJETIVO: Conhecer a frequência mundial da violência física e verbal contra os profissionais de enfermagem nos serviços de emergência e seu impacto na saúde e no trabalho. MÉTODOS: A pesquisa foi realizada em fevereiro de 2020 por meio de uma revisão integrativa nas bases de dados MEDLINE, LILACS, CINAHL e SciELO utilizando os seguintes descritores: "Nurses", "Workplace Violence", "Physical Aggression", "Psychological Aggression", "Stress, Psychological", "Psychological Trauma", "Aggression", "Health Impact Assessment", "Health Impact", "Impacts on Health", "Impact Assessment, Health" e "Occupational Health". RESULTADOS: Dentre os artigos identificados, 18 foram incluídos na análise. Os estudos confirmaram que os profissionais da saúde mais afetados pela violência são os profissionais de enfermagem. Agressões verbais e violência física são as formas mais comuns de violência. O local dentro do hospital onde mais ocorrem as agressões é o serviço de emergência. O impacto na saúde dos profissionais de enfermagem está associado ao estresse, esgotamento emocional, ansiedade e medo, entre outros sintomas. Da perspectiva do trabalho, evidencia-se uma relação indireta significativa com queda de produtividade. Todos estes aspectos fazem com que os profissionais de enfermagem considerem desistir de trabalhar nos serviços de emergência. CONCLUSÕES: Os resultados do estudo permitem identificar um perfil de risco de violência contra os profissionais de enfermagem nos serviços de emergência, evidenciado pela alta incidência de violência física e verbal que repercute com queda de produtividade no trabalho e surgimento de sintomas relacionados à síndrome de burnout.

Salud mental y calidad de vida en adultos mayores: revisión sistémica / Mental health and quality of life in older adults: systemic review

INTRODUCCIÓN: Actualmente el número de personas con más de 60 años es el segmento etario que más crece a nivel mundial, lo que representa un gran desafío para la salud pública. Objetivo: Identificar a través de evidencias científicas, la existencia de una relación entre los trastornos de salud mental y la calidad de vida de los adultos mayores. MÉTODO: La investigación fue realizada mediante una revisión sistemática, en enero de 2020, en las bases bibliografías MEDLINE, LILACS, CINAHL y ScIELO, utilizando los descriptores "aged", "elderly", "aged,80 and over", "mental health", "dementia", "depression", "alzheimer disease", "quality of life", "WHOQOL-BREE", "WHOQOL-BREF", "WHOQOL-OLD", "SF-12", "SF-36", "NdF", "geriatric depression scale" y "mental health scales". RESULTADOS: De los 1.231 artículos localizados, 15 fueron incluidos en el análisis. En 4 estudios se demostró una asociación estadística entre el riesgo de depresión y el deterioro de la calidad de vida. No obstante, un estudio mostró que la población de adultos mayores tenía una calidad de vida definida como media o alta, a pesar de presentar un 31.1% de esta población trastornos mentales como estrés, depresión o ansiedad. CONCLUSIONES: Para evaluar la calidad de vida y salud mental se evidencia un aumento de publicaciones en los últimos 3 años. Los instrumentos utilizados fueron diversas escalas o cuestionarios. Se identificaron varios factores que afectan positivamente o negativamente la relación entre la salud mental y la calidad de vida de los adultos mayores.

INTRODUCTION: Currently the number of people over 60 years of age is the fastest growing age segment worldwide, which represents a great challenge for public health. OBJECTIVE: Identify through scientific evidence, the existence of a relationship between mental health disorders and the quality of life of older adults. METHOD: The research was carried out through a systematic review, in January 2020, in the bibliographic databases MEDLINE, LILACS, CINAHL and ScIELO, using the descriptors "aged", "elderly", "aged, 80 and over", "mental health "," Dementia "," depression "," alzheimer disease "," quality of life "," WHOQOL-BREE "," WHOQOL-BREF "," WHOQOL-OLD "," SF-12 "," SF-36 ", "NdF", "geriatric depression scale" and "mental health scales". RESULTS: Of the 1,231 articles located, 15 were included in the analysis. A statistical association between the risk of depression and impaired quality of life was demonstrated in 4 studies. However, a study showed that the population of older adults had a quality of life defined as medium or high, despite 31.1% of this population having mental disorders such as stress, depression or anxiety. CONCLUSIONS: To assess the quality of life and mental health, an increase in publications in the last 3 years is evident. The instruments used were various scales or questionnaires. Several factors that positively or negatively affect the relationship between mental health and quality of life of older adults were identified.

Impacto en la calidad de vida de los adolescentes con diabetes mellitus tipo 1 / Impact on the quality of life of adolescents with diabetes mellitus type 1

INTRODUCCIÓN: La diabetes mellitus tipo 1 (DM1) es una enfermedad que se perfila para toda la vida. OBJETIVO: Identificar evidencia científica sobre el impacto de la DM1 en la calidad de vida de los adolescentes portadores de esta enfermedad. MÉTODO: Revisión sistemática en las bases bibliografías MEDLINE, LILACS, CINAHL y ScIELO, utilizando los descriptores "Adolescent*", "Teen*", "Diabe tes Mellitus, Type1", "Diabetes, type 1", "Type 1 diabetes", "Quality of life", "Health related quality of life", "Life quality", "Health impact assessment", "Health impact", "Impact assessment, health", "Diabetes Impact Measurement Scales", "PedsQL", "Glycated Hemoglobin A1c", "Glycosylated He moglobin A1c", y "HbA1c". De los 679 artículos localizados, 25 fueron incluidos en el análisis. Al gunos estudios fueron multicéntricos nacionales e internacionales. Los instrumentos más utilizados, relativos a las mediciones de la calidad de vida, fueron el Cuestionario de Calidad de Vida Pediátrica (PedsQL) en su versión genérica y módulo diabetes. RESULTADOS: La calidad de vida evaluada por el adolescente que padece DM1 mediante Escalas de calidad de vida, está significativamente e inversa mente asociada a los valores de HbA1c. Esta vinculación se extiende a una correlación significativa entre los puntajes genéricos totales de calidad de vida y HbA1c, pero no tiene la misma repercusión en los puntajes específicos. CONCLUSIONES: El control metabólico se establece como la piedra angular que incide en el impacto en la relación DM1 y calidad de vida; vinculación que se vislumbra como bidireccional, aunque no se evidencia un consenso absoluto sobre los tipos de factores y los grados que influirían en el control metabólico.

INTRODUCTION: Type 1 diabetes mellitus (DM1) is a chronic disease. OBJECTIVE: To identify scientific evidence on the impact of DM1 on the quality of life of adolescents with this disease. METHOD: Sys tematic review in the bibliographic databases MEDLINE, LILACS, CINAHL, and ScIELO, using the following descriptors: "Adolescent *", "Teen *", "Diabetes Mellitus, Type1", "Diabetes, type 1", "Type 1 diabetes", "Quality of life", "Health related quality of life", "Life quality", "Health impact assessment", "Health impact", "Impact assessment, health", "Diabetes Impact Measurement Scales", "PedsQL", "Glycated Hemoglobin A1c", "Glycosylated Hemoglobin A1c", and "HbA1c". Out of 679 articles identified, 25 were included in the analysis. Some studies were national and international multicenter. The most widely used instruments related to quality of life measurements were the Pediatric Quality of Life Questionnaire (PedsQL) in its generic version and the diabetes module. RESULTS: The quality of life assessed by the adolescent with DM1 using Quality of Life Scales is significantly and inversely associated with HbA1c values. This association includes a significant correlation between the total generic quality of life scores and HbA1c but does not have the same impact on specific sco res. CONCLUSIONS: Metabolic control appears to be the cornerstone that influences the impact on the bidirectional relationship between DM1 and quality of life, however, there is no absolute consensus on the types of factors and degrees that would influence metabolic control.

Calidad del sueño según progresión académica en estudiantes chilenos de Obstetricia / Sleep quality according to academic progression in Chilean Obstetrics students

RESUMEN Fundamento: el sueño es reconocido como un indicador de calidad de vida y, en la vida cotidiana de un estudiante, adquiere gran relevancia por su relación con el funcionamiento cognitivo y las actividades académicas. Objetivo: identificar y evaluar los factores asociados a la calidad de sueño que presentan estudiantes chilenos de la carrera de Obstetricia, según años cursados. Métodos: estudio transversal y analítico realizado en el año lectivo 2018 en una universidad chilena, que incluyó la totalidad de estudiantes de la carrera de Obstetricia, quienes respondieron un cuestionario que evaluó los antecedentes sociodemográficos, el perfil académico, los hábitos previos al dormir y la calidad de sueño, evaluada mediante la encuesta de Pittsburg de calidad de sueño (Pittsburgh Sleep Quality Index, PSQI). Resultados: el comportamiento en torno a los hábitos del sueño difiere significativamente entre los cursos, en el 1° y el 4° año se encuentran quienes duermen menos y los estudiantes de este último curso son clasificados como los peores dormidores. El promedio de los componentes del PSQI varía entre 6, 6 (5° año) y 9,2 (4° año); el componente disfunción diurna mostró los valores más extremos. Conclusiones: existe una débil asociación entre la calidad de sueño y las variables sociodemográficas, perfil académico y hábitos previos al dormir. Solo se asocia fuertemente con algunos componentes de la encuesta de calidad de sueño, como la hora de acostarse y las horas de sueño del estudiante. La progresión de la carrera no supone un alza o disminución de los malos o buenos dormidores.

ABSTRACT Foundation: sleep is recognized as an indicator of quality of life and, in a student´s daily life, it acquires great importance for its relationship with cognitive functioning and academic activities. Objective: to identify and evaluate factors associated with quality of sleep presented by the Chilean students of the Obstetric training program, according to years studied. Methods: cross-sectional and analytical study conducted in the 2018 school year in a Chilean university, which included all the students of Obstetrics, who answered a questionnaire that evaluated sociodemographic background, academic profile, previous sleep habits and sleep quality, assessed by the Pittsburgh Sleep Quality Index (PSQI) survey. Results: the behavior around the sleep habits differs significantly among courses, in the 1st and 4th year there are those who sleep less and the students of this last course are classified as the worst sleepers. The average of the PSQI components varies between 6, 6 (5th year) and 9.2 (4th year); daytime dysfunction component showed the most extreme values. Conclusions: there is a weak association between sleeping quality and sociodemographic variables, academic profile and previous sleep habits. It is only strongly associated with some components of the sleep quality survey, such as bedtime and student sleeping hours. The training program progression does not mean an increase or decrease in bad or good sleepers.

[Impact on the quality of life of adolescents with diabetes mellitus type 1]. / Impacto en la calidad de vida de los adolescentes con diabetes mellitus tipo 1.

INTRODUCTION: Type 1 diabetes mellitus (DM1) is a chronic disease. OBJECTIVE: To identify scientific evidence on the impact of DM1 on the quality of life of adolescents with this disease. METHOD: Sys tematic review in the bibliographic databases MEDLINE, LILACS, CINAHL, and ScIELO, using the following descriptors: "Adolescent *", "Teen *", "Diabetes Mellitus, Type1", "Diabetes, type 1", "Type 1 diabetes", "Quality of life", "Health related quality of life", "Life quality", "Health impact assessment", "Health impact", "Impact assessment, health", "Diabetes Impact Measurement Scales", "PedsQL", "Glycated Hemoglobin A1c", "Glycosylated Hemoglobin A1c", and "HbA1c". Out of 679 articles identified, 25 were included in the analysis. Some studies were national and international multicenter. The most widely used instruments related to quality of life measurements were the Pediatric Quality of Life Questionnaire (PedsQL) in its generic version and the diabetes module. RESULTS: The quality of life assessed by the adolescent with DM1 using Quality of Life Scales is significantly and inversely associated with HbA1c values. This association includes a significant correlation between the total generic quality of life scores and HbA1c but does not have the same impact on specific sco res. CONCLUSIONS: Metabolic control appears to be the cornerstone that influences the impact on the bidirectional relationship between DM1 and quality of life, however, there is no absolute consensus on the types of factors and degrees that would influence metabolic control.

Cumplimiento del flujo de decisiones clínicas de los algoritmos de derivación y confirmación diagnóstica del primer PAP atípico H1- Santiago Sur / Compliance with the flow of clinical decisions of the algorithms for referral and diagnostic confirmation of the first atypical PAP H1- Santiago Sur

RESUMEN Antecedentes: Un algoritmo puede definirse como un conjunto de operaciones y procedimientos que se deben seguir con el fin de resolver un problema. Objetivo: Conocer el cumplimiento del flujo de decisiones clínicas del protocolo preconizado en los algoritmos de derivación y de confirmación diagnóstica para la citología cervical atípica de significado indeterminado - H1, estipulados en el Programa Nacional de Búsqueda y Control del Cáncer Cervical de Chile. Métodos: Estudio epidemiológico de tipo descriptivo, observacional, cuantitativo y de seguimiento de una cohorte de mujeres portadoras de un primer informe de citología cervical atípica de significado indeterminado - H1, pertenecientes a los consultorios de Atención Primaria de Salud del área Metropolitana Sur de Santiago, Chile. El seguimiento fue a través de la aplicación de los "Algoritmo de derivación a especialista o U.P.C. del primer PAP atípico según la clasificación Bethesda 2001" y "Algoritmos para confirmación diagnóstica". Resultados: Se seleccionaron 446 mujeres con un primer informe H1. El cumplimiento de conductas de acuerdo al algoritmo de derivación fue de 42.4% y las conductas alternativas fue de 5.8%. La adherencia de conducta en los algoritmos para confirmación diagnóstica fue cumplida en un 89.6%. Conclusiones: El cumplimiento de las conductas ajustadas a algoritmo de derivación del primer Pap atípico fue realizado por la mitad de las mujeres y el cumplimiento del algoritmo de confirmación diagnóstica fue realizado por la gran mayoría.

SUMMARY Background: An algorithm can be defined as a set of operations and procedures that must be followed in order to solve a problem. Objective: Determine the compliance of the clinical decisions flow and procedures recommended by the ASCUS results derivation and diagnostic confirmation algorithms established in the National Program of Search and Control of Cervical Cancer of Chile. Methods: An epidemiological, descriptive, observational and quantitative study of a follow up investigation of a cohort of women with ASCUS cytological reports. These women belonging in the health care centers in the South Metropolitan area of Santiago de Chile. The algorithms "The Specialist Derivation Algorithm or UPC for the first atypical Pap according to the Bethesda 2001 classification" and "Diagnosis Confirmation Algorithm" were used for the follow-up process of these patients. Results: Women with a first ASCUS report were selected (n = 446). The compliance of the clinical decisions flow to derivation algorithm was 42.4% and alternative behaviors were 5.8%. In the diagnosis confirmation algorithm was 89.6% the compliance the recommended procedures. Conclusion: Half ASCUS carrier women followed the procedures recommended by the derivation algorithm. In the algorithms of diagnostic confirmation it is met mostly.

Calidad de sueño y rendimiento académico en alumnos de educación secundaria / Quality of sleep and academic performance in high school students

Background: Sleeping and studying are the day-to-day activities of a teenager attending school. Aim: To determine the quality of sleep and its relationship to the academic performance among students attending morning and afternoon shifts in a public high school. Material and Methods: Students of the first and second year of high school answered an interview about socio-demographic background, academic performance, student activities and subjective sleep quality; they were evaluated using the Pittsburgh Sleep Quality Index (PSQI). Results: The interview was answered by 322 first year students aged 15 ± 5 years attending the morning shift and 364 second year students, aged 16 ± 0.5 years, attending the afternoon shift. The components: sleep latency, habitual sleep efficiency, sleep disturbance, drug use and daytime dysfunction were similar and classified as good in both school shifts. The components subjective sleep quality and duration of sleep had higher scores among students of the morning shift. The mean grades during the first semester of the students attending morning and afternoon shifts were 5.9 and 5.8, respectively (of a scale from 1 to 7). Among students of both shifts, the PSQI scale was associated inversely and significantly with academic performance. Conclusions: A bad sleep quality influences academic performance in these students.

[Quality of sleep and academic performance in high school students]. / Calidad de sueño y rendimiento académico en alumnos de educación secundaria.

BACKGROUND: Sleeping and studying are the day-to-day activities of a teenager attending school. AIM: To determine the quality of sleep and its relationship to the academic performance among students attending morning and afternoon shifts in a public high school. MATERIAL AND METHODS: Students of the first and second year of high school answered an interview about socio-demographic background, academic performance, student activities and subjective sleep quality; they were evaluated using the Pittsburgh Sleep Quality Index (PSQI). RESULTS: The interview was answered by 322 first year students aged 15 ± 5 years attending the morning shift and 364 second year students, aged 16 ± 0.5 years, attending the afternoon shift. The components: sleep latency, habitual sleep efficiency, sleep disturbance, drug use and daytime dysfunction were similar and classified as good in both school shifts. The components subjective sleep quality and duration of sleep had higher scores among students of the morning shift. The mean grades during the first semester of the students attending morning and afternoon shifts were 5.9 and 5.8, respectively (of a scale from 1 to 7). Among students of both shifts, the PSQI scale was associated inversely and significantly with academic performance. CONCLUSIONS: A bad sleep quality influences academic performance in these students.

Clinical management of the first ASCUS report in Chile. Prospective single-cohort study / Manejo clínico do primeiro relatório ASCUS no Chile. Estudo prospectivo de coorte única

ABSTRACT CONTEXT AND OBJECTIVE: Worldwide, there is no single strategy for optimal management of patients with ASCUS (atypical squamous cells of undetermined significance) cytology reports. The objective of this study was to determine the kind of clinical management conducted among women with a first ASCUS Pap smear report. DESIGN AND SETTING: Prospective single cohort study at a cervical pathology unit in Santiago, Chile. METHODS: This was an epidemiological, descriptive, observational and quantitative follow-up study on a cohort of women with ASCUS cytological reports. RESULTS: In the screening phase, 92,001 cervical cytological smears were collected in primary healthcare clinics. In the diagnostic phase, all women with a first ASCUS report were selected (n = 446). These women were asked to undergo the Pap test again and it was found that 301 women had normal results, 62 women had abnormal results and 83 did not repeat the test. In the diagnostic confirmation phase, the 62 women with abnormal results underwent colposcopy and, from these results, 58 of them underwent a biopsy. The results from the biopsies showed that 16 women had negative histological reports, 13 had CIN 1 and 29 had CIN 2+. In the treatment phase, the 42 women with lesions underwent a variety of treatments, according to the type of lesion. In the post-treatment phase, cytological and colposcopic monitoring was instituted. CONCLUSION: The clinical management consisted of traditional management of screening, diagnosis, diagnostic confirmation, treatment and post-treatment monitoring.

RESUMO CONTEXTO E OBJETIVO: Mundialmente, não existe estratégia única para o gerenciamento ideal de pacientes com laudos de citologia ASCUS ( atypical squamous cells of undetermined significance ). O objetivo do estudo foi determinar o tipo de gerenciamento clínico realizado em mulheres com o primeiro laudo de Papanicolaou ASCUS. DESENHO E LOCAL: Estudo prospectivo de coorte única em uma unidade de patologia cervical em Santiago, Chile. MÉTODOS: Estudo epidemiológico, descritivo, observacional e quantitativo de seguimento de um grupo de mulheres com laudos de citologia ASCUS. RESULTADOS: Na fase de rastreamento, 92.001 relatórios de citologia cervical foram coletados nos ambulatórios da rede pública de saúde. Na fase de diagnóstico, foi selecionada a totalidade de mulheres com relatórios citológicos de ASCUS (n = 446). Essas mulheres foram submetidas a repetição do exame de Papanicolaou, obtendo-se 301 mulheres com resultados normais, 62 mulheres com resultados anormais e 83 que não repetiram o exame. Na fase de confirmação de diagnóstico, as 62 mulheres com resultados anormais foram submetidas a colposcopia e, considerando-se os resultados obtidos, 58 foram submetidas a biópsia. Os resultados das biópsias mostraram 16 mulheres com laudos histológicos negativos, 13 com NIC 1 e 29 com NIC 2 +. Na fase terapêutica, as 42 mulheres com lesões foram submetidas a diversos tratamentos de acordo com o tipo de lesão. Para a fase pós-tratamento, foi instituído um sistema de monitoramento citocolposcópico. CONCLUSÃO: As condutas clínicas tiveram gestão tradicional de rastreamento, diagnóstico, confirmação diagnóstica, tratamento e acompanhamento pós-tratamento.

Clinical management of the first ASCUS report in Chile. Prospective single-cohort study.

CONTEXT AND OBJECTIVE: Worldwide, there is no single strategy for optimal management of patients with ASCUS (atypical squamous cells of undetermined significance) cytology reports. The objective of this study was to determine the kind of clinical management conducted among women with a first ASCUS Pap smear report. DESIGN AND SETTING: Prospective single cohort study at a cervical pathology unit in Santiago, Chile. METHODS: This was an epidemiological, descriptive, observational and quantitative follow-up study on a cohort of women with ASCUS cytological reports. RESULTS: In the screening phase, 92,001 cervical cytological smears were collected in primary healthcare clinics. In the diagnostic phase, all women with a first ASCUS report were selected (n = 446). These women were asked to undergo the Pap test again and it was found that 301 women had normal results, 62 women had abnormal results and 83 did not repeat the test. In the diagnostic confirmation phase, the 62 women with abnormal results underwent colposcopy and, from these results, 58 of them underwent a biopsy. The results from the biopsies showed that 16 women had negative histological reports, 13 had CIN 1 and 29 had CIN 2+. In the treatment phase, the 42 women with lesions underwent a variety of treatments, according to the type of lesion. In the post-treatment phase, cytological and colposcopic monitoring was instituted. CONCLUSION: The clinical management consisted of traditional management of screening, diagnosis, diagnostic confirmation, treatment and post-treatment monitoring.

Follow-up of women with inadequate Pap smears: a prospective cohort study / Acompanhamento de mulheres com esfregaços de Papanicolaou inadequados: um estudo prospectivo de coorte

CONTEXT AND OBJECTIVE: Inadequate Pap smears do not provide satisfactory cell samples for evaluation, thus making it more difficult to detect cervical cytological abnormalities. The objective of this study was to determine the cytological and histological follow-up results from women with inadequate smear reports in primary healthcare centers in Santiago, Chile 2010-2011. DESIGN AND SETTING: Prospective cohort study at primary healthcare clinics in Santiago, Chile. METHODS: The population was taken from the “Cito-Expert" database of 2010. The data were then organized according to the cytological and histological follow-up results of 2,547 women with inadequate cervical cytological reports over the 12-month period. The samples were assigned to groups based on the cause of inadequacy (smears with endocervical cells alone; insufficient, hemorrhagic, inflammatory or poorly fixed samples; insufficient and hemorrhagic samples; or insufficient and inflammatory specimens). The data were analyzed using the “conditional probability tree diagram" and descriptive statistics. RESULT: Half of the women (n = 1,285) met the requirements of the Ministry of Health for repeating these inadequate smears, and 1,104 of these women had normal cytological results (85.9%). The detection rate for cervical lesions according to group ranged ...

CONTEXTO E OBJETIVO: Esfregaços inadequados de Papanicolaou não fornecem amostra satisfatória de células para avaliação, ficando assim mais difícil detectar anomalias citológicas cervicais. O objetivo deste estudo foi determinar os resultados de seguimento citológico e histológico de mulheres com relatórios de esfregaços inadequados nas unidades básicas de saúde em Santiago, Chile, 2010-2011. DESENHO E LOCAL: Estudo prospectivo de coorte em unidades básicas de saúde em Santiago, Chile. MÉTODOS: A população foi selecionada do banco de dados Cito-Expert em 2010. Na sequência, os dados foram organizados pelos resultados de seguimento citológico e histológico de 2.547 mulheres com relatórios inadequados de citologia cervical pelo período de 12 meses. As amostras foram atri-buídas a grupos com base na causa de inadequação (esfregaços com células endocervicais; amostras insuficientes, inflamatórias, ou com má fixação, amostras insuficientes e hemorrágicas, ou espéci-mes insuficientes e inflamatórios). Os dados foram analisados com base no “conditional probability tree diagram" e estatísticas descritivas. RESULTADOS: Metade das mulheres (n = 1.285) preencheram os requisitos ...

Follow-up of women with inadequate Pap smears: a prospective cohort study.

CONTEXT AND OBJECTIVE: Inadequate Pap smears do not provide satisfactory cell samples for evaluation, thus making it more difficult to detect cervical cytological abnormalities. The objective of this study was to determine the cytological and histological follow-up results from women with inadequate smear reports in primary healthcare centers in Santiago, Chile 2010-2011. DESIGN AND SETTING: Prospective cohort study at primary healthcare clinics in Santiago, Chile. METHODS: The population was taken from the "Cito-Expert" database of 2010. The data were then organized according to the cytological and histological follow-up results of 2,547 women with inadequate cervical cytological reports over the 12-month period. The samples were assigned to groups based on the cause of inadequacy (smears with endocervical cells alone; insufficient, hemorrhagic, inflammatory or poorly fixed samples; insufficient and hemorrhagic samples; or insufficient and inflammatory specimens). The data were analyzed using the "conditional probability tree diagram" and descriptive statistics. RESULT: Half of the women (n = 1,285) met the requirements of the Ministry of Health for repeating these inadequate smears, and 1,104 of these women had normal cytological results (85.9%). The detection rate for cervical lesions according to group ranged from 0% (smears with endocervical cells alone or insufficient and hemorrhagic specimens) to 4.1% (poor fixation). CONCLUSION: The large proportion of normal results justifies revision of the current clinical guidelines. The results showed that it is not necessary to repeat the Pap test early on, with the exception of inadequate hemorrhagic and inflammatory cytological results.

Follow-up of women with atypical squamous cells cannot exclude high-grade squamous intraepithelial lesions (ASC-H).

CONTEXT AND OBJECTIVE: The concept that the presence of atypical squamous cells cannot exclude high-grade squamous intraepithelial lesions (ASC-H) was introduced in the 2001 Bethesda System of cervical cytology classification. This nomenclature defines cervical cancer precursor lesions. The objective of this study was to investigate the colpocytological-histological results from a three-year follow-up conducted on a cohort of women with reports of ASC-H who were attended during 2005-2006 at clinics of the Southern Metropolitan Healthcare Service of Santiago, Chile. DESIGN AND SETTING: Prospective cohort study at primary healthcare clinics in Santiago, Chile. METHODS: Colpocytological-histological follow-up was conducted over a three-year period on 92 women with cytological reports of ASC-H who were attended at primary healthcare clinics during 2005-2006. RESULTS: At the end of the follow-up period, high-grade lesions were evaluated and the following outcomes were observed: seven women presented invasive cancer (7.6%), 49 presented high-grade lesions (53.3%), 26 presented low-grade lesions (28.2%) and 10 presented normal results (10.9%). The "Conditional Probabilities Tree Diagram" was used to show the results from tests and the times of lesion detection. It demonstrated that, after a first report of ASC-H, clinical management needed to be interventionist. CONCLUSION: The follow-up on our cohort of women showed that the majority of uncertain ASC-H diagnoses (82.6%) had abnormal colposcopic results and that during the follow-up using ASC-H smears, two out of every three women developed high-grade lesions.

Follow-up of women with atypical squamous cells cannot exclude high-grade squamous intraepithelial lesions (ASC-H) / Acompanhamento de mulheres com celulas escamosas atipicas nao pode excluir lesao intraepitelial de alto grau (ASC-H)

CONTEXT AND OBJECTIVE: The concept that the presence of atypical squamous cells cannot exclude high-grade squamous intraepithelial lesions (ASC-H) was introduced in the 2001 Bethesda System of cervical cytology classification. This nomenclature defines cervical cancer precursor lesions. The objective of this study was to investigate the colpocytological-histological results from a three-year follow-up conducted on a cohort of women with reports of ASC-H who were attended during 2005-2006 at clinics of the Southern Metropolitan Healthcare Service of Santiago, Chile. DESIGN AND SETTING: Prospective cohort study at primary healthcare clinics in Santiago, Chile. METHODS : Colpocytological-histological follow-up was conducted over a three-year period on 92 women with cytological reports of ASC-H who were attended at primary healthcare clinics during 2005-2006. RESULTS : At the end of the follow-up period, high-grade lesions were evaluated and the following outcomes were observed: seven women presented invasive cancer (7.6%), 49 presented high-grade lesions (53.3%), 26 presented low-grade lesions (28.2%) and 10 presented normal results (10.9%). The "Conditional Probabilities Tree Diagram" was used to show the results from tests and the times of lesion detection. It demonstrated that, after a first report of ASC-H, clinical management needed to be interventionist. CONCLUSION: The follow-up on our cohort of women showed that the majority of uncertain ASC-H diagnoses (82.6%) had abnormal colposcopic results and that during the follow-up using ASC-H smears, two out of every three women developed high-grade lesions. .

CONTEXTO E OBJETIVO: O conceito de que à presença de células escamosas atípicas não se pode excluir lesão intraepitelial de alto grau (ASC-H) foi introduzido pelo Sistema de Bethesda 2001, na classificação de citologia cervical. Esta nomenclatura define lesões precursoras do câncer cervical. O objetivo deste estudo foi investigar os resultados colpo-cito-histológicos de três anos de acompanhamento realizado em uma coorte de mulheres com relatórios de ASC-H que receberam atendimento no período 2005-2006 em clínicas do Serviço Metropolitano de Saúde Sul de Santiago, Chile. TIPO DE ESTUDO E LOCAL: Estudo de coorte prospectivo em unidades básicas de saúde de Santiago, Chile. MÉTODOS: Foi conduzido um acompanhamento colpo-cito-histológico por um período de três anos em 92 mulheres com laudos citológicos de ASC-H, que receberam atendimento nas unidades básicas de saúde de 2005-2006. RESULTADOS: No final do período de acompanhamento, as lesões de alto grau foram avaliadas e os resultados foram observados: sete mulheres apresentaram câncer invasivo (7,6%), 49 apresentaram lesões de alto grau (53,3%), 26 apresentaram lesões de baixo grau (28,2%) e 10 apresentaram resultados normais (10,9%). O "Diagrama de Árvore Condicional de Probabilidades" foi utilizado para mostrar os resultados dos testes e o período de detecção das lesões, demonstrando que, depois de um primeiro relatório de ASC-H, o manejo clínico deve ser intervencionista. CONCLUSÃO: O acompanhamento de nossa coorte de mulheres mostra que a maioria dos diagnósticos incertos de ASC-H (82,6%) tiveram resultado colposcópico anormal e, durante o acompanhamento de esses esfregaços ASC-H, duas de cada três mulheres desenvolvem lesões de alto grau. .

Algoritmos de derivación y confirmación diagnóstica de citología cervical atípica: desafíos para la actualización / Derivation algorithms for the clinical management of women with cytologic abnormalities

El Programa Nacional de Pesquisa y Control del Cáncer Cervicouterino de Chile ha contribuido al descenso sostenido de la mortalidad por cáncer de cuello uterino. Para la reducción de esta mortalidad ha sido fundamental la citología exfoliativa del cérvix, la que no está exenta de resultados inciertos. En este sentido, los frotis clasificados como atípicos se consideran ambiguos por la presencia de anomalías celulares de difícil determinación, lo que se traduce en un diagnóstico de probabilidad incierta. En la literatura nacional como internacional, se manifiesta un notorio interés por unificar la nomenclatura citológica cervical y los algoritmos de derivación y confirmación diagnóstica, para el manejo clínico de las mujeres con anomalías citológicas cervicales y lesiones precursoras de cáncer cervicouterino. Por lo anterior, se considera relevante los estudios que proporcionen evidencia clínica epidemiológica actualizada, que permitan optimizar el cumplimiento del Programa Nacional de Cáncer Cervicouterino, conducentes al logro de los Objetivos Sanitarios del período 2011-2020.

The National Research and Control of Cervical Cancer in Chile had contributed to the sustained decline in mortality from cervical cancer. The exfoliative cytology of the cervix has been to reduce this mortality, which is not without uncertain results. The smears classified as atypical are considered ambiguous by the presence of cellular abnormalities difficult to determine, resulting in a diagnosis of uncertain probability. The literature, both nationally and internationally, is widespread interest to unify the nomenclature cervical cytology and the support of the derivation algorithms for the clinical management of women with cytologic abnormalities cervical and cervical cancer precursor lesions. Therefore, it is relevant to perform studies the provide updated epidemiological clinical evidence, to optimize the performance of the National Program for the achievement of health objectives for the period 2011-2020.