National Seroprevalence of Coxiella burnetii in Chile, 2016-2017.

Coxiella burnetii is an intracellular bacterium and the cause of the zoonotic infection, Q fever. National surveillance data on C. burnetii seroprevalence is currently not available for any South American country, making efforts of public health to implement strategies to mitigate infections in different at-risk groups within the population extremely challenging. In the current study, we used two commercial anti-C. burnetii immunoassays to screen sera collected from a sample of the Chilean population as part of a 2016-2017 national health survey (n = 5166), nationwide and age-standardized. The seroprevalence for C. burnetii for persons ≥ 15 years was estimated to be 3.0% (95% CI 2.2-4.0), a level similar to national surveys from The Netherlands (2.4%) and USA (3.1%), but lower than Australia (5.6%). A linear increase of C. burnetii seropositivity was associated with an individual's age, with the peak seroprevalence 5.6% (95% CI 3.6-8.6) observed in the ≥65 years' group. C. burnetii seropositivity was significantly higher in the southern macro-zone 6.0% (95% CI 3.3-10.6) compared to metropolitan region 1.8% (95% CI 0.9-3.3), the former region being home to significant livestock industries, particularly dairy farming. These data will be useful to inform targeted strategies for the prevention of Q fever in at-risk populations in Chile.

C-reactive protein (CRP) polymorphisms and haplotypes are associated with SLE susceptibility and activity but not with serum CRP levels in Mexican population.

To evaluate the association of C-reactive protein (CRP) polymorphisms with risk of development SLE in a group of Mexican individuals. Five CRP polymorphisms (rs3093059, rs3093062, rs1800947, rs1130864, and rs1205) were determined by PCR-restriction fragment length polymorphism and SNP rs3093061 by refractory mutation system PCR assay in 126 SLE patients and 131 controls. Four of the polymorphisms showed differences between patients and controls. rs3093061 polymorphism was associated with a lower risk of developing lupus principally in the codominant 2 (OR = 0.219, 95% CI 0.108-0.785, P = 0.015) model. rs1130864 was associated with decreased risk mainly under codominant 1 (OR = 0.288, 95% CI 0.143-0.581, P = 0.001) model. rs1205 was associated under the over-dominant model (OR = 0.504, 95% CI 0.270-0.942, P = 0.032). The rs3091244 polymorphism was associated with decreased risk of SLE mostly under additive (OR = 0.605, 95% CI 0.393-0.931. P = 0.022) model. Our study establishes that rs3093061, rs1130864, rs1205, and rs3091244 polymorphisms are associated with decreased risk of developing SLE.

Use and withdrawal of immunosuppressors in primary Sjögren's syndrome.

OBJECTIVES: To assess the use and causes of withdrawal of glucocorticoids and immunosuppressors among patients with primary Sjögren's syndrome (pSS) in the clinical setting. METHODS: We retrospectively reviewed the medical records of 155 pSS patients and registered demographics, glandular/extraglandular features, serological data, cumulative ESSDAI and SSDDI. A single rheumatologist attributed the indication and cause of withdrawal of glucocorticoids and immunosuppressors. RESULTS: 92.2% of the patients were female, mean age 57.4±14.7 years and median follow-up 11 years. One hundred and four (67%) patients received glucocorticoids and/or immunosuppressors: 3.8% only glucocorticoids, 43.9% only immunosuppressors and 56.5% their combination. The most used drugs were antimalarials (46.4%), prednisone (36.7%), azathioprine (AZA) (23.8%) and methotrexate (MTX) (18%). At the multivariate analysis, the presence of non-erosive arthritis OR 5.02 (95% CI 1.74-14.47, p=0.003) and the median cumulative ESSDAI score OR 1.10 (95% CI 1.03-1.17, p=0.002) were associated with the use of these drugs. The causes of withdrawal were: 39% improvement, 35.2% patient's own decision, 18.1% toxicity and 11% lack of efficacy. We found toxicity in 14.2% MTX users, 9.7% for AZA, 9.7% for antimalarials and 7.6% for cyclophosphamide. CONCLUSIONS: More than half the patients received glucocorticoids and/or immunosuppressors and a not negligible number decided on their own to suspend them, alerting physicians of secondary adverse events and tolerability.

Evolución dialéctica de la función docente educativa del especialista en Medicina General Integral / Dialectic evolution of the educational teaching function of the general integral medicine specialist

Con la implementación del Plan de Estudio del Especialista en Medicina General Integral quedó establecida la necesaria continuidad, en la formación médica, entre el pregrado y el posgrado. La precisión de la función docente educativa sustenta el desempeño de este especialista como profesor. Las experiencias formativas de la Universidad Médica cubana, han asumido cada vez más al especialista de Medicina General Integral en su desempeño docente. De ahí la importancia de analizar el desarrollo dialéctico de la función docente educativa del especialista en Medicina General Integral, como el profesor por excelencia del futuro médico a egresar. El camino a seguir en la formación de los profesionales médicos en el ámbito internacional, sitúan al especialista en Medicina General Integral como un médico y profesor en permanente desarrollo. Nuevos paradigmas sustentan un modelo transformador en la formación de médicos, se impone también una transformación radical del modelo de formación de los docentes

The implementation of the curriculum of the general integral medicine specialist studies set the necessary continuity of the undergraduate and the graduate education within the medical formation. The precision of the teaching educational function supports the performance of this specialist as a professor. The formative experiences of the Cuban medical university have increasingly involved the general integral medicine specialist in the teaching process; hence, it is important to analyze the dialectic development of the teaching educational function of this specialist as a professor per se of the future physician to be graduated. The way to be paved in the formation of medical professionals at the international scale turns the general integral medicine specialist into both a physician and a professor in ceaseless development. New paradigms support the existence of a transforming model in the formation of physicians, so it is compulsory to make a radical change in the formation model of educators

High levels of hsCRP are associated with carbohydrate metabolism disorder.

AIM: To determine risk parameters associated with high values of high sensitive C-reactive protein (hsCRP) in subjects with different glucose fasting levels. METHODS: Anthropometric parameters, arterial pressure, glycemia, lipid profile, uric acid, and hsCRP were studied in a population of 513 individuals between 40 and 65 years. RESULTS: In total, 349 (68.0%) were normoglycemic (NG); 113 (22.0%) had impaired fasting glucose (IFG); and 51 (9.9%) were diabetic subjects. A multivariate linear regression analysis showed that the natural logarithm of hsCRP was associated significantly with glycemia levels (P = 0.009), uric acid (P = 0.001), diastolic blood pressure (P = 0.011), smoking habit (P = 0.021), BMI (P<0.001), and sex (P<0.001). One-third of the NG subjects had high hsCRP levels. A multiple logistic regression analysis showed that sex and BMI were variables related to high levels of hsCRP in subjects with IFG and NG. In NG subjects, uric acid levels were associated with risk of presenting high hsCRP levels and were higher in women than men. In NG women, ROC curves analysis identified a uric acid level of 3.9 mg/dl as a cut-off point to predict a high value of hsCRP. Those individuals with uric acid values higher than 3.9 mg/dl and normal glycemia had 3.5-fold more risk of having hsCRP levels over 3.0 mg/l. CONCLUSIONS: We sustain that high levels of hsCRP are associated with disturbance in carbohydrate metabolism. In addition, we believe that in low cardiovascular risk population, such as NG women, uric acid levels above 3.9 mg/dl might represent a signal of possible pro-inflammatory state and cardiovascular risk.

Elevated concentration of asymmetric dimethylarginine (ADMA) in individuals with metabolic syndrome.

The metabolic syndrome (MS) is a cluster of pathophysiological alterations that includes the presence of hypertension, insulin resistance, dyslipidemia, and abdominal obesity. MS is associated with increased risk of developing diabetes and cardiovascular diseases. Endothelial dysfunction with impaired nitric oxide (NO) bioavailability has been implicated in insulin resistance and hypertension. NO is synthesized by nitric oxide synthase (NOS) using l-arginine as substrate. Asymmetric dimethyl arginine (ADMA) is a major and potent endogenous NOS inhibitor, associated with cardiovascular and renal diseases. We tested the hypothesis that plasmatic ADMA levels are increased in patients with MS. We studied 85 adult individuals from Talca, Chile, separated in two groups, 48 individuals with MS (according to modified ATP III criteria), and 37 individuals without MS as controls. ADMA levels were significantly increased in the MS group (mean±standard deviation 0.71±0.38 vs. 0.48±0.28µmol/L, p=0.0009). Furthermore, the levels of ADMA were modestly but significantly correlated with waist circumference (p=0.01) but not with the other components of MS (blood pressure, glycemia, triglycerides and high density lipoprotein cholesterol HDL-c). These results suggest a possible link between increased ADMA levels and the MS.

Intervention with education and exercise reverses the metabolic syndrome in adults.

About 29% of the adult population of Talca, Chile, suffers from the metabolic syndrome (MS), a value higher than the national prevalence. Evidence indicates that exercise and nutritional changes reduce the predominance of this syndrome. The goal of this study was to evaluate the effects of a structured interventional program of physical activity and nutritional counseling in adults with MS. Fifty-one subjects were studied: 27 were included in the interventional program (I-MS). The control group was formed by 24 individuals who did not participate in the program (NI-MS). We assessed body weight, corporal composition, arterial pressure, glycemia, and lipid profile at baseline and after 18 weeks of treatment. After this period, the I-SM group showed a significant decrease in triglycerides (geometric mean 202.2 to 110.5 mg/dL, P < .001), diastolic blood pressure (mean 85.4 to 79.6 mm Hg, P = .001), waist circumference (mean men 101.5 to 94.1 cm, P < .001; mean women 107.2 to 96.2 cm, P < .001), weight (mean 81.1 to 77.2 kg, P < .001), and body mass index (mean 31.8 to 30.2 kg/m(2), P < .001). In the NI-MS group, the individual parameters did not change significantly. Our results show that a non-pharmacological treatment based on exercise exerts an important beneficial effect in patients with MS, mainly on the waist circumference, blood pressure, and triglycerides.

[Discordance between nutritional status and self perception of weight among adults from Talca, Chile]. / Discordancia en autopercepción de peso en población adulta de Talca.

BACKGROUND: Obesity is related to underestimation of one's own weight. AIM: To determine the agreement between nutritional status and self perception of weight status in apparently healthy adults from Talca. SUBJECTS AND METHODS: Data were obtained from a survey applied at 1007 randomly selected subjects, aged 18-74 years old (66% women). The survey identified age, gender, educational level and socioeconomic status. Self-perception of weight was estimated with pictures representing the four nutritional status categories: underweight, normal, overweight and obese. Body Mass index (BMI, kg/m(2)) was calculated to determine nutritional status. Statistical analysis included kappa index, Bowman s symmetry test and a logistic regression model to calculate the odds ratio in different variables related to underestimation of weight. RESULTS: Seventy three percent of subjects were overweight or obese and 44% underestimated their nutritional status. Sixty percent of subjects with a BMI between 25 and 26 kg/m(2), perceived themselves as normal. A higher underestimation was observed in obese subjects (odds ratio (OR) 17.2 95% confidence intervals (CI) 10.9-27.1), in overweight individuals (OR 3.5 95% CI 2.3-5.3), in men (OR 1.5 95% CI 1.1-2.1) and in people aged from 45 to 59 years (OR 1.7 95% CI 1.0-2.7). CONCLUSION: Almost half of studied population had an erroneous self-perception of weight, mainly due to underestimation. Obese subjects, males and people older than 45 years were those with the higher degree of underestimation.

Discordancia en autopercepción de peso en población adulta de Talca / Discordance between nutritional status and self perception of weight among adults from Talca, Chile

Background: Obesity is related to underestimation of one’s own weight. Aim: To determine the agreement between nutritional status and self perception of weight status in apparently healthy adults from Talca. Subjects and methods: Data were obtained from a survey applied at 1007 randomly selected subjects, aged 18-74 years old (66% women). The survey identified age, gender, educational level and socioeconomic status. Self-perception of weight was estimated with pictures representing the four nutritional status categories: underweight, normal, overweight and obese. Body Mass Index (BMI, kg/m2) was calculated todetermine nutritional status. Statistical analysis included kappa index, Bowman’s symmetry test and a logistic regression model to calculate the odds ratio in different variables related tounderestimation of weight. Results: Seventy three percent of subjects were overweight or obese and 44% underestimated their nutritional status. Sixty percent of subjects with a BMI between 25 and 26 kg/m2, perceived themselves as normal. A higher underestimation was observed in obesesubjects (odds ratio (OR) 17.2 95% confidence intervals (CI) 10.9-27.1), in overweight individuals (OR 3.5 95% CI 2.3-5.3), in men (OR 1.5 95% CI 1.1-2.1) and in people aged from 45 to 59 years (OR 1.7 95% CI 1.0-2.7). Conclusion: Almost half of studied population had an erroneous self perception of weight, mainly due to underestimation. Obese subjects, males and people older than 45 years were those with the higher degree of underestimation.

Increased concentration of plasminogen activator inhibitor-1 and fibrinogen in individuals with metabolic syndrome.

Metabolic syndrome (MS) is closely linked to a generalized metabolic disorder referred to as insulin resistance. Disturbances in the hemostasis and fibrinolytic systems are a feature of MS. The aim of this study was to determine the concentration levels of fibrinogen and plasminogen activator inhibitor-1 (PAI-1) in a group of patients with MS with respect to a non-MS group, and to evaluate their possible relation with other risk factors in MS. The study was carried out in a total of 186 male and female non-smoking individuals aged 45-64 years, 93 with MS (ATP III criteria) and 93 without MS. Plasmatic levels of PAI-1 were measured by ELISA, and those of fibrinogen by the Claus method. The plasmatic levels of PAI-1 (men 49.2±19.8 vs. 35.0±12.2 ng/ml and women 42.0±19.7 vs. 31.6±14.6 ng/ml; p=0.0026) and fibrinogen (274.0±82.1 vs. 232.7±66.6 ng/ml; p=0.0002) were significantly higher in the MS group than in the non-MS group. PAI-1 was significantly associated with diastolic blood pressure, triglycerides and waist circumference. Fibrinogen was negatively associated with HDL-c. High plasmatic levels of PAI-1 and fibrinogen contribute to the cardiovascular risk that characterizes individuals with MS.

[Value of a clinical test for assessing physical activity in children]. / Valor de un test clínico para evaluar actividad física en niños.

BACKGROUND: An appropriate measurement of physical activity (PA) in children is useful, since inactivity is associated to obesity, cardiovascular and metabolic risk. AIM: To assess the reliability of the INTA questionnaire of PA, to compare the derived PA score with accelerometry and to assess its ability to identify excessively inactive children. MATERIAL AND METHODS: One hundred eighty children aged 8 to 13 years answered an interviewer-administered questionnaire about their usual PA, consisting in 5 items (recumbent, seated, walking, playing outdoor, sports). The answers were converted to a PA score with a 0-10 points scale. Reliability was tested in 87 children by test/retest conducted 3-5 days apart. The PA score was compared with 3-day accelerometry in 77 of 93 children (35 obese and 42 non obese). Receiver operating characteristic (ROC) curves were used to determine the optimal cut-point for identify an excessively sedentary child. RESULTS: The test/retest reliability of the questionnaire was 0.69 to 0.93 (Lin coefficient). Accelerometry was significantly associated with PA score (RHO: 0.60, p =0.008), outdoor plays (RHO: 0.37, p =0.0009) and practicing of sports (RHO: 0.33, p =0.003). Obese children were less active than non obese children, according both to PA score and to accelerometry. The optimal cut-point for classifying a child as too sedentary was a score of 5 (sensitivity =0.89). CONCLUSIONS: The INTA-test is a valuable instrument for measuring usual PA in clinical practice and is easy to administer.

Valor de un test clínico para evaluar actividad física en niños / Value of a clinical test for assessing physical activity in children

Background: An appropriate measurement of physical activity (PA) in children is useful, since inactivity is associated to obesity, cardiovascular and metabolic risk. Aim: To assess the reliability of the INTA questionnaire of PA, to compare the derived PA score with accelerometry and to assess its ability to identify excessively inactive children. Material and methods: One hundred eighty children aged 8 to 13 years answered an interviewer-administered questionnaire about their usual PA, consisting in 5 items (recumbent, seated, walking, playing outdoor, sports). The answers were converted to a PA score with a 0-10 points scale. Reliability was tested in 87 children by test/retest conducted 3-5 days apart. The PA score was compared with 3-day accelerometry in 77 of 93 children (35 obese and 42 non obese). Receiver operating characteristic (ROC) curves were used to determine the optimal cut-point for identify an excessively sedentary child. Results: The test/retest reliability of the questionnaire was 0.69 to 0.93 (Lin coefficient). Accelerometry was significantly associated with PA score (RHO: 0.60, p =0.008), outdoor plays (RHO: 0.37, p =0.0009) and practicing of sports (RHO: 0.33, p =0.003). Obese children were less active than non obese children, according both to PA score and to accelerometry. The optimal cut-point for classifying a child as too sedentary was a score of 5 (sensitivity =0.89). Conclusions: The INTA-test is a valuable instrument for measuring usual PA in clinical practice and is easy to administer.

Evaluation of metabolic syndrome in adults of Talca city, Chile.

OBJECTIVE: Insulin resistance (IR) is an important risk factor for type 2 Diabetes Mellitus (DM2) and cardiovascular disease (CVD). Metabolic Syndrome (MS) is a clustering of metabolic alterations associated to IR; however, there is no international consensus for defining its diagnosis. Our objective was to evaluate the prevalence and characteristics of MS identified by the ATP III and IDF criteria in adults from Talca city. RESEARCH AND METHODS: We studied 1007 individuals, aged 18-74, and residents from Talca. MS subjects were defined according to ATP III (three altered factors) and IDF criteria (patients with waist circumference >80/90 cm (W/M) and two others altered factors). RESULTS: The prevalence of metabolic syndrome according to the IDF and ATP III criteria was 36.4% and 29.5%, respectively after adjustment for age and sex. The agreement for both criteria was 89%. The prevalence in men was higher than in women for both MS definitions, although not significant. MS probability increased with age, and the highest risk was in the 57-68 age group (ATP-MS) and 53-72 age group (IDF-MS). Hypertension, high triglycerides and abdominal obesity are the most frequent alterations in MS. CONCLUSION: MS prevalence in adults was higher when diagnosed with IDF than with ATP criterion; in both, age is directly related with the MS presence. The MS subjects showed higher levels of blood pressure, waist circumference and plasma triglycerides. Considering our results, it is worrisome that one third of our population has a high risk of developing DM2 and CVD in the future.

Protective effect of Bacillus Calmette-Guerin (BCG) vaccination in children with extra-pulmonary tuberculosis, but not the pulmonary disease. A case-control study in Rosario, Argentina.

A hospital-based case-control study was carried out at the Vilela Children's Hospital in Rosario, Argentina, to measure the protection conferred by BCG vaccination against tuberculosis (TB). The study included 148 newly diagnosed cases of TB (75 males and 73 females, mean age 3.34+/-2.97 years, S.D.), 134 of them with pulmonary TB and 14 cases with extra-pulmonary disease. Controls (425 males and 357 females, 3.39+/-2.98 years) were selected randomly among children who attended to the Hospital showing, neither respiratory diseases nor any other infectious illnesses. Information on BCG vaccination history was assessed from scars or immunisation records. All participants were negative to human immunodeficiency virus and belonged to the lower and upper-lower socioeconomic status, being similar in place of residence and ethnic characteristics. Rate of vaccinated children was 92.6% of cases and 94.5% of controls (3.4 and 3.9% of them without scars, respectively). Regarding the total cases, the protective association between BCG and TB was statistically insignificant, as was for the pulmonary form. Among cases with extra-pulmonary disease, vaccine effectiveness attained significance [79% (95% CI=26-94)], no matter their age, sex or nutritional status. BCG vaccination exerted a beneficial role in extra-pulmonary TB, even in children not seriously undernourished.

Chilean school-age children twin registry: planning, sampling and implications.

We describe subject recruitment from the University of Chile School-Age Children Twin Registry (REMEUCHI). The research aim of REMEUCHI is to quantify the impact of genetic and environmental factors on scholastic achievement in a multicausal approach. The Ministry of Education of Chile, in collaboration with the Registry Office, provided the list of possible twin pairs graduated from high school in 2004 in Chile's metropolitan region. From a population of 70,065 school-age children who had graduated from high school, 434 possible twin pairs were analyzed. Of these, 327 were twins reared together (75.3% of the 434 possible twins pairs) and born between 1986 and 1987 in Chile (mean age 18 years), and approximately 8% were not twins despite matches on full name and birth data. The rest of the possible twin pairs were probably twins reared apart, since one member of the pair had moved to study in another region of Chile. Zygosity was determined through questionnaires, maternal reports of twin similarities, and by the hospital records of the twins at the time of birth. Three hundred and twenty-seven pairs were identified, where monozygotic (MZ) and dizygotic (DZ) twins represented 46.8% and 53.2% of pairs, respectively, with a DZ/MZ ratio of 1.14. Considering same-sex MZ pairs, the percentage of female pairs was greater (55.6%) than male pairs (44.4%). When DZ pairs were analyzed, 47.7% were of opposite sex, 20.1% were male pairs and 32.2% female pairs. In Chile, these findings represent a baseline study to contribute to the establishment of a national twin registry in the future.

[A methodological proposal to include nutrition education in primary schools. Experience in Chile]. / Propuesta metodológica para incorporar la educación en nutrición en la enseñanza básica. La experiencia de Chile.

This article presents the methodology to incorporate nutrition education in Chilean primary schools. In 2001, nutritional status, food and nutrition knowledge, attitudes and practices of 1701 school children from ten urban and rural public schools (3rd to 7th grade) were evaluated. This information was necessary to design the nutrition education strategy. The prevalence of obesity was 15.4% and overweight 19.6%. Daily intake of dairy products, fruits and vegetables was low, while the consumption of energy dense snacks was very high. Because the Ministry of Education does not allow the incorporation of new programs to the curriculum, the educational strategy was based on the development of a text book, a teacher's guide, five practical guides for students from third to eight grade and a CD-Rom. These materials were validated by 36 teachers through an educational intervention during 5 months in six schools (intervention groups). The teachers reported that the educational materials were useful, motivational and easy to understand for both, teachers and students. Preliminary results showed a significant increase in food and nutrition knowledge, in the consumption of dairy products and a decrease in the consumption of bread among the intervention groups. Intake of snacks increased in both groups, but it was significantly higher in the control group. These results indicate that nutrition education will only produce significant changes in food habits if health and educational authorities establish regulations for food advertisement oriented to children and also to food items sold in the schools.

Scholastic achievement: a multivariate analysis of nutritional, intellectual, socioeconomic, sociocultural, familial, and demographic variables in Chilean school-age children.

OBJECTIVE: We determined relative effects of nutritional status, intellectual ability, exposure to mass media, and socioeconomic, sociocultural, familial, demographic, and educational variables on scholastic achievement (SA). METHODS: This was a cross-sectional study. Exposure to mass media and nutritional, intellectual, socioeconomic, sociocultural, familial, demographic, and educational factors, including approximately 2000 variables, were measured in a representative and proportional sample of 4509 school-age children from elementary and high schools in Chile's Metropolitan Region. The field study was carried out between 1986 and 1987, and data processing, which lasted 15 y, was completed in 2002. RESULTS: Within the total sample, intellectual ability, level of maternal schooling, head circumference-for-age Z score, book reading, in-door plumbing, level of paternal schooling, type of school, quality of housing, height-for-age Z score, and calcium intake were the independent variables with the greatest explanatory power in SA variance (r(2) = 0.508). In most grades, IA was the independent variable with the greatest explanatory power in SA variance. In adolescents in their fourth year of high school and whose physical growth and intellectual development processes are consolidated, intellectual ability, age, head circumference-for-age Z score, book reading, type of school, and level of paternal schooling were the independent variables with the greatest explanatory power in SA variance (r(2) = 0.60). CONCLUSIONS: These findings show that SA is conditioned by multiple factors depending on the characteristics of school-age children, their families, and the educational system. Nutritional indicators of past nutrition are significantly associated with SA, especially head circumference-for-age Z score. This information may be useful for health and educational planning.

Propuesta metodológica para incorporar la educación en nutrición en la enseñanza básica: la experiencia de Chile / A methodological proposal to include nutrition education in primary schools: experience of Chile

Se presenta la metodología utilizada para incorporar la educación en nutrición en las escuelas básicas de Chile. El 2001, se evaluó el estado nutricional, los conocimientos, actitudes y prácticas alimentarias de 1.701 escolares de 3° a 7° básico (927 niños y 774 niñas) de 10 escuelas municipales urbanas y rurales de 3 regiones del país, cuyos resultados sirvieron de base para diseñar el modelo educativo. En el total de la muestra se encontró 15,4 por ciento de escolares obesos y 19,6 por ciento con sobrepeso, sin diferencias por región o sector urbano o rural. Se observó un consumo insuficiente de lácteos, verduras y frutas y excesivo de snacks de alta densidad enérgica. Debido a que el Ministerio de Educación no permite incorporar nuevos programas al currículo, el modelo educativo consistió en la elaboración de un libro, una Guía para el Profesor, cinco Guías para Alumnos de 3° a 8° básico y un CD-Rom. Los materiales fueron validados por 36 profesores en un programa de 5 meses con niños de 4° a 8° básico en 6 escuelas el 2002, resultando motivadores y fáciles de utilizar por profesor y alumnos. Resultados preliminares mostraron un significativo aumento en los conocimientos alimentarios, el consumo de lácteos, y una disminución en el consumo de pan en el grupo que recibió educación. El consumo de snacks aumentó ambos grupos (intervenido y control). Se concluye que para mejorar los hábitos alimentarios en los niños, se requiere mayor regulación de la publicidad y venta de snacks en las escuelas y fuera de ellas

Head size and intelligence, learning, nutritional status and brain development. Head, IQ, learning, nutrition and brain.

This multifactorial study investigates the interrelationships between head circumference (HC) and intellectual quotient (IQ), learning, nutritional status and brain development in Chilean school-age children graduating from high school, of both sexes and with high and low IQ and socio-economic strata (SES). The sample consisted of 96 right-handed healthy students (mean age 18.0 +/- 0.9 years) born at term. HC was measured both in the children and their parents and was expressed as Z-score (Z-HC). In children, IQ was determined by means of the Wechsler Intelligence Scale for Adults-Revised (WAIS-R), scholastic achievement (SA) through the standard Spanish language and mathematics tests and the academic aptitude test (AAT) score, nutritional status was assessed through anthropometric indicators, brain development was determined by magnetic resonance imaging (MRI) and SES applying the Graffar modified method. Results showed that microcephalic children (Z-HC < or = 2 S.D.) had significantly lower values mainly for brain volume (BV), parental Z-HC, IQ, SA, AAT, birth length (BL) and a significantly higher incidence of undernutrition in the first year of life compared with their macrocephalic peers (Z-HC > 2S.D.). Multiple regression analysis revealed that BV, parental Z-HC and BL were the independent variables with the greatest explanatory power for child's Z-HC variance (r(2) = 0.727). These findings confirm the hypothesis formulated in this study: (1) independently of age, sex and SES, brain parameters, parental HC and prenatal nutritional indicators are the most important independent variables that determine HC and (2) microcephalic children present multiple disorders not only related to BV but also to IQ, SA and nutritional background.

Evaluación de la sensibilidad del cultivo de semen en el diagnóstico de prostatitis bacteriana crónica / Assessment of the sensitivity of semen culture in the diagnosis of chronic bacterial prostatitis

Objetivo: Evaluar la sensibilidad del cultivo de semen en el diagnóstico de pacientes con prostatis bacteriana crónica (PBC). Materiales y métodos: Es un estudio de serie de casos prospectivos y analíticos realizado en varones con clínica sugerente de PBC y sin tratamiento previo. Se evaluaron variables clínicas, demográficas y de laboratorio. A todos los pacientes se les realizó la prueba de Meares y Stamey y la prueba a la que denominamos. Alterna (espermocultivo y 3 urocultivo). Se evaluó la sensibilidad del cultivo de semen. Resultados: De 130 pacientes, solo en 69 se realizaron ambas pruebas. La edad promedio fue de 37.07±11.16 años. El tiempo promedio de enfermedad antes de acudir a consulta médica fue de 12.5 meses. El síntoma más frecuente fue el dolor testicular bilateral presente en 32 (46.59 por ciento) pacientes. El examen digito rectal de la próstata fue normal en 64 (92.75 por ciento) de los pacientes. La prueba alterna fue positiva en 7 (10.14 por ciento) casos siendo Escherichia coli el germen más frecuentemente aislado en el cultivo de semen. La prueba de Meares y Stamey fue positiva en todos los pacientes. Staphylococcus aureus fue el germen más frecuentemente encontrado en el cultivo de secreción prostática. La sensibilidad del cultivo de semen para el diagnóstico de PBC fue de 10.14 por ciento. Conclusión: En nuestro estudio el cultivo de semen tiene una baja sensibilidad en el diagnóstico de PBC y su empleo nos llevaría a sub diagnosticar esta condición.