Traducción y análisis de validez de contenido del instrumento Opening Minds Scale for Healthcare Practitioners (OMS-HC) para la evaluación del estigma hacia la enfermedad mental en profesionales de la salud en Chile / Translation and content analysis of the Opening Minds Scale for Healthcare Practitioners (OMS-HC) for the assessment of stigma towards mental illness in health care professionals in Chile

INTRODUCCIÓN: Las personas con enfermedades mentales con frecuencia experimentan estigma por parte de profesionales de la salud, por lo que es necesario disponer de instrumentos para evaluar el estigma e implementar acciones para reducirlo. Este manuscrito describe el proceso de traducción y validación de contenido en Chile del instrumento Opening Minds Scale for Healthcare Practitioners (OMS-HC), para la evaluación del estigma en profesionales de la salud hacia personas con enfermedad mental desarrollado originalmente en Canadá. MÉTODO: Se realizó la traducción y análisis de validación de contenido, incluyendo etapas de traducción inglés-castellano y traducción inversa por traductora profesional, triangulación, y finalmente consulta a expertos para evaluación de validez de contenido según Índice de Validez de Contenido (IVC) con 10 expertos de investigación, academia, y experto por experiencia en salud mental. Se consideró aceptables ítems con IVC entre 0,51-0,99. RESULTADOS: Del total de 20 ítems del cuestionario, dos fueron evaluados con IVC menor al establecido, relacionados con constructos "hope" y "compassion", propios del marco teórico-modelo de Recovery, base del instrumento. Los dos ítems fueron re-evaluados con autores originales para adaptarlos procurando fidelidad al constructo, en un proceso iterativo con expertos. CONCLUSIONES: Se presenta la traducción del instrumento Opening Minds Scale for Healthcare Practitioners (OMS-HC) adaptado al castellano y con análisis de su validación de contenido, consistente de 20 ítems para evaluación del estigma hacia personas con enfermedades mentales en profesionales de la salud, posibilitando nuevos estudios que analicen su validez de criterio, y la exploración de su utilidad a nivel local.

INTRODUCTION: People with mental illnesses frequently experience stigma from health care professionals, which is why it is an urge to count with adequate assessments to evaluate stigma to address it. This manuscript describes the process of language translation and content validation in Chile of the Opening Minds Scale for the assessment of stigma against people with mental illnesses in Healthcare Practitioners (WHO-HC), originally developed in Canada. METHODS: Language translation and content validation analysis were performed, including English-Spanish translation and reverse translation by professional translator, item triangulation by researchers, and content validity analysis of the translated questionnaire by expert evaluation based on the Content Validity Index (CVI), including 10 experts in academia, research, and one expert by experience. Items rated with CVI 0.51-0.99 were considered acceptable. RESULTS: From the total of 20 items of the questionnaire, two were rated with lower CVI than acceptable, specifically related to the constructs "hope" and "compassion", part of the theoretical framework of Recovery in which the questionnaire is based on. The two items were re-evaluated including original authors to adapt them seeking fidelity to the foundational constructs, through an iterative process with experts. CONCLUSIONS: The translation of the Opening Minds Scale for Healthcare Practitioners (WHO-HC) is presented, adapted to Spanish in Chile after content analysis, consisting of 20 items for the evaluation of stigma towards people with mental illness in health professionals, enabling the development of new studies to analyze criterion validity, and the exploration of feasibility and utility at the local level.

Desafíos de la terapia ocupacional en la inclusión social de jóvenes infractores de ley, en medios de régimen cerrados de internación en Chile / Challenges of occupational therapy in the social inclusion of young offenders in closed centers in Chile

La presente investigación de carácter cualitativo y exploratorio, tuvo por objetivo desarrollar un análisis de las acciones que un grupo de terapeutas ocupacionales realizan en los programas de reinserción social de jóvenes infractores de ley, en centros de régimen cerrado y de internación. Para esto, se contactó a un grupo de 29 profesionales que contestaron un cuestionario semiestructurado. El análisis de los hallazgos se realizó empleando la técnica del análisis de contenido. Dentro de los resultados se identificó que las acciones profesionales se orientan a las necesidades ocupacionales de los adolescentes, enfocadas hacia la participación social e inclusión laboral. Las intervenciones se concentran en los procesos motivacionales y de responsabilización, con eje en el vínculo terapéutico, la entrevista motivacional y la consideración de los intereses de los adolescentes. Se estima que las rutinas al interior del centro y el área educacional no son abordadas, en su mayoría, por los terapeutas ocupacionales. Los equipos interdisciplinarios de los centros han incorporado el rol de Terapia Ocupacional con dificultades y desconocimiento, atribuyéndoles cierta experticia solamente en las áreas de capacitación y en el ámbito laboral.Concluimos que existen distintos niveles de desarrollo profesional en el área, ya que no todos los profesionales presentan experiencia de trabajo con población adolescente privada de libertad, los cuales presentan altos niveles de complejidad psicosocial. Existen avances en propuestas de diagnóstico ocupacional del adolescente infractor, sin embargo se requiere generar evidencia en lo que respecta a intervenciones específicas que fortalezcan acciones que mejoren el desempeño ocupacional de los adolescentes para lograr procesos de reinserción efectivos...

The research study has a qualitative and exploratory approach and aimed to develop an analysis of the actions made by a group of occupational therapists within social reintegration programs for young offenders in closed centers. For this, we contacted a group of 29 professionals who answered a semi-structured questionnaire. The analysis of the findings was performed using the content analysis method. The results identified that professional actions are oriented towards young’ occupational needs, focused towards social participation and work inclusion. The interventions focus on motivational processes and accountability, with emphasis in the therapeutic relationship, motivational interviewing and consideration of the interests of teenagers. It is estimated that the teenagers’ routines in the center and the area of education are mostly not addressed by occupational therapists. Centers’ Interdisciplinary teams have incorporated the role of Occupational Therapy with difficulties and lack of knowledge, attributing them only certain expertise in the areas of workplace training.We conclude that there are different levels of professional development in the area, since not all professionals have experience working with teenagers deprived of freedom, which challenges with high levels of psychosocial complexity. There are advances in diagnosis of occupational proposed juvenile offenders, but is necessary to generate evidence regarding specific interventions to strengthen actions to improve teenagers’ occupational performance to achieve effective reintegration processes...

Presencia de macroprolactina en sueros con normo e hiperprolactinemia: comparación de dos métodos de detección / Comparison of two techniques to detect the presence of macroprolactin in serum

Background: Macroprolactin is biologically inactive but may be detected by immnoassays. This leads to errors in diagnosis and inadequate treatment of patients with hyperprolactinemia. Aim:To assess two techniques to detect the presence of macroprolactin. Material and Methods: Prolactin was measured by immunoassay in 57 serum samples (from 4 males and 53 females aged33 +/- 13 years), before and after precipitation with polyethyleneglycol (PEG) and separation by ultrafiltration. A significant level of macroprolactin was considered to be present when prolactin detected in the supernatant after PEG precipitation or in the ultrafiltrate was less than 40 percent of the initial concentration of prolactin. Results: Prolactin levels fluctuated from 5 to 411 ng/ml. The percentages of recuperation were independent of the initial prolactin concentration. In 12 and 14 percent of samples, using polyethyleneglycol and ultrafiltration respectively, there was a prolactin recuperation of less than 40 percent. Eight and 11 percent of samples with a prolactin concentration of more than 30 ng/ml, had a recuperation of less than 40 percent using polyethyleneglycol and ultrafiltration respectively. Conclusions: Approximately 10 percent of samples with a prolactin concentration over 30ng/ml have recuperation values suggestive of the presence of macroprolactin. There is a good concordance between precipitation using polyethyleneglycol or ultrafiltration.

Marked increase in bladder and lung cancer mortality in a region of Northern Chile due to arsenic in drinking water.

Studies in Taiwan and Argentina suggest that ingestion of inorganic arsenic from drinking water results in increased risks of internal cancers, particularly bladder and lung cancer. The authors investigated cancer mortality in a population of around 400,000 people in a region of Northern Chile (Region II) exposed to high arsenic levels in drinking water in past years. Arsenic concentrations from 1950 to the present were obtained. Population-weighted average arsenic levels reached 570 microg/liter between 1955 to 1969, and decreased to less than 100 microg/liter by 1980. Standardized mortality ratios (SMRs) were calculated for the years 1989 to 1993. Increased mortality was found for bladder, lung, kidney, and skin cancer. Bladder cancer mortality was markedly elevated (men, SMR = 6.0 (95% confidence interval (CI) 4.8-7.4); women, SMR = 8.2 (95% CI 6.3-10.5)) as was lung cancer mortality (men, SMR = 3.8 (95% CI 3.5-4.1); women, SMR = 3.1 (95% CI 2.7-3.7)). Smoking survey data and mortality rates from chronic obstructive pulmonary disease provided evidence that smoking did not contribute to the increased mortality from these cancers. The findings provide additional evidence that ingestion of inorganic arsenic in drinking water is indeed a cause of bladder and lung cancer. It was estimated that arsenic might account for 7% of all deaths among those aged 30 years and over. If so, the impact of arsenic on the population mortality in Region II of Chile is greater than that reported anywhere to date from environmental exposure to a carcinogen in a major population.

[Current human and canine seroprevalence of Chagasic infection in San Pedro de Atacama County, II Region of Antofagasta, Chile, 1995]. / Estado actual de la seroprevalencia de la infección chagásica humana y canina en la comuna de San Pedro de Atacama, II Región de Antofagasta, Chile, 1995.

In order to assess the impact of a control program against Triatoma infestans launched in 1988, based on insecticide spraying of dwellings, a serological survey for chagasic infection was carried out during 1995 in three localities from San Pedro de Atacama County (22 degrees 55' South lat., 68 degrees 12' West long.), II Region of Antofagasta in northern Chile. Blood samples from 531 children and adolescents and 65 dogs were subjected to ELISA test and indirect immunofluorescent test for Chagas' disease respectively. Tests resulted positive in 12 (2.3%) persons, all above 5 years old, in contrast with the 16.8% serological positivity observed in 1985. Three (4.6%) dogs (two 0-12 months old) resulted positive. These results indicate that dwelling sprayings with long-term activity insecticides against T. infestans is a good tool to prevent new human infections with T. cruzi. However, active vector transmission among domestic animals (canines) could be recently acquired.

Hemofilia A: análisis de intron 18 e intron 7 del gen del factor VIII y su rol en una estrategia de diagnóstico de portadoras en una población chilena / Hemophilia A: analysis of intron 18 and intron 7 of factor VIII gene and its role in a strategy of carrier diagnosis in a chilean population

Hemophilia A is an X-linked disorder of coagulation caused by a deficiency of factor VIII. A large number of different mutations in the VIII gene have been identified. Thus, the detection of female carriers, depends upon the analysis of DNA polymorphism in and near the factor VIII gene. Our aim was to develop a strategy, earlier reported, for carrier testing in families at risk of hemophilia A. In this study, we analyzed the DNA polymorphisms in 26 affected families, with use of the factor VIII intragenic polymorphisms identified by the restriction enzymes Bcll and AlwNI and by differential hybridization with sequence-specific oligonuclaotide probes recognizing Bcll and AlwNI polymorphisms. While the DNA polymorphism detected by Bcll site in intron 18 of the factor VIII gene was informative for 30 percent families studied, the AlwNI/intron 7 polymorphism provided aditional information (4 percent). The carrier status of the remaining 58 percent could be determined utilizing the other polymorphisms suggested the strategy. The 2 polymorphic sites used combined with the other polymorphisms, intragenic and extragenic, can generate levels of informativeness greater than 98 percent. We concluded that the strategy for carrier testing would be a good alternative in genetic counselling for hemophilia A., but its limitations must be carefully taken into account

Resistencia a la proteína C activada: estudio de laboratorio y prevalencia del defecto en la población chilena / Activated protein C resistance: laboratory study and prevalence of the defect in chilean population

Activated protein C resistance (APCR) or factor V leiden has been recently described as the most prevalent hemostatic abnormality associated with venous thrombosis. In patients with familial thrombophilia, the prevalence of APCR is 19-60 percent and around 20 percent in sporadic venous thrombosis. APCR is usually measured by the degree of prolongation of activated Partial Thromboplastin Time (APTT) on patient's plasma, induced by addition of APC in comparison to normal plasma. At the molecular level the defect is caused by a single-point mutation in the gene for factor V (FV) (G1.691-A), that predict the replacement of Arg506 by Glutamine. This mutation makes activated factor V resistant to inactivation by APC. Since the prevalence of the defect is highly variable among different populations, the objective of this work was to study its frequency in our population and in patients with thrombophilia. We defined the normal range for APTT ratio (APTT+APC/APTT-APC) in a group of 73 healthy volunteers in whom the presence of FV Q506 mutation was searched using Mnll enzyme digestion of PCR amplified genomic fragment containing the nucleotide 1.691. The lower limit of APTT ratio stablished in this group was 2.13. APCR was found in 6 out of 159 control subjects (3.8 percent) and in 14/50 (28 percent) of patients with thrombosis. In 13 cases as a single defect and in 1 associated to type I protein C deficiency. All the APCR patients and control subjects were heterozygotes by gene analysis. The results demonstrate that in our population APCR is also the most common defect associated with thrombosis, in accordance with a high prevalence in the population. The ability to screen for this defect will permit the identification of carriers that would benefit preventive therapy at risk situations