Levetiracetam prescription profile in children younger than 4 years treated at a tertiary care hospital in Chile. / Perfil de prescripción de levetiracetam en niños menores de cuatro años atendidos en un hospital de alta complejidad de Chile.

Introduction. Levetiracetam (LEV) is an antiepileptic drug approved by the Chilean Institute of Public Health as concomitant therapy for epileptic seizures in children older than 4 years of age. However, it is widely prescribed from the neonatal period, which makes it necessary to evaluate its off-label use. Objective. To determine the prescription-indication profile of LEV in the treatment of epileptic seizures in children younger than 4 years in a tertiary care hospital in southern Chile. Population and method. Observational, descriptive, and retrospective study. The medical records of patients who started treatment with LEV between 2014 and 2019 were reviewed, and data on sociodemographic, pharmacological, and clinical variables were collected. The analysis was based on the description of the profile of patients, prescriptions, follow-up, and safety. Results. A total of 68 patients were included: 40 (58.8%) were males, 49 (72.1%) were born at a gestational age ≥ 37 weeks. The main etiology of epilepsy was structural (35.3%); LEV was mostly used in children diagnosed with central nervous system malformation (17.6%), and monotherapy was the prevailing dosage (55.9%). LEV was used for focal seizures in 50% of cases. Five children (7.3%) had psychiatric disorders, classified as probable adverse drug reactions. Conclusion. LEV was used in children with various diagnoses, with a low rate of adverse events. The profile of drug use varied in the different age groups. Future studies are needed to identify effectiveness, especially in newborn infants and patients with refractory epilepsy.

Introducción. El levetiracetam (LEV) es un antiepiléptico aprobado por el Instituto de Salud Pública de Chile como terapia concomitante en crisis epilépticas en niños mayores de cuatro años. Sin embargo, es ampliamente indicado desde el periodo neonatal, lo que hace necesario evaluar su utilización fuera de ficha técnica. Objetivo. Determinar el perfil de prescripción-indicación de LEV en el tratamiento de las crisis epilépticas en menores de cuatro años en un hospital de alta complejidad del sur de Chile. Población y método. Estudio observacional, descriptivo y retrospectivo. Se revisaron las historias clínicas de quienes iniciaron tratamiento con LEV entre 2014 y 2019, y se recopilaron datos sobre variables sociodemográficas, farmacológicas y clínicas. El análisis se basó en la descripción del perfil de los pacientes, prescripción, seguimiento y seguridad. Resultados. Se incluyeron 68 pacientes: 40 (58,8 %) de sexo masculino, 49 (72,1 %) con edad gestacional ≥ 37 semanas. La etiología principal de la epilepsia fue de tipo estructural (35,3 %); el LEV se utilizó principalmente en niños diagnosticados con malformación del sistema nervioso central (17,6 %) y predominó la monoterapia (55,9 %). En el 50 % se usó LEV para crisis focales. Cinco niños (7,3 %) presentaron trastornos de tipo psiquiátrico clasificados como probables reacciones adversas al medicamento. Conclusión. El LEV se utilizó en niños con diferentes diagnósticos con baja frecuencia de eventos adversos. El perfil de utilización varió en los diferentes grupos etarios. Es necesario identificar en futuros estudios la efectividad especialmente en el recién nacido y en epilepsias refractarias.

The Effectiveness of Aquatic Therapy Based on the Halliwick Concept in Children with Cerebral Palsy: A Systematic Review.

The aim of the review was to evaluate the evidence regarding the effectiveness of aquatic rehabilitation based on the Halliwick concept (HC) in psychomotor development, gross motor function and aquatic skills of children with cerebral palsy. We followed PRISMA recommendations, performing a systematic search in PubMed, Science Direct, LILACS, SciELO, and PEDro database. We identified 474 studies; five met the eligibility criteria and were included in the review. Four studies demonstrated a significant improvement in gross motor function and aquatic skills. Social interaction skills were also improved. However, the methodological quality of these studies was limited, and then, research that adopt controlled experimental designs are necessary.

[Profile of patients evaluated with the Carbon Monoxide Diffusion Capacity Test: A Chilean experience]. / Perfil de pacientes evaluados con el Test de Capacidad de Difusión de Monóxido de Carbono: Una experiencia chilena.

BACKGROUND: The carbon monoxide diffusion capacity test (DLCO) is a clinically useful, routine, non-invasive lung function assessment to determine the status of lung function in patients with chronic disorders such as interstitial lung disease (ILD). AIM: To describe the sociodemographic and clinical profile of users of the DLCO test in Valdivia, Chile. MATERIALS AND METHODS: Observational, retrospective, documentary-based study. From the records of 490 patients who underwent the DLCO test between 2017 and 2019, sociodemographic and clinical characteristics and reports of cigarette consumption are described, such as cigarettes/d and pack-year index (PYI), comparing by sex. RESULTS: The highest proportion of those evaluated were women (61%), with a median age of 65 years, higher in women (66 vs. 64 years; p = 0.0361). The majority consulted for ILD (54.5%). According to nutritional status, 38% presented pre-obesity and 24.7% obesity I (24.7%), highlighting that 40.5% of women and 33% of men were in some category of obesity. Among those who reported information on cigarette consumption (n = 346, 70.6%), 14.7% (n = 51) were current consumers, with a median consumption of 10 cigarettes/d, without differences by sex. Among exsmokers (n = 144; 50% men/women) there was significantly less daily (5 vs 15; p = 0.0300) and IPA (7 vs 18; p = 0.0083) consumption in women. CONCLUSIONS: In DLCO users, the main consultation diagnosis was ILD. High frequency of obesity and smoking stood out, with no difference in consumption by sex in current smokers, but yes in ex-smokers.

Cumplimiento de las medidas de restricción del uso residencial de leña en la ciudad de Valdivia / Compliance with the measures of restrict the residential use of firewood in Valdivia, Chile

BACKGROUND: Atmospheric pollution is a problem that causes great concern and health risks for the population and the earth, as it affects developed countries and third world countries. Locally, there are no studies that prove the fulfillment level of the restriction about the usage of residential firewood, considering that since 2014 there is a procedure called "The Environmental Decontamination Plan" in Valdivia (PDAV). Aim: To determine the fulfillment level of the restriction about residential firewood and its related factors. MATERIAL AND METHODS: The population study were 594 homes that were assigned randomly and proportionally according to 2 territorial areas (A and B) established in the PDAV. The sample's characteristics were described, comparison techniques were applied by subgroups (sociodemographic, home's structures and humidity's perception and percentage of the firewood) to identify factors related mainly with the fulfillment of measurements about firewood usage. RESULTS: 52% of households do not comply with the residential firewood use restriction measure, having sociodemographic factors related with this failure, such as schooling, health insurance and home structure. Besides, it is noted that the knowledge level of PDAV is associated with the accomplish level of restriction measures. When people know more about PDAV, there is a higher proportion of accomplishment. Conclusion: In more than half of the households, the restriction on the use of woodstove is not complied. The lack of knowledge of the population about the PDAV directly influences its compliance, which requires strategies to promote adherence to this program.

[Compliance with the measures of restrict the residential use of firewood in Valdivia, Chile]. / Cumplimiento de las medidas de restricción del uso residencial de leña en la ciudad de Valdivia.

BACKGROUND: Atmospheric pollution is a problem that causes great concern and health risks for the population and the earth, as it affects developed countries and third world countries. Locally, there are no studies that prove the fulfillment level of the restriction about the usage of residential firewood, considering that since 2014 there is a procedure called "The Environmental Decontamination Plan" in Valdivia (PDAV). AIM: To determine the fulfillment level of the restriction about residential firewood and its related factors. MATERIAL AND METHODS: The population study were 594 homes that were assigned randomly and proportionally according to 2 territorial areas (A and B) established in the PDAV. The sample's characteristics were described, comparison techniques were applied by subgroups (sociodemographic, home's structures and humidity's perception and percentage of the firewood) to identify factors related mainly with the fulfillment of measurements about firewood usage. RESULTS: 52% of households do not comply with the residential firewood use restriction measure, having sociodemographic factors related with this failure, such as schooling, health insurance and home structure. Besides, it is noted that the knowledge level of PDAV is associated with the accomplish level of restriction measures. When people know more about PDAV, there is a higher proportion of accomplishment. CONCLUSION: In more than half of the households, the restriction on the use of woodstove is not complied. The lack of knowledge of the population about the PDAV directly influences its compliance, which requires strategies to promote adherence to this program.

Effects of inhalation aromatherapy as a complementary therapy in pediatric patients in the clinical practice: A systematic review.

BACKGROUND: Inhalation aromatherapy is a complementary therapy in different clinical settings, but there is little evidence about its effectiveness in childcare. OBJECTIVE: To assess the effectiveness of inhalational aromatherapy in the care of hospitalized pediatric patients. METHODS: Systematic review of clinical trials and quasi-experimental studies, based on PRISMA recommendations, searching Medline, Web of Science, Scopus, SciELO, LILACS, CINAHL, Science Direct, EBSCO, and updated databases. The Down and Black 2020, RoB 2020 CLARITY, and ROBINS-I 2020 scales were used through the Distiller SR software to verify the studies' internal validity and risk of bias. RESULTS: From 446 articles identified, 9 fulfilled the inclusion criteria. Seven were randomized controlled trials (RCTs), one pilot RCT, and one non-randomized quasi-experimental trial. Different outcomes were analyzed, with pain being the most frequently measured variable. None of the 6 studies that evaluated pain showed significant effects with inhalation aromatherapy. Additionally, non-significant effects were found regarding nausea, vomiting, and behavioral/emotional variables. CONCLUSIONS: The findings are still inconclusive, and more evidence is required from future studies with high methodological quality, blinding, and adequate sample sizes.

Evolution of infant mortality in Chile and how it has been reflected in scientific publications between 1980 and 2019. / Evolución de la mortalidad infantil en Chile y su reflejo en las publicaciones científicas entre 1980 y 2019.

INTRODUCTION: One of the Millennium Development Goals is to reduce the child mortality rate (CMR), an indicator still present in the Sustainable Development Goals (2015-2030). At the same time, scientific investigations and reports were necessary to assess the behavior of the infant mortality rate (IMR) and the effectiveness of interventions to approach it. OBJECTIVE: To describe IMR behavior in Chile and how it has been reflected in the scientific publications made in the 1980-2019 period. MATERIAL AND METHODS: Implementation of the multivariate adaptive regression spline (MARS) method in relation to IMR between 1980 and 2016, and search for related articles published between 1980 and 2019 in SciELO, Lilacs, PubMed, Cochrane Library, and Embase. The analysis included IMR behavior and its reflection in the publications made in that period. RESULTS: IMR decreased from 28 % to 7.2 % per 1000 live births between 1980 and 2016 (-74 %) and 82 publications were identified in this period. Two types of studies about IMR were reported as of the cutoff point of 1996. In the first period, studies focused on preventable diseases and interventions, while IMR showed a slowing down in its reduction. After the cutoff point, studies focused on non-preventable diseases and factors related to inequalities and inequities. CONCLUSIONS: IMR prevails as a synthetic indicator of health conditions. Changes in its evolution and causes have been reflected in publications, which have shifted their focus and areas of interest in accordance with the changes in this indicator.

Introducción. Los Objetivos de Desarrollo del Milenio incluyen la reducción de la tasa de mortalidad infantil (TMI), indicador que sigue vigente en las metas de los Objetivos de Desarrollo Sostenible (2015-2030). En paralelo, se requirieron investigaciones y reportes científicos para evaluar el comportamiento de la TMI y la efectividad de intervenciones para su abordaje. Objetivo. Describir el comportamiento de la TMI en Chile y su reflejo en las publicaciones científicas durante el período 1980-2019. Material y métodos. Aplicación del método de regresión lineal multivariable adaptiva (MARS, por su sigla en inglés) sobre las TMI entre 1980 y 2016, y búsqueda de artículos relacionados publicados entre 1980 y 2019 en SciELO, Lilacs, PubMed, Cochrane Library y Embase. Se analizó el comportamiento de la TMI y su reflejo en las publicaciones del período. Resultados. Hubo una reducción de la TMI de 28 ‰ a 7,2 ‰ nacidos vivos entre 1980 y 2016 (-74 %) y se identificaron 82 publicaciones en el período. Se registraron dos tipos de estudio sobre la TMI a partir de un punto de corte en 1996. En el primer período, los estudios abordaron patologías evitables e intervenciones, a la par de una reducción de la velocidad de descenso de la TMI. Posteriormente al punto de corte, los estudios se enfocaron en enfermedades no evitables y factores relacionados con inequidades y desigualdades. Conclusiones. La TMI prevalece como indicador sintético de las condiciones de salud. Las modificaciones en su evolución y sus causas se han reflejado en las publicaciones, que han variado sus énfasis y focos de atención según el cambio en este indicador.

Humanized Care from the Perception of Oncology Patients from Southern Chile.

OBJECTIVES: This work sought to determine the perception of behaviors of humanized nursing care and its relation with sociodemographic and clinical variables in patients hospitalized in a Hemato-Oncology Department. METHODS: Analytic cross-sectional study conducted with 51 patients hospitalized in the Hemato-Oncology Unit at Hospital Base Valdivia, Chile. A survey containing sociodemographic and clinical information was applied together with the questionnaire on Perception of Behaviors of Humanized Nursing Care 3rd version" -PBHNC 3v (32 items distributed in the categories: Qualities of nursing work, Openness to nurse-patient communication, and Willingness to care). RESULTS: Of the participants, 51% were women, with mean age of 46.5±16.6 years; 54.9% were diagnosed with Lymphoma and 78.4% were in the treatment induction stage. In 30 of the 32 items of the instrument, > 90% of the participants evaluated compliance with the behavior of caring at level of "always". By categories, it was observed that for "Willingness to care" there was significantly lower score among patients from 18 to 49 years of age (p=0.0455). For the category "Openness to nurse-patient communication" lower median score existed in patients with Myeloma (p=0.0043) and in patients in the Remission-Consolidation stage (p=0.0084). Days of hospitalization were associated significantly with the category "Willingness to care", being lower with 16 days and more (p=0.0242). CONCLUSIONS: High frequency was observed of humanized-care behaviors and small differences in their assessment that were associated with demographic factors like age, and clinical factors, like diagnosis, treatment stage, and days of hospitalization.

Humanized Care from the Perception of Oncology Patients from Southern Chile / Cuidado humanizado desde la percepción de pacientes oncológicos del sur de Chile / Cuidado humanizado a partir da percepção de pacientes com câncer no sul do Chile

Objective. This work sought to determine the perception of behaviors of humanized nursing care and its relation with sociodemographic and clinical variables in patients hospitalized in a Hemato-Oncology Department. Methods. Analytic cross-sectional study conducted with 51 patients hospitalized in the Hemato-Oncology Unit at Hospital Base Valdivia, Chile. A survey containing sociodemographic and clinical information was applied together with the questionnaire on Perception of Behaviors of Humanized Nursing Care 3rd version" -PBHNC 3v (32 items distributed in the categories: Qualities of nursing work, Openness to nurse-patient communication, and Willingness to care). Results. Of the participants, 51% were women, with mean age of 46.5±16.6 years; 54.9% were diagnosed with Lymphoma and 78.4% were in the treatment induction stage. In 30 of the 32 items of the instrument, > 90% of the participants evaluated compliance with the behavior of caring at level of "always". By categories, it was observed that for "Willingness to care" there was significantly lower score among patients from 18 to 49 years of age (p=0.0455). For the category "Openness to nurse-patient communication" lower median score existed in patients with Myeloma (p=0.0043) and in patients in the Remission-Consolidation stage (p=0.0084). Days of hospitalization were associated significantly with the category "Willingness to care", being lower with 16 days and more (p=0.0242). Conclusion. High frequency was observed of humanized-care behaviors and small differences in their assessment that were associated with demographic factors like age, and clinical factors, like diagnosis, treatment stage, and days of hospitalization.

Objetivo. Determinar la percepción de comportamientos de cuidados humanizados de enfermería y su relación con variables sociodemográficas y clínicas en pacientes hospitalizados en una Unidad de Hemato-Oncología. Métodos. Estudio transversal analítico realizado con la participación de 51 pacientes hospitalizados en la Unidad de Hemato-Oncología del Hospital Base Valdivia, Chile. Se aplicó un formulario que contenía información sociodemográfica, clínica y el instrumento Percepción de Comportamientos de Cuidados Humanizados de Enfermería 3ª versión" -PCHE 3v (32 ítems distribuidos en las categorías: Cualidades del hacer de enfermería, Apertura a la comunicación enfermera(o)-paciente y Disposición para la atención). Resultados. De los participantes, 51% fueron mujeres, con una edad media de 46.5±16.6 años. Un 54.9% presentó diagnóstico de Linfoma y 78.4% estaba en etapa de Inducción del tratamiento. En 30 de los 32 ítems del instrumento, sobre 90% de los participantes evaluaron el cumplimiento del comportamiento de cuidado en nivel "siempre". Por categorías se observó que para "Disposición para la atención" hubo significativa menor puntuación entre los pacientes de 18 a 49 años (p=0.0455). Para la categoría "Apertura a la comunicación enfermera(o)-paciente" existió menor puntaje mediano en pacientes con Mieloma (p=0.0043) y en los pacientes en etapa de Remisión-Consolidación (p=0.0084). Los días de hospitalización se asociaron significativamente con la categoría "Disposición para la atención", siendo menor con 16 días y más (p=0.0242). Conclusión. Hubo alta frecuencia de comportamientos de cuidados humanizados y pequeñas diferencias en su valoración que se asociaron con factores demográficos como la edad y a factores clínicos como el diagnóstico, la etapa de tratamiento y los días de hospitalización.

Objetivo. Verificar a percepção dos comportamentos de cuidado humanizado de enfermagem e sua relação com variáveis sociodemográficas e clínicas em pacientes internados em uma Unidade de Hemato-Oncologia. Métodos. Estudo transversal analítico realizado com a participação de 51 pacientes internados na Unidade de Hemato-Oncologia da Base Hospitalar de Valdivia, Chile. Foi aplicado um formulário que continha informações sociodemográficas e clínicas e o instrumento Percepção de Comportamentos da Assistência Humanizada de Enfermagem 3ª versão -PCHE 3v (32 itens distribuídos nas categorias: Qualidades do trabalho de enfermagem, Abertura à comunicação do enfermeiro (a) - Paciente e Disponibilidade para o cuidado). Resultados. Dos participantes, 51% eram mulheres, com média de idade de 46.5±16.6 anos. 54.9% apresentavam diagnóstico de Linfoma e 78.4% encontravam-se na fase de indução do tratamento. Em 30 dos 32 itens do instrumento, mais de 90% dos participantes avaliaram a adesão ao comportamento de cuidado no nível "sempre". Por categorias, observou-se que para "Disponibilidade para o cuidado" houve significativamente menor pontuação entre os pacientes de 18 a 49 anos (p=0.0455). Na categoria "Abertura à comunicação enfermeiro-paciente" houve menor pontuação mediana nos pacientes com Mieloma (p=0.0043) e nos pacientes em fase de Remissão-Consolidação (p=0.0084). Os dias de internação estiveram significativamente associados à categoria "Disponibilidade para o atendimento", sendo menos com 16 dias e mais (p=0.0242). Conclusão. Observou-se alta frequência de comportamentos de cuidado humanizado e pequenas diferenças na avaliação que estiveram associadas a fatores demográficos como idade e a fatores clínicos como diagnóstico, fase do tratamento e dias de internação.

Evolución de la mortalidad infantil en Chile y su reflejo en las publicaciones científicas entre 1980 y 2019 / Evolution of infant mortality in Chile and how it has been reflected in scientific publications between 1980 and 2019

Introducción. Los Objetivos de Desarrollo del Milenio incluyen la reducción de la tasa de mortalidad infantil (TMI), indicador que sigue vigente en las metas de los Objetivos de Desarrollo Sostenible (2015-2030). En paralelo, se requirieron investigaciones y reportes científicos para evaluar el comportamiento de la TMI y la efectividad de intervenciones para su abordaje. Objetivo. Describir el comportamiento de la TMI en Chile y su reflejo en las publicaciones científicas durante el período 1980-2019. Material y métodos. Aplicación del método de regresión lineal multivariable adaptiva (MARS, por su sigla en inglés) sobre las TMI entre 1980 y 2016, y búsqueda de artículos relacionados publicados entre 1980 y 2019 en SciELO, Lilacs, PubMed, Cochrane Library y Embase. Se analizó el comportamiento de la TMI y su reflejo en las publicaciones del período. Resultados. Hubo una reducción de la TMI de 28 ‰ a 7,2 ‰ nacidos vivos entre 1980 y 2016 (-74 %) y se identificaron 82 publicaciones en el período. Se registraron dos tipos de estudio sobre la TMI a partir de un punto de corte en 1996 En el primer período, los estudios abordaron patologías evitables e intervenciones, a la par de una reducción de la velocidad de descenso de la TMI. Posteriormente al punto de corte, los estudios se enfocaron en enfermedades no evitables y factores relacionados con inequidades y desigualdades. Conclusiones. La TMI prevalece como indicador sintético de las condiciones de salud. Las modificaciones en su evolución y sus causas se han reflejado en las publicaciones, que han variado sus énfasis y focos de atención según el cambio en este indicador

Introduction. One of the Millennium Development Goals is to reduce the child mortality rate (CMR), an indicator still present in the Sustainable Development Goals (2015-2030). At the same time, scientific investigations and reports were necessary to assess the behavior of the infant mortality rate (IMR) and the effectiveness of interventions to approach it. Objective. To describe IMR behavior in Chile and how it has been reflected in the scientific publications made in the 1980-2019 period. Material and methods. Implementation of the multivariate adaptive regression spline (MARS) method in relation to IMR between 1980 and 2016, and search for related articles published between 1980 and 2019 in SciELO, Lilacs, PubMed, Cochrane Library, and Embase. The analysis included IMR behavior and its reflection in the publications made in that period. Results. IMR decreased from 28 % to 7.2 % per 1000 live births between 1980 and 2016 (-74 %) and 82 publications were identified in this period. Two types of studies about IMR were reported as of the cutoff point of 1996. In the first period, studies focused on preventable diseases and interventions, while IMR showed a slowing down in its reduction. After the cutoff point, studies focused on non-preventable diseases and factors related to inequalities and inequities. Conclusions. IMR prevails as a synthetic indicator of health conditions. Changes in its evolution and causes have been reflected in publications, which have shifted their focus and areas of interest in accordance with the changes in this indicator.

Relationship between body composition and sleep-disordered breathing in schoolchildren from Valdivia, Chile. / Composición corporal y trastornos respiratorios del sueño en escolares de Valdivia, Chile.

INTRODUCTION: Overnutrition in childhood constitutes a global epidemic and has been associated with multiple di seases and complications. Among them, sleep-disordered breathing (SDB) stands out, a spectrum of diseases that have emerged as a relevant health problem. OBJECTIVE: To evaluate the association between nutritional status and SDB in schoolchildren. SUBJECTS AND METHOD: Cross-sectional analyti cal study of 127 schoolchildren randomly selected from five public schools in Valdivia, Chile. After the informed assent and informed consent process of the child and parents/guardian respectively, the students were incorporated into the study. Anthropometric measurements were performed and the presence of SDB was determined through the Pediatric Sleep Questionnaire (PSQ). For the data analysis, the t-test and %2 test were used to determine the association of variables with SDB. Re sults: There was a high prevalence of overnutrition (71.7%) and obesity reached 39.4%. Regarding the prevalence of SDB, it was 32.3%. There was a higher proportion of children with SDB in severely obese schoolchildren (56.3%), as well as, a significantly higher mean of biceps and triceps skinfold thickness in children with SDB (14.6 mm ± 7.3 vs. 12.0 mm ± 6.6, p = 0.002, and 19.8 ± 6.7 mm vs. 16.2 mm ± 6.0, p = 0.04, respectively). CONCLUSIONS: There is high prevalence of overnutrition and SDB. Out of the anthropometric measurements, the presence of SDB was associated with greater thickness of the biceps and triceps skinfolds.

Composición corporal y trastornos respiratorios del sueño en escolares de Valdivia, Chile / Relationship between body composition and sleep-disordered breathing in schoolchildren from Valdivia, Chile

Resumen: Introducción: La malnutrition por exceso en la infancia constituye una epidemia mundial y se asocia a múltiples enfermedades y complicaciones. Entre ellas, destacan los trastornos respiratorios del sueño (TRS), espectro de enfermedades que han emergido como un problema de salud relevante. Objetivo: Eva luar la relación entre la composición corporal y la presencia de TRS en escolares. Sujetos y Méto do: Estudio observacional analítico de corte transversal en 127 escolares de primero a octavo básico escogidos aleatoriamente de cinco establecimientos municipales de Valdivia, Chile. La incorporación al estudio ocurrió luego del proceso de consentimiento informado del responsable del escolar y asentimiento informado del menor. Se realizaron mediciones antropométricas y se determinó la presencia de TRS mediante el Pediatric Sleep Questionnaire (PSQ). Para el análisis se aplicó esta dística descriptiva, t de Student y test x2 para determinar asociación de variables con la presencia de TRS. Resultados: Destacó alta prevalencia de malnutrición por exceso (71,7%) y la obesidad alcanzó 39,4%. En tanto la prevalencia de TRS fue 32,3%. Hubo mayor proporción de niños con TRS en escolares obesos severos (56,3%), así como una media significativamente mayor en niños con TRS para los pliegues bicipital (14,6 mm ± 7,3 vs. 12,0 mm ± 6,6; p=0,002) y tricipital (19,8 ± 6,7 mm vs. 16,2 mm ± 6,0; p =0,04). Conclusiones: Existen altas prevalencias de malnutrición por exceso y TRS. De las medidas antropométricas, la presencia de TRS se asoció con mayor grosor de los plie gues bicipital y tricipital.

Abstract: Introduction: Overnutrition in childhood constitutes a global epidemic and has been associated with multiple di seases and complications. Among them, sleep-disordered breathing (SDB) stands out, a spectrum of diseases that have emerged as a relevant health problem. Objective: To evaluate the association bet ween nutritional status and SDB in schoolchildren. Subjects and Method: Cross-sectional analytical study of 127 schoolchildren randomly selected from five public schools in Valdivia, Chile. After the informed assent and informed consent process of the child and parents/guardian respectively, the students were incorporated into the study. Anthropometric measurements were performed and the presence of SDB was determined through the Pediatric Sleep Questionnaire (PSQ). For the data analysis, the t-test and x2 test were used to determine the association of variables with SDB. Re sults: There was a high prevalence of overnutrition (71.7%) and obesity reached 39.4%. Regarding the prevalence of SDB, it was 32.3%. There was a higher proportion of children with SDB in severely obese schoolchildren (56.3%), as well as, a significantly higher mean of biceps and triceps skinfold thickness in children with SDB (14.6 mm ± 7.3 vs. 12.0 mm ± 6.6, p = 0.002, and 19.8 ± 6.7 mm vs. 16.2 mm ± 6.0, p = 0.04, respectively). Conclusions: There is high prevalence of overnutrition and SDB. Out of the anthropometric measurements, the presence of SDB was associated with greater thickness of the biceps and triceps skinfolds.

Tactile acuity and predominance of central sensitization in subjects with non-specific persistent low back pain.

Aim: This study aimed to evaluate differences in tactile acuity (TA) in people with non-specific persistent low back pain (NSPLBP) with and without predominant central sensitisation (CS).Method: An analytical cross-sectional study was conducted with 45 participants divided into three groups: (i) subjects with NSPLBP with predominant CS (n = 14), (ii) subjects with NSPLBP without predominant CS (n = 16) and (iii) subjects without low back pain (n = 15). Using an analogue calliper, TA was measured using the two-point discrimination threshold (TPD) in the three groups, both horizontally and vertically in the painful region. The analysis was based on the comparison of median discrimination thresholds between groups using the Kruskal-Wallis test.Result: A higher median TPD value was observed in the group with NSPLBP with predominant CS (vertical measurement 37.5 mm; horizontal measurement 52.5 mm) compared to the group with NSPLBP without predominant CS (vertical measurement 32.5 mm; horizontal measurement 33.8 mm) and the group without low back pain (vertical measurement 30 mm; horizontal measurement 27.5 mm) (p < 0.0001), both in vertical and horizontal measurement.Conclusion: The findings found in this study highlight the need to differentiate patients with NSPLBP with predominant CS when considering therapeutic evaluation as an indirect mechanism for assessing the perceptual function of the primary somatosensory cortex.

Medidas declaradas por padres y cuidadores de lactantes y preescolares para prevenir la exposición a humo de tabaco ambiental / Measures stated by parents and caregivers of infants, toddlers, and preschoolers to prevent environmental tobacco smoke exposure

Introducción. La exposición a humo de tabaco ambiental constituye un problema de salud pública por sus potenciales riesgos en los niños. Objetivo. Determinar las acciones preventivas adoptadas por padres y/o cuidadores de lactantes y preescolares respecto de la exposición a humo de tabaco ambiental. Métodos. Estudio transversal analítico en padres y cuidadores de lactantes y preescolares escolarizados, residentes en la ciudad de Valdivia, Chile. Se aplicó un cuestionario sobre medidas preventivas del humo de tabaco ambiental. Se analizó con estadística descriptiva y de asociación usando el test exacto de Fisher y la regresión logística para calcular odds ratio (OR) y sus respectivos intervalos de confianza del 95% (IC95%) como estimación de riesgo de no adopción de medidas preventivas en el hogar. Resultados. Participaron 469 padres y cuidadores. La prevalencia de hogares con un miembro fumador fue 51,8%. La mayoría fumaba fuera del hogar (92,2%). La medida más adoptada fuera del hogar fue evitar lugares con gente fumando. En este ambiente, hubo diferencia significativa entre hombres y mujeres en no prevenir la exposición (7,6% vs. 2,2%; p= 0,040). Se constató mayor riesgo de no prevenir el consumo en el hogar (dentro o fuera) cuando hubo algún miembro fumador (OR 3,55; IC95%: 2,05-6,14). Y menor riesgo cuando hubo dos o más niños en el hogar (OR 0,46; IC95%: 0,26-0,83). Conclusiones. La mayoría de los padres y cuidadores piden que se fume fuera del hogar y evitan los lugares con gente fumando, aunque, en los hogares con miembros fumadores, la prevención es menor.

Introduction. The exposure to environmental tobacco smoke is a public health problem because of its potential risks for children. Objective. To determine the preventive actions taken by parents and/or caregivers of infants, toddlers, and preschoolers regarding environmental tobacco smoke exposure. Methods. Cross-sectional, analytical study in parents and caregivers of infants, toddlers, and preschoolers from Valdivia, Chile. A questionnaire on preventive measures regarding environmental tobacco smoke was administered. The questionnaire was analyzed with descriptive and association statistics using Fisher's exact test and logistic regression to calculate the odds ratios (ORs) and their corresponding 95% confidence intervals (95% CIs) as an estimation of the risk for not taking preventive measures at home. Results. A total of 469 parents and caregivers participated. The prevalence of households with one member who smoked was 51.8%. Most of them smoked outside the house (92.2%). The most common measure taken outside the household was to avoid places where people smoked. In this setting, a significant difference was observed between men and women in relation to avoiding exposure (7.6% versus 2.2%; p= 0.040). A higher risk for not avoiding tobacco use inside or outside the housewas confirmed when a household member smoked (OR: 3.55; 95% CI: 2.05-6.14). Also, a lower risk was observed when there were two or more children in the household (OR: 0.46; 95% CI: 0.26-0.83). Conclusions. Most parents and caregivers ask others to smoke outside and avoid places where people smoke; however, the level of prevention is lower among households with smokers.

Measures stated by parents and caregivers of infants, toddlers, and preschoolers to prevent environmental tobacco smoke exposure. / Medidas declaradas por padres y cuidadores de lactantes y preescolares para prevenir la exposición a humo de tabaco ambiental.

INTRODUCTION: The exposure to environmental tobacco smoke is a public health problem because of its potential risks for children. Objective. To determine the preventive actions taken by parents and/or caregivers of infants, toddlers, and preschoolers regarding environmental tobacco smoke exposure. Methods. Cross-sectional, analytical study in parents and caregivers of infants, toddlers, and preschoolers from Valdivia, Chile. A questionnaire on preventive measures regarding environmental tobacco smoke was administered. The questionnaire was analyzed with descriptive and association statistics using Fisher's exact test and logistic regression to calculate the odds ratios (ORs) and their corresponding 95% confidence intervals (95% CIs) as an estimation of the risk for not taking preventive measures at home. RESULTS: A total of 469 parents and caregivers participated. The prevalence of households with one member who smoked was 51.8%. Most of them smoked outside the house (92.2%). The most common measure taken outside the household was to avoid places where people smoked. In this setting, a significant difference was observed between men and women in relation to avoiding exposure (7.6% versus 2.2%; p= 0.040). A higher risk for not avoiding tobacco use inside or outside the housewas confirmed when a household member smoked (OR: 3.55; 95% CI: 2.05-6.14). Also, a lower risk was observed when there were two or more children in the household (OR: 0.46; 95% CI: 0.26-0.83). CONCLUSIONS: Most parents and caregivers ask others to smoke outside and avoid places where people smoke; however, the level of prevention is lower among households with smokers.

Introducción. La exposición a humo de tabaco ambiental constituye un problema de salud pública por sus potenciales riesgos en los niños. Objetivo. Determinar las acciones preventivas adoptadas por padres y/o cuidadores de lactantes y preescolares respecto de la exposición a humo de tabaco ambiental. Métodos. Estudio transversal analítico en padres y cuidadores de lactantes y preescolares escolarizados, residentes en la ciudad de Valdivia, Chile. Se aplicó un cuestionario sobre medidas preventivas del humo de tabaco ambiental. Se analizó con estadística descriptiva y de asociación usando el test exacto de Fisher y la regresión logística para calcular odds ratio (OR) y sus respectivos intervalos de confianza del 95% (IC95%) como estimación de riesgo de no adopción de medidas preventivas en el hogar. Resultados. Participaron 469 padres y cuidadores. La prevalencia de hogares con un miembro fumador fue 51,8%. La mayoría fumaba fuera del hogar (92,2%). La medida más adoptada fuera del hogar fue evitar lugares con gente fumando. En este ambiente, hubo diferencia significativa entre hombres y mujeres en no prevenir la exposición (7,6% vs. 2,2%; p= 0,040). Se constató mayor riesgo de no prevenir el consumo en el hogar (dentro o fuera) cuando hubo algún miembro fumador (OR 3,55; IC95%: 2,05-6,14). Y menor riesgo cuando hubo dos o más niños en el hogar (OR 0,46; IC95%: 0,26-0,83). Conclusiones. La mayoría de los padres y cuidadores piden que se fume fuera del hogar y evitan los lugares con gente fumando, aunque, en los hogares con miembros fumadores, la prevención es menor.

Rights and duties policy implementation in Chile: health-care professionals' perceptions.

OBJECTIVE: To explore the perceptions of health professionals in an integrated network of public provision of health services regarding the implementation of the Law on Rights and Duties of People in Chile. METHOD: Qualitative descriptive study. A stratified qualitative sample of 53 professionals from five low complexity centres and one from a high complexity centre, all part of the integrated network of health services in Valdivia, Los Rios Region, Chile, were selected according to the criteria of an overall saturation of the explored dimensions. The information was gathered through a semi-structured, in-depth interview carried out after signing the informed consent. Data were analysed using an inductive approach of content analysis. RESULTS: Three categories emerged from the interviews: conceptualization and knowledge, factors influencing the implementation and recommendations for strengthening the implementation, and seven subcategories. It was highlighted that health professionals in the health-care network perceived difficulties in implementing the Law on rights and duties of patients. Among them were the lack of knowledge about the Law, poor exposure and a lack of resources for its implementation. They suggested adapting the infrastructure of the institution and offering training as recommendations to improve the implementation of the Law. CONCLUSIONS: There are hindering factors for the implementation of the Law related to organizational and professional gaps in the institutions providing health care.

Factors associated with exclusive breastfeeding at 3 months postpartum in Valdivia, Chile.

A prospective cohort study was conducted in 315 mother-newborn dyads from Valdivia, Chile. A questionnaire was administered to mothers before 48 hours postpartum, and sociodemographic, obstetric, and neonatal data were collected. At 3 months postpartum, a follow-up by telephone interview or home visit was made, determining the proportion of mothers providing exclusive breastfeeding. Multivariate logistic regression was carried out to identify variables significantly associated with exclusive breastfeeding. Follow-up data showed 98.1% were breastfeeding, and exclusive breastfeeding reached 69.5%. Withdrawal of exclusive breastfeeding was positively associated with single marital status (odds ratio, 2.49; 95% confidence interval: 1.48-4.20) and smoking during pregnancy (odds ratio, 2.61; 95% confidence interval: 1.48-4.60), while maternal education greater than 8 years was associated with continuation of exclusive breastfeeding (odds ratio, 0.45; 95% confidence interval: 0.24-0.84). Breastfeeding education strategies addressed to high-risk pregnant women (single with a low education level) must be emphasized in addition to prevention of nonhealthy habits, such as tobacco and alcohol consumption during gestation.

Randomized controlled trial of vascular access in newborns in the neonatal intensive care unit.

OBJECTIVE: To compare the effectiveness of two methods of vascular access in newborns. DESIGN: Randomized controlled trial. SETTING: Neonatal intensive care unit in Regional Hospital of Valdivia, Chile. PARTICIPANTS: Seventy-four high-risk newborns. INTERVENTIONS: Peripherally inserted central catheter and peripheral intravenous catheter. MAIN OUTCOME MEASURES: Length of neonatal intensive care unit stay and incidence of sepsis and phlebitis. RESULTS/DATA ANALYSIS: There were no statistically significant differences in the length of the neonatal intensive care unit stay and in the incidence of sepsis between groups. There was a significant higher incidence of phlebitis in the peripheral intravenous catheter group. CONCLUSIONS: Although there was not a significant effect of the kind of catheter on length of neonatal intensive care unit stay, the peripherally inserted central catheter is recommended because of the decreased risk of phlebitis and the decreased number of venipuncture attempts and catheters needed to complete intravenous therapy.

[Nutrition transition: a review of Latin American profile]. / Transició nutricional: una revisión del perfil latinoamericano.

The nutrition situation has evolved in different ways in Latin-American countries. The aim of the study was to analyze the nutritional change and some conditions within Latin America in the last years. An electronic and manual search of articles published between 1995 and 2005 was made, selecting those that included the nutritional situation of Latin American countries. Additionally, data was collected from national surveys and international reports including information since 1990. The countries have evolved through different transition stages. For example, an increase of excess of weight, particularly in adult women, which exceeded 30% in some countries also reached up to 70% in others. Equally worrisome was the over 6% obesity level in children in five of the countries surveyed. There is a tendency to diminish the deficit of weight with seven of nine countries displaying a reduction of women with low weight while stunting diminished globally. An increase of the caloric availability in 17 of 20 countries was also observed. The total population that lives under the poverty line has diminished in 9 of 13 countries although some exceeded 60%. Some indicators of sedentary lifestyle have increased, the number of cars has been increasing in all countries and similar figures are recorded with respect to television and personnel computers. The evolution of the nutritional status is reflected through the action of set factors, the most important of which being the increase in caloric ingestion and sedentary activities in an urbanized environment, the promotion of the use of technologies that limit physical activity. There is also a reduction in food insecurity due to a fall in poverty levels although social inequalities still persist.