Fuerza prensil en adultos chilenos sanos de 20 a 69 años: un estudio transversal / Grip strength in Chilean healthy adults from 20 to 69 years: A cross-sectional study

Objetivo El objetivo de este estudio es caracterizar el rendimiento de fuerza prensil de las manos dominante y no dominante de hombres y mujeres entre 20 y 69 años de edad de la ciudad de Valdivia, Chile. Métodos A través de un muestreo estratificado no probabilístico por conveniencia, 401 sujetos sanos fueron reclutados y estratificados por quinquenios de edad. La fuerza prensil de las manos dominante y no dominante fueron medidas siguiendo el protocolo de la Sociedad Americana de Terapistas de Mano (ASHT, por sus siglas en inglés). Los resultados fueron estratificados y comparados según edad, sexo y dominancia. Resultados Un total de 401 sujetos (203 mujeres) fueron incluidos en el estudio, de los cuales el 94,8% tenía dominancia derecha. En general, la mano dominante de hombres y mujeres en cada quinquenio de edad tuvo una fuerza prensil más alta (p<0,05), y la diferencia entre manos dominante y no dominante en hombres y mujeres fue similar (∼4%). El peak de rendimiento de la mano dominante en hombres se observó entre los 25-29 años (46,2±6,6kg) y en mujeres entre los 40-44 años (29,7±3,7kg), mientras que en la mano no dominante, en hombres se observó entre los 50-54 años (43,2±6,3kg) y en mujeres entre los 40-44 (28,2±4,1kg). Conclusiones La fuerza prensil fue más alta en hombres en cada quinquenio de edad, sin embargo, los cambios de rendimiento por edad son diferentes entre hombres y mujeres. Por tanto, estas diferencias deberían ser tomadas en consideración cuando esta herramienta sea utilizada para valorar la funcionalidad de extremidad superior en población sana (AU)

Objective To characterize hand grip strength performance of the dominant hand and the non-dominant hand in men and women between 20 and 69 years of age from Valdivia, Chile. Methods Through a stratified non-probabilistic sampling by convenience, 401 healthy subjects were recruited and stratified in quinquennial age groups. Hand grip strength in the dominant hand and non-dominant hand was measured using the protocol established by the American Society of Hand Therapists (ASHT). Results were stratified and compared by age, sex, and hand dominancy. Results 401 subjects (203 women) completed the study, of whom ∼94% had right dominance. Overall, the dominant hand of the men and women exhibited better hand grip performance in every quinquennial age group (p<.05), and the difference between the dominant hand and the non-dominant hand in the men and women was similar (∼4%). Peak performance in the dominant hand was seen in the men aged between 25-29 (46.2±6.6kg) years while in the women it was between 40-44 years of age (29.7±3.7kg), whereas in the non-dominant hand peak performance was between the ages 50-54 in the men (43.2±6.3kg) and between 40-44 in the women (28.2±4.1kg). Conclusions As expected, grip strength was higher in men in every quinquennial group, nevertheless, changes in performance with age were different between the men and the women, therefore these differences should be taken into account when this tool is used to assess upper limb function in a healthy population (AU)

Nivel de autonomía de enfermeras en la práctica pediátrica. Una experiencia chilena / Level of autonomy among pediatric practice nurses: A Chilean experience / Nível de autonomia de enfermeiras na prática pediátrica. Uma experiência chilena

Objetivo: Determinar el nivel de autonomía que perciben las enfermeras pediátricas en su ejercicio profesional. Métodos: Estudio transversal observacional analítico en una población de 31 enfermeras pediátricas de un hospital público de Valdivia, Chile. Se aplicó un cuestionario previamente traducido, adaptado transculturalmente y validado por juicio experto. Se determinó el nivel de autonomía en acciones asistenciales de cuidado y operacionales mediante escalas Likert de 5 puntos. Se analizó mediante estadística descriptiva, se utilizaron medidas de frecuencia y de tendencia central y dispersión. Se analizó la asociación entre nivel de autonomía y variables demográficas y laborales, y se empleó el test t de Student o el exacto de Fisher, según correspondiera. Resultados: En asistencia y cuidado los niveles más elevados de autonomía ocurrieron en «enseñar al paciente actividades de autocuidado¼, «ensenar a pacientes actitudes de promoción de salud¼ y «prevenir las caídas¼, con 96.8% de preferencia del nivel más elevado de autonomía (media = 4.96). En actividades operacionales, los mayores valores medios se observaron en «desarrollar y revisar procedimientos¼ y «desarrollar y revisar la norma de cuidados de enfermería¼ (media = 4.2), en tanto que los más bajos se detectaron en «planificar el gasto anual¼ y «entrevistar y seleccionar nuevo personal¼, con medias de 2.5 y 2.6, respectivamente. El nivel de autonomía en actividades operacionales se asoció significativamente a la edad, a la antigüedad laboral total y a la antigüedad en unidades pediátricas. Conclusiones: Hubo variabilidad en el nivel de autonomía en diferentes áreas del rol. Se constató que las tareas asistenciales son desarrolladas con mayor independencia, en particular las acciones de educación y promoción, mientras que las funciones administrativas muestran un desempeño más dependiente.

Objective: To determine the level of autonomy which pediatric nurses perceive within their professional practice. Methods: This is transversal, observational, and analytic study over a population of 31 pediatric nurses from a public hospital in Valdivia, Chile. A previously translated and trans-culturally validated by expert opinion questionnaire was used. The level of autonomy related to care assistance and operational activities was estimated through 5-point-Likert scales. Descriptive statistics which included frequency, central tendency, and dispersion measurements were carried out. Using the t student and the Fisher exact tests, the association between the level of autonomy and the demographical and working-related variables was analyzed. Results: Regarding assistance and care, the highest autonomy levels were found in ''teaching the patient self-care activities'', ''teaching the patients health promoting attitudes'' and ''falls prevention'', with 96.8% preference (mean = 4.96). Regarding operational activities the highest values were found in ''developing and reviewing procedures'', and ''developing and reviewing the nursing care norm'' (mean = 4.2). On the other hand, the lowest autonomy levels were found in ''planning the year expenditure'' and ''selecting new personnel'', with means of 2.5 and 2.6 respectively. The level of autonomy in operational activities was significantly associated with age, total working-seniority, and pediatric-related working-seniority. Conclusions: Variability in the level of autonomy was found among diverse role areas. It was acknowledged that the assistance tasks were carried out with greater independence, particularly in relation to education and promotion activities, while on the other hand the management functions were performed with less independence.

Objetivo: Determinar o nível de autonomia que percebem enfermeiras pediátricas no seu labor profissional. Métodos: Estudo transversal observacional analítico em população de 31 enfermeiras pediátricas de um hospital público de Valdivia, Chile. Aplicou-se um questionário previamente traduzido, adaptado transculturalmente e validado por juízo experiente. Determinou-se o nível de autonomia em ações assistenciais de cuidado e operacionais mediante escalas Likert de 5 pontos. Analisou-se mediante a estatística descritiva, realizaram-se medidas de frequência e de tendência central e de dispersão. Analisou-se associação entre o nível de autonomia e variáveis demográficas e laborais, empregou-se teste t de Student e exato de Fisher conforme correspondeu. Resultados: Em assistência e cuidado, os níveis mais elevados de autonomia aconteceram em «mostrar ao paciente atividades de autocuidado¼, «ensinar ao paciente atitudes de promoção de saúde¼ e «prevenir as quedas¼, com um 96.8% de preferência do nível mais alto de autonomia (media = 4.96). Em atividades operacionais os valores maiores médios observaram-se em «desenvolver e revisar procedimentos¼ y «desenvolver e revisar a norma de cuidados de enfermagem¼ (media = 4.2), enquanto os mais baixos em «planificar o gasto anual¼ e «entrevistare escolher novo pessoal¼, com médias de 2.5 e 2.6, respetivamente. O nível de autonomia em atividades operacionais associou-se significativamente à idade, antiguidade laboral total e antiguidade em unidades pediátricas. Conclusões: Houve variabilidade no nível de autonomia em diferentes áreas do rolo. Constatou-se que as tarefas assistenciais são desenvolvidas com maior independência, em especial ações de educação e promoção, enquanto que funções administrativas mostram desempenho mais dependente.

[Leukomalacia and periventricular echogenicity in very low birth weight premature infants]. / Leucomalacia y ecogenicidad periventricular en prematuros de muy bajo peso al nacer.

INTRODUCTION: Cystic periventricular leukomalacia (c-PVL) and persistent periventricular echogenicity (PPVE) are white matter injuries of multifactorial etiology, high incidence in premature infants and with harmful effect in neurodevelopment. AIMS: To determine PPVE and c-PVL incidence, and to assess potential predictors. PATIENTS AND METHODS: Cohort of 164 very low birth weight premature infants (< 1,500 g and with gestational age equal or below 32 weeks), admitted to the Neonatal Care Unit of Hospital Clinico Regional de Valdivia, Chile. Cerebral ultrasound within the first week, at day 15 and day 30 of life was performed, and diagnosis of the lesions was made according Volpe's classification. The association of PPVE and c-PVL with several perinatal factors was evaluated by univariate risk estimation -relative risk (RR), and 95% confidence interval (95% CI)-, and then, multivariate analysis through multiple logistic regression -adjusted odds ratio (OR)--was carried out. RESULTS: The incidence of PPVE and c-PVL was 13.4 and 23.8%, respectively. 66.7% of c-PVL cases were observed in infants lower than 28 weeks (RR = 4.83; 95% CI = 2.72-8.58). The risk of c-PVL was lower with gestational age for each additional week (OR = 0.5; 95% CI = 0.38-0.65) and maternal hypertension (OR = 0.27; 95% CI = 0.08-0.87). A significant decrease of PPVE risk was found with better Apgar score after 1 minute and male sex. No association was found with either chorioamnionitis, antenatal corticosteroids nor other perinatal factors. CONCLUSIONS: This study confirms high incidence of white matter lesions, being gestational age a strong predictor of c-PVL. Studies are needed to clarify maternal hypertension effect on c-PVL development.

Leucomalacia y ecogenicidad periventricular en prematuros de muy bajo peso al nacer / Leukomalacia and periventricular echogenicity invery low birth weight premature infants

Introducción. La leucomalacia periventricular cística (c-LPV) y la ecogenicidad periventricular persistente (EPVP)son lesiones de la sustancia blanca de etiología multifactorial, de alta frecuencia en prematuros y con potencial efecto deletéreo en el neurodesarrollo. Objetivos. Determinar la incidencia de EPVP y c-LPV y evaluar posibles predictores. Pacientes y métodos. Cohorte de 164 neonatos de menos de 1.500 g de peso y edad gestacional igual o inferior a 32 semanas, ingresados en la Unidad de Neonatología del Hospital Clínico Regional de Valdivia, Chile. Se realizó ecografía cerebral durante la primera semana, a los 15 y 30 días de vida, y se diagnosticaron las lesiones según la clasificación de Volpe. Se evaluó la asociacióncon distintos factores perinatales y se efectuó estimación de riesgo univariado –riesgo relativo (RR) e intervalo de confianza al 95% (IC 95%)– y análisis multivariado mediante regresión logística múltiple –odds ratio (OR) ajustadas–.Resultados. La incidencia de EPVP y c-LPV fue del 13,4 y 23,8%, respectivamente. El 66,7% de los casos de c-LPV ocurrió en menores de 28 semanas (RR = 4,83; IC 95% = 2,72-8,58). Se encontró significativa reducción del riesgo de c-LPV con la edad gestacional por cada semana adicional (OR = 0,5; IC 95% = 0,38-0,65) e hipertensión del embarazo (OR = 0,27; IC 95% = 0,08-0,87). Seobservó significativa reducción del riesgo de EPVP con la mejor puntuación Apgar al minuto y el sexo masculino. No hubo asociación con corioamnionitis, uso de corticoides prenatales ni otros factores perinatales. Conclusiones. Se confirma una alta incidencia de trastornos de la sustancia blanca, y la edad gestacional es un potente predictor de c-LPV. Se precisan estudiosadicionales para esclarecer el efecto de la hipertensión del embarazo sobre la c-LPV

Introduction. Cystic periventricular leukomalacia (c-PVL) and persistent periventricular echogenicity (PPVE) are white matter injuries of multifactorial etiology, high incidence in premature infants and with harmful effect in neurodevelopment.Aims. To determine PPVE and c-PVL incidence, and to assess potential predictors. Patients and methods. Cohort of 164 very low birth weight premature infants (< 1,500 g and with gestational age equal or below 32 weeks), admitted to the Neonatal Care Unit of Hospital Clínico Regional de Valdivia, Chile. Cerebral ultrasound within the first week, at day 15 and day 30 of life was performed, and diagnosis of the lesions was made according Volpe’s classification. The association of PPVE and c-PVL with several perinatal factors was evaluated by univariate risk estimation –relative risk (RR), and 95% confidence interval (95% CI)–, and then, multivariate analysis through multiple logistic regression –adjusted odds ratio (OR)– was carried out. Results. The incidence of PPVE and c-PVL was 13.4 and 23.8%, respectively. 66.7% of c-PVL cases were observed in infants lower than 28 weeks (RR = 4.83; 95% CI = 2.72-8.58). The risk of c-PVL was lower with gestationalage for each additional week (OR = 0.5; 95% CI = 0.38-0.65) and maternal hypertension (OR = 0.27; 95% CI = 0.08-0.87). A significant decrease of PPVE risk was found with better Apgar score after 1 minute and male sex. No association was found with either chorioamnionitis, antenatal corticosteroids nor other perinatal factors. Conclusions. This study confirms highincidence of white matter lesions, being gestational age a strong predictor of c-PVL. Studies are needed to clarify maternal hypertension effect on c-PVL development