Relación entre estado nutricional y salud bucal en un grupo de preescolar en Pereira, Colombia en el periodo 2022-1 / Relationship between nutritional status and oral health in a group of preschoolers in Pereira, Colombia in the period 2022-1

RESUMEN Introducción. La evidencia científica ha demostrado que una adecuada nutrición durante los primeros años de vida contribuye al desarrollo y funcionamiento de los tejidos de la cavidad bucal. Diferentes investigaciones han demostrado la relación entre estado nutricional y afectaciones bucales en la infancia. Objetivo. Determinar la relación entre el estado nutricional y la salud bucal en los niños y niñas entre 3 a 5 años atendidos en un Centro de Desarrollo Infantil (CDI) en el período 2022-1. Métodos: Estudio cuantitativo, de tipo descriptivo, corte transversal, con componente analítico. La población estuvo conformada por niños y niñas entre 3 a 5 años de edad atendidos en un CDI, cumpliendo criterios de inclusión y exclusión. Se realizó un análisis univariado con estadística descriptiva y análisis bivariado con prueba Chi-cuadrado y prueba de Fisher. Resultados: El estado nutricional presentó una relación estadísticamente significativa con la salud bucal. Se evidencia en las variables riesgo de sobrepeso y riesgo para la delgadez con la caries dental. Se demostró que el 32.2 % de la población presentó caries y el 3.2 % gingivitis. Conclusión: La buena nutrición contribuye al desarrollo adecuado de tejidos bucales en la población infantil, por tanto, se minimiza el riesgo de patologías orales en especial la caries y la gingivitis. Así mismo se cree que falta más investigaciones en este entorno que lo confirmen y concienticen a la población.

ABSTRACT Introduction: Scientific evidence has shown that adequate nutrition during the first years of life contributes to the development and functioning of the tissues of the oral cavity. Different investigations have shown the relationship between nutritional status and oral affections in childhood. Objective: To determine the relationship between nutritional status and oral health in children between 3 to 5 years of age attended at a Child Development Center (CDI) in the period 2022-1. Methods: Quantitative, descriptive, cross-sectional study, with an analytical component. The population consisted of boys and girls between 3 to 5 years of age cared for in a CDI, meeting inclusion and exclusion criteria. A univariate analysis was performed with descriptive statistics and bivariate analysis with Chi-square test and Fisher's test. Results: Nutritional status presented a statistically significant relationship with oral health. It is evident in the variables risk of overweight and risk for thinness with dental caries. It was shown that 32.2 % of the population presented caries and 3.2 % gingivitis. Conclusion. Good nutrition contributes to the proper development of oral tissues in the child population, therefore, the risk of oral pathologies, especially caries and gingivitis, is minimized. Likewise, it is believed that more research is needed in this environment to confirm it and raise awareness among the population.

Acceptability of HPV Vaccines: A Qualitative Systematic Review and Meta-Summary.

In 2006, the human papillomavirus (HPV) vaccine was approved for use as an effective intervention for reducing the risk of developing cervical cancer; however, its successful implementation is dependent on acceptability. This study aims to provide a comprehensive understanding of the reasons that favor or do not favor the acceptability of HPV vaccines. METHODS: We conducted a systematic review and meta-summary of qualitative research on 16 databases. A total of 32 articles that considered the perspectives of vaccine users, their parents, and the professionals who care for them were reviewed. Synthesis was conducted as described by Sandelowski and Barroso. RESULTS: We used inductive and deductive methods to obtain a total of 22 dimensions, out of which three issues stood out that should be considered to improve acceptability and are formed by three groups of study, namely, information about the vaccine, fears and side effects, and sexuality associated with the vaccine. CONCLUSIONS: Acceptability, as well as adherence to HPV vaccination, is a complex concept. This review highlights the perspectives of the three sets of actors involved in the process (i.e., users, parents, and professionals) and views these factors in relation to acceptability as a guide for new interventions.

Alkylation converts riboflavin into an efficient photosensitizer of phospholipid membranes.

A new decyl chain [-(CH2)9CH3] riboflavin conjugate has been synthesized and investigated. A nucleophilic substitution (SN2) reaction was used for coupling the alkyl chain to riboflavin (Rf), a model natural photosensitizer. As expected, the alkylated compound (decyl-Rf) is significantly more lipophilic than its precursor and efficiently intercalates within phospholipid bilayers, increasing its fluorescence quantum yield. The oxidative damage to lipid membranes photoinduced by decyl-Rf was investigated in large and giant unilamellar vesicles (LUVs and GUVs, respectively) composed of different phospholipids. Using a fluorogenic probe, fast radical formation and singlet oxygen generation was demonstrated upon UVA irradiation in vesicles containing decyl-Rf. Photosensitized formation of conjugated dienes and hydroperoxides, and membrane leakage in LUVs rich in poly-unsaturated fatty acids were also investigated. The overall assessment of the results shows that decyl-Rf is a significantly more efficient photosensitizer of lipids than its unsubstituted precursor and that the association to lipid membranes is key to trigger phospholipid oxidation. Alkylation of hydrophilic photosensitizers as a simple and general synthetic tool to obtain efficient photosensitizers of biomembranes, with potential applications, is discussed.

Antimicrobial-Loaded Polyacrylamide Hydrogels Supported on Titanium as Reservoir for Local Drug Delivery.

Arthroplasty is a highly successful treatment to restore the function of a joint. The contamination of the implant via bacterial adhesion is the first step toward the development of device-associated infections. The emerging concern about antimicrobial resistance resulted in a growing interest to develop alternative therapeutic strategies. Thus, the increment in the incidence of bacterial periprosthetic infections, the complexity of treating infections caused by organisms growing in biofilms, together with the rise in antibiotic resistant bacteria, expose the need to design novel surfaces that provide innovative solutions to these rising problems. The aim of this work is to develop a coating on titanium (Ti) suitable for inhibiting bacterial adhesion and proliferation, and hence, biofilm formation on the surface. We have successfully prepared polyacrylamide hydrogels containing the conventional antibiotic ampicillin (AMP), silver nanoparticles (AgNPs), and both, AMP and AgNPs. The release of the antibacterial agents from the gelled to aqueous media resulted in an excellent antibacterial action of the loaded hydrogels against sessile S. aureus. Moreover, a synergic effect was achieved with the incorporation of both AMP and AgNPs in the hydrogel, which highlights the importance of combining antimicrobial agents having different targets. The polyacrylamide hydrogel coating on the Ti surface was successfully achieved, as it was demonstrated by FTIR, contact angle, and AFM measurements. The modified Ti surfaces having the polyacrylamide hydrogel film containing AgNPs and AMP retained the highest antibacterial effect against S. aureus as it was found for the unsupported hydrogels. The modified surfaces exhibit an excellent cytocompatibility, since healthy, flattened MC3T3-E1 cells spread on the surfaces were observed. In addition, similar macrophage RAW 264.7 adhesion was found on all the surfaces, which could be related to a low macrophage activation. Our results indicate that AMP and AgNP-loaded polyacrylamide hydrogel films on Ti are a good alternative for designing efficient antibacterial surfaces having an excellent cytocompatibility without inducing an exacerbated immune response. The approach emerges as a superior alternative to the widely used direct adsorption of therapeutic agents on surfaces, since the antimicrobial-loaded hydrogel coatings open the possibility of modulating the concentration of the antimicrobial agents to enhance bacterial killing, and then, reducing the risk of infections in implantable materials.

Prevalencia de síndrome de Burnout en internos de pediatría de la Universidad Católica del Maule / Burnout Syndrome Prevalence in pediatric interns of the Catholic University of Maule

Burnout syndrome is a public health problem, a pathological entity that affects professionals who work directly with people, such as health professionals. It is currently described as being composed of three dimensions: emotional exhaustion, depersonalization and personal fulfillment, and its evaluation is carried out through the Maslach Burnout Inventory questionnaire. The present study aims to measure, by means of the aforementioned instrument, the prevalence of Burnout Syndrome in pediatric interns of the Universidad Católica del Maule and find out which is the most frequent characteristic that the pathology presents, in relation to the 3 subgroups. It corresponds to a descriptive and cross-sectional study, in which the Maslach Burnout Inventory questionnaire was applied to a sample of 18 pediatric inmates of the Regional Hospital of Talca, together with an informed consent to each participant. The results showed that the burnout syndrome is present in 11,11% of pediatric interns, in addition it was observed that a high percentage manifests alterations in the studied subdimensions, which makes us conclude that attention should be given urgently to this problem, in order to guarantee mental health support to those who need it.

Validity of a questionnaire on self-efficacy for Pap test adherence screening.

Introduction: Self-efficacy has been related to different health preventive behaviors, included adherence to the Papanicolaou test-also called Pap smear or Pap test. The aim of this study is to test construct and criterion validity and reliability of a questionnaire on self-efficacy and the Pap test in Chilean women. Method: This study was carried out on a sample of 969 women of ages from 25 to 64, who are users of the public health care system in Santiago, Chile. The validity of the Self-Efficacy Scale for the Pap Smear Screening Participation (SES-PSSP) questionnaire was done by confirmatory factor analysis, external criteria by t-test, and reliability by Cronbach's alpha. Results: Three models were tested, obtaining a questionnaire with 20 items and 2 dimensions. The criteria validity was confirmed by adherence to the Pap test. The final questionnaire has a reliability of 0.95, measured by Cronbach´s alpha. Conclusion: A valid and reliable questionnaire to measure self-efficacy in relation to the Pap test is a relevant contribution in cervical cancer prevention, especially related to interventions focused on increasing adherence.

[The significance of menopause for Chilean women attending primary health care centers]. / El significado de la menopausia para un grupo de mujeres chilenas atendidas en el sistema público de salud.

BACKGROUND: Menopause connects a biological event with social representations related to aging Aim: To assess the meaning of menopause in a group of Chilean women attending primary health care. MATERIAL AND METHODS: Secondary analysis of a descriptive qualitative study of in-depth interviews to explore the meaning of menopause in fifteen women aged 55 to 71 years who experienced menopause between 2 and 29 years before. Data were collected using the method proposed by the Grounded Theory. Guba's criteria of scientific rigor were used. RESULTS: Relational analysis shows that menopause divides the life cycle of women into two stages related with the possibility of having children, which is heavily influenced by the cultural significance of menopause. CONCLUSIONS: Women perceive that menopause is a natural stage and that it is the end of a period focused on tasks related to reproduction and motherhood. However, that "normality" includes a suffering process, loaded with negative cultural beliefs about menopause passed down for generations.

Escala de Calidez en Enfermería (ECAE): construcción y validación empírica / Escala de Calor Humano em Enfermagem (ECHE): construção e validação empírica / Nursing Warmth Scale (NWS): Development and empirical validation

Objetive: To construct and validate the Nursing Warmth Scale (NWS) through the development of a standardized measurement of nurses' warmth, perceived from the perspective of patients, and identify the behaviors and factors associated with this feeling of warmth. Materials and methods: The NWS was developed following the scale construction methodology under a triphasic model. The construction of items was elaborated based on the results of a previously published integrative review that consolidated the construct and the related variables. A qualitative phase was also incorporated to evaluate the latent variable. Content validity was assessed with 10 expert judges. An item try-out was conducted with 476 patients in health institutions. Exploratory factor analysis ­through the common factor method and oblique rotation­ was used for the item reduction process. Results: The construct "Nursing Warmth" was established after the theoretical and empirical phases of the study. The literature review and interviews with 23 patients and 25 nursing professionals provided a set of behaviors divided into 2 categories: verbal and nonverbal behaviors. Exploratory factor analysis allowed identifying 5 factors and 35 items. The reliability was estimated through Cronbach's alpha. The identified factors are: F1-Nonverbal connection-relationship with the other (0.943), F2-Empathy (0.909), F3-Verbal connection-relationship with the other (0.914), F4-Inclusion (0.858), and F5-Confidence (0.852). The Tucker-Lewis Index was 0.901. Conclusions: The NWS demonstrates evidence of reliability and validity. This tool may be useful in clinical settings and for teaching and research addressing interpersonal nursing skills.

Objetivo: construir y validar la Escala de Calidez de Enfermería (ECAE) mediante el desarrollo de una medida estandarizada de la calidez de la enfermería desde la perspectiva de los pacientes, además de identificar los comportamientos y factores asociados con la calidez. Materiales y métodos: la ECAE fue desarrollada según la metodología de construcción de escalas y empleando un modelo trifásico. La construcción de ítems se elaboró con los resultados de una revisión integrativa previamente publicada, que consolidó el constructo y las variables relacionadas. Se incorporó además una fase cualitativa con el fin de evaluar la variable latente. La validez de contenido fue testeada con 10 jueces expertos. Se realizó la validación de los ítems con 476 pacientes de instituciones de salud. Para el proceso de reducción de ítems se utilizó el análisis factorial exploratorio, mediante el método de factores comunes y rotación oblicua. Resultados: luego de las fases teórica y empírica del estudio, se estableció el constructo "Calidez en Enfermería". La revisión de la literatura y las entrevistas a 23 pacientes y 25 profesionales en enfermería proporcionaron un conjunto de comportamientos divididos en dos categorías: conductas verbales y conductas no verbales. El análisis factorial exploratorio identificó 5 factores y 35 ítems. La confiabilidad se estimó con Alfa de Cronbach. Los factores identificados son: F1-Conexión no verbal (0,943), F2-Empatía (0,909), F3-Conexión verbal (0,914), F4-Inclusión (0,858) y F5-Confianza (0,852). El índice de Tucker-Lewis fue de 0,901. Conclusiones: la ECAE demuestra evidencias de confiabilidad y validez. Esta herramienta puede ser útil en el ámbito clínico y en la enseñanza e investigación de habilidades interpersonales en Enfermería.

Objetivo: construir e validar a Escala de Calor Humano em Enfermagem (ECHE) mediante o desenvolvimento de uma medida padronizada do calor humano da enfermagem sob a perspectiva dos pacientes, além de identificar os comportamentos e fatores associados com o calor humano. Materiais e métodos: a ECHE foi desenvolvida de acordo com a metodologia de construção de escalas e utilizando um modelo trifásico. A construção dos itens foi elaborada com os resultados de uma revisão integrativa publicada previamente, que consolidou o construto e as variáveis relacionados. Uma fase qualitativa também foi incorporada para avaliar a variável latente. A validade do conteúdo foi testada com 10 juízes especialistas. Os itens foram validados com 476 pacientes de instituições de saúde. Para o processo de redução de itens, foi utilizada a análise fatorial exploratória por meio do método fatorial comum e da rotação oblíqua. Resultados: após as fases teórica e empírica do estudo, foi estabelecido o construto "calor humano em enfermagem". A revisão da literatura e as entrevistas com 23 pacientes e 25 profissionais de enfermagem forneceram um conjunto de comportamentos divididos em duas categorias: comportamentos verbais e não verbais. A análise fatorial exploratória identificou cinco fatores e 35 itens. A confiabilidade foi estimada com o alfa de Cronbach. Os fatores identificados são F1-Conexão não verbal (0,943), F2-Empatia (0,909), F3-Conexão verbal (0,914), F4-Inclusão (0,858) e F5-Confiança (0,852). O índice de Tucker-Lewis foi de 0,901. Conclusões: a ECHE demonstra evidência de confiabilidade e validade. Essa ferramenta pode ser útil no cenário clínico e no ensino e pesquisa de habilidades interpessoais em Enfermagem.

El significado de la menopausia para un grupo de mujeres chilenas atendidas en el sistema público de salud / The significance of menopause for Chilean women attending primary health care centers

BACKGROUND: Menopause connects a biological event with social representations related to aging AIM: To assess the meaning of menopause in a group of Chilean women attending primary health care. MATERIALS AND METHODS: Secondary analysis of a descriptive qualitative study of in-depth interviews to explore the meaning of menopause in fifteen women aged 55 to 71 years who experienced menopause between 2 and 29 years before. Data were collected using the method proposed by the Grounded Theory. Guba's criteria of scientific rigor were used. RESULTS: Relational analysis shows that menopause divides the life cycle of women into two stages related with the possibility of having children, which is heavily influenced by the cultural significance of menopause. CONCLUSIONS: Women perceive that menopause is a natural stage and that it is the end of a period focused on tasks related to reproduction and motherhood. However, that "normality" includes a suffering process, loaded with negative cultural beliefs about menopause passed down for generations.

Cambios en las consultas traumatológicas de urgencias pediátricas durante la pandemia SARS-CoV-2 / Changes in pediatric emergency trauma consultations during the SARS-CoV-2 pandemic

In pediatrics urgency room, one of the main causes of consultation are traumatological problems, including those caused by school accidents and car accidents. We analyzed the change in these causes during SARS-CoV-2 pandemics at a regional hospital in Talca, Chile . We saw a clear droop in traumatological consultations due to sanitary restrictions. This clearly shows the impact that sanitary restrictions had on population behavior

Cambios epidemiológicos en urgencia infantil durante la pandemia por SARS-CoV-2 en Hospital Regional de Talca / Epidemiolocal changes in childrens emergency consultations during SARS-CoV-2 pandemic at Hospital Regional de Talca

Infection by SARS-COV-2, was first described in November 2019 in Wuhan, China. First chilean cases where reported in March 2020.Our objective was to identify epidemiological changes in the pediatric population in the emergency service of the Hospital Regional de Talca (HRT). We carried out an observational and retrospective study. The reason and number of consultations in pediatric patients in the emergency room was analyzed during the periods defined as "Pre-pandemic" and "Pandemic". The target population was all consulting patients between 0-15 years of age. We separated the cases according to the reason of consultation. We obtained the data from the HRT statistics department. The number of consultations decreased by 67.6% per month, while the number of patients who consulted in pediatric emergencies for respiratory symptoms decreased by 75.4% per month. Within the pandemic period, 15,101 COVID PCR samples were performed in pediatric patients, with 13.7% positivity. This allows us to see the epidemiological impact that this new disease has had on pediatric patients in the Maule región

Mono- and Bis-Alkylated Lumazine Sensitizers: Synthetic, Molecular Orbital Theory, Nucleophilic Index and Photochemical Studies.

Mono- and bis-decylated lumazines have been synthesized and characterized. Namely, mono-decyl chain [1-decylpteridine-2,4(1,3H)-dione] 6a and bis-decyl chain [1,3-didecylpteridine-2,4(1,3H)-dione] 7a conjugates were synthesized by nucleophilic substitution (SN 2) reactions of lumazine with 1-iododecane in N,N-dimethylformamide (DMF) solvent. Decyl chain coupling occurred at the N1 site and then the N3 site in a sequential manner, without DMF condensation. Molecular orbital (MO) calculations show a p-orbital at N1 but not N3 , which along with a nucleophilicity parameter (N) analysis predict alkylation at N1 in lumazine. Only after the alkylation at N1 in 6a, does a p-orbital on N3 emerge thereby reacting with a second equivalent of 1-iododecane to reach the dialkylated product 7a. Data from NMR (1 H, 13 C, HSQC, HMBC), HPLC, TLC, UV-vis, fluorescence and density functional theory (DFT) provide evidence for the existence of mono-decyl chain 6a and bis-decyl chain 7a. These results differ to pterin O-alkylations (kinetic control), where N-alkylation of lumazine is preferred and then to dialkylation (thermodynamic control), with an avoidance of DMF solvent condensation. These findings add to the list of alkylation strategies for increasing sensitizer lipophilicity for use in photodynamic therapy.

Mechanistic Insight into the Photodynamic Effect Mediated by Neutral Red and a New Azine Compound in Staphylococcus aureus Cells.

The photodynamic activity of Neutral Red and the new monobrominated Neutral Red was studied in suspensions of Staphylococcus aureus. The effect of mannitol and sodium azide in the presence of 25 µm photosensitizer on lethal photosensitization were investigated. The results of the mechanistic evaluation of Neutral Red showed that both mannitol and sodium azide produced a completed protective effect after irradiation without significant differences between them. The evaluation of monobrominated Neutral Red also showed a protective effect of microorganisms with the addition of mannitol. Although sodium azide produced a protective effect of the photoinactivation, it was incomplete and less than that exhibited by mannitol. The results indicate that the starting reagent, Neutral Red, is a producer of radical species, acting through a type I mechanism, whereas the halogenated derivative of Neutral Red produced reactive oxygen species and a contribution of singlet molecular oxygen cannot be discarded in the photoinactivation of Staphylococcus aureus cells. These results, analyzed together with the previously evaluated properties of the dyes, allow us to explain the differences observed in the photoinactivation of Staphylococcus aureus mediated by both azine photosensitizers.

Photo-Oxidation of Unilamellar Vesicles by a Lipophilic Pterin: Deciphering Biomembrane Photodamage.

Pterins are natural products that can photosensitize the oxidation of DNA, proteins, and phospholipids. Recently, a new series of decyl-chain (i.e., lipophilic) pterins were synthesized and their photophysical properties were investigated. These decyl-pterins led to efficient intercalation in large unilamellar vesicles and produced, under UVA irradiation, singlet molecular oxygen, a highly oxidative species that react with polyunsaturated fatty acids (PUFAs) to form hydroperoxides. Here, we demonstrate that the association of 4-(decyloxy)pteridin-2-amine ( O-decyl-Ptr) to lipid membranes is key to its ability to trigger phospholipid oxidation in unilamellar vesicles of phosphatidylcholine rich in PUFAs used as model biomembranes. Our results show that O-decyl-Ptr is at least 1 order of magnitude more efficient photosensitizer of lipids than pterin (Ptr), the unsubstituted derivative of the pterin family, which is more hydrophilic and freely passes across lipid membranes. Lipid peroxidation photosensitized by O-decyl-Ptr was detected by the formation of conjugated dienes and oxidized lipids, such as hydroxy and hydroperoxide derivatives. These primary products undergo a rapid conversion into short-chain secondary products by cleavage of the fatty-acid chains, some of which are due to subsequent photosensitized reactions. As a consequence, a fast increase in membrane permeability is observed. Therefore, lipid oxidation induced by O-decyl-Ptr could promote cell photodamage due to the biomembrane integrity loss, which in turn may trigger cell death.

Características del Papanicolaou y de la atención recibida como factores para adherir (o no) al tamizaje. Estudio cualitativo en mujeres chilenas / Characteristics of the Pap smear and the care received as factors to adhere (or not) to the screening. Qualitative study in Chilean women

RESUMEN Objetivo: Describir la percepción de un grupo de mujeres chilenas acerca de la calidad de la atención y las características del Papanicolaou (PAP) como factores que influyen en la decisión de realizarse o no el examen. Método: Investigación cualitativa descriptiva con análisis de contenido. Cincuenta y siete mujeres chilenas de 4 consultorios distintos del Servicio de Salud Metropolitano Sur Oriente participaron de este estudio. Los datos fueron recogidos mediante la metodología de grupo focal. Resultados: Las características del procedimiento, la asociación a síntomas y a cáncer, la periodicidad, la experiencia con cercanos con cáncer y la susceptibilidad son temas asociados al examen. En lo que respecta a la atención, el tipo de sistema de salud, la falta de dinero, el género del profesional, las experiencias negativas previas, la falta de información y el sistema de agendamiento de horas fueron los temas analizados. Conclusión: La adherencia al tamizaje de cáncer cérvicouterino es un fenómeno multifactorial y debe ser abordado como tal. Los profesionales de la salud juegan un papel importante en la promoción del tamizaje y deben abordar de manera proactiva las percepciones y el conocimiento de las mujeres sobre el mismo, sin olvidar que la calidad de la atención también influye de forma importante en la decisión de realizarse o no el PAP.

ABSTRACT Objective: To describe the perception of a group of Chilean women about the quality of care and the characteristics of the PAP test as factors that influence the decision to take or not the test. Method: Qualitative descriptive research with content analysis. Fifty-seven Chilean women from four public primary healthcare centers from the South East Metropolitan Health Service participated in this study. Data was obtained using the focus group methodology. Results: The characteristics of the procedure, the association with symptoms and cancer, the periodicity, the experience with close persons with cancer and the susceptibility are subjects associated with the exam. Regarding quality of care, the type of health system, the lack of money, the gender of the professional, the previous negative experiences, the lack of information and the appointment scheduling system were the topics analyzed. Conclusion: Adherence to cervical cancer screening is a multifactorial phenomenon and should be addressed as such. Healthcare professionals play an important role in the promotion of screening, and must proactively address women's perceptions and knowledge about it, without forgetting that the quality of care has also an important influence on the decision of taking or not the Pap test.

Adolescentes Libres de Tabaco: Efectividad de una intervención educativa. Estudio antes-después controlado / Smoke-Free Adolescents: Effectiveness of an educational intervention. Controlled, before and after study

El tabaquismo es considerado la principal causa de muerte prevenible en el mundo. La mayoría de los fumadores inician esta adicción durante edades tempranas, especialmente, durante la adolescencia. El objetivo del estudio fue identificar los determinantes de consumo adolescente y evaluar el impacto de una intervención educativa en la prevalencia del tabaquismo. Métodos. Estudio antes-después controlado, realizado durante los años 2010-2012 en dos colegios secundarios de la ciudad de La Plata. En ambos, se realizó una encuesta basal seguida de dos mediciones posteriores; en uno de ellos, se implementó una intervención educativa dirigida a jóvenes de 12 y 13 años. Se utilizaron modelos de regresión múltiple para identificar las variables asociadas al tabaquismo y evaluar el impacto de la intervención. Resultados. Se incluyeron 1911 encuestas (Colegio A: 617; Colegio B: 1294). Las variables asociadas al tabaquismo adolescente fueron la tenencia de un hermano fumador (odds ratio -OR- 2,55), madre fumadora (OR 2,32), años de edad (OR 1,92) y el sexo femenino (OR 1,75). El OR ajustado por dichos determinantes para ser fumador actual en el colegio intervención versus el control fue 0,54 (intervalo de confianza -IC- del 95%: 0,35-0,83) en el primer año de seguimiento y 0,98 (IC 95%: 0,60-1,61) en el segundo año. Conclusiones. La tenencia de una madre o un hermano fumador, la edad y el sexo femenino se correlacionaron fuertemente con el consumo de cigarrillos. La intervención educativa tuvo un efecto positivo en el primer año de seguimiento, pero luego no se mantuvo.

Smoking is considered the main cause of preventable death worldwide. Most smokers start using tobacco at an early age, especially during adolescence. The objective of this study was to identify the determinants of adolescent use of tobacco and assess the impact of an educational intervention on the prevalence of smoking. Methods. Controlled, before and after study conducted between 2010 and 2012 at two secondary schools in the city of La Plata. A baseline survey was administered at both schools followed by two subsequent measurements; an educational intervention aimed at youth aged 12 and 13 years was implemented in one of the schools. Multiple regression models were used to identify the outcome measures associated with smoking and assess the impact of the intervention. Results. A total of 1911 surveys were included (school A: 617; school B: 1294). The outcome measures associated with adolescent smoking were having a sibling who smokes (odds ratio -amp;#91;OR-amp;#93;: 2.55), a mother who smokes (OR: 2.32), age (OR: 1.92), and female sex (OR: 1.75). The OR adjusted for these determinants to be a current smoker at the intervention school versus the control school was 0.54 (95% confidence interval -amp;#91;CI-amp;#93;: 0.35-0.83) in the first year of follow-up and 0.98 (95% CI: 0.60-1.61) in the second year. Conclusions. Having a mother or a sibling who smokes, age, and female sex were strongly correlated to cigarette smoking. The educational intervention had a positive effect in the first year of follow-up, which was not maintained over time.

Smoke-Free Adolescents. Effectiveness of an educational intervention. Controlled, before and after study. / Adolescentes Libres de Tabaco. Efectividad de una intervención educativa. Estudio antes-después controlado.

Smoking is considered the main cause of preventable death worldwide. Most smokers start using tobacco at an early age, especially during adolescence. The objective of this study was to identify the determinants of adolescent use of tobacco and assess the impact of an educational intervention on the prevalence of smoking. Methods. Controlled, before and after study conducted between 2010 and 2012 at two secondary schools in the city of La Plata. A baseline survey was administered at both schools followed by two subsequent measurements; an educational intervention aimed at youth aged 12 and 13 years was implemented in one of the schools. Multiple regression models were used to identify the outcome measures associated with smoking and assess the impact of the intervention. Results. A total of 1911 surveys were included (school A: 617; school B: 1294). The outcome measures associated with adolescent smoking were having a sibling who smokes (odds ratio [OR]: 2.55), a mother who smokes (OR: 2.32), age (OR: 1.92), and female sex (OR: 1.75). The OR adjusted for these determinants to be a current smoker at the intervention school versus the control school was 0.54 (95% confidence interval [CI]: 0.35-0.83) in the first year of follow-up and 0.98 (95% CI: 0.60-1.61) in the second year. Conclusions. Having a mother or a sibling who smokes, age, and female sex were strongly correlated to cigarette smoking. The educational intervention had a positive effect in the first year of follow-up, which was not maintained over time

El tabaquismo es considerado la principal causa de muerte prevenible en el mundo. La mayoría de los fumadores inician esta adicción durante edades tempranas, especialmente, durante la adolescencia. El objetivo del estudio fue identificar los determinantes de consumo adolescente y evaluar el impacto de una intervención educativa en la prevalencia del tabaquismo. Métodos. Estudio antes-después controlado, realizado durante los años 2010-2012 en dos colegios secundarios de la ciudad de La Plata. En ambos, se realizó una encuesta basal seguida de dos mediciones posteriores; en uno de ellos, se implementó una intervención educativa dirigida a jóvenes de 12 y 13 años. Se utilizaron modelos de regresión múltiple para identificar las variables asociadas al tabaquismo y evaluar el impacto de la intervención. Resultados. Se incluyeron 1911 encuestas (Colegio A: 617; Colegio B: 1294). Las variables asociadas al tabaquismo adolescente fueron la tenencia de un hermano fumador (odds ratio ­OR­ 2,55), madre fumadora (OR 2,32), años de edad (OR 1,92) y el sexo femenino (OR 1,75). El OR ajustado por dichos determinantes para ser fumador actual en el colegio intervención versus el control fue 0,54 (intervalo de confianza ­IC­ del 95%: 0,35-0,83) en el primer año de seguimiento y 0,98 (IC 95%: 0,60-1,61) en el segundo año. Conclusiones. La tenencia de una madre o un hermano fumador, la edad y el sexo femenino se correlacionaron fuertemente con el consumo de cigarrillos. La intervención educativa tuvo un efecto positivo en el primer año de seguimiento, pero luego no se mantuvo.

Development and testing of the questionnaire CEC-61: Knowledge about cervical cancer in Chilean adolescents.

Despite a clear association between human papillomavirus and cervical cancer, knowledge in adolescent populations regarding the disease and methods for its detection and prevention is deficient. The aim of this study was to develop and test a new questionnaire concerning knowledge on cervical cancer. An instrument was developed and validated to measure knowledge in 226 Chilean adolescents between April and June 2011. Content validity, construct validity, and reliability analysis of the instrument were performed. The new, validated instrument, called CEC-61 (Conocimientos en Cancer Cérvicouterino-61 items/Knowledge in Cervical Cancer-61 items), contains nine factors and 61 items. The new questionnaire explained 81% of the variance with a reliability of 0.96. The assessment of knowledge with a valid and reliable instrument is the first step in creating interventions for a population and to encourage appropriate preventive behavior. CEC-61 is highly reliable and has a clear factorial structure to evaluate knowledge in nine domains related to cervical cancer disease, cervical cancer risk, papilloma virus infection, the Papanicolaou test, and the papilloma virus vaccine.

El desafío de la sostenibilidad de los programas ampliados de inmunizaciones

[RESUMEN]. Objetivo. Analizar la sostenibilidad y la integración de los programas prioritarios en el marco de la Estrategia para el acceso universal a la salud y la cobertura universal de salud (Salud Universal) de la Organización Panamericana de la Salud de 2014. Métodos. Se llevó a cabo una revisión no sistemática de la bibliografía reciente enfocada al análisis de la integración y la sostenibilidad. Resultados. El principal resultado que se extrae de la bibliografía revisada es la necesidad de abordar la sostenibilidad de tal modo que se superen los límites de cualquier análisis restringido a la sostenibilidad financiera. Aunque la integración y la sostenibilidad no se interpretan de forma homogénea, sobresale un abordaje que contempla la integración como un factor facilitador del proceso de sostenibilidad del PAI. Conclusiones. La efectividad de las estrategias de integración del PAI depende en buena medida de que se consideren la presencia, el fortalecimiento y la transformación de las estructuras organizativas e institucionales que faciliten la participación de los actores con capacidad técnica y política para garantizar sus procesos de implementación. De esta forma, se podrán ponderar los procesos políticos que legitiman una agenda de inclusión del PAI en la Estrategia de salud universal y, por tanto, como parte integrante del fortalecimiento de los sistemas de salud.

[ABSTRACT]. Objective. Analyze the sustainability and integration of priority programs in the framework of the Pan American Health Organization’s 2014 Strategy for Universal Access to Health and Universal Health Coverage (Universal Health). Methods. A non-systematic review was carried out of the recent literature focused on analysis of integration and sustainability. Results. The main result extracted from the literature review is the need to address sustainability in a way that goes beyond the limits of any analysis restricted to financial sustainability. Although integration and sustainability are not interpreted uniformly, an approach that includes integration as a facilitating factor of the EPI sustainability process does stand out. Conclusions. Effectiveness of EPI integration strategies depends to a large extent on considering the presence, strengthening, and transformation of organizational and institutional structures that facilitate the participation of actors with the technical and political ability to ensure its implementation processes. Thus, political processes can be weighed that legitimize an agenda to include EPI in the Universal Health strategy and, accordingly, as an integral part of health systems strengthening.

[RESUMO]. Objetivo. Avaliar a sustentabilidade e a integração do Programa ampliado de imunização (PAI) como parte da estratégia de acesso universal à saúde e cobertura universal de saúde da Organização Pan-Americana da Saúde (OPAS) de 2014. Métodos. Uma revisão não sistemática da literatura científica recente foi realizada dando enfoque à análise da integração e sustentabilidade do PAI. Resultados. O principal achado é a necessidade de contemplar a sustentabilidade além da análise de sustentabilidade financeira. Embora a integração e a sustentabilidade não sejam interpretadas de forma homogênea na literatura, são destacadas as virtudes de uma abordagem que conceba a integração como um fator facilitador do processo de sustentabilidade do PAI. Conclusões. A efetividade das estratégias de integração do PAI depende em grande parte da existência, fortalecimento e transformação das estruturas organizacionais e institucionais facilitando a participação dos interessados com capacidade técnica e política para garantir os processos de implementação. Desse modo, será possível examinar com atenção os processos políticos que legitimam a agenda de inclusão do PAI na estratégia de saúde universal e, portanto, como parte integrante do fortalecimento dos sistemas de saúde.

Creencias sobre el cancer cervicouterino y papanicolaou y su relación con la adherencia al tamizaje / Beliefs about cervical cancer and Pap smear and their relationship with adherence to screening

INTRODUCCIÓN Y OBJETIVO: Actualmente, las tasas de mortalidad por cáncer cérvicouterino (CC) en Latinoamérica y el Caribe son mayores comparadas con otros países, a pesar de ser altamente prevenible. El objetivo de este trabajo es identificar la relación entre la adherencia al tamizaje de cáncer cérvicouterino y las creencias sobre el CC y el Papanicolaou (PAP) en mujeres chilenas. MÉTODOS: Estudio realizado en una muestra probabilística de 969 mujeres entre 25 y 64 años de edad, beneficiarias del sistema de salud público y pertenecientes a la comuna de Puente Alto en Santiago, Chile. El reclutamiento y recolección de datos fue entre Marzo 2014 y Octubre 2015. Se midieron variables sociodemográficas, adherencia al PAP y creencias en relación al PAP y CC. RESULTADOS: La mayor adherencia al tamizaje de CC tiene relación significativa con el sentimiento de bienestar al estar cuidando la salud, la percepción de menor cantidad de barreras para tomarse el PAP particularmente en mujeres que adhieren en el sistema privado, el conocimiento de la radio o quimioterapia como tratamiento para el CC, la percepción del riesgo personal de desarrollar la enfermedad, saber que los síntomas no son un requisito para el PAP, y la motivación dada por profesionales de salud o la madre. CONCLUSIONES: La adherencia al PAP es multifactorial y las creencias de las mujeres deben ser consideradas para el éxito de un programa de tamizaje eficaz.

INTRODUCTION AND OBJECTIVES: Currently, cervical cancer's mortality rates in Latin America and the Caribbean are higher compared to other countries, despite being highly preventable. The aim of this study is to identify the relationship between beliefs on CC and PAP test and adherence to screening in Chilean women. MATERIAL AND METHOD: This study was carried out in a probabilistic sample of 969 women aged between 25 and 64 years old, belonging to public health care system and enrolled in any of the four selected primary healthcare centers in Puente Alto, Santiago, Chile. Data collection was carried out between March 2014 and October 2015. Socio-demographic variables, adherence to screening and beliefs regarding CC and PAP test were measured. RESULTS: Greater adherence to CC screening has a significant relationship with the feeling of well-being while taking care of one's health, the perception of fewer barriers to the test particularly in women who adhere in the private health care system, knowledge of radio or chemotherapy as a treatment for CC, the perception of the personal risk of developing the disease, knowing that symptoms are not a requirement for the test, and the motivation given by health care professionals or the mother. CONCLUSION: Adherence to screening is multifactorial and women's' beliefs should be considered for the success of an effective screening program.