Modelo explicativo del autocuidado, la regulación emocional y el burnout en psicólogas en condición de aislamiento por COVID-19 / Explanatory model of self-care, emotional regulation and burnout in psychologists in isolation due to COVID-19

Resumen Los efectos negativos en la salud mental de la población mundial derivados de la pandemia por coronavirus 2019 (COVID-19) han incrementado la demanda de los servicios de atención psicológica. Por ello resulta importante estudiar también el bienestar emocional de este grupo de profesionales. El objetivo de este estudio fue analizar los procesos de autorregulación emocional y autocuidado como factores protectores frente a la presencia del burnout en un grupo de psicólogas mexicanas. Para esto, se utilizó un diseño cuantitativo transversal con alcance explicativo, en una muestra por voluntarios de 226 psicólogas con trabajo clínico. Los datos se recolectaron en formato electrónico, y para su obtención se aplicó la Escala de Conductas de Autocuidado para Psicólogos Clínicos (APC), el Cuestionario de Regulación Emocional (ERQ) y el Inventario Maslach de Burnout (MBI-HS). Para el análisis, se obtuvieron estadísticos descriptivos para cada una de las escalas y subes-calas, se estimaron coeficientes de correlación de Pearson, se ajustaron modelos de regresión lineal simple y múltiple para las subescalas del MBI-HS, y se ajustó un modelo de senderos mediante el método GLS. Los resultados indican un bajo nivel de burnout, que se asocia al autocuidado como factor protector frente al agotamiento emocional, a la realización personal, a un mayor uso de la supresión emocional como estrategia de autorregulación, y a la reevaluación cognitiva como factor protector ante la despersonalización. El estudio subraya la importancia fomentar el uso de conductas de autocuidado para disponer del mayor número de psicólogas en las mejores condiciones posibles para hacer frente a los efectos a largo plazo de la pandemia por COVID-19.

Abstract The negative effects on the mental health of the world's population from the 2019 coronavirus pandemic has increased the demand for psychological care services, which is why it is important to study the emotional well-being of this group of professionals. The objective of the study was to analyze the processes of emotional self-regulation and self-care as protective factors against the presence of burnout in a group of Mexican psychologists. To this end, a cross-sectional quantitative design with explanatory scopes was used. An intentional sample of 226 female psychologists who were conducting clinical work was used. Data were collected by means of an electronic format. The Clinical Psychologist Self-Care Conduct Scale (EAP), the Emotional Regulation Questionnaire (ERQ) and the Burnout Maslach Inventory (MBI) were applied. Descriptive statistics were obtained for each of the scales and subscales; Pearson correlation coefficients were estimated, and single and multiple linear regression models were adjusted for the MBI subscales. A path analysis was later adjusted using the GLS method. The results indicated a low level of burnout, demonstrating self-care as a protective factor against emotional exhaustion; personal fulfillment and increased use of emotional suppression, as a self-regulation strategy, and cognitive reevaluation, as a protective factor against depersonalization. The study underlines the importance of encouraging the use of self-care behaviors to have as many psychologists as possible in the best possible conditions to cope with the long-term effects of the pandemic.

Ansiedad, desesperanza y afrontamiento ante el COVID-19 en usuarios de atención psicológica

Objetivo. Identificar los niveles de síntomas de ansiedad y desesperanza, así como, las estrategias de afrontamiento durante la pandemia de COVID-19 en usuarios de servicios de atención psicológica en línea. Método. Se utilizó un diseño de tipo transversal predictivo, con una muestra de 78 personas voluntarias. Se aplicó la Escala de estrategias de afrontamiento frente a riesgos extremos, Inventario de Ansiedad de Beck (BAI) y la Escala de Desesperanza de Beck (BHS). Resultados. Al existir un alto nivel de ansiedad en las personas participantes, se tiende a manifestar mayor nivel de indefensión y de conductas de afrontamiento orientadas hacia la evitación y de naturaleza pasiva.

Objective. The main goal was to identify the levels of symptoms of anxiety and hopelessness, as well as the coping strategies during the COVID-19 pandemic in users of online psychological care services. Method. A predictive cross-sectional design was used, with a sample of 78 volunteers. The scale of coping strategies in the face of extreme risks, the Beck Anxiety Inventory (BAI) and the Beck Hopelessness Scale (BHS) were applied. Results. The results indicated that since there is an elevated level of anxiety in the participants, they tend to manifest a higher level of helplessness and coping behaviors oriented towards avoidance and passive nature.

Rendimiento del GeneXpert en el diagnóstico de tuberculosis pulmonar y extrapulmonar en la edad pediátrica / GeneXpert for the diagnosis of pulmonary and extrapulmonary tuberculosis in pediatric patients / GeneXpert para o diagnóstico da tuberculose pulmonar e extrapulmonar em pacientes pediátricos

resumen está disponible en el texto completo

Summary: Introduction: the World Health Organization (WHO) recommends molecular biology techniques, such as Xpert MTB/RIF, for the diagnosis of tuberculosis (TB) and for the detection of Rifampicin resistance. In Uruguay, the Xpert MTB/RIF has been used since 2014, and no research papers have yet assessed its performance. A Cochrane review recommends the assessment of the Xpert diagnostic accuracy in difficult to diagnose groups, such as, children, people living with HIV and with extrapulmonary tuberculosis. Objectives: describe cases of TB in children of under 15 years of age in Uruguay during 2018 and 2019 and describe the influence of the various diagnostic tests on the bacteriological confirmation of the disease. Evaluate the performance of the Xpert MTB/RIF for the diagnosis of TB in respiratory and non- respiratory samples using the culture as a reference standard. Compare the performance of GeneXpert with smear microscopy for TB diagnosis. Material and methods: analytical, retrospective study of children of under 15 years of age in Uruguay between January 2018 and June 2019, based on data obtained from the PNC-TB information system. Clinical-epidemiological characteristics of the TB cases were described. Definitions were taken from CHLA-EP, as per WHO recommendations. All respiratory and non-respiratory samples received by the National Reference Laboratory in Tuberculosis of the CHLA-EP from 1/1/2018 to 6/30/2019, entered in the IT system ("TB soft") were analyzed; they belonged to patients with clinical suspicion of TB, studied as contacts, or to TB risk groups (patients with immunodeficiency or at risk of immunosuppression, mainly). All samples underwent smear microscopy and/or Xpert MTB/RIF (according to the CHLA-EP protocol) and culture. The detection of Rifampicin resistance in the Xpert was compared with first- line drug sensitivity tests using molecular methods made from the cultures. The sensitivity, specificity, PPV and NPV of GeneXpert and ZN microscopy were calculated using Mycobacterium tuberculosis culture as gold standard. We calculated the Xpert positive and negative likelihood ratio (LR). Results: 67 patients under 15 years of age were diagnosed with TB, and 46% cases were bacteriologically confirmed. A total of 1670 samples were analyzed; 82% respiratory and 17% non-respiratory. A total of 32 samples showed a positive culture for M. tuberculosis (14 respiratory and 18 non- respiratory). One rifampicin resistance sample was detected in the Xpert that was not confirmed in the culture. The sensitivity of Xpert for all samples was 80%; the specificity 99,5%; PPV 80%; NPV 99,5%. In the case of smear microscopy for all samples: S 44,4%, specificity 99,4%, PPV 70,6%; NPV 98,2%. Respiratory samples: Xpert S 100%; E 99,4%; PPV 66,7%; NPV 100%. Bacilloscopy: S 72,7%; E 99,6%; PPV 72,7%; NPV 99,6%. Non-respiratory samples: Xpert S: 66,7%; E 100%; PPV 100%; NPV 97,9%. Bacilloscopy: S 25%; E 98,8%; PPV 66,7%; NPV 93,2%. The LR + of the Xpert for all samples was 160 and the LR - 0,2. Conclusions: TB in children under 15 remains difficult to diagnose. Bacteriological confirmation was attempted in 88% of TB cases, and almost 50% showed positive results by some bacteriological technique. The Xpert showed a good sensitivity and specificity profile in both respiratory and non-respiratory samples, similar to those reported in international papers. The main contribution in relation to smear microscopy is the greater sensitivity for the diagnosis of TB in children under 15 years of age. The Xpert is very useful for TB diagnosis when it is positive, although it does not ensure we can rule out the disease in case of negative results.

Resumo: Introdução: a Organização Mundial da Saúde (OMS) recomenda técnicas de biologia molecular, como o Xpert MTB / RIF para o diagnóstico de tuberculose (TB) e para a detecção de resistência à Rifampicina. No Uruguai, o Xpert MTB / RIF é usado desde 2014, e o seu desempenho ainda não tem sido avaliado. Uma revisão recente da Cochrane promove que pesquisas futuras devem avaliar a precisão diagnóstica do Xpert, em grupos difíceis de diagnosticar, como crianças, pessoas vivendo com HIV e pessoas com tuberculose extrapulmonar. Objetivos: descrever os casos de tuberculose em crianças menores de 15 anos no Uruguai nos anos 2018-2019 e a contribuição dos diferentes testes de diagnóstico na confirmação bacteriológica da doença. Avaliar o desempenho do Xpert MTB / RIF para o diagnóstico de TB em amostras respiratórias e não respiratórias de pacientes menores de 15 anos, utilizando a cultura como padrão de referência. Comparar o desempenho do GeneXpert com a baciloscopia para o diagnóstico da TB. Material e métodos: estudo analítico e retrospectivo de crianças menores de 15 anos estudadas para TB no Uruguai entre janeiro de 2018 e junho de 2019, utilizando a base em dados do sistema informático PNC-TB. Descrevemos as características clínico-epidemiológicas dos casos de TB. As definições foram retiradas do CHLA-EP de acordo com as recomendações da OMS. Todas as amostras respiratórias e não respiratórias recebidas pelo Laboratório Nacional de Referência (LNR) em Tuberculose do CHLA-EP de 01/01/2018 a 30/06/2019, inseridas no sistema computacional (TB Soft), corresponderam a pacientes com suspeita clínica de TB, estudados como contatos ou na detecção de TB em grupos de risco (pacientes com imunodeficiências ou com risco de imunossupressão, principalmente). As amostras foram realizadas por esfregaço (baciloscopia) e/ou Xpert MTB/RIF (de acordo com o protocolo CHLA-EP) e por cultura. A detecção da resistência à Rifampicina no Xpert foi comparada com os testes de sensibilidade a drogas de primeira linha (PSD), utilizando os métodos moleculares das culturas. A sensibilidade, especificidade, PPV e NPV do Xpert e esfregaço foram calculados usando a cultura como padrão de referência. Calculamos a razão de verossimilhança positiva e negativa (LR) do Xpert. Resultados: 67 crianças menores de 15 anos foram diagnosticadas com TB, e 46% dos casos foram confirmados bacteriologicamente. 1670 amostras foram analisadas; 82% respiratórias e 17% não respiratórias. 32 amostras tiveram uma cultura positiva para M. tuberculosis (14 respiratórias e 18 não respiratórias). A sensibilidade (S) do Xpert para todas as amostras foi de 80% (IC95% 37,5-96,3), especificidade (E) 99,5% (IC95% 97,3-99,9), PPV 80% (37,5-96,3), NPV 99,5% (97,3-99,9). Baciloscopia: S de 46,1% (28,7-64,5), E 99,5% (98,7-99,8), PPV 75% (50,5-89,8), VPL 98,3% (97,2-99). Amostras respiratórias: Xpert S 100%; E 99,3% VPP 66% e VPN 100%. Baciloscopia: S 66,6%, E 99,8%, PPV 80%, NPV 99,7%. Amostras não respiratórias: Xpert S: 66,6%, E 100%, PPV 100%, NPV 97,9%; Esfregaço S: 25%, E 99,3%, PPV 80%, NPV 93%. O LR + do Xpert para todas as amostras foi de 160 e o LR - 0,2. Conclusões: a TB em crianças menores de 15 anos é ainda difícil de diagnosticar. Tentamos a confirmação bacteriológica em 88% dos casos de TB, e quase 50% deles tiveram resultados positivos utilizando alguma técnica bacteriológica. O Xpert mostrou um bom perfil de sensibilidade e especificidade em amostras respiratórias e não respiratórias, semelhante ao relatado em papers internacionais. A principal contribuição em relação à baciloscopia é a maior sensibilidade para o diagnóstico de TB em menores de 15 anos. O Xpert é muito útil para o diagnóstico de TB em caso de ser positivo, embora não permita descartar a doença em casos negativos.

Estructura interna de la Escala de Conciliación Vida-Trabajo para mujeres asalariadas del noreste de México / Internal Structure of the Conciliation Scale of Family and Work Life, for women who are in paid works in the north-east of Mexico

Resumen Objetivo: Realizar la validación inicial de la estructura de la Escala de Conciliación Vida-Trabajo en mujeres insertas en el mercado laboral del noreste de México. Método: Se utilizó un diseño cuantitativo de corte explicativo. El muestreo fue intencional, 554 mujeres mayores de 18 años y que desempeñan actividades laborales remuneradas. El instrumento contó con 35 reactivos organizados en ocho dimensiones: desarrollo personal, vida familiar, vida social, cuidado personal, alimentación, actividad física, satisfacción e interferencia. Resultados: Se obtuvo la consistencia interna y el análisis factorial exploratorio (AFE) y confirmatorio (AFC). Se logró una reducción de ocho a seis dimensiones y de 35 a 25 reactivos. Una vez obtenidos estos valores, la escala tiene una adecuada estructura interna (GFI=0,867, RMSEA= 0,063) es válida y confiable (α=0,874) para evaluar el nivel de conciliación vida-familia de mujeres que se desempeñan en diferentes sectores laborales. Conclusiones: La gratificación, interferencia, pareja y crianza, cuidado de la salud, responsabilidades en el hogar y tiempo libre son dimensiones de la ECVT que permiten identificar la estructura de la conciliación desde la perspectiva de las mujeres trabajadoras.

Abstract Objective: Validation of the Conciliation Scale of Family and Work Life, for women who are in the north-east of Mexico labor market. Method: In this research, a quantitative and explanatory design was developed. 554 women over 18 years who are in paid works were intentionally sampled. An instrument of 35 reagents organized in eight dimensions such as: personal development, family life, social life, personal care, food, physical activity, satisfaction and interference was used. Results: Internal consistency, exploratory factorial analysis (AFE) and confirmatory analysis (AFC) were performed. There was a reduction from eight to six dimensions and from 35 to 25 reagents. As soon as these values were obtained, this scale has an appropriate structure as follows: (GFI=0,867, RMSEA= 0,063), becoming valid and reliable (α=0,874) to assess the level of reconciliation between women and their Family and Work Life. Conclusions: Gratification, interference, couple and upbringing, health care, responsibilities in the home and free time are dimensions of the ECVT that allow to identify the structure of the conciliation from the perspective of working women.

Estructura interna de una escala de indefensión para jóvenes del norte de México / Internal Structure of a Scale of Helplessness for young people in northern Mexico

Resumen Objetivo. Analizar la estructura interna de la propuesta de una Escala de Indefensión para Jóvenes (EIJ) en una muestra de la ciudad de Saltillo, Coahuila, México. Método. Se utilizó una metodología cuantitativa de diseño instrumental. Se eligió una muestra incidental de 750 casos, 50.3% hombres y 49.7% mujeres. La edad promedio fue de 21.85. Se utilizó la EIJ, que constó de 47 ítems que miden: afectividad, motivación, cognición y conducta. La confiabilidad fue de .898. Resultados. Se realizó el Análisis Factorial Exploratorio y Confirmatorio. Los índices de ajuste cumplieron con el criterio de buen ajuste. Esta herramienta aporta una forma de medir las variables predictoras de la conducta suicida, las cuales constituyen un problema de salud pública y que, en parte, son predichas por los indicadores de indefensión.

Abstract Objective. Analyze the internal structure of the proposal for a Youth Helplessness Scale (EIJ, by its acronym in Spanish) in a sample of the city of Saltillo, Coahuila, Mexico. Method. A quantitative methodology of instrumental design was used. An incidental sample of 750 cases was chosen, of which 50.3% were men and 49.7% women, and whose average age was 21.85. A Scale of Hopelessness for Young people consisting of 47 reactants was used, measuring affection, motivation, cognition and behavior. The reliability was. 898, and an exploratory and confirmatory factor analysis was carried out. Results. Adjustment indices met the criterion of good fit. This tool provides a way to measure the predictor variables of suicidal behavior, all of which constitute a current public health problem, and which are partly predicted by indicators of helplessness.

Estructura interna del Cuestionario de Evaluación de Violencia Escolar Infantil y Primaria en un entorno violento de México / Internal structure of the Childhood and Primary School Violence Assessment Questionnaire

El objetivo de este estudio es validar la estructura interna del Cuestionario de Evaluación de Violencia Escolar en Infantil y Primaria en una muestra del noreste de México. Es un estudio de corte cuantitativo y transversal. Se incluyeron, 733 niños, de los cuales, 49.8% son hombres, 50.2% mujeres, mediante un muestreo intencional, obtenido de 78 instituciones de educación básica de la ciudad de Saltillo, Coahuila, México. La edad promedio fue de 12 años. Los resultados confirmaron una estructura factorial de tres dimensiones que miden situaciones presenciadas, vividas y realizadas. El instrumento se redujo a 30 indicadores de dichas dimensiones conservando la fiabilidad obtenida en estudios previos. La aportación del estudio es la incorporación de una herramienta que permita una valoración del acoso escolar y del daño percibido y sus características, evitando principalmente la subestimación y normalización de la violencia.

The objective of this study is to validate the internal structure of the School Violence Evaluation Questionnaire in Children and Primary in a sample of northeastern Mexico. It is a quantitative and transversal study. A total of 733 children were included, of which 49.8% are men, 50.2% women, through intentional sampling, obtained from 78 basic education institutions in the city of Saltillo, Coahuila, Mexico. The average age was 12 years. The results confirmed a factorial structure of three dimensions that measure situations witnessed, lived and carried out. The instrument was reduced to 27 indicators of these dimensions, conserving the reliability obtained in previous studies. The contribution of the study is validation of the internal structure of the evaluation tool that allows the identification of school bullying and perceived damage and its characteristics, avoiding mainly the underestimation and normalization of violence.

Osteoma osteoide de cuello femoral: A propósito de un caso / Femoral neck osteoid osteoma: about a case

El osteoma osteoide es un tumor óseo benigno, de pequeño tamaño, sin potencial de crecimiento. Habitualmente se considera a los tumores óseos benignos y malignos como una causa poco frecuente de cojera en apirexia, siendo más frecuentes las patologías inflamatorias inespecíficas como la sinovitis transitoria de cadera, la enfermedad de Perthes y la condropatía conjugal del adolescente. Se presenta el caso clínico de un escolar de 8 años con una cojera dolorosa en apirexia de 4 meses de evolución con sospecha imagenológica de osteoma osteoide de cuello de fémur. Se decide realizar prueba terapéutica con ácido acetilsalicílico. A las 24 horas el niño se encontraba asintomático. Se indicó procedimiento quirúrgico de resección mediante punción bajo tomografía axial computada. El diagnóstico se confirmó mediante anatomía patológica. Se realizó resección completa del tumor con buena evolución. Es importante desde el punto de vista pediátrico realizar un correcto diagnóstico diferencial entre las diferentes causas de cojera dolorosa en apirexia, basándonos en la historia clínica y la imagenología.

Osteoid osteomas are small benign bone tumors which lack growth potential. All bone tumors, whether benign or malign, are considered a rare cause of apyretic limping, being non-specific inflammatory diseases more frequent, such as transient synovitis of the hip, Perthes disease and adolescent conjugal chondropathy. The study presents the clinical case of an 8 year old school boy with a 4 month evolution painful apyretic limp, being there a suspicion of femoral neck osteoid osteoma according to imaging studies. Therapeutic trial of acetylsalicylic acid was performed. Twenty four hours later the boy was asymptomatic. A tomography-guided puncture was indicated. Clinical diagnosis was pathologically confirmed. Subsequently, complete surgical resection of the tumor was performed, the evolution being favorable. From a pediatric perspective it is important to make an accurate differential diagnosis between the different possible causes of painful apyretic limp, based on clinical history and imaging studies.

Diferencias de la conciliación vida-carrera en mujeres de Sonora y Coahuila, México / Differences in life-job balance among women of Coahuila and Sonora, Mexico

Resumen El objetivo de este estudio fue analizar las diferencias de la conciliación de los componentes vida y carrera laboral de mujeres trabajadoras de dos estados del norte de México, Coahuila y Sonora, con el fin de conocer los contrastes en la distribución y la armonización de las tareas dentro y fuera de casa. Se aplicó una escala para medir la conciliación vida-trabajo a 556 mujeres en ambos estados. Se exploraron seis dimensiones: gratificación, interferencia, pareja y crianza, cuidado y salud, responsabilidad en el hogar y tiempo libre. Los resultados indican que la muestra de Sonora presenta niveles más altos de conciliación. En general, la incorporación de las mujeres al ámbito laboral les genera gratificaciones personales, sin embargo, esta condición no ha modificado, en lo substancial, la división sexual del trabajo, es decir, las mujeres cumplen con sus jornadas de trabajo y continúan en casa con las tareas de cuidado y atención de la familia.

Abstract The aim of this study was to analyze the differences in the life-job balance of women in two northern states of Mexico, Coahuila and Sonora, in order to know the contrasts in the distribution and harmonization of tasks inside and outside the home. A scale was applied to measure life-job balance to 556 women in both states. Six dimensions were explored: gratification, interference, family and parenting, health care and responsibility at home and free time. The results indicate that the sample of Sonora has higher levels of conciliation. In general, the incorporation of women into the workplace generates personal rewards, however, this condition has not substantially changed the sexual division of labor, and women working their daily hours and then continue with care and family care tasks at home.

Características epidemiológicas de niños que debutaron con diabetes mellitus tipo I en el período 2000-2010 en el Centro Hospitalario Pereira Rossell / Epidemiological characteristics of children who presented with type I diabetes mellitus in the 2000-2010 period at the Pereira Rossell Hospital

Introducción: la diabetes mellitus tipo I (DM1) es una de las enfermedades crónicas no transmisibles más prevalentes en la población infantil. Su incidencia es variable. En la etiopatogenia están implicados factores genéticos y ambientales. Objetivo: describir las características epidemiológicas de niños que debutaron con DM1 entre 2000 y 2010 en el Hospital Pediátrico del Centro Pereira Rossell (HP-CHPR). Material y métodos: estudio retrospectivo, incluyendo los menores de 15 años con debut diagnóstico de DM1, asistidos en el HP-CHPR entre el 1/1/2000 y el 31/12/2009. Se realizó la revisión de las historias clínicas. Resultados: se identificaron 183 pacientes, que representaron en promedio 1,3/1.000 egresos/año. El número absoluto de casos y su relación con el número de egresos fue variable. Los pacientes tuvieron una media de edad al debut de 7,3 años. El 54% procedía del interior del país, 98,6% eran de raza blanca, 67% debutó como cetoacidosis diabética. Se observó mayor prevalencia en invierno. No se identificaron antecedentes perinatales, familiares ni ambientales con prevalencia mayor que en la población general. Conclusiones: el número de pacientes con debut de DM1 asistidos en el HP-CHPR fue variable, con un aumento entre 2003 y 2005. Algunas características epidemiológicas fueron similares a las descriptas en la bibliografía. No se identificaron antecedentes que pudieran actuar como factores de riesgo para el desarrollo de la enfermedad. Una proporción importante de pacientes debutó bajo una forma grave que remarca la necesidad de promover programas de educación diabetológica.

Introduction: type I diabetes mellitus is one of the most prevalent non transmissible chronic diseases in children. Its incidence varies. The etiopathogenesis included genetic and environmental factors Objective: to describe the epidemiological characteristics of children who presented with Type I diabetes mellitus between 2000 and 2010 at the Pereira Rossell Hospital Center. Methods: retrospective study, that included children under 15 years old who presented with type I diabetes mellitus, who were seen at the Pereira Rossell Hospital Center between January 1, 2000 and December 31, 2009. The medical records were reviewed. Results: 183 patients were identified, who represented on average 1.3/1000 hospital discharges. The absolute number of cases and their relationship with the number of discharges varied. Patients had an average age of 7.3 upon debut of the disease. 54% were coming from the provinces, 98.6% were Caucasian, 67% presented with diabetic ketoacidosis. Prevalence was higher in winter. No perinatal precedents were identified, neither family history nor environment conditions different from or greater than the general population. Conclusions: the number of patients who presented with Type I diabetes mellitus seen at the Pereira Rossel Hospital varied, and an increase was seen between 2003 and 2005. A few epidemiological characteristics were similar to those described in the bibliography. No history was identified that could represent risk factors for the development of the disease. An important proportion of patients presented with a severe way that points out the need to promote education programs on diabetes.

Creencias sobre estereotipos de género de jóvenes universitarios del norte de México / Gender stereotypes of college students in northern Mexico

El objetivo de este estudio fue analizar las valoraciones sociales de género presentes en las creencias de la población estudiantil universitaria del norte de México, con el fin de conocer los cambios que se van produciendo en relación a este fenómeno. Se aplicó una escala de creencias estereotipadas de género a 1921 estudiantes de ambos sexos de dos universidades públicas del norte de México, localizadas en las ciudades de Hermosillo, Sonora y Saltillo, Coahuila. Se exploraron cinco dimensiones: feminidad/masculinidad, roles de maternidad/paternidad, sexualidad, competencias y capacidades y expresiones de emotividad/agresividad. Los resultados indican un mayor arraigo a posturas tradicionales en varones y en los estudiantes provenientes de la división académica de ingeniería. En general, los estudiantes de semestres avanzados tienen los mismos prejuicios de género que los de recién ingreso a la institución. Se recomienda transversalizar la perspectiva de género en las instituciones de educación superior a través de programas de sensibilización y capacitación.

The purpose of this study was to analyze the beliefs about social gender assessments in a college student population, in order to know the changes that these beliefs undergo. A sample of 1.921 students of both sexes of two public universities in northern Mexico, located in the cities of Hermosillo, Sonora and Saltillo, Coahuila, completed a scale of gender stereotyped beliefs. Five dimensions were explored: Femininity / masculinity, maternity / paternity roles, sexuality, skills and abilities, and expressions of emotion / aggression. The results indicate greater attachment to traditional positions in men and in Engineering students. In general, all students irrespective of semester have the same gender biases. It is recommended that the gender perspective be transversalised in higher education institutions through awareness and training programs.

Tos convulsa: brote epidémico 2011-2012, Hospital Las Piedras: características clínico-evolutivas de los pacientes hospitalizados / Whooping cough: epidemic outbreak 2011-2012, Hospital Las Piedras: clinical-evolutionary characteristics of hospitalized patients

Introducción: la tos convulsa es una enfermedad infecciosa respiratoria aguda debida a Bordetella pertussis y Bordetella parapertussis. Factores de mal pronóstico son edad menor a 6 meses, hiperleucocitosis, coinfección bacteriana. En Uruguay, desde la incorporación de la vacuna antipertussis en 1963, disminuyeron significativamente las notificaciones con comportamiento endémico con brotes. En el 2011, luego del fallecimiento de dos niños con tos convulsa, se registró un aumento de casos en el Hospital Las Piedras (HLP). Objetivo: describir las características clínico-evolutivas de los niños hospitalizados por tos convulsa en el HLP entre el 1º de agosto de 2011 y el 30 de abril de 2012. Material y método: estudio descriptivo, prospectivo, de los niños hospitalizados por tos convulsa. La confirmación se realizó por reacción en cadena de polimerasa (PCR) en secreciones respiratorias. Se analizan variables epidemiológicas, características clínicas y evolutivas. Resultados: se hospitalizaron 41 niños con tos convulsa confirmada (6,4%); 48,8% fueron menores de 6 meses. Diez fueron derivados a centros de tratamiento intensivo (CTI), ocho de ellos menores de 6 meses; dos fallecieron. Tuvieron contacto con casos confirmados 10% y con casos sospechosos 51%. Presentaron leucocitosis > 20.000 cel/mm3, 39%. En tres casos existió coinfección con adenovirus. Discusión y conclusiones: el brote de tos convulsa comenzó en 2011, siendo el HLP el centro que alertó su inicio y registró la tasa más elevada de hospitalización. Las características clínico-evolutivas de los niños afectados son similares a las descritas en la región. Su abordaje requiere accesibilidad a nuevas herramientas diagnósticas de biología molecular. Para el control y la prevención se requiere reforzar las estrategias de vacunación.

Abstract Introduction: whooping cough is an acute respiratory infectious disease caused by a type of bacteria called Bordetella pertussis and Bordetella parapertussis. Being younger than 6 months, hyperleukocytosis and bacterial coinfection are some bad prognosis factors. In Uruguay, since the antipertussis vaccination was included in the vaccination schedule in 1963, notifications with endemic outbreak behavior significantly diminished. In 2011, after two children with whooping cough died, an increase of the cases was recorded at the Las Piedras Hospital. Objective: to describe the clinical characteristics and evolution of children hospitalized for whooping cough at the Las Piedras Hospital from August 1st, 2011 through April 30, 2012. Method: descriptive, prospective study, of the children hospitalized for whooping cough. Confirmation was made by polymerase chain reaction in respiratory secretions. Epidemiological variables, clinical characteristics and evolution are analysed. Results: 41 children were hospitalized with confirmed whooping cough (6.4%); 48.8% were younger than 6 months. Ten of them were referred to intensive care units, eight of them were younger than 6 months and two of them died. Ten per cent were in contact with confirmed cases and 51% were in contact with suspicious cases. Leukocytosis > 20.000 cel/mm3 was seen in 39% of children. There was coinfection with adenovirus in three cases. Discussion and conclusions: the whooping cough outbreak started in 2011, being the Pereira Rossell the health center that issued the warning and had the highest hospitalization rate. Clinical characteristics and evolution of the children affected are the similar to those described in the region. Access to new diagnostic tools of molecular biology is necessary to address this condition. Control and prevention requires strengthening vaccination strategies.

Resumo Introdução: a coqueluche é uma doença infecciosa respiratória aguda devida a Bordetella pertussis e Bordetella parapertussis. Idade menor a 6 meses, hiperleucocitoses e co-infecção bacteriana são fatores de mal prognóstico. No Uruguai, desde a incorporação da vacina contra a coqueluches em 1963, as notificacoes com comportamento endêmico com surtos diminuiram significativamente. Em 2011, depois dos óbitos de duas crianças com coqueluche, registrou-se um aumento de casos no Hospital Las Piedras (HLP). Objetivo: descrever as características clínico-evolutivas das crianças hospitalizadas por coqueluche no HLP no período 1º de agosto de 2011 - 30 de abril de 2012. Material e método: estudo descritivo e prospectivo das crianças hospitalizadas por coqueluche. A confirmação do diagnóstico foi feita por reação em cadeia de polimerase (PCR) em secreções respiratórias. Foram analisadas variáveis epidemiológicas, características clínicas e evolutivas. Resultados: 41 crianças foram hospitalizadas com diagnóstico confirmado de coqueluche (6,4%); 48,8% tinham menos de 6 meses de vida. Dez foram derivadas a unidades de terapia intensiva (UTII) sendo que oito tinham menos de 6 meses; duas faleceram. 10% teve contato com casos confirmados e 51% com casos suspeitos. 39% apresentou leucocitose > 20.000 cel/mm3. Em três casos foi observada co-infecção com adenovirus. Discussão e conclusões: o surto de coqueluche começou em 2011, sendo o HLP o centro que alertou sobre seu inicio e registrou a taxa mais elevada de hospitalização. As características clínico-evolutivas das crianças afetadas foram similares às descritas na região. A abordagem desta patologia requer acesso a novas ferramentas diagnósticas de biologia molecular. Para o controle e a prevenção é necessário reforçar as estratégias de vacinação.

Glomerulonefritis difusa aguda postestreptocócica-psoriasis guttata. A propósito de un caso clínico / A case of acute diffuse poststreptococcal glomerulonephritis: guttate psoriasis

La glomerulonefritis asociada a la infección por estreptococo beta hemolítico del grupo A es la más conocida y es la causa más común de síndrome nefrítico en la edad pediátrica. La psoriasis es una enfermedad cutánea hereditaria eritematodescamativa poco frecuente, representa el 4,1% de las dermatosis que ocurren en niños menores de 16 años. Se presenta el caso de un adolescente de 12 años donde la infección por estreptococo beta hemolítico del grupo A de las vías respiratorias altas ocasionó glomerulonefritis difusa aguda, con expresión concomitante de psoriasis guttata. Se revisan los mecanismos inmunes en ambas patologías.

Glomerulonephritis associated with group A beta-hemolytic streptococcal infection is the best known and most common cause of nephritic syndrome in children. Psoriasis is often an erythematous hereditary skin disease. It represents 4.1% of the dermatoses children under 16 years. The study presents the case of a 12 year old patient where Group A beta-hemolytic streptococcal acute upper respiratory infection caused diffuse glomerulonephritis, with concomitant expression of guttate psoriasis. A review of immune mechanisms of both diseases is added.

Changes in hospitalizations for pneumonia after universal vaccination with pneumococcal conjugate vaccines 7/13 valent and haemophilus influenzae type b conjugate vaccine in a Pediatric Referral Hospital in Uruguay.

BACKGROUND: In 1994, Uruguay included Haemophilus influenzae b (Hib) conjugated vaccine in a 3 + 1 schedule. In March 2008, 7-valent pneumococcal conjugate vaccines (PCV7) was included in a 2 +1 schedule. In 2010, 13-valent PCV replaced PCV7. Catch-up immunization was offered. The aim of this study was to describe the etiology of community-acquired pneumonia (CAP) in children 0-14 years of age hospitalized at the Hospital Pediatrico-Centro Hospitalario Pereira Rossell between 2003 and 2012. METHODS: Annual hospitalization rates (per 10,000 discharges) for CAP and bacterial-confirmed CAP in children 0-14 years of age was described prior PCV7 vaccination (2003-2007), during the year of implementation of PCV7 (2008) and after the introduction of PCV7 (2009-2012). Data regarding age, strains isolated from pleural fluid and/or blood, vaccination status, pneumococcal and H. influenzae serotypes were obtained from Hospital Pediatrico-Centro Hospitalario Pereira Rossell databases and vaccination records. RESULTS: Hospitalization rates for CAP and pneumococcal CAP between prevaccine years and the last year after introduction of vaccination with PCV (2012) significantly decreased by 78.1% and 92.4%, respectively. Significant reduction for 13-valent PCV vaccine serotypes and significant increase for nonvaccine serotypes was observed. A decrease in Staphylococcus aureus pneumonia was observed. Hospitalization rates for H. influenzae CAP remain stable before and after pneumococcal vaccination. CONCLUSIONS: Three years after PCV7/13 introduction into the routine vaccination schedule, there was a rapid and significant reduction in rates of CAP and P-CAP. An increase of etiology of CAP by other agents was not observed.

[Neonatal cholestasis due to congenital toxoplasmosis. Case report]. / Colestasis neonatal por toxoplasmosis congénita. A propósito de un caso clínico.

Neonatal cholestasis is the manifestation of many different diseases. Its early etiological diagnosis is crucial, since treatment before 60 days of life changes the prognosis in children with biliary atresia. Congenital toxoplasmosis can be asymptomatic in the newborn, or have mainly neurological, ophthalmological or gastrointestinal symptoms (hepatomegaly, cholestatic jaundice). Neonatal cholestasis secondary to congenital toxoplasmosis is not a situation frequently reported. We report the case of an infant with neonatal cholestasis due to a congenital toxoplasmosis, in order to discuss the difficulties in establishing the etiological diagnostic and to review the indications of invasive studies such as liver biopsy in these situations.

Colestasis neonatal por toxoplasmosis congénita: A propósito de un caso clínico / Neonatal cholestasis due to congenital toxoplasmosis: Case report

La colestasis neonatal es la forma de presentación de diversas enfermedades; es necesario un diagnóstico etiológico temprano, ya que el tratamiento antes de los 60 días de vida cambia el pronóstico en los niños que presentan atresia biliar. La toxoplasmosis congénita puede ser asintomática en el recién nacido, o presentar fundamentalmente alteraciones neurológicas, oftalmológicas y hepáticas (hepatomegalia, ictericia no colestásica). La colestasis neonatal secundaria a toxoplasmosis congénita no es una situación informada con frecuencia. Se presenta el caso de un lactante con colestasis neonatal cuya etiología responde a una toxoplasmosis congénita, con el objetivo de discutir las difcultades en establecer el diagnóstico etiológico y las indicaciones de realizar estudios invasivos, como la biopsia hepática, en estas situaciones.(AU)

Neonatal cholestasis is the manifestation of many different diseases. Its early etiological diagnosis is crucial, since treatment before 60 days of life changes the prognosis in children with biliary atresia. Congenital toxoplasmosis can be asymptomatic in the newborn, or have mainly neurological, ophthalmological or gastrointestinal symptoms (hepatomegaly, cholestatic jaundice). Neonatal cholestasis secondary to congenital toxoplasmosis is not a situation frequently reported. We report the case of an infant with neonatal cholestasis due to a congenital toxoplasmosis, in order to discuss the diffculties in establishing the etiological diagnostic and to review the indications of invasive studies such as liver biopsy in these situations.(AU)

Colestasis neonatal por toxoplasmosis congénita: A propósito de un caso clínico / Neonatal cholestasis due to congenital toxoplasmosis: Case report

La colestasis neonatal es la forma de presentación de diversas enfermedades; es necesario un diagnóstico etiológico temprano, ya que el tratamiento antes de los 60 días de vida cambia el pronóstico en los niños que presentan atresia biliar. La toxoplasmosis congénita puede ser asintomática en el recién nacido, o presentar fundamentalmente alteraciones neurológicas, oftalmológicas y hepáticas (hepatomegalia, ictericia no colestásica). La colestasis neonatal secundaria a toxoplasmosis congénita no es una situación informada con frecuencia. Se presenta el caso de un lactante con colestasis neonatal cuya etiología responde a una toxoplasmosis congénita, con el objetivo de discutir las difcultades en establecer el diagnóstico etiológico y las indicaciones de realizar estudios invasivos, como la biopsia hepática, en estas situaciones.

Neonatal cholestasis is the manifestation of many different diseases. Its early etiological diagnosis is crucial, since treatment before 60 days of life changes the prognosis in children with biliary atresia. Congenital toxoplasmosis can be asymptomatic in the newborn, or have mainly neurological, ophthalmological or gastrointestinal symptoms (hepatomegaly, cholestatic jaundice). Neonatal cholestasis secondary to congenital toxoplasmosis is not a situation frequently reported. We report the case of an infant with neonatal cholestasis due to a congenital toxoplasmosis, in order to discuss the diffculties in establishing the etiological diagnostic and to review the indications of invasive studies such as liver biopsy in these situations.

Colestasis neonatal por toxoplasmosis congénita. A propósito de un caso clínico. / [Neonatal cholestasis due to congenital toxoplasmosis. Case report].

Neonatal cholestasis is the manifestation of many different diseases. Its early etiological diagnosis is crucial, since treatment before 60 days of life changes the prognosis in children with biliary atresia. Congenital toxoplasmosis can be asymptomatic in the newborn, or have mainly neurological, ophthalmological or gastrointestinal symptoms (hepatomegaly, cholestatic jaundice). Neonatal cholestasis secondary to congenital toxoplasmosis is not a situation frequently reported. We report the case of an infant with neonatal cholestasis due to a congenital toxoplasmosis, in order to discuss the difficulties in establishing the etiological diagnostic and to review the indications of invasive studies such as liver biopsy in these situations.

Prevención de hepatitis A mediante vacunación en Uruguay (2005-2010) / Preventing hepatitis A through immunization in Uruguay

Introducción: la hepatitis A es un problema sanitario en países en vías de desarrollo. Objetivos: describir estrategias para controlar hepatitis A mediante vacunación. Describir evolución de número de casos, tasas y brotes entre 2005-2010. Material y método: estudio descriptivo retrospectivo 2005-2010. Se analizan:-Estrategias utilizadas por Ministerio de Salud Pública (MSP) para controlar hepatitis A mediante vacunación: bloqueo de brotes; población de riesgo e inclusión universal de vacuna. Descripción: número de casos de hepatitis A en Uruguay y Artigas; número de brotes en ciudades, barrios, familia y otros; número de casos/edad.Resultados: se registraron 21 brotes. Se aplicaron 16.715 primeras dosis y 11.354 segundas dosis. Entre el 10 de setiembre de 2007 y el 26 de noviembre de 2007, el MSP y el Ministerio de Desarrollo Social realizaron una campaña de vacunacióndirigida a niños de entre 1 y 5 años del subsector público. Docentes y estudiantes de Medicina de la Universidad de la República apoyaron y difundieron la campaña. Se aplicaron44.716 primeras dosis y 25.095 segundas dosis. En 2008 se incluye la vacuna en dos dosis en el esquema de vacunación, obligatoria y gratuita. La tasa país disminuyó de 69,6 a 2,7 entre 2005 y 2010 (p<0,05); en el Departamento de Artigas de 780,57/100.000 en 2005 a 0,66 en 2010 (p<0,05). Durante 2005-2008 ocurrieron 22 brotes en ciudades; en 2010 se registraron escasos brotes intrafamiliares y en escuelas. El descenso de número de casos de 2005 a 2010 fue significativo en todas las edades. Comentario: del 2005 al 2010 se produjo una disminución significativay sostenida del número de brotes y tasas de hepatitis A en Uruguay.

Introduction: Hepatitis A is a health problem in developing countries.Objectives: To describe strategies to control Hepatitis A through immunization. To describe the evolutionof the number of cases, rates and outbreaks from 2005 through 2010.Method: Retrospective descriptive study covering the 2005-2010 period of time. The following was analysed:- Strategies used by the Ministry of Public Health to control Hepatitis A through immunization: blocking ofoutbreaks; population at risk; universal immunization. - Description: Number of cases of Hepatitis A in Uruguay, and in the department of Artigas; number ofoutbreaks in cities, neighborhoods, families and other; number of cases/age.Results: 21 outbreaks were recorded. 16.715 first doses and 11.354 second doses were applied. From 10 September, 2007 through 26 November, 2007 the Ministry of Public Health and the Ministry of Social Developmentconducted an immunization campaign aimed at children in the public sub-sector who were between 1 and 5 years old. Professors at the School of Medicine of the University of the Republic and medical students supported and contributed to the dissemination of the campaign. 44.716 first doses and 25.095 second doses were applied. In 2008 the two dose vaccine is included in the mandatory and free immunization plan. The national rate dropped from 69.6 to 2.7 from 2005 through 2010 (p<0,05); and in the department ofArtigas from 780.57/100.000 in 2005 to 0.66 in 2010 (p<0,05). Between 2005 and 2008 there were 22 outbreaks in cities, in 2010 few intra-family outbreaks and in schools were registered. The decrease in the number of cases from 2005 through 2010 was significant for all ages. Comment: A significant and sustained decrease ofHepatitis A outbreaks and rates was evidenced in Uruguay from 2005 through 2010.

Introdução: a hepatite A é um problema sanitário nos países em vias de desenvolvimento. Objetivos: Descrever estratégias para controlar hepatiteAporvacinação. Descrever a evolução do número de casos, taxas e surtos entre 2005-2010. Material e método: estudo descritivo retrospectivo 2005-2010. Foram analisadas: - Estratégias utilizadas pelo Ministério de Salud Pública (MSP) para controlar a hepatite A por vacinação: bloqueio de surtos; população de risco; inclusão universal da vacina. - Descrição: número de casos de hepatite A no Uruguai e especificamente no departamento de Artigas; número de surtos en cidades, bairros, famílias e outros; número de casos/idade. Resultados: foram registrados 21 surtos. Foram aplicadas16.715 primeiras doses e 11.354 segundas doses. Entre o dia 10 de setembro de 2007 e o dia 26 de novembro de 2007, o MSP e o Ministério de Desenvolvimento Social realizaram una campanha de vacinação dirigida acrianças entre 1 e 5 anos do setor público. Docentes e estudantesde Medicina da Universidad de la República apoiaram e difundiram a campanha. Foram aplicadas 44.716 primeiras doses e 25.095 segundas doses. Em 2008 a vacina em duas doses foi incluída ao esquema de vacinação, obrigatória e gratuita. La taxa país diminuiu de 69,6 a 2,7 entre 2005 y 2010 (p<0,05); no departamento de Artigas passou de 780,57/100.000 em 2005 a 0,66 em 2010 (p<0,05). Durante 2005-2008 foram registrados 22 surtos em cidades; em 2010, foram registrados poucos surtos intrafamiliarese em escolas. A redução do número de casos de 2005 a 2010 foi significativa em todas as idades. Comentário: de 2005 a 2010 observou-se uma diminuição significativa e mantida do número de surtos e das taxas de hepatite A no Uruguai.

Desnutrición aguda severa en niños hospitalizados en el Hospital Pereira Rossell aplicación y evaluación de una pauta de diagnóstico y tratamiento / Severe acute malnutrition in children hospitalized in the Hospital Pereira Rossell: implementation and evaluation of a course of diagnosis and treatment

Introducción:La desnutrición aguda severa requiere el comienzo inmediato de un tratamiento específico. En el Hospital Pereira Rossell se creó y se puso en práctica una pauta de diagnóstico y tratamiento del niño con desnutrición aguda severa, basada en recomendaciones de OMS. Objetivo:evaluar los resultados de la aplicación de dicha pauta. Pacientes y Métodos: estudio prospectivo realizado entre el 1/5 y el 30/9 del 2008, incluyendo todos los niños hospitalizados en la Unidad de Nutrición, con diagnóstico de desnutrición aguda severa. Se aplicó la pauta de diagnóstico y tratamiento.Conclusiones: la desnutrición aguda severa afecta a niños pequeños. Se debe principalmente a fallas en la alimentación. Estos niños pueden ser tratados en forma exitosa con fórmulas de bajo costo y el agregado de electrolitos y micronutrientes. La ausencia decomplicaciones habilita a que el tratamiento nutricional pueda llevarse a cabo en domicilio.

Introduction: Severe acute malnutrition requires the immediate commencement of a specific treatment. Hospital Pereira Rossell was developed and implemented a guideline for diagnosis and treatment of children with severe a c u t e ma l n u t r i t i o n , b a s e d o n WHO recommendations. Objective:To evaluate the results of applying this standard. Patients and Methods: A prospective study between 1/5 and 30/9, 2008, including all children hospitalized in the Nutrition Unit, diagnosed with severe acute malnutrition.We applied the standard of diagnosis and treatment. Conclusions:Severe acute malnutrition affects young children. Is mainly due to power failures. These children can be treated successfully with low-cost formula and the addition of electrolytes and micronutrients. The absence of complications enables that nutritional therapy can be done at home

Impact of universal pneumococcal vaccination on hospitalizations for pneumonia and meningitis in children in Montevideo, Uruguay.

BACKGROUND: In March 2008, Uruguay included PCV7 into the routine vaccination program, in a 2 + 1 schedule for children <2 years of age. Catch-up immunization was offered to children born in 2007. Greater than 95% of children received their first and second doses. The aim of this study was to assess the effect of this strategy. METHODS: Annual hospitalization rates (per 10,000 discharges) for community-acquired pneumonia (CAP) in children <14 years of age and pneumococcal meningitis are described prior to PCV7 vaccination (2005-2007), during the year of implementation (2008) and following vaccine introduction (2009). Data regarding age, diagnosis, vaccination status, and pneumococcal serotype were obtained from Hospital Pereira Rossell databases and vaccination records. RESULTS: Comparison of hospitalization rates for CAP and pneumococcal-CAP (P-CAP) between prevaccine years (2005-2007) and the year after vaccination (2009) decreased significantly in all children by 56% and 48.2%, respectively. Significant reduction was observed for vaccine serotype P-CAP (serotype 14 P-CAP decreased from 26.6 to 2.5 per 10,000 discharges) in children <2 years of age. A significant reduction in pneumococcal meningitis of 59% was seen in this age group; median rates prevaccination decreased from 17 (12.2-24.9) to 7 (3-11.8) after the administration of vaccine. No vaccine failures for P-CAP or pneumococcal meningitis were seen in fully immunized children. CONCLUSIONS: One year after PCV7 introduction into the routine vaccination schedule of Uruguay, there was a rapid and significant reduction in rates of CAP, P-CAP, and pneumococcal meningitis in children <2 years of age.