Consensus of the Respiratory Committee of the Latin American Society for Pediatric Intensive Care: Management of pediatric SARS-CoV-2. (SLACIP): COVID-19 Pediatric / Consenso del Comité Respiratorio Sociedad Latinoamericana Terapia Intensiva Pediátrica: Manejo SARS-CoV-2 pediátrico. (SLACIP): COVID-19 Pediátrico

Introduction The COVID-19 pandemic generated many controversies in the management of critically ill pediatric patients. The main ones were about ventilatory support, phenotypic differences between adults and children, and acute and subacute clinical forms. For this reason, the Respiratory Committee (RC) of the Latin American Society of Pediatric Intensive Care (SLACIP) generated a document to summarize the recommendations with the best evidence. The objective of these recommendations is to provide an update on issues related to pediatric COVID-19. Methods and Materials The Respiratory Committee created a group composed of 19 pediatric kinesiologists/physiotherapists and intensivists from 8 Latin American countries and defined on 3/27/20 the 15 most relevant topics, assigning 3 referents and 2 reviewers for each. The manuscripts went through 4 stages until their final version. The complete document was freely distributed on 22/05/20 and updated twice (07/08/20 and 02/09/21). For the current version there were 3 special collaborators. Result The material consists of a complete 94-page document and an executive summary. The topics included are case definition, epidemiology, clinical classification, subacute inflammatory syndrome, personal protective equipment, aerosolization situations (intubation, extubation, suctioning, sampling, filter replacement, cardiopulmonary resuscitation, early mobilization), high flow cannula support, invasive, non-invasive and high frequency mechanical ventilation, pharmacological treatment, laboratory and imaging. Conclusion The purpose of this document is to serve as a guide for nurses, kinesiologists/physiotherapists and physicians in the management of critically ill pediatric patients with COVID-19.

Introducción La pandemia por COVID-19 generó muchas controversias en el manejo de los pacientes pediátricos críticos. Las principales fueron sobre el soporte ventilatorio, las diferencias fenotípicas entre adultos y niños y las formas clínicas aguda y subaguda.Por esa razón el Comité Respiratorio (CR) de la Sociedad Latinoamericana de Cuidados Intensivos Pediátricos (SLACIP) generó un documento para resumir las recomendaciones con mayor evidencia. El objetivo de estas recomendaciones es brindar una actualización de temas relacionados a COVID-19 pediátrico.Métodos y Materiales El Comité Respiratorio creó un grupo compuesto por 19 kinesiólogos/fisioterapeutas y médicos intensivistas pediátricos de 8 países de Latinoamérica y definió el 27/03/20 los 15 temas más relevantes, asignando 3 referentes y 2 revisores por cada uno. Los manuscritos pasaron por 4 etapas hasta su versión final. El documento completo se distribuyó libremente el 22/05/20, actualizándose en dos oportunidades (07/08/20 y el 02/09/21). Para la versión actual se contó con 3 colaboradores especiales.Resultado El material se compone de un documento completo de 94 páginas y un resumen ejecutivo. Los temas incluidos son definición de caso, epidemiología, clasificación clínica, síndrome inflamatorio subagudo, equipos de protección personal, situaciones de aerosolización (intubación, extubación, aspiración, toma de muestras, recambio de filtros, reanimación cardiopulmonar, movilización temprana), soporte con cánula de alto flujo, ventilación mecánica invasiva, no invasiva y de alta frecuencia, tratamiento farmacológico, laboratorio e imágenes.Conclusión La elaboración de este documento ha tenido como fin servir de guía para enfermeros, kinesiólogos/fisioterapeutas y médicos en el manejo de pacientes pediátricos en estado crítico por COVID-19.

Modelo socio-pedagógico de formación del Técnico Superior en Enfermería para labor de prevención / Socio-pedagogical model in Higher Technician´s Nursing Training for prevention work

Introducción: En el perfil del Técnico Superior en Enfermería se establece la formación de un técnico consciente de su práctica social y comunitaria que contribuya a aportar a la sociedad una atención con calidad y calidez. Objetivo: Proponer un modelo socio-pedagógico de formación del Técnico Superior en Enfermería para la labor de prevención. Material y métodos: A partir de la consulta a artículos publicados en base de datos y documentos normativos del contexto ecuatoriano, se elaboró la propuesta del modelo. Se emplearon métodos del nivel teórico en la comprensión y explicación del proceso de formación del Técnico Superior en Enfermería. Desarrollo: Se propone un modelo cuya intencionalidad socio-pedagógica esté planteada desde la perspectiva de la comunidad a partir de una dirección pedagógica, una orientación epistemológica y criterios lógicos de sistematización de los contenidos y la práctica, y considerar las características inherentes a la lógica de formación profesional del TSE en el Instituto Superior Tecnológico Bolivariano de Tecnología (ITB). Conclusiones: Se reconocen como subsistemas de la modelación: el contexto escolar comunitario y el contexto preventivo comunitario, construido a partir del método sistémico estructural funcional desde un enfoque cualitativo. El modelo es resultado teórico de un proyecto de formación doctoral en Ciencias Pedagógicas a partir del convenio Cuba-Ecuador(AU)

Introduction: The technician´s awareness of its social and community practice that contributes to a higher quality and affectionate attention to society is established in the profile of the Higher Technician´s Nursing Training. Objective: To propose a socio-pedagogical model in the Higher Technician´s Nursing Training for prevention work. Material and methods: A model proposal was made after a review of articles published in the database, and normative documents in the Ecuadorian context. Theoretical methods were applied for the comprehension, and explanation in the training of the Higher Technician in Nursing. Development: A model is proposed, which socio-pedagogical intent is posed from the community perspective starting from a pedagogical direction, an epistemological approach, and logical systematization criteria of theory and practice, also considering the characteristics inherent to the sense of professional formation of the higher technician in nursing in the Bolivarian Technological Institute of Technology. Conclusions: Community and school context, and community preventive service, built from a functional-structural systemic method with a qualitative approach were recognized as modeling subsystems. The model is a theoretical result of a project on doctoral programs in Pedagogical Sciences from the Cuba-Equator Agreement(AU)

Factores pronósticos de mortalidad en la neumonía adquirida de la comunidad en niños que requieren hospitalización

Objetivo: Identificar los factores pronósticos de mortalidad en NAC en niños que requieren hospitalización. Método: Estudio observacional, que incluyó a pacientes (pts) <16 años que se hospitalizaron entre 2004-2008 por NAC, distribuyéndose en dos grupos según que hayan fallecido o sobrevivido durante la hospitalización. Se compararon variables demográficas, clínicas, laboratoriales, y evolutivas. La comorbilidad se definió en 3 categorías: I (sobrepeso, DCP I), II (cardiopatía congénita, Sindrome de Down) y III (VIH, cáncer hematológico, desnutrición grave). Se realizó análisis univariado y multivariado. Resultados: Se hospitalizaron 341 pts con NAC, (edad media 33,6+34,8 meses), de los cuales 37 (11%) fallecieron. La edad <6 meses (RR 0.12, IC 0.03-0.47, p=0.006), la presencia de comorbilidad II y III (RR 0.25, IC 0,14-0,45, p=0.00003), hipotensión (RR 0.05, IC 0.03-0.11, p=0.00001), convulsiones (RR 0.20, IC 0.10-0.39, p<0.05) o Glasgow<12 (RR 0.02, IC 0.01-0.05, p=0.00001) al ingreso se correlacionaron con mayor mortalidad. Laboratorialmente, la presencia de GB <4000 (RR 0.21, IC 0.07-0.07, p=0.02), pH<7.2, HCO3 <15 (RR 0.02, IC 0.01-0.06, p=0.00001), saturación de O2 <90% (RR 0.2, IC 0.11-0.36, p=0.0007), hiponatremia (RR 0.1, IC 0.04-0.23, p<0.05), y compromiso multilobar fueron significativamente más frecuentes en los que fallecieron (RR 0.06, IC 0.02-0.17, p<0.005). Durante la evolución clínica, el riesgo de morir se correlacionó con la necesidad de ARM y presencia de insuficiencia renal. (RR 0.04, IC 0.02-0.07, p=0.0001) Conclusiones. La mortalidad en NAC que se hospitaliza es significativa. Se han identificado condiciones predisponentes, variables demográficas, clínicas, de gabinete y evolutivas que son altamente predictivas de mortalidad.

Abstract Aim: To identify the prognostic factors of mortality in CAP in children requiring hospitalization. Method: An observational study, which included patients (pts) <16 years who were hospitalized between 2004-2008 for CAP, and distributed in two groups according to whether they died or survived during hospitalization. Demographic, clinical, laboratorial, and evolutionary variables were compared. Comorbidity was defined in 3 categories: I (overweight, DCP I), II (congenital heart disease, Down Sx) and III (HIV, hematologic cancer, severe malnutrition). Univariate and multivariate analyzes were performed. Results: 341 pts were hospitalized with CAP, (mean age 33.6 ± 34.8 months), of which 37 (11%) died. The presence of comorbidity II and III (RR 0.25, CI 0.14-0.45, p = 0.00003), hypotension (RR 0.05, CI 0.03-0.11, p = 0.00001), seizures (RR 0.20, IC 0.10-0.39, p <0.05) or Glasgow <12 (RR 0.02, IC 0.01-0.05, p = 0.00001) at admission were correlated with higher mortality. The presence of GB <4000 (RR 0.21, IC 0.07-0.07, p = 0.02), pH <7.2, HCO3 <15 (RR 0.02, IC 0.01-0.06, p = 0.00001), O2 saturation <90% (RR 0.16, p <0.05), and multilobar involvement were significantly more frequent in those who died (RR 0.06, CI 0.02-0.17, p <0.05) 0.005). During the clinical course, the risk of dying was correlated with the need for MRA and presence of renal failure. (RR 0.04, IC 0.02-0.07, p = 0.0001) Conclusions: Mortality in hospitalized CAP is significant. Predisposing conditions, demographic, clinical, cabinet and evolutionary variables that are highly predictive of mortality have been identified

Clinical Characteristics and Risk Factors of Dengue Shock Syndrome in Children.

BACKGROUND: Dengue shock syndrome (DSS) represents one of the most severe manifestations of dengue virus infection. The objective of the present study was to analyze the clinical and laboratory characteristics, risk factors and outcome of DSS in children. METHODS: Patients <15 years old admitted with DSS during the 2012 and 2013 outbreak of serotype 2 of dengue virus in Paraguay were included. Demographic, clinical and laboratory data of patients with/without DSS were analyzed. RESULTS: Of 471 children hospitalized with dengue, 354 patients (75%) presented with shock at admission or developed later. The mean age of patients with DSS was 10.2 ± 4 years (no difference with patients without shock), without gender preference. Rash (50% vs. 56%), myalgias (45% vs. 40%), vomiting (66% vs. 68%) and bleeding manifestations (24% vs. 21.2%) were similar for 2 groups. Similarly, there was no difference in the frequency of DSS between primary versus secondary infection cases (76.2% vs. 71.6%, P = 0.3). Age group >5 years [odds ratio (OR) 1.6, 95% confidence interval (CI): 1-2.8, P < 0.05), presence of abdominal pain (OR 2.5, 95% CI: 1.3-4.9, P = 0.006), an activated partial thromboplastin time prolonged (OR 4; 95% CI: 1.6-10, P < 0.001) and low fibrinogen level (OR 2.5; 95% CI: 1-5.9, P = 0.02) were found significantly associated with DSS. About 12% of patients required intensive care unit admission, and 2 patients died (lethality 0.35%). CONCLUSIONS: This study validated most of the clinical variables present in the current WHO guidelines as markers of severe disease and add additional variables that can help to predict the risk of progression to shock.

Formación de la competencia ética en técnicos de la salud / Training of the ethical competence in health technicians

La propuesta consiste en la elaboración de una estratégica pedagógica para la formación de la competencia ética en el Técnico Superior en Enfermería, estructurada desde el punto de vista formativo como eje central integrador que permite, de forma coordinada y planificada, llevar el encargo social mediante el establecimiento de pasos y vías, a fin de alcanzar el crecimiento de las partes involucradas para que respondan a las necesidades individuales y exigencias sociales. Se tiene en cuenta además, la relación dialéctica entre bioética global o profunda, filosofía del buen vivir y bioética médica, que supera las concepciones eminentemente médicas de la ética y permite la articulación del pensamiento ético contemporáneo con las ideas que sirven de marco conceptual a la estrategia propuesta(AU)

The proposal consists on the elaboration of a pedagogic strategic for the training of an ethical competence in the Nursing Higher Technician, structured from the training point of view as integrative central axis that allows, in a coordinated and planned way, to carry out the social responsibility by means of the establishment of steps and means, in order to reach the growth of the involved participants so that they respond to the individual necessities and social demands. It is also taken into account, the dialectical relationship between global or deep bioethics, good living philosophy and medical bioethics that overcomes the eminently medical conceptions of the ethics and allows the articulation of the contemporary ethical thought with the ideas that serve as conceptual mark to the proposed strategy(AU)

Estrategia sociopedagógica para la formación del técnico superior en Enfermería en Ecuador / Sociopedagogical strategy for the higher technician's nursing training in Ecuador

Las estrategias, como resultado científico de su función investigativa, suelen asociarse al proceso de planeación al igual que los proyectos, fundamentalmente a la aspiración administrativa o a una fundamentación axiológica en relación con los intereses institucionales; sin embargo, estas coinciden al instituirse como un proceso que describe una acción organizada para lograr fines u objetivos, y que opera en el contexto en que surge y se desarrolla. En este trabajo se presenta una estrategia sociopedagógica para la formación del técnico superior en Enfermería en cuanto a la prevención de enfermedades, a partir de su vínculo con la comunidad(AU)

The strategies, as a scientific result of their investigative function are usually associated to the planning process as well as the projects, fundamentally to the administrative ambition or an axiologic basis related to the institutional interests; however, these coincide when being instituted as a process that describes an organized action to achieve aims or objectives, and which operate in the context where it arises and develops. In this work a sociopedagogical strategy for the higher technician's nursing training in the prevention of diseases is presented, starting from its link with the community(AU)

[Clinical skills of Chilean general practitioners for the management of depressive disorders]. / Habilidades clínicas para el manejo de trastornos depresivos en médicos generales en Santiago de Chile.

BACKGROUND: Diverse and sustained efforts have been developed to improve the management of depression by general practitioners (GPs), but they have not improved treatment coverage and quality of services. AIM: To explore the level of knowledge and clinical skills to diagnose and treat depression by GPs in Primary Health Care (PHC) in the Metropolitan Area of Santiago de Chile (RM). MATERIAL AND METHODS: Theoretical knowledge (TK), diagnostic skills (DS) and treatment skills (TS) were evaluated in 56 GPs of the RM with a battery of specially designed instruments. RESULTS: In TK there were significant differences between GPs aged 31 years or less and their older counterparts and between Chilean and foreign doctors. Five percent of observed differences in TK were explained by age and nationality, respectively. Chilean GPs achieved higher scores in recognition of symptoms (RS), one of the dimensions of DS. No significant differences by age or nationality were observed for DS and TS. CONCLUSIONS: Achievement of GPs on tests measuring TK, DS, and TS was generally below 50%. This deficiency should be improved.

Habilidades clínicas para el manejo de trastornos depresivos en médicos generales en Santiago de Chile / Clinical skills of Chilean general practitioners for the management of depressive disorders

Background: Diverse and sustained efforts have been developed to improve the management of depression by general practitioners (GPs), but they have not improved treatment coverage and quality of services. Aim: To explore the level of knowledge and clinical skills to diagnose and treat depression by GPs in Primary Health Care (PHC) in the Metropolitan Area of Santiago de Chile (RM). Material and Methods: Theoretical knowledge (TK), diagnostic skills (DS) and treatment skills (TS) were evaluated in 56 GPs of the RM with a battery of specially designed instruments. Results: In TK there were significant differences between GPs aged 31 years or less and their older counterparts and between Chilean and foreign doctors. Five percent of observed differences in TK were explained by age and nationality, respectively. Chilean GPs achieved higher scores in recognition of symptoms (RS), one of the dimensions of DS. No significant differences by age or nationality were observed for DS and TS. Conclusions: Achievement of GPs on tests measuring TK, DS, and TS was generally below 50%. This deficiency should be improved.

Application of a Prognostic Scale to Estimate the Mortality of Children Hospitalized with Community-acquired Pneumonia.

BACKGROUND: Pneumonia is a major cause of mortality in children. The objective of this study was to construct a prognostic scale for estimation of mortality applicable to children with community-acquired pneumonia (CAP). METHODS: This observational study included patients younger than 15 years with a diagnosis of CAP who were hospitalized between 2004 and 2013. A point-based scoring system based on the modification of the PIRO scale used in adults with pneumonia was applied to each child hospitalized with CAP. It included the following variables: predisposition (age <6 months, comorbidity), insult [hypoxia (O2 saturation < 90), hypotension (according to age) and bacteremia], response (multilobar or complicated pneumonia) and organ dysfunction (kidney failure, liver failure and acute respiratory distress syndrome). One point was given for each feature that was present (range, 0-10 points). The association between the modified PIRO score and mortality was assessed by stratifying patients into 4 levels of risk: low (0-2 points), moderate (3-4 points), high (5-6 points) and very high risk (7-10 points). RESULTS: Eight hundred sixty children hospitalized with CAP were eligible for study. The mean age was 2.8 ± 3.2 years. The observed mortality was 6.5% (56/860). Mortality ranged from 0% for a low PIRO score (0/708 pts), 18% (20/112 pts) for a moderate score, 83% (25/30 pts) for a high score and 100% (10/10 pts) for a very high modified PIRO score (P < 0.001). CONCLUSION: The present score accurately discriminated the probability of death in children hospitalized with CAP, and it could be a useful tool to select candidates for admission to intensive care unit and for adjunctive therapy in clinical trials.

[Qualitative impact of a training program on depressive disorders for primary care physicians]. / Impacto de una capacitación en trastornos depresivos para médicos generales de atención primaria en salud: resultados cualitativos.

BACKGROUND: There are suggestions that, despite training efforts for Primary Health Care physicians, difficulties in making accurate diagnoses and timely treatments persist. AIM: To evaluate the impact of a new training model in Depressive disorders integrated with Mindful Practice, on the diagnostic and therapeutic skills of primary care general physicians. MATERIAL AND METHODS: A voluntary sample of 56 general physicians was studied. The design of this study was experimental and randomized, with two groups attending theoretical sessions followed by differing workshops that were carried out in a parallel fashion. The Quantitative phase of this study considered measuring the impact of training in physician's skills. The Qualitative phase included nine semi-structured interviews and Qualitative Content Analysis. This paper reports the results of the interviews. RESULTS: As a consequence of training sessions, physicians learned that above the mental health problems, other issues such as self-efficacy and self-confidence are important for the management of depressive patients. CONCLUSIONS: This qualitative study shows that physicians are obtaining significant benefits from their training sessions.

La medicina preventiva comunitaria incorporada al plan de estudios del técnico superior en enfermería ecuatoriano / Preventive community medicine included to the curriculum of the higher technician's studies in Ecuadorian nursing

Actualmente, el plan de estudios del técnico superior en enfermería ecuatoriano, incluye diversas estrategias curriculares de coordinación interdisciplinaria que antes no existían, y cuya aplicación requiere del funcionamiento de estructuras que se encarguen de su planificación, en correspondencia con la organización piramidal tradicional de dirección académica. La intencionalidad es educar a los enfermeros para que incorporen, en su práctica profesional, la labor de prevención como parte del contenido curricular; sin embargo, se evidencian carencias en el proceso de formación, el cual, en ocasiones, se caracteriza por formalismo y esquematismo, sin abrir el espacio necesario e imprescindible para realizar el trabajo preventivo. El uso de los métodos de análisis-síntesis y lógico-histórico permitió sistematizar presupuestos en torno al desarrollo de la medicina preventiva y el vínculo con la comunidad(AU)

The curriculum of the higher technician's studies in Ecuadorian nursing, includes at present diverse curricular strategies of interdisciplinary coordination which didn't exist before and which inclusion requires of the functioning of structures dealing with its planning, in correspondence to the traditional pyramidal organization of academic management. The objective is to educate the male nurses, so that they incorporate, in their professional practice, the work of prevention as part of the curricular content; however, lacks are evidenced in the training process, which occasionally, is characterized by formal and schematic methods, without opening the necessary and indispensable space to carry out the preventive work. The use of the analysis-synthesis and logical-historical methods allowed to systematize budgets around the development of the preventive medicine and the link with community(AU)

Factores pronósticos de mortalidad en la neumonía adquirida de la comunidad en niños que requieren hospitalización

Objective: To identify predictors of mortality in CAP in children requiring hospitalization. Method: observational study, which included patients (pacientes) <16 years who were hospitalized between 2004-2008 by the NAC, distributed into two groups depending on whether they died or survived hospitalization. Demographic, clinical, laboratory, and outcome variables were compared. Comorbidity was defined in 3 categories: I (overweight, DCP I), II (congenital heart disease, Down Sx) and III (HIV, blood cancer, severe malnutrition). Univariate and multivariate analysis. Results: 341 pts were hospitalized with CAP (mean age 33.6 + 34.8 months), of which 37 (11%) died. The age <6 months (RR 0.12, CI 0.03 to 0.47, p = 0.006), presence of comorbidity II and III (RR 0.25, CI 0.14 to 0.45, p = 0.00003), hypotension (RR 0.05, CI 0.03 to 0.11, p = 0.00001), seizures (RR 0.20, CI 0.10 to 0.39, p <0.05) or Glasgow <12 (RR 0.02, CI 0.01-0.05, p = 0.00001) on admission were correlated with higher mortality. Laboratorial, the presence of GB <4000 (RR 0.21, CI 0.07 to 0.07, p = 0.02), pH <7.2, HCO3 <15 (RR 0.02, CI 0.01-0.06, p = 0.00001), O2 saturation <90% (RR 0.2, CI from 0.11 to 0.36, p = 0.0007), hyponatremia (RR 0.1, CI 0.04 to 0.23, p <0.05), and multilobar involvement were significantly more frequent in patients who died (RR 0.06, CI .02-.17, p <0005). During the clinical course, the risk of dying was correlated with the need for ARM and presence of renal insufficiency. (RR 0.04, CI 0.02-0.07, p = 0.0001) Conclusions. The mortality in CAP who are hospitalized is significant. Have been identified predisposing conditions, demographic, clinical, and developmental cabinet that are highly predictive of mortality

Objetivo: Identificar los factores pronósticos de mortalidad en NAC en niños que requieren hospitalización. Material y métodos. Estudio observacional, que incluyó a pacientes (pts) <16 años que se hospitalizaron entre 2004-2008 por NAC, distribuyéndose en dos grupos según que hayan fallecido o sobrevivido durante la hospitalización. Se compararon variables demográficas, clínicas, laboratoriales, y evolutivas. La comorbilidad se definió en 3 categorías: I (sobrepeso, DCP I), II (cardiopatía congénita, Sx de Down) y III (VIH, cáncer hematológico, desnutrición grave). Se realizó análisis univariado y multivariado Resultados. Se hospitalizaron 341 pacientes con NAC, (edad media 33,6+/-34,8 meses), de los cuales 37 (11%) fallecieron. La edad <6 meses (RR 0.12, IC 0.03-0.47, p=0.006), la presencia de comorbilidad II y III (RR 0.25, IC 0,14-0,45, p=0.00003), hipotensión (RR 0.05, IC 0.03-0.11, p=0.00001), convulsiones (RR 0.20, IC 0.10-0.39, p<0.05) o Glasgow<12 (RR 0.02, IC 0.01-0.05, p=0.00001) al ingreso se correlacionaron con mayor mortalidad. Laboratorialmente, la presencia de GB <4000 (RR 0.21, IC 0.07-0.07, p=0.02), pH<7.2, HCO3 <15 (RR 0.02, IC 0.01-0.06, p=0.00001), saturación de O2 <90% (RR 0.2, IC 0.11-0.36, p=0.0007), hiponatremia (RR 0.1, IC 0.04-0.23, p<0.05), y compromiso multilobar fueron significativamente más frecuentes en los que fallecieron (RR 0.06, IC 0.02-0.17, p<0.005). Durante la evolución clínica, el riesgo de morir se correlacionó con la necesidad de ARM y presencia de insuficiencia renal. (RR 0.04, IC 0.02-0.07, p=0.0001) Conclusión. La mortalidad en NAC que se hospitaliza es significante. Se han identificado condiciones predispo-nentes, variables demográficas, clínicas, de gabinete y evolutivas que son altamente predictoras de mortalidad.

La depresión como un diagnóstico complejo: Implicancias para el desarrollo de recomendaciones clínicas / A new proposal for the diagnosis of depression

Depression has a high impact on mental health. However its diagnosis is a challenge even for specialists. This problem derives from a failure in an adequate description and differentiation of the disease. This inadequate conceptualization generates these difficulties. Our thesis is that depression should be understood as a complex phenomenon that can be analyzed from multiple perspectives, from genes to behavior, including personality and interaction with the sociocultural environment. The aim of this paper is to review the psychopathological construct of depression from a multidimensional point of view, considering clinical, sociocultural, characterological and pathogenic variables. Finally we provide a proposal for an adequate diagnostic approach.

[A new proposal for the diagnosis of depression]. / La depresión como un diagnóstico complejo: Implicancias para el desarrollo de recomendaciones clínicas.

Depression has a high impact on mental health. However its diagnosis is a challenge even for specialists. This problem derives from a failure in an adequate description and differentiation of the disease. This inadequate conceptualization generates these difficulties. Our thesis is that depression should be understood as a complex phenomenon that can be analyzed from multiple perspectives, from genes to behavior, including personality and interaction with the sociocultural environment. The aim of this paper is to review the psychopathological construct of depression from a multidimensional point of view, considering clinical, sociocultural, characterological and pathogenic variables. Finally we provide a proposal for an adequate diagnostic approach.

[Characteristics of employment and wellbeing among physicians working in Santiago, Chile]. / Características del empleo y bienestar subjetivo en médicos de la Región Metropolitana.

BACKGROUND: Profound changes have been observed in medical practice during the last thirty years. This may be understood as a result of the influence of economic variables in health services management, among other probable causes. At the same time, doctors' work has been diversified, and a tendency to work in several paid jobs simultaneously has been observed. AIM: To describe the characteristics of employment in a representative sample of Chilean physicians. MATERIAL AND METHODS: A probabilistic sample of 414 physicians residing in Metropolitan Santiago answered a survey about their number and type of jobs and completed the BIS UMED questionnaire that measures the subjective wellbeing of physicians. RESULTS: Forty percent of surveyed physicians had three or more jobs (36.3% of men and 47.5% of women). There was a significant inverse association between the number of jobs, general wellbeing and facing medicine from a new perspective. CONCLUSIONS: The number of jobs is inversely related to the general wellbeing of physicians.

Características del empleo y bienestar subjetivo en médicos de la Región Metropolitana / Characteristics of employment and wellbeing among physicians working in Santiago, Chile

Background: Profound changes have been observed in medical practice during the last thirty years. This may be understood as a result of the influence of economic variables in health services management, among other probable causes. At the same time, doctors' work has been diversified, and a tendency to work in several paid jobs simultaneously has been observed. Aim: To describe the characteristics of employment in a representative sample of Chilean physicians. Material and Methods: A probabilistic sample of 414 physicians residing in Metropolitan Santiago answered a survey about their number and type of jobs and completed the BIS UMED questionnaire that measures the subjective wellbeing of physicians. Results: Forty percent of surveyed physicians had three or more jobs (36.3% of men and 47.5% of women). There was a significant inverse association between the number of jobs, general wellbeing and facing medicine from a new perspective. Conclusions: The number of jobs is inversely related to the general wellbeing of physicians.

Percepción de cambios en la práctica médica y estrategias de afrontamiento / A survey about physicians’ professional satisfaction

Background: A change in the social structure of medicine and its impact on clients has occurred in the last decades. Aim: To perform a survey about subjective wellbeing among physicians. Material and Methods: A physician’ professional satisfaction survey consisting in 90 questions, was applied to 580 physicians (70 percent males), working in Metropolitan Santiago. Results: Physicians perceive changes in all the examined professional domains and approximately 50 percent of the changes are evaluated as negative. Change perception is a general phenomena among physicians, since there were no differences in relation to gender and only in few aspects with respect to age and medical specialty. There was a predominant positive attitude, based on the profession, to face changes. Conclusions: The positive evaluation of changes and the frequent use of managing strategies are associated with a higher satisfaction among physicians.

Predicción de la mortalidad de la meningitis neumocóccica en niños / Predicting mortality from pneumococcal meningitis in children

Objetivo: Elaborar una escala pronóstica de mortalidad aplicable al ingreso en niños con meningitis neumocóccica (MN). Métodos: Estudio observacional, retrospectivo, realizado en el Servicio de Pediatría del Instituto de Medicina Tropical, en el que se incluyeron todos los pacientes (pts) <16 años internados entre los años 2000 y 2010 con diagnóstico confirmado por laboratorio de meningitis a Spn. La confirmación se basó en el aislamiento del microorganismo en LCR y/o hemocultivo. Se identificaron aquellos factores de riesgo significantes de mortalidad. Luego de identificados los factores asociados con mortalidad, se construyó una escala de puntuación en la que se asignó un puntaje de 0 a 3 a cada variable según el peso de significancia de las mismas. Resultados: 49 pts con MN se hospitalizaron en el periodo de estudio, siendo evaluables por expedientes completos 46 pts, de los cuales 19/46 (38 ) fallecieron y 27/46 (58) sobrevivieron. 8/19 de los pts fallecidos presentaron síntomas <48 hs vs 17/26 de los no fallecidos (p=0.1), constándose una tendencia a mayor frecuencia de convulsiones al ingreso o dentro de las 48 hs en los fallecidos [15/18 (83) vs 17/26 (65)]. 6/18 pts (33) de los óbitos vs 2/26 pts (7) de los no fallecidos ingresaron con un Glasgow ≤ 10 puntos (p=0.03), observándose valor de Hb ≤7mg/dl en 5/18 pts (28) fallecidos vs 0/26 pts sobrevivientes (p=0.04). Fueron igualmente factores de riesgo de mortalidad la presencia de hipoglucorraquia<20 mg/dl (94 vs 46, p<0.005), hiperalbuminorraquia ≥250 mg/dl (61 vs 30, p=0.04) y pleocitosis ≤ 200/mm3 (50 vs 23, p=0.06). La edad ≤6 meses, la condición de desnutrición o la presencia de bacteremia no fueron variables diferentes en ambos grupos. La escala de riesgo de mortalidad construída con hipoglucorraquia<20 mg/dl, Hb ≤7 gr/dl, Glasgow <10, albuminorraquia ≥250 mg/dl y pleocitosis ≤ 200/mm3 se correlacionó significantemente con mortalidad (p<0.001).

Estudio caso-control de infecciones que requieren Hospitalización en niños con Síndrome de Down

Objective. Identify the leading infectious causes of hospitalization of children with Down syndrome who are hospitalized in a referral hospital and assess whether conditions Down syndrome to a worse outcome for patients. Materials and Methods: A retrospective, case-control, of patients <15 years with Down syndrome hospitalized in the Institute of Tropical Medicine between 2000-2008 by infectious disease. The control group was formed by patients of the same sex, age and diagnosis without Down syndrome (ratio 1:3) in hospital, comparing the clinical, laboratory and evolution. Results were hospitalized in the study period 32 patients with Down syndrome control group, n = 96), with an average age of 39 + Male 48 months and relationship / Fem 1.7:1. Thirteen patients (41%) with Down syndrome had associated congenital heart disease. Pneumonia (n = 24, 75%) and infections of skin and soft tissue (n = 5, 15%) were the main causes of hospitalization. More Down syndrome patients admitted afebrile (28% vs. 2%, p <0.01), with normal blood leukocyte count or leukopenia (63% vs. 26%) (p = 0.0001) and bacteremic (16% vs. 4%, p <0.05). Patients with Down syndrome and pneumonia more often required admission to mechanical ventilation [8 / 21 (38%) vs. 8 / 63 (12%), p = 0.015)], more days of supplemental O2 (6.4 + 3 vs. 3 + 2, p <0.05) and longer hospital stay (10 + 6.5 vs. 6.4 + 3 days, p <0.05). The mortality rate observed in both groups was similar (3% in patients with Down syndrome vs. 1% in the control group). Conclusion: This study shows that Down syndrome patients who are hospitalized for infectious pictures most popular courses without fever, and less frequently reactive hematological changes, showing higher prevalence of bacteremia, and severity of respiratory infections

Objetivo.Determinar las principales causas infecciosas de hospitalización de niños con síndrome de Down que se hospitalizan en un hospital de referencia y evaluar si el síndrome de Down condiciona a una peor evolución de los pacientes. Materiales y Métodos Estudio retrospectivo, caso-testigo, de pacientes <15 años con síndrome de Down hospitalizados en el Instituto de Medicina Tropical entre 2000-2008 por patología infecciosa. El grupo testigo lo formaron pacientes del mismo sexo, edad y diagnóstico sin síndrome de Down (proporción 1:3) hospitalizados, comparándose las características clínicas, laboratoriales y evolución. Resultados: Se hospitalizaron en el periodo de estudio 32 pacientes con síndrome de Down (grupo testigo, n=96), con una edad media de 39 + 48 meses y relación Masc/Fem 1.7:1. Trece pacientes (41%) con síndrome de Down presentaban cardiopatía congénita asociada. Las neumonías (n=24, 75%) y las infecciones de piel y partes blandas (n=5, 15%) representaron las principales causas de hospitalización. Más pacientes con síndrome de Down ingresaron afebriles (28% vs 2%, p<0.01), con recuento leucocitario sanguíneo normales o leucopenia (63% vs 26%) (p=0.0001) y bacterémicos (16% vs 4%, p<0.05). Los pacientes con síndrome de Down y neumonía requirieron más frecuentemente ingreso a asistencia respiratoria mecánica [8/21 (38%) vs 8/63 (12%), p=0,015)], más días de suplemento de O2 (6.4 + 3 vs 3 + 2, p<0.05), y hospitalización más prolongada (10 + 6.5 vs 6.4 + 3 días, p<0.05). La tasa de mortalidad observada en ambos grupos fue similar (3% en pacientes con síndrome de Down vs 1% en el grupo control). Conclusión: El presente estudio demuestra que pacientes con síndrome de Down que se hospitalizan por cuadros infecciosos cursan más frecuentemente sin fiebre, y con menor frecuencia de cambios hematológicos reactivos, exhibiendo mayor prevalencia de bacteriemia, y severidad de las infecciones respiratorias.

[A survey about physicians’ professional satisfaction]. / Percepción de cambios en la práctica médica y estrategias de afrontamiento.

BACKGROUND: A change in the social structure of medicine and its impact on clients has occurred in the last decades. AIM: To perform a survey about subjective wellbeing among physicians. MATERIAL AND METHODS: A physician’ professional satisfaction survey consisting in 90 questions, was applied to 580 physicians (70% males), working in Metropolitan Santiago. RESULTS: Physicians perceive changes in all the examined professional domains and approximately 50% of the changes are evaluated as negative. Change perception is a general phenomena among physicians, since there were no differences in relation to gender and only in few aspects with respect to age and medical specialty. There was a predominant positive attitude, based on the profession, to face changes. CONCLUSIONS: The positive evaluation of changes and the frequent use of managing strategies are associated with a higher satisfaction among physicians.