Reliability and Validity of the Spanish Adaptation of the Stanford Proxy Test for Delirium in Two Clinical Spanish-Speaking Communities.

BACKGROUND: Delirium is the most prevalent neuropsychiatric syndrome experienced by patients admitted to inpatient clinical units, occurring in at least 20% of medically hospitalized patients and up to 85% of those admitted to critical care units. Although current guidelines recommend the implementation of universal prevention strategies, the use of management strategies largely depends on constant surveillance and screening. This allows for the timely diagnosis and correction of its underlying causes and implementation of management strategies. OBJECTIVE: It was to adapt and analyze the Spanish adaptation of the Stanford Proxy Test for Delirium (S-PTDsv) instrument for its use among Spanish-speaking populations. The S-PTD is an instrument consisting of 13 observational items to be completed by a clinician observer, usually the patient's nurse. The completion of the questionnaire takes about 1 minute and does not require the active participation of the person evaluated, which has important clinical advantages compared to other available instruments (e.g., the Confusion Assessment Method). METHODS: The psychometric properties of the S-PTDsv were evaluated in a population of 123 patients using a quantitative, cross-sectional design. All subjects were over 18 years of age and hospitalized in various inpatient medico-surgical and intensive care unit services, either at the Barcelona Clinical Hospital (Barcelona, Spain) or the UC-Christus Health Network Clinical Hospital (Santiago, Chile, S.A.). The ultimate diagnosis of delirium was made by a member of the Psychiatry Consult Service by means of an independent neuropsychiatric evaluation based on the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria, published in 2013, which is the latest version of the diagnostic manual. All study tests were performed by study personnel who were blinded to each other's test results within an hour of each other. RESULTS: In the receiver operator characteristic (ROC) curve analysis, the S-PTDsv demonstrated excellent classification qualities when compared with the DSM-5 as the classification reference standard. Using a cutoff point of ≥3, the S-PTDsv had a sensitivity of 94% and a specificity of 97%. The area under the curve indicator was equal to 0.95, suggesting the S-PTDsv has an excellent overall performance in accurately identifying cases of delirium. Accordingly, the S-PTDsv's positive predictive value = 0.93, and the negative predictive value = 0.97. The internal reliability measured with Cronbach's alpha was 0.96. Confirmatory factor analysis revealed a 1-dimensional structure with high loadings (>0.72), demonstrating that all items similarly contribute to the total diagnostic dimension, suggesting adequate construct validity. This provided evidence of convergent validity. CONCLUSIONS: The performance of the S-PTDsv, as compared to a blinded neuropsychiatric assessment based on DSM-5, indicates that it is an effective instrument for the detection of delirium, in the Spanish-speaking populations. These results are comparable and consistent with previously published studies in the English language version.

Vulnerabilidad y cuidado desde la perspectiva de enfermería: Una revisión integrada de la literatura

La vulnerabilidad es un concepto ampliamente utilizado en la literatura de las ciencias sociales, e incorporado al ámbito sanitario con el desarrollo de la bioética y el modelo de determinantes sociales de la salud. Ha sido descrito por expertos como un concepto complejo y de gran utilidad para abordar poblaciones susceptibles de enfermar. Esto obliga a enfermería a identificar estos grupos y responder a sus necesidades de cuidado. Objetivo. Revisar la literatura para analizar las intersecciones en la relación conceptual entre vulnerabilidad y cuidado, desde una perspectiva de enfermería. Metodología. Se realizó una revisión integradora de la literatura basada en la sistematización propuesta por Whittemore y Knafl. Se consideró la literatura de los últimos cinco años disponible en las bases de datos Wos®, Scopus® y PubMed®. En la estrategia de búsqueda se utilizaron las palabras claves "vulnerability" and "care". Resultados. Se seleccionaron 18 artículos, coincidente con países que han desarrollado modelos sanitarios con enfoque social, como Canadá y Brasil. En el análisis se identificaron y describieron cinco temas en que se interceptan vulnerabilidad y cuidado; paradigma ontológico, epidemiológico, social y bioético, y la asociación entre vulnerabilidad y necesidades de cuidado. Conclusiones. La literatura da cuenta de la estrecha relación entre vulnerabilidad y cuidado, dado que la naturaleza de los cuidados profesionales de enfermería es la respuesta organizada socialmente a la vulnerabilidad humana.

Vulnerability is a concept widely used in the social sciences literature, and incorporated into the health field with the development of bioethics, and the model of social determinants of health. It has been described by experts as a complex concept, and very useful for addressing populations susceptible to illness. This ethically obliges nursing to identify these groups and respond to their care needs. Goal. To review the literature to analyze the intersections in the conceptual relationship between vulnerability and care, from a nursing perspective. Methodology. An integrative review of the literature was carried out based on the systematization proposed by Whittemore and Knafl. Literature from the last five years available in the Wos®, Scopus® and PubMed® databases was considered. The keywords "vulnerability" and "care" were used in the search strategy. Results. 18 articles were selected, coinciding with countries with health models with a social focus, such as Canada and Brazil. In the analysis, five themes were identified and described in which vulnerability and care intersect; ontological, epidemiological, social and bioethical paradigm, and the association between vulnerability and care needs. conclusions. The literature reports the close relationship between vulnerability and care, given that the nature of professional nursing care is the socially organized response to human vulnerability.

A vulnerabilidade é um conceito amplamente utilizado na literatura das ciências sociais, incorporado ao âmbito sanitário com o desenvolvimento da bioética e o modelo de determinantes sociais da saúde. Foi descrito por especialistas como um conceito complexo e de grande utilidade para abordar populações suscetíveis a adoecer. Isto obriga eticamente a enfermagem a identificar estes grupos e responder a suas necessidades de cuidado. Objetivo. Revisar a literatura para analizar as intersecções na relação conceitual entre vulnerabilidade e cuidado, a partir de uma perspectiva da enfermagem. Metodologia. Realizou-se uma revisão integradora da literatura baseada na sistematização proposta por Whittemore e Knafl. Considerou-se a literatura dos últimos cinco anos disponíveis nas bases de dados Wos®, Scopus® e PubMed®. Na estratégia de busca utilizou-se as palavras chaves "vulnerability" and "care". Resultados. Foram selecionados 18 artigos, coincidentes com países que desenvolveram modelos sanitários com enfoque social, como o Canadá e o Brasil. Na análise identificaram-se e descreveram-se cinco temas em que se interceptam vulnerabilidade e cuidado: paradigma ontológico, epidemiológico, social e bioético, e a associação entre vulnerabilidade e necessidades de cuidado. Conclusões. A literatura dá conta da estreita relação entre vulnerabilidade e cuidado, dado que a natureza dos cuidados profissionais de enfermagem é a resposta organizada socialmente à vulnerabilidade humana.

Síndromes compresivos del nervio mediano. Revisión y actualización de la bibliografía / Median nerve compression syndromes. Literature review and update

El nervio mediano desciende por el brazo y, en el codo, comienza a atravesar estructuras que pueden generar compresión, como el ligamento de Struthers, el lacertus fibrosus, el pronador redondo, el flexor superficial de los dedos. Finalmente, en la muñeca, se encuentra otro sitio de compresión producido por el ligamento transverso del carpo. Todas estas estructuras pueden provocar signos y síntomas de atrapamiento nervioso y favorecer el deterioro funcional del nervio. Nuestro objetivo es dar a conocer una actualización sobre estos sitios de atrapamiento del nervio mediano, y cómo realizar un diagnóstico preciso e indicar un trata-miento adecuado. Nivel de Evidencia: IV

The median nerve is a nervous structure that begins to cross structures at the level of the elbow that might cause compression. The Struthers ligament, lacertus fibrosus, pronator teres, and flexor digitorum superficialis are among them. Finally, the transverse carpal ligament creates another compression site in the wrist. All these structures can develop pathological signs and symptoms of nerve entrapment, which favors nerve functional degradation. Our objective is to provide an update on these median nerve entrap-ment sites, as well as information on how to establish an accurate diagnosis and provide adequate treatment. Level of Evidence: IV

Seminarios autogestionados de psiquiatría como modelo de participación estudiantil activa en pregrado. Experiencia 2014-2021 en la Pontificia Universidad Católica de Chile / Self-managed psychiatry seminars as a model of active student participation in undergraduate education

In the last decade, medical students stood out as active agents in their training, which implies their involvement in the design, implementation, evaluation, and curricular co-governance. This article describes a model of active undergraduate student participation from 2014 to 2021 and compares the face-to-face and synchronous online modalities, later brought forward by the SARS-COV-2 pandemic. Annually, a call was made to UC School of Medicine undergraduate students to establish the topics and areas to be addressed during self-managed seminars. Then, medical students located in Chile were invited to attend the activity. Psychiatry was established as a priority topic in six out of eight years. Five seminars were conducted, the last two in synchronous online mode. The number of people enrolled in the online modality increased by 251% compared to the face-to-face modality (face-to-face mean = 133 ± 33 SD; online mean = 336 ± 24SD), with no significant differences in rates of attendance between modalities (Odds ratio (OR) = 1,12; 95% CI= 0,82 - 1,55; p = 0,45). The online modality was associated with a higher proportion of enrollees belonging to an institution outside the Metropolitan Region (OR 12,63; 95% CI = 8,64 - 18,46; p < 0,01). The self-managed psychiatry seminars correspond to a model of active undergraduate student participation, with the synchronous online modality representing an opportunity to massify it throughout the national territory.

Lithium in Drinking Water as a Public Policy for Suicide Prevention: Relevance and Considerations.

Although suicide is considered a major preventable cause of mortality worldwide, we do not have effective strategies to prevent it. Lithium has been consistently associated with lowering risk of suicide. This effect could occur at very low concentrations, such as trace doses of lithium in tap water. Several ecological studies and recent meta-analysis have suggested an inverse association between lithium in water and suicide in the general population, with a lack of knowledge of clinically significant side effects. This paper is aimed as a proposal to discuss the addition of lithium to drinking water to decrease the suicide rate. For this, we review the evidence available, use previous experiences, such as water fluoridation to prevent dental caries, and discuss the complexity involved in such a public policy. Considering the limited data available and the controversies contained in this proposal, we suggest that a consensus on lithium concentration in water is needed, where the suicide rates start to reduce, as happened with water fluoridation. This measure will require to develop community-controlled trials with strict monitoring of any side effects, where democratic procedures would constitute one of the most appropriate ways to validate its implementation according to the reality of each community.

[Self-managed psychiatry seminars as a model of active student participation in undergraduate education]. / Seminarios autogestionados de psiquiatría como modelo de participación estudiantil activa en pregrado. Experiencia 2014-2021 en la Pontificia Universidad Católica de Chile.

In the last decade, medical students stood out as active agents in their training, which implies their involvement in the design, implementation, evaluation, and curricular co-governance. This article describes a model of active undergraduate student participation from 2014 to 2021 and compares the face-to-face and synchronous online modalities, later brought forward by the SARS-COV-2 pandemic. Annually, a call was made to UC School of Medicine undergraduate students to establish the topics and areas to be addressed during self-managed seminars. Then, medical students located in Chile were invited to attend the activity. Psychiatry was established as a priority topic in six out of eight years. Five seminars were conducted, the last two in synchronous online mode. The number of people enrolled in the online modality increased by 251% compared to the face-to-face modality (face-to-face mean = 133 ± 33 SD; online mean = 336 ± 24SD), with no significant differences in rates of attendance between modalities (Odds ratio (OR) = 1,12; 95% CI= 0,82 - 1,55; p = 0,45). The online modality was associated with a higher proportion of enrollees belonging to an institution outside the Metropolitan Region (OR 12,63; 95% CI = 8,64 - 18,46; p < 0,01). The self-managed psychiatry seminars correspond to a model of active undergraduate student participation, with the synchronous online modality representing an opportunity to massify it throughout the national territory.

Investigación en pregrado de las escuelas de Medicina de Chile: percepción sobre facilitadores y limitantes entre los asistentes al III Congreso Chileno de Estudiantes de Medicina (CoCEM) / Involvement of medical students in research. Facilitators and constraints

BACKGROUND: Scientific research is fundamental to the education of medical students. However, their involvement in research is limited. AIM: To describe the perceptions of medical students about facilitators and constraints to perform undergraduate research. MATERIAL AND METOHDS: Medical students attending the Chilean Congress of Medical Students in the Metropolitan Region in 2018, were surveyed. The responses obtained were subjected to a qualitative content analysis and were grouped according to perceptions of facilitators and constraints. RESULTS: The main facilitators reported were linkage with research teachers, personal motivation towards research, and research-oriented curriculum. The main constraints were lack of time for research, lack of access to formal information channels to engage in research, and sub-optimal conditions for research. CONCLUSIONS: The main factor promoting research at the undergraduate level was the link with the teacher, mainly through informal channels. The lack of official information provided through formal instances and lack of time hampers the access to research.

Combining Materials Obtained by 3D-Printing and Electrospinning from Commercial Polylactide Filament to Produce Biocompatible Composites.

The design of scaffolds to reach similar three-dimensional structures mimicking the natural and fibrous environment of some cells is a challenge for tissue engineering, and 3D-printing and electrospinning highlights from other techniques in the production of scaffolds. The former is a well-known additive manufacturing technique devoted to the production of custom-made structures with mechanical properties similar to tissues and bones found in the human body, but lacks the resolution to produce small and interconnected structures. The latter is a well-studied technique to produce materials possessing a fibrillar structure, having the advantage of producing materials with tuned composition compared with a 3D-print. Taking the advantage that commercial 3D-printers work with polylactide (PLA) based filaments, a biocompatible and biodegradable polymer, in this work we produce PLA-based composites by blending materials obtained by 3D-printing and electrospinning. Porous PLA fibers have been obtained by the electrospinning of recovered PLA from 3D-printer filaments, tuning the mechanical properties by blending PLA with small amounts of polyethylene glycol and hydroxyapatite. A composite has been obtained by blending two layers of 3D-printed pieces with a central mat of PLA fibers. The composite presented a reduced storage modulus as compared with a single 3D-print piece and possessing similar mechanical properties to bone tissues. Furthermore, the biocompatibility of the composites is assessed by a simulated body fluid assay and by culturing composites with 3T3 fibroblasts. We observed that all these composites induce the growing and attaching of fibroblast over the surface of a 3D-printed layer and in the fibrous layer, showing the potential of commercial 3D-printers and filaments to produce scaffolds to be used in bone tissue engineering.

[Negative effects of the patients' rights law and neuro-rights bill in Chile]. / Efectos negativos en la investigación y el quehacer médico en Chile de la Ley 20.584 y la Ley de Neuroderechos en discusión: la urgente necesidad de aprender de nuestros errores.

Recently, the Chilean Senate approved the main ideas of a constitutional reform and a Neuro-rights bill. This bill aims to protect people from the potential abusive use of "neuro-technologies". Unfortunately, a literal interpretation of this law can produce severe negative effects both in the development of neuroscience research and medical practice in Chile, interfering with current treatments in countless patients suffering from neuropsychiatric diseases. This fear stems from the observation of the negative effects that recent Chilean legislations have produced, which share with the Neuro-Rights Law the attempt to protect vulnerable populations from potential abuse from certain medical interventions. In fact, Law 20,584 promulgated in 2012, instead of protecting the most vulnerable patients "incapacitated to consent", produced enormous, and even possibly irreversible, damage to research in Chile in pathologies that require urgent attention, such as many neuropsychiatric diseases. This article details the effects that Law 20.584 had on research in Chile, how it relates to the Neuro-Rights Law, and the potential negative effects that the latter could have on research and medical practice, if it is not formulated correcting its errors.

Computer-assisted planning with 3D printing for mandibular reconstruction caused by a mandibular fracture with secondary osteomyelitis: A Case Report.

Mandibular reconstructions are complex clinical pictures that require careful planning for functional and aesthetic outcomes. Virtual surgical planning and 3D printing are ideal to achieve a predictable result. Through "hybrid techniques" (prebending plates with 3D-models) and free software, this goal is within reach for clinics with limited financial resources.

Contribución y desafíos de las enfermeras en tiempos de Covid-19: una revisión narrativa de la literatura / Contribuição e desafios do enfermeiro em tempos de Covid-19: uma revisão narrativa da literatura / Contribution and challenges of nurses in times of Covid-19: a narrative review of the literature

La pandemia por Covid-19 ha puesto a prueba el liderazgo y experiencia prácticade las enfermeras, y ha visibilizado el cuidado como un tema esencial para la vida humanay la salud global. Objetivo. El propósito de esta revisión de la literatura es reflexionarsobre las contribuciones y desafíos de las enfermeras en tiempos de pandemia. Método.Se realizó una revisión de la literatura, usando la base de datos Wos y SciencieDirect conla búsqueda de las palabras claves “nursing” AND “Covid-19” AND “disaster”, luego secomplementó con otros documentos seleccionados de variadas fuentes, principalmenteinformes de organizaciones internacionales que han sido relevantes en el quehacer deenfermería y de la salud pública durante el periodo de pandemia. Resultados. Se revisaron48 documentos y artículos que cumplieron con los criterios de inclusión. Conclusiones.La principal contribución de las enfermeras a la pandemia se relaciona con la capacidadde formar una gran fuerza de contención en contra del Covid-19, guiada por un cuidadocompasivo. Mientras algunos desafíos son el autocuidado y la planificación para larecuperación del sistema salud postpandemia.(AU)

The Covid-19 pandemic has put the leadership and practical experience of nursesto the test, and has made care visible as an essential issue for human life and global health.Objective. The purpose of this literature review is to reflect on the contributions andchallenges of nurses in times of pandemic. Method. A literature review was carried out,using the Wos and SciencieDirect databases, searching for the keywords “nursing” AND“Covid-19” AND “disaster”, then it was supplemented with other documents selectedfrom various sources, mainly reports of international organizations that have beenrelevant in the nursing and public health work during the pandemic period. Results. 48documents and articles that met the inclusion criteria were reviewed. Conclusions. Themain contribution of nurses to the pandemic is related to the ability to form a largecontainment force against Covid-19, guided by compassionate care. While somechallenges are self-care and planning for the recovery of the post-pandemic health system.(AU)

A pandemia Covid-19 colocou à prova a liderança e a experiência prática dosenfermeiros e tornou o cuidado visível como uma questão essencial para a vida humanae a saúde global. Objetivo. O objetivo desta revisão de literatura é refletir sobre ascontribuições e desafios dos enfermeiros em tempos de pandemia. Método. Foi realizadauma revisão da literatura, utilizando as bases de dados Wos e SciencieDirect, buscandoas palavras-chave “enfermagem” AND “Covid-19” AND “desastre”, a seguir foicomplementada com outros documentos selecionados de várias fontes, principalmente relatórios de organizações internacionais que foram relevantes no trabalho deenfermagem e saúde pública durante o período de pandemia. Resultados. Foram revisados48 documentos e artigos que atenderam aos critérios de inclusão. Conclusões. A principalcontribuição dos enfermeiros para a pandemia está relacionada à capacidade de formaruma grande força de contenção contra a Covid-19, guiada pelo cuidado compassivo.Enquanto alguns desafios são o autocuidado e o planejamento para a recuperação dosistema de saúde pós-pandemia.(AU)

Ageísmo como fenómeno sociocultural invisible que afecta y excluye el cuidado de personas mayores / Ageism as an invisible sociocultural phenomenon that affects and excludes the care of the elderly / Preconceito de idade como um fenómeno sócio-cultural invisível que afecta e exclui o cuidado das pessoas idosas

Resumen: El ageísmo en la vejez se ha relacionado con el imaginario social, responsable de mantener prejuicios y estereotipos hacia personas mayores. Prevaleciendo como fenómeno común en países occidentalizados como Chile, replicando una imagen de vejez llena de carencias y deterioro corporal. Este artículo reflexiona sobre el fenómeno de ageísmo que promueve conductas que excluyen a las personas mayores de la vida en sociedad y del cuidado formal. Para ello, se contextualizará sobre los imaginarios que predominan en la sociedad chilena sobre la vejez, y que afectan transversalmente a la familia, las instituciones y las profesiones; en segundo lugar se describirán algunas teorías explicativas sobre el ageísmo para mayor comprensión del fenómeno y su impacto generacional, y finalmente, sobre el abandono inicial de las personas mayores durante la pandemia por Covid-19 resultado del ageísmo de Estado. Visibilizar este tema favorece el debate social informado y la promoción de nuevas políticas públicas en favor de inclusión de personas mayores.

Abstract: Ageism in old age has been related to the social imaginary, responsible for maintaining prejudices and stereotypes towards older people. Prevailing as a common phenomenon in westernized countries like Chile, replicating an image of old age full of deficiencies and bodily deterioration. This article reflects on the phenomenon of ageism that promotes behaviors that exclude older people from life in society and from formal care. For this, it will be contextualized on the imaginaries that predominate in Chilean society about old age, and that transversally affect the family, institutions and professions; secondly, some explanatory theories about ageism will be described to better understand the phenomenon and its generational impact, and finally, about the initial abandonment of the elderly during the Covid-19 pandemic as a result of State ageism. Making this issue visible favors informed social debate and the promotion of new public policies in favor of the inclusion of older people.

Resumo: O preconceito de idade na velhice tem sido relacionado ao imaginário social, responsável por manter preconceitos e estereótipos em relação aos idosos. Prevalece como fenômeno comum em países ocidentalizados como o Chile, reproduzindo uma imagem da velhice repleta de deficiências e deterioração corporal. Este artigo reflete sobre o fenômeno do preconceito de idade que promove comportamentos que excluem os idosos da vida em sociedade e dos cuidados formais. Para isso, será contextualizado nos imaginários que predominam na sociedade chilena sobre a velhice e que afetam transversalmente a família, as instituições e as profissões; em segundo lugar, algumas teorias explicativas sobre o preconceito de idade serão descritas para melhor compreender o fenômeno e seu impacto geracional e, por fim, sobre o abandono inicial de idosos durante a pandemia de Covid-19 como resultado do preconceito de idade do Estado. A visibilidade dessa questão favorece o debate social informado e a promoção de novas políticas públicas em prol da inclusão dos idosos.

Efectos negativos en la investigación y el quehacer médico en Chile de la Ley 20.584 y la Ley de Neuroderechos en discusión: la urgente necesidad de aprender de nuestros errores / Negative effects of the patients' rights law and neuro-rights bill in Chile

Recently, the Chilean Senate approved the main ideas of a constitutional reform and a Neuro-rights bill. This bill aims to protect people from the potential abusive use of "neuro-technologies". Unfortunately, a literal interpretation of this law can produce severe negative effects both in the development of neuroscience research and medical practice in Chile, interfering with current treatments in countless patients suffering from neuropsychiatric diseases. This fear stems from the observation of the negative effects that recent Chilean legislations have produced, which share with the Neuro-Rights Law the attempt to protect vulnerable populations from potential abuse from certain medical interventions. In fact, Law 20,584 promulgated in 2012, instead of protecting the most vulnerable patients "incapacitated to consent", produced enormous, and even possibly irreversible, damage to research in Chile in pathologies that require urgent attention, such as many neuropsychiatric diseases. This article details the effects that Law 20.584 had on research in Chile, how it relates to the Neuro-Rights Law, and the potential negative effects that the latter could have on research and medical practice, if it is not formulated correcting its errors.

[Involvement of medical students in research. Facilitators and constraints]. / Investigación en pregrado de las escuelas de Medicina de Chile: percepción sobre facilitadores y limitantes entre los asistentes al III Congreso Chileno de Estudiantes de Medicina (CoCEM).

BACKGROUND: Scientific research is fundamental to the education of medical students. However, their involvement in research is limited. AIM: To describe the perceptions of medical students about facilitators and constraints to perform undergraduate research. MATERIAL AND METHODS: Medical students attending the Chilean Congress of Medical Students in the Metropolitan Region in 2018, were surveyed. The responses obtained were subjected to a qualitative content analysis and were grouped according to perceptions of facilitators and constraints. RESULTS: The main facilitators reported were linkage with research teachers, personal motivation towards research, and research-oriented curriculum. The main constraints were lack of time for research, lack of access to formal information channels to engage in research, and sub-optimal conditions for research. CONCLUSIONS: The main factor promoting research at the undergraduate level was the link with the teacher, mainly through informal channels. The lack of official information provided through formal instances and lack of time hampers the access to research.

Opiniones de familias vulnerables sobre promoción de la salud bucal infantil: un análisis de contenido

RESUMEN Objetivo: El propósito de este estudio fue interpretar las opiniones de familias que participaron en el programa de promoción de la salud bucal "Sembrando Sonrisas" en la Región de Atacama. Material y Método: Estudio descriptivo-interpretativo que utilizó metodología cualitativa y análisis de contenido. Se analizaron 294 opiniones expresadas por 194 familias, en el cuaderno viajero del programa piloto realizado el año 2017 en doce jardines públicos repartidos en cuatro comunas diferentes de la región. El análisis de contenido se realizó con apoyo del programa Atlas.ti®. Resultados: En la primera fase se construyeron 25 categorías y en una segunda fase emergieron 8 categorías teóricas, destacando: actitudes de los padres sobre la salud bucal en sus hijos(as), conocimiento sobre salud bucal, relación lúdica con la higiene bucal, relación entre imagen física y salud bucal, entre otras. Conclusiones: La estrategia educativa contribuye a disminuir brechas de conocimiento en salud bucal de padres y madres de sectores vulnerables, y aporta a mayor justicia social en cuanto mayor acceso al cuidado bucal, pero se requiere de acompañamiento continuo de personal capacitado.

ABSTRACT Objective: The purpose of this article is to evaluate the opinions of families that participated in the oral health promotion program "Sembrando sonrisas" (Sowing smiles) in the Atacama Region in northern Chile. Materials and Methods: Descriptive-interpretative study using qualitative methodology and content analysis. We analyzed 294 opinions expressed by 194 families in the class project book called "cuaderno viajero" of the pilot program, carried out in 2017 in twelve public kindergardens of four different cities. The content analysis was carried out with the support of the Atlas.ti® software. Results: 25 categories were established in the first phase and 8 theoretical categories emerged in a second phase, of which the following stand out: parental attitudes that favor oral health in their children, knowledge about oral health, playful relationship with oral hygiene, relationship between physical image and oral health, among others. Conclusions: The educational strategy contributes to reducing gaps in knowledge of oral health among parents from vulnerable sectors, and contributes to greater social justice in terms of greater access to oral care, but requires continuous monitoring by trained personnel.

RESUMO Objetivo: O objetivo deste artigo foi interpretar a opinião das famílias que participaram do programa de promoção da saúde bucal "Semeando sorrisos" na Região de Atacama. Material e Método: Estudo descritivo-interpretativo que utilizou metodologia qualitativa e análise de conteúdo. Foram analisadas 294 opiniões expressas por 194 famílias, no caderno itinerante do programa piloto realizado em 2017 em doze creches públicas de quatro cidades diferentes na região. A análise de conteúdo foi realizada com o apoio do programa Atlas.ti®. Resultados: Na primeira fase foram construídas 25 categorias e na segunda fase emergiram 8 categorias teóricas, destacando: atitudes dos pais sobre a saúde bucal de seus filhos(as), conhecimentos sobre saúde bucal, relação lúdica com a higiene bucal, relação entre imagem física e saúde bucal, entre outras. Conclusões: A estratégia educativa contribui para a redução das lacunas de conhecimento em saúde bucal de pais e mães de setores vulneráveis e contribui para maior justiça social em termos de maior acesso à higiene bucal, mas é preciso acompanhamento contínuo de pessoal capacitado.

Investigación en pregrado de las escuelas de medicina de Chile: Motivación y participación de estudiantes de medicina asistentes al Congreso Chileno de Estudiantes de Medicina (COCEM)

Background: The participation of medical students in research generates professional, scientific, and personal benefits for the student. Aim: To evaluate the interest and opportunities for medical students in Chile to participate in scientific research and their perceptions about factors influencing research. Material and Methods: All students attending the 2018 Chilean Congress for Medical Students were invited to answer a 44 questions survey about interest and opportunities to participate in research. Results: The survey was answered by 489 of the 538 students attending the congress. Eighty five percent referred interest in conducting scientific research, but only 47% had the opportunity to actively participate in a research project. The main research area providing opportunities was epidemiology and the main form to access a research project was through direct contact with a medical professor or researcher. Seventy seven percent of respondents had courses of scientific investigation in their medical curriculum and 92% had a scientific society for medical students in their university. Conclusions: Respondents showed a great deal of interest in participating in scientific research. However, there is a gap between this interest and the available opportunities. Medical professors should promote and facilitate the participation of their students in research.

Aspectos éticos relacionados con la atención de enfermería en personas en situación de discapacidad: un análisis cualitativo / Ethical aspects related to nursing care for persons with disabilities: a qualitative analysis / Aspectos éticos relacionados com a atenção de enfermagem em pessoas com deficiência: uma análise qualitativa

Resumen Este estudio tiene como propósito describir aspectos éticos relacionados con la atención de enfermería en personas con discapacidad, población considerada socialmente vulnerable y reconocida en condiciones de desigualdad. Corresponde a una primera fase de estudio primario realizado en la región de Atacama, Chile, que utilizó metodología cualitativa y análisis de contenido. Se realizan entrevistas a profesionales de enfermería respetando los criterios éticos de Ezekiel Emanuel. Los principales hallazgos dan cuenta de las categorías ontológicas: razonamiento moral, sistema de valores, modelo de relación enfermera-paciente, consecuencias de la acción ética de enfermería, estrategias para superar conflictos morales y barreras en el cuidado. Se concluye que cuidar personas con discapacidad es fuente de dilema y angustia moral para los profesionales de enfermería, especialmente cuando se trata de sujetos con discapacidad sensitiva o cognitiva. El modelo médico paternalista predomina en el contexto clínico, lo que limita el derecho a la autonomía de las personas con discapacidad. A los valores morales tradicionales promovidos por los profesionales de enfermería se suman valores instrumentales como la eficiencia. No se mencionan valores cívicos considerados fundamentales ante el desafío de la diversidad humana y la vida en democracia.

Abstract The purpose of the study is to describe ethical aspects related to nursing care for persons with disabilities; a population considered socially vulnerable and in conditions of inequality. It corresponds to the first phase of a primary study conducted in Atacama, Chile using a qualitative methodology and content analysis. Nursing graduates are interviewed respecting Ezekiel Emanuel's ethical criteria. The main findings account for ontological categories such as moral reasoning, value system, nurse-patient relationship model, consequences of the ethical nursing action, strategies to overcome moral conflicts, and barriers in care. It is concluded that caring for people with disabilities is a source of dilemma and moral anguish for nurses, especially when it comes to individuals with sensitive or cognitive disabilities. The paternalistic medical model predominates in the clinical context, limiting the right to autonomy of persons with disabilities. Instrumental values such as efficiency are added to traditional moral values promoted by nurses. Civic values considered fundamental to the challenge of human diversity and life in democracy are not mentioned.

Resumo Este estudo tem como objetivo descrever aspectos éticos relacionados com a atenção de enfermagem em pessoas com deficiência, população considerada socialmente vulnerável e reconhecida em condições de desigualdade. Corresponde a uma primeira fase de estudo realizado na região de Atacama, Chile, que utilizou metodologia qualitativa e análise de conteúdo. Foram realizadas entrevistas com profissionais de enfermagem, respeitando os critérios éticos de Ezekiel Emanuel. Os principais achados evidenciam as categorias ontológicas: raciocínio moral, sistema de valores, modelo de relação enfermeiro-paciente, consequências da ação ética de enfermagem, estratégias para superar conflitos morais e barreiras no cuidado. Conclui-se que cuidar de pessoas com deficiência é fonte de dilema e angústia moral para os profissionais de enfermagem, especialmente quando se trata de pessoas com deficiência sensitiva ou cognitiva. O modelo médico paternalista predomina no contexto clínico, o que limita o direito à autonomia das pessoas com deficiência. Aos valores morais tradicionais promovidos pelos profissionais de enfermagem, somam-se valores instrumentais como a eficiência. Não são mencionados valores cívicos considerados fundamentais ante o desafio da diversidade humana e a vida na democracia.

[Participation of Chilean undergraduate medical students in scientific research]. / Investigación en pregrado de las escuelas de medicina de Chile: Motivación y participación de estudiantes de medicina asistentes al Congreso Chileno de Estudiantes de Medicina (COCEM).

BACKGROUND: The participation of medical students in research generates professional, scientific, and personal benefits for the student. AIM: To evaluate the interest and opportunities for medical students in Chile to participate in scientific research and their perceptions about factors influencing research. MATERIAL AND METHODS: All students attending the 2018 Chilean Congress for Medical Students were invited to answer a 44 questions survey about interest and opportunities to participate in research. RESULTS: The survey was answered by 489 of the 538 students attending the congress. Eighty five percent referred interest in conducting scientific research, but only 47% had the opportunity to actively participate in a research project. The main research area providing opportunities was epidemiology and the main form to access a research project was through direct contact with a medical professor or researcher. Seventy seven percent of respondents had courses of scientific investigation in their medical curriculum and 92% had a scientific society for medical students in their university. CONCLUSIONS: Respondents showed a great deal of interest in participating in scientific research. However, there is a gap between this interest and the available opportunities. Medical professors should promote and facilitate the participation of their students in research.

Iron-related brain damage in patients with intracerebral hemorrhage.

BACKGROUND AND PURPOSE: Iron plays a detrimental role after experimental intracerebral hemorrhage (ICH). This study investigates whether high-serum ferritin levels are associated with poor outcome in patients with ICH. METHODS: We studied 92 consecutive patients with primary hemispheric ICH within the first 12 hours from onset of symptoms (median, 3.3 hours). National Institute of Health Stroke Scale score, ICH, and peripheral edema volumes were measured at admission, 72 hours, and 7 days. Serum levels of ferritin and biomarkers of the inflammatory response were determined. The adjusted effect of ferritin on the full range of Rankin scale was analyzed by a general linear model. RESULTS: Fifty-one patients (55.4%) had poor outcome (Rankin score >2). Older age, higher stroke severity, larger hematoma volume, intraventricular extension, mass effect, and higher IL-6 and ferritin levels at baseline (270.6 [SD 81.4] vs 74.6 [SD 43.4] ng/mL; P<0.001) were associated with poor outcome. The higher the ferritin quartile, the worse the Rankin score. For every ferritin quartile, the Rankin score increased by a mean of 1.4 points (95% CI, 1.04-1.69) after adjusting for prognostic variables. Ferritin levels remained stable for 72 hours and did not correlate with acute phase reactants. CONCLUSIONS: High-serum ferritin levels at admission are independently associated with poor outcome in patients with ICH. These findings may suggest a neurotoxic effect of increased body iron stores in patients with hemorrhagic stroke.

[Primary vasculitis of the central nervous system: report of one case]. / Vasculitis primaria del sistema nervioso central, diagnóstico diferencial de demencia subaguda: Caso clínico.

A primary central nervous system vasculitis is an uncommon and invalidating disease, which has a fatal course if left untreated. We report a 63 year-old woman presenting with a history of two months of cognitive impairment, dysarthria, gait instability and tremor. After four months of evolution a right hemianopsia and a flaccid paresis of upper right limb appeared. A brain biopsy was performed and the histological findings confirmed the suspicion of primary cerebral vasculitis. The patient was treated with cyclophosphamide and prednisone, observing a partial recovery of cognitive and motor function.