Borders and liminality in the right to health of migrants in transit: The case of Colchane in Chile and Necoclí in Colombia.

The absence of the right to health of migrants in transit has evolved into a significant global health concern, particularly in the border regions thus, this study aims to improve knowledge in this area by exploring the effects of the spatio-temporal liminal characteristics at borders in the achievement of the right to health of migrants in transit moving across two of the most transited and dangerous borders in Latin America: Colchane (Chile-Bolivia) and the Darién Gap (Colombia-Panamá). Through a qualitative descriptive multi-case study, we implemented 50 semi-structured interviews (n = 30 in Chile and n = 20 in the Darién/Necoclí) involving national, regional, and local stakeholders. The findings highlight that the fulfilment of the right to health of migrants in transit is hindered by liminal dynamics at the borders. These dynamics include closure of borders, (in)securities, uncertainty and waiting, lack of economic resources, lack of protection to all, liminal politics, and humanitarian interventions. These findings surface how the borders' liminality exacerbates the segregation of migrants in transit by placing them in a temporospatial limbo that undermines their right to health. Our study concludes that not just the politics but also the everyday practices, relationships and social infrastructure at borders impedes the enjoyment of the right to health of distressed migrants in transit. The short-term humanitarian response; illicit dynamics at borders; migratory regulations; and border and cross-border political structures are some of the most significant determinants of health at these borderlands.

Injerto de piel libre como tratamiento exitoso de una úlcera de Marjolin / Free skin graft as a successful treatment of a Marjolin ulcer

Introducción: la úlcera de Marjolin hace referencia a la aparición de un carcinoma de células escamosas ulcerado sobre un área previamente lesionada, crónicamente inflamada o con cicatrices. Se estima que solo el 1,7 % de las heridas crónicas se malignizan. Caso clínico: se trata de una mujer de 76 años que presentó una úlcera venosa crónica en la región maleolar de diez años de evolución que se había extendido. Se realizó una biopsia insicional y se obtuvo un carcinoma de células escamosas, por lo que se realizó la resección del tejido afectado, cubriendo el área con injerto autólogo de piel libre, fenestrado, de espesor parcial, y posteriormente se realizaron curas durante la hospitalización y el manejo ambulatorio, con lo que se obtuvieron resultados satisfactorios. Discusión: la resección-desbridamiento quirúrgico de la úlcera de Marjolin y el cierre con injerto libre de piel permitió la evolución satisfactoria y la cicatrización de las lesiones.(AU)

Introduction: Marjolin’s ulcer refers to the appearance of ulcerated squamous cell carcinoma on a previously injured,chronically inflamed or scarred area; it is estimated that only 1.7 % of chronic wounds become malignant.Case report: this is a 76-year-old woman who presented a chronic venous ulcer in the malleolar region of ten years ofevolution that had spread. An incisional biopsy was taken, resulting in squamous cell carcinoma, for which resectionof the affected tissue was performed: the area was covered with a free, fenestrated, partial-thickness autologous skingraft. Later, cures were carried out during hospitalization and ambulatory management, obtaining satisfactory results.Discussion: the surgical resection-debridement of the Marjolin ulcer and the closure with a free skin graft allowed thesatisfactory evolution and healing of the lesions.(AU)

Insights into the Effect of Charges on Hydrogen Bonds.

Previous computational and experimental studies showed that charges located at the surroundings of hydrogen bonds can exert two opposite effects on them: rupture or strengthening of the hydrogen bond. This work aims to generalize the effect of charges in different hydrogen-bonded systems and to propose a coherent explanation of this effect. For these purposes, 19 systems with intra- and intermolecular hydrogen bonds were studied computationally with DFT. The FT-IR spectra of the systems were simulated, and two energy components of the hydrogen bond were studied separately to determine their variation upon the presence of a charge: charge transfer and molecular overlap. It was determined that either the breaking or strengthening of the hydrogen bond can be favored one over the other, for instance, depending on the heteroatom involved in the hydrogen bond. In addition, it is showed that the strengthening of the hydrogen bond by the presence of a charge is directly related to the decrease in charge transfer between the monomers, which is explained by an increase in molecular overlapping, suggesting a more covalent character of the interaction. The understanding of how hydrogen bonds are affected by charges is important, as it is a key towards a strategy to manipulate hydrogen bonds at convenience.

Gurka vs Slaughter equations to estimate the fat percentage in children with cerebral palsy from all subtypes and levels of the Gross Motor Function Classification System.

BACKGROUND: Body composition assessment in children with cerebral palsy (CP) is a challenge, specially the fat percentage. There are different methods that can be used to estimate the fat percentage in this population, such as anthropometric equations, but there is still a need to determine which is the best and most accurate. The purpose of the study was to determine the method that best estimates the fat percentage in children from all CP subtypes and levels of the Gross Motor Function Classification System (GMFCS). METHODS: Analytical cross-sectional study in which 108 children with CP diagnosed by a pediatric neurologist were included with any type of dysfunction and from all levels of the GFMCS. Slaughter equation, Gurka equation and Bioelectrical impedance analysis (BIA) as reference method, were used. Groups were stratified by sex, CP subtypes, GMFCS level and Tanner stage. Median differences, Kruskal-Wallis, Mann-Whitney U test, Spearman's correlation coefficients and simple regressions were used, also multivariate models were performed. RESULTS: The Slaughter equation differed from the other methods in the total population and when it was compared by sex, CP subtypes, gross motor function and Tanner stage. The Gurka equation showed significant differences by sex and gross motor function. Gurka equation correlated positively and significantly with BIA to estimate the fat percentage in all the CP subtypes and levels of the GMFCS. Tricipital skinfold (TSF), arm fat area (AFA) and weight for age index (W/A) showed the highest variability with respect to fat percentage. CONCLUSION: Gurka equation is more appropriate and accurate than Slaughter equation to estimate the fat percentage in children with CP from all subtypes and levels of the GMFCS.

Caracterización microbiológica y fenotipificación de la resistencia bacteriana en las infecciones intraabdominales en el Instituto Autónomo Hospital Universitario de los Andes, 2014-2017 / Microbiological characterization and phenotyping of bacterial resistance in intra-abdominal infections at the Instituto Autonomo Hospital Universitario de los Andes, 2014-2017

Objetivo: caracterizar los microorganismos involucrados en las infecciones intraabdominales, y fenotipificar sus perfiles de resistencia al uso de los antibióticos en el Servicio de Cirugía General del Instituto Autónomo Hospital Universitario de Los Andes, entre los años 2014 al 2017. Metodología: enfoque cuantitativo; tipo descriptivo, diseño no experimental de estudio de casos y transversal, a través de toma de muestras de secreciones abdominales en quirófano a las cuales se les realizó cultivo en medios de agar sangre y McConkey, tinción Gram, contaje de leucocitos, y prueba Kirby-Bauer de sensibilidad antimicrobiana. Muestra de 211 pacientes mayores de 16 años que acudieron a la institución con el diagnóstico de abdomen agudo quirúrgico infeccioso. Resultados: el abdomen agudo quirúrgico infeccioso por apendicitis aguda fue la infección intraabdominal más común, grupo etario que acudió con más frecuencia: <26 años. Agentes etiológicos más frecuentemente aislados: bacilos Gram negativos, especies más frecuentes: E. col i (57,3%), K. pneumon iae (10,9%) y P. a e rug i nosa (6,16%). De todos los microorganismos aislados 57,6% expresaron al menos un fenotipo de resistencia. Fenotipo más común: betalactamasa de espectro extendido y bomba de eflujo de quinolonas (18,8%). Microorganismos con mayores porcentajes de resistencia: Staphylococcus sp. y Enterococcus sp (~100%). Los mejores porcentajes de sensibilidad de la E. col i , K . p neumon ia e y P . a e rug i nosa fueron hacia al colistin, carbapenémicos y amikacina (100%). Conclusión: Los carbapenémicos y los aminoglucósidos seguirán siendo los fármacos de elección en las infecciones intraabdominales del Instituto Autónomo Hospital Universitario de Los Andes(AU)

Objective: to characterize the microorganisms involved in intraabdominal infections, and to phenotype their resistance profiles to the use of antibiotics in the General Surgery Service of the Instituto Autónomo Hospital Universitario de Los Andes, from 2014 to 2017. Methodology: quantitative approach; descriptive type, nonexperimental design of case study and transversal, through sampling of abdominal secretions in the operating room which were cultured in blood agar and McConkey media, Gram stain, leukocyte count, and Kirby-Bauer test for antimicrobial sensitivity. Sample of 211 patients older than 16 years who attended the institution with the diagnosis of acute surgical infectious abdomen. Results: acute surgical infectious abdomen due to acute appendicitis was the most common intra-abdominal infection, most frequent age group: <26 years. Most frequently isolated etiologic agents: Gram-negative bacilli, most frequent species: E. co l i (57.3%), K. p neumon ia e (10.9%) and P . a e rug i nosa (6.16%). Of all the isolated microorganisms, 57.6% expressed at least one resistance phenotype. Most common phenotype: extended-spectrum beta-lactamase and quinolone efflux pump (18.8%). Microorganisms with the highest percentages of resistance: Staphylococcus sp. and Enterococcus sp (~100%). The best percentages of sensitivity of E. col i , K . pneumoniae and P . a e rug i nosa were to colistin, carbapenemics and amikacin (100%). Conclusion: Carbapenemics and aminoglycosides will remain the drugs of choice in intra-abdominal infections at Instituto Autónomo Hospital Universitario de Los Andes(AU)

Optimized method for the extraction of contaminant-free IgY antibodies from egg yolk using PEG 6000.

Hens are oviparous vertebrates and produce IgY antibodies, which is the main type of immunoglobulin in the egg yolk, and high concentrations can be obtained by using a simple method that does not require sophisticated equipment and reagents. The Polyethylene Glycol 6000 method allows the removal of lipids and the precipitation of IgY in two days with an approximated purity of around 80%, however during the original protocol other contaminant proteins can be precipitated. To overcome the issue of contamination with other proteins and extraction time, we optimized the previously method described by Pauly et al. (2011) by adding some changes that improved the aforementioned problems. • Our protocol is customized by the addition of one more filtration step or one more step with PEG 6000 at 3.5% to avoid the contamination with lipids. • Additionally, the changes in the type of agitation, centrifugation and the skip of dialysis make the method more accessible for all the laboratories. • In summary, these modifications serve to enhance the purity, reduce the time for IgY extraction from egg yolk and make it more accessible for every basic research laboratory.

Psychosocial stress, bicultural identity integration, and bicultural self-efficacy among Hispanic emerging adults.

Most studies on psychosocial stress among Hispanics have focused on risk factors. To better understand psychosocial stress among this population, this study aimed to examine components of bicultural identity integration and bicultural self-efficacy, that may be associated with lower psychosocial stress among Hispanic emerging adults (ages 18-25). This aim was tested on a cross-sectional sample of Hispanic emerging adults (Mage = 21.30, SD = 2.09) that included 200 participants (Arizona n = 99, Florida n = 101). The sample included men (n = 98) and women (n = 102). Most participants were US-born (70%), college students (69.5%), and of Mexican heritage (44%). Standardized coefficients from a hierarchical multiple regression model indicate that higher levels of the bicultural harmony component of bicultural identity integration (ß = -0.26, p < 0.001) and the social groundedness component of bicultural self-efficacy (ß = -0.23, p < 0.01) were associated with lower levels of psychosocial stress. To our knowledge, this is the first study to examine components of bicultural identity integration and bicultural self-efficacy and their respective associations with psychosocial stress among any racial/ethnic group. Thus, more studies are needed to replicate our findings to determine if bicultural identity integration and bicultural self-efficacy should be considered in psychosocial stress interventions for Hispanics.

Lactobacillus reuteri DSM 17938 and Agave Inulin in Children with Cerebral Palsy and Chronic Constipation: A Double-Blind Randomized Placebo Controlled Clinical Trial.

The main objective was to assess the efficacy of a probiotic (Lactobacillus reuteri DSM 17938), a prebiotic (agave inulin), and a synbiotic on the stool characteristics in children with cerebral palsy and chronic constipation. Thirty-seven children with cerebral palsy and chronic constipation were included. The probiotic group received 1 × 108 colony forming unit (cfu) of L. reuteri DSM 17938 plus placebo, the prebiotic group received 4 g of agave inulin plus placebo, the synbiotic group received L. reuteri DSM 17938 plus agave inulin, and the placebo group received two placebos for 28 days. The probiotic group showed a significant decrease in stool pH (p = 0.014). Stool consistency improved in the prebiotic group (p = 0.008). The probiotic, prebiotic, and synbiotic groups showed a significant improvement in the history of excessive stool retention, the presence of fecal mass in the rectum, and the history of painful defecation. L. reuteri concentration in feces was higher in the probiotic group than in the placebo group (p = 0.001) and showed an inverse correlation with stool pH in the probiotic group (r = -0.762, p = 0.028). This study showed that the use of L. reuteri DSM 17938 and/or agave inulin improved the stool characteristics such as the history of painful defecation and the presence of fecal mass in the rectum against placebo in children with cerebral palsy and chronic constipation.

[Associations between psychosocial risk factors, organizational dimensions, and mental health problems related to workplace violence among workers of three Chilean hospitals of high complexity]. / Asociaciones entre factores de riesgos psicosociales, dimensiones organizacionales y problemas de salud mental, relacionados con la violencia laboral, en trabajadores de tres hospitales chilenos de alta complejidad.

The objective was to analyze the association between psychosocial risk factors, organizational dimensions, workplace violence, and indicators of mental health problems in three Chilean hospitals. A total of 1,023 workers answered a questionnaire, and descriptive, bivariate (chi-square), and multivariate (logistic regression with odds ratio as the measure of association) analyses were performed. Of all the interviewees, 14.7% reported workplace violence. Increased odds of workplace violence were associated with exposure to ISOSTRAIN (OR = 2.32, p = 0.001), effort-reward imbalance (OR = 5.52, p ≤ 0.001), tyrannical leadership (OR = 3.02, p ≤ 0.001), and vulnerability (OR = 1.97, p = 0.010). Workers exposed to ISOSTRAIN (OR = 1.78, p = 0.024), effort-reward imbalance (OR = 2.49, p = 0.001), workplace violence (OR = 2.13, p = 0.003), and vulnerability (OR = 2.29, p = 0.001) showed increased odds of high stress when compared to unexposed workers. Workers exposed to effort-reward imbalance (OR = 2.84, p ≤ 0.001) and workplace violence (OR = 1.76, p = 0.041) showed higher odds of reporting depressive symptoms. Those exposed to effort-reward imbalance (OR = 2.07, p ≤ 0.001) and work vulnerability (OR = 1.96, p = 0.001) showed higher odds of consuming psychoactive drugs. Work contexts with psychosocial risk factors, adverse organizational dimensions, and work vulnerability were associated with higher odds of workplace violence. Workers exposed to workplace violence, psychosocial risks, and vulnerability have higher odds of reporting mental health problems.

El objetivo fue analizar la asociación entre factores de riesgos psicosociales, dimensiones organizacionales, violencia laboral e indicadores de problemas de salud mental en tres hospitales chilenos. Mil veintitrés trabajadores respondieron una encuesta, se realizó análisis descriptivos, bivariados (chi-cuadrado) y multivariados (regresión logística con odds ratio como medida de asociación). El 14,7% de los encuestados reporta violencia laboral. Tienen más oportunidad de reportar violencia laboral los/as trabajadores/as expuestos a ISOSTRAIN (OR = 2,32, p = 0,001); desequilibrio esfuerzo-recompensa (OR = 5,52, p ≤ 0,001); liderazgo tiránico (OR = 3,02, p ≤ 0,001) y vulnerabilidad (OR = 1,97, p = 0,010), respecto a los no expuestos. Los expuestos a ISOSTRAIN (OR = 1,78, p = 0,024); desequilibrio esfuerzo-recompensa (OR = 2,49, p = 0,001); violencia laboral (OR = 2,13, p = 0,003) y vulnerabilidad (OR = 2,29, p = 0,001) tienen más oportunidad de reportar distrés elevado, en relación a los no expuestos. Los expuestos a desequilibrio esfuerzo-recompensa (OR = 2,84, p ≤ 0,001) y violencia laboral (OR = 1,76, p = 0,041) tienen más oportunidad de reportar síntomas depresivos que los no expuestos. Los expuestos a desequilibrio esfuerzo-recompensa (OR = 2,07, p ≤ 0,001) y vulnerabilidad laboral (OR = 1,96, p = 0,001) tienen más oportunidad de consumir psicotrópicos. Los contextos laborales con factores de riesgos psicosociales, dimensiones organizacionales adversas y vulnerabilidad laboral se asocian a una mayor oportunidad de violencia laboral. Asimismo, trabajadores expuestos a violencia laboral, riesgos psicosociales y vulnerabilidad tienen mayor oportunidad de reportar problemas de salud mental.

O objetivo foi analisar a associação entre fatores de riscos psicossociais, dimensões organizacionais, violência no trabalho e indicadores de problemas de saúde mental em três hospitais chilenos. Mil e vinte e três trabalhadores responderam um questionário, foram realizadas análises descritivas, bivariadas (qui-quadrado) e multivariadas (regressão logística com odds ratio como medida de associação). Relataram violência no trabalho, 14,7% dos entrevistados. Os/as trabalhadores/as expostos/as a ISOSTRAIN (OR = 2,32, p = 0,001) têm maior chance de relatar violência no trabalho; desequilíbrio esforço-recompensa (OR = 5,52, p ≤ 0,001); liderança tirânica (OR = 3,02, p ≤ 0,001) e vulnerabilidade (OR = 1,97, p = 0,010), em relação aos não expostos. Os expostos a ISOSTRAIN (OR = 1,78, p = 0,024); desequilíbrio esforço-recompensa (OR = 2,49, p = 0,001); violência no trabalho (OR = 2,13, p = 0,003) e vulnerabilidade (OR = 2,29, p = 0,001) têm uma maior chance de reportar distresse elevado, em relação aos não expostos. Os expostos a desequilíbrio esforço-recompensa (OR = 2,84, p ≤ 0,001) e violência laboral (OR = 1,76, p = 0,041) têm maior chance de reportar sintomas depressivos do que os nãos expostos. Os expostos a desequilíbrio esforço-recompensa (OR = 2,07, p ≤ 0,001) e vulnerabilidade laboral (OR = 1,96, p = 0,001) têm maior chance de consumir psicotrópicos. Os contextos laborais com fatores de riscos psicossociais, dimensões organizacionais adversas e vulnerabilidade laboral foram associados a uma maior chance de violência no trabalho. Além disso, trabalhadores expostos à violência no trabalho, riscos psicossociais e vulnerabilidade têm maior chance de reportar problemas de saúde mental.

Factors associated with the stool characteristics of children with cerebral palsy and chronic constipation.

BACKGROUND: chronic constipation is a common gastrointestinal problem in children with cerebral palsy and several factors can influence the stool frequency, consistency and pH in these cases. AIM: to identify the association of dietary factors, use of anticonvulsants and family history of constipation with the stool characteristics of children with cerebral palsy and chronic constipation. METHODS: an analytical cross-sectional study was performed of 45 children with cerebral palsy and chronic constipation that included 19 females and 26 males, aged 37 ± 13 months. Dietary factors, the use of anticonvulsants and family history were analyzed. Stool frequency, consistency (Bristol Stool Form Scale) and pH (using a pH-meter) were also determined. RESULTS: there was a positive correlation between stool frequency and the consumption of oilseeds (r = 0.339, p = 0.023). There was a negative correlation between hard stools and fluid intake (r = -0.336, p = 0.042) and between stool pH and the consumption of cereals rich in insoluble fiber, high soluble fiber vegetables, carrots and potatoes (r = -0.339, p = 0.030; r = -0.308, p = 0.044; r = -0.336, p = 0.027; r = -0.307, p = 0.045, respectively). An association was also identified between the use of anticonvulsant polytherapy and hard stools (OR = 14.2 [95% CI 1.16-174], p = 0.038). There was no association between family history and constipation. CONCLUSIONS: rich-fiber food consumption, fluids intake and anticonvulsant polytherapy were associated with the stool characteristics of children with cerebral palsy and chronic constipation.

Asociaciones entre factores de riesgos psicosociales, dimensiones organizacionales y problemas de salud mental, relacionados con la violencia laboral, en trabajadores de tres hospitales chilenos de alta complejidad / Associations between psychosocial risk factors, organizational dimensions, and mental health problems related to workplace violence among workers of three Chilean hospitals of high complexity / Associação entre fatores de riscos psicossociais, dimensões organizacionais e problemas de saúde mental relacionados com a violência no trabalho em trabalhadores de três hospitais chilenos de alta complexidade

Resumen: El objetivo fue analizar la asociación entre factores de riesgos psicosociales, dimensiones organizacionales, violencia laboral e indicadores de problemas de salud mental en tres hospitales chilenos. Mil veintitrés trabajadores respondieron una encuesta, se realizó análisis descriptivos, bivariados (chi-cuadrado) y multivariados (regresión logística con odds ratio como medida de asociación). El 14,7% de los encuestados reporta violencia laboral. Tienen más oportunidad de reportar violencia laboral los/as trabajadores/as expuestos a ISOSTRAIN (OR = 2,32, p = 0,001); desequilibrio esfuerzo-recompensa (OR = 5,52, p ≤ 0,001); liderazgo tiránico (OR = 3,02, p ≤ 0,001) y vulnerabilidad (OR = 1,97, p = 0,010), respecto a los no expuestos. Los expuestos a ISOSTRAIN (OR = 1,78, p = 0,024); desequilibrio esfuerzo-recompensa (OR = 2,49, p = 0,001); violencia laboral (OR = 2,13, p = 0,003) y vulnerabilidad (OR = 2,29, p = 0,001) tienen más oportunidad de reportar distrés elevado, en relación a los no expuestos. Los expuestos a desequilibrio esfuerzo-recompensa (OR = 2,84, p ≤ 0,001) y violencia laboral (OR = 1,76, p = 0,041) tienen más oportunidad de reportar síntomas depresivos que los no expuestos. Los expuestos a desequilibrio esfuerzo-recompensa (OR = 2,07, p ≤ 0,001) y vulnerabilidad laboral (OR = 1,96, p = 0,001) tienen más oportunidad de consumir psicotrópicos. Los contextos laborales con factores de riesgos psicosociales, dimensiones organizacionales adversas y vulnerabilidad laboral se asocian a una mayor oportunidad de violencia laboral. Asimismo, trabajadores expuestos a violencia laboral, riesgos psicosociales y vulnerabilidad tienen mayor oportunidad de reportar problemas de salud mental.

Abstract: The objective was to analyze the association between psychosocial risk factors, organizational dimensions, workplace violence, and indicators of mental health problems in three Chilean hospitals. A total of 1,023 workers answered a questionnaire, and descriptive, bivariate (chi-square), and multivariate (logistic regression with odds ratio as the measure of association) analyses were performed. Of all the interviewees, 14.7% reported workplace violence. Increased odds of workplace violence were associated with exposure to ISOSTRAIN (OR = 2.32, p = 0.001), effort-reward imbalance (OR = 5.52, p ≤ 0.001), tyrannical leadership (OR = 3.02, p ≤ 0.001), and vulnerability (OR = 1.97, p = 0.010). Workers exposed to ISOSTRAIN (OR = 1.78, p = 0.024), effort-reward imbalance (OR = 2.49, p = 0.001), workplace violence (OR = 2.13, p = 0.003), and vulnerability (OR = 2.29, p = 0.001) showed increased odds of high stress when compared to unexposed workers. Workers exposed to effort-reward imbalance (OR = 2.84, p ≤ 0.001) and workplace violence (OR = 1.76, p = 0.041) showed higher odds of reporting depressive symptoms. Those exposed to effort-reward imbalance (OR = 2.07, p ≤ 0.001) and work vulnerability (OR = 1.96, p = 0.001) showed higher odds of consuming psychoactive drugs. Work contexts with psychosocial risk factors, adverse organizational dimensions, and work vulnerability were associated with higher odds of workplace violence. Workers exposed to workplace violence, psychosocial risks, and vulnerability have higher odds of reporting mental health problems.

Resumo: O objetivo foi analisar a associação entre fatores de riscos psicossociais, dimensões organizacionais, violência no trabalho e indicadores de problemas de saúde mental em três hospitais chilenos. Mil e vinte e três trabalhadores responderam um questionário, foram realizadas análises descritivas, bivariadas (qui-quadrado) e multivariadas (regressão logística com odds ratio como medida de associação). Relataram violência no trabalho, 14,7% dos entrevistados. Os/as trabalhadores/as expostos/as a ISOSTRAIN (OR = 2,32, p = 0,001) têm maior chance de relatar violência no trabalho; desequilíbrio esforço-recompensa (OR = 5,52, p ≤ 0,001); liderança tirânica (OR = 3,02, p ≤ 0,001) e vulnerabilidade (OR = 1,97, p = 0,010), em relação aos não expostos. Os expostos a ISOSTRAIN (OR = 1,78, p = 0,024); desequilíbrio esforço-recompensa (OR = 2,49, p = 0,001); violência no trabalho (OR = 2,13, p = 0,003) e vulnerabilidade (OR = 2,29, p = 0,001) têm uma maior chance de reportar distresse elevado, em relação aos não expostos. Os expostos a desequilíbrio esforço-recompensa (OR = 2,84, p ≤ 0,001) e violência laboral (OR = 1,76, p = 0,041) têm maior chance de reportar sintomas depressivos do que os nãos expostos. Os expostos a desequilíbrio esforço-recompensa (OR = 2,07, p ≤ 0,001) e vulnerabilidade laboral (OR = 1,96, p = 0,001) têm maior chance de consumir psicotrópicos. Os contextos laborais com fatores de riscos psicossociais, dimensões organizacionais adversas e vulnerabilidade laboral foram associados a uma maior chance de violência no trabalho. Além disso, trabalhadores expostos à violência no trabalho, riscos psicossociais e vulnerabilidade têm maior chance de reportar problemas de saúde mental.

Differences in patients derived from otolaryngology and other specialties with sleep apnea.

BACKGROUND: Snoring is a main concern in patients who consult an otolaryngologist (ENT physicians) and patients who have cardiovascular comorbidities or excessive daytime sleepiness who usually consult with other specialists. The aim of this study was to describe the clinical differences in patients with obstructive sleep apnea (OSA) referred from ENT or other specialists. METHODS: A prospective study was carried out between June 2015 and July 2018 in a tertiary center. We included patients with suspected OSA referred by the Home Sleep Apnea Test (HSAT) from different specialties such as ENT or other specialties. The main outcome measures of our study were demographic characteristics, clinical characteristics, sleep questionnaire results and HSAT results between OSA patients referred from ENT or other specialists. We used a t-test and chi-squared test for analysis. The diagnostic accuracy of the sleep questionnaires was achieved using receiver operating characteristic (ROC) curve and the area under the curve (AUC). RESULTS: A total of 481 patients were included. OSA was occurred in 82.4% of the subjects (90 in ENT and 306 in other specialties). Patients with OSA referred from other specialists were older than ENT patients (55 ± 13 vs 44 ± 12; p < 0.001), there was more obesity (IMC 31 ± 5.0 vs 28.7 ± 3.8; p < 0,001), a larger neck circumference (42.2 cm ± 3.7 vs 40.6 cm ± 3.0; p < 0.001) and more reported comorbidities (p < 0.001). ENT patients reported mild OSA (46% vs 31%, p = 0.015) and more positional apnea (62% vs 39%, p = 0.002). In this group, the STOP-BANG questionnaire showed an AUC 0.695 vs AUC 0.804, and for sensitivity, the best cutoff was 4 points. Patients referred from otorhinolaryngology are different from those referred from other specialties. Clinical evaluation and screening of OSA should be patient-centered according to these clinical findings.

Bone mineral density and biochemical and hormonal indicators in children with quadriplegic cerebral palsy / Densidad mineral ósea e indicadores bioquímicos y hormonales en niños con parálisis cerebral cuadripléjica

Introduction: children with cerebral palsy (CP) have multiple risk factors for low bone mineral density or osteoporosis. Objective: to explore the association between bone mineral density (BMD) and biochemical and hormonal indicators of bone metabolism in children with quadriplegic cerebral palsy (CP). Methods: a cross-sectional analytical study included 59 participants from six to 18 years of age with quadriplegic CP. Serum concentrations of calcium, phosphorus, 25OHD metabolite, parathyroid hormone (PTH), alkaline phosphatase, and thyroid hormones were determined using standardized methods. The BMD measurement was obtained from the lumbar spine expressed in g/cm2 and Z-score. Unpaired Student's t-test, Chi-square test, odds ratio and Pearson's correlation were performed. Results: participants with CP and malnutrition had lower serum concentrations of calcium, phosphorus and alkaline phosphatase. Those who had low BMD showed lower serum concentrations of calcium, phosphorus and alkaline phosphatase. Most participants with low and normal BMD had vitamin D deficiency (27.1% and 10%) and insufficiency (35.4% and 30%), respectively. There was a significant correlation between BMD and serum concentrations of calcium, phosphorus, alkaline phosphatase, vitamin D and thyroid-stimulating hormone (TSH). There were no differences in the biochemical and hormonal indicators by level of gross motor function, use of anticonvulsants and oral versus enteral feeding method. Conclusion: malnutrition and alteration of vitamin D nutritional status were associated with low BMD and alterations of biochemical indicators of bone metabolism in pediatric patients with quadriplegic CP. The relationship between BMD and biochemical indicators of bone metabolism in children with quadriplegic CP was also demonstrated

Introducción: los niños con parálisis cerebral (PC) presentan múltiples factores de riesgo de densidad mineral ósea baja u osteoporosis. Objetivo: explorar la asociación entre la baja densidad mineral ósea (DMO) e indicadores bioquímicos y hormonales del metabolismo óseo en niños con PC cuadripléjica. Métodos: un estudio transversal analítico incluyó a 59 participantes de entre seis y 18 años de edad con PC cuadripléjica. Las concentraciones séricas de calcio, fósforo, metabolito 25OHD, hormona paratiroidea (PTH), fosfatasa alcalina y hormonas tiroideas se determinaron utilizando métodos estandarizados. La medición de DMO se obtuvo de la columna lumbar expresada en g/cm2 y puntaje Z. Se realizaron pruebas t de Student no pareada, Chi-cuadrado, razón de momios y correlación de Pearson. Resultados: los participantes con PC y desnutrición tenían concentraciones séricas más bajas de calcio, fósforo y fosfatasa alcalina. Los participantes con DMO baja tuvieron menor concentración sérica de calcio, fósforo y fosfatasa alcalina. Los participantes con DMO baja y normal tenían deficiencia de vitamina D (27.1% y 10%) e insuficiencia (35.4% y 30%), respectivamente. Hubo una correlación significativa entre DMO y las concentraciones séricas de calcio, fósforo, fosfatasa alcalina, vitamina D y hormona estimulante de la tiroides. Conclusión: la desnutrición y la alteración del estado nutricio de la vitamina D se asociaron con DMO baja y alteraciones de los indicadores bioquímicos del metabolismo óseo. Se demostró una asociación entre DMO e indicadores bioquímicos y hormonales del metabolismo óseo en niños con PC cuadripléjica

Densidad mineral ósea e indicadores bioquímicos y hormonales en niños con parálisis cerebral cuadripléjica.

INTRODUCTION: Introduction: children with cerebral palsy (CP) have multiple risk factors for low bone mineral density or osteoporosis. Objective: to explore the association between bone mineral density (BMD) and biochemical and hormonal indicators of bone metabolism in children with quadriplegic cerebral palsy (CP). Methods: a cross-sectional analytical study included 59 participants from six to 18 years of age with quadriplegic CP. Serum concentrations of calcium, phosphorus, 25OHD metabolite, parathyroid hormone (PTH), alkaline phosphatase, and thyroid hormones were determined using standardized methods. The BMD measurement was obtained from the lumbar spine expressed in g/cm2 and Z-score. Unpaired Student's t-test, Chi-square test, odds ratio and Pearson's correlation were performed. Results: participants with CP and malnutrition had lower serum concentrations of calcium, phosphorus and alkaline phosphatase. Those who had low BMD showed lower serum concentrations of calcium, phosphorus and alkaline phosphatase. Most participants with low and normal BMD had vitamin D deficiency (27.1% and 10%) and insufficiency (35.4% and 30%), respectively. There was a significant correlation between BMD and serum concentrations of calcium, phosphorus, alkaline phosphatase, vitamin D and thyroid-stimulating hormone (TSH). There were no differences in the biochemical and hormonal indicators by level of gross motor function, use of anticonvulsants and oral versus enteral feeding method. Conclusion: malnutrition and alteration of vitamin D nutritional status were associated with low BMD and alterations of biochemical indicators of bone metabolism in pediatric patients with quadriplegic CP. The relationship between BMD and biochemical indicators of bone metabolism in children with quadriplegic CP was also demonstrated.

INTRODUCCIÓN: Introducción: los niños con parálisis cerebral (PC) presentan múltiples factores de riesgo de densidad mineral ósea baja u osteoporosis. Objetivo: explorar la asociación entre la baja densidad mineral ósea (DMO) e indicadores bioquímicos y hormonales del metabolismo óseo en niños con PC cuadripléjica. Métodos: un estudio transversal analítico incluyó a 59 participantes de entre seis y 18 años de edad con PC cuadripléjica. Las concentraciones séricas de calcio, fósforo, metabolito 25OHD, hormona paratiroidea (PTH), fosfatasa alcalina y hormonas tiroideas se determinaron utilizando métodos estandarizados. La medición de DMO se obtuvo de la columna lumbar expresada en g/cm2 y puntaje Z. Se realizaron pruebas t de Student no pareada, Chi-cuadrado, razón de momios y correlación de Pearson. Resultados: los participantes con PC y desnutrición tenían concentraciones séricas más bajas de calcio, fósforo y fosfatasa alcalina. Los participantes con DMO baja tuvieron menor concentración sérica de calcio, fósforo y fosfatasa alcalina. Los participantes con DMO baja y normal tenían deficiencia de vitamina D (27.1% y 10%) e insuficiencia (35.4% y 30%), respectivamente. Hubo una correlación significativa entre DMO y las concentraciones séricas de calcio, fósforo, fosfatasa alcalina, vitamina D y hormona estimulante de la tiroides. Conclusión: la desnutrición y la alteración del estado nutricio de la vitamina D se asociaron con DMO baja y alteraciones de los indicadores bioquímicos del metabolismo óseo. Se demostró una asociación entre DMO e indicadores bioquímicos y hormonales del metabolismo óseo en niños con PC cuadripléjica.

Energy expenditure is associated with age, anthropometric indicators and body composition in children with spastic cerebral palsy.

INTRODUCTION: proper estimation of energy requirements in children with cerebral palsy (CP) is essential in ensuring that their energy needs are optimally met. OBJECTIVE: therefore, the purpose of this study was to demonstrate that resting energy expenditure (REE) and total energy expenditure (TEE) are associated with age, anthropometric indicators and body composition in children with spastic cerebral palsy. METHODS: a cross-sectional study included 79 participants with spastic CP from 24 months to 16 years nine months. Weight and height (estimated by lower leg length) were obtained; body composition and energy expenditure were estimated by bioelectrical impedance analysis. ANOVA, post hoc tests, the Pearson correlation and determination coefficients (R2) were performed. RESULTS: significant gradual increases according to age in REE and TEE (both in kcal/d) were observed. There were highly significant positive correlations between REE and TEE (kcal/d, kcal/cm/d) with fat-free mass (FFM) and fat mass (FM), but negative correlations between REE (kcal/ kg/d) with body composition and energy indicators. FFM and total body water, and to a lesser extent FM, explained a high percentage of the direct variability of REE and TEE in kcal/d and the inverse in kcal/kg/d. CONCLUSIONS: as age increased, energy expenditure also increased. The estimated energy expenditure in kcal/cm/d did not differ with age and sex. The estimated energy expenditure, based on height, would be a practical and reliable method for estimating energy expenditure and ensuring adequate nutritional status.

Energy expenditure is associated with age, anthropometric indicators and body composition in children with spastic cerebral palsy / El gasto energético se asocia con la edad, los indicadores antropométricos y la composición corporal en niños con parálisis cerebral espástica

Introduction: proper estimation of energy requirements in children with cerebral palsy (CP) is essential in ensuring that their energy needs are optimally met. Objective: therefore, the purpose of this study was to demonstrate that resting energy expenditure (REE) and total energy expenditure (TEE) are associated with age, anthropometric indicators and body composition in children with spastic cerebral palsy. Methods: a cross-sectional study included 79 participants with spastic CP from 24 months to 16 years nine months. Weight and height (estimated by lower leg length) were obtained; body composition and energy expenditure were estimated by bioelectrical impedance analysis. ANOVA, post hoc tests, the Pearson correlation and determination coefficients (R2) were performed. Results: significant gradual increases according to age in REE and TEE (both in kcal/d) were observed. There were highly significant positive correlations between REE and TEE (kcal/d, kcal/cm/d) with fat-free mass (FFM) and fat mass (FM), but negative correlations between REE (kcal/ kg/d) with body composition and energy indicators. FFM and total body water, and to a lesser extent FM, explained a high percentage of the direct variability of REE and TEE in kcal/d and the inverse in kcal/kg/d. Conclusions: as age increased, energy expenditure also increased. The estimated energy expenditure in kcal/cm/d did not differ with age and sex. The estimated energy expenditure, based on height, would be a practical and reliable method for estimating energy expenditure and ensuring adequate nutritional status

Introducción: la estimación adecuada de los requerimientos de energía en niños con parálisis cerebral (PC) es indispensable para garantizar que sus necesidades energéticas se cumplan de manera optima. Objetivo: demostrar que el gasto de energía en reposo (GER) y el gasto energético total (GET) se asocian con la edad y los indicadores antropométricos y de composición corporal en niños con parálisis cerebral (PC) espástica. Métodos: un estudio transversal incluyo 79 participantes con PC espástica de 24 meses a 16 años y nueve meses de edad. Se obtuvieron el peso y la talla (estimados por la longitud de la pierna inferior); la composición corporal y el gasto de energía se estimaron mediante análisis de impedancia bioelectrica. Se realizaron ANOVA, pruebas post hoc, los coeficientes de correlación y determinación de Pearson (R2). Resultados: se observaron incrementos graduales significativos según la edad en GER y GET (ambos en kcal/d). Hubo correlaciones positivas altamente significativas entre GER y GET (kcal/d, kcal/cm/d) con masa libre de grasa (MLG) y masa grasa (MG) y correlaciones negativas entre GER (kcal/kg/d) con la composición corporal e indicadores de energía. La MLG y el agua corporal total, y en menor grado la MG, explicaron un porcentaje elevado de la variabilidad de GER y GET en kcal/d y en kcal/kg/d Conclusiones: conforme aumento la edad, aumento también el gasto de energía. El gasto energético estimado en kcal/cm/d no difirió con la edad y el sexo. Por tanto, el gasto energético basado en la talla seria un método practico y confiable para garantizar un estado nutricio adecuado

Differences between manual and automatic analysis in determining the severity of obstructive sleep apnea using home sleep apnea testing.

INTRODUCTION: Home sleep apnea testing (HSAT) is a diagnostic measure for obstructive sleep apnea hypopnea syndrome (OSAHS) in moderate/high risk patients. Some HSAT companies contain automatic analysis (AA). However, guidelines recommend manual analysis (MA) despite the weak evidence for this recommendation. OBJECTIVE: Evaluate the concordance between AA and MA of HSAT to make either a diagnosis and severity classification. METHODS: We evaluated AA and MA of HSAT between 2015 and 2016. The study was a blind analysis reviewed by two physicians using currents recommendations. The differences between AA and MA were compared with single variable T analysis, inter-scorer agreement for diagnosis was evaluated with Cohen Kappa coefficient, correlation was examined using Tau-b Kendall, and Bland-Altman plot was constructed to analyze differences between AA and MA. RESULTS: One hundred and ninety-eight patients were included. In our study, the mean age was 50 ± 15 years, 83% male, BMI 30 ± 5 and neck circumference 41 ± 4 cm. Eighty-two percent of subjects showed an apnea-hypopnea index (AHI) > 5 ev/h. Thirty-five percent of patients with OSAHS were mild (AHI: 5-15 ev/h), 34% moderate and 31% severe (>30 ev/h). The kappa coefficient between physicians was 1.0 (high), between AA and MA was 0.58 (moderate) for the diagnosis of OSAHS and 0.33 (weak) for severity with 0.70 Tau-b. The AA underestimates the IAH -8 ev/h, (95% CI -9 to -7 ev/h, p < 0.001) and delivers a misclassification of severity by 47%. CONCLUSIONS: AA underestimates the rate of respiratory events and alters the classification of the severity of the disease and may modify the therapeutic approach.

Bone mineral density and nutritional status in children with quadriplegic cerebral palsy.

This study demonstrated the relationship of low bone mineral density (BMD) with the degree of motor impairment, method of feeding, anthropometric indicators, and malnutrition in children with quadriplegic cerebral palsy (CP). The control of these factors could optimize adequate bone mineralization, avoid the risk of osteoporosis, and would improve the quality of life. PURPOSE: The purpose of the study is to explore the relationship between low BMD and nutritional status in children with quadriplegic CP. METHODOLOGY: A cross-sectional analytical study included 59 participants aged 6 to 18 years with quadriplegic CP. Weight and height were obtained with alternative measurements, and weight/age, height/age, and BMI/age indexes were estimated. The BMD measurement obtained from the lumbar spine was expressed in grams per square centimeter and Z score (Z). Unpaired Student's t tests, chi-square tests, odds ratios, Pearson's correlations, and linear regressions were performed. RESULTS: The mean of BMD Z score was lower in adolescents than in school-aged children (p = 0.002). Patients with low BMD were at the most affected levels of the Gross Motor Function Classification System (GMFCS). Participants at level V of the GMFCS were more likely to have low BMD than levels III and IV [odds ratio (OR) = 5.8 (confidence interval [CI] 95% 1.4, 24.8), p = 0.010]. There was a higher probability of low BMD in tube-feeding patients [OR = 8.6 (CI 95% 1.0, 73.4), p = 0.023]. The probability of low BMD was higher in malnourished children with weight/age and BMI indices [OR = 11.4 (1.3, 94), p = 0.009] and [OR = 9.4 (CI 95% 1.1, 79.7), p = 0.017], respectively. CONCLUSION: There was a significant relationship between low BMD, degree of motor impairment, method of feeding, and malnutrition. Optimizing these factors could reduce the risk of osteopenia and osteoporosis and attain a significant improvement of quality of life in children with quadriplegic CP.