Fishing through the cracks: The unregulated nature of global squid fisheries.

While most research has focused on the legality of global industrial fishing, unregulated fishing has largely escaped scrutiny. Here, we evaluate the unregulated nature of global squid fisheries using AIS data and nighttime imagery of the globalized fleet of light-luring squid vessels. We find that this fishery is extensive, fishing 149,000 to 251,000 vessel days annually, and that effort increased 68% over the study period 2017-2020. Most vessels are highly mobile and fish in multiple regions, largely (86%) in unregulated areas. While scientists and policymakers express concerns over the declining abundance of squid stocks globally and regionally, we find a net increase in vessels fishing squid globally and spatial expansion of effort to novel areas. Since fishing effort is static in areas with increasing management, and rising in unmanaged areas, we suggest actors may take advantage of fragmented regulations to maximize resource extraction. Our findings highlight a profitable, but largely unregulated fishery, with strong potential for improved management.

Detection of Trypanosoma cruzi infection by PCR in Canis lupus familiaris and their ectoparasites in Chile.

Chronic Chagas disease affects humans and animals, involving rural and urban inhabitants. Dogs participate in the maintenance and transmission of Trypanosoma cruzi. The objective of this study was to evaluate the presence of T. cruzi in dogs and their ticks and fleas, in a rural area of Central Chile. Trypanosoma cruzi was detected by PCR both in dogs and ectoparasites. From the blood samples obtained, 57% were infected by T. cruzi, 5.4% of the ticks detected were positive, and all fleas were negative. Additionally, we performed electrocardiograms and found supraventricular arrhythmia in 44% of T. cruzi-positive dogs. Nevertheless, their risk for supraventricular arrhythmias was not higher in infected versus noninfected dogs. Considering the detected infection levels, dogs act as T. cruzi hosts in Central Chile, and ticks could be used as an indicator of infection when blood samples are not available. However, at this point, there is no indication that these ticks could pass on the parasite to another host. Periodic ectoparasitic treatment of pets should reduce the chance of vectorial transmission of T. cruzi and improve canine health; however, this is an uncommon practice among rural communities, so governmental programs are encouraged to tackle this problem.

[A pediatric cohort with Gilles de la Tourette syndrome]. / Descripción de una cohorte pediátrica con síndrome de Gilles de la Tourette.

INTRODUCTION: Tourette Syndrome (TS) is a common disorder with chronic motor and phonic tics, associated with neuropsychiatric comorbidities. OBJECTIVE: To characterize clinical-demographic variables, comor bidities, and management in a pediatric cohort with TS and compare them according to sex. PATIENTS AND METHOD: A retrospective cohort of patients < 18 years old with TS followed up between 2000 and 2018 was evaluated. Clinical records were reviewed obtaining variables of age, sex, reason for consul tation, age of onset, type and complexity of tics, follow-up time, family history, obsessive behaviors, neuropsychiatric and psychopathological comorbidity, neurological disorders, and pediatric mor bidity. Studies and treatments performed, and management used were also recorded. RESULTS: 126 patients were included, aged between 4-18 years, 103 males (sex F:M ratio = 4.5:1), with a follow-up of 4.8 ± 1.9 years. The mean age of tic onset and TS diagnosis was 6.5 ± 2.2 and 9.4 ± 2.7 years, res pectively, and a diagnostic latency of 2.8 ± 2.2 years. The first consultation in the total of girls was due to tics, in contrast to the boys of whom 14.6% (n = 15) consulted due to comorbidities. There was 38.9% of tics and 8,7% of TS. Neuropsychiatric comorbidities were frequent, recorded in 69.8%, with Attention Deficit Disorder (43.6%) and Obsessive-Compulsive Disorder (20.6%) standing out.110 cases (87.3%), received pharmacological therapy and 54.4% required three or more drugs at some point in their evolution. Only in 16 cases (12.7%), no pharmacological therapy was required, only psychoeducation in 7 (5.6%) cases, and behavioral therapy in 9 cases (7.1%). CONCLUSIONS: The cli nical characteristics of our children with TS are similar to international descriptions, highlighting that in the group of boys, the first consultation could be due to comorbidity, recognizing later the presence of tics. Although psychoeducation and behavioral therapies are recommended as first-line management, most of the patients in this group required pharmacological therapy.

Mola hidatidiforme completa con preeclampsia e hipertiroidismo: presentación clásica / Complete hydatidiform mole with preeclampsia and hyperthyroidism: classic presentation

Introducción: La enfermedad trofoblástica gestacional es un espectro de enfermedades de la placenta, existiendo entre ellas algunas con potencial de invasión y metástasis, dentro de las cuales se incluye la mola invasiva, coriocarcinoma, tumores del sitio de inserción de la placenta y mola hidatidiforme. Esta última a su vez se divide en mola completa y parcial, diferenciándose en histopatología, morfología, cariotipo, malignización y comportamiento clínico, que es el punto al cual nos referiremos en este caso. Caso clínico: mujer de 46 años ingresa por hemoptisis, metrorragia, disnea a pequeños esfuerzos, ortopnea y disnea paroxística nocturna, asociado a hipertensión, taquicardia, masa hipogástrica firme e inmóvil y edema de extremidades. Se realiza ecografía abdominal compatible con MH y bhCG elevada. Evoluciona con crisis hipertensivas, insuficiencia cardiaca congestiva y tirotoxicosis. Inicia trabajo de parto expulsando 665 grs de mola, presentando posteriormente a legrado uterino anemia severa y shock hipovolémico, requiriendo transfusiones y drogas vasoactivas. Se recupera progresivamente con posterior control al alta de bhCG indetectable a los 6 meses. Discusión: Es infrecuenta en la actualidad la presentación clínica clásica de la mola hidatidiforme completa debido al diagnóstico y control precoz del embarazo asociado al uso masivo de la ecografía. Sin embargo es relevante tener un alto grado de sospecha de esta patología debido a sus graves consecuencias, y así realizar una derivación y manejo precoz.

Background: Gestational trophoblastic disease is a spectrum of diseases of the placenta, existing some with potential for invasion and metastasis, among which include invasive mole, choriocarcinoma, tumors of the insertion site of the placenta and hydatidiform mole. The last one is divided into complete and partial mole, differing in histopathology, morphology, karyotype, and clinical malignant behavior, witch is the point we refer to in this case. Case report: 46 year old woman admitted for hemoptysis, metrorrhagia, dyspnea on slight exertion, orthopnea and paroxysmal nocturnal dyspnea associated with hypertension, tachycardia, firm and immovable hypogastric mass and limb edema. Abdominal ultrasound compatible with MH and high BhCG is performed. Evolve with hypertensive crisis, congestive heart failure and thyrotoxicosis. Labor starts driving out 665 grams of mole, after the curettage present hypovolemic shock and severe anemia requiring transfusions and vasoactive drugs. It gradually recovers further control the discharge of BhCG undetectable at 6 months. Discussion: It is currently infrequent classical clinical presentation of complete hydatidiform mole due to early diagnosis and management of pregnancy associated with the widespread use of ultrasound. However it is important to have a high degree of suspicion of this disease because of its serious consequences, and thus make a referral and early management.

Percepción de la vivencia del acceso oportuno al diagnóstico del VIH, en personas viviendo con VIH/SIDA: Acceso oportuno al test de VIH / Perceptions about the elisa test of people diagnosed at the aids stage

Background: The delay in the diagnosis of AIDS results in higher treatment costs. Aim: To reveal the experiences of people who were diagnosed in the AIDS stage about the access to the ELISA test. Material and Methods: In depth interviews were carried out to 15 participants from public hospitals who were in the AIDS stage at the moment of the diagnosis. The main questions asked were about the motivations to take the test, the barriers found and the help received from the health care personnel. All interviews were recorded and analyzed according to Kripperdorff. Results: The three categories that emerged were the motivations to take the test, the facilitators found and the difficulties to access to the test. The main motivation was a condition of vulnerability due to the suspicion or certainty of being infected. The main facilitator was the sensation of being accepted and not discriminated. The main difficulties were the fear of having a positive test and of being discriminated and the lack of information. Conclusions: Knowing these experiences will help to improve the early detection of HIV infections.

Uso de la alitretinoína oral para el tratamiento del eczema crónico de manos grave y refractario al tratamiento en el sistema sanitario público español: descripción y análisis de la práctica clínica actual / Oral Alitretinoin in the Treatment of Severe Refractory Chronic Hand Eczema in the Spanish National Health System: Description and Analysis of Current Clinical Practice

INTRODUCCIÓN: El eczema de manos (ECM) afecta a cerca del 10% de la población, presentándose entre el 5 y el 7% de los casos como una enfermedad crónica grave y siendo refractario al tratamiento con corticoides tópicos entre el 2 y el 4% de las veces. El propósito del artículo es describir el uso de la alitretinoína oral en pacientes con ECM refractario a corticoides tópicos potentes en el ámbito sanitario público español. MATERIAL Y MÉTODOS: Estudio observacional descriptivo, exploratorio, transversal, basado en la revisión retrospectiva de historias clínicas de pacientes con ECM en tratamiento con alitretinoína en el ámbito sanitario público español. RESULTADOS: Se revisaron 62 historias clínicas de pacientes de 13 centros distribuidos en 5 comunidades autónomas del territorio español. Alitretinoína se utilizó predominantemente a dosis de 30mg/día, principalmente en un único ciclo, tras el cual la mayoría de pacientes lograron una respuesta clínica satisfactoria según el juicio médico. Los eventos adversos fueron todos previsibles y en línea con los tratamientos sistémicos con retinoides. Los dermatólogos estuvieron de acuerdo en que los beneficios clínicos logrados con alitretinoína favorecían la adherencia al tratamiento y una reincorporación más rápida de los pacientes al trabajo. CONCLUSIÓN: Los resultados muestran un uso de alitretinoína oral en línea con las recomendaciones establecidas así como la buena respuesta al tratamiento asociado y los pocos efectos adversos. Los dermatólogos coinciden que los beneficios alcanzados favorecen la adherencia al tratamiento y mejoran la calidad de vida relacionada con la salud de los pacientes

BACKGROUND AND OBJECTIVE: Hand eczema affects nearly 10% of the population. The condition becomes severe and chronic in 5% to 7% of cases and is refractory to topical corticosteroids in 2% to 4%. This study aimed to describe the current use of oral alitretinoin in treating Spanish national health system patients with hand eczema that is refractory to potent topical corticosteroids. MATERIALS AND METHODS: Observational, descriptive, exploratory, cross-sectional study based on the retrospective analysis of records for patients with hand eczema treated with alitretinoin in the Spanish national health system. RESULTS: We reviewed the records for 62 patients in 13 hospitals in 5 different administrative areas (autonomous communities) of Spain. Alitretinoin was usually used at a dosage of 30mg/d. In most cases the physician judged the clinical response to be satisfactory after a single cycle. The recorded adverse effects were foreseeable and of the type reported for systemic retinoids. The dermatologists agreed that the clinical benefits achieved with alitretinoin favored adherence to treatment and an early return to work. CONCLUSIONS: The results show that oral alitretinoin is being used according to established recommendations and that response is good, with few adverse effects. The dermatologists agreed that the benefits favored adherence and improved the patients' health related quality of life

Oral Alitretinoin in the Treatment of Severe Refractory Chronic Hand Eczema in the Spanish National Health System: Description and Analysis of Current Clinical Practice.

BACKGROUND AND OBJECTIVE: Hand eczema affects nearly 10% of the population. The condition becomes severe and chronic in 5% to 7% of cases and is refractory to topical corticosteroids in 2% to 4%. This study aimed to describe the current use of oral alitretinoin in treating Spanish national health system patients with hand eczema that is refractory to potent topical corticosteroids. MATERIALS AND METHODS: Observational, descriptive, exploratory, cross-sectional study based on the retrospective analysis of records for patients with hand eczema treated with alitretinoin in the Spanish national health system. RESULTS: We reviewed the records for 62 patients in 13 hospitals in 5 different administrative areas (autonomous communities) of Spain. Alitretinoin was usually used at a dosage of 30mg/d. In most cases the physician judged the clinical response to be satisfactory after a single cycle. The recorded adverse effects were foreseeable and of the type reported for systemic retinoids. The dermatologists agreed that the clinical benefits achieved with alitretinoin favored adherence to treatment and an early return to work. CONCLUSIONS: The results show that oral alitretinoin is being used according to established recommendations and that response is good, with few adverse effects. The dermatologists agreed that the benefits favored adherence and improved the patients' health related quality of life.

[Perceptions about the elisa test of people diagnosed at the aids stage]. / Percepción de la vivencia del acceso oportuno al diagnóstico del VIH, en personas viviendo con VIH/SIDA: Acceso oportuno al test de VIH.

BACKGROUND: The delay in the diagnosis of AIDS results in higher treatment costs. AIM: To reveal the experiences of people who were diagnosed in the AIDS stage about the access to the ELISA test. MATERIAL AND METHODS: In depth interviews were carried out to 15 participants from public hospitals who were in the AIDS stage at the moment of the diagnosis. The main questions asked were about the motivations to take the test, the barriers found and the help received from the health care personnel. All interviews were recorded and analyzed according to Kripperdorff. RESULTS: The three categories that emerged were the motivations to take the test, the facilitators found and the difficulties to access to the test. The main motivation was a condition of vulnerability due to the suspicion or certainty of being infected. The main facilitator was the sensation of being accepted and not discriminated. The main difficulties were the fear of having a positive test and of being discriminated and the lack of information. CONCLUSIONS: Knowing these experiences will help to improve the early detection of HIV infections.

[High flow nasal cannula in infants: Experience in a critical patient unit]. / Cánula nasal de alto flujo en lactantes: experiencia en una unidad de paciente crítico.

INTRODUCTION: The high flow nasal cannula (HFNC) is a method of respiratory support that is increasingly being used in paediatrics due to its results and safety. OBJECTIVE: To determine the efficacy of HFNC, as well as to evaluate the factors related to its failure and complications associated with its use in infants. PATIENTS AND METHOD: An analysis was performed on the demographic, clinical, blood gas, and radiological data, as well as the complications of patients connected to a HFNC in a critical care unit between June 2012 and September 2014. A comparison was made between the patients who failed and those who responded to HFNC. A failure was considered as the need for further respiratory support during the first 48hours of connection. The Kolmogorov Smirnov, Mann-Whitney U, chi squared and the Exact Fisher test were used, as well as correlations and a binary logistic regression model for P≤.05. RESULTS: The study included 109 patients, with a median age and weight: 1 month (0.2-20 months) and 3.7kg (2-10kg); 95 percentile: 3.7 months and 5.7kg, respectively. The most frequent diagnosis and radiological pattern was bronchiolitis (53.2%) and interstitial infiltration (56%). Around 70.6% responded. There was a significant difference between failure and response in the diagnosis (P=.013), radiography (P=018), connection context (P<.0001), pCO2 (median 40.7mmHg [15.4-67 mmHg] versus 47.3mmHg [28.6-71.3mmHg], P=.004) and hours on HFNC (median 60.75hrs [5-621.5 hrs] versus 10.5hrs [1-29 hrs], P<.0001). The OR of the PCO2 ≥ 55mmHg for failure was 2.97 (95% CI; 1.08-8.17; P=.035). No patient died and no complications were recorded. CONCLUSION: The percentage success observed was similar to that published. In this sample, the failure of HFNC was only associated with an initial pCO2 ≥ 55mmHg. On there being no complications reported as regards it use, it is considered safe, although a randomised, controlled, multicentre study is required to compare and contrast these results.

Cánula nasal de alto flujo en lactantes: experiencia en una unidad de paciente crítico / High flow nasal cannula in infants: Experience in a critical patient unit

Introducción: La cánula nasal de alto flujo (CNAF) es un método de soporte respiratorio cada vez más utilizado en pediatría por sus resultados y seguridad. Objetivo: Determinar la efectividad de la CNAF, evaluar factores asociados a fracaso y complicaciones relacionadas con su uso en lactantes. Pacientes y método: Se analizaron los datos demográficos, clínicos, gasométricos, radiológicos y complicaciones de los pacientes conectados a CNAF en una unidad crítica entre junio de 2012 y septiembre de 2014. Se compararon los pacientes que fracasaron con los respondedores a CNAF, considerándose fracaso la necesidad de un mayor soporte respiratorio durante las primeras 48 h de conexión. Se utilizó test de Kolmogorov Smirnov, U de Mann-Whitney, Chi cuadrado, test exacto de Fisher, correlaciones y Modelo de regresión logística binaria para p ≤ 0,05. Resultados: Un total de 109 pacientes. Mediana de edad y peso: 1 mes (0,2-20 meses) y 3,7 kg (2-10 kg); percentil 95: 3,7 meses y 5,7 kg respectivamente. El diagnóstico y patrón radiológico más frecuente fue bronquiolitis (53,2%) e infiltrado intersticial (56%). Un 70,6% respondió. Hubo diferencia significativa entre fracaso y respuesta en el diagnóstico (p = 0,013), radiografía (p = 0,018), contexto de conexión (p < 0,0001), pCO2 (mediana 40,7 mm Hg [15,4-67 mm Hg] versus 47,3 mm Hg [28,6-71,3 mm Hg], p = 0,004) y horas de CNAF (mediana 60,75 h [5-621,5 h] versus 10,5 h [1-29 h], p < 0,0001). El OR de PCO2 ≥ 55 mm Hg para fracaso fue 2,97 (IC 95%: 1,08-8,17; p = 0,035). Ningún paciente falleció ni registró complicaciones. Conclusión: El porcentaje de éxito observado fue similar a lo publicado. En esta muestra el fracaso de CNAF solo se asoció a una pCO2 inicial ≥ 55 mm Hg. Su uso se consideró seguro al no reportarse complicaciones relacionadas a su utilización. Se requiere de un estudio multicéntrico, aleatorizado y controlado para contrastar estos resultados.

Introduction: The high flow nasal cannula (HFNC) is a method of respiratory support that is increasingly being used in paediatrics due to its results and safety. Objective: To determine the efficacy of HFNC, as well as to evaluate the factors related to its failure and complications associated with its use in infants. Patients and method: An analysis was performed on the demographic, clinical, blood gas, and radiological data, as well as the complications of patients connected to a HFNC in a critical care unit between June 2012 and September 2014. A comparison was made between the patients who failed and those who responded to HFNC. A failure was considered as the need for further respiratory support during the first 48 hours of connection. The Kolmogorov Smirnov, Mann-Whitney U, chi squared and the Exact Fisher test were used, as well as correlations and a binary logistic regression model for P ≤ .05. Results: The study included 109 patients, with a median age and weight: 1 month (0.2-20 months) and 3.7 kg (2-10 kg); 95 percentile: 3.7 months and 5.7 kg, respectively. The most frequent diagnosis and radiological pattern was bronchiolitis (53.2%) and interstitial infiltration (56%). Around 70.6% responded. There was a significant difference between failure and response in the diagnosis (P = .013), radiography (P = 018), connection context (P < .0001), pCO2 (median 40.7 mmHg [15.4-67 mmHg] versus 47.3 mmHg [28.6-71.3 mmHg], P = .004) and hours on HFNC (median 60.75 hrs [5-621.5 hrs] versus 10.5 hrs [1-29 hrs], P < .0001). The OR of the PCO2 ≥ 55 mmHg for failure was 2.97 (95% CI; 1.08-8.17; P = .035). No patient died and no complications were recorded. Conclusion: The percentage success observed was similar to that published. In this sample, the failure of HFNC was only associated with an initial pCO2 ≥ 55 mmHg. On there being no complications reported as regards it use, it is considered safe, although a randomised, controlled, multicentre study is required to compare and contrast these results.

Instrucciones para la utilización de la escala mincir para valorar calidad metodológica de estudios de terapia / Instructions for the use of mincir scale to assess methodological quality in therapy studies

La calidad metodológica (CM) es un constructo multidimensional complejo que evalúa diferentes variables. Una aproximación al tema fue la generación de escalas para valorar CM de estudios de terapia, diagnóstico y pronóstico por parte de nuestro grupo de trabajo; todas ellas validadas. El objetivo de este artículo es entregar una pauta para estandarizar la aplicación para la escala MINCir, para valorar CM de estudios de terapia. Se realiza una descripción detallada de cada ítem y dominio que conforman la escala MINCir Terapia, junto con una guía de cómo dar respuesta a cada uno de ellos. Se generó una guía de usuario para aplicar la escala MINCir Terapia.

Methodological quality (MQ) is a complex multidimensional construct that tests different types of variables. An approach to this issue was the potential to generate a group of valid scales to assess MQ in therapy, diagnosis and prognosis studies. The aim of this article is to provide a guideline to standardize the implementation of a MinCir scale to assess MQ in therapy studies. A detailed description of each item and discipline of the therapy MinCir scale is provided, along with guidelines on how to respond each query. A user guide for applying the therapy MinCir scale was generated.

Perfil de riesgo de pacientes adultos sometidos a traslado secundario por móviles avanzados del sistema de atención médica de urgencia del Área Metropolitana / Risk assessment of critical patients requiring ambulance transfers

Background: Secondary transfers of critical patients between hospitals may be associated with risk of death and complications Aim: To determine the risk profile of adults subjected to secondary transfers using the Emergency Medical Attention System (SAMU) operating in Metropolitan Santiago. Material and Methods: Cross sectional study including 432 adults undergoing secondary transfers using SAMU between January 1 and June 30 2010. Demographic, biomedical, hemodynamic and transfer data were obtained. Cardiopulmonary arrests (CPR) and an increase in the Rapid Emergency Medicine Score (REMS) scale, were considered as outcome variables. Results: CPR occurred in 6.4% of the study population and was significantly associated with the initial REMS score and the need for hemodynamic and ventilator support. The initial REMS score was a good predictor of the final REMS score. The final REMS was significantly associated with the presence of comorbidities and the need for hemodynamic and ventilator support. Conclusions: REMS is a useful scale to assess the risk profile of critical patients requiring transfers between hospitals.

[Risk assessment of critical patients requiring ambulance transfers]. / Perfil de riesgo de pacientes adultos sometidos a traslado secundario por móviles avanzados del sistema de atención médica de urgencia del Área Metropolitana.

BACKGROUND: Secondary transfers of critical patients between hospitals may be associated with risk of death and complications AIM: To determine the risk profile of adults subjected to secondary transfers using the Emergency Medical Attention System (SAMU) operating in Metropolitan Santiago. MATERIAL AND METHODS: Cross sectional study including 432 adults undergoing secondary transfers using SAMU between January 1 and June 30 2010. Demographic, biomedical, hemodynamic and transfer data were obtained. Cardiopulmonary arrests (CPR) and an increase in the Rapid Emergency Medicine Score (REMS) scale, were considered as outcome variables. RESULTS: CPR occurred in 6.4% of the study population and was significantly associated with the initial REMS score and the need for hemodynamic and ventilator support. The initial REMS score was a good predictor of the final REMS score. The final REMS was significantly associated with the presence of comorbidities and the need for hemodynamic and ventilator support. CONCLUSIONS: REMS is a useful scale to assess the risk profile of critical patients requiring transfers between hospitals.

Creencias y virus papiloma humano / Beliefs and human papilloma virus

Antecedentes: La infección por Virus Papiloma Humano (VPH) es una enfermedad de transmisión sexual, que afecta a un alto porcentaje de mujeres jóvenes de todo el mundo. Su alta incidencia está asociada al inicio precoz y mayor frecuencia de la actividad sexual. A pesar de que la infección por VPH está ampliamente difundida en el mundo, es una infección aún desconocida por la población, lo que asociado a diversos factores culturales, favorece el desarrollo de múltiples creencias que dificultan la prevención y diagnóstico precoz. Objetivo: Identificar, describir y analizar las principales creencias relacionadas al VPH. Método: Se realizó búsqueda bibliográfica en MEDLINE, ProQuest, Scielo y metabuscador Tripdatabase, seleccionándose para su análisis, 45 artículos. Análisis del tema: La educación en salud debe considerar aspectos cognitivos, sociales y culturales de donde emergen las creencias de la población para poder abordarlas con un modelo teórico que lo sustente. Las creencias identificadas en esta revisión corresponden a la relación de infección por VPH y cáncer de cuello uterino en donde en general esta asociación es reconocida; creencias en relación al riesgo de contraer la infección por VPH asociado al nivel de conocimiento; estoicismo; negación y fatalismo/familismo presente preferentemente en las mujeres en donde niegan su enfermedad postergando su diagnóstico y tratamiento por mantener el bienestar de la familia.

Background: The infection produced by Human Papilloma Virus (HPV) is a sexually transmitted disease that affects a large percentage of young women around the world. This high incidence of HPV infection is associated with early onset and greater frequency of sexual activity. Although HPV infection is widespread in the world, is still an unknown infection, which is associated with cultural factors that favor the development of multiple beliefs that hinder the prevention and early diagnosis. Objective: To identify, describe and analyze the major beliefs that limit HPV detection. Methods: Literature search was carried out in MEDLINE, Pro-Quest, Scielo and Tripdatabase metasearch, selecting 45 articles for analysis. Analysis of the theme: The health education should consider cultural and social cognitive aspects of a given society and culture from which they emerge to address these beliefs with a theoretical model to support it. The beliefs identified in this review correspond to the relationship between HPV infection and cervical cancer where the association is generally recognized, beliefs regarding the risk of HPV infection associated with the level of knowledge, stoicism, denial and fatalism/familism preferably present in women who deny their illness where diagnosis and treatment are postponed for maintaining the family and others.

Intervenciones educativas para la prevención del cáncer cervicouterino / Educational interventions for the prevention of cervical cancer

Antecedentes: El cáncer cervicouterino (CC) se ha convertido en los últimos años en el cáncer más común en la mujer. La detección precoz a través del screening de PAP ha sido insuficiente, siendo indispensable buscar nuevas estrategias para prevenirlo, una de las cuales es la incorporación de intervenciones educativas. Objetivos: Conocer las intervenciones educativas destinadas a la prevención del CC e identificar sus características principales. Método: Se realizó búsqueda bibliográfica en MEDLINE, ProQuest, Scielo y metabuscador Tripdatabase, seleccionándose para su análisis, 15 artículos que respondían al objetivo planteado. Análisis: Las intervenciones educativas utilizadas para la prevención del CC abordan temas como el conocimiento general sobre CC, PAP y HPV, las creencias sobre CC, y las actitudes preventivas entre otros. Los folletos educativos y las sesiones de discusión son las metodologías más utilizadas en este tipo de intervenciones, midiéndose la efectividad de éstas a través de la aplicación de pre y post test, ya sea inmediatamente después de la intervención, o a lo largo del tiempo. Se observa que este tipo de intervenciones educativas son efectivas para mejorar aspectos como el nivel de conocimiento en la población y la adquisición de conductas preventivas (adherencia a la toma de PAP). Conclusión: Considerando los beneficios de las intervenciones educativas en la prevención del CC, se hace fundamental ampliar su utilización, no olvidando que su empleo implica la prevención de la enfermedad, pudiéndose evitar muertes de mujeres jóvenes y el aumento de la carga de salud por enfermedad de un país.

Background: Cervical cancer has become in recent years the most common cancer in women. Early detection through screening of PAP has been insufficient, being indispensable to search for new strategies to prevent it, one of which is the incorporation of educational interventions. Objective: To educational interventions aimed at preventing cervical cancer and identify its main features. Method: Literature search was conducted in MEDLINE, ProQuest, Scielo and Tripdatabase, selecting for analysis, 15 research articles that reflected the purpose stated. Analysis: Educational interventions used to address cervical cancer prevention topics such as general knowledge about cervical cancer, PAP and HPV, cervical cancer beliefs, attitudes, preventive against this disease, among others. The educational brochures (pamphlets) and discussion sessions are the methodologies used in these interventions, measuring the effectiveness of these through the application of pre and post test, either immediately after surgery, or over time. Note that this type of educational interventions are effective in improving aspects such as the level of knowledge in the population and the acquisition of preventive behavior (adherence to PAP). Conclusion: Considering the benefits of educational interventions in the prevention of cervical cancer, it is essential to expand its use, not forgetting that their job involves the prevention of the disease, being able to prevent deaths of young women and increasing health burden of disease of a country.

Creencias sobre Papanicolaou y cáncer cérvicouterino en un grupo de mujeres chilenas / Beliefs about Papanicolaou and cervical cancer in a group of Chilean women

ANTECEDENTES: Son variadas las descripciones en relación a las creencias y como estas se relacionan con las conductas preventivas en cáncer cérvicouterino. OBJETIVO: Describir las creencias que tienen un grupo de mujeres chilenas pertenecientes al sistema público de atención acerca del Papanicolaou y cáncer cérvicouterino. MÉTODO: Estudio analítico de corte transversal realizado en 333 mujeres chilenas. Se estudiaron las creencias sobre el Papanicolaou y el cáncer cérvicouterino con un instrumento desarrollado y validado en población chilena (CPC-28). RESULTADOS: El 96% de las mujeres refiere tener un Papanicolaou en los últimos 3 años. El antecedente familiar es reportado por el 49,8% como causa de cáncer cérvicouterino. La barrera principal para adherir al Papanicolaou es la falta de conocimiento en cuanto a la edad requerida. La principal señal de acción que impulsa a que la mujer adhiera al tamizaje es la indicación entregada por el doctor. El beneficio mas importante es el cuidado de la salud. El 14,1% señala la presencia de relaciones sexuales como necesaria para adherir al tamizaje. El 17,4% de las mujeres se percibe fuera de riesgo de desarrollar un cáncer cérvicouterino. Las 6 dimensiones estudiadas se correlacionan entre si. CONCLUSIÓN: Las creencias deben ser consideradas al momento de intervenir una población, empezando por valorarlas y comprenderlas para posteriormente poder modificarlas.

BACKGROUND: Many reasons has been described about relation between beliefs and cervical cancer behaviors. OBJECTIVE: To describe the beliefs about cervical cancer and Pap test in a group of chilean women. METHOD: Cross sectional and analytic study was done with 333 chilean women. Beliefs about cervical cancer and Pap test was studied with the CPC-28 questionnaire, developed and validated in Chilean population. RESULTS: 96% have had a Pap test in the last 3 years. Family history about cervical cancer was reported by 49.8% as a cause of cervical cancer. The principal barrier to Pap test was lack of knowledge about the age. The principal cue to action was the doctor recommendation. The benefit was the care of health. The sexual intercourse was reported by 14.1% as necessary to take a Pap test. The risk to develop cervical cancer is reported by 17.4%. The six dimensions studied were correlated between them. CONCLUSION: The beliefs must be considered to education programs, firstly understanding and then modifying them.

Respuesta al tratamiento con alitretinoína oral en ECM refractario con eczema crónico de manos refractario al tratamiento con corticoides tópicos potentes: nuestra experiencia en 15 pacientes / Response to Treatment With Oral Alitretinoin in Patients With Chronic Hand Eczema That Is Refractory to Treatment With Potent Topical Corticosteroids: Experience in 15 Patients

Introducción: alitretinoína (ácido 9-cis-retinoico) es un derivado endógeno de la vitamina A, panagonista de ambas familias de receptores nucleares (RAR-α, -β, -γ, RXR-α, -β, -γ) estudiado en el eczema crónico de manos en diversos trabajos durante los últimos años con resultados prometedores. Objetivos: evaluar la eficacia y seguridad de alitretinoína oral en el tratamiento del eczema crónico de manos refractario al tratamiento con corticoides tópicos potentes, y su respuesta mantenida a largo plazo. Material y métodos: llevamos a cabo un estudio prospectivo, descriptivo y observacional. Se reclutaron un total de 15 pacientes con eczema crónico de manos refractarios al tratamiento con corticoides tópicos potentes, a los que se les administró una dosis de alitretinoína oral de 30mg/día durante tres meses, con un seguimiento posterior de 6 meses. Resultados: un total de 7 pacientes (47%) obtuvo respuesta completa con «manos limpias» al finalizar el tratamiento, 5 pacientes (33%) alcanzaron una respuesta parcial «manos casi limpias», un paciente (7%) obtuvo mejoría importante, otro paciente (7%) evidenció mejoría moderada y sólo un paciente (7%) no respondió al tratamiento. El porcentaje de recaída durante los 6 meses después de haber terminado el tratamiento fue del 54%. El tratamiento fue bien tolerado con efectos colaterales en el 50% de los pacientes, considerados leves (cefalea, hiperlipidemias, aumento leve de transaminasas, epigastralgias), excepto un paciente, que presentó una disminución importante de la hormona estimulante del tiroides. Conclusiones: los resultados presentados son coherentes con la propuesta de alitretinoína como un medicamento eficaz y seguro para el tratamiento a corto y medio plazo del eczema crónico de manos en pacientes refractarios a tratamiento con corticoides tópicos potentes (AU)

Background: Alitretinoin (9-cis-retinoic acid) is an endogenous derivative of vitamin A and functions as an agonist of both families of nuclear receptors (retinoic acid receptor-α, -β, -γ; retinoid X receptor-α, -β, -γ). It has been investigated in the treatment of chronic hand eczema in many studies in recent years and the results have been promising. Objectives: To evaluate the efficacy and safety of oral alitretinoin in the treatment of chronic hand eczema that is refractory to treatment with potent topical corticosteroids and to analyze the long-term response to treatment. Materials and methods: A prospective, observational, descriptive study was undertaken in 15 patients with chronic hand eczema that was refractory to treatment with potent topical corticosteroids. Patients were administered oral alitretinoin 30mg/d for 3 months followed by 6 months of follow-up. Results: A complete response, with “clear” hands was obtained in 7 patients (47%), 5 patients (33%) achieved a partial response (almost clear hands), 1 patient (7%) showed substantial improvement, 1 (7%) showed moderate improvement, and 1 patient (7%) did not respond to treatment. Relapse occurred within 6 months of treatment suspension in 54% of cases. The treatment was well tolerated. Side effects, observed in 50% of cases, were mild (headache, elevated lipid levels, slightly elevated transaminase levels, and epigastric pain), except in 1 patient, who had a substantial reduction in thyroid stimulating hormone levels. Conclusions: The results of our study support the proposal of alitretinoin as an effective and safe short-term and medium-term treatment for chronic hand eczema in patients whose disease is refractory to treatment with potent topical corticosteroids (AU)

Variables relacionadas con la calidad de atención de la consulta nutricional y percepción del éxito en el tratamiento para el control del peso corporal / Variables related to the quality of care nutritional consulting and perception

Objetivo: Determinar la asociación entre variables relacionadas con la calidad de la consulta nutricional y la percepción del paciente en el éxito del tratamiento para el control del peso corporal en un grupo de mujeres mayores de 20 años, habitantes de la Ciudad Autónoma de Buenos Aires o del Gran Buenos Aires. Metodología: Diseño observacional, transversal de correlación. Muestreo aleatorio simple de 97 mujeres que concurrieron por lo menos una vez a una consulta nutricional llevada a cabo por un Licenciado en Nutrición. Se realizó encuesta estructurada y voluntaria analizando como variable dependiente la percepción del éxito del tratamiento nutricional y como variables independientes, tres variables relacionadas con la calidad de la atención, como la escucha del profesional (buena, regular o mala), indicaciones adecuadas a gustos, hábitos y tolerancias digestivas y tipo de material entregado en la consulta. Resultados: Del total de la muestra estudiada el 61,9% percibió como exitoso a su último tratamiento para el control del peso corporal. Para la mayoría el ámbito físico donde se desarrolló la consulta fue adecuado (95,9%), siendo suficiente el tiempo destinado a la misma (89,7%), con buena escucha llevada a cabo por el profesional (75,3%). La percepción del éxito fue asociada significativamente con una buena escucha del profesional en la consulta (p: 0,0001) y con el manejo de indicaciones adecuadas a los gustos y hábitos de las pacientes (p: 0,002). No se observó asociación entre las indicaciones adecuadas a la tolerancia digestiva y el tipo de material empleado con la percepción de éxito en la consulta nutricional. Conclusiones: La percepción del éxito en el tratamiento nutricional fue asociada significativamente con una buena escucha por parte del profesional en la consulta e indicaciones adecuadas en cuanto a sus gustos y hábitos alimentarios.

[Response to treatment with oral alitretinoin in patients with chronic hand eczema that is refractory to treatment with potent topical corticosteroids: experience in 15 patients]. / Respuesta al tratamiento con alitretinoína oral en ECM refractario con eczema crónico de manos refractario al tratamiento con corticoides tópicos potentes: nuestra experiencia en 15 pacientes.

BACKGROUND: Alitretinoin (9-cis-retinoic acid) is an endogenous derivative of vitamin A and functions as an agonist of both families of nuclear receptors (retinoic acid receptor-α, -ß, -γ; retinoid X receptor-α, -ß, -γ). It has been investigated in the treatment of chronic hand eczema in many studies in recent years and the results have been promising. OBJECTIVES: To evaluate the efficacy and safety of oral alitretinoin in the treatment of chronic hand eczema that is refractory to treatment with potent topical corticosteroids and to analyze the long-term response to treatment. MATERIALS AND METHODS: A prospective, observational, descriptive study was undertaken in 15 patients with chronic hand eczema that was refractory to treatment with potent topical corticosteroids. Patients were administered oral alitretinoin 30 mg/d for 3 months followed by 6 months of follow-up. RESULTS: A complete response, with "clear" hands was obtained in 7 patients (47%), 5 patients (33%) achieved a partial response (almost clear hands), 1 patient (7%) showed substantial improvement, 1 (7%) showed moderate improvement, and 1 patient (7%) did not respond to treatment. Relapse occurred within 6 months of treatment suspension in 54% of cases. The treatment was well tolerated. Side effects, observed in 50% of cases, were mild (headache, elevated lipid levels, slightly elevated transaminase levels, and epigastric pain), except in 1 patient, who had a substantial reduction in thyroid stimulating hormone levels. CONCLUSIONS: The results of our study support the proposal of alitretinoin as an effective and safe short-term and medium-term treatment for chronic hand eczema in patients whose disease is refractory to treatment with potent topical corticosteroids.