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The objective was to determine the plasma concentrations of ionized Ca (iCa) and Mg (iMg) and to establish the prevalence of subclinical hypocalcemia (SCHC) and hypomagnesemia (SCHM) in dairy cows at calving (within 6 hours of parturition) and at 7 days postpartum (pp) in Chilean grazing herds with spring parturitions. Plasma iCa and iMg were assessed using a clinical analyzer. A total of 113 and 175 cows in 18 herds selected at random were sampled at calving and at 7 days pp, respectively. From these 18 herds, 11 herds provided reliable records of lactation number and 8 cows per herd were scored for body condition and sampled at calving and then at 7 days pp. Ionized Ca concentrations for the 18 herds were 0.99 ± 0.16 mmol/L (calving) and 1.01 ± 0.13 mmol/L [7 d pp (P > 0.05)]. Ionized Mg concentrations were 0.58 ± 0.12 mmol/L and 0.51 ± 0.09 mmol/L (P ≤ 0.05). For the 11 herds, iCa concentrations at calving were 1.06 mmol/L (lactation 1), 1.02 mmol/L (lactation 2) and 0.89 mmol/L (lactation ≥ 3), while iMg concentrations were 0.63 mmol/L, 0.60 mmol/L, and 0.61 mmol/L, respectively. Herd prevalence for SCHC (iCa < 1.0 mmol/L) at calving was 64.8%. Prevalence by parity was 40%, 54.5% and 86.7% for lactations 1, 2 and ≥ 3, respectively. Herd prevalence of SCHC on day 7 pp was 30.1%. For SCHM (iMg < 0.52 mmol/L) prevalence was 21.6% and 48.9% at calving and at 7 days pp, respectively.

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INTRODUCTION: Alternating hemiplegia of childhood (AHC), is a rare disease characterized by episodes of hemi/quadriplegia, dystonic postures, abnormal eye movements, and movement disorders. ATP1A3 gene mu tations are the most frequently associated with AHC. OBJECTIVE: To present a clinical case of AHC, where genetic study and the observation of home videos were of great diagnostic utility. CLINICAL CASE: Female patient who at 3 months of age presented with several episodes of dystonic postures, clonic movements of extremities, cephalic version, and lateral gaze deviation lasting several minutes. Epilepsy was diagnosed and levetiracetam was administrated, without improvement. EEG and brain MRI were performed, with normal results. Therefore, epilepsy was ruled out and transient dystonia of infancy was suspected, however, the events became more frequent, longer in duration, and charac teristically subsided during sleep. Family members provided home videos that clarified the events. At 6 months of age, the patient presented with alternating hemiparesis. Dystonia genetic panel showed a pathogenic variant of the ATP1A3 gene, confirming the diagnosis. Flunarizine treatment was ini tiated with a good clinical response at 12 months of follow-up. CONCLUSIONS: The diagnosis of AHC is complex and is frequently confused with epilepsy, so it is important to correctly perform the diffe rential diagnosis, including anamnesis, tests such as EEG, and careful observation of clinical events that, with the current access to audiovisual technology, becomes more accurate. The genetic analysis is a great diagnostic tool that, when performed in time, avoids other unnecessary tests and therapies.

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This study aims to assess the accuracy of temporary employment as indicator or proxy measure of precarious employment. Using sensitivity and specificity analysis, we compared type of contract (temporary versus permanent) with the Chilean version of the multidimensional Employment Precariousness Scale. Temporary employment exhibited very low sensitivity (<30%) (specificity >90%), resulting in roughly 38% of false negative results. Different EPRES-Ch cut-off scores produced similar results. The main implication of these findings is that the public health relevance of precarious employment is being underestimated both in terms of prevalence and of its association with health, making it critical that valid multidimensional measures of precarious employment be implemented.

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The purpose of this study is to perform a psychometric analysis (acceptability, reliability and factor structure) of the Chilean version of the new Employment Precariousness Scale (EPRES). The data is drawn from a sample of 4,248 private salaried workers with a formal contract from the first Chilean Employment Conditions, Work, Health and Quality of Life (ENETS) survey, applied to a nationally representative sample of the Chilean workforce in 2010. Item and scale-level statistics were performed to assess scaling properties, acceptability and reliability. The six-dimensional factor structure was examined with confirmatory factor analysis. The scale exhibited high acceptability (roughly 80%) and reliability (Cronbach's alpha 0.83) and the factor structure was confirmed. One subscale (rights) demonstrated poorer metric properties without compromising the overall scale. The Chilean version of the Employment Precariousness Scale (EPRES-Ch) demonstrated good metric properties, pointing to its suitability for use in epidemiologic and public health research.

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Tuberous sclerosis complex (TSC) is a multisystem autosomal dominant disease caused by mutations in the tumor suppressor genes TSC1 or TSC2. OBJECTIVE: To characterize clinically and genetically patients diagnosed with TSC. PATIENTS AND METHOD: Descriptive study of clinical records of 42 patients from a pediatric neuropsychiatry department diagnosed with TSC and genetic study in 21 of them. The exon 15 of TSC1 gene and exons 33, 36 and 37 of TSC2 gene were amplified by polymerase chain reaction and sequenced. The relationship between the mutations found with the severity and clinical course were analyzed. RESULTS: In 61.9% of the patients the symptoms began before 6 months of age. The initial most frequent manifestations of TSC were new onset of seizures (73.8%) and the detection of cardiac rhabdomyomas (16.6%). During the evolution of the disease all patients had neurological involvement; 92.9% had epilepsy. All patients presented hypomelanotic spots, 47.6% facial angiofibromas, 23.8% Shagreen patch, 47.6 heart rhabdomyomas and 35.7% retinal hamartomas. In the genetic study of 21 patients two heterozygous pathogenic mutations in TSC1 and one in TSC2 genes were identified. The latter had a more severe clinical phenotype. CONCLUSIONS: Neurological and dermatological manifestations were the most frequent ones in patients with TSC. Two pathogenic mutations in TSC1 and one in TSC2 genes were identified. The patient with TSC2 mutation manifested a more severe clinical phenotype.

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BACKGROUND: A growing number of studies have identified an association between exposure to inorganic arsenic and hypertension. However, results have not been consistent across studies. Additional studies are warranted, given the global prevalence of both arsenic exposure and morbidity attributable to hypertension. METHODS: We analyzed data collected from October 2007-December 2010 for a population-based cancer case-control study in northern Chile. Data included lifetime individual arsenic exposure estimates and information on potential confounders for a total of 1266 subjects. Those self-reporting either a physician diagnosis of hypertension or use of an anti-hypertensive medication were classified as having hypertension (n=612). The association between hypertension and drinking water arsenic exposure was analyzed using logistic regression models. RESULTS: Compared to those in the lowest category for lifetime highest 5-year average arsenic exposure (<60µg/L), those in the middle (60-623µg/L) and upper (>623µg/L) exposure categories had adjusted hypertension ORs of 1.49 (95% CI: 1.09, 2.05) and 1.65 (95% CI: 1.18, 2.32), respectively. Similar results were observed in analyses of lifetime cumulative exposures and analyses restricted to exposures from the distant past. CONCLUSIONS: We identified evidence of increased odds of hypertension with exposure to arsenic in drinking water among study participants. Our findings add to the growing body of research supporting this association, which could have important public health implications.

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Abstract: The purpose of this study is to perform a psychometric analysis (acceptability, reliability and factor structure) of the Chilean version of the new Employment Precariousness Scale (EPRES). The data is drawn from a sample of 4,248 private salaried workers with a formal contract from the first Chilean Employment Conditions, Work, Health and Quality of Life (ENETS) survey, applied to a nationally representative sample of the Chilean workforce in 2010. Item and scale-level statistics were performed to assess scaling properties, acceptability and reliability. The six-dimensional factor structure was examined with confirmatory factor analysis. The scale exhibited high acceptability (roughly 80%) and reliability (Cronbach's alpha 0.83) and the factor structure was confirmed. One subscale (rights) demonstrated poorer metric properties without compromising the overall scale. The Chilean version of the Employment Precariousness Scale (EPRES-Ch) demonstrated good metric properties, pointing to its suitability for use in epidemiologic and public health research.

Resumen: El estudio tuvo como objetivo realizar el análisis psicométrico (aceptabilidad, confiabilidad y estructura factorial) de la versión chilena de la nueva Escala de Precariedad Laboral (EPRES). Los datos proporcionan una muestra de 4.248 trabajadores asalariados formales del sector privado, de la primera Encuesta Nacional de Condiciones de Empleo, Trabajo y Salud (ENETS) de Chile, aplicado a una muestra representativa de la fuerza de trabajo chilena en 2010. Se calcularon las estadísticas en el nivel de ítem y escala para evaluar la distribución de las respuestas, aceptabilidad y confiabilidad. La estructura factorial con seis dimensiones se examinó con un análisis factorial confirmatorio. La escala mostró una alta aceptabilidad (aproximadamente 80%) y confiabilidad (alfa de Cronbach de 0,83), y la estructura factorial fue confirmada. Una sub-escala (derechos) demostró un peor desempeño, sin comprometer la escala general. La versión chilena de la Employment Precariousness Scale (EPRES-Ch) mostró buenas propiedades métricas, sugeriendo su idoneidad al uso en epidemiología y salud pública.

Resumo: O estudo teve como objetivo realizar a análise psicométrica (aceitabilidade, confiabilidade e estrutura fatorial) da versão chilena da nova Employment Precariousness Scale (EPRES). Os dados proveem de uma amostra de 4.248 trabalhadores assalariados formais do setor privado, do primeiro Inquérito Nacional de Condições de Emprego, Trabalho e Saúde (ENETS) do Chile, aplicado a uma amostra representativa da força de trabalho chilena em 2010. Foram calculadas as estatísticas em nível de item e escala para avaliar as propriedades de escalabilidade, aceitabilidade e confiabilidade. A estrutura fatorial com seis dimensões foi examinada com análise fatorial confirmatória. A escala mostrou alta aceitabilidade (aproximadamente 80%) e confiabilidade (alfa de Cronbach de 0,83), e a estrutura fatorial foi confirmada. Uma sub-escala (direitos) demonstrou propriedades métricas piores, sem comprometer a escala geral. A versão chilena da Employment Precariousness Scale (EPRES-Ch) mostrou boas propriedades métricas, destacando sua adequação para uso em epidemiologia e saúde pública.

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El complejo de esclerosis tuberosa (CET) es una enfermedad autosómica dominante multisistémica producida por mutaciones en los genes supresores de tumores TSC1 o TSC2. Objetivo: Caracterizar clínica y genéticamente pacientes pediátricos con diagnóstico de CET. Pacientes y Método: Estudio descriptivo de registros clínicos de 42 pacientes pediátricos controlados en un servicio de neuropsiquiatría infantil con diagnóstico de CET y estudio genético en 21 de ellos. Se amplificó por reacción en cadena de la polimerasa y secuenció el exón 15 del gen TSC1 y los exones 33, 36 y 37 del gen TSC2. Se analizó la relación entre las mutaciones encontradas con la severidad y evolución clínica. Resultados: En el 61,9% de los pacientes las manifestaciones comenzaron antes de los 6 meses de edad. Las manifestaciones iniciales de CET más frecuentes fueron las crisis convulsivas (73,8%) y el hallazgo de rabdomiomas cardiacos (16,6%). Durante su evolución, todos los pacientes presentaron compromiso neurológico; el 92,9% presentó epilepsia. Todos los pacientes presentaron máculas hipomelanóticas, 47,6% pangiofibromas faciales, 23,8% parches de Shagreen, 47,6% rabdomiomas cardiacos y 35,7% hamartomas retinianos. El estudio genético realizado a 21 pacientes identificó 2 mutaciones heterocigotas patogénicas en TSC1 y una en TSC2. Este último paciente presentaba un fenotipo clínico más severo. Conclusiones: Las manifestaciones neurológicas y dermatológicas fueron las más frecuentes en los pacientes con CET. Se identificaron 2 mutaciones patogénicas en el gen TSC1 y una en el gen TSC2. La mutación en TSC2 se manifestó en un fenotipo clínico más severo.

Tuberous sclerosis complex (TSC) is a multisystem autosomal dominant disease caused by mutations in the tumor suppressor genes TSC1 or TSC2. Objective: To characterize clinically and genetically patients diagnosed with TSC. Patients and Method: Descriptive study of clinical records of 42 patients from a pediatric neuropsychiatry department diagnosed with TSC and genetic study in 21 of them. The exon 15 of TSC1 gene and exons 33, 36 and 37 of TSC2 gene were amplified by polymerase chain reaction and sequenced. The relationship between the mutations found with the severity and clinical course were analyzed. Results: In 61.9% of the patients the symptoms began before 6 months of age. The initial most frequent manifestations of TSC were new onset of seizures (73.8%) and the detection of cardiac rhabdomyomas (16.6%). During the evolution of the disease all patients had neurological involvement; 92.9% had epilepsy. All patients presented hypomelanotic spots, 47.6% facial angiofibromas, 23.8% Shagreen patch, 47.6 heart rhabdomyomas and 35.7% retinal hamartomas. In the genetic study of 21 patients two heterozygous pathogenic mutations in TSC1 and one in TSC2 genes were identified. The latter had a more severe clinical phenotype. Conclusions: Neurological and dermatological manifestations were the most frequent ones in patients with TSC. Two pathogenic mutations in TSC1 and one in TSC2 genes were identified. The patient with TSC2 mutation manifested a more severe clinical phenotype.

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El estudio explora el contraste intergeneracional entre valores personales en estudiantes y profesionales de enfermería y su ajuste a las predicciones de la teoría del cambio de valores. La muestra estuvo formada por 369 estudiantes y profesionales de enfermería distribuidos en tres grupos: estudiantes (n = 150), profesionales menores de 40 años (n = 114), y profesionales entre 41 y 60 años (n = 105). Los participantes informaron de sus valores en orden de prioridad en un cuestionario abierto. Los informes se organizaron en categorías de valores para analizar las diferencias entre grupos. Se encuentran dos tendencias en el informe de valores personales, que se ajustan en algunos casos a lo predicho por la teoría del cambio de valores y, en otros casos, la contradicen. Se discute la importancia de estos hallazgos y la necesidad de potenciar una formación orientada hacia los valores de la profesión de enfermería. El estudio contribuye al conocimiento del cambio de valores personales en profesionales de enfermería.

The study explores the generational contrast between personal values in students and nurses and their adjustment to the predictions of the theory of changing values. The sample was comprised of 369 students and nurses who were divided into three groups: students (n = 150), nurses under age 40 (n = 114), and nurses between 41 and 60 years of age (n = 105). The participants reported their values on an open questionnaire, in order of priority. The reports were organized into value categories to analyze the differences between groups. Two trends were found in the report on personal values: in some cases, they fit what is predicted by the theory of changing values; in others, they contradict it. The importance of these findings and the need to empower training oriented towards the values of the nursing profession is discussed. The study contributes to what we know about the change in personal values among nursing professionals.

Este estudo explora o contraste intergeracional entre valores pessoais em estudantes e profissionais de enfermagem e seu ajuste às predições da teoria da mudança de valores. A amostra esteve conformada por 369 estudantes e profissionais de enfermagem distribuídos em três grupos: estudantes (n = 150), profissionais menores de 40 anos (n = 114) e profissionais entre 41 e 60 anos (n = 105). Os participantes informaram sobre seus valores em ordem de prioridade num questionário aberto. Os relatórios foram organizados por categorias de valores para analisar as diferenças entre grupos. Constataram-se duas tendências no relatório de valores pessoais que se ajustam, em alguns casos, ao dito pela teoria da mudança de valores; em outros casos, contradizem-na. Discute-se a importância dessas constatações e a necessidade de potencializar uma formação orientada aos valores da profissão de enfermagem. O estudo contribui para o conhecimento da mudança de valores pessoais em profissionais de enfermagem.

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The present study evaluates the personal values reported by a sample of New York Hispanic residents using an open evaluation format in which the participants identified and prioritized their personal values. Four hundred and forty-five participants were assigned to one of three groups: Young (N= 159), Adult (N= 168) and Senior (N= 118). The values reported were categorized into post-materialist, materialist or non-classifiable. The Percentage Difference Index between post-materialist and materialist values was calculated in order to determine the value profile for each age group. The results showed that reports of personal values and values attributed to the participants' own generation were similar in Adult and Senior groups, but were very different in the Young Group, with a differential report of post-materialist values. Furthermore, exposure to American culture did not appear to have a significant effect on the reported values of NYC Hispanics. To confirm these findings, we need to conduct additional studies with larger samples of culturally diverse populations.

Se exploran los valores en una muestra de hispanos de New York, empleando un formato abierto en el que los participantes identifican y priorizan su valores personales y los de su generación. Los 445 participantes se distribuyeron en tres grupos: Jóvenes (N = 159), Adultos (N = 168) y Mayores (N = 118). Los informes de valores se categorizaron como postmaterialistas, materialistas o no clasificables, y se calculó el Percentage Difference Index entre valores postmaterialistas y materialistas para determinar el perfil de valores de cada grupo. Los resultados mostraron que los informes de valores personales y generacionales fueron similares en los grupos Adulto y Mayor, y diferentes en el Grupo Joven con un reporte diferencial entre valores personales y generacionales. Por otro lado, el tiempo vivido bajo la influencia de la cultura norteamericana parece no tener un efecto significativo en el informe de valores para esta población. Para confirmar estos hallazgos son necesarios estudios adicionales con muestras más amplias y en poblaciones culturalmente diversas.

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OBJECTIVE: To explore students' assessments of the clinical seminar as a complementary teaching method to the clinical practicum experience. METHODS: This was a qualitative study based on the hermeneutic phenomenology of Gadamer. Twenty-three open-ended interviews were conducted from among the 132 first-year students who attended an initial clinical practicum. We performed a qualitative analysis of the data using ATLAS.ti software. RESULTS: The students agreed that the clinical seminar gave them the opportunity to learn about procedures, nursing care and interpersonal relationships. They also found it very helpful when they encountered challenging stressful situations as they performed their practice, and believed it allowed them to make a connection between the theory in the classroom and the clinical practice. CONCLUSIONS: These seminars can contribute to reducing levels of stress during clinical practice. They can also help students obtain significant learning from their fellows and reduce the theory-practice gap.

OBJETIVO: Avaliar a importância que os alunos atribuem ao seminário clínico como método de ensino complementar às práticas clínicas em estágio. MÉTODO: Estudo qualitativo baseado na fenomenologia hermenêutica de Gadamer. Foram realizadas 23 entrevistas abertas entre um universo de 132 alunos do primeiro ano da licenciatura de enfermagem, que assistiram a um seminário clínico, durante o seu primeiro ensino clínico/estágio. Foi realizada uma análise qualitativa dos dados através do software ATLAS.ti. RESULTADOS: Os entrevistados coincidiram na opinião de que o seminário lhes deu oportunidades de aprendizagem sobre procedimentos, cuidados de enfermagem e relações interpessoais. Referiram também que o mesmo foi útil para lidar com situações estressantes e relacionar os conteúdos teóricos com a prática. CONCLUSÕES: Este tipo de seminários pode contribuir para a redução dos níveis de estresse durante a prática clínica, para a aquisição e partilha de aprendizagens significativas em grupo e para colmatar lacunas teórico-práticas.

OBJETIVO: Evaluar la importancia atribuida por los alumnos al seminario clínico como método de enseñanza complementaria a las prácticas clínicas. MÉTODO: Estudio cualitativo basado en la fenomenología hermenéutica de Gadamer. Se realizaron 23 entrevistas abiertas entre un universo de 132 alumnos del primer año del pregrado en enfermería, que asistieron a un seminario clínico, durante su primera enseñanza clínica/práctica. Se llevó a cabo un análisis cualitativo de los datos a través del software ATLAS.ti. RESULTADOS: Los entrevistados coincidieron en la opinión de que el seminario les dio oportunidades de aprendizaje sobre procedimientos, cuidados de enfermería y relaciones interpersonlaes. Refirieron también que el mismo fue útil para lidiar con situaciones estresantes y relacionar los contenidos teóricos con la práctica. Conclusiones: Este tipo de seminarios puede contribuir en la reducción de los niveles de estrés durante la práctica clínica, para adquirir y compartir aprendizajes significativos en grupo y para corregir lagunas teórico-prácticas.

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Los autores abordan consideraciones específicas que atañen a la aplicación de cuidados de enfermería a personas ancianas con problemas médico-quirúrgicos. Se trata de un compendio de medidas esenciales en su cuidado, y que afectan directamente tanto a las técnicas empleadas, como a la propia relación enfermera-paciente. Su aplicación protocolizada repercute en forma positiva en el proceso cuidador (AU)

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Los autores abordan consideraciones específicas que atañen a la aplicación de cuidados de enfermería a personas ancianas con problemas médico-quirúrgicos. Se trata de un compendio de medidas esenciales en su cuidado, y que afectan directamente tanto a las técnicas empleadas, como a la propia relación enfermera-paciente. Su aplicación protocolizada repercute en forma positiva en el proceso cuidador

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La apendicitis aguda es la intervención quirúrgica más frecuente efectuada en los servicios de urgencia. La clínica sigue siendo el método de elección para efectuar el diagnóstico, dado que hasta el momento los métodos de laboratorio e imágenes no han logrado superar los rendimientos de la clínica, si bien se han constituido en una importante ayuda. En este trabajo se evalúan los casos de pacientes operados por apendicitis aguda, pero con informe histopatológico negativo para esa enfermedad. Ellos corresponden a un bajo porcentaje del total de apendicectomías (4 por ciento), lo que probablemente obedece a un buen estudio clínico y el apoyo de laboratorio e imágenes disponible, además de que la laparoscopía diagnóstica ha disminuido la frecuencia de apendicectomías en blanco. Cuatro de los pacientes correspondieron a otras patologías graves con compromiso apendicular como ser cáncer o enfermedad de Crohn. La morbimortalidad de esta serie correspondió a estos últimos pacientes

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Se describen los casos de maltrato infantil (MI) o violencia intrafamiliar (VIF) identificados durante un año en un consultorio de atención primaria, en las atenciones habituales a niños y embarazadas. Las sospechas de MI y VIF se referían al equipo social del consultorio para entrevista y visita domiciliaria, éstas en conjunto con las psicólogas, descartaban o confirmaban los casos. Según su patología fueron referidos a instituciones especializadas. Se organizaron actividades educativas, en la sala de espera, destinadas a los usuarios del consultorio y se desarrollaron talleres y psicoterapia para los grupos familiares involucrados. Se confirmaron 67 casos. El 41,8 por ciento de las familias eran víctimas de VIF, la mayoría asociada a abuso de alcohol y drogas; hubo maltrato físico en el 62,4 por ciento de los casos, psicológico en 17,9 por ciento; negligencia o abandono en 20,9 por ciento; abuso sexual en 22,4 por ciento. En el 55,2 por ciento se encontró más de un factor de maltrato. Sólo un tercio de los casos fueron detectados por el equipo de salud del consultorio, el resto fue denunciado por algún miembro de la familia de la víctima. Se calcula que 1,67 por ciento de las familias con niños menores de 15 años, inscritas en el consultorio y que acudieron por alguna razón en un año, presentan MI

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