Eficacia y seguridad de antipsicóticos y antidepresivos en el tratamiento de la anorexia nerviosa: revisión sistemática / Efficacy and Safety of Antipsychotics and Antidepressants in the Treatment of Anorexia Nervosa: a Systematic Review

RESUMEN Introducción: Las recomendaciones de las guías vigentes están basadas en evidencia de baja calidad. Se requiere su actualización periódica considerando la evidencia reciente. Objetivo: Sintetizar la mejor evidencia clínica disponible sobre eficacia y seguridad de antidepresivos y antipsicóticos de segunda generación en pacientes con anorexia nerviosa. Métodos: Revisión sistemática (CRD42020150577). Se buscaron en PubMed, SCOPUS, Ovid(Cochrane), EMBASE y LILACS los ensayos clínicos aleatorizados realizados en pacientes con anorexia nerviosa que evaluasen el uso de antipsicóticos de segunda generación o antidepresivos orales a cualquier dosis y por cualquier tiempo en el tratamiento ambulatorio y/u hospitalario tomando como resultados el peso (índice de masa corporal), las entidades psicopatológicas y la seguridad. Resultados: Se incluyeron 5 estudios, 4 catalogados como con alto riesgo de sesgo. La evidencia indica que los pacientes que reciben tratamiento con olanzapina o fluoxetina tienden a mantenerse por más tiempo dentro de los programas de tratamiento. La olanzapina mostró resultados favorables (un estudio) en cuanto al aumento de peso, pero no mostró los mismos resultados en psicopatología, donde la evidencia es contradictoria. Conclusiones: En concordancia con las revisiones anteriores, nuestro trabajo permite concluir que hay información contradictoria sobre la eficacia de los psicofármacos para la anorexia nerviosa. El trabajo futuro debe enfocarse en desarrollar ensayos clínicos de alta calidad metodológica.

ABSTRACT Introduction: The recommendations of the current guidelines are based on low quality evidence. Periodic updating is required, taking recent evidence into consideration. Objective: To synthesise the best available clinical evidence on the efficacy and safety of second-generation antidepressants and antipsychotics in patients with anorexia nervosa. Methods: Systematic review (CRD42020150577). We searched PubMed, SCOPUS, Ovid(Cochrane), EMBASE and LILACS for randomised clinical trials performed in patients with anorexia nervosa that evaluated the use of second-generation antipsychotics or oral antidepressants, at any dose and for any length of time, in outpatient and/or hospital treatment, taking weight (body mass index), psychopathological entities and safety as results. Results: Five studies were included, with four assessed as having a high risk of bias. The evidence indicates that patients receiving treatment with olanzapine or fluoxetine tend to stay in treatment programmes for longer. Olanzapine showed favourable results (one study) in terms of weight gain, but did not show the same results in psychopathology, where the evidence is contradictory. Conclusions: In accordance with previous reviews, our work allows us to conclude that there is contradictory information on the efficacy of psychotropic drugs in the treatment of anorexia nervosa. Future work should focus on developing clinical trials of high methodological quality.

Factores legales, de imagen, sociales y económicos que determinan la contratación de personas con discapacidad en empresas de la ciudad de Chillán / Legal, image, social and economic factors that determine hiring of people with disabilities into companies in the city of Chillán

Introducción: La baja contratación de personas con discapacidad, falta de oportunidades y discriminación, en un país post inclusión, está condicionada por diversas barreras, factores o preocupaciones de las empresas y empleadores, las cuales dificultan la inclusión laboral debido a diferentes apreciaciones de índole personal y cultural. Objetivo: La presente investigación tiene por objetivo describir factores legales, de imagen, sociales y económicos que determinan la contratación de personas con discapacidad, según la percepción de los gerentes, administradores y jefes de recursos humanos de empresas de la ciudad de Chillán. Metodología: Para llevar a cabo dicho análisis, se consideró a 50 representantes de 50 empresas de la ciudad, pertenecientes a los rubros del comercio, servicios básicos y otros rubros, los cuales entregaron la percepción sobre los factores a través de una encuesta de auto aplicación. Resultados: Los análisis de los resultados demostraron una tendencia generalizada de la muestra sobre el factor social, identificándolo como un determinante sobre la contratación de personas con discapacidad. Discusión: Se concluyó que el factor social seguido del factor económico, mayormente determinan la contratación de personas con discapacidad, independiente del rubro empresarial, tamaño de las empresas y experiencias previas en la contratación de personas discapacitadas.

Introduction: The low hiring, lack of opportunities and discrimination of people with disabilities, in a post-inclusion country, is conditioned by various barriers, factors or concerns in companies and employers, which hinder labor inclusion, due to different views from a personal and cultural nature. Aim: To describe legal, image, social and economic factors that determine the hiring of people with disabilities, according to the perception of managers, chief of staff and human resources manager of companies in the city of Chillán. Methods: To carry out this analysis, 50 representatives of 50 companies in the city, belonging to the trade, basic services and other items were considered. Participants gave their perception of the factors, through a self-application survey. Results: The analysis of the results showed a general trend in the sample, regarding the social factor, identifying it as a determining factor in hiring people with disabilities. Discussion: It was concluded that the social factor followed by the economic factor, mainly determine the hiring of people with disabilities, regardless the business category, size of the companies and previous experiences in hiring people with disabilities.

Influence of Nursing in Health Economics: an Integrative Review of Literature

In times of great socio-sanitary conjunctures, such as these, to identify the influence of nursing in the complex dynamics of the health economy and health management becomes vital. Objective: To determine the implications of nursing on health economics as seen in the literature. Methodology: To integrative a review of the literature, in OVID, Pubmed, Clinikal Key, Scielo databases, published in the 2000 - 2018 period in English, Portuguese, and Spanish languages, following the recommendations of the SALSA review method and adjusted to modified PRISMA requirements. Of a total of 26 retrieved articles, 18 were eligible for review, after applying the inclusion and exclusion criteria. The data were summarized using a narrative-qualitative-descriptive synthesis. Results: 44% of the publications were made between 2005 and 2009; 78% were made in the United States; 56% were obtained from PUBMED; and 44% are of quantitative design. The categorical analysis shows a clear tendency to reveal the economic cost related to the impact of the nursing professional's work in various areas, rather than considerations of quality of care or effectiveness of the work. Conclusion: Links were observed between nursing actions and health economics in three main aspects: quality of care, costs, and effectiveness.

En momentos de grandes coyunturas socio sanitarias actuales, se vuelve vital identificar la influencia de enfermería en las dinámicas complejas de la economía de la salud y la gestión sanitaria. Objetivo: Determinar las implicancias evidenciadas en la literatura que enfermería posee en la economía de la salud. Metodología: Revisión integrativa de la literatura, en bases de datos OVID, Pubmed, Clinikal Key, Scielo publicados entre 2000 - 2018 en idiomas inglés, portugues y español, siguiendo las recomendaciones del método SALSA de revisión y ajustada a requerimientos PRISMA modificado. De un total de 26 artículos recuperados, 18 fueron elegibles para revisión, luego de aplicar los criterios inclusión y exclusión. Los datos fueron resumidos mediante síntesis narrativa-cualitativa- descriptiva. Resultados: Un 44% de las publicaciones se realizaron entre 2005 al 2009; el 78% fueron hechas en Estados Unidos; un 56% se obtuvieron de PUBMED y el 44% son de diseño cuantitativo. El análisis categorial muestra una clara tendencia por relevar el costo económico relacionado al impacto del trabajo del profesional de enfermería en diversas áreas del quehacer, más que consideraciones de calidad del cuidado o efectividad del trabajo. Conclusión: Se observaron vinculaciones entre el actuar de enfermería y la economía de la salud, en tres aristas principales: calidad de atención, costos y efectividad.

Resultados del sistema de puntuación del Concurso Nacional de Ingreso a los Servicios de Salud entre 2016 y 2020

Background: Medical specialists are an essential resource for the functioning of the health system and in Chile there is a growing deficit of these specialists. To address this shortage, the government has strategies for training health professionals, such as a national public contest for medical scholarships, named CONISS, which stands out for its high capacity to produce medical specialists. The scoring system of this contest is used for the allocation of training resources to the best candidates. Aim: To describe the results of the CONISS scoring system between 2016 and 2020. Material and Methods: Analysis of public registries of physicians participating in the CONISS contest between 2016 and 2020. Results: During the study period 7,373 physicians participated in this contest (49% females). Annual participation increased progressively. The participants graduated from 21 Chilean universities and a variable number from foreign universities. The scores obtained by participants improved by 1.47 points between the first and last year of the study period. Conclusions: Interpretation of these results is complicated by the characteristics and limitations of the measurements of the CONISS scoring system. This precludes establishing whether this system effectively filters out the best candidates for medical specialization programs.

Infancias y colecho en la Argentina: factores sociodemográficos, socioeconómicos y de salud familiar / Bedsharing and childhood: socio-demographic, socio-economic and family health factors / Co-leito na infância: fatores sócio-demográficos, socioeconômicos e de saúde familiar

Resumen (analítico) Se caracteriza el fenómeno del colecho en términos sociodemográficos, socioeconómicos y en relación con las vulnerabilidades específicas de los hogares, tales como la violencia intrafamiliar y los consumos nocivos. A través de la Encuesta de la Deuda Social Argentina y un análisis multivariado cuantitativo, se abordan los siguientes interrogantes: ¿el colecho es una práctica asociada únicamente a los bebés?, ¿resulta más frecuente en contextos de pobreza o se trata de una práctica que atraviesa a diferentes infancias? Se concluye que el colecho no es un fenómeno exclusivo de los y las bebés; que en la adolescencia es más regresivo para las mujeres y que el factor socio-económico remite a un «colecho forzoso¼ que se especifica en interacción con el hacinamiento, la monoparentalidad, los consumos nocivos y la violencia intrafamiliar.

Abstract (analytical) This paper analyses the phenomenon of bed-sharing in terms of sociodemographic and socioeconomic variables, but also considers specific vulnerabilities like domestic violence and addictions. It is worth examining whether this practice is associated only with babies, or else if vulnerable contexts also have an impact on children's and adolescent's co-sleeping. The information was obtained through Social Debts in Argentina Survey, and this quantitative research concludes that in this country not only early years bed-share, the phenomenon impairs teenage girls more often and that the socio-economic factor plays a decisive role. For this reason, we propose the term "forced-bed-sharing", which refers to when co-sleeping is intensified by variables like overcrowding, single-parent family type, addictions and domestic violence.

Resumo (analítico) O artigo caracteriza o fenómeno do coleito considerando variáveis sócio demográficas e socioeconómicas, mas também vulnerabilidades específicas como a violência doméstica ou vícios. Neste contexto, perguntamo-nos: associa-se só aos bebés? Tem mais frequência em condições de vulnerabilidade? Esta prática tem um impacto ou motivações diferentes em relação ás características das crianças? A informação foi obtida através do Questionário da Dívida Social Argentina, e o desenho de pesquisa quantitativo conclui que não é somente um fenómeno exclusivo da primeira infância, na adolescência é mais frequente em meninas e que o fator socioeconómico é decisivo. Por isso, propomos o termo "coleito forçoso", que refere a quando a regularidade da cama compartilhada se intensifica por variáveis como a superlotação, o tipo de família monoparental, vícios e violência doméstica.

Diálogos entre o método da cartografia e alguns pressupostos filosóficos de Hannah Arendt na pesquisa em educação / Diálogos entre el método de la cartografía y algunas presuposiciones filosóficas de Hannah Arendt en la investigación en educación / Dialogs between the cartography method and some philosophical assumptions of Hannah Arendt in educational research

O artigo aventura-se nas fronteiras do método cartográfico e dos escritos de Hannah Arendt sobre ação, política e educação. Desse encontro, busca-se construir posições para uma pesquisa feita em campo no âmbito da educação, tendo em vista a implicação do pesquisador no processo da pesquisa, reconhecendo-se como parte desse processo e rompendo com sua suposta neutralidade; a aceitação da imprevisibilidade no percurso de criação da pesquisa; e, por fim, o compromisso político com o coletivo com o qual se trabalha e com o mundo que nós, pesquisadores e pesquisados, habitamos. Apresentam-se também questões suscitadas a partir da relação de uma das autoras, como pesquisadora, com o seu campo de pesquisa, tomando a experiência como produtora de pensamento sobre os desafios metodológicos de trabalhos pautados na cartografia. (AU)

El artículo se aventura en las fronteras del método cartográfico y de los escritos de Hannah Arendt sobre acción, política y educación. A partir de ese encuentro, se busca construir posiciones para una investigación realizada en el campo en el ámbito de la educación: la implicación del investigador en el proceso de la investigación, reconociéndose como parte de ese proceso y rompiendo con su supuesta neutralidad. La aceptación de la imprevisibilidad en el recorrido de creación de la investigación; y, finalmente, el compromiso político con el colectivo con el que se trabaja y con el mundo que nosotros, investigador e investigados, habitamos. También se presentan cuestiones suscitadas a partir de la relación de una de las autoras como investigadora, con su campo de investigación utilizando la experiencia como productora de pensamiento sobre los desafíos metodológicos de trabajo pautados en la cartografía. (AU)

The article explores the cartography method and the writings of Hannah Arendt on action, politics and education. Based on the articulation between these two universes, the authors aim to build the following positions for a field research in the sphere of education: the researcher's implication in the research process, recognizing themselves as part of the process and breaking with their alleged neutrality; acceptance of unpredictability during the development of the research; and, finally, the political commitment to the collective with which the researcher works and to the world we, researcher and participants, inhabit. Furthermore, the study presents questions about the relationship of one of the authors, as a researcher, with her research field, taking into consideration her experience as a producer of thoughts about the methodological challenges faced by works grounded on cartography. (AU)

Percepciones que tienen trabajadores chilenos sobre el impacto del teletrabajo en el entorno de covid-19

RESUMEN La pandemia ha generado diversos cambios que han llevado a las empresas a buscar estrategias para continuar sus procesos productivos y proteger la salud de los trabajadores; entre estas, la más destacada es el Teletrabajo. Objetivo: Analizar las percepciones que tienen los trabajadores chilenos sobre el impacto del teletrabajo en términos de Estrés laboral, Balance Vida-Trabajo y Satisfacción, en ambiente de contingencia producto del COVID-19. Material y Método: Investigación de tipo cuantitativa, tipo relacional y de corte transversal que utilizó un muestreo por conveniencia y se obtuvieron datos de 225 trabajadores chilenos que estaban realizando teletrabajo producto del COVID-19 y respondieron la encuesta on-line. Se utilizó un instrumento con 26 reactivos, que se aplicó a trabajadores mayores de edad que estuvieran realizando actividades desde casa, entre los meses de septiembre a octubre de 2020, logrando obtener 181 respuestas útiles. Resultados: Los trabajadores que se encuentran en modalidad telemática corresponden mayormente a mujeres, solteras, entre 24 a 40 años, del ámbito educativo, del sector público y tienen experiencia laboral mayor a diez años; existe una relación positiva entre la satisfacción laboral y el teletrabajo (r= 0,381), mientras que para las variables Estrés laboral y Balance vida-trabajo sucede lo contrario, es decir, una relación negativa (r= -0,408). Conclusión: Las actividades telemáticas producen a los trabajadores sintomatología de estrés, como tensión y/o ansiedad, pero a pesar de esto, tienen una actitud positiva ante este cambio en la modalidad laboral, tratando de vivir el día a día y buscando cómo apoyar a otros.

ABSTRACT The pandemic has caused several changes that have led companies to look for strategies to continue their production processes and protect the health of workers. Among these strategies, the most important is Teleworking. Objective: To analyze the perceptions that Chilean workers have on the impact of teleworking in terms of work stress, work-life balance and satisfaction, in a contingency environment as a result of COVID-19. Material and Method: Quantitative, relational and cross-sectional research using convenience sampling and data from 225 Chilean workers who were teleworking as a result of COVID-19 and responded to the on-line survey. An instrument with 26 items was applied to workers of legal age who were carrying out activities from home, between the months of September to October 2020, collecting 181 useful responses. Results: People working from home correspond mostly to single women, between 24 to 40 years old, who work in the field of education or the public sector and have work experience of more than ten years; there is a positive relationship between job satisfaction and teleworking (r= 0.381), while for the variables work stress and work-life balance a negative relationship was observed (r= -0.408). Conclusion: Teleworking produces stress symptoms among workers, such as tension and/or anxiety. Nevertheless, workers have a positive attitude towards this modality, trying to adapt and seeking support from other people.

RESUMO A pandemia gerou várias mudanças que levaram as empresas a procurar estratégias para continuar os seus processos de produção e proteger a saúde dos trabalhadores; entre estas, a mais relevante é o Teletrabalho. Objetivo: Analisar as percepções dos trabalhadores chilenos sobre o impacto do teletrabalho em termos de Estresse no trabalho, Equilíbrio Vida-Trabalho e Satisfação, em um ambiente de contingência resultante da COVID-19. Material e Método: Pesquisa quantitativa, do tipo relacional e corte transversal utilizando amostragem de conveniência e obtendo dados de 225 trabalhadores chilenos que estavam realizando teletrabalho como resultado da COVID-19 e responderam ao questionário online. Foi utilizado um instrumento com 26 reativos, que foi aplicado a trabalhadores adultos que realizavam atividades desde casa, entre setembro e outubro de 2020, obtendo 181 respostas úteis. Resultados: Os trabalhadores que estão no modo telemático, correspondem maioritariamente a mulheres, solteiras, entre 24 e 40 anos, do campo educativo, do sector público e têm mais de dez anos de experiência de trabalho; existe uma relação positiva entre a satisfação profissional e o teletrabalho (r= 0,381), enquanto para as variáveis Estresse no trabalho e Equilíbrio Vida-Trabalho acontece o contrário, ou seja, uma relação negativa (r= -0,408). Conclusão: As atividades telemáticas produzem sintomas de estresse nos trabalhadores, tais como tensão e/ou ansiedade, mas apesar disso, têm uma atitude positiva em relação a esta mudança na modalidade de trabalho, tentando viver dia após dia e procurando formas de apoiar os outros.

Análise de custo por desfecho das novas terapias de combinação tripla com lenalidomida para o mieloma múltiplo recidivado/refratário no Brasil / Cost by outcomes analysis of novel triplecombination therapies with lenalidomide for relapsed/refractory multiple myeloma in Brazil

Objetivo: Estimar o custo de tratamento das novas terapias de combinação tripla com lenalidomida no manejo dos pacientes com mieloma múltiplo recidivado/refratário (MMRR) sob a perspectiva do sistema de saúde privado brasileiro. Métodos: Os custos associados da combinação de lenalidomida + dexametasona com carfilzomibe (KRd), daratumumabe (DRd), elotuzumabe (ERd) e ixazomibe (IRd) foram comparados. Para cada terapia, a duração de tratamento foi estimada pela média do tempo de sobrevida livre de progressão (SLP) restrita a três anos a partir de dados de SLP dos estudos pivotais das respectivas terapias. Os custos de tratamento foram estimados para a duração de tratamento, considerando a posologia específica dos regimes terapêuticos. Os preços dos medicamentos foram baseados no preço fábrica de abril de 2020. Não foi considerado o compartilhamento de doses. O custo total do tratamento, o custo médio por ciclo e o custo por taxa de resposta objetiva (TRO) em três anos foram comparados. Resultados: A duração de tratamento no período de três anos foi de 23,3, 27,6, 20,3 e 20,9 meses para KRd, DRd, ERd e IRd, respectivamente. O custo médio total de tratamento foi estimado em 975.557 reais (BRL) para KRd, 1.507.544 BRL para DRd (+55% versus KRd), 1.207.899 BRL para ERd (+24% versus KRd) e 983.917 para IRd (+1% versus KRd). KRd teve o menor custo médio por mês de SLP (horizonte de três anos) entre as terapias, 41.957 BRL versus 54.709 BRL para DRd (+30% versus KRd), 59.635 BRL para ERd (+42% versus KRd) e 47.147 para IRd (+12% versus KRd). Similarmente, o custo por TRO foi 31% menor para KRd (1.119.770 BRL), comparado ao DRd (1.621.015 BRL), 27% menor, comparado ao ERd (1.528.986 BRL), e 11% menor, comparado ao IRd (1.256.064). Conclusões: Resultados da presente análise indicam que KRd está associado a um menor custo médio de tratamento, acompanhado de maior previsibilidade, menor custo por TRO e por mês de SLP, comparado ao DRd, ERd e IRd no horizonte de três anos sob a perspectiva do sistema de saúde privado brasileiro. Os resultados estão associados com alguma incerteza em razão das diferenças nas populações dos estudos, desenho dos estudos (duração fixa de carfilzomibe vs. tratamento até a progressão para daratumumabe, elotuzumabe e ixazomibe) e porque a duração de tratamento é tipicamente menor do que a SLP.

Objective: To estimate treatment costs for novel triple-combination therapies with lenalidomide in the management of relapsed/refractory multiple myeloma (RRMM) patients from the Brazilian private healthcare perspective. Methods: Treatment costs associated with lenalidomide + dexamethasone combinations with carfilzomib (KRd), daratumumab (DRd), elotuzumab (ERd) and ixazomib (IRd) were compared. For each therapy, treatment duration was estimated as the mean progression-free survival (PFS) time restricted to three years using published PFS data from pivotal trials available for these treatments. Treatment costs were estimated for the modeled treatment duration considering therapy-specific dosing schedules. Drug prices were based on April 2020 Brazilian list prices. No vial sharing was assumed. Total treatment costs, average cost per cycle, and cost per overall response rate (ORR) over the three-year period were compared. Results: Modeled treatment duration over the three-year period was 23.3, 27.6, 20.3 and 20.9 months for KRd, DRd, ERd and IRd respectively. Corresponding average total treatment costs were estimated to be 975,557 Brazilian Real (BRL) for KRd; 1,507,544 BRL for DRd (+55% versus KRd); 1,207,899 BRL for ERd (+24% versus KRd) and 983,917 for IRd (+1% versus KRd). KRd had the lowest average cost per month of restricted PFS (3-year time frame) among the therapies, 41,957 BRL versus 54,709 BRL for DRd (+30% versus KRd); 59,635 BRL for ERd (+42% versus KRd); and 47,147 for IRd (+12% versus KRd). Similarly, the cost per achieved ORR was lower for KRd (1,119,770 BRL) than that for DRd (1,621,015 BRL); ERd (1,528,986 BRL); and IRd (1,256,064) by 31%, 27% and 11%, respectively. Conclusions: Results of the present analysis indicate that KRd is associated with lower mean treatment costs and more predictable costs, lower cost per ORR and per month in PFS than DRd, ERd and IRd over a relevant three-year time horizon from the Brazilian private healthcare perspective. The results are associated with some uncertainty due to differences in trial populations, trial design (fixed duration for carfilzomib vs treatment till progression for daratumumab, elotuzumab and ixazomib) and because treatment duration is typically shorter than PFS.

Characterization of patients with epithelial dysplasia and carcinoma in situ in the oral cavity, 2000 to 2014 / Caracterización de pacientes con displasia epitelial y carcinoma in situ en cavidad oral, entre 2000 y 2014

Objetive: To characterize patients diagnosed with oral epithelial dysplasia and carcinoma in situ, according to their severity, location, age, sex and smoking habits. Materials and Methods: A descriptive study, based on 126 histopathological reports of biopsies diagnosed with mild, moderate, severe epithelial dysplasia and carcinoma in situ, with information regarding anatomical location, age and gender of the patient, recorded in the biopsy reports of the histopathology services of the Faculty of Dentistry of Andrés Bello University and Major University, between the years 2000 and 2014. The dichotomous qualitative variables were described based on percentage and age using the Shapiro-Wilk test, presenting as average and standard deviation, in the STATA 12® program (StataCorpLP, Texas, USA). Result: A similar frequency was found for men and women diagnosed with OED, 53.17% and 46.83% respectively. A mild degree of OED was the most diagnosed in both sexes. The group most affected by OED was between 50 and 69 years old (57.94%) and the most frequent anatomic location was the lateral border of the tongue (34.13%). Conclusion: Most of the analyzed cases corresponded to mild degrees of dysplasia; however, it is important to always carry out a histopathological diagnosis of the lesion, patient follow-up and education regarding risk habits.

Objetivo: Caracterizar a pacientes con diagnóstico de displasia epitelial oral (DEO) y carcinoma in situ (CIS) según su severidad, localización, edad, género y hábito tabáquico. Materiales and Métodos: Se realizó un estudio descriptivo, en base a 126 informes histopatológicos de biopsias diagnosticadas con displasia epitelial leve, moderada, severa y carcinoma in situ, que contaban con información relativa a localización del diagnóstico, edad y género del paciente, registrados en los informes de biopsias de los servicios de histopatología de la Facultad de Odontología de la Universidad Andrés Bello y Universidad Mayor, entre los años 2000 y 2014. Las variables cualitativas dicotómicas se describieron en base a porcentaje y la edad mediante el test de Shapiro-Wilk, presentándose como media y desviación estándar, en el programa STATA 12 ® (StataCorpLP, Texas, USA). Resultados: Se encontró una frecuencia levemente aumentada de mujeres y hombres con diagnóstico de DEO, 67 (53,17%) y 59 (46,83%), respectivamente. El grado leve de DEO fue el más diagnosticado en ambos sexos. El grupo más afectado por DEO fue entre los 50 a 69 años (57,94%) y la localización anatómica más frecuente fue el borde lateral de la lengua (34,13%). Conclusión: La mayoría de los casos analizados correspondieron a grados leve de displasia; no obstante, es importante realizar siempre un diagnóstico histopatológico de la lesión, seguimiento al paciente y educación en cuanto a hábitos de riesgo.

Factores ambientales y síndrome cardiopulmonar por virus hanta en Chile / Environmental factors and cardiopulmonary syndrome due to hanta virus in Chile

RESUMEN Objetivo Evaluar la relación entre la temperatura ambiente, humedad relativa y el material particulado ambiental 2,5 con el número de casos de síndrome cardiopulmonar por virus hanta en Chile durante el periodo 2015-2017. Métodos Estudio observacional transversal en 197 casos de síndrome cardiopulmonar por virus hanta notificados y confirmados, ocurridos entre los años 2015 y 2017 en Chile. Se realizó análisis bi- y multivariado entre variables de estudio. Resultados Se determinó una relación positiva y significativa entre temperatura ambiente y número de casos de Síndrome Cardiopulmonar por virus Hanta y una relación negativa y significativa entre el número de casos de Síndrome Cardiopulmonar por virus Hanta y la humedad relativa. Además se observó que la temperatura ambiental junto con material particulado 2,5 aumentan significativamente el número de casos de Síndrome Cardiopulmonar por virus Hanta. Conclusiones Los factores ambientales están relacionados con el número de casos de síndrome cardiopulmonar por virus Hanta en Chile entre los años 2015 y 2017.(AU)

ABSTRACT Objective Evaluate the relationship between ambient temperature, relative humidity and particulate matter 2,5 with the number of cases Hantavirus Cardiopulmonary Syndrome in Chile between 2015 and 2017. Methods Observational, cross-sectional study in 197 cases of Hantavirus Cardiopulmonary Syndrome reported and confirmed, occurring between 2015 and 2017 in Chile. Results Positive and significant relationship was identified between ambient temperature and number of cases of Hantavirus Cardiopulmonary Syndrome and a negative and significant relationship between the number of cases Hantavirus Cardiopulmonary Syndrome and the relative humidity. Also, ambient temperature together with particulate matter 2,5 was observed to increase significantly the number of cases of Hantavirus Cardiopulmonary Syndrome. Conclusions Environmental factors are related to the number of cases Hantavirus Pulmonary Syndrome in Chile between the years 2015 to 2017.(AU)

Fatiga laboral y ausentismo en el trabajo en mujeres auxiliares de enfermería de un hospital de alta complejidad, Chile / Occupational fatigue and work absenteeism in female assistant nurses of a high-complexity hospital, Chile

Resumen Esta investigación ignifi la asociación entre la fatiga y el absentismo en el trabajo en 110 asistentes de enfermería de un hospital altamente complejo en Chile. Se ignifi un cuestionario sociodemográfico y la escala Check Strength Individual Strength. Los resultados mostraron que el ignific de absentismo predominante fue de 11 a 29 días. Los mayores promedios de fatiga se presentaron en los mayores de 2 años, con más de 10 pacientes en el consultorio y con contrato annual. No hubo diferencias significativas entre la fatiga media en relación con el absentismo, pero hubo una asociación ignificative entre la fatiga física (p = 0,040; OR = 1,054) y la antigüedad en el trabajo (p = 0,001; OR = 1,084) con el absentismo laboral. Finalmente, se concluye que la fatiga física y la antigüedad en el servicio clínico representaron un factor de riesgo significativo para el absentismo.

Abstract This research examined the association between occupational fatigue and work absenteeism in 110 female assistant nurses of a high-complexity hospital in Chile. A sociodemographic questionnaire and the Checklist Individual Strength (CIS) scale were used. The results showed that the predominant absenteeism range was 11-29 days. The highest means of fatigue occurred in those with seniority above 2 years, with more than 10 patients in charge and an annual contract. No significant difference was observed between the fatigue means concerning absenteeism, but a significant association was observed between physical fatigue (p = 0.040, OR = 1.054) and service seniority (p = 0.001, OR = 1.084) with work absenteeism. Finally, we can conclude that physical fatigue and seniority in the clinical service are significant risk factors for the occurrence of absenteeism.

Leiomiosarcoma y colitis ulcerosa: reporte de caso / Leiomyosarcoma and ulcerative colitis: Case report

Resumen Los pacientes con colitis ulcerosa (CU) y enfermedad de Crohn (EC) presentan un mayor riesgo de cáncer colorrectal (CCR), debido a la inflamación crónica, la susceptibilidad genética y los factores de riesgo ambientales. Sin embargo, las neoplasias no epiteliales son infrecuentes. Presentamos el caso de un varón de 83 años con una CU de larga evolución, que presenta una lesión polipoide. Una vez resecada, se diagnosticó de un leiomiosarcoma de alto grado. En la literatura, únicamente se han publicado tres casos previos de leiomiosarcoma en pacientes con CU, por lo que este reporte representaría el cuarto caso. La asociación directa de la CU y el leiomiosarcoma no ha sido bien establecida. No obstante, se sugiere que la inmunosupresión y la inflamación crónica son factores de riesgo.

Abstract Ulcerative colitis (UC) and Crohn's disease (CD) patients present an increased risk of colorectal cancer (CRC) due to chronic inflammation, genetic susceptibility and environmental risk factors. In contrast, non-epithelial neoplasms are uncommon. We discuss the case of an 83-year-old male with a long-standing UC, presenting with a polypoid lesion. Once resected, the lesion was identified as a high-grade leiomyosarcoma. A review of the literature revealed that only three previous cases of leiomyosarcoma among patients with UC have been published. Thus, this one would represent the fourth case where this rare non-epithelial neoplasm was detected in a patient with UC. The direct association of UC and leiomyosarcoma has not been well established; however, immunosuppression is suggested to be a risk factor for leiomyosarcoma in the literature.

Abordaje interlaminar complementamente endoscópico para hernias centrales extruidas y migradas en L5­S1. Serie de casos / Full-endoscopic interlaminar approach for L5- S1 extruded and migrated central hernias. Case series study

Introducción La cirugía endoscópica de columna ha demostrado ser una opción en el tratamiento de hernias discal y estenosis foraminal. El abordaje más empleado es la vía transforaminal, sin embargo, este abordaje es limitado en casos de hernias discales centrales extruidas y migradas. El abordaje interlaminar completamente endoscópico ha permitido el tratamiento sintomático de hernias discales centrales extruidas y migradas en el nivel L5 ­ S1, además es una novedosa alternativa para la resolución de las dificultades técnicas relacionadas con el abordaje posterolateral en éste nivel. El propósito del estudio es reportar los resultados obtenidos con el abordaje endoscópica interlaminar en el tratamiento de hernias discales centrales extruidas y migradas en dos años de seguimiento. Materiales y métodos Se realizó un estudio retrospectivo observacional descriptivo con las historias de pacientes que presentaron sintomatología radicular secundaria a hernia discal central en el nivel L5 ­ S1 y que fueron tratados con cirugía por abordaje interlaminar completamente endoscópico. Se evaluaron los índices de escala visual análoga (EVA) pre y posoperatorio, el criterio Oswestry ODI y el criterio MacNab. Resultados Entre los años 2008 y 2015 se realizaron un total de 99 procedimientos en el mismo número de pacientes. Todos fueron sometidos a una técnica quirúrgica estándar bajo anestesia local y sedación. La EVA tuvo una reducción de 5,81 puntos. El ODI bajó 45,63%. Y el 88% de los pacientes tuvo una completa satisfacción frente al tratamiento. Discusión Los resultados obtenidos en esta muestra permiten considerar la fragmentectomía interlaminar endoscópica bajo anestesia local y sedación como un procedimiento seguro, preciso y efectivo en la resolución del dolor secundario a hernias discales centrales extruidas y migradas en el nivel L5 ­ S1 que cursan con radiculopatía. El uso de anestesia local y sedación como única alternativa analgésica puede no ser la mejor opción en este tipo de técnicas Nivel de evidencia IV

Background Endoscopic spine surgery has shown to be an option for disc hernias and foraminal stenosis. Although the most used approach is transforaminal, this approach is limited in cases of extruded and migrated central hernias. The full-endoscopic interlaminar approach has led to the treatment of the lumbar pain secondary to extruded and migrated central herniated discs at L5 - S1, and is an alternative for resolving technical difficulties related to the transforaminal approach at this level. The aim of this article is to report the results obtained with a full-endoscopic interlaminar approach for the treatment of central extruded and migrated herniated discs, with a two-year follow-up. Methods A descriptive observational retrospective study was conducted using the records of patients who had a radiculopathy secondary to a central herniated disc at level L5 - S1, and who were treated with a full-endoscopic interlaminar approach. An evaluation was made of the pre-operative and post-operative visual analogue scale (VAS) scores, Oswestry ODI criteria, and MacNab criteria. Results A total of 99 procedures were performed in the same number of patients between 2008 and 2015. All were treated with a standard surgical technique and under local anaesthesia and sedation. The visual analogue score showed a reduction of 5.81 points. The ODI was down 45.63%, and 88% of the patients were completely satisfied with the treatment. Discussion The results lead us to consider that full-endoscopic interlaminar fragmentectomy under local anaesthesia and sedation is a safe, accurate, and effective procedure for the treatment of radiculopathy related to L5 - S1 extruded and migrated central hernia. Use of local anaesthesia and sedation as the only analgesic alternative may not be the best option in this type of technique. Evidence Level IV

Factores asociados a la adopción de conducta promotora de salud en estudiantes de una universidad en Chile / Factors associated with the adoption of health promoting behavior in students of a university in Chile

La Conducta Promotora de Salud se ve influenciada por diversos factores que definen el estilo de vida de una persona. El objetivo de este estudio es determinar los factores que condicionan la adopción de Conducta Promotora de Salud en estudiantes de una Universidad en Chile. Se realizó un estudio analítico, de corte transversal, en 189 estudiantes, se aplicó la Escala de Estilo de vida Promotor de Salud, Escala de Autoeficacia General, Escala de Autoestima de Rosenberg y un cuestionario para caracterizar a los participantes. Se utilizó estadística descriptiva e inferencial y el programa SPSS 22. Se observó que los dominios de la Escala de Estilo de Vida Promotor de Salud que presentaron mayor media fueron, crecimiento espiritual y relaciones interpersonales con una media de 24,7 (D.S=5,4) y 23,9 (D.S=4,8) respectivamente. En cuanto a los Factores de Riesgo para la Salud solo el consumo de marihuana se relacionó con Conducta Promotora de Salud (p value 0,036). Además se aprecia que la Conducta Promotora de Salud tiene una relación directamente proporcional y significativa con percepción de Autoestima y Autoeficacia (p value< 0,01). Se concluye que, a mayor percepción de Autoestima y Autoeficacia mayor es la adopción de Conducta Promotora de Salud.

Health Promoting Behavior is influenced by various factors that define a person's lifestyle. The objective of this study is to determine the factors that condition the adoption of Promoting Health Conduct in students of a University in Chile. An analytical, cross-sectional study was carried out on 189 students; the Health Promoter Lifestyle Style Scale, the General Self-Efficacy Scale, the Rosenberg Self-Esteem Scale and a questionnaire to characterize the participants were applied. Descriptive and inferential statistics and the SPSS 22 program were used. It was observed that the domains of the Health Promoter Lifestyle Scale that had the highest average were spiritual growth and interpersonal relationships with a mean of 24.7 (SD = 5.4) and 23.9 (SD = 4.8) respectively. Regarding the Risk Factors for Health, only marijuana consumption was related to Health Promoting Behavior (p value 0.036). It is also seen that the Health Promotion Conduct has a directly proportional and significant relationship with the perception of Self-Esteem and Self-Efficacy (p value <0.01). It is concluded that, the greater the perception of Self-esteem and Self-efficacy, the greater is the adoption of Promoting Health Behavior.

Accidentes laborales no cortopunzantes notificados en trabajadores de un hospital de la Red de Salud Pública, Chile 2014-2016 / Non-sharps work accidents notified in workers of a hospital of the Public Health Network, Chile 2014-2016

Objetivo: describir los accidentes laborales no cortopunzantes en trabajadores de un Hospital de la Red de Salud Pública, Chile en el período 2014-2016. Materiales y Métodos: estudio cuantitativo, descriptivo y retrospectivo de los accidentes laborales no cortopunzantes notificados en un Hospital de la red de Salud Publica en Chile.Se analizaron un total de 345 accidentes laborales no cortopunzantes notificados, período de estudio de 2014 a 2016. Resultados: el 76% de los accidentes laborales no cortopunzantes corresponden a accidentes en el trabajo y el 24% accidentes en el trayecto al trabajo. Se presentan en mayor frecuencia en: funcionarios que tienen entre 1 y 11 años de antigüedad laboral, en mujeres (75%), pertenecientes a Unidades Hospitalizados Adulto y Pediátrico (37%) y en el día jueves de la semana (21%). El motivo más común de los accidentes laborales no cortopunzantes es la caída (25%); la parte corporal mayormente lesionada corresponde a manos, dedos y muñecas (26%) y lesión más común es la contusión (44%). Finalmente, se pierden 2127 días laborales, a causa de este tipo de accidentes. Conclusiones: los hallazgos evidencian que los trabajadores se ven afectados por accidentes laborales no cortopunzantes, con predominio de caídas, lesiones en manos y a causa del ambiente de trabajo. Que estos, se producen mayormente en mujeres y en Unidades de Hospitalizado Adulto y Pediátrico..(AU)

Objective: to describe non-sharps work accidents in workers of a Hospital of the Public Health Network, Chile in the 2014-2016 period. Materials and Methods: quantitative, descriptive and retrospective study of non-sharps work accidents reported in a Hospital of the Public Health network in Chile. A total of 345 notified non-sharps work accidents were analyzed, from 2014 to 2016. Results: 76% of non-sharps injuries correspond to accidents at work and 24% accidents on the way to work. They occur in greater frequency in: officials who have between 1 and 11 years of working seniority, in women (75%), belonging to Adult and Pediatric Hospitalized Units (37%) and on Thursday of the week (21%). The most common reason for non-sharp accidents is falling (25%); the body part mostly injured corresponds to hands, fingers and wrists (26%) and the most common injury is contusion (44%). Finally, 2127 business days are lost, because of this type of accident. Conclusions: the findings show that workers are affected by non-sharp accidents, with a predominance of falls, hand injuries and the work environment. That these are produced mostly in women and in Adult and Pediatric Hospitalized Units..(AU)

Recomendaciones para el uso correcto de densitometría ósea en la práctica clínica. Consenso de la Sociedad Chilena de Endocrinología y Diabetes / Guidelines of the Chilean Endocrinology Society for the correct clinical use of bone densitometry

Osteoporosis is a silent and frequent disease, which increases fracture risk. Approximately half of women and one of five men over 50 years old will suffer an osteoporotic fracture throughout their lives. Dual-energy x-ray absorptiometry (DXA) allows a real bone mineral density (BMD) measurement in different parts of the skeleton and is considered the "gold standard" for quantifying osteoporosis with high accuracy and precision. The Board of the Chilean Society of Endocrinology and Diabetes (SOCHED) required from the Bone Disease Study Group to develop a consensus about the "Correct use of bone densitometry in clinical practice in Chilean population". Therefore, we elaborated 25 questions which addressed key aspects about the indications for a DXA scan, and the details of how to perform and report this test. Since some of the evidence obtained was of low quality or inconclusive, we decided to create a multidisciplinary group of national experts in osteoporosis to develop a consensus in this subject. The group consisted of 22 physicians including endocrinologists, gynecologists, geriatricians, radiologists, rheumatologists and nuclear medicine specialists. Using the Delphi methodology to analyze previously agreed questions, we elaborated statements that were evaluated by the experts who expressed their degree of agreement. The final report of this consensus was approved by the SOCHED board.

Consumo de bebidas energizantes en una población de escolares de Bogotá, Colombia / Consumption of energy drinks among students of Bogotá, Colombia

RESUMEN Objetivo El objetivo de este estudio fue evaluar el patrón de consumo de bebidas energizantes en una muestra de estudiantes de dos colegios públicos y dos privados de Bogotá. Método Se realizó un estudio transversal. Se incluyeron 671 escolares de 10 a 20 años. Se analizaron las medidas antropométricas y la encuesta de frecuencia de consumo de alimentos a través de un cuestionario autoaplicado. Resultados El 80% tenía IMC normal, 12,4% de sobrepeso, 3,6% de obesidad. No hay asociación entre el IMC y el consumo de bebidas energéticas (p=0,514). El consumo de bebidas energéticas por parte de los estudiantes se asocia con el ejercicio físico (p=0,01) y el consumo de bebidas alcohólicas (p=0,000). Conclusiones El consumo de bebidas energizantes está asociado con el ejercicio físico y el consumo de alcohol. Los hallazgos demuestran la importancia de establecer campañas educativas destinadas a informar sobre los peligros de ingerir estas bebidas e incluso el mezclarlas con alcohol etílico.(AU)

ABSTRACT Objective To assess the pattern of energy drinks consumption in a sample of students from two public and two private schools of Bogotá. Materials and Methods Cross-sectional study in a population of 671 students aged 10 to 20 years. Anthropometric measurements and a food consumption frequency survey were analyzed through a self-applied questionnaire. Results 80% had normal Body Mass Index (BMI), 12.4% were overweight and 3.6% were obese. No association between BMI and energy drinks consumption was observed (p=0.514). Energy drinks consumed by students is associated with physical activity (p=0.01) and alcohol intake (p=0.000). Conclusions The consumption of energy drinks is associated to physical exercise and alcohol intake. The findings show the importance of establishing educational campaigns to inform about the dangers of ingesting energy drinks and mixing them with ethyl alcohol.(AU)

Anterior percutaneous cervical discectomy. two-year follow-up of a blunt technique procedure / Discotomia cervical percutânea anterior. dois anos de acompanhamento de um procedimento com técnica romba / Discectomía cervical anterior percutánea. dos años de seguimiento de una técnica roma

ABSTRACT Objective: To report the outcomes of non-endoscopic percutaneous cervical discectomy by anterior blunt approach for the treatment of degenerative disc disease. Methods: A review of the medical records of patients with axial cervical pain resulting from degenerative disc disease and treated with discectomy and percutaneous nucleoplasty by anterior blunt approach with radiofrequency source was carried out. The data were evaluated according to modified MacNab and pre- and postoperative VAS criteria at 3, 12 and 24 months. Results: Sixty-two procedures were performed in 48 patients between 2008 and 2014. The mean age of the population was 52.4 years. MacNab results were 84.6%, 92.3%, and 89.2% improvement (excellent and good results) at 3, 12 and 24 months, respectively. The VAS changed from 7.4 to 2.3 two years after the procedure, showing a statistically significant difference (p=0.000). There were no major complications or re-interventions related to the technique. Conclusions: Anterior non-endoscopic discectomy and nucleoplasty for the treatment of discogenic axial cervical pain may be an effective alternative to open surgery. In the two-year follow-up, our blunt technique proved to be a safe procedure with no approach-related complications, and provided outcomes comparable to those reported using the original needle technique.

RESUMO Objetivo: Relatar os resultados de discotomia percutânea não endoscópica por acesso anterior rombo para tratamento de doença degenerativa do disco. Métodos: Realizou-se uma revisão dos prontuários clínicos de pacientes com dor cervical axial decorrente de doença degenerativa do disco e tratados com discotomia e nucleoplastia percutâneas não endoscópicas por acesso anterior rombo com fonte de radiofrequência. Os dados foram avaliados de acordo com MacNab modificado e os critérios pré e pós-operatórios da EVA aos 3, 12 e 24 meses. Resultados: Um total de 62 procedimentos foi realizado em 48 pacientes entre 2008 e 2014. A média de idade da população foi de 52,4 anos. Os resultados de MacNab obtidos foram 84,6%, 92,3% e 89,2% de melhora (resultados excelentes e bons) aos 3, 12 e 24 meses, respectivamente. A EVA passou de 7,4 para 2,3 dois anos depois do procedimento, mostrando diferença estatisticamente significante (p = 0,000). Não houve complicações importantes ou reintervenções relacionadas com a técnica. Conclusões: A discotomia e nucleoplastia não endoscópicas anteriores para tratamento da dor cervical axial discogênica podem ser uma alternativa efetiva à cirurgia aberta. Nos dois anos de acompanhamento, nossa técnica romba provou ser um procedimento seguro, sem complicações relacionadas com o acesso e proporcionou resultados comparáveis aos relatados quando se usa a técnica original com agulha.

RESUMEN Objetivo: Reportar los resultados de la discectomía percutánea no endoscópica a través de abordaje anterior romo para el tratamiento de la enfermedad degenerativa del disco. Métodos: Se realizó una revisión de las historias clínicas de los pacientes con dolor cervical axial resultante de enfermedad degenerativa del disco y tratados con discectomía y nucleoplastia percutáneas no endoscópicas por abordaje anterior romo con fuente de radiofrecuencia. Los datos fueron evaluados de acuerdo con MacNab modificado y los criterios pre y postoperatorios de EVA a los 3, 12 y 24 meses. Resultados: Se realizaron un total de 62 procedimientos en 48 pacientes entre 2008 y 2014. La edad promedio de la población fue de 52,4 años. Los resultados de MacNab obtenidos fueron 84,6%, 92,3% y 89,2% de mejora (resultados excelentes y buenos) a los 3, 12 y 24 meses, respectivamente. La EVA cambió de 7,4 a 2,3 dos años después del procedimiento, mostrando diferencia estadísticamente significativa (p = 0,000). No hubo complicaciones importantes o reintervenciones relacionadas con la técnica. Conclusiones: La discectomía y nucleoplastia no endoscópicas anteriores para el tratamiento del dolor cervical axial discogénico pueden ser una alternativa efectiva a la cirugía abierta. En los dos años de seguimiento, nuestra técnica roma demostró ser un procedimiento seguro, sin complicaciones relacionadas con el abordaje y proporcionó resultados comparables a los reportados cuando se usa la técnica original con aguja.

Diagnóstico e tratamento dos eventos adversos do ácido hialurônico: recomendações de consenso do painel de especialistas da América Latina / Diagnosis and treatment of hyaluronic acid adverse events: Latin American expert panel consensus recommendations

Introdução: Na última década, o uso do preenchimento com ácido hialurônico para aprimoramento facial aumentou na América Latina. O preenchimento com ácido hialurônico é considerado seguro com baixa incidência de eventos adversos. Como eventos adversos são pouco observados na prática clínica ou têm sido possivelmente sub-relatados são necessárias mais orientações para diagnosticar e tratar eventos adversos relacionados ao ácido hialurônico. Objetivo: Compreender melhor os eventos adversos relacionados ao ácido hialurônico e propor recomendações para o diagnóstico e tratamento. Métodos: Reunião em painel de 25 especialistas médicos multidisciplinares da América Latina foi realizada em São Paulo, Brasil, para discutir o que se conhece sobre eventos adversos relacionados ao ácido hialurônico e fornecer conhecimentos baseados na experiência clínica. Por meio de consenso, foram desenvolvidos recomendações e algoritmos. Resultados: O painel categorizou eventos adversos relacionados ao ácido hialurônico baseado em três momentos de início (imediato, precoce e tardio) e propôs um novo termo para eventos adversos que apresentam edema tardio intermitente persistente ("Etip"). Foram criados algoritmos para diagnóstico e tratamento em cada momento. Conclusões: Novos algoritmos consensuais para diagnósticos e tratamentos associados ao momento de início dos eventos adversos relacionados ao ácido hialurônico orientarão melhores práticas no uso clínico do preenchimento com ácido hialurônico.

Introduction: In the last decade, the use of hyaluronic acid fillers for facial enhancement has increased in Latin America. Hyaluronic acid fillers are considered relatively safe with a low incidence of adverse events. Because adverse events are not seen frequently in clinical practice or have been potentially underreported, there is a need for more guidance on the diagnosis and treatment of Hyaluronic acid-related adverse events. Objecti ve: To provide an enhanced understanding of hyaluronic acid-related adverse events and to propose recommendations for their diagnosis and treatment. Methods: A 25-member multi-disciplinary expert panel meeting of Latin-American physicians was convened in Sao Paulo, Brazil to discuss what is known about hyaluronic acid-related adverse events and to provide insights based on clinical experience. Recommendations and algorithms were developed through a consensus process. Results: The panel categorized hyaluronic acid-related adverse events based on 3 time frames of onset (immediate, early and Late) and proposed a new term for adverse events that display persistent, intermittent, delayed Swelling (PIDS). Algorithms were created for diagnosis and treatment for each time frame. Conc lusions: The new consensus algorithms for time-related diagnosis and treatment of hyaluronic acid-related adverse events will provide guidance for best practices in the clinical use of hyaluronic acid fillers.

Barreras en la implementación de los hallazgos de la investigación y sugerencias para su enfrentamiento / Barriers to the implementation of research findings and suggestions for its confrontation

RESUMEN Objetivo: Identificar las barreras percibidas por las enfermeras(os) en la implementación de los hallazgos de la investigación y las sugerencias establecidas para su abordaje. Material y método: Revisión sistematizada de la literatura en las bases de datos de Web of Science y Pubmed, utilizando los términos Barriers and Research Utilization and Nursing, publicados entre los años 2008 al 2014. El total de artículos recuperados fue de 158, luego de aplicar los criterios de inclusión y exclusión, 22 artículos fueron elegibles para revisión: 15 artículos de Web of Science y 7 de Pubmed. Resultados: Las principales barreras identificadas fueron falta de tiempo, falta de conocimiento de las enfermeras(os) en investigación, falta de autoridad y/o autonomía de las enfermeras(os) en la implementación de resultados que lleven a cambios en los cuidados otorgados a las personas y falta de apoyo organizacional. Las principales sugerencias de enfrentamiento fueron: apoyo organizacional y formación de enfermeras en investigación. Conclusión: Existen diversas barreras que dificultan la implementación en los hallazgos de la investigación, las que han permanecido en el tiempo y no son diferentes entre países. Es opor tuno comenzar a realizar intervenciones efectivas sobre las sugerencias de enfrentamiento y así favorecer el uso de los resultados de la investigación en la práctica clínica y de esta manera contribuir a elevar la calidad de los cuidados de enfermería.

ABSTRACT Objective: To identify barriers perceived by male and female nurses in the implementation of research findings and the suggestions set forth for this approach. Method: Systematized review of the literature in the databases PubMed and Web of Science using the terms Barriers and Nursing Research Utilization and published between the years 2008 and 2014; the total of articles recovered was 158. After applying the inclusion and exclusion cri teria, 22 articles were eligible for reviewing: 15 articles from Web of Science and 7 from PubMed. Results: The main barriers identified were lack of time, nurses lack of knowledge about in researching, lack of authority and/ or autonomy of nurses in the implementation of results that lead to changes in the care provided to people, and also lack of organizational support. The main suggestions of improvement were: organizational support and training of nurses in researching. Conclusion: There are various barriers to the implementation of research findings, which have remained over time and are similar among countries. It is necessary to implement effective interventions based on the suggestions of confrontation and thus promote the use of research findings in clin ical practice and also to contribute to the improvement of the quality of nursing care.