An exploratory cross-sectional study on Mental health literacy of Spanish adolescents.

BACKGROUND: Mental health literacy (MHL) is especially important for young people, but comprehensive studies on MHL in adolescents are limited, with no nationwide studies in Spain. This research aims to study MHL among Spanish adolescents and its relationship with sociodemographic factors. METHODS: An exploratory study is carried out using stratified random sampling in Spanish adolescents (N = 1000), aged 12-16 years and balanced in terms of gender, age and territorial distribution. Data collection took place in October and November 2023 through online surveys using the CAWI methodology. Sociodemographic variables, contact with mental health and the Spanish version of the Mental Health Literacy Questionnaire (MHLq-E), a self-administered instrument of 32 Likert-type items (1-5) that assesses the dimensions of help-seeking skills, knowledge about causes and symptoms, and stigma, were evaluated. Descriptive and multivariate analyses of variance (MANOVA) were conducted. RESULTS: In general, adequate levels of literacy were observed, although some aspects related to help-seeking towards teachers, stigmatising attitudes towards people of low economic status and knowledge of severe mental health problems could be improved. The results show contact with previous mental health problems as a key variable for stigma and knowledge about symptomatology together with age. Likewise, gender and family educational level were found to be related to the ability to seek professional help. CONCLUSION: This study provides information on levels of MHL among Spanish adolescents and highlights significant socio-demographic variables. These findings pave the way for interventions aimed at improving adolescents' understanding, attitudes and skills to manage mental health problems, making possible to adapt content and focus on specific groups, thus increasing its effectiveness.

Effectiveness of an intervention to improve ART adherence among men who have sex with men living with HIV: a randomized controlled trial in three public HIV clinics in Mexico.

We conducted a parallel-group randomized controlled trial in three HIV clinics in Mexico to evaluate a user-centred habit-formation intervention to improve ART adherence among MSM living with HIV. We randomized 74 participants to the intervention group and 77 to the control group. We measured adherence at one, four, and ten months through medication possession ratio and self-reported adherence. Additionally, we measured viral load, CD4 cell count, major depression disorder symptoms, and alcohol and substance use disorder at baseline, fourth and tenth months. We found no statistically significant effect on adherence between groups. However, the intervention demonstrated positive results in major depression disorder symptoms (21% vs. 6%, p = 0.008) and substance use disorder (11% vs. 1%, p = 0.018) in the fourth month. The latter is relevant because, in addition to its direct benefit, it might also improve the chances of maintaining adequate adherence in the long term. This trial was retrospectively registered at ClinicalTrials.gov (trial number NCT03410680) on 8 January 2018.Trial registration: ClinicalTrials.gov identifier: NCT03410680.

Psychological well-being of teachers: influence of burnout, personality, and psychosocial climate.

Introduction: Those who are professionally dedicated to teaching can be exposed with their work to situations that influence their perception of psychological well-being. This study aims to evaluate how the factors of personality, emotional intelligence, burnout and the psychosocial climate derived from the work environment of teachers influence their levels of psychological well-being, to verify whether these variables allow us to establish a predictive model of psychological well-being by means of multiple regression analysis. Methods: Participants were a group of 386 teachers in early childhood, Primary and Secondary education, both in training and in active service (71.5% women; 28.5% men). A correlation and multiple regression analysis were performed to establish a predictive model of psychological well-being. We used 5 instruments: Psychosocial Climate at Work Scales (ECPT); verall Personality Assessment Scale (OPERAS); Questionnaire for Evaluation of Burnout Syndrome at Work (CESQT); Spanish adaptation of the Riff Psychological Well-being Scales (EBP) and Spanish validation of the Trait Meta-Mood Scale (TMMS-24). Results: Most of the relationships were significant, and the multiple regression analysis explains 58.5% of the global variance of psychological well-being in teachers, being emotional stability the most relevant and main predictor of psychological well-being, explaining its 38.1%. Discussion: Personality shows a great influence in psychological well-being of teachers, particularly emotional stability. The ability to establish predictive models to explain psychological well-being in educational environments is confirmed.

Emotional Intelligence, Psychological Well-Being and Burnout of Active and In-Training Teachers.

The main activating variables of psychological well-being and Emotional Intelligence that influence teachers include the process of evaluating well-being, their motivation, and their ability to perceive and regulate sources of stress and burnout. The relationship and influence of psychological well-being and emotional intelligence was analyzed with the adequate regulation of burnout. Those who participated included 386 active teachers (55%), and teachers in training (45%), studying for degrees in Pre-School and Primary Education, and Master's degrees in Secondary Education Teacher Training of which 71.5% were women. The following were used: Psychological Well-Being Scales, Trait Meta-Mood Scale and the Spanish Burnout Inventory. Pearson's correlation analysis and multiple regression analysis were performed. The results showed that enthusiasm for the teaching job is related to psychological well-being, especially domain of the environment and personal growth. Multiple regression analysis made it possible to establish a predictive model of well-being, showing that psychological well-being is the main adjustment predictor and/or the mismatch in the work of the teaching staff in both samples, through an adequate regulation of positive relationships, mastery of their environment and having a purpose in life.

CSI-SF: Propiedades psicométricas de la versión española del inventario breve de estrategias de afrontamiento / CSI-SF: Psychometric properties of Spanish version of the coping strategies inventory - short form

Antecedentes/Objetivo: El estudio establece las propiedades psicométricas de la adaptación española de la versión abreviada del Inventario de Estrategias de Afrontamiento (CSI-SF) publicado por Addison et al. (2007). La prueba utiliza un modelo de dos ejes para clasificar las estrategias de afrontamiento (de compromiso y de evitación) y las categorías objetivas del afrontamiento (centrada en el problema y centrada en la emoción). Método: Participaron 940 personas (62.87% mujeres; 37.12% hombres) divididas en dos submuestras. Se realizó un análisis factorial exploratorio (AFE) y un análisis factorial confirmatorio (AFC), así mismo la correlación de Pearson y el Alfa de Cronbach para examinar la fiabilidad y validez de la adaptación al español del CSI-SF. Resultados: El análisis de consistencia interna reveló una alta fiabilidad para todas las escalas (EFE = .890, PFE = .836. PFD = .767, EFD = .934), y todos los índices de ajuste utilizados para examinar el CSI-SF versión española proporcionaron soporte para su uso como una medida adecuada de las estrategias de afrontamiento del estrés. Discusión/Conclusión: La escala CSI-SF versión española es una prueba que proporciona un diagnóstico rápido y eficiente cuyos factores explican el 62.79% de la varianza común total de las estrategias de afrontamiento que se emplean frente a la situación de estrés en distintos ámbitos.(AU)

Background / Objective: The study establishes the psychometric properties of the Spanish adaptation of the abbreviated version of the Coping Strategies Inventory (CSI-SF) published by Addison et al. (2007). The test uses a two-axis model to classify coping strategies (commitment and avoidance) and objective categories of coping (problem-focused and emotion-focused). Method: 940 people participated (62.87% women; 37.12% men) aged between 18 and 66 years (x̄= 33.2; dt = 12.01). An exploratory factor analysis (EFA) and a confirmatory factor analysis (CFA) were carried out, as well as Pearson's correlation and Cronbach's Alpha to examine the reliability and validity of the Spanish adaptation of the CSI-SF. Results: Internal consistency analysis revealed high reliability for all scales, and all adjustment indexes used to examine the CSI-SF Spanish version provided support for its use as an adequate measure of stress coping strategies. Discussion/Conclusions: The CSI-SF scale Spanish version is a test that provides a quick and efficient diagnosis of the coping strategies used in the face of stress in different settings.

Sufrimiento psicológico en hombres y mujeres con síntomas de depresión / Psychological suffering in men and women with symptoms of depression

Resumen El objetivo del presente estudio descriptivo comparativo era determinar si existían diferencias en la expresión de sufrimiento psicológico en una muestra de 269 personas con edades entre los 18 y 58 años (M= 31.2), distribuidas en 4 grupos de acuerdo con el sexo y el reporte o no de síntomas de depresión. Para evaluar sufrimiento se utilizó la Entrevista de Percepción del Paso del Tiempo, el Cuestionario de Depresión de Hombres, la Escala Zung de Depresión para las mujeres y la Escala de Salud Mental Self Reporting Questionare (SRQ). Se utilizó el estadístico ANOVA para determinar la diferencia de medias y un análisis pos hoc para identificar la dirección de la diferencia. Los resultados indican que, aunque las mujeres reportaron puntajes más altos en la escala de depresión, los hombres reportan significativamente más sufrimiento psicológico, y que este es independiente del reporte del puntaje de depresión obtenido.

Abstract The hardiness is a variable of great importance in the protection of health, so the validation and adaptation of instruments to evaluate it are necessary. The objective of the research was to evaluate the psychometric properties of the Hardiness Questionnaire (non-work version) for a sample of the Cuban population. An instrumental study was carried out based on the quantitative research paradigm. The sample selection was made based on a cluster sampling that included 400 subjects residing in six provinces of the country. The standard age chosen was 48 (±14.7) ; 54.5 % of the simple was for females. Three models were estimated, the one who showed better scores was the trifactorial one (control, implication and challenge) with a factor of a second order (hardiness) reduced from the elimination of two reactive. Some acceptable figures of reliability were obtained, both global (a=0.83) and as in each dimension: control and challenge (a=0.77) and implication (a=0.70). The recurrent validity brings evidence of the value of the subscales control and commitment.

Causal attributions in early childhood education: a new categorization system / Atribuciones causales en Educación Infantil: nuevo sistema de categorización

BACKGROUND: From Early Childhood Education onwards, causal attributions influence explanations of school performance. We performed a systematic review of the available knowledge (1970-2019) about Weiner's (1986) Attribution Theory of the Motivation of Achievement in order to examine studies related to the causal attributions of success and failure at school. We found numerous empirical studies related to Bernard Weiner's theory. However, little research exists about students in Early Childhood Education. Therefore, the aim of this study was to identify the causes to which children attribute their successes and failures during this educational period. METHOD: A sample of 200 students aged between 3 and 6 years old was selected. To collect the data, an individually implemented Piagetian clinical interview was used. RESULTS: A large volume of qualitative information was collected for classification which exceeded Weiner's traditional causal attributions. Creating a category to group all new attributions implied losing too much information under a non-specific label. CONCLUSION: A new categorization of the causal attributions was designed, made up of 10 categories -adapted to the 3-6 years age range- which revises and expanding on the categorization created by Weiner

ANTECEDENTES: las atribuciones causales de la motivación influyen desde Educación Infantil en la explicación del rendimiento escolar. Se realizó una revisión sistemática de los conocimientos disponibles (1970-2019) de la Teoría Atribucional de la Motivación de Logro de Weiner (1986) para conocer los trabajos relacionados con las atribuciones causales del éxito y fracaso escolar. Se hallaron numerosos estudios empíricos relacionados con la teoría de Bernard Weiner. Sin embargo, son escasas las investigaciones con estudiantes de Educación Infantil. Por ello, el objetivo de este estudio fue identificar las causas a las que atribuyen sus éxitos y fracasos escolares en Educación Infantil. MÉTODO: se seleccionó una muestra de 200 estudiantes con edades comprendidas entre los 3 y 6 años. Para recopilar los datos se utilizó una entrevista clínica piagetiana implementada individualmente. RESULTADOS: se recopiló un gran volumen de información cualitativa para clasificar que desbordaba las atribuciones causales tradicionales de Weiner. Crear una categoría para agrupar todas las nuevas atribuciones implicaba perder demasiada información bajo una etiqueta inespecífica. CONCLUSIÓN: se diseñó una nueva categorización de las atribuciones causales formada por 10 categorías -adaptada al rango de edad 3-6 años- que revisa y amplía la creada por Weiner

Causal attributions in Early Childhood Education: A new categorization system.

BACKGROUND: From Early Childhood Education onwards, causal attributions influence explanations of school performance. We performed a systematic review of the available knowledge (1970-2019) about Weiner's (1986) Attribution Theory of the Motivation of Achievement in order to examine studies related to the causal attributions of success and failure at school. We found numerous empirical studies related to Bernard Weiner's theory. However, little research exists about students in Early Childhood Education. Therefore, the aim of this study was to identify the causes to which children attribute their successes and failures during this educational period. METHOD: A sample of 200 students aged between 3 and 6 years old was selected. To collect the data, an individually implemented Piagetian clinical interview was used. RESULTS: A large volume of qualitative information was collected for classification which exceeded Weiner's traditional causal attributions. Creating a category to group all new attributions implied losing too much information under a non-specific label. CONCLUSION: A new categorization of the causal attributions was designed, made up of 10 categories -adapted to the 3-6 years age range- which revises and expanding on the categorization created by Weiner.

Bridging the gap: an economic case study of the impact and cost effectiveness of comprehensive healthcare intermediaries in rural Mexico.

BACKGROUND: In rural settings where patients face significant structural barriers to accessing healthcare services, the formal existence of government-provided health coverage does not necessarily translate to meaningful care delivery. This paper analyses the effectiveness of an innovative approach to overcome these barriers, the Right to Health Care programme offered by Compañeros en Salud in Chiapas, Mexico. This programme provides comprehensive free coverage of all additional direct and indirect medical costs as well as accompaniment through the medical system. Over 550 patients had participated from 2013 until November 2018. METHODS: Focusing on ten of the most frequently treated conditions, including hernias, cataracts and congenital heart defects, we performed a retrospective case study analysis of the quality-adjusted life years (QALYs) gained from treatment and the cost per QALY for 69 patients. This analysis used disability weights and uncertainty intervals from the Global Burden of Disease study and organisational micro-costing data for each patient. Each patient was compared to their own hypothetical counterfactual health outcome had they not received the secondary and tertiary care required for the specific condition. A mixed methods approach is used to establish this counterfactual baseline, drawing on pre-intervention observations, qualitative interviews and established literature precedent. RESULTS: The programme was found to deliver an average of 14.4 additional QALYs (95% uncertainty interval 12.4-15.8) without time discounting. The mean cost per QALY over these conditions was $388 USD (95% UI $262-588) at purchasing power parity. CONCLUSIONS: These numbers compare favourably with studies of other health services and international cost per QALY guidelines. They reflect the on-treatment effect for the ten conditions analysed and are presented as a case study indicative of the promise of healthcare intermediaries rather than a definitive assessment of cost-effectiveness. Nonetheless, these results show the potential feasibility and cost effectiveness of a more comprehensive approach to healthcare provision in a resource-limited rural setting. TRIAL REGISTRATION: This study involves economic analysis of a programme facilitating access to public healthcare services. Thus, there was no associated clinical trial to be registered.

Rapid quantitative analysis of methylphenidate and ritalinic acid in oral fluid by liquid chromatography triple quadrupole mass spectrometry (LC-QqQ-MS).

Methylphenidate (MPH), which is metabolized into ritalinic acid (RA), is an amphetamine derivative largely used in the treatment of attention-deficit hyperactivity disorder, a neurological condition commonly diagnosed in early childhood. Ensuring that patients comply with clinical treatment is crucial and compliance is generally monitored in blood or urine specimens which, especially in the case of children, can be challenging to obtain on a repetitive basis. Here we report validation of a specific, non-invasive, and rapid dilute-and-shoot analytical method for the detection and quantitation of MPH and RA in oral fluid (OF). The method is based on liquid chromatography coupled to triple quadrupole MS with electrospray ionization utilizing dynamic MRM mode. Subject OF specimens were collected using a Quantisal™ device, processed, and diluted for analysis with seven-point quadratic calibration curves (weighting of 1/x) using MPH-d9 and (±)-threo-RA-d10 as internal standards. QC samples and diluted specimens showed intra- and inter-day bias and imprecision values no greater than ±12%. The LOD and LOQ for MPH were 0.1 and 0.5 ng/mL, respectively, and 0.2 ng/mL and 0.5 ng/mL for RA, respectively, indicating the validity of the method for identification and confirmation at low concentrations. Selectivity was specific for the analytes of interest and matrix effects were minimized through the use of internal standard based quantitation.

Vasculitis primaria del sistema nervioso central: presentación de caso clínico / Primary vasculitis of the central nervous system: presentation of clinical case / Vasculite primária do sistema nervoso central: apresentação do caso clínico

La vasculitis Primaria del Sistema Nervioso Central (VPSNC) se refiere a un grupo de enfermedades que resultan de la inflamación y destrucción de los vasos sanguíneos de la medula espinal, encéfalo y meninges, tanto en el sector venoso como arterial. La presentación es heterogénea y poco sistematizable. El diagnóstico se establece con un cuadro clínico compatible, una angiografía que evidencie vasculitis y/o biopsia del parénquima encefálico o meninges. Las alteraciones en los estudios de imagen son constantes pero inespecíficas para el diagnóstico y se acompañan habitualmente de alteraciones en el líquido cefalorraquídeo (LCR) y electroencefalograma (EEG) Presentamos un paciente con probable VPSNC basados en un cuadro clínico compatible, hallazgos imagenológicos sugestivos, junto con alteraciones en LCR y EEG. Se realizó tratamiento en base a corticoides e inmunosupresores con mala respuesta y evolución.

The primary central nervous system vasculitis (VPSNC) refers to a group of diseases that result from inflammation and destruction of the blood vessels of the spinal cord, brain and meninges, both in the venous and arterial sector. The presentation is heterogeneous and unsystematized. The diagnosis is made based on compatible symptoms, supported by an angiography showing evidence of vasculitis and/or biopsy of the brain parenchyma or meninges. Alterations in imaging studies are consistent but nonspecific for diagnostic and are usually accompanied by alterations in the electroencephalogram (EEG) and cerebrospinal fluid (CSF). We present a clinical case of probable VPSNC based on clinical presentation and findings on imagenological studies suggestive vasculitis, along with alterations in CSF and EEG. Treatment was based on Corticosteroids and immunosuppressive agents with poor response and evolution.

Vasculite Primária do Sistema Nervoso Central (VPSNC) refere-se a um grupo de doenças que resultam de inflamação e destruição dos vasos sanguíneos na medula espinal, o sector venosa arterial cerebral e meninges, ambos. A apresentação é heterogênea e não muito sistematizável. O diagnóstico é estabelecido com um quadro clínico compatível, uma angiografia que evidencia vasculite e / oubiópsia do parênquima cerebral ou meninges. Alterações nos estudos de imagemsão constantes, mas não específica para o diagnóstico e são normalmente acompanhadas por alterações no líquido cefalorraquidiano (LCR) e eletroencefalograma (EEG) descrevem um paciente com VPSNC provável com base em um quadro clínico, achados de imagem sugestivos compatíveis, em conjunto com alterações no CSF e EEG. O tratamento foi realizado com base em corticosteróides e imunos supressores compouca resposta e evolução.

Intraoperative Flap Complications in LASIK Surgery Performed by Ophthalmology Residents.

PURPOSE: To report the rate of flap-related complications in LASIK surgery performed by in-training ophthalmology residents and to analyze the risk factors for these complications. METHODS: We analyzed 273 flap dissections in 145 patients from March 2013 to February 2014. We included all LASIK surgeries performed by 32 ophthalmology residents using a Moria M2 microkeratome. All the flap-related complications were noted. Comparison between both groups with and without complications was performed with an independent Student's t-test and relative risks were calculated. RESULTS: There were 19 flap-related complications out of the 273 flap dissections (6.95%). The most common complication was incomplete flap dissection (n = 10; 3.66%), followed by free-cap (n = 5; 1.83%), and flap-buttonhole (n = 2; 0.73%). There was no significant difference between the complicated and uncomplicated cases in terms of the right versus the left eye, pachymetry results, white-to-white diameter, and spherical equivalent. But this difference was significant for mean keratometry (P = 0.008), K-min (P = 0.01), and K-max (P = 0.03) between these groups. Final visual acuity after rescheduling laser treatment was similar in both groups. Relative risks for flap-related complications were 2.03 for the first LASIK surgery (CI 95% 0.64 to 6.48; P = 0.22) and 1.26 (CI 95% 0.43 to 3.69; P = 0.66) for the surgeon's flap-related complications. Female gender presented an odds ratio of 2.48 (CI 95% 0.68 to 9.00; P = 0.16) for complications. CONCLUSION: Flap-related complications are common intraoperative event during LASIK surgery performed by in-training ophthalmologists. Keratometries and surgeon's first procedure represent a higher probability for flap related complications than some other biometric parameters of patient's eye.

Conjunctival and corneal sensitivity in patients under topical antiglaucoma treatment.

The purpose of the study is to measure corneal and conjunctival sensitivity in patients under glaucoma topical treatment as compared to a control group. It is a case-control study. Corneal and conjunctival esthesiometry were carried out through a Cochet-Bonnet esthesiometer. We took healthy individuals as controls, who did not use any type of ophthalmic topical medications and without history of ocular surface pathology or irritation. The study group was subdivided per number of applications (1, 2, and 3 or more applications). From a total 182 eyes from 91 patients, of which 26 (28.57 %) were controls and 65 (71.43 %) were in the study group, a mean corneal sensitivity of 58.98 ± 2.25 mm was found in the control group and 52.97 ± 6.41 mm in patients using topical medication. Mean conjunctival sensitivity was 18.80 ± 5.40 mm in the control group and 11.76 ± 5.45 mm in the study group. There was no statistically significant difference among groups when separated by 1, 2, and 3 or more applications. Eyes under use of timolol-containing medications showed lower sensitivity values as compared to other topical antiglaucoma medications. Corneal and conjunctival sensitivities are diminished in patients with chronic use of topical hypotensive medications and these results can explain the lack of correlation between signs and symptoms that is typically found in patients treated for glaucoma or ocular hypertension.

Hospitalizaciones por ALTE en el Centro Hospitalario Pereira Rossell: (1/12/2010 - 1/12/2011) / Hospitalizations due to ALTE in the Pereira Rossell Hospital Center: 1/12/2010 - 1/12/2011

Introducción: el ALTE (evento de aparente amenaza a la vida) genera ansiedad y preocupación en la familia y representa un desafío para el personal de salud. En Uruguay no se dispone de datos para evaluar la magnitud del problema. Objetivo: describir la prevalencia y características de los lactantes hospitalizados por ALTE en el Departamento de Pediatría del Centro Hospitalario Pereira Rossell (CHPR). Material y método: diseño descriptivo, retrospectivo. Período: 1°/12/2010 - 1°/12/2011. Criterios de inclusión: menores de un año hospitalizados en salas de cuidados moderados con diagnóstico de ALTE. Variables: edad, sexo, factores de riesgo (FR) para síndrome de muerte súbita (SMSL), estudios e interconsultas realizadas, evolución, duración de la estadía hospitalaria y diagnóstico al egreso. Fuente de datos: historias clínicas. Análisis: EpiInfo versión 2002. Resultados: fueron hospitalizados 2.695 menores de un año: 71 (2,6%) con ALTE. Tasa de hospitalización 26,3/1.000 (IC95% 20,2-32,3); 52,1% varones; 62% menores de dos meses. Se solicitaron estudios paraclínicos en 62 de los 71 niños con ALTE: en 8/8 c/ALTE mayor, en 46/50 con ALTE menor con FR, 8/13 con ALTE menor s/FR. El diagnóstico al egreso fue ALTE idiopático 36/71 (50,7%) y secundario 35/71 (49,3%). Se identificó causa digestiva en 21/35, respiratoria en 12/35 y neurológica en 2/35. La media de la estadía hospitalaria fue de 7 días (rango 1-51 días). Cuatro niños fueron hospitalizados en centro de tratamiento intensivo (CTI). Ninguno requirió soporte ventilatorio ni falleció. Conclusión: en el CHPR la mayoría de las hospitalizaciones por ALTE ocurren en niños menores de dos meses de edad que consultan por cambios de coloración y presentan factores de riesgo para SMSL. Se destaca la falta de criterios uniformes en el abordaje de estos niños y el bajo rendimiento de las pruebas diagnósticas.

Introduction: ALTE creates anxiety and results in families being worried families, constituting a challenge for health professionals. However, there are no data available in Uruguay to assess how big the problem is.Objective: To describe prevalence and characteristics infants hospitalized due to ALTE in the Pediatrics Unit at the Pereira Rossell Hospital Center.Method: Design: descriptive, retrospective study. Period: December 1, 2010 through December 1, 2011. Criteria for inclusion: hospitalized infants younger that one year old, who had a diagnosis of ALTE. Variables: age, sex, risk factors for sudden infant death syndrome, studies and interconsultations, evolution, length of hospitalization and diagnosis on discharge. Source of data: clinical records. Analysis: Epiinfo 2002 version.Results: Two thousand six hundred and ninety five children younger than 1 year old: 71 (2.6 %) had ALTE. Hospitalization rate: 26.3/1000 (IC95% 20.2-32-3); 52% were boys; 62% < 2 months. Paraclinical studies were requested in 62 out of 71 children with ALTE: in 8/8 with high ALTE, in 46/50 with lower ALTE with risk factors, 8/13 with lower ALTE without risk factors. Diagnosis on discharge was idiopathic ALTE in 36/71 (50.7%) and secondary ALTE in 35/71 (49.3%). Digestive causes were identifies in 21 out of 35 cases, respiratory in 12 out of 35 cases and neurological in 2 out of 35 cases. Average hospital stay was 7 days (1-51 days range). Four children were admitted to the ICU. None of them required mechanic ventilation and none of them died.Conclusion: Most hospitalizations due to ALTE occur in infants younger than 2 months old at the CHPR, and they consult for changes in color, evidencing risk factors for sudden infant death syndrome. The present study points out there are no uniform criteria to treat these children and diagnostic testing had a low yield.

Introdução: O ALTE gera ansiedade e preocupação na família e é um desafio para a equipe de saúde. No Uruguai não se dispõe de dados para avaliar a magnitude do problema.Objetivo: Descrever a prevalência e as características dos lactentes internados por ALTE no Departamento de Pediatria do CHPR.Material e método: Tipo de estudo: descritivo, retrospectivo. Período: 1°/12/2010 - 1°/12/2011. Critérios de inclusão: < 1 ano internados em salas de cuidados moderados com diagnóstico de ALTE. Variáveis: idade, sexo, fatores de risco (FR) para síndrome de morte súbita (SMSL), estudos e interconsultas realizadas, evolução, duração da internação hospitalar e diagnostico na alta. Fonte de dados: prontuários médicos. Análise: Epiinfo versão 2002.Resultados: Foram hospitalizados 2695 <1 ano: 71 (2.6%) com ALTE. Taxa de hospitalização 26.3/1000 (IC95%20.2-32.3). 52.1% de sexo masculino; 62% < 2 meses. Foram solicitados exames de rotina de 62 das 71 crianças com ALTE: em 8/8 com ALTE maior, em 46/50 com ALTE menor com FR, 8/13 com ALTE menor sem FR. O diagnóstico na alta foi ALTE idiopático 36/71(50,7%) e secundário 35/71(49,3%). Identificou-se causa digestiva em 21/35, respiratória em 12/35 e neurológica em 2/35. A média da permanência no hospital foi de 7 dias (intervalo 1-51 dias). Foram internadas na UTI quatro crianças. Nenhuma necessitou suporte ventilatório nem faleceu.Conclusão: No CHPR a maioria das internações por ALTE são de crianças com menos de 2 meses de idade que consultam por mudanças na coloração e apresentam fatores de risco para SMSL. Destaca-se a falta de critérios uniformes na abordagem destas crianças e o baixo rendimento dos exames diagnósticos.

Disclosure of genetic research results to members of a founder population.

There is currently extensive discussion and debate in the literature on how, when, and to whom genetic research results should be returned (see Genetics in Medicine, April 2012 issue). Here, we describe our experience in disclosing genetic information on Mendelian disorders discovered during the course of our research in the Hutterites. We first assessed attitudes toward the disclosure of carrier results, which revealed that many individuals wanted carrier information and that many intended to use the information in family planning. Based on this information, we developed a pilot study to test and disclose cystic fibrosis (CF) carrier status. Next, a larger scale project was developed in order to disclose genetic research results for 14 diseases to those interested in receiving the information. We developed brochures, offered a live interactive educational program, conducted a consent process, and disclosed results in letters mailed to the consented individuals. Overall, ~80% of individuals who participated in the educational program signed consent forms for the release of their results for 14 diseases. We describe our experience with returning individual genetic research results to participants in a population-based research study.

Black heel, talon noir or calcaneal petechiae?

We describe a series of six patients with superficial cutaneous haemorrhages of the feet, including a classical case of black heel (talon noir) and other similar cases with diverse clinical presentations that do not match the typical description of that process. The main differences lay in production mechanism, morphology and location. The causes of these 'atypical' lesions were: burns with hot sand, friction against the rough edge of a swimming pool, wearing new shoes, jogging, or pricking a blister with a needle. Clinically, they consisted of isolated or multiple, small, large or linear, brown or black lesions located in areas that did not include the convex part of the heel, in which talon noir usually appears; on the contrary, the lesions affected the back third of the soles, the toes, periungual fold and plantar arch. As the presence of blood in the horny layer was a common final factor in all these cases, a better name for this process would be 'post-traumatic cutaneous intracorneal blood' to describe black heel and its diverse clinical presentations.