Using compositional mixed-effects models to evaluate responses to amino acid supplementation in milk replacers for calves.

The consequences of supplementing Lys, Met, and Thr in milk replacers (MR) for calves have been widely studied, but scarce information exists about potential roles of other AA (whether essential or not). The effects on growth performance of supplementation of 4 different AA combinations in a mixed ration (25.4% crude protein and 20.3% fat) based on skim milk powder and whey protein concentrate were evaluated in 76 Holstein male calves (3 ± 1.7 d old). The 4 MR were as follows: CTRL with no AA supplementation; PG, supplying additional 0.3% Pro and 0.1% Gly; FY, supplying additional 0.2% Phe and 0.2% Tyr; and KMT, providing additional 0.62% Lys, 0.22% Met, and 0.61% Thr. All calves were fed the same milk allowance program and were weaned at 56 d of study. Concentrate intake was limited to minimize interference of potential differences in solid feed intake among treatments. Animals were weighed weekly, intakes recorded daily, and blood samples obtained at 2, 5, and 7 wk of study to determine serum urea and plasma AA concentrations. Plasma AA concentrations were explored using compositional data analysis, and their isometric log-ratio transformations were used to analyze their potential influence on ADG and serum urea concentration using a linear mixed-effects model. We detected no differences in calf performance and feed intake. Plasma relative concentration of the AA supplemented in the KMT and PG treatments increased in their respective treatments, and, in PG calves, a slight increase in the proportion of plasma Gly, Glu, and branched-chain AA was also observed. The proportions of plasma branched-chain AA, His, and Gln increased, and those of Thr, Arg, Lys, and Glu decreased with calves' age. A specific log-contrast balance formed by Arg, Thr, and Lys was found to be the main driver for lowering serum urea concentrations and increasing calf growth. The use of compositional mixed-effects models identified a cluster formed by the combination of Arg, Thr, and Lys, as a potential AA to optimize calf growth.

¿Cuáles son las barreras de acceso a la atención odontológica de las mujeres embarazadas? Una revisión de la literatura / What are the barriers of access to women's dental care pregnant? A review of the literature

Introducción: Las enfermedades bucales son altamente prevalentes a nivel mundial; una de las estrategias utilizadas para mejorar el estado de salud bucal de la población es la atención odontológica de la embarazada. En Chile esta atención está garantizada, sin embargo, la cobertura de las atenciones no es la esperada, sólo el 31 por ciento de las mujeres embarazadas accede a la atención odontológica y un 14 por ciento abandona el tratamiento antes de terminarlo. Métodos: El objetivo de este artículo es revisar la evidencia internacional y nacional respecto a las barreras que impiden a las mujeres embarazadas acceder al tratamiento odontológico. Resultados: Se describen diferentes barreras para la atención odontológica de la mujer embarazada, las que se pueden clasificar en las relacionadas con la organización del sistema de salud (costo de la atención, acceso a los prestadores y las características de los proveedores de la atención de salud) y las barreras personales (creencias de las pacientes, percepción de necesidad de tratamiento, miedo a la atención y valoración de la salud bucal). Conclusión: Existe evidencia internacional sobre cuáles son las barreras para el acceso a la atención odontológica de la mujer embarazada, entre ellas, destacan las barreras de acceso, como el costo de atención, sin embargo, a nivel nacional, esa barrera está soslayada, ya que el acceso y la protección financiera están garantizadas gracias a la cobertura GES. Por esta razón son necesarios estudios nacionales que indaguen sobre el fenómeno que impide que las embarazadas chilenas accedan al tratamiento odontológico.(AU)

Introduction: Oral diseases are highly worldwide prevalent; one of the strategies used to improve oral health status of the population is the specific pregnant women dental care program. In Chile this care is guaranteed by law, however, the dental attention coverage is not as well as expected, only 31% of pregnant women have access to dental care and 14percent of them, leave treatment before ending. Methods: The aim of this article is to review international and national evidence regarding the barriers that prevent pregnant women from accessing to dental treatment. Results: Different barriers are described. They can be classified in those related to the organization of the oral health system (care cost access to providers, care health providers characteristics) and personal barriers (patient's beliefs, perceived needs for treatment, fear and oral health assessment). Conclusion: There is international evidence about the barriers to access to pregnant women, dental care including barriers access such the care cost; however, at the national level, this barrier is overlooked since access and the financial protection is guaranteed by GES coverage. More studies are needed to investigate the phenomenon that avoids Chilean pregnant women from accessing to dental treatment.(AU)

[Detectig errors in chemotherapy prescription]. / Detección de errores en la prescripción de quimioterapia.

OBJECTIVE: To analyse errors detected in the prescription of cytostatic drugs. MATERIAL AND METHODS: Prospective study (February 1st to April 15th, 2002). All medical orders containing cytostatic agents were checked and 13 variables were studied: identification, anthropometric data, diagnosis, protocol, number of cycles, cytostatic drug, length of treatment, dose, route of administration, volume of infusion and/or final concentration, infusion time, diluent, and doctor's signature. Several possible errors were identified for each variable. Information on whether it was the first cycle, prescribing service, and prescription format was also recorded. RESULTS: In all, 618 medical orders were reviewed for a total of 1178 lines of cytostatic agents and 2,171 doses. The possible number of errors was 12.101 and the total number of errors actually found was 2,706 (22,03%). Not all these errors had the same impact on patients. Errors by omission were 2,340 (87,77%). Those which nursing staff found difficult to check and/or administer stood at 281 (10,54%). Potentially serious errors numbered 60 (2.06%): wrong body area > 10%: 5; wrong body area 5-10%: 2; erroneus protocol: 2; incorrect volume: 16; wrong dosage: 23 (difference < 25%: 5; difference 10-25%: 14; difference < 10%: 4). Reductions indicated but not implemented: 9; Inappropiate diluent: 3. There were no incorrect or omitted medications. CONCLUSION: The description of such errors and their uantification is a useful method of quality asurance in order to establish appropiate corrective measures. The most common error was the omission of information and therefore this issue, along with the development of computerised prescriptions, should be addressed.

Detección de errores en la prescripción de quimioterapia / Detecting errors in chemotherapy prescription

Objetivo: Analizar los tipos de errores en la prescripción de citostáticos. Material y métodos: Estudio prospectivo del 1 de febrero al 15 de abril de 2002). Se revisaron todas las órdenes médicas con citostáticos. Se estudiaron 13 variables: identificación, datos antropométricos, diagnóstico, protocolo, número de ciclo, citostáticos, duración de tratamiento, dosificación, vía de administración, volumen de infusión y/o concentración final, tiempo de infusión, diluyente y firma del médico. Para cada variable se distinguieron varias posibilidades de error. También se recogió si era primer ciclo, el servicio prescriptor y el formato de la prescripción. Resultados: Se revisaron 618 órdenes médicas con 1.178 líneas de citostáticos y 2.171 dosis. El número de oportunidades de error fue 12.101 y el número total de errores encontrados 2.706 (22,03 por ciento). De éstas no todas tienen igual repercusión para el paciente. Los errores causados por omisión fueron 2.340 (87,77 por ciento). Los que dificultan la revisión y/o administración por enfermería fueron 281 (10,54 por ciento). Los errores potencialmente graves fueron 60 (2,06 por ciento): superficie corporal errónea >10 por ciento: 5; SC errónea 5-10 por ciento: 2; protocolo erróneo: 2; volumen incorrecto: 16; dosificación errónea: 23 (difiere > 25 por ciento: 5; difiere 1025 por ciento: 14; difiere < 10 por ciento: 4); se indica reducción y no hay: 9; diluyente inapropiado: 3. No hubo ningún medicamento omitido ni equivocado. Conclusiones: La descripción de errores y su cuantificación es útil como método de garantía de calidad para establecer las medidas correctoras oportunas. Los errores más frecuentes han sido por omisión de información, por lo que habrá que incidir en ello y en la promoción de la prescripción informatizada (AU)