Impacto de la caries dental y enfermedad periodontal sobre la sexualidad de la mujer / Impact of dental caries and periodontal disease on women’s Sexuality

El desarrollo de la sexualidad es imprescindible para lograr un estado de salud integral en un individuo. El sistema estomatognático participa activamente en el desarrollo pleno y armónico de ésta, por lo que patologías como la caries dental y enfermedad periodontal, y la consecuente pérdida de dientes afectan el aspecto físico, psicológico y social de quien las padece. El propósito de esta investigación fue determinar si la caries dental, la enfermedad periodontal o pérdida de dientes afectan los rasgos afectivo, creativo y comunicacional en la sexualidad femenina. La muestra se constituyó por 86 mujeres de entre 18 y 40 años, quienes presentaban caries dental, enfermedad periodontal o pérdida de dientes, a quienes se les realizó el examen oral confirmando el diagnóstico. A todo el grupo se aplicó una encuesta de 15 preguntas desarrolladas para este estudio. Se observó que la presencia de signos y síntomas como halitosis, falta de dientes y alteraciones en la estética influyen en la sexualidad de la mujer, afecciones que aumentan al progresar la severidad de estas patologías. Dado el diseño y las condiciones del presente estudio, los resultados indican que la caries dental y enfermedad periodontal, así como sus consecuencias, tienen relación con las alteraciones en la sexualidad femenina, por lo que sería de gran importancia considerar estas patologías al momento de crear programas de salud bucal enfocándose en la salud integral de la mujer (AU)

The development of sexuality is essential to achieve an integral health state in the individual. The stomatognathic system is actively involved in the full and harmonious development of the person, so diseases such as dental caries and periodontal disease and subsequent tooth loss affect the physical, psychological and social aspect of the patient. The purpose of this research was to determine whether dental caries, periodontal disease or tooth loss affect the emotional, creative and communicative traits of female sexuality. The sample consisted of 86 women between 18 and 40 who had dental caries, periodontal disease or tooth loss, who underwent oral examination to confirm the diagnosis. A survey of 15 questions developed for this study was applied to the whole group. It was observed that the presence of signs and symptoms such as halitosis, missing teeth and cosmetic alterations influence the sexuality of women, increasing with the progression of the severity of these pathologies. Given the design and the conditions of this study, the results indicate that dental caries and periodontal disease and its consequences, are related to changes in female sexuality, so it would be very important to consider these pathologies to create oral health programs and to focus on the overall health of women (AU)

Análisis crítico del paradigma positivista y su influencia en el desarrollo de la enfermería / Critical analysis of positivist paradigm and its influence in knowledge development of nursing

Este artículo tiene como propósito analizar la influencia del paradigma positivista en Enfermería. Se describen las características de esta corriente de pensamiento y la mirada de Enfermería a través de la visión reactiva o particular-determinística. Se profundiza sobre algunos elementos del positivismo presentes en los ámbitos de desempeño, como: asistencia sanitaria, formación, investigación y gestión. Se concluye que visibilizando dichos ámbitos desde una mirada holística, a la que se accede desde otros paradigmas, y la reflexión de los beneficios del cuidado integral y transpersonal por parte de los usuarios, del equipo de salud y de la sociedad, se puede contribuir para cambiar la valoración que tiene la sociedad de la disciplina de enfermería (AU)

This paper aims to analyze the influence of positivist paradigm in nursing. This thought tendency is described in terms of history and characteristics and nursing view under the reactive or particular - deterministic vision. Afterwards, it deepens over some positivism elements which are present in nursing area, such as: sanitary assistance, training nurses, and research care management. It is concluded that being able to visualize named areas under a holistic view, which is given by other paradigms as well as the observation of benefits comprehensively and transpersonal care by users, health team and society, a change in the value placed on nursing discipline can be reached (AU)

Miedo a la muerte y su relación con la inteligencia emocional de estudiantes de enfermería de Concepción / Fear of death and its relationship with emotional intelligence of nursing students in Concepción

OBJETIVO: Conocer el miedo a la muerte y su relación con la inteligencia emocional y otras variables en estudiantes de enfermería de los últimos años de estudio. MÉTODOS: Estudio descriptivo y correlacional. Los estudiantes (n=188) respondieron a un cuestionario sobre: características socioculturales; Escalas de Miedo a la Muerte y de Inteligencia Emocional. RESULTADOS: Se obtuvo un promedio medio-alto en miedo a la muerte (3,35). La percepción emocional se correlacionó positivamente con miedo a la muerte, mientras que la comprensión y la regulación emocional se correlacionaron negativamente con el miedo a la muerte. Las puntuaciones más altas de miedo a la muerte se asociaron con el sexo femenino, con los niveles inferiores de los cursos y con la percepción de menor preparación académica en el tema. CONCLUSIONES: Los niveles altos de inteligencia emocional, se asociaron con menos miedo a la muerte, lo que evidencia la necesidad de desarrollar en los estudiantes habilidades emocionales frente a situaciones trascendentales y desconocidas, como son la muerte y el proceso de morir.

OBJECTIVE: To understand fear of death and its relationship with emotional intelligence and other variables in nursing students in the last years of study. METHODS: A descriptive and correlational study. Students (n = 188) responded to a questionnaire about: socio-cultural characteristics; Fear of Death and Emotional Intelligence Scales. RESULTS: We obtained a measure of medium to high for fear of death (x = 3.35) and also the emotional perception component was positively correlated with the fear of death, while understanding and emotional regulation were negatively correlated with fear of death. The higher scores for fear of death were associated with the female gender, with lower levels of courses, and the perception of lower academic preparation on the subject. CONCLUSIONS: High levels of emotional intelligence, associated with less fear of death, provides evidence for the necessity of developing emotional skills in students facing transcendent situations and the unknown, such as death and the dying process.

OBJETIVO: Conhecer o medo da morte e sua relação com a inteligência emocional e outras variáveis em estudantes de enfermagem dos últimos anos de estudo. MÉTODOS: Estudo descritivo e correlacional. Os estudantes (n=188) responderam a um questionário sobre: características socioculturais; Escalas de Medo da Morte e de Inteligência Emocional. RESULTADOS: Obteve-se uma medida de médio para alto em medo da morte (x=3,35) e também o componente percepção emocional se correlacionou positivamente com o medo da morte, enquanto a compreensão e regulação emocional se correlacionaram negativamente com o medo da morte. As pontuações mais altas de medo da morte associaram-se com o gênero feminino, com os niveis inferiores dos cursos e com a percepção de menor preparo acadêmico no tema. CONCLUSÕES: Os níveis altos de inteligência emocional, associaram-se com menos medo da morte, o que evidencia a necessidade de desenvolver nos estudantes habilidades emocionais frente a situações transcendentais e desconhecidas, como são a morte e o processo morrer.

[Competences on hypoglycemia management among healthcare professionals in a clinical hospital]. / Diagnóstico y manejo de la hipoglicemia en adultos diabéticos hospitalizados: evaluación de competencias en un equipo profesional multidisciplinario de salud.

BACKGROUND: A tight glycemic control of hospitalized patients increases the risk of hypoglycemia, whose management is not always optimal. AIM: To assess the hypoglycemia management competences of a multidisciplinary team in a clinical hospital. MATERIAL AND METHODS: An anonymous questionnaire about hypoglycemia management was answered by 11 staff physicians, 42 residents and 28 nurses of the department of medicine and critical care unit ofa university hospital. RESULTS: Respondents had a mean of 60% of correct answers, without significant differences between groups. The capillary blood glucose level that defines hypoglycemia was known by most of the respondents, but the value that defines severe episodes was known only by 60%. The initial management and follow up was well known only for severe episodes. Less than 50%o knew the blood glucose value that required continuing with treatment. CONCLUSIONS: Although most professionals are able to recognize hypoglycemia, the knowledge about is management if insufficient.

Diagnóstico y manejo de la hipoglicemia en adultos diabéticos hospitalizados: evaluación de competencias en un equipo profesional multidisciplinario de salud / Competences on hypoglycemia management among healthcare professionals in a clinical hospital

Background: A tight glycemic control of hospitalized patients increases the risk of hypoglycemia, whose management is not always optimal. Aim: To assess the hypoglycemia management competences of a multidisciplinary team in a clinical hospital. Material and Methods: An anonymous questionnaire about hypoglycemia management was answered by 11 staff physicians, 42 residents and 28 nurses of the department of medicine and critical care unit ofa university hospital. Results: Respondents had a mean of 60 percent of correct answers, without significant differences between groups. The capillary blood glucose level that defines hypoglycemia was known by most of the respondents, but the value that defines severe episodes was known only by 60 percent. The initial management and follow up was well known only for severe episodes. Less than 50 percento knew the blood glucose value that required continuing with treatment. Conclusions: Although most professionals are able to recognize hypoglycemia, the knowledge about is management if insufficient.

Competencia en investigación en enfermería / Research competence in nursing

Enfermería como profesión y disciplina social se ve inmersa en el acelerado desarrollo de la humanidad en todos sus ámbitos, debiendo ajustarse para responder con calidad e integralidad a las nuevas necesidades de cuidado de los usuarios y de la sociedad, y adaptarse al mismo tiempo a un mundo laboral progresivamente más competitivo. La utilización de la investigación permite obtener información y generar conocimientos propios, necesarios para tomar decisiones y resolver problemas de la práctica; siendo el medio para responder a ésta y al mismo tiempo hacer visible el carácter humanista y autónomo de Enfermería. El propósito de este trabajo es examinar la competencia en investigación en enfermería aplicando los cinco elementos de una competencia desde la mirada de recursos humanos en el contexto laboral de enfermería. Se concluye que para el desarrollo de la competencia en investigación en enfermería profesional el querer hacer y el poder hacer resultan determinantes para llevar a cabo los estudios de los fenómenos de la práctica, sumados al saber, saber hacer y saber estar. Siendo responsabilidad de la institución de salud proveer los medios y la infraestructura necesarios para concretar el poder hacer dentro de la competencia en investigación.

Nursing as a social profession and discipline finds itself immersed in the accelerated development of mankind in every aspect, needing to adjust in order to give an integrated and quality response to the new healthcare needs of users and society, as well as adapting to an increasingly competitive labor market. The use of research allows obtaining information and generating own knowledge needed to make decisions and solve problems in the practice, being the means to respond to it and, at the same time, make the humanist and autonomous nature of nursing visible. The purpose of this paper is to examine the research competence in nursing, applying the five elements of a competence from the human resources perspective in nursing work environment. It is concluded that, for the development of competence in professional Nursing research, wanting to do and being able to, turn out to be determinants to carry out studies of the phenomena of the practice, added to the knowledge, know how to do and know how to be. It is the responsibility of the institution of health to provide the resources and the necessary infrastructure to specify the power to do in research competence.

Hipoglicemia recurrente como causa reversible de síndrome demencial en adultos mayores diabéticos, a propósito de un caso / Cognitive impairment probably related to repeated episodes of hypoglycemia. Report of one case

We report a 78 year-old diabetic woman, treated with gliburide and metformin, consulting in the emergency room for a non fuctuating impairment in consciousness. She had a history of similar episodes in the last two months. A brain CAT scan showed an old putamen lacunar infarction. Noteworthy was the presence of a low glycosilated hemoglobin level of 5.2 percent. Hypoglycemic medications were discontinued and the patient was discharged in good conditions. After six months of follow up, the patient did not have further episodes of impairment of consciousness.

[Cognitive impairment probably related to repeated episodes of hypoglycemia. Report of one case]. / Hipoglicemia recurrente como causa reversible de síndrome demencial en adultos mayores diabéticos, a propósito de un caso.

We report a 78 year-old diabetic woman, treated with gliburide and metformin, consulting in the emergency room for a non fuctuating impairment in consciousness. She had a history of similar episodes in the last two months. A brain CAT scan showed an old putamen lacunar infarction. Noteworthy was the presence of a low glycosilated hemoglobin level of 5.2%. Hypoglycemic medications were discontinued and the patient was discharged in good conditions. After six months of follow up, the patient did not have further episodes of impairment of consciousness.

[Management of community acquired pneumonia in adults following clinical guidelines at a rural hospital]. / Evaluación y manejo del adulto inmunocompetente hospitalizado por neumonía adquirida en la comunidad, en un hospital de baja complejidad, basado en la Guía Clínica Chilena.

BACKGROUND: A National Consensus Guideline published in 2005 established the basis for the diagnostic, severity assessment and treatment of community acquired pneumonia (CAP) in the adult population. The compliance with pneumonia clinical guidelines has been associated to a reduction in hospital stay healthcare-related costs, morbidity and mortality. AIM: To describe the management and outcome of non-severe CAP in hospitalized adult patients treated in a rural hospital, based on the national clinical guidelines. PATIENTS AND METHODS: Ninety six patients aged 74 +/- 13 years (50 males) hospitalized with non-severe pneumonia (group 3) at a community-based primary care center between January 1, 2006, and March 31, 2007, were evaluated. RESULTS: Eighty percent of patients had concomitant diseases such as hypertension in 49%, diabetes in 23% and chronic obstructive pulmonary disease in 18%. All were treated with a third generation cephalosporin (ceftriaxone 1-2 g/day TV) as empirical therapy. Only 9% of patients also received a macrolide. Early switch to oral antimicrobial therapy was successful in two third of cases. Mean hospital length of stay was 5.0 +/- 2.5 days, and 30-day mortality was 6.3%. CONCLUSIONS: Following the recommendations of the national clinical guidelines, most of these patients had a favorable response to monotherapy with a beta-lactam antimicrobial. Early switch therapy to oral antibiotic was effective and safe, reducing significantly hospital length of stay as compared to previous national clinical studies.

[Fever of unknown origin caused by multiple myeloma. Report of one case]. / Fiebre de origen desconocido como forma de presentación atípica de mieloma múltiple: Caso clínico.

Fever of unknown origin (FUO) can be caused by tumors, especially those arising from the hematopoietic system. Multiple myeloma can also cause fever but it is not a common cause of fever of unknown origin. We report a 53 year-old man presenting with fever lasting eight weeks. An extensive study for common causes of FUO was negative. The appearance of hypercalcemia and proteinuria during the evolution suggested the presence of a multiple myeloma, that was confirmed with a bone marrow biopsy. Thalidomide and dexametasone were prescribed with resolution of fever.

Evaluación y manejo del adulto inmunocompetente hospitalizado por neumonía adquirida en la comunidad, en un hospital de baja complejidad, basado en la Guía Clínica Chilena / Management of community acquired pneumonia in adults following clinical guidelines at a rural hospital

Background: A National Consensus Guideline published in 2005 established the basis for the diagnostic, severity assessment and treatment of community acquired pneumonia (CAP) in the adult population. The compliance with pneumonia clinical guidelines has been associated to a reduction in hospital stay healthcare-related costs, morbidity and mortality. Aim To describe the management and outcome of non-severe CAP in hospitalized adult patients treated in a rural hospital, based on the national clinical guidelines. Patients and methods: Ninety six patients aged 74 ± 13 years (50 males) hospitalized with non-severe pneumonia (group 3) at a community-based primary care center between January 1, 2006, and March 31, 2007, were evaluated. Results: Eighty percent of patients had concomitant diseases such as hypertension in 49 percent, diabetes in 23 percent and chronic obstructive pulmonary disease in 18 percent. All were treated with a third generation cephalosporin (ceftriaxone 1-2 g/day TV) as empirical therapy. Only 9 percent of patients also received a macrolide. Early switch to oral antimicrobial therapy was successful in two third of cases. Mean hospital length of stay was 5.0 ± 2.5 days, and 30-day mortality was 6.3 percent. Conclusions: Following the recommendations of the national clinical guidelines, most of these patients had a favorable response to monotherapy with a B-lactam antimicrobial. Early switch therapy to oral antibiotic was effective and safe, reducing significantly hospital length of stay as compared to previous national clinical studies.

Fiebre de origen desconocido como forma de presentación atípica de mieloma múltiple: Caso clínico / Fever of unknown origin caused by multiple myeloma: Report of one case

Fever of unknown origin (FUO) can be caused by tumors, especially those arising from the hematopoietic system. Multiple myeloma can also cause fever but it is not a common cause of fever of unknown origin. We report a 53 year-old man presenting with fever lasting eight weeks. An extensive study for common causes of FUO was negative. The appearance of hypercalcemia and proteinuria during the evolution suggested the presence of a multiple myeloma, that was confirmed with a bone marrow biopsy. Thalidomide and dexametasone were prescribed with resolution of fever.

Caracterización epidemiológica y complicaciones postoperatorias de las hernias de pared abdominal operadas en el servicio de cirugía del hospital Dr. Gustavo Fricke / Epidemiological characterization and postoperative complications of abdominal wall hernia operated in the surgical service of the hospital dr. Gustavo Fricke

Objetivo: Elaborar una caracterización epidemiológica de la patología herniaria de la pared abdominal en el Servicio de Cirugía del Hospital Dr. Gustavo Fricke durante el año 2006, así como también establecer la incidencia de complicaciones postoperatorias. Material y método: estudio retrospectivo en 178 pacientes intervenidos en el Servicio de Cirugía Adulto del Hospital Fricke, durante el año 2006 por hernias de la pared abdominal. Se excluyeron pacientes menores de 15 años, pertenecientes a otro servicio quirúrgico y aquellos que presentasen hernias distintas a las de la pared antero o póstero lateral. Las variables registradas fueron datos propios del paciente, del tipo herniario, del tratamiento quirúrgico, complicaciones y controles en policlícico. Resultados: el promedio de edad de los pacientes estudiados fue de 56,6 años, de ellos la mayoría fueron hombres. El tipo de hernia más prevalente en la serie fue la hernia inguinal correspondiendo al 51,1 por ciento de los casos, seguida de las hernias incisionales en un 18,5 por ciento y umbilicales en un 14 por ciento. Un 27,5 por ciento de ellas se encontraba complicada en forma previa a la cirugía, de éstas un 67,3 por ciento se encontraba finalmente atascada, un 12,2 por ciento estrangulada y un 20 ,4 por ciento correspondía a una obstrucción intestinal. El tiempo de hospitalización promedio fue de 48,6 horas y los controles postoperatorios en el policlínico presentaron una mediana de 1 control. De los pacientes controlados en policlínico, el 21,9 por ciento presentó alguna complicación postoperatoria. Conclusiones: en general, las características epidemiológicas arrojadas por la serie coinciden con los datos aportados por la literatura nacional e internacional. A pesar de ser una patología frecuente y de baja morbimortalidad, no está exenta de complicaciones.

Objetive: To develop an epidemiological characterization of abdominal wall hernia at Hospital Dr. Gustavo Fricke during 2006, as well as establishing the incidence of postoperative complications. Material and method: A retrospective study of 178 patients admited to the Surgical Service of Hospital Fricke during 2006, for abdominal wall hernias. We excluded patients under the age of 15, belonging to another surgical service and those who had other types of hernia. The variables analyzed were data given by the patient, hernial type, surgical treatment, complications and polyclinic controls. Results: The average age was 56.6 years, the majority of them were men. The most prevalent type was inguinal hernia, (51.1 percent) of cases, followed by incisional hernias (18.5 percent) and umbilical hernias (14 percent). In 27.5 percent of the cases, there were complications before surgery, of those, 12.2 percent were strangled and 20.4 percent with intestinal obstruction. The average length of hospitalization was 48.6 hours and the postoperative control had a median of 1. Of the patients controlled, 21.9 percent had a postoperative complication. Conclusion: Overall, the epidemiological characteristics of this serie coincide with data provided by the national and international literature. Despite being a frequent pathology with low morbidity, it is not without complications. This is why we recommend elective surgical repair, especially in patients at risk, such as the elderly with chronic diseases.

Precisión del diagnóstico clínico de apendicitis aguda v/s diagnóstico histopatológico / Precise clinic diagnostic of acute of appendicitis v/s hystophatologic diagnostic

Introducción: Permanece en la actualidad la discusión sobre el porcentaje aceptable que deben manejar los hospitales de apendicectomías en blanco versus el de intervenciones tardías complicadas con peritonitis. Por esta razón decidimos investigar las situaciones actual de nuestro establecimiento en cuanto el porcentaje de laparotomías en blanco y las variables que nos permitirían mejorar estos porcentajes. Método: Se realizó un estudio retrospectivo que incluyó a todos los pacientes mayores de 15 años que ingresaron durante el año 2006 a la Unidad de Emergencia Adultos (UEA) del Hospital Dr. Gustavo Fricke de Viña del Mar y que fueron intervenidos con el diagnóstico de apendicitis aguda o dolor en fosa iliaca derecha. Se revisaron todos los registros clínicos y posteriormente se analizaron las variables de interés, para finalmente correlacionar la sensibilidad del diagnóstico clínico con el posterior informe de biopsia del apéndice resecado. Resultados: De los 566 pacientes estudiados, el 14,8 por ciento fue diagnosticado histológicamente con un apéndice sano. En el grupo de hombres este porcentaje fue de 9,4 por ciento, siendo de 19,7 por ciento en el grupo de mujeres. Se encontró peritonitis localizada en el 22,6 por ciento de las muestras y difusa en el 4,1 por ciento de la población estudiada. El porcentaje de complicaciones postoperatorias fue de 9,3 por ciento y sólo hubo un fallecido. Discusión: El porcentaje de apéndices en blanco encontrado no difiere al descrito en la literatura internacional. No se demostraron diferencias por grupos etáreos pero si por sexos. Con el objetivo de disminuir la tasa de peritonitis, sin aumentar las apendicectomías en blanco, es necesario seguir perfeccionando la clínica y la integración de los elementos de laboratorio, para lograr así la precisión diagnóstica.

Background: Physicians still discuss about the acceptable proportion that modern hospitals should present between healthy and perforated appendixes found on biopsy, after surgery for a suspected appendicitis. We decided to study the current scenario of our hospital in this matter, also considering the clinical variables that could help us avoid unnecessary surgeries. Method: A retrospective study was performed, including all the patients, 15 years old and older, who had surgery with the clinical suspicion of acute appendicitis at Dr. Gustavo Fricke's Hospital during the year 2006. The clinical records of these patients were reviewed, and all the variables of interest were analyzed. Finally, we contrasted the sensitivity of the clinical diagnosis against the pathologist diagnosis of the extirpated appendix. Results: Of the 566 patients studied, only 14,8 percent had a healthy appendix according to the pathologist report. Considering only the group of men, this percent went down to 9,4 percent and in the group of women it went up to 19, 7 percent appendixes. Local peritonitis was found in 22 percent of the samples and diffuse peritonitis only in 4,1 percent. Almost 10 percent had complications after the surgery, and only one patient died. Discussion: The proportion of healthy appendixes found in this study was similar to the ones described in the international reports. We did not found any differences in this matter between age groups, but there was a higher risk in women than in men. To reduce these values, it is imperative that clinicians keep practicing and perfecting their examining skills, and then manage to integrate this with the laboratory and imaging exams to achieve a precise diagnosis.

Contribuir a la calidad del morir en el cáncer / Contributing to the quality of dying during cancer

El proceso que conduce a la muerte es único e irrepetible y la forma como se viva depende de la calidad de los cuidados proporcionados. El cáncer constituye un motivo frecuente del paso a este proceso y los esfuerzos tendientes a apoyarlo se concretan a través de programas de alivio del dolor y cuidados paliativos, cuyo objetivo principal es mejorar la calidad de vida de los pacientes mientras se viva con una amenaza de muerte. La calidad de vida en estas personas se entrelaza en su significado con la calidad del morir, el que enfatizaría el enfrentar la experiencia misma de morir. Calidad del morir se puede definir cómo el grado en el cual las preferencias de una persona para morir en el momento de su muerte concuerdan con las observaciones de como realmente murió la persona, según lo informan los demás. Esto motivó la exploración teórica y empírica de la calidad del morir en la persona con cáncer, a fin de promover el conocimiento y profundización en un tema que forma parte ineludible del tipo de cuidado que deben entregar los equipos de salud que trabajan en el área.

The death process is unique and finite and the manner in which it is experienced depends on the manner and quality of care received. Cancer is often responsible for the initiation of this process. Throughout the death process, palliative care and pain control programs have the ability to enhance the quality of life of patients. The quality of the last stages of life of patients coping with Cancer is weaved within the meaning of the quality of death which leads to confronting the death experience. A person's quality of death can be defined by comparing their preferences at the end of life contrasted with the observations and information observed by others. These points motivated the theoretical and empirical exploration of the quality of death of people with Cancer, which is a necessary step to further increase the knowledge base and understanding for professionals working in this area.

Analgesia in patients with acute abdominal pain.

BACKGROUND: For decades, analgesia for patients with acute abdominal pain was withheld until a definitive diagnosis was established for fear of masking the symptoms, changing physical findings or ultimately delaying diagnosis and treatment of a surgical condition. This non-evidence-based approach has been challenged by recent studies demonstrating that the use of analgesia in the initial evaluation of patients with acute abdominal pain leads to significant pain reduction without affecting diagnostic accuracy. However, early administration of analgesia to such patients can greatly reduce their pain and does not interfere with a diagnosis, which may even be facilitated due to the severity of physical symptoms being reduced. OBJECTIVES: To determine if the currently available evidence supports the use of opioid analgesia in patient management with acute abdominal pain; and to assess changes in a patient comfort while awaiting definitive diagnosis and final treatment decisions. SEARCH STRATEGY: Trials were identified by searching the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, issue 4, 2006), MEDLINE (1966 to 2006) and EMBASE (1980 to 2006). Randomized controlled trial filter for MEDLINE and EMBASE search. Trials will also be identified by "related articles". The searches were not limited by language or publication status. SELECTION CRITERIA: Randomized controlled trials (RCTs) that include adult patients with acute abdominal pain, without gender restriction, comparing any opioid analgesia regime to no analgesia administered prior to any intervention regardless of outcomes. DATA COLLECTION AND ANALYSIS: Two authors looked independently at the titles and abstracts of reports. Potentially relevant studies selected by at least one reviewer were retrieved in full text versions for potential inclusion. Allocation concealment was important to avoid bias and was graded using the Cochrane approach. The data from studies included was reviewed qualitatively and quantitatively using the Cochrane Collaborations methodology and statistical software RevMan Analysis 1.0.5. In the case of homogeneity or non- worrying heterogeneity, a random effects model was used. Sensitivity analysis was performed based on quality assessment. MAIN RESULTS: Six studies fulfilled the inclusion criteria. Improvement with use of opioid analgesia was verified in variables patient comfort, reduction of pain, changes in physical examination. AUTHORS' CONCLUSIONS: The review provide some evidence to support the notion that the use of opioid analgesics in patients with acute abdominal pain is helpful in terms of patient comfort and does not retard decisions to treat.

Propionate induces pH(i) changes through calcium flux, ERK1/2, p38, and PKC in bovine neutrophils.

Propionate is a short-chain fatty acid produced under normal physiological conditions in the rumen of cattle. It is also involved in the inflammatory process and neutrophil function via calcium release, reactive oxygen species and intracellular pH (pH(i)) changes. This study examined the effect of propionate on the pH(i) of bovine neutrophils; specifically if pH(i) changes are controlled by calcium flux, and the mitogen-activated protein kinase (MAPK) pathway. Propionate caused rapid intracellular acidification and sustained alkalinization in bovine neutrophils loaded with 2',7'-bis-(2-carboxyethyl)-5-(and-6)-carboxyfluorescein acetoxymethyl ester (BCECF-AM), a fluorescent indicator of pH(i). The acidification phase seems to be controlled by intracellular calcium release and p38 MAPK pathway. The pH recovery phenomenon was mediated by an amiloride-sensitive Na+/H+ exchanger and H+ channel, and was inhibited by UO126 (an ERK1/2 MAPK phosphorylation inhibitor), Gö6850 (a PKC inhibitor) and calcium chelating. Ionomycin, a calcium ionophore, induced intracellular acidification and sustained alkalinization. The intracellular acidification was strongly inhibited by BAPTA-AM (an intracellular calcium chelator) and SB203580 (a p38 MAPK inhibitor). In addition, the intracellular alkalinization was reduced by EGTA (a calcium chelator), UO126, LY294002 (a PI3K inhibitor) and Gö6850. Propionate did not increase superoxide production, however it reduced the superoxide production induced by platelet-activating factor (PAF), and increased the release of superoxide induced by ionomycin. Our results suggest that propionate-induced intracellular acidification is mediated by intracellular calcium release and p38 MAPK activation, and that pH recovery is controlled via ERK1/2 MAPK, PKC and calcium entry in bovine neutrophils.

Desarrollo de la autoestima profesional / Professional self-esteem development in nursing

Este artículo analiza, desde una perspectiva histórica,los acontecimientos vividos en el desarrollo de la enfermería como profesión y sus efectos en la autoestima profesional de las enfermeras, en primera instancia como encargadas del cuidado, y más tarde como enfermeras, realizando una reflexión crítica sobre los hechos que marcaron la práctica de enfermería en cada una de las etapas de su evolución histórica como profesión, esto es: la doméstica, la vocacional, la técnica y la profesional,y cómo estos hechos pudieron incidir y aún repercuten en el desarrollo de la autoestima profesional.Se analizan las principales problemáticas que de cada etapa se derivan, y luego se presentan algunas alternativas de cambio para mejorar la situación expuesta.Palabras clave: autoestima.

Modelo estructural de enfermeria de calidad de vida e incertidumbre frente a la enfermedad / Quality of life and uncertatinty towards disease: a nursing structural modelL

Se presenta un modelo estructural que relaciona el concepto de calidad de vida y nivel de incertidumbre frente al cáncer como enfermedad, a ser aplicado a pacientes con cáncer de mamas, cérvico uterino y de vesícula en el Servicio de Oncología del Hospital Guillermo Grant Benavente del Servicio de Salud Concepción. Su formulación forma parte del desarrollo de una Tesis de Doctorado en Enfermería de la Universidad de Concepción, cuyo propósito es indagar respecto a la influencia del nivel de incertidumbre en la calidad de vida de estas pacientes. Este modelo discute los aspectos conceptuales del constructo calidad de vida y nivel de incertidumbre, basado en los modelos de L. Schwartzmann y de M. Mishel, respectivamente, proponiendo una integración dinámica de ambos. El modelo propuesto será valorado empíricamente en el transcurso del trabajo de la tesis, a objeto de ser incorporado en la valoración de las pacientes con diagnóstico de cáncer y posterior intervención de enfermería, destinado a mejorar la calidad de vida de esas mujeres.

Pérdida de flúor en piezas dentarias permanentes expuestas a refrescos: estudio comparativo in vitro / Fluor loss in permanent teeth exposed to beverages: comparative study in vitro

Introducción: La exposición a refrescos y zumos de frutas se encuentra en constante aumento, siendo su principal característica la elevada acidez que presentan. Con estas alteraciones del equilibrio oral, la perdida mineral de la estructura dentaria es muy frecuente. Nuestro objetivo fue identificar la cantidad de flúor perdido de una pieza dentaria y comparar el efecto de dos bebidas presentes en el mercado. Metodología: Se formaron dos grupos con 15 premolares cada uno, extraídos por indicación de ortodoncia; las piezas no presentaban patologías clínicas. El experimento consistió en la aplicación de un amortiguador de fuerza iónica para posteriormente llevarlo a una curva de calibración. Luego con un pH metro (ORION, modelo 920 A) se obtuvo los datos de pH de las bebidas; luego, durante 30 minutos se sumergió en la respectiva bebida para que con el electrodo se obtuviera los resultados de flúor presente. Se realizo la prueba estadística T test para muestras independientes. Resultados: cada vez más estudios confirman el impacto de los ácidos en la cavidad oral y su papel en la erosión dentaria. En nuestro estudio se aprecio un pH de 3,1 para la bebida de naranja y 2,5 para la bebida cola. Además arrojo diferencia significativa de la pérdida de flúor según la bebida aplicada (p<0,0001).Conclusión: existe una importante pérdida de flúor de las piezas dentarias cuando se aplica una bebida ácida así como también existe diferencia significativa en el efecto de bebidas ácidas con solo 0,6 pH de diferencia (AU)

Introduction: The exposure of soft drinks and fruit juices is constantly increasing and the main caracteristic of these beverages is the high acidity. This alteration of oral balance causes a more frequent loss of dental minerals. Our main objective was to identify the quantity loss of fluor of a tooth and compare this effect caused by two different kinds of soft drinks. Methodology: 30 bicuspids were put in two different groups, 15 in each, extracted by ortodontics indication The tooth did not have evidence of clinical pathology. The experiment consisted in applying an ionic buffer, and later put the results in a calibration curve. So with a pH-Meter (Orion, model 920 a) the pH value was obtained. Then the tooth was submerged for 30 minutes in the soft drink and with the electrode the result of the presente quantity of fluor was obtained. The statistic T-test for independent proof where done. Results: more and more research confirm the impact of the acid in the mouth and its role in dental erosion. In our research the pH value of the orange drink was 3.1 and the value for the coke drink was 2.5. Otherwise it shows a statistic difference of the loss of fluor by the different drinks (p<0.0001). Conclusion: An important loss of fluor occurs in the tooth when it gets in contact with an acid drink, as it also occurs a significant difference in the effect of acid drinks with a variation of 0.6 pH (AU)