Discurso narrativo y lectura de cuentos en el hogar por padres a preescolares que presentan trastorno del lenguaje / Narrative discourse and parents' story telling at home to preschool children who present language impairment

RESUMEN El objetivo del estudio es analizar el discurso narrativo productivo de estudiantes de kínder en escuelas de lenguaje de Chile, considerando Trastorno Específico del Lenguaje (TEL) expresivo y mixto junto a la periodicidad de la lectura de cuentos en el hogar. Ambientes naturales enriquecidos en la familia aportan mayores oportunidades de desarrollo favoreciendo la literacidad, las habilidades lingüísticas y sociales. Los niños y niñas con TEL pueden mostrar dificultades en la narración, afectando el desempeño académico, social y en su calidad de vida. El discurso narrativo en una muestra de 150 preescolares es evaluado, utilizando un instrumento formal a través del recontado de 3 cuentos originales. Se examina la etapa del desarrollo narrativo y la lectura de cuentos realizada por padres en el hogar. Se aplica una ficha para recoger información demográfica de las familias. A través de un estudio descriptivo comparativo, se aplica estadística descriptiva e inferencial (ANOVA de dos factores) para analizar las variables. Los resultados muestran que ni el tipo de TEL, ni la frecuencia de lectura o la interacción de ambas, provocan cambios estadísticamente significativos en el discurso narrativo. Sin embargo, se observan hallazgos cualitativos en la cantidad de narración, en función de la lectura de cuentos.

ABSTRACT The study aimed to analyze the productive narrative discourse of students who attended kindergarten in special language schools in Chile, considering the expressive and mixed Specific Language Impairment (SLI) with the periodicity of reading stories at home. Enriched natural environments into the family provide better opportunities to develop early literacy, linguistic and social skills. Children with SLI may show difficulties in narration, affecting academic, social performance, and generally affecting their quality of life. The narrative discourse in a sample of 150 preschoolers was evaluated using a formal instrument that included the retelling of three original stories. The performance of narrative development and reading stories by parents at home were examined. A form was applied to collect demographic information from families. Through a comparative-descriptive study, descriptive and inferential statistics (two-way ANOVA) were used to analyze the variables. The results show that type of SLI, frequency of reading and the interaction of both variables did not cause statistically significant effects in the narrative discourse. However, qualitative findings were observed, in the quantity of oral discourse related to storytelling.

Effectiveness of intermittent fasting on biochemical and anthropometric markers in obese adults with cardiovascular risk. A systematic review / Efectividad del ayuno intermitente sobre marcadores bioquímicos y antropométricos en adultos obesos con riesgo cardiovascular. Una revisión sistemática.

Background. Obesity is a problem present in almost all societies, which has led to the search for different methods to combat it. One of them is intermittent fasting (IF), characterized by periods without eating (16 to 24 hours), limited or no caloric intake, combined with normal eating windows. Target. To determine the effectiveness of intermittent fasting on biochemical and anthropometric markers in obese adults. Materials and methods. A systematic review was proposed that postulated to study blinded or open clinical trials of IA interventions, compared with a control group. The response variables were: systolic and diastolic blood pressure, total cholesterol, LDL, HDL and triglycerides, blood glucose, fat mass, weight, waist circumference, BMI and heart rate. The search and identification of studies was masked. The risks of bias for the Cochrane collaboration were assessed. They underwent meta-analysis (random effect), with R 4.0.0. Results. Six studies were included, involving 10-48 weeks of intervention with alternate-day fasting and time-restricted feeding, reporting some statistically significant changes for different variables. Conclusion. Intermittent fasting could intervene in the reduction of cardiovascular risk due to improvement in BMI and biochemical parameters.

Antecedentes. La obesidad es un problema presente en casi todas las sociedades, lo que ha conllevado a buscar distintos métodos para combatirla. Uno de ellos es el ayuno intermitente (AI), caracterizado por periodos sin ingesta (16 a 24 hr), ingesta calórica limitada o nula, combinada con ventanas de alimentación normal. Objetivo. Determinar la efectividad del ayuno intermitente sobre los marcadores bioquímicos y antropométricos en adultos obesos. Materiales y Métodos. Se planteó una revisión sistemática que postuló estudiar ensayos clínicos enmascarados o abiertos de intervenciones de AI, comparado con grupo control. Las variables de respuesta fueron: presión arterial sistólica y diastólica, colesterol total, LDL, HDL y triglicéridos, glicemia, masa grasa, peso, circunferencia de cintura, IMC y frecuencia cardiaca. La búsqueda e identificación de los estudios fue enmascarada. Se evaluaron los riesgos de sesgo de la colaboración Cochrane. Se sometieron a meta-análisis (efecto aleatorio), con R 4.0.0. Resultados. Se incluyeron 6 estudios, de 10-48 semanas de intervención con ayuno en días alternos y alimentación con restricción de tiempo, reportándose algunos cambios estadísticamente significativos para distintas variables. Los meta-análisis obtenidos muestran diferencias de medias estadísticamente significativas.  Conclusión. Existe evidencia que respalda un beneficio de AI a nivel de indicadores bioquímicos.

Experiencia de terapia asistida con animal es en una unidad de odontopediatría / Experience of animal assisted therapy in a pediatric dentistry unit

Los niños y adolescentes con necesidades especiales de atención en Salud corresponden a un grupo de individuos que presentan distintos problemas de salud de complejidad variable, siendo una de éstas la atención dental exitosa. La alta prevalencia de patologías orales no es la única complicación al atender a pacientes pediátricos con necesidades especiales de atención en Salud, se suman alteraciones del comportamiento y comunicación, afectando el nivel de cooperación en la atención. A pesar de las limitaciones previamente mencionadas, han surgido diversas adaptaciones y técnicas para conseguir realizar un tratamiento odontológico. En este artículo se describe la terapia asistida con animales como un método complementario beneficioso en la atención de odontopediatría. El objetivo es describir la experiencia de la implementación de terapia asistida con animales, en el tratamiento Odontológico de Niños y Adolescentes con Necesidades Especiales de Atención en Salud. El método usado es el estudio descriptivo - retrospectivo del año 2019, revisión de 32 registros clínicos del sistema de atención digital del hospital, de pacientes pediátricos con necesidades especiales de atención en Salud entre 4 y 13 años, atendidos en odontopediatría con apoyo de terapia asistida por animales. Los resultados muestran que 32 pacientes pediátricos que recibieron atención dental, donde en 26 (81.25%) la intervención dental fue exitosa. Se realizaron en total 36 procedimientos odontológicos, 19 invasivos y 17 no invasivos. La implementación de terapia asistida con animales como complemento de la atención odontopediátrica tuvo una gran aceptación y permitió la realización con éxito de procedimientos dentales invasivos o no invasivos en población pediátrica con necesidades especiales de atención en Salud.

Children and youth with special health care needs, belongs to a group of individuals presenting several health issues of variable complexity and special care needs in health, one of them a successful dental treatment. The high prevalence of oral pathologies is not the only complication we found in dental attention; there are also behaviour and communication disorders, affecting the cooperation level in dental treatment. In spite of the limitations previously mentioned, different adaptations and techniques have surged in order to achieve a successful dental treatment. In this article we describe animal assisted therapy as a useful complementary method for pediatric dental treatment.Objective:Describe the experience of animal assisted therapy in pediatric dentistry treatment of children and youth with special health care needs.Methods:Descriptive-retrospective study performed in 2019, revision of 32 clinical digital records of Hospital, of children and youth with special health care needs, ages between 4-13 years old, and their pediatric dentistry treatment records with animal assisted therapy.Results:32 patients with dental treatment, in 26 patients (81.25%) dental treatment was successful; 36 dental procedures were performed, 19 invasive and 17 non invasive.Conclusion:The implementation of animal assisted therapy as a complement of pediatric dentistry treatment had a high acceptance and allowed successful invasive and non invasive dental procedures in children and youth with special health care needs.

IL-10 expression in macrophages from neonates born from obese mothers is suppressed by IL-4 and LPS/INFγ.

Obese women offspring have a higher risk of developing chronic diseases associated with an altered immune function. We aim to determine, in neonatal monocyte-derived macrophages, whether maternal obesity is associated with an altered expression and DNA methylation of pro- and anti-inflammatory genes, along with a higher pro-inflammatory response. Cord blood from newborns of obese (Ob) and lean (control) women were obtained at delivery. Monocytes were isolated and differentiated into macrophages, in which M1 (LPS/IFNγ) and M2 (IL-4) polarization were assayed. The mRNA levels for TNFα, IL-1ß, IL-12A, IL-12B, IL-10, and IL-4R were quantified by qPCR and the DNA methylation of candidate genes determined by pyrosequencing. RESULTS: Ob-monocytes had decreased levels of mRNA for pro-inflammatory cytokines IL-1ß, IL-10, and IL-12B compared with controls. Conversely, Ob-macrophages showed increased levels of mRNA for TNFα, IL-4R, and IL-10 compared with controls. M1 response was comparable between both groups, characterized by an important induction of TNFα and IL-1ß. In response to an M2 stimulus, control macrophages showed a decreased expression of inflammatory mediators while Ob-macrophages had an additional suppression of the anti-inflammatory mediator IL-10. Changes in IL-1ß (monocytes) and IL-10 (macrophages) in Ob-monocytes were paralleled by changes in their promoter DNA methylation in fetal monocytes. These results suggest that monocyte-derived macrophages from obese newborns show a basal anti-inflammatory phenotype with an unbalanced response to M1 and M2 polarization stimuli. The presence of changes in DNA methylation of key inflammatory genes in neonatal monocytes suggests an intrauterine programing of immune function by maternal obesity.

N-Acetylcysteine, a glutathione precursor, reverts vascular dysfunction and endothelial epigenetic programming in intrauterine growth restricted guinea pigs.

KEY POINTS: Intrauterine growth restriction (IUGR) is associated with vascular dysfunction, oxidative stress and signs of endothelial epigenetic programming of the umbilical vessels. There is no evidence that this epigenetic programming is occurring on systemic fetal arteries. In IUGR guinea pigs we studied the functional and epigenetic programming of endothelial nitric oxide synthase (eNOS) (Nos3 gene) in umbilical and systemic fetal arteries, addressing the role of oxidative stress in this process by maternal treatment with N-acetylcysteine (NAC) during the second half of gestation. The present study suggests that IUGR endothelial cells have common molecular markers of programming in umbilical and systemic arteries. Notably, maternal treatment with NAC restores fetal growth by increasing placental efficiency and reverting the functional and epigenetic programming of eNOS in arterial endothelium in IUGR guinea pigs. ABSTRACT: In humans, intrauterine growth restriction (IUGR) is associated with vascular dysfunction, oxidative stress and signs of endothelial programming in umbilical vessels. We aimed to determine the effects of maternal antioxidant treatment with N-acetylcysteine (NAC) on fetal endothelial function and endothelial nitric oxide synthase (eNOS) programming in IUGR guinea pigs. IUGR was induced by implanting ameroid constrictors on uterine arteries of pregnant guinea pigs at mid gestation, half of the sows receiving NAC in the drinking water (from day 34 until term). Fetal biometry and placental vascular resistance were followed by ultrasound throughout gestation. At term, umbilical arteries and fetal aortae were isolated to assess endothelial function by wire-myography. Primary cultures of endothelial cells (ECs) from fetal aorta, femoral and umbilical arteries were used to determine eNOS mRNA levels by quantitative PCR and analyse DNA methylation in the Nos3 promoter by pyrosequencing. Doppler ultrasound measurements showed that NAC reduced placental vascular resistance in IUGR (P < 0.05) and recovered fetal weight (P < 0.05), increasing fetal-to-placental ratio at term (∼40%) (P < 0.001). In IUGR, NAC treatment restored eNOS-dependent relaxation in aorta and umbilical arteries (P < 0.05), normalizing eNOS mRNA levels in EC fetal and umbilical arteries (P < 0.05). IUGR-derived ECs had a decreased DNA methylation (∼30%) at CpG -170 (from the transcription start site) and this epigenetic signature was absent in NAC-treated fetuses (P < 0.001). These data show that IUGR-ECs have common molecular markers of eNOS programming in umbilical and systemic arteries and this effect is prevented by maternal treatment with antioxidants.

Técnicas de injerto óseo alveolar en fisura labio alveolo palatina: revisión de la literatura / Techniques of alveolar bone grafting in cleft lip and palate: Literature review

La fisura labio-palatina es una de las malformaciones congénitas más comunes de la región orofacial, y puede incidir significativamente en la calidad de vida de los afectados. El tratamiento integral de estos pacientes es complejo e incluye el uso de injerto óseo alveolar, para restaurar la morfología y función normal de los arcos. El objetivo de este trabajo fue describir las características de las diversas técnicas de injerto alveolar que aún son objeto de controversia. La osteoplastía secundaria es el enfoque más ampliamente aceptado, y consiste en la realización del injerto alveolar durante la dentición mixta, entre los 9 y 12 años, antes de la erupción del canino permanente, pues la disponibilidad de hueso es más predecible en este período, a la vez que proporcionaría el apoyo periodontal adecuado para la erupción y la preservación de los dientes adyacentes a la hendidura. La literatura señala que el hueso esponjoso autólogo fresco es el estándar de oro para este procedimiento, ya que proporciona las células óseas inmunocompatibles necesarias; pero estudios más recientes han señalado una superioridad del injerto córtico-medular, además del uso complementario de rhBMP-2. De la misma manera, se señala que la cresta iliaca corresponde al sitio dador más promovido, aunque la calota craneal puede representar una opción igual o aún más efectiva y con un menor nivel de morbilidad postoperatoria. Es necesario continuar explorando las alternativas mencionadas y promover la investigación en búsqueda de nuevas opciones, incluyendo avances en la ingeniería tisular(AU)

The lip and palatal cleft is one of the most common congenital malformations of the buccal-facial region and can significantly impact the quality of life of the affected people. The comprehensive treatment of these patients is complex and includes the use of alveolar bone graft to restore the normal dental arches morphology and function. The aim of this article was describing the features of several alveolar grafting techniques which are still controversial. The secondary osteoplasty is the most widely accepted approach and it is the implementation of the alveolar graft during the mixed dentition, at the ages between 9 and 12 years, before the eruption of the permanent canine tooth, because the bone availability is more predictable in this period, while it would provide an adequate periodontal support for the eruption and preservation of the teeth adjacent to the cleft. The literature indicates that fresh autologous cancellous bone is the golden rule for this procedure because it provides the necessary immunocompatible bone cells; but more recent studies have shown the superiority of cortico-medullar graft, besides the complementary use of rhBMP-2. Similarly, it is noted that the iliac crest is the most recommended donor site, although the skull graft may represent the same or even more effective option and with a lower level of post surgery morbidity. It is necessary to continue exploring such alternatives and promoting research for new options, including advances in tissue engineering(AU)

Técnicas de injerto óseo alveolar en fisura labio alveolo palatina. Revisión de la literatura / Techniques of alveolar bone grafting in cleft lip and palate. Literature review

La fisura labio-palatina es una de las malformaciones congénitas más comunes de la región orofacial, y puede incidir significativamente en la calidad de vida de los afectados. El tratamiento integral de estos pacientes es complejo e incluye el uso de injerto óseo alveolar, para restaurar la morfología y función normal de los arcos. El objetivo de este trabajo fue describir las características de las diversas técnicas de injerto alveolar que aún son objeto de controversia. La osteoplastía secundaria es el enfoque más ampliamente aceptado, y consiste en la realización del injerto alveolar durante la dentición mixta, entre los 9 y 12 años, antes de la erupción del canino permanente, pues la disponibilidad de hueso es más predecible en este período, a la vez que proporcionaría el apoyo periodontal adecuado para la erupción y la preservación de los dientes adyacentes a la hendidura. La literatura señala que el hueso esponjoso autólogo fresco es el estándar de oro para este procedimiento, ya que proporciona las células óseas inmunocompatibles necesarias; pero estudios más recientes han señalado una superioridad del injerto córtico-medular, además del uso complementario de rhBMP-2. De la misma manera, se señala que la cresta iliaca corresponde al sitio dador más promovido, aunque la calota craneal puede representar una opción igual o aún más efectiva y con un menor nivel de morbilidad postoperatoria. Es necesario continuar explorando las alternativas mencionadas y promover la investigación en búsqueda de nuevas opciones, incluyendo avances en la ingeniería tisular.

The lip and palatal cleft is one of the most common congenital malformations of the buccal-facial region and can significantly impact the quality of life of the affected people. The comprehensive treatment of these patients is complex and includes the use of alveolar bone graft to restore the normal dental arches morphology and function. The aim of this article was describing the features of several alveolar grafting techniques which are still controversial. The secondary osteoplasty is the most widely accepted approach and it is the implementation of the alveolar graft during the mixed dentition, at the ages between 9 and 12 years, before the eruption of the permanent canine tooth, because the bone availability is more predictable in this period, while it would provide an adequate periodontal support for the eruption and preservation of the teeth adjacent to the cleft. The literature indicates that fresh autologous cancellous bone is the golden rule for this procedure because it provides the necessary immunocompatible bone cells; but more recent studies have shown the superiority of cortico-medullar graft, besides the complementary use of rhBMP-2. Similarly, it is noted that the iliac crest is the most recommended donor site, although the skull graft may represent the same or even more effective option and with a lower level of post surgery morbidity. It is necessary to continue exploring such alternatives and promoting research for new options, including advances in tissue engineering.

[Pilot plan for a mobile health communication and monitoring system for people with diabetes]. / Plan piloto del sistema de comunicación y seguimiento móvil en salud para personas con diabetes.

mHealth is a practical, useful, and available tool for one-way or two-way communication between health professionals and patients. It is especially promising in countries such as Chile, with widespread and growing mobile telephone coverage that is very well accepted by the public. Our objective is to demonstrate the process for designing a mobile communication and monitoring model, aimed at providing communication between professionals in primary healthcare centers and their patients, to facilitate timely diagnosis and initiation of treatment for type 2 diabetes. This model's characteristics include use of mobile telephones as a communication tool, a one-way method (from health centers to patients), integration into in-person care delivered at health centers, use of different communication strategies (voice and written), and integrated functioning using open-source software. The system includes personalized communication, automated voice communication, and automated written communication using short message service (SMS). We describe the strategies and components of the system. The lessons learned include the contribution from successful implementation of COSMOS (consolidated online modulated operating systems), a technological innovation, to support the health care of people with suspected type 2 diabetes in primary healthcare centers. Working together with teams in the field is essential to this achievement.

Plan piloto del sistema de comunicación y seguimiento móvil en salud para personas con diabetes / Pilot plan for a mobile health communication and monitoring system for people with diabetes

La mSalud es una herramienta práctica, útil y disponible para la comunicación unidireccional o bidireccional entre profesionales de la salud y el paciente, cuyo uso es especialmente promisorio en países como Chile, con una amplia y creciente cobertura de telefonía móvil muy bien aceptada por la población. Nuestro objetivo es mostrar el proceso de diseño de un modelo de comunicación y seguimiento móvil, destinado a facilitar la comunicación entre profesionales de los centros atención primaria en salud y sus usuarios, para lograr el diagnóstico oportuno e inicio del tratamiento de la diabetes mellitus de tipo 2 (DM2). Este modelo se caracteriza por utilizar el teléfono móvil como herramienta de comunicación, ser un método unidireccional (desde los centros de salud hacia los usuarios), estar integrado con la atención presencial que se entrega en los centros de salud, utilizar diferentes estrategias de comunicación (vía voz y escrita), y funcionar integrado en un software diseñado en código abierto. El sistema incluyó la implementación de comunicación personalizada, comunicación automatizada de voz y comunicación automatizada escrita a través de servicio de mensaje corto de voz. Se describen estas estrategias y los componentes del sistema. Entre las lecciones aprendidas, se destaca el aporte de lograr implementar la innovación tecnológica COSMOS (sistemas operadores modulados consolidados en línea, por su sigla en inglés), para apoyar el proceso de cuidado de la salud de las personas con sospecha de DM2 en centros de atención primaria de salud. Para este logro, resulta imprescindible el trabajo conjunto con los equipos en terreno.

mHealth is a practical, useful, and available tool for one-way or two-way communication between health professionals and patients. It is especially promising in countries such as Chile, with widespread and growing mobile telephone coverage that is very well accepted by the public. Our objective is to demonstrate the process for designing a mobile communication and monitoring model, aimed at providing communication between professionals in primary healthcare centers and their patients, to facilitate timely diagnosis and initiation of treatment for type 2 diabetes. This model's characteristics include use of mobile telephones as a communication tool, a one-way method (from health centers to patients), integration into in-person care delivered at health centers, use of different communication strategies (voice and written), and integrated functioning using open-source software. The system includes personalized communication, automated voice communication, and automated written communication using short message service (SMS). We describe the strategies and components of the system. The lessons learned include the contribution from successful implementation of COSMOS (consolidated online modulated operating systems), a technological innovation, to support the health care of people with suspected type 2 diabetes in primary healthcare centers. Working together with teams in the field is essential to this achievement.