Traducción y análisis de validez de contenido del instrumento Opening Minds Scale for Healthcare Practitioners (OMS-HC) para la evaluación del estigma hacia la enfermedad mental en profesionales de la salud en Chile / Translation and content analysis of the Opening Minds Scale for Healthcare Practitioners (OMS-HC) for the assessment of stigma towards mental illness in health care professionals in Chile

INTRODUCCIÓN: Las personas con enfermedades mentales con frecuencia experimentan estigma por parte de profesionales de la salud, por lo que es necesario disponer de instrumentos para evaluar el estigma e implementar acciones para reducirlo. Este manuscrito describe el proceso de traducción y validación de contenido en Chile del instrumento Opening Minds Scale for Healthcare Practitioners (OMS-HC), para la evaluación del estigma en profesionales de la salud hacia personas con enfermedad mental desarrollado originalmente en Canadá. MÉTODO: Se realizó la traducción y análisis de validación de contenido, incluyendo etapas de traducción inglés-castellano y traducción inversa por traductora profesional, triangulación, y finalmente consulta a expertos para evaluación de validez de contenido según Índice de Validez de Contenido (IVC) con 10 expertos de investigación, academia, y experto por experiencia en salud mental. Se consideró aceptables ítems con IVC entre 0,51-0,99. RESULTADOS: Del total de 20 ítems del cuestionario, dos fueron evaluados con IVC menor al establecido, relacionados con constructos "hope" y "compassion", propios del marco teórico-modelo de Recovery, base del instrumento. Los dos ítems fueron re-evaluados con autores originales para adaptarlos procurando fidelidad al constructo, en un proceso iterativo con expertos. CONCLUSIONES: Se presenta la traducción del instrumento Opening Minds Scale for Healthcare Practitioners (OMS-HC) adaptado al castellano y con análisis de su validación de contenido, consistente de 20 ítems para evaluación del estigma hacia personas con enfermedades mentales en profesionales de la salud, posibilitando nuevos estudios que analicen su validez de criterio, y la exploración de su utilidad a nivel local.

INTRODUCTION: People with mental illnesses frequently experience stigma from health care professionals, which is why it is an urge to count with adequate assessments to evaluate stigma to address it. This manuscript describes the process of language translation and content validation in Chile of the Opening Minds Scale for the assessment of stigma against people with mental illnesses in Healthcare Practitioners (WHO-HC), originally developed in Canada. METHODS: Language translation and content validation analysis were performed, including English-Spanish translation and reverse translation by professional translator, item triangulation by researchers, and content validity analysis of the translated questionnaire by expert evaluation based on the Content Validity Index (CVI), including 10 experts in academia, research, and one expert by experience. Items rated with CVI 0.51-0.99 were considered acceptable. RESULTS: From the total of 20 items of the questionnaire, two were rated with lower CVI than acceptable, specifically related to the constructs "hope" and "compassion", part of the theoretical framework of Recovery in which the questionnaire is based on. The two items were re-evaluated including original authors to adapt them seeking fidelity to the foundational constructs, through an iterative process with experts. CONCLUSIONS: The translation of the Opening Minds Scale for Healthcare Practitioners (WHO-HC) is presented, adapted to Spanish in Chile after content analysis, consisting of 20 items for the evaluation of stigma towards people with mental illness in health professionals, enabling the development of new studies to analyze criterion validity, and the exploration of feasibility and utility at the local level.

Cáncer de piel: melanoma. Revisión de la literatura / Skin cancer: melanoma. Literature review

Skin cancer is usually classified into melanoma (SCM) and non-melanoma (SCNM), with different cell origins; being the SCM responsible for the highest mortality. In Chile, an incidence (2008) of 434 new cases is estimated, obtaining a standardized rate of 2.2 cases per 100,000 habitants. There are multiple associated risk factors, the main ones being exposure to UV radiation and sunburn. The strategies to prevent this pathology fall on these same factors. The clinical evaluation of the lesions with ABCD mnemonics added to the use of dermoscopy increases the diagnostic sensitivity and specificity; however, the definitive confirmation is through biopsy, which must include the necessary parameters to define prognosis of disease. The definitive treatment is Surgical. There are alternatives such as the use of the sentinel lymph node to define lymph node dissections. Regarding systemic therapies, the use of immunotherapy has shown results that improve survival in these patients.

Widespread infection of Areospora rohanae in southern king crab (Lithodes santolla) populations across south Chilean Patagonia.

Cottage cheese disease is caused by microsporidian parasites that infect a wide range of animal populations. Despite its potential to affect economically important activities, the spatial patterns of prevalence of this disease are still not well understood. Here, we analyse the occurrence of the microsporidian Areospora rohanae in populations of the king crab Lithodes santolla over ca 800 km of the southeastern Pacific shore. In winter 2011, conical pots were deployed between 50 and 200 m depth to capture crabs of a wide range of sizes. The infection was widely distributed along the region, with a mean prevalence of 16%, and no significant association between prevalence and geographical location was detected. Males, females and ovigerous females showed similar prevalence values of 16.5 (13-18.9), 15 (9.2-15) and 16.7% (10-19%), respectively. These patterns of prevalence were consistent across crab body sizes, despite the ontogenetic and sex-dependent variations in feeding behaviour and bathymetric migrations previously reported for king crabs. This study provided the first report of the geographical distribution of A. rohanae infecting southern king crabs.

CONECTA-2: entrenamiento de la cognición social y el lenguaje, al servicio de la eficacia comunicativa. Una experiencia clínica interactiva con personas con diagnóstico de esquizofrenia / CONECTA-2: training of social cognition and language, at service of communicative effectiveness. A clinical and interactive experience with people with diagnosis of schizophrenia

Resumen Introducción: En el presente trabajo, nos proponemos describir una experiencia terapéutica piloto con un programa desarrollado por el equipo, al que denominamos CONECTA-2, un plan de entrenamiento de cognición social y habilidades comunicativas para personas con diagnóstico de esquizofrenia. Nuestro objetivo fue establecer si un dispositivo clínico terapéutico teórico-práctico, de entrenamiento grupal en funciones ejecutivas, de procesos de cognición social y lenguaje, puede mejorar la eficacia comunicativa en personas con diagnóstico de esquizofrenia. Método: Participaron 10 personas entre 18 y 24 años, 7 hombres y 3 mujeres, con diagnóstico de esquizofrenia desde hace menos de tres años al momento de efectuar el taller. Se realizó una evaluación previa y posterior de atribución emocional y eficacia comunicativa. Se realizaron 24 sesiones grupales, de entrenamiento en funciones ejecutivas, cognición social y habilidades pragmático-comunicativas. Resultados: Se verificaron cambios positivos tanto en atribución emocional como en la eficacia comunicativa en 9 de los 10 participantes. Conclusiones: Los resultados de esta experiencia piloto, nos plantean un desafío en términos de desarrollar planes de intervención clínica, que permitan rehabilitar aquellas habilidades, en pos de lograr una mejor adaptación e inserción social de personas con esquizofrenia.

Introduction: In this paper, we propose to describe a pilot therapeutic experience with a program developed by the team, which we call CONECTA-2, a training plan for social cognition and communication skills for people diagnosed with schizophrenia. Our objective was to establish whether a theoretical-practical therapeutic clinical device, training in executive functions, processes of social cognition and language, can improve the effectiveness of communication in people diagnosed with schizophrenia. Method: Participants were 10 people between 18 and 24 years old, 7 men and 3 women, diagnosed with schizophrenia for less than three years at the time of the program. A prior and subsequent evaluation of emotional attribution and communicative effectiveness was carried out. 24 group sessions were held, training in executive functions, social cognition and pragmatic-communicative skills. Results: Positive changes were verified both in emotional attribution and in the communicative effectiveness of the participants. Conclusions: The results of this pilot experience present a challenge in terms of developing clinical intervention plans that allow rehabilitating those skills to achieve a better adaptation and social insertion of people with schizophrenia.

Fabrication of Silver Nanoparticles Using a Gas Phase Nanocluster Device and Preliminary Biological Uses.

Nanoparticles can be used in a large variety of applications, including magnetic sensing, biological, superconductivity, tissue engineering, and other fields. In this study, we explore the fabrication of gas phase silver nanoparticles using a sputtering evaporation source. This setup composed of a dual magnetron cluster source holds several advantages over other techniques. The system has independent control over the cluster concentration and a wide range of cluster size and materials that can be used for the clusters and for the matrix where it can be embedded. Characterization of these silver nanoparticles was done using transmission electron microscopy (TEM). We obtain a lateral width of 10.6 nm with a dispersion of 0.24 nm. With atomic force microscopy (AFM) a Gaussian fit of this distribution yields and average height of 6.3 nm with a standard deviation of 1.4 nm. We confirm that the deposited silver nanoparticles have a homogenous area distribution, that they have a defined shape and size distribution, and that they are single standing nanoparticles. Given that the scientific literature is not precise regarding the toxic concentration of the nanoparticles, devices such as ours can help clarify these questions. In order to explore further biological applications, we have done preliminary experiments of cell spreading (myoblast adhesion), obtaining interesting morphological changes correlated with the silver concentration on the surface. With a deposited silver concentration ranging from 100⁻620 ng/cm², the cells showed morphological changes in a short time of 2 h. We conclude that this high precision nanoparticle fabrication technique is adequate for further biological research.

Hernia diafragmática secundaria a trauma: presentación tardía / Complicated diaphragmatic hernia: late outcome of trauma

Resumen Introducción: La hernia diafragmática complicada de presentación tardía constituye una urgencia quirúrgica. Los objetivos del presente estudio son la descripción de las características del diagnóstico de las hernias diafragmáticas de presentación tardía, tratamiento, resultados y la identificación del punto de corte entre el inicio de los síntomas y el desarrollo de necrosis. Pacientes y Métodos: Estudio retrospectivo de una serie de casos constituida por todos los pacientes operados por hernia diafragmática complicada de presentación tardía entre los años 2006 y 2016. Se midieron variables categóricas y continuas que se presentan con estadística descriptiva. Se utilizaron curvas Receiver Operating Characteristics (ROC) a las 6 y 12 h desde el inicio de los síntomas, para determinar el punto de corte del tiempo de presentación clínica en pacientes sometidos a resección de algún órgano. Una vez establecido el punto de corte se calcularon la sensibilidad; especificidad; las razones de verosimilitud positiva y negativa; los valores predictivos positivo y negativo; y la prevalencia. Resultados: La presentación clínica, estudio, diagnóstico y tratamiento fue similar a lo descrito en la literatura quirúrgica. Se estableció el punto de corte a las 12 h con sensibilidad de 80% y especificidad de 83%. Conclusiones: El diagnóstico y tratamiento de estos pacientes debería ser llevado a cabo antes de las 6 h desde el inicio de los síntomas. Aun cuando el universo descrito es reducido, se sugiere que después de las 12 h desde el momento de la estrangulación, los órganos comprometidos se encontrarán necróticos requiriendo resección quirúrgica.

Introduction: Late presentation of traumatic diaphragmatic hernia constitutes a true surgical emergency. The purposes of this study were to describe the diagnostic characteristics, treatment and outcomes of late presentation diaphragmatic hernias and to identify a cutoff point from the onset of symptoms to necrosis development. Patients and Methods: A retrospective series of cases constituted by all patients subjected to emergency diaphragmatic hernia repair form 2006 to 2016 was studied. Categorical and continuous variables were measured and analyzed with descriptive statistics. Receiver Operating Characteristics (ROC) curves at 6 and 12 hours from the onset of symptoms were used to determine the cutoff point for organ resection. Once stablished the cutoff point, sensitivity, specificity, positive and negative predictive values and prevalence were calculated. Results: Clinical presentation, diagnostic study and surgical treatment were similar to what has been already described. The cutoff point was defined at 12 hours from the onset of symptoms with 80% sensitivity and 83% sensibility. Conclusions: The diagnosis and treatment of these cases should be carried on before the first 6 hours after the onset of symptoms. Even though the universe of this study was small, we may suggest that after 12 hours form the onset of symptoms, the implicated organs would be found necrotic requiring surgical resection.

Evidence for spin-to-charge conversion by Rashba coupling in metallic states at the Fe/Ge(111) interface.

The spin-orbit coupling relating the electron spin and momentum allows for spin generation, detection and manipulation. It thus fulfils the three basic functions of the spin field-effect transistor. However, the spin Hall effect in bulk germanium is too weak to produce spin currents, whereas large Rashba effect at Ge(111) surfaces covered with heavy metals could generate spin-polarized currents. The Rashba spin splitting can actually be as large as hundreds of meV. Here we show a giant spin-to-charge conversion in metallic states at the Fe/Ge(111) interface due to the Rashba coupling. We generate very large charge currents by direct spin pumping into the interface states from 20 K to room temperature. The presence of these metallic states at the Fe/Ge(111) interface is demonstrated by first-principles electronic structure calculations. By this, we demonstrate how to take advantage of the spin-orbit coupling for the development of the spin field-effect transistor.

Highly efficient and tunable spin-to-charge conversion through Rashba coupling at oxide interfaces.

The spin-orbit interaction couples the electrons' motion to their spin. As a result, a charge current running through a material with strong spin-orbit coupling generates a transverse spin current (spin Hall effect, SHE) and vice versa (inverse spin Hall effect, ISHE). The emergence of SHE and ISHE as charge-to-spin interconversion mechanisms offers a variety of novel spintronic functionalities and devices, some of which do not require any ferromagnetic material. However, the interconversion efficiency of SHE and ISHE (spin Hall angle) is a bulk property that rarely exceeds ten percent, and does not take advantage of interfacial and low-dimensional effects otherwise ubiquitous in spintronic hetero- and mesostructures. Here, we make use of an interface-driven spin-orbit coupling mechanism-the Rashba effect-in the oxide two-dimensional electron system (2DES) LaAlO3/SrTiO3 to achieve spin-to-charge conversion with unprecedented efficiency. Through spin pumping, we inject a spin current from a NiFe film into the oxide 2DES and detect the resulting charge current, which can be strongly modulated by a gate voltage. We discuss the amplitude of the effect and its gate dependence on the basis of the electronic structure of the 2DES and highlight the importance of a long scattering time to achieve efficient spin-to-charge interconversion.

Spin to Charge Conversion at Room Temperature by Spin Pumping into a New Type of Topological Insulator: α-Sn Films.

We present results on spin to charge current conversion in experiments of resonant spin pumping into the Dirac cone with helical spin polarization of the elemental topological insulator (TI) α-Sn. By angle-resolved photoelectron spectroscopy (ARPES), we first check that the Dirac cone (DC) at the α-Sn (0 0 1) surface subsists after covering Sn with Ag. Then we show that resonant spin pumping at room temperature from Fe through Ag into α-Sn layers induces a lateral charge current that can be ascribed to the inverse Edelstein effect by the DC states. Our observation of an inverse Edelstein effect length much longer than those generally found for Rashba interfaces demonstrates the potential of TIs for the conversion between spin and charge in spintronic devices. By comparing our results with data on the relaxation time of TI free surface states from time-resolved ARPES, we can anticipate the ultimate potential of the TI for spin to charge conversion and the conditions to reach it.

Spin transport in p-type germanium.

We report on the spin transport properties in p-doped germanium (Ge-p) using low temperature magnetoresistance measurements, electrical spin injection from a ferromagnetic metal and the spin pumping-inverse spin Hall effect method. Electrical spin injection is carried out using three-terminal measurements and the Hanle effect. In the 2-20 K temperature range, weak antilocalization and the Hanle effect provide the same spin lifetime in the germanium valence band (≈1 ps) in agreement with predicted values and previous optical measurements. These results, combined with dynamical spin injection by spin pumping and the inverse spin Hall effect, demonstrate successful spin accumulation in Ge. We also estimate the spin Hall angle θ(SHE) in Ge-p (6-7 x 10(-4) at room temperature, pointing out the essential role of ionized impurities in spin dependent scattering.

Enhanced Spin Pumping Efficiency in Antiferromagnetic IrMn Thin Films around the Magnetic Phase Transition.

We report the measurement of a spin pumping effect due to fluctuations of the magnetic order of IrMn thin films. A precessing NiFe ferromagnet injected spins into IrMn spin sinks, and enhanced damping was observed around the IrMn magnetic phase transition. Our data were compared to a recently developed theory and converted into interfacial spin mixing conductance enhancements. By spotting the spin pumping peak, the thickness dependence of the IrMn critical temperature could be determined and the characteristic length for the spin-spin interactions was deduced.

Areospora rohanae n.gen. n.sp. (Microsporidia; Areosporiidae n. fam.) elicits multi-nucleate giant-cell formation in southern king crab (Lithodes santolla).

This paper utilises histological, ultrastructure and molecular phylogenetic data to describe a novel genus and species (Areospora rohanae n.gen., n.sp.) within the phylum Microsporidia. Phylogenetic and morphological distinction from other known lineages within the phylum also provide strong support for erection of a new family (Areosporiidae n. fam) to contain the parasite. Recognised via lesions observed by workers in king crab processing facilities in southern Chile, the parasite elicits giant cell formation in infected crabs. Merogony within haemocytes and fixed phagocytes proceeds apparent fusion of infected cells to produce multinucleate syncitia in which further development of the parasite occurs. Subsequent recruitment of adjacent cells within the haemal spaces of the hepatopancreas, the podocytes of the gill, and particularly in the subcuticular connective tissues, characterises the pathogenesis of A. rohanae. In late stages of infection, significant remodelling of the subcuticular tissues corresponds to the clinical lesions observed within processing plants. Sporogony of A. rohanae also occurs within the syncitial cytoplasm and culminates in production of bizarre spores, ornamented with distinctive tubular bristles. Spores occur in sets of 8 within a sporophorous vesicle. The description of A. rohanae offers considerable insight into the pathogenesis of giant-cell forming Microsporidia, signifies a new lineage of giant-cell forming Microsporidia in marine hosts, and may reflect emergence of a commercially-significant pathogen in the southern ocean Lithodes santolla fishery.

Desarrollo de resistencia secundaria a imatinib y tratamiento quirúrgico de un GIST gástrico maligno / Secondary imatinib resistance and surgical treatment of a malignant gastric GIST

Introduction. Gastrointestinal stromal tumors (GIST) constitute a pathological condition whose treatment require the interaction of surgical and pharmacological procedures in primary, recurrent, and metastatic disease. Herein, we discuss the case of a patient operated for malignant primary GIST who suffered recurrence of his disease secondary to the development of imatinib resistance. Case report: A male patient was operated on March 2007 because of a malignant gastric GIST, with wedge resection of the tumor. In June 2008, a computerized abdominal tomography scan (CT) showed the presence of nodules over the porta hepatis, mesocolon, greater omentum and gastric antrum; at this moment imatinib 400 mg/day was initiated. A new CT in June 2010, showed a cystic tumor in the right lower abdominal quadrant besides the previously described peritoneal implants, and surgical treatment was proposed. The surgical findings consisted on a big cystic GIST implanted over the greater omentum, and multiple epiploic nodules over the gallbladder and gastric antrum. All visible tumors were resected including the gallbladder and gastric antrum. A positron emission tomography taken on December 2010, described 2 small hypermetabolic peritoneal nodules. The imatinib dose was increased to 800 mg/day, and at the last control, one year after the last surgery, the CT did not show disease progression. Discussion: This case report illustrates the GIST’s malignant potential. The tumor developed imatinib resistance after an initial period of good response to the drug. To control the disease, a new surgical intervention and an increase in the dose of imatinib was required.

Introducción. Los tumores del estroma gastrointestinal (GIST) constituyen una condición patológica cuyo tratamiento requiere la interacción de procedimientos terapéuticos y farmacológicos en los tumores primarios, recurrencias y metástasis. Reportamos el caso de un paciente operado por un GIST primario que sufrió recurrencia secundaria a desarrollo de resistencia al imatinib. Caso clínico: Paciente que se operó en marzo de 2007 por un GIST gástrico maligno, realizándose resección en cuña del tumor. En junio de 2008, como parte del seguimiento, se tomó una tomografía abdominal que informó la presencia de nódulos en el hilio porta, mesocolon, epiplón mayor y antro gástrico, iniciándose tratamiento con imatinib 400 mg diarios. La tomografía realizada en junio de 2010 demostró en el hemiabdomen derecho un tumor quístico, además de los implantes previamente descritos. Con estos antecedentes se decidió el tratamiento quirúrgico. Los hallazgos consistieron en un GIST del epiplón mayor, múltiples lesiones epiploicas, vesiculares y del antro gástrico. Se decidió resecar todas las lesiones visibles, la vesícula biliar y el antro gástrico. Una tomografía por emisión de positrones de diciembre de 2010 describe 2 pequeños nódulos hipermetabólicos peritoneales. Se aumentó la dosis de imatinib a 800 mg diarios y en el último control a 1 año de la última cirugía, la tomografía no demostró progresión de la enfermedad. Discusión: El presente caso ilustra el potencial maligno de los GIST. El tumor desarrolló resistencia al imatinib después de un período inicial con buena respuesta. Para controlar la enfermedad se requirió una nueva intervención quirúrgica y aumento de la dosis de imatinib.

Tumores primarios del estroma gastrointestinal (GIST) localizados en yeyuno e íleon: reporte de un caso / Primary gastrointestinal stromal tumors (GIST) presenting in jejunum and ileum: a case report

Introduction. Multiple primary gastrointestinal stromal tumors (GIST) are an infrequent finding in patients without known risk factors for this condition, such as type I neurofibromatosis or Carney’s triad. Benign and malignant tumors might coexist in the same patient. We discuss one case of a benign jejunal GIST and a malignant ileal GIST coexisting in the same patient. Case Report. A 46-years-old male patient presented with a distal ileum perforated GIST and a small non-complicated proximal jejunum GIST diagnosed by computerized tomography. The patient was submitted to surgery and both tumors were managed without incidents. Discussion. Radiological and pathological characteristics of GIST are clearly established, this clinical case highlights those characteristics and illustrates an uncommon clinical scenario in patients without known risk factors for multiple GIST.

Introducción: Los tumores múltiples del estroma gastrointestinal (GIST), son un hallazgo infrecuente en pacientes sin factores de riesgo como neurofibromatosis tipo I o tríada de Carney. En estos casos pueden coexistir GIST benignos y malignos en un mismo paciente. El presente reporte discute el caso de un paciente que se presenta con un GIST maligno perforado de íleon distal y con un GIST benigno de yeyuno proximal. Reporte de caso: Paciente masculino de 46 años de edad que se presentó con un GIST de íleon distal perforado y un pequeño GIST no complicado de yeyuno proximal diagnosticados mediante tomografía abdominal. Ambos tumores se resolvieron quirúrgicamente sin incidentes. Discusión: Las características anatomopatológicas y radiológicas de los GIST se encuentran actualmente claramente establecidas, el presente caso remarca estas características e ilustra una situación clínica poco habitual en pacientes sin factores de riesgo para GIST múltiples.

Hacia la construcción de las prácticas comunitarias de terapeutas ocupacionales en Chile, desde una mirada socio histórica, desde 1972 hasta la actualidad / Towards the construction of the occupational therapists community practices in Chile, from a social historic view, from 1972 until nowadays

Esta investigación, muestra la construcción de prácticas de Terapeutas Ocupacionales que, desde diversas perspectivas, han realizado trabajo comunitario en Chile, pretendiendo comprender su desarrollo en distintos contextos históricos desde 1972 hasta la actualidad, rescatando relatos en base a la experiencia, que den cuenta de la relación entre contextos socio históricos y prácticas comunitarias. La metodología utilizada para este estudio fue cualitativa. Se recopiló información mediante once entrevistas semiestructuradas y un grupo de discusión. Posteriormente, se analizó la información a través de Teoría Fundada, en diferentes categorías, abierta y axial con un eje central en discusión con planteamientos teóricos. Los hallazgos de este estudio, permiten concluir que los contextos socio históricos determinan las formas de hacer prácticas comunitarias en Chile; y éstas, a su vez, influyen en la interacción con la comunidad favoreciendo o dificultando su participación social. El Terapeuta Ocupacional es parte de ese contexto sociohistórico por lo que su identidad, equipo de trabajo y su práctica comunitaria está configurada y construida desde ahí, sin embargo, el no hacer consciente sus prácticas y cómo éstas se han construido, no permitiría establecer la dimensión política de su hacer. Ocuparse de la ocupación, junto con la cotidianeidad en el campo comunitario implica una comprensión de la realidad socio-histórica, determinando las prácticas comunitarias de los Terapeutas Ocupacionales así como la construcción de comunidad.

This investigation will show the process of constructing Occupational Therapy practices that have been realized from various perspectives via community work in Chile, attempting to understand its development in the different social and historical periods since 1972 until the present time, emphasizing experience accounts, wich make clear the relation between social and historical contexts and practices. The methodology employed in this work was qualitative with information based on eleven semi-structured interviews and a discussion group. The information was analyzed using the Grounded Theory, through opened and axial categories, related to a central theoretical axis. The findings conclude that the social and historical contexts determine the way of doing community practice in Chile, and these affect the interaction with community, favoring or making difficult their social participation. The therapist is part of that social and historical context. Therefore, his identity, work team and community practice are constructed there. Nevertheless, if he does not become conscious of his practice and how it has been constructed, he will not build the political dimension of his work. To be in charge of daily occupation in the community field involves an understanding of the social and historical reality, determining the community practices of the Occupational Therapists and likewise the construction of community.

Melanoma anorrectal primario: una causa infrecuente de rectorragia en el adulto mayor / Primary anorectal melanoma: an uncommon source of rectal bleeding in the elderly

El melanoma anorrectal primario es un tumor maligno muy infrecuente y con un pobre pronóstico. Se presenta un paciente de 66 años con rectorragia, en el cual el diagnóstico de melanoma anorrectal se efectuó por colonoscopia e histología. Se trató mediante una resección abdominoperineal. Se efectúa revisión de la literatura.

Primary anorectal melanoma is a very rare malignant tumor, with poor prognosis. A 66 years old man presenting with rectal bleeding is reported. The diagnosis of anorectal melanoma was confirmed by colonoscopy and histological findings. An abdominoperineal resection was performed. A review of the literature is presented.

Reflujo faringolaríngeo: una patología con identidad propia / Pharyngolaryngeal reflux: a pathology with a distinctive identity

Se presenta un grupo compuesto por 70 pacientes portadores de síntomas atribuibles a reflujo faringolaríngeo y 20 pacientes controles. Se describen y proponen 3 estadios clínocos nasofibroscópicos de la enfermedad y se correlacionan con los síntomas digestivos, broncopulmonares y faringolaríngeos en los pacientes y controles. En los 70 pacientes se analizan los resultados del tratamiento médico propuesto, siendo bueno en el 88,4 por ciento de los casos y regular en 11,6 por ciento

Sarcoidosis laríngea: caso clínico / Laryngeal sarcoidosis: clinical case

Se presenta un caso de paciente se sexo masculino de 17 años, portador de Sarcoidosis localizada en laringe (supraglotis), con la metodología de estudio, diagnóstico y tratamiento empleado, mostrando una remisión lenta, pero estable. Además se hace una revisión de dicha patología en cuanto a sus características generales, diagnóstico, histopatología y alternativas terapéuticas