Instrucciones con foco atencional durante el ejercicio terapéutico en personas con trastornos musculoesqueléticos. Una revisión de alcance / Attentional focus instructions for therapeutic exercise in people with musculoskeletal disorders. A scoping review

Las instrucciones con foco atencional son estrategias verbales que podrían maximizar los efectos del ejercicio. El objetivo de esta revisión fue explorar y sintetizar la evidencia sobre la incorporación de instrucciones con foco atencional al ejercicio terapéutico de personas con trastornos musculoesqueléticos. Se realizó una búsqueda en 11 bases de datos hasta octubre de 2020. De 4.227 estudios identificados en las búsquedas, 15 fueron incluidos. Los estudios presentaron deficiencia en la conceptualización y definición de instrucciones con foco atencional. La evidencia disponible indica que el foco externo es efectivo para mejorar el aprendizaje motor y la función. Sin embargo, limitaciones metodológicas, la heterogeneidad clínica, el reducido número de artículos incluidos y los nuevos estudios experimentales desafían las conclusiones de las revisiones sistemáticas disponibles a la fecha. Las instrucciones con foco atencional en los trastornos musculoesqueléticos es un campo emergente y requiere más investigación. Esta revisión es una guía para futuros estudios.(AU)

Attentional focus instructions are verbal strategies that could maximize the effects of exercise. The objective of this review was to explore and synthesize the available evidence on the incorporation of attentional focus instruction in the exercise of people with musculoskeletal disorders. A search of 11 databases was carried out until October 2020. Of 4,227 studies identified in the searches, 15 were included. The studies showed deficiencies in the conceptualization and definition of attentional focus instructions. The available evidence indicates that external focus is effective in improving motor learning and function. However, methodological limitations, clinical heterogeneity, the small number of articles included, and new experimental studies challenge the conclusions of the systematic reviews available to date. Attentional focus instructions in musculoskeletal disorders is an emerging field and requires further research. This review is a guide for future studies.(AU)

[Attentional focus instructions for therapeutic exercise in people with musculoskeletal disorders. A scoping review]. / Instrucciones con foco atencional durante el ejercicio terapéutico en personas con trastornos musculoesqueléticos. Una revisión de alcance.

Attentional focus instructions are verbal strategies that could maximize the effects of exercise. The objective of this review was to explore and synthesize the available evidence on the incorporation of attentional focus instruction in the exercise of people with musculoskeletal disorders. A search of 11 databases was carried out until October 2020. Of 4,227 studies identified in the searches, 15 were included. The studies showed deficiencies in the conceptualization and definition of attentional focus instructions. The available evidence indicates that external focus is effective in improving motor learning and function. However, methodological limitations, clinical heterogeneity, the small number of articles included, and new experimental studies challenge the conclusions of the systematic reviews available to date. Attentional focus instructions in musculoskeletal disorders is an emerging field and requires further research. This review is a guide for future studies.

Intervención para cesación tabáquica en pacientes con enfermedad pulmonar obstructiva crónica en 6 Centros de Salud / Intervention for smoking cessation in patients with chronic obstructive pulmonary disease in 6 municipal health care centers in Santiago de Chile

Entre un 30 y un 70% de los pacientes con EPOC determinado por tabaquismo continúan fumando a pesar del consejo médico. En estos casos la única medida que puede impedir el deterioro de la función pulmonar y alargar la vida es detener el consumo de tabaco. En este artículo se comunican los resultados de un Proyecto Piloto realizado durante 2012 por los profesionales del programa EPOC de 6 consultorios de Atención Primaria de Salud (APS). Se identificaron los pacientes fumadores y se ofreció consejería intensiva y medicamentos a los que fumaban >=10 cigarrillos día. Ingresaron a estudio pacientes con diagnóstico clínico y/o espirométrico de EPOC y se excluyeron aquellos con condiciones médicas o psicológicas inestables y/o consumo actual de alcohol. En 3 centros se usó vareniclina 2 mg/día y en 3 bupropión 300 mg/día más chicle de nicotina de 4 mg. Duración del tratamiento: 3 meses. Ingresaron a terapia 50 pacientes. Edad promedio 58,8, rango 37- 80, sexo femenino 60%. Los pacientes mostraron alto grado de adicción, 47,7% fumaban >=20 cpd y 64% lo hacían antes de 30 min luego de despertar. El promedio de sesiones de terapia fueron de 8,9. Los efectos secundarios de los fármacos se presentaron leves en 17 pacientes (34%) e intensos en 3 (6%), determinando la suspensión del tratamiento. El coste de fármacos por paciente tratado fue de US$ 138. Dejaron de fumar a los 6 meses 19 pacientes (38%). Conclusiones. El paciente con EPOC se caracteriza por alto grado de adicción. El tratamiento intensivo con terapia psicosocial y medicamento realizado en consultorio por los mismos profesionales que los controlan puede obtener resultados aceptables (AU)

Between 30-70% of patients with COPD caused by tobacco consume remain smoking despite medical advice. In these cases the only measure that can prevent deterioration of pulmonary function and to prolong life is to stop tobacco use. Here are the results of a pilot project done in 2012 by professionals of the COPD control program of six Primary Health Care Centers (PHCC). The strategy was to identify patients, who smoke, provide intensive treatment though counseling and medications. The patients that entered the study, were previously diagnosed COPD clinically and/or by spirometry and were excluded those with unstable medical or psychological conditions and/or current use of alcohol. Six counseling sessions were planned. Drugs were administered to those who smoked >= 10 cigarettes daily. At three PHCCs Varenicline 2 mg was used daily. At three other PHCCs Bupropion 300mg plus Nicotine Gum 4 mg were used daily. The duration of treatment was 3 months. 50 patients average 58.8 years of age range 37-80, 60% being female. Patients showed high degree of addiction 47.7% smoked >= 20 cpd and 64% did so within 30 min after awakening. Average therapy sessions were 8.9 and side effects were 34%, severe in 6%. 3 patients discontinued treatment due to intolerance. 19 patients quit smoking after 6 months (38%). Conclusions. COPD patients are characterized by high degree of addiction. Intensive treatment with medication and psychosocial therapy performed in PCCs by the same professionals whom perform routine check-ups can achieve acceptable results (AU)

[Risk factors for home deaths due to pneumonia among low socioeconomic level Chilean children, Santiago de Chile (1994)]. / Factores de riesgo de fallecer en domicilio por neumonía, de niños chilenos de estratos socioeconómicos bajos, Santiago de Chile (1990-1994).

BACKGROUND: Pneumonia is the main cause of late infant mortality in Chile. Over 60% of these deaths occur at home. The lack of hospital beds and the inadequate outpatient management are contributing factors. AIM: To assess risk factors for home deaths due to pneumonia in Chilean children. PATIENTS AND METHODS: The clinical and environmental histories of 53 (39 male) children that died due to pneumonia in their homes were analyzed. The cause of death was confirmed by necropsy with histopathological studies in all cases. These cases were compared with 88 control children of similar age, gender, socioeconomic status and living in the same geographical area of Metropolitan Santiago. RESULTS: Fifty four percent of deceased children were of less than 3 months of age and only 3 cases and their controls were above 1 year old. Identified risk factors for death were malnutrition with an odds ratio of 30.6 (CI 3.9-64.8, p < 0.001), low birth weight with an odds ratio of 5 (CI 1.8-14.1, p < 0.001), previous admissions to hospitals with an odds ratio of 5.79 (CI 2-17.1, p < 0.001), congenital malformations (mainly cardiac) with an odds ratio of 8.4 (CI 2-39.9, p = 0.001) and a history of bronchial obstruction with an odds ratio of 5.68 (p < 0.001). Identified maternal risk factors were smoking with an odds ratio of 4.13 (CI 1.6-10.7 p < 0.001) and being a teenager with an odds ratio of 4.3 (CI 1.7-11, p < 0.001). Malnutrition, low birth weight, history of previous hospital admissions and having a teenager or smoker mother were considered as independent risk factors using a stepwise analysis. CONCLUSIONS: Chilean low income children have identifiable risk factors for death at their homes due to pneumonia, that can be preventively managed.

[Pulmonary aspiration in children. Quantification of lipid laden alveolar macrophages]. / Aspiración pulmonar en niños. Cuantificación de macrófagos alveolares cargados de lípidos.

BACKGROUND: The search for lipid laden macrophages in sputum could be a simple diagnosis method for pulmonary aspiration. AIM: To assess the usefulness of sputum lipid laden macrophages in the diagnosis of pulmonary aspiration. PATIENTS AND METHODS: Sixteen children aged 0 to 4 years old, admitted with aspiration pneumonia were studied. The diagnosis was based on clinical grounds (vomiting or radiologically diagnosed swallowing abnormalities plus persistent pulmonary condensations) or radionucleide milk scanning. As controls, 6 children of 1 to 5 years old, admitted for elective tonsillectomy, were studied. Sputum was stained with Sudan III-Hematoxylin, 100 macrophages were read and each cell received a score from 0 to 4 according to the degree of staining. RESULTS: Lipid laden macrophages of children with aspiration pneumonia had a mean score of 150 +/- 107 (8-323) compared with those of controls that had a score of 1.3 +/- 1.5 (0-4). CONCLUSION: The study of sputum lipid laden macrophages may be a useful diagnostic method for aspiration pneumonia.

Tuberculosis pulmonar en el lactante. / Pulmonary tuberculosis in infants

Se hizo un estudio retrospectivo en 59 menores de 2 anos con TBC pulmonar, internados en el Hospital Josefina Martinez de Ferrari durante el periodo 1970-1979. Se encontro desnutricion severa en 55.9% de los casos, antecedente de contacto tuberculoso en 68.8%, principalmente por enfermedad de la madre y falta de vacunacion BCG previa en el 39%. En los no vacunados hubo viraje tuberculinico en 20 de 23 casos. El PPD fue (-) en 35,5% de los vacunados. La extension de las lesiones, fue minima en 33,9% moderada en 39% y avanzada en 27.1% entre estos ultimos 4 casos tenian, cavernas y TBC miliar. En las formas avanzadas el PPD fue negativo en el 56,2% habia desnutricion en el 87% y solo el 18% tenia cicatriz BCG. En las formas minimas ocurrio lo inverso. Se analizaron los sintomas que orientaron el diagnostico y el o los elementos claves en que se fundamento este. La radiologia fue el principal elemento en 2/3 de los casos, el viraje tuberculinico en 20 ninos (34%) y la bacteriologia positiva en 18(30.5%)