Lactancia materna en España y factores relacionados con su instauración y mantenimiento: estudio LAyDI (PAPenRed) / Breastfeeding in Spain and the factors related to its establishment and maintenance: LAyDI Study (PAPenRed)

Objetivo: Conocer estadísticas reales sobre lactancia materna en España, así como factores socioculturales y perinatales que afectan a su inicio y mantenimiento. Diseño: Estudio prospectivo, multicéntrico, longitudinal, de ámbito nacional (estudio LAyDI). Sitio: Consulta de pediatras de atención primaria. Participantes: Cohorte de recién nacidos entre abril de 2017 y marzo de 2018 en España que se siguieron hasta los dos años en ocho visitas. Medidas principales: Se analizaron las tasas de los diferentes tipos de lactancia en cada visita y también se analizaron variables relacionadas con la gestación, el parto, el período neonatal, sociales, económicas y biológicas. Resultados: Muestra inicial de 1.946 (50,1% varones). El 90,7% decidieron iniciar lactancia materna al nacimiento. La cifra de lactancia materna exclusiva (LME) fue del 66,4% a los 15días y del 35,2% a los 6meses. Cualquier tipo de lactancia materna (lactancia materna total [LMT]) a los 6meses fue del 61,7%. La supervivencia de LMT presentó una mediana de 6,0meses (IC95%: 6,0-6,1). Variables relacionadas con LME a los 15días: hijos previos, nivel de educación de madre, ausencia de enfermedad durante el embarazo, no separación madre e hijo al nacer, no utilización de chupete, no existencia de problemas en pezones, y momento de decisión tipo lactancia. Variables relacionadas con mayor duración LMT son: la relación mayor de 5años de los padres, no usar de chupete, colecho al mes de vida, decidir lactancia materna antes del embarazo, recibir información sobre lactancia durante el embarazo y utilizar apoyo de asociaciones. Conclusiones: El abandono temprano de la lactancia materna es un problema importante en las sociedades occidentales. Existen factores sobre los que se puede actuar para mejorar resultados.(AU)

Objective: To find out actual statistics on breastfeeding in Spain, as well as sociocultural and perinatal factors that affect its initiation and maintenance. Design: Prospective, multicentre, longitudinal, nationwide study (XXX study). Site: Primary care paediatricians’ office. Participants: Cohort of newborns born between April 2017 and March 2018 in Spain who were followed up to two years of age in 8 visits. Main measures: Rates of different types of breastfeeding were analysed at each visit and variables related to gestation, delivery, neonatal period, social, economic and biological variables were also analysed. Results: Initial sample of 1946 (50.1% male). 90.7% decided to initiate breastfeeding at birth. Exclusive breastfeeding (EBF) was 66.4% at 15days and 35.2% at 6months. Any type of breastfeeding (total breastfeeding [TBF]) at 6months was 61.7%. Median survival from TBF was 6.0months (95%CI: 6.0-6.1). Variables related to EBF at 15days: previous children, mother's level of education, absence of illness during pregnancy, no separation of mother and child at birth, no dummy use, no nipple problems, and time of decision to breastfeed. Variables related to longer duration of TBF: relationship of parents older than 5years, no dummy use, co-sleeping at one month of life, deciding to breastfeed before pregnancy, receiving information on breastfeeding during pregnancy and using support from associations. Conclusions: Early abandonment of breastfeeding is a major problem in Western societies. There are factors that can be worked on to improve outcomes.(AU)

[Breastfeeding in Spain and the factors related to its establishment and maintenance: LAyDI Study (PAPenRed)]. / Lactancia materna en España y factores relacionados con su instauración y mantenimiento: estudio LAyDI (PAPenRed).

OBJECTIVE: To find out actual statistics on breastfeeding in Spain, as well as sociocultural and perinatal factors that affect its initiation and maintenance. DESIGN: Prospective, multicentre, longitudinal, nationwide study (XXX study). SITE: Primary care paediatricians' office. PARTICIPANTS: Cohort of newborns born between April 2017 and March 2018 in Spain who were followed up to two years of age in 8 visits. MAIN MEASURES: Rates of different types of breastfeeding were analysed at each visit and variables related to gestation, delivery, neonatal period, social, economic and biological variables were also analysed. RESULTS: Initial sample of 1946 (50.1% male). 90.7% decided to initiate breastfeeding at birth. Exclusive breastfeeding (EBF) was 66.4% at 15days and 35.2% at 6months. Any type of breastfeeding (total breastfeeding [TBF]) at 6months was 61.7%. Median survival from TBF was 6.0months (95%CI: 6.0-6.1). Variables related to EBF at 15days: previous children, mother's level of education, absence of illness during pregnancy, no separation of mother and child at birth, no dummy use, no nipple problems, and time of decision to breastfeed. Variables related to longer duration of TBF: relationship of parents older than 5years, no dummy use, co-sleeping at one month of life, deciding to breastfeed before pregnancy, receiving information on breastfeeding during pregnancy and using support from associations. CONCLUSIONS: Early abandonment of breastfeeding is a major problem in Western societies. There are factors that can be worked on to improve outcomes.

Control hospitalario de la diabetes y de la hiperglucemia: una auditoría en hospitales españoles / Inpatient management of diabetes and hyperglycemia: an audit of Spanish hospitals

Objetivos Evaluación de la calidad de la asistencia a los pacientes con diabetes mellitus ingresados en España. Métodos Estudio transversal que incluyó a 1.193 (26,7%) pacientes con diabetes tipo 2 o hiperglucemia de un total de 4.468 pacientes ingresados en los servicios de medicina interna de 53 hospitales (España). Se recogieron datos demográficos, adecuación de la monitorización de la glucemia capilar, tratamiento administrado durante el ingreso y terapia recomendada al alta. Resultados La edad mediana fue de 80 años (74-87), 561 (47%) pacientes eran mujeres, con un índice de Charlson de 4 (2-6) puntos, siendo clasificados frágiles 742 (65%). La mediana de glucemia al ingreso fue de 155 (119-213) mg/dL. Al tercer día de ingreso el número de glucemias capilares en objetivo (80-180mg/dL) fue de 792/1.126 (70,3%) en el predesayuno, 601/1.083 (55,4%) en la precomida, 591/1.073 (55,0%) en la precena y 317/529 (59,9%) durante la noche. Se observó hipoglucemia en 35 (0,9%) pacientes. El tratamiento durante el ingreso fue realizado con insulina en escala móvil en 352 (40,5%) pacientes, insulina basal y análogos de insulina rápida en 434 (50%) y dieta exclusivamente en 101 (9,1%). Un total de 735 (61,6%) pacientes disponían de un valor reciente de HbA1c. En el alta se incrementó el uso de iSGLT2 (30,1 vs. 21,6%; p<0,001) y el uso de insulina basal (25,3 vs. 10,1%; p<0,001). Conclusiones Existe un excesivo uso de insulina en escala móvil, una deficiente información de los valores de HbA1c y una prescripción aún deficiente de tratamientos con beneficio cardiovascular al alta (AU)

Objectives Evaluation of the quality of care for patients with diabetes mellitus admitted to hospitals in Spain. Methods Cross-sectional study in one day that included 1193 (26.7%) patients with type 2 diabetes or hyperglycemia out of 4468 patients admitted to the internal medicine departments of 53 hospitals in Spain. We collected demographic data, adequacy of capillary glycemic monitoring, treatment administered during admission, and recommended therapy at discharge. Results The median age of the patients was 80 years (74-87), of which 561 (47%) were women, with a Charlson index of 4 points (2-6), and 742 (65%) were fragile. Median blood glucose on admission was 155mg/dL (119-213). On the third day, the number of capillary blood glucose levels in target (80-180mg/dL) was pre-breakfast 792/1126 (70.3%), pre-lunch 601/1083 (55.4%), pre-dinner 591/1073 (55.0%) and night 317/529 (59.9%). A total of 35 patients (0.9%) were suffering from hypoglycemia. Treatment during hospitalization was performed with sliding scale insulin in 352 (40.5%) patients, with basal insulin and rapid insulin analogs in 434 (50%), or with diet exclusively in 101 (9.1%). A total of 735 (61.6%) patients had a recent HbA1c value. At the time of discharge, the use of iSGLT2 increased significantly (30.1% vs. 21.6%; p<0.001), as well as the use of basal insulin (25.3% vs. 10.1%; p<0.001). Conclusions There is an excessive use of insulin on a sliding scale as well as deficient information on HbA1c values and an even deficient prescription at the discharge of treatments with cardiovascular benefit (AU)

Inpatient management of diabetes and hyperglycaemia: an audit of Spanish hospitals.

OBJECTIVES: Evaluation of quality of care for patients with diabetes mellitus admitted to hospitals in Spain. METHODS: Cross-sectional study in one day that included 1193 (26.7%) patients with type 2 diabetes or hyperglycaemia out of a total of 4468 patients admitted to the internal medicine departments of 53 hospitals in Spain. We collected demographic data, adequacy of capillary glycaemic monitoring, treatment administered during admission, and recommended therapy at discharge. RESULTS: The median age of the patients was 80 years [74-87], of which 561 (47%) were women, with a Charlson index of 4 points [2-6], and 742 (65%) were fragile. Median blood glucose on admission was 155 mg/dl [119-213]. On the third day, the number of capillary blood glucose levels in target (80-180 mg/dl) at pre-breakfast was 792/1126 (70.3%), pre-lunch 601/1083 (55.4%), pre-dinner 591/1073 (55.0%), and at night 317/529 (59.9%). A total of 35 patients (0.9%) were suffering from hypoglycemia. Treatment during hospitalization was performed with sliding scale insulin in 352 (40.5%) patients, with basal insulin and rapid insulin analogues in 434 (50%), or with diet exclusively in 101 (9.1%). A total of 735 (61.6%) patients had a recent HbA1c value. At discharge, the use of SGLT2i increased significantly (30.1% vs. 21.6%; p < 0.001), as did the use of basal insulin (25.3% vs. 10.1%; p < 0.001). CONCLUSIONS: There is an excessive use of sliding scale insulin as well as insufficient information on HbA1c values and prescription upon discharge of treatments with cardiovascular benefit.

Prevalencia y factores asociados al Potencial Uso Inapropiado de Medicamentos en el adulto mayor de centros geriátricos de Cuenca / Prevalence and factors associated with the Potential Inappropriate Use of Medications in the elderly at geriatric centers in Cuenca

Antecedentes: el envejecimiento aumenta la probabilidad de presentar morbilidad múltiple, con el uso de varios fármacos simultáneos, la polimedicación acrecienta el uso inadecuado de fármacos y de reacciones adversas a medicamentos, caídas, hospitalización y muerte. Objetivo: determinar la prevalencia y factores asociados al potencial uso inapropiado de medicamentos en el adulto mayor de centros geriátricos del cantón Cuenca en el periodo Junio a noviembre del año 2016. Diseño metodológico: es un estudio analítico, transversal y de prevalencia. La muestra estuvo constituida por 292 adultos mayores de los centros geriátricos de Cuenca. Se elaboraró un formulario con datos sociodemográficos, clínicos y uso de medicamentos en el adulto mayor. El análisis estadístico se realizó con el programa SPSS v.25; las medidas utilizadas para presentar los resultados son frecuencias, porcentajes, media aritmética y desvió estándar; para contrastar la hipótesis el chi cuadrado (significancia p < 0,05); para medir asociación la razón de prevalencia y su intervalo de confianza al 95%; y para control de variables confusoras, la regresión logística binaria. Resultados: la muestra se compone de 292 adultos mayores de centros geriátricos de Cuenca, se ha encontrado 79 casos de prescripción inapropiada (27,1%), 63 casos de omisión de la prescripción (21,6%) y 88 casos de interacciones medicamentosas riesgosas (30,01%). Las potenciales prescripciones inadecuadas de medicamentos se asociaron con edad avanzada e instrucción baja; las potenciales omisiones en la prescripción con baja instrucción, la depresión y polimedicación; y las potenciales interacciones medicamentosas con la edad avanzada, un nivel bajo de instrucción, el deterioro cognitivo y la polimedicación. Conclusiones: la prevalencia del uso inapropiado de medicamentos en el adulto mayor fue alta y se encontró una asociación de riesgo al uso inapropiado de medicamentos con la edad avanzada, baja instrucción, depresión, deterioro cognitivo y polimedicación. Palabras clave: Prescripción inadecuada. Anciano. Centros geriátricos. Factores de riesgo. Estudio de prevalencia.

Abstract: Background: aging increases the probability of presenting multiple morbidity, with the use of several drugs simultaneously, polymedication increases the inappropriate drug use and the frequency of adverse drug reactions, falls, hospitalization and death. Objective: to determine the prevalence and factors associated with the potential inappropriate use of medicines in the elderly of geriatric centers in the canton of Cuenca in the period June to November of 2016. Methodological design: it is an analytical, cross-sectional and prevalence study. The sample consisted of 292 older adults from the geriatric centers of Cuenca. A form with sociodemographic, clinical data and medication use in the elderly was developed. Statistical analysis was performed with the SPSS v.25 program; the measures used to present the results are frequencies, percentages, arithmetic mean and standard deviation; to test the chi square (significant p <0.05); to measure association the prevalence ratio and its 95% confidence interval; and for the control of confusing variables, binary logistic regression was applied. Results: the sample is composed of 292 older adults from geriatric centers in Cuenca, 79 cases of inappropriate prescription (27.1%), 63 cases of prescription omission (21.6%), and 88 cases of risky drug interactions have been found (30.01%). Potential inappropriate medication prescriptions were associated with advanced age and low education; the potential omissions in prescription with low instruction, depression and polymedication; and the potential drug interactions with advanced age, a low level of instruction, cognitive impairment and polymedication Conclusions: the prevalence of inappropriate medication use in the elderly was high and a risk association was found for inappropriate medication use with advanced age, low education, depression, cognitive impairment and polymedication.

Brucelosis en Cochabamba, Bolivia. Primer estudio de prevalencia departamental / Brucellosis in Cochabamba, Bolivia. First regional prevalence study

Objetivo: establecer la prevalencia de serología positiva por ELISA IgG para Brucella spp y conocer la relación con factores asociados. Métodos: se realizaron ELISA IgG en 276 muestras del Banco de Sangre de Referencia - Cochabamba. Resultados: obtuvimos una prevalencia de 10,87/1 000 habitantes. Conclusiones: los datos de prevalencia obtenidos son congruentes con los reportados por otros países a nivel mundial.

Objective: to establish positive ELISA IgG seroprevalence for Brucella spp and to find associated risk factors. Method: 276 samples provided by the Banco de Sangre de Referencia - Cochabamba" underwent IgG ELISA. Results: we obtained a 10.87/1 000 prevalence rate result.Conclusions: data obtained by this study is consistent with the one reported by country worldwide.

[Prevalence of potentially inappropriate drug prescription in the elderly]. / Prevalencia de prescripción potencialmente inapropiada de medicamentos en adultos mayores.

INTRODUCTION: One of the causes of preventable adverse drug events (ADES) in older patients constitutes inappropriate prescription of drugs (PIM). The PIM is where risks exceed the clinical benefit. Several instruments can be use to measure this problem, the most used are: a) Beers criteria; b) Screening tool to Older People Potentially inappropriate Prescription (STOPP); c) Screening tool to Alert Doctors to Right Appropriate indicated Treatments (START); d) The Medication Appropriateness Index (MAI). This study aims to assess the prevalence of PIM, in a population of older adults in three clinical scopes of university hospital. MATERIAL AND METHODS: cross sectional study of 300 cases from a random sample of fields: hospitalization (n=100), ambulatory (n=100) and emergency (n=100), all patients over 65 years old or more who where treated at our hospital. RESULTS: 1355 prescription drugs were analized, finding patients hospitalized (PIM) of 57.7%, 55%, 26%, and 80% according to Beers, in ambulatory 36%, 36.5%, 5% and 52% with the same tools and in emergency 35%, 35%, 6% y 52% with the same tools. Was found significant association the PIM with polipharmacy with Beers, STOPP and MAI. CONCLUSIONS: results can be compare to world literature (26-80% vs 11-73.1%). The STOPP-START used in an integrated manner would be best estimating the problem of PIM.

The first national tuberculosis prevalence survey of Lao PDR (2010-2011).

OBJECTIVE: The objective of the study was to measure the prevalence of bacteriologically confirmed pulmonary tuberculosis (TB) in Lao PDR in 2010-2011. METHOD: A nationwide, multistage cluster-sampled cross-sectional survey was undertaken in 2010-2011. All consenting participants ≥15 years were screened for pulmonary TB with chest X-ray and symptom questionnaire. Two sputum specimens for bacteriological examination by microscopy and culture were collected from those who screened positive. Prevalence was estimated using multiple imputation and inverse probability weighting methods. RESULTS: Of 39 212 eligible participants from 50 clusters, 6290 participants provided at least one sputum sample for smear and culture. There were 237 bacteriologically confirmed pulmonary TB cases, 107 of which were smear-positive. Chest X-ray screening alone identified 230 (97.0%) cases compared with 118 (49.8%) by symptom screening alone. The estimated prevalence of smear-positive and bacteriologically confirmed TB in those ≥15 years was 278 per 100 000 (95%C.I. 199-356) and 595 per 100 000 (95%C.I. 457-733), respectively. Prevalence significantly increased with age and was higher in men than women. CONCLUSIONS: The prevalence of TB in Lao PDR is almost twice as high than previous estimates, with the greatest burden in the older population. Case detection efforts remain the primary goal of the national TB programme with case notifications being very low in comparison with the estimated number of prevalent cases. The survey observed major limitations with the diagnostic strategy of passive (symptom based) case finding that uses only direct smear microscopy for confirmation.

National tuberculosis prevalence surveys in Asia, 1990-2012: an overview of results and lessons learned.

OBJECTIVE AND METHODS: In many countries, national tuberculosis (TB) prevalence surveys are the only way to reliably measure the burden of TB disease and monitor trends. They can also provide evidence about the current performance of TB care and control and how this could be improved. We developed an inventory of Asian surveys from 1953 to 2012 and then compiled and analysed a standard set of data for all national surveys implemented between 1990 (the baseline year for 2015 global TB targets) and 2012. RESULTS: There were 21 surveys in 12 countries between 1990 and 2012; published results were available for 18. The participation rate was at least 80% and often much higher except for two surveys in Thailand. The prevalence of bacteriologically-positive TB disease among adults aged ≥15 years varied widely among countries (1.2 per 1000 population in China in 2010 to 15 per 1000 population in Cambodia in 2002), but age and sex distribution patterns were consistent with a progressive increase in rates of disease by age, and men accounting for 66-75% of prevalent cases. A high proportion of cases (40-79% across all surveys) did not report TB symptoms that met screening criteria (generally cough of 2-3 weeks or more, and blood in the sputum) and were only detected due to chest X-ray screening of all survey participants; this proportion increased over time in countries with repeat survey data. The ratio of prevalent cases to cases notified to national TB programmes was typically around two, but was as high as three in Lao PDR and Pakistan even after the internationally recommended TB control strategy had been implemented nationwide for several years. Four countries (China, Cambodia, the Republic of Korea and the Philippines demonstrated declines in smear or culture-positive pulmonary TB prevalence of approximately 50% over 10 years. CONCLUSIONS: National TB prevalence surveys in Asia show that large reductions in the prevalence of TB disease can be achieved within a decade, that men bear much more of the burden than women and that the epidemic is ageing. Comparisons among countries show that more can be achieved in TB control in some countries with existing strategies and technologies. However, with many prevalent cases not reporting classic TB symptoms, all countries face the challenge of defining and implementing strategies that will result in earlier detection and treatment of cases.

Ideación suicida en estudiantes de medicina: prevalencia y factores asociados / Suicide Ideation Among Medical Students: Prevalence and Associated Factors

Introducción: Los médicos tienen mayores tasas de suicidio en comparación con la población general. Este riesgo tiende a incrementarse incluso a partir del inicio de la formación de pregrado en medicina. Existen pocos estudios que evalúen la frecuencia de conductas suicidas en estudiantes de pregrado de medicina, especialmente en Latinoamérica. Objetivo: Determinar la prevalencia de vida y factores asociados con la ideación suicida e intentos suicidas en una muestra de estudiantes de medicina de Bucaramanga, Colombia. Materiales y métodos: Se condujo un estudio observacional analítico de corte transversal, para determinar la prevalencia de vida de ideación suicida e intentos suicidas, en una muestra no probabilística de estudiantes de medicina matriculados en las 3 facultades de medicina de Bucaramanga. El cuestionario autoaplicado fue respondido de forma voluntaria y anónima por los participantes. Las versiones validadas de las escalas CES-D y CAGE fueron utilizadas para evaluar síntomas depresivos y uso problemático de alcohol, respectivamente. Se generó un modelo multivariado de regresión logística, con el fin de ajustar los estimadores de las variables asociadas con el desenlace «ideación suicida alguna vez en la vida¼. Resultados: La muestra de estudio estuvo formada por 963 estudiantes. El 57% (n = 549) de los participantes fueron mujeres. El promedio de edad fue de 20,3 años (DE 2,3 años). En relación con la prevalencia de ideación suicida, el 15,7% (n = 149) de los estudiantes informó haber tenido por lo menos un episodio de ideación suicida serio a lo largo de la vida. El 5% (n = 47) señaló haber realizado por lo menos un intento suicida. El 13,9% (n = 131) de los estudiantes informó haber ingerido antidepresivos durante su entrenamiento médico. Las variables asociadas con la ideación suicida en el modelo de regresión logística fueron: síntomas depresivos clínicamente significativos (OR: 6,9; IC 95%: 4,54-10,4), historia de consumo de sustancias psicoactivas ilícitas (OR: 2,8; IC 95%: 1,6-4,8) y percepción del regular o mal rendimiento académico durante el último año (OR: 2,2; IC 95%: 1,38-3,63). El modelo de regresión logística clasificó correctamente al 85% de los sujetos con antecedente de ideación suicida. Conclusión: La ideación suicida es un fenómeno de frecuente ocurrencia en estudiantes de medicina. Es necesario que las facultades de medicina establezcan programas de detección e intervención temprana que permitan disminuir la probabilidad de ocurrencia de desenlaces negativos.

Introduction: It is well documented that physicians have higher rates of suicide than the general population. This risk tends to increase even from the beginning of undergraduate training in medicine. There are few studies evaluating the frequency of suicidal behaviors in undergraduate medical students, particularly in Latin America. Objective: To determine the lifetime prevalence and the variables associated with suicidal ideation and suicide attempts in a sample of medical students from the city of Bucaramanga, Colombia. Materials and methods: An analytical cross-sectional observational study was conducted to determine the lifetime prevalence of suicidal ideation and suicide attempts in a nonrandom sample of medical students enrolled in three medical schools in Bucaramanga. A self-administered questionnaire was voluntarily and anonymously answered by the participants. Validated versions of the CES-D and CAGE scales were used to assess the presence of depressive symptoms and problematic alcohol use, respectively. A multivariate logistic regression model was generated in order to adjust the estimates of variables associated with the outcome «suicidal ideation in life¼. Results: The study sample consisted of 963 medical students, of which 57% (n = 549) of the participants were women. The average age was 20.3 years (SD = 2.3 years). Having had at least one episode of serious suicidal ideation in their lifetime was reported by 15.7% (n = 149) of the students, with 5% (n = 47) of the students reported having made at least one suicide attempt. Having taken antidepressants during their medical training was reported by 13.9% (n = 131) of the students. The variables associated with the presence of suicidal ideation in the logistic regression model were: clinically significant depressive symptoms (OR: 6.9, 95% CI; 4.54-10.4), history of illicit psychoactive substance use (OR 2.8, 95% CI; 1.6-4.8), and perception of poor academic performance over the past year (OR: 2.2, 95% CI; 1.4-3.6). The logistic regression model correctly classified 85% of the subjects with a history of suicidal ideation. Conclusion: Suicidal ideation is a frequently occurring phenomenon in medical students. Medical schools need to establish screening procedures for early detection and intervention of students with emotional distress and suicide risk.

Prevalencia de queilitis actínica en trabajadores expuestos a radiación ultravioleta en Talca, Chile / Prevalence of actinic cheilitis in chilean workers exposed to ultraviolet radiation

El objetivo de esta investigación es determinar la prevalencia de queilitis actínica (QA) y factores asociados en trabajadores expuestos a radiación UV solar en la ciudad de Talca, Chile. Se examinaron 151 trabajadores, donde un 16.6 por ciento presentó QA. Todas las lesiones se presentaron en el labio inferior. El 40 por ciento de los casos poseía una edad entre 50 y 59 años y el 96 por ciento de los pacientes diagnosticados trabajaba más de 6 horas diarias expuestos al sol. El 56 por ciento de los diagnósticos de QA presentaron un historial 20 o más años totales de exposición a radiación UV por motivos laborales. El 56 por ciento de los casos de QA presentaron antecedentes de hábito de fumar. Los principales signos presentes en los casos de QA fueron la sequedad (100 por ciento), esfumación del margen del bermellón (88 por ciento) y el edema labial (84 por ciento). La mayoría de las lesiones fueron asintomáticas (60 por ciento).

The objective of this research is to determine the prevalence of actinic cheilitis (AC) and associated factors in workers exposed to solar UV radiation in the city of Talca (Chile). A total of 151 workers, of which 16.6 percent exhibited AC, were examined. All lesions appeared on the lower lip. The 40 percent of cases aged between 50-59 years and 96 percent of patients diagnosed worked up to 6 hours daily exposed to the sun. 56 percent of the diagnoses of AC had a history of 20 or more years of exposure to UV radiation for work. 56 percent of cases of AC had a history of smoking. Major signs present in the AC cases were the dryness (100 percent), blurred demarcation between the lip vermilion border and the skin (88 percent) and labial edema (84 percent). Most lesions were asymptomatic (60 percent).

[Suicide Ideation Among Medical Students: Prevalence and Associated Factors]. / Ideación suicida en estudiantes de medicina: prevalencia y factores asociados.

INTRODUCTION: It is well documented that physicians have higher rates of suicide than the general population. This risk tends to increase even from the beginning of undergraduate training in medicine. There are few studies evaluating the frequency of suicidal behaviors in undergraduate medical students, particularly in Latin America. OBJECTIVE: To determine the lifetime prevalence and the variables associated with suicidal ideation and suicide attempts in a sample of medical students from the city of Bucaramanga, Colombia. MATERIALS AND METHODS: An analytical cross-sectional observational study was conducted to determine the lifetime prevalence of suicidal ideation and suicide attempts in a non-random sample of medical students enrolled in three medical schools in Bucaramanga. A self-administered questionnaire was voluntarily and anonymously answered by the participants. Validated versions of the CES-D and CAGE scales were used to assess the presence of depressive symptoms and problematic alcohol use, respectively. A multivariate logistic regression model was generated in order to adjust the estimates of variables associated with the outcome «suicidal ideation in life¼. RESULTS: The study sample consisted of 963 medical students, of which 57% (n=549) of the participants were women. The average age was 20.3 years (SD=2.3 years). Having had at least one episode of serious suicidal ideation in their lifetime was reported by 15.7% (n=149) of the students, with 5% (n=47) of the students reported having made at least one suicide attempt. Having taken antidepressants during their medical training was reported by 13.9% (n=131) of the students. The variables associated with the presence of suicidal ideation in the logistic regression model were: clinically significant depressive symptoms (OR: 6.9, 95% CI; 4.54-10.4), history of illicit psychoactive substance use (OR 2.8, 95% CI; 1.6-4.8), and perception of poor academic performance over the past year (OR: 2.2, 95% CI; 1.4-3.6). The logistic regression model correctly classified 85% of the subjects with a history of suicidal ideation. CONCLUSION: Suicidal ideation is a frequently occurring phenomenon in medical students. Medical schools need to establish screening procedures for early detection and intervention of students with emotional distress and suicide risk.

Frecuencia del apiñamiento dentario en adolescentes del área de salud Masó: 2008 / Frecuency of the dental crowding in adolescents of the Health Area Masó: 2008

Como propósito se ha tenido el determinar la prevalencia del apiñamiento dentario en adolescentes del área de salud Masó, en el curso escolar 2007-2008, identificar la prevalencia por sexos, precisar la arcada más afectada, clasificarlo y relacionarlo con la clasificación de Angle. Se realizó un estudio descriptivo-prospectivo en un universo de 987 adolescentes, seleccionando de forma aleatoria estratificada una muestra de 138; se examinaron en sus propios escenarios, con luz natural y se utilizaron depresores linguales, pie de rey y solución esterilizante. La frecuencia del apiñamiento dentario fue de 44,2%; según el sexo, el masculino mostró 49,2% y el femenino, 50,8%; el apiñamiento dentario en la mandíbula mostró 44,2%; en el maxilar, 23% y en ambos maxilares, 32,8%. Al clasificarlo, el apiñamiento ligero se observó en 52 adolescentes (64,2%) y es la clase I de Angle la que más se relacionó con el apiñamiento (57,4%). La frecuencia del apiñamiento dentario se presentó por encima de 40%, no existen diferencias significativas en cuanto al sexo. Apareció el apiñamiento más en la mandíbula y es el ligero, él que aportó mayor número de casos, es la Clase I la que se relacionó más con la patología en estudio.

To determine the prevalence of the dental crowding in adolescents of the Health Area Masó, in the schoolar course 2007-2008, identificate the prevalence by gender, select the most affected arcade, clasify and relate with Angle's classification. A descriptive-prospected study was made in an univrse of 987 adolescents, selecting the aleatory form stratificated in their own stages with natural lihght and lingual tonge pusher, dental vernier and sterilizer solution were used. The prevalence of the dental crowding was of the 44,2%; according to the gender, the masculine shows 44,2% and the female 50,8%. The dental crowding in the jaw showed 42,2%, in the maxilar 23%, in both maxilars 32,8%. At the moment of classify the crowding was observed in 52 adolescents (64,2%) and it is Class I of Angle the one that had most relation with the crowding (57,4%). The prevalence of the dental crowding was presented over the 40%, there aren't significant differences according to the gender. Appeared the dental crowding more in the jaw and it is the light the one that offered a greater number of cases, it is Class I of Angle the one most related with the patology in study.

Frecuencia del apiñamiento dentario en adolescentes del área de salud Masó: 2008 / Frecuency of the dental crowding in adolescents of the Health Area Masó: 2008

Como propósito se ha tenido el determinar la prevalencia del apiñamiento dentario en adolescentes del área de salud Masó, en el curso escolar 2007-2008, identificar la prevalencia por sexos, precisar la arcada más afectada, clasificarlo y relacionarlo con la clasificación de Angle. Se realizó un estudio descriptivo-prospectivo en un universo de 987 adolescentes, seleccionando de forma aleatoria estratificada una muestra de 138; se examinaron en sus propios escenarios, con luz natural y se utilizaron depresores linguales, pie de rey y solución esterilizante. La frecuencia del apiñamiento dentario fue de 44,2 por ciento; según el sexo, el masculino mostró 49,2 por ciento y el femenino, 50,8 por ciento; el apiñamiento dentario en la mandíbula mostró 44,2 por ciento; en el maxilar, 23 por ciento y en ambos maxilares, 32,8 por ciento. Al clasificarlo, el apiñamiento ligero se observó en 52 adolescentes (64,2 por ciento) y es la clase I de Angle la que más se relacionó con el apiñamiento (57,4 por ciento). La frecuencia del apiñamiento dentario se presentó por encima de 40 por ciento, no existen diferencias significativas en cuanto al sexo. Apareció el apiñamiento más en la mandíbula y es el ligero, él que aportó mayor número de casos, es la Clase I la que se relacionó más con la patología en estudio(AU)

To determine the prevalence of the dental crowding in adolescents of the Health Area Masó, in the schoolar course 2007-2008, identificate the prevalence by gender, select the most affected arcade, clasify and relate with Angle´s classification. A descriptive-prospected study was made in an univrse of 987 adolescents, selecting the aleatory form stratificated in their own stages with natural lihght and lingual tonge pusher, dental vernier and sterilizer solution were used. The prevalence of the dental crowding was of the 44,2 por ciento; according to the gender, the masculine shows 44,2 por ciento and the female 50,8 por ciento. The dental crowding in the jaw showed 42,2 por ciento, in the maxilar 23 por ciento, in both maxilars 32,8 por ciento. At the moment of classify the crowding was observed in 52 adolescents (64,2 por ciento) and it is Class I of Angle the one that had most relation with the crowding (57, por ciento 4 por ciento). The prevalence of the dental crowding was presented over the 40 por ciento, there aren´t significant differences according to the gender. Appeared the dental crowding more in the jaw and it is the light the one that offered a greater number of cases, it is Class I of Angle the one most related with the patology in study(AU)

El tamaño de una muestra en un estudio de prevalencia / The size of a sample in a prevalence study

La investigación epidemiológica moderna se realiza por medio de muestras representativas cuyos valores, con determinado nivel de confianza, se generalizan a la correspondiente población. Este artículo expone nociones básicas para calcular el tamaño de una muestra probabilística simple en estudios de prevalencia y como, a partir del tamaño muestral, calcular el parámetro en el caso de una proporción.