Salud de los trabajadores

Actividad física y su relación con los factores de riesgo cardiovascular de carteros chilenosAnálisis de resultados: riesgos psicosociales en el trabajo Suceso-Istas 21 en Cesfam QuellónAusentismo laboral por enfermedades oftalmológicas, Chile 2009Brote de diarreas por norovirus, posterremoto-tsunami, Constitución, Región del MauleCalidad de vida en profesionales de la salud pública chilenaCaracterización del reposo laboral en personal del SSMN durante el primer semestre de 2010Concentración de nicotina en pelo en trabajadores no fumadores expuestos a humo de tabaco ambientalCondiciones de trabajo y bienestar/malestar docente en profesores de enseñanza media de SantiagoDisfunción auditiva inducida por exposición a xilenoErgonomía aplicada al estudio del síndrome de dolor lumbar en el trabajoEstimación de la frecuencia de factores de riesgo cardiovascular en trabajadores de una empresa mineraExposición a plaguicidas inhibidores de la acetilcolinesterasa en Colombia, 2006-2009Factores de riesgo y daños de salud en conductores de una empresa peruana de transporte terrestre, 2009Las consecuencias de la cultura en salud y seguridad ocupacional en una empresa mineraPercepción de cambios en la práctica médica y estrategias de afrontamientoPercepción de la calidad de vida en la Universidad del BiobíoPesos máximos aceptables para tareas de levantamiento manual de carga en población laboral femeninaRiesgo coronario en trabajadores mineros según la función de Framingham adaptada para la población chilenaTrastornos emocionales y riesgo cardiovascular en trabajadores de la salu

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Unconscious fantasy (or phantasy) as clinical concept

A clinical phenomenology of the concept unconscious fantasy' attempts to describe it from a bottom-up' perspective, that is, from the immediate experience of the analyst working in session. Articles of psychoanalytic authors from different persuasions are reviewed, which taken as a whole would shed some light on how the concept of unconscious fantasy takes shape in the analyst's mind during the session with the patient. A clinical phenomenology in three steps is described. Each step is illustrated by clinical material. Current controversies around the concept of unconscious fantasy (or phantasy) are still trapped in the discussion about if and how they are really unconscious. The strategy to describe from a bottom-up' perspective the process of how the analyst's mind embraces the idea that an emerging phenomenon in the relationship with the patient can be defined as unconscious fantasy', allows us to elude the question as to whether or not we believe that unconscious fantasies exist at all, since we are neither required to assert or deny such a prior existence in order to describe the process of elaboration which, in the end, does formulate a fantasy as fantasy

La práctica del psicoanálisis. Evolución y actualidad

Esta obra es un trabajo colectivo, dirigido por el Dr. Juan Pablo Jiménez de la Jara y la Ps. Josefina Figueroa, en donde el lector encontrará una reflexión teórico-clínica sistemática de la experiencia de un grupo de psicoanalistas que ha trabajado durante 30 años, primero en una institución hospitalaria y después en una corporación privada sin fines de lucro, atendiendo pacientes y formando psicoterapeutas psicoanalíticos. A través de los diversos capítulos, que abarcan los distintos aspectos de la práctica del psicoanálisis en el ámbito institucional, el lector se informará cómo estos profesionales han ido descubriendo y construyendo un psicoanálisis que, sin renunciar a su esencia, permite abordar el sufrimiento de pacientes que consultan en un encuadre institucional, esto es, a través de la aplicación de dispositivos terapéuticos de bajo costo y de corta duración. El libro está dirigido a profesionales de la Salud Mental, psicólogas y psiquiatras, trabajadoras sociales, enfermeras y terapeutas ocupacionales, es decir, a todos aquellos que necesitan herramientas teóricas y prácticas para establecer relaciones terapéuticas eficaces con sus pacientes

Walking the middle ground between hermeneutics and science: A research proposal on psychoanalytic process

In 100 years of clinical research and 40 years of empirical research, the concept of psychoanalytic process continues to elude a consensual definition, probably because the problem and methodology must be approached in a different way. This article outlines the empirical implications of the epistemological model exposed in a previous article, by proposing a scientific, innovative, and clinically sensitive research programme for the study of psychoanalytic process. This proposal is an attempt at developing psychotherapy research that is founded on psychoanalytic hypotheses derived from a two-person psychology. The research programme focuses on the interactional nature of the analytical work, and on the relationship between the implicit (unconscious) and the explicit (conscious) levels of the analytic endeavour. The authors propose that this research programme be articulated around three methodological approaches: (1) the use of systematic case studies; (2) the adoption of the events paradigm for accessing the salient phenomena of the psychoanalytic process; and (3) a micro-analytic approach to the specific phenomena occurring within relevant sequences of interaction. These ideas are illustrated with a description of the micro-analysis of a clinical case. This article is intended to contribute to a constructive dialogue between psychoanalytic practice and psychotherapy research.CONICYT (National Commission for Scientific and Technological Research) Comisión Nacional de Investigación Científica y Tecnológica (CONICYT) CONICYT FONDECYT 1150166 11180671 PII20150035 Fund for Innovation and Competitiveness (FIC) of the Chilean Ministry of Economy, Development and Tourism, through the Millennium Scientific Initiative IS13000

Vulnerability or sensitivity to the environment?: methodological isues trends, and recommendations in Gene-environment interactions research in human behavior

Research on the potential role of gene-environment interactions (GxE) in explaining vulnerability to psychopathology in humans has witnessed a shift from a diathesis-stress perspective to differential susceptibility approaches. This paper critically reviews methodological issues and trends in this body of research. Databases were screened for studies of GxE in the prediction of personality traits, behavior, and mental health disorders in humans published between January 2002 and January 2015. In total, 315 papers were included. Results showed that 34 candidate genes have been included in GxE studies. Independent of the type of environment studied (early or recent life events, positive or negative environments), about 67-83% of studies have reported significant GxE interactions, which is consistent with a social susceptibility model. The percentage of positive results does not seem to differ depending on the gene studied, although publication bias might be involved. However, the number of positive findings differs depending on the population studied (i.e., young adults vs. older adults). Methodological considerations limit the ability to draw strong conclusions, particularly as almost 90% (n = 283/315) of published papers are based on samples from North America and Europe, and about 70% of published studies (219/315) are based on samples that were also used in other reports. At the same time, there are clear indications of methodological improvements over time, as is shown by a significant increase in longitudinal and experimental studies as well as in improved minimum genotyping. Recommendations for future research, such as minimum quality assessment of genes and environmental factors, specifying theoretical models guiding the study, and taking into account of cultural, ethnic, and lifetime perspectives, are formulated.National Ph.D. Program CONICYT-PCHA, 21110130 / CONICYT, Ministry of Education, Chilean Government, 21110134 / FONDECYT, 1130810, 1150166 / Fund for Innovation and Competitiveness (FIC) of the Chilean Ministry of Economy, Development and Tourism, through the Millennium Science Initiative, IS130005 / scientific cooperation programme / Latin American Universities (Universidad de Chile) / KU Leuve

History of child abuse among patients with bipolar disorders

Background: A history of child abuse is common and has a significant impact in the clinical course of patients diagnosed with bipolar disorders (BD). Aims: To assess the frequency of child abuse experiences in patients BD type I and to evaluate its association with clinical course and cognitive functioning variables. Material and Methods: 117 patients with BD aged 45 +/- 14 years (66% women) answered the Childhood Trauma Questionnaire (CTQ). The clinical course (illness onset, history of suicide attempts and number of hospitalizations) was obtained from medical records. Cognitive functioning was evaluated through social and non-social cognition tasks. Results: 64% of participants reported some type of child abuse. This variable was associated with an early onset of the disease (Odds ratio (OR) = 3.3; p < 0.02), increased risk of suicide attempts (OR = 2.4; p < 0.04) and specific disturbances in social cognitive tasks. Conclusions: Our study supports evidence of a common history of child abuse in patients with BD. Although child abuse predicts a worse clinical course, major clinical practice guidelines, as well as research designs, do not highlight this evidence

Emergencias y desastres

Aplicaci&oacute;n de encuesta en aldeas, instaladas posterremoto/tsunami, Regi&oacute;n del MauleCooperaci&oacute;n internacional y respuesta del sistema de salud frente al terremoto de febrero de 2010Estudio de los fallecidos durante el desastre del 27 de febrero en ChileExperiencia de solidaridad internacional de urgencia en Rancagua, Chile, postsismo 2010Incidencia de patolog&iacute;as posterremoto en la comunidad de Huala&ntilde;&eacute;Incidencia de trastorno de estr&eacute;s postraum&aacute;tico posterior al terremoto en Chile en los trabajadores bancario

La retórica y el debate como herramientas de aprendizaje

Convocatoria proyectos de innovación de Extremadura 2019/2020Se describe un proyecto llevado a cabo en el IES San Fernando (Badajoz) surgido del Departamento de Filosofía que tiene como objetivo principal mejorar las habilidades comunicativas del alumnado. Se pretendía que supieran hablar, transmitir ideas y opiniones, saber escuchar, compartir posturas, rebatir y estar preparados para cambiar de opinión. Otros objetivos del trabajo fueron: transmitir una visión de sociedad que se basa en el diálogo constructivo a través de una interacción respetuosa, rigurosamente fundamentada, reflexiva e inclusiva; lograr en los alumnos el desarrollo del pensamiento crítico y conseguir que comprendan la información que reciben, las inferencias y que sean capaces de evaluarla y generar nuevas propuestasExtremaduraES