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A fast and environment-friendly analytical method was implemented to determine multiclass pesticides in river sediments. Twenty-three pesticides-organochlorine pesticides, organophosphorus pesticides, and triazines-were extracted via matrix solid-phase dispersion (MSPD) and analyzed by gas chromatography-tandem mass spectrometry (GC-MS/MS). Florisil demonstrated excellent analytes uptake capability as the extractant phase, with suitable selectivity for treating complex sediment samples. Under defined extraction conditions, the MSPD-GC-MS/MS method demonstrated robustness in the n inter-day analysis of sediments from different sources, providing limit of quantifications (LOQs) between 5 and 15 ng/g, linear responses in the range between LOQs and 150 ng/g, extraction recoveries of 71%-106%, and precision, assessed as relative standard deviation below 20%. The MSPD significantly reduced samples and solvents' consumption, providing critical environmental gains compared to traditional extraction methods like Soxhlet. Finally, the method was applied to analyze sediment samples from three different collection areas of the Subachoque River (Cundinamarca, Colombia), demonstrating a fast, efficient, confident, and profitable analytical tool for pollution control and monitoring in environmental samples. The method allowed us to determine the current use in Colombia of banned pesticides under the 2001 Stockholm Convention.

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INTRODUCTION: Systemic Lupus Erythematosus (SLE) is an autoimmune, multisystemic, chronic disease that is diffi cult to diagnose. Few studies describe its features in the South American pediatric population. Ob jective: to describe clinical and laboratory features, course, and treatment of childhood-onset SLE patients and their transition into adulthood. PATIENTS AND METHOD: Retrospective study of patients diagnosed with SLE in a Children's Rheumatology Unit of a hospital in Santiago de Chile between 2001 and 2017. Epidemiological, clinical, laboratory, treatment received, evolution, complications and hospitalizations data were registered. It was considered severe SLE the cases with renal or cen tral nervous system involvement. RESULTS: 31 patients were studied, all with the disease longer than 6 months. The female/male ratio was 5.2/1. The median age of presentation was 12.5 years. In 94% of cases, the diagnostic delay was less than 6 months. The most frequent clinical characteristics were arthritis (87%), skin lesions (58%), and renal involvement (58%). The most frequent laboratory findings were positive antinuclear antibodies (100%), positive anti-dsDNA antibodies (74%), and hypocomplementemia (71%). Corticosteroids, hydroxychloroquine, and mycophenolate were the most commonly used drugs. There was no mortality in this group. 97% of patients had "satisfactory check-ups" during pediatric care and 59% in the adult one. The transition was scheduled in most cases. CONCLUSIONS: The results of this study were similar to other publications and is one of the few studies describing SLE in the Chilean pediatric population. In addition, it describes the transition into adulthood.

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El Programa de formación de especialistas para la atención primaria de salud y el sistema público, fue iniciado por el Ministerio de Salud de Chile en el año 2007 y se implementa en ocho facultades de Medicina. El Programa dura seis años; la mitad del período transcurre en centros de salud familiar. La primera cohorte de médicos se graduará a comienzos del año 2014. Participan 498 médicos jóvenes, estudiando en hospitales de nivel universitario y trabajando en 73 centros de salud que atienden una población de cerca de dos millones de usuarios potenciales. Actualmente hay suficiente evidencia de que las autoridades, los profesores de clínica, los residentes, las municipalidades y los evaluadores externos consideran que el Programa es necesario y efectivo. El Ministerio proporciona el financiamiento adecuado; pero todavía preocupa su estatus legal y organizacional. Las actividades se orientan a la consolidación de la gestión clínica, al fortalecimiento de las funciones de promoción y prevención en los centros de salud, al progreso en la equidad y efectividad del sistema y a la educación de los usuarios y de las comunidades. Durante la formación también se desarrolla un curso (diploma) de Salud Pública. Los objetivos de mayor alcance incluyen: la planificación de la cobertura a alcanzar durante el próximo ciclo de seis años, la definición de las condiciones deseables para ejecutar la atención primaria, y la evaluación del costo efectividad de las acciones, incluyendo el destino ulterior de los egresados.

The Training Program of specialists incorporated in the primary health care teams and in the public medical care system was started by the Ministry of Health of Chile in 2007 and is carried out in cooperation with eight Medical Faculties. The program lasts six years; half of the time is spent in primary care clinics. The fist cohort will graduate as specialists beginning of 2014. In all, 498 young physicians are now participating in the Program in 73 clinics that cover nearly 2 million potential users. It is generally agreed by all concerned – authorities, faculty, residents, municipalities, external evaluators - that the Program is necessary and effective. However, at this stage and in spite of the financial and administrative support so far provided, there is a concern regarding the legal and organizational status of the Program. Current efforts are being directed towards consolidating the clinical management of patients, strengthening promotion and prevention in the clinics, improving the equity and effectiveness of the system and educating the users and the communities. This is supported by a public health course delivered during the entire duration of the Program. Broader objectives include: planning the coverage to be attained during the next six-year cycle; defining the required type of PHC facilities, and evaluating the cost-effectiveness of the Program, including the subsequent destination of its graduates.

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BACKGROUND: "Children with special health care needs" (CSHCN) is a novel definition for pediatric patients with chronic diseases, adopted by the Chilean Pediatric Society in 2008. As life expectancy in Chile increases, prevalence of CSHCN is progressively growing, leading to higher health costs. AIM: To describe the epidemiological profile and clinical characteristics of hospitalized CSHCN, and compare the risk assessment of adverse events during hospitalization using two definitions for CSHCN. PATIENTS AND METHODS: A cohort of hospitalized CSHCN in a Pediatric Center at Santiago, Chile, was followed from September to December 2009. Clinical and demographic data were registered in a database, including admission to intensive care unit (ICU), nosocomial infections and prolonged hospitalization (> 7 days). Incidence ratios for these events were compared between CSHCN and non-CSHCN, and between children attended by three or more health care professionals (CSHCN-3) and non-CSHCN. RESULTS: Nine hundred twenty patients were included (54% male), with a median age 14 months (0-221) and median days of hospitalization 4 days (1-229). Prevalence of CSHCN was 60.8% of hospitalized children. When using CSHCN definition and comparing with non-CSHCN, no excess of risk was documented. On the other hand, prevalence of CSHCN-3 was 19.9%. Compared to non-CSHCN, these patients had a higher risk of ICU admission (relative risk (RR) 1.58; 95% confidence intervals (CI) = 1.22-2.05; p < 0.01), nosocomial infections (RR 2.28; 95% CI = 1.54-3.39; p < 0.001) and prolonged hospitalization (RR 1.99; 95% CI = 1.52-2.60; p < 0.001). CONCLUSIONS: One in five hospitalized children met CSHCN-3 definition. These patients had an increased risk of adverse events during their hospitalization compared to non-CSHCN.

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Background: "Children with special health care needs" (CSHCN) is a novel definition for pediatric patients with chronic diseases, adopted by the Chilean Pediatric Society in 2008. As life expectancy in Chile increases, prevalence of CSHCN is progressively growing, leading to higher health costs. Aim: To describe the epide-miological profile and clinical characteristics of hospitalized CSHCN, and compare the risk assessment of adverse events during hospitalization using two definitions for CSHCN. Patients and Methods: A cohort of hospitalized CSHCN in a Pediatric Center at Santiago, Chile, was followed from September to December 2009. Clinical and demographic data were registered in a database, including admission to intensive care unit (ICU), nosocomial infections and prolonged hospitalization (> 7 days). Incidence ratios for these events were compared between CSHCN and non-CSHCN, and between children attended by three or more health care professionals (CSHCN-3) and non-CSHCN. Results: Nine hundred twenty patients were included (54% male), with a median age 14 months (0-221) and median days of hospitalization 4 days (1-229). Prevalence of CSHCN was 60.8% of hospitalized children. When using CSHCN definition and comparing with non-CSHCN, no excess of risk was documented. On the other hand, prevalence of CSHCN-3 was 19.9%. Compared to non-CSHCN, these patients had a higher risk of ICU admission (relative risk (RR) 1.58; 95% confidence intervals (CI) = 1.22-2.05; p < 0.01), nosocomial infections (RR 2.28; 95% CI = 1.54-3.39; p < 0.001) and prolonged hospitalization (RR 1.99; 95% CI = 1.52-2.60; p < 0.001). Conclusions: One in five hospitalized children met CSHCN-3 definition. These patients had an increased risk of adverse events during their hospitalization compared to non-CSHCN.

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BACKGROUND: Teenager counseling to recognize risks and reinforce strengths is carried out in a primary care outpatient clinic since 2003. AIM: To describe the epidemiology and causes for consultation in this teenage counseling program. MATERIAL AND METHODS: Retrospective review of the records of 116 teenagers (median age 13 years, 67% females) that received teenager counseling. RESULTS: Seventy percent of women and 50% of men came from nuclear families. More than two thirds were primogenital. Most adolescents were accompanied by their mother, that were the main adult raw model. Fifty percent had dysfunctional families. All were attending school regularly and 21% of women and 29% of men had repeated a school level. Sixty eight percent of women and 62% of men declared to have a life project. Twenty percent were worried about their physical appearance. Seventy seven percent of women and 62% of men considered themselves as happy. Thirty six percent of women and 14% of men smoked. The figures for alcohol consumption were 21% and 14%, respectively. The causes for consultation were obesity, overweight, unspecific symptoms, behavioral problems, bad school achievement, communication problems or pregnancy. Reasons for counseling were family dysfunction, low self esteem, bad school achievement and information about sexuality. CONCLUSIONS: The information obtained could help to improve the interdisciplinary work and to coordinate counseling with the family and schools.

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BACKGROUND: Previous studies in Metropolitan Santiago, showed that at least 10% of mothers changed their reproductive partner. AIM: To study the frequency of reproductive partner change and its associated factors among women delivering in a public hospital. SUBJECTS AND METHODS: We interviewed 859 non primiparous women that gave birth to a child in a public hospital of Metropolitan Santiago, between March 2001 and February 2002. RESULTS: Mean maternal age rose according to birth order from 27.4 to 33.6 years from the second to the fourth sibling. Married women were the largest group and single ones decreased from the second to the third sibling. Twenty two percent had some activity out of home and those with a high birth order (fourth or more) exhibited poorer schooling. Unwanted pregnancies increased with birth order, reaching 55% among "fourth and over" births. Thirty four percent of women delivering their second child, changed their partner. Among women delivering their third child, 38.6% had one sibling with a different father; 20.4% had changed partner during their second pregnancy and 20% during the current one. Among those in the "fourth and over, group, 56.1% had at least one sibling with a different father; 18.3% had changed partner in the second sibling; 15%, in the third and 27.8%, in the fourth and over. In all birth orders, mothers with activity out of home exhibited a higher frequency of partner change. The most common reasons to change partner were infidelity, abandon or a personal decision, while economic reasons were uncommon. CONCLUSIONS: A great number of children are exposed to bonding ruptures and to the consequential mental health or behavioral problems.

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Con información encontrada en Internet, resultados de investigaciones hechas en Chile en las décadas de 1980 y 1990 y experiencia personal, se analiza la transición desde la infancia a la adolescencia para formular algunas proposiciones. Estas apuntan a facilitar la transición y prevenir problemas, así como a detectar en forma rápida y mejor, crisis mayores eventuales que pudiesen ocurrir. Se hace énfasis en la ventaja de considerar el entorno general y familiar del individuo; así como en la ventaja de irse preparando para este cambio. Se destacan herramientas potencialmente útiles para estos fines, como las guías anticipatorias y elempleo de actitudes adecuadas. En estas últimas se subraya la importancia de una buena comunicación y del empleo de estilos comunicacionales adecuados por parte de los padres.(AU)

The transition from childhood to adolescence is analyzed based on information found in Internet, Chilean research results obtained in the decades of 1980 and 1990 and personal experience. Some guidelines are proposed to make this transition easier and softer as well as to prevent problems or to allow quick and better detection of eventual major crises. Emphasis is made on the advantage of taking into account individual general and family contexts and the convenience of preparedness. Anticipatory guides for parents and children are out lined as potentially useful tools while some practical management attitudes are suggested for preparation. The importance of good communication and advisable parentãs communication styles is emphasized.(AU)

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