[National action plan for the emergence of invasive meningococcal disease in Chile, 2012-2013]. / Plan de acción nacional frente a la emergencia de la cepa W-135 responsable de enfermedad meningocócica invasora en Chile, 2012-2013.

Invasive meningococcal disease is challenging for public health, mainly when it manifests with sudden changes in incidence, serogroups and hypervirulent clones that spread in the population, causing great alarm due to its sequelae and often fatal course, a situation that occurred in Chile, starting at week 26 of the year 2012. To face this scenario, an organization of multidisciplinary teams was required, called W-135 Action Plan in Chile, which included sanitary alerts, education, reinforcement of the epidemiological surveillance of suspicious cases, immediate diagnosis through state-of-the-art techniques, blocking of contacts, communication plans, and, from the 42nd week, ON the vaccination campaign was started for children aged from 9-months-old to less than 5 years of age. The vaccination strategy had a great impact on the decrease in incidence (1.3 to 0.1/100,000) and case fatality rate in the vaccinated population (23% to 0%), with a high safety profile, leading to its subsequent inclusion in the national immunization program. The ability to develop molecular, clinical and epidemiological studies allowed us to better understand the situation, supporting public health policy decisions for its control. The W-135 Action Plan implemented by the Ministry of Health in Chile, to manage the outbreak of meningococcal disease by Neisseria meningitidis serogroup W, demonstrated that the coordination of these efforts, through an organized Action Plan, allows the implementation of campaigns at the national level achieving high coverage of risk populations in short periods of time, generating a positive impact on the health of the population.

Plan de acción nacional frente a la emergencia de la cepa W-135 responsable de enfermedad meningocócica invasora en Chile, 2012-2013 / National action plan for the emergence of invasive meningococcal disease in Chile, 2012-2013

Invasive meningococcal disease is challenging for public health, mainly when it manifests with sudden changes in incidence, serogroups and hypervirulent clones that spread in the population, causing great alarm due to its sequelae and often fatal course, a situation that occurred in Chile, starting at week 26 of the year 2012. To face this scenario, an organization of multidisciplinary teams was required, called W-135 Action Plan in Chile, which included sanitary alerts, education, reinforcement of the epidemiological surveillance of suspicious cases, immediate diagnosis through state-of-the-art techniques, blocking of contacts, communication plans, and, from the 42nd week, ON the vaccination campaign was started for children aged from 9-months-old to less than 5 years of age. The vaccination strategy had a great impact on the decrease in incidence (1.3 to 0.1/100,000) and case fatality rate in the vaccinated population (23% to 0%), with a high safety profile, leading to its subsequent inclusion in the national immunization program. The ability to develop molecular, clinical and epidemiological studies allowed us to better understand the situation, supporting public health policy decisions for its control. The W-135 Action Plan implemented by the Ministry of Health in Chile, to manage the outbreak of meningococcal disease by Neisseria meningitidis serogroup W, demonstrated that the coordination of these efforts, through an organized Action Plan, allows the implementation of campaigns at the national level achieving high coverage of risk populations in short periods of time, generating a positive impact on the health of the population.

Variables psicológicas asociadas a adherencia, cronicidad y complicaciones en pacientes con diabetes mellitus tipo 2 / Psychological variables associated with adherence to treatment and complications in patients with type 2 diabetes mellitus

Background:: Lack of adherence to treatment may hamper the management of type 2 Diabetes Mellitus. Aim To identify if there is a profile of psychological variables associated with adherence to treatment and complications in patients with type 2 diabetes mellitus. Material and Methods: The psychometric instruments Multidimensional Scale of Locus of Control in Health, Locus of Control of Rotter and Inventory of Temporary Orientation of Zimbardo & Boyd were applied to 192 patients aged 64 ± 10 years (78% women) with type 2 diabetes attending public primary health clinics. Adherence to treatment was assessed using glycosylated hemoglobin levels. Results: There was an inverse association between glycosylated hemoglobin and adherence to treatment (p < 0.01). Adherence in patients with renal damage and diabetic foot was associated with the psychological variables Negative Time Perspective Profile (p < 0.05) and External Locus of Control Powerful Other (p < 0.05). Conclusions: A psychological profile associated with adherence was observed in the presence of kidney damage and diabetic foot. A fatalistic present and a negative past are the outstanding features of a negative temporal profile.

[Psychological variables associated with adherence to treatment and complications in patients with type 2 diabetes mellitus]. / Variables psicológicas asociadas a adherencia, cronicidad y complicaciones en pacientes con diabetes mellitus tipo 2.

BACKGROUND: Lack of adherence to treatment may hamper the management of type 2 Diabetes Mellitus. Aim To identify if there is a profile of psychological variables associated with adherence to treatment and complications in patients with type 2 diabetes mellitus. MATERIAL AND METHODS: The psychometric instruments Multidimensional Scale of Locus of Control in Health, Locus of Control of Rotter and Inventory of Temporary Orientation of Zimbardo & Boyd were applied to 192 patients aged 64 ± 10 years (78% women) with type 2 diabetes attending public primary health clinics. Adherence to treatment was assessed using glycosylated hemoglobin levels. RESULTS: There was an inverse association between glycosylated hemoglobin and adherence to treatment (p < 0.01). Adherence in patients with renal damage and diabetic foot was associated with the psychological variables Negative Time Perspective Profile (p < 0.05) and External Locus of Control Powerful Other (p < 0.05). CONCLUSIONS: A psychological profile associated with adherence was observed in the presence of kidney damage and diabetic foot. A fatalistic present and a negative past are the outstanding features of a negative temporal profile.

[Validation of the short assessment of health literacy for spanish-speaking adults test in Chile]. / Validación del test Short Assessment of Health Literacy for Spanish-speaking Adults en Chile, para medir alfabetización en salud.

BACKGROUND: Health literacy is defined as the degree to which individuals obtain, process and understand basic health information and services. It is necessary to make appropriate decisions about their health. Evidence has shown that the level of health literacy is critical to the prognosis of chronic diseases. The Short Assessment of Health Literacy for Spanish-speaking Adults (SAHLSA-50) is a short and simple health literacy adult assessment. AIM: To determine the validity and reliability indicators of SAHLSA-50 in Chilean adults. MATERIAL AND METHODS: The survey was applied to 84 older adults living in high and low income neighborhoods. RESULTS: The survey had an adequate construct validity and reliability, its Comparative Fit Index was 0.93, its Tucker-Lewis index was 0.927 and its Root Mean Square Error of Approximation was 0.044. “Close fit” was not statistically significant (p = 0.828). Reliability was estimated by K-Richardson, which reported a good outcome (0.9255). Despite the good global indicators obtained, it is necessary to pay attention to some items that would fail to explain the “Health literacy” construct or were beyond the parameters of difficulty and discrimination proposed by the authors of the test. CONCLUSIONS: We propose this test as a useful tool to assess health literacy in the adult population in Chile. Its use and incorporation into local research can be especially recommended in the areas of education and health promotion.

Validación del test Short Assessment of Health Literacy for Spanish-speaking Adults en Chile, para medir alfabetización en salud / Validation of the short assessment of health literacy for spanish-speaking adults test in Chile

Background: Health literacy is defined as the degree to which individuals obtain, process and understand basic health information and services. It is necessary to make appropriate decisions about their health. Evidence has shown that the level of health literacy is critical to the prognosis of chronic diseases. The Short Assessment of Health Literacy for Spanish-speaking Adults (SAHLSA-50) is a short and simple health literacy adult assessment. Aim: To determine the validity and reliability indicators of SAHLSA-50 in Chilean adults. Material and Methods: The survey was applied to 84 older adults living in high and low income neighborhoods. Results: The survey had an adequate construct validity and reliability, its Comparative Fit Index was 0.93, its Tucker-Lewis index was 0.927 and its Root Mean Square Error of Approximation was 0.044. “Close fit” was not statistically significant (p = 0.828). Reliability was estimated by K-Richardson, which reported a good outcome (0.9255). Despite the good global indicators obtained, it is necessary to pay attention to some items that would fail to explain the “Health literacy” construct or were beyond the parameters of difficulty and discrimination proposed by the authors of the test. Conclusions: We propose this test as a useful tool to assess health literacy in the adult population in Chile. Its use and incorporation into local research can be especially recommended in the areas of education and health promotion.

[Stethoscope or staphyloscope?: Potential vector in nosocomial infections]. / ¿Estetoscopio o estafiloscopio?: Potencial vector en las infecciones asociadas a la atención de la salud.

Healthcare-associated infections (HCAI) are a problem worldwide. In our country, the estimated incidence of HCAI is 70,000 per year. This results in an increase in the average length of hospital stay by 10 days per patient, an estimated annual cost of US $ 70 million and an overstay of 700 thousand bed days a year. For over 30 years stethoscopes have been considered as potential HCAI vectors, since pathogens like methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus strains adhere and colonize them. These organisms can be transmitted between patients if the instruments are not sanitized. Several studies conclude that disinfecting the stethoscope with isopropyl alcohol eliminates up to 99% of bacteria. Simple, economic measures such as implementation of guidelines for stethoscope disinfection are a clear opportunity for preventing infections.

¿Estetoscopio o estafiloscopio?: Potencial vector en las infecciones asociadas a la atención de la salud / Stethoscope or staphyloscope?: Potential vector in nosocomial infections

Healthcare-associated infections (HCAI) are a problem worldwide. In our country, the estimated incidence of HCAI is 70,000 per year. This results in an increase in the average length of hospital stay by 10 days per patient, an estimated annual cost of US $ 70 million and an overstay of 700 thousand bed days a year. For over 30 years stethoscopes have been considered as potential HCAI vectors, since pathogens like methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus strains adhere and colonize them. These organisms can be transmitted between patients if the instruments are not sanitized. Several studies conclude that disinfecting the stethoscope with isopropyl alcohol eliminates up to 99% of bacteria. Simple, economic measures such as implementation of guidelines for stethoscope disinfection are a clear opportunity for preventing infections.

Las infecciones asociadas a la atención de la salud (IAAS) son un problema a mundial. Sólo en nuestro país se estima una incidencia de 70.000 al año, lo que se traduce en un aumento de la estadía hospitalaria en 10 días promedio por paciente, un costo anual estimado en 70 millones de dólares y una sobre-estadía de 700 mil días cama al año. La evidencia señala que diferentes instrumentos de uso hospitalario resultan contaminados por patógenos; entre ellos, el estetoscopio se ha identificado como potencial vector de IAAS hace más de 30 años y adquiere gran relevancia al ser de uso generalizado. Microorganismos patógenos, incluyendo cepas de Staphylococcus aureus resistente a meticilina y cepas de Enterococcus resistente a vancomicina se adhieren y contaminan los estetoscopios, pudiendo transmitirse a otros pacientes si no son desinfectados. Diversos estudios concluyen que la desinfección del estetoscopio con alcohol isopropílico elimina hasta 99% de estas y otras bacterias, por lo que existe una clara oportunidad para aportar a la prevención de las IAAS, interviniendo a través de la implementación de medidas sencillas, económicas y operativas al corto plazo, normando por ejemplo la limpieza del estetoscopio.

Impact of the novel influenza A (H1N1) during the 2009 autumn-winter season in a large hospital setting in Santiago, Chile.

BACKGROUND: In Chile, the novel influenza A (H1N1) epidemic began in the middle-high income area of Santiago. Clinical and laboratory surveillance was intensified with the aim to characterize the epidemic and determine its impact in a large hospital setting. METHODS: Demographic and clinical data were obtained from all patients whose symptoms met the clinical definition of influenza A (H1N1) infection during the epidemic period. Laboratory confirmation was obtained by use of a nasopharyngeal antigen detection test for influenza A and/or influenza A (H1N1) polymerase chain reaction (PCR). A case was considered confirmed if the antigen detection test result for influenza A and/or the PCR test result were positive. RESULTS: The total number of emergency department (ED) visits increased by 88.5% from a mean of 14,489 ED visits in 2006-2008 to a mean of 27,308 ED visits in 2009, during the epidemic period. There were 10,048 patients who were clinically diagnosed with influenza A (H1N1), and they represented 78% of all visits, of which 4591 (45.6%) were laboratory confirmed. The median time from symptom onset to diagnosis was 1 day, and 99.7% of individuals received antiviral treatment. School-aged children represented 67% of ED visits at the beginning of the epidemic and 24% of ED visits at the end of the epidemic. Only 2% of cases were hospitalized; of these, 70% of cases occurred in patients 6-50 years of age, and 32% of cases occurred in patients who had an underlying medical condition. Eleven patients (age range, 1-53 years) required admission to the intensive care unit (ICU); 6 of these patients had pneumonia with or without hemodynamic shock. No influenza-associated deaths occurred. CONCLUSIONS: Many cases of influenza A (H1N1) occurred in school-aged and adult individuals who required an ED visit; these visits resulted in a low impact on the use of hospital beds. Aggressive ICU management and/or experience in extracorporeal membrane oxygenation significantly improved outcomes. Early antiviral treatment may have played an important role in the low number of severe cases. Vaccines targeted for school-aged children and young adults may modify the first epidemic wave in the northern hemisphere.

A simple method to calculate cyclosporine dosage to obtain a target C2 drug level.

C(2) Cyclosporine (CsA) level, as a surrogate of area under the time-concentration curve (AUC) 0-4 hours, is a good predictor of drug absorption and clinical outcome after kidney transplantation. It has been difficult to define the optimal C(2) level in the individual case and given the broad range of C(2) due to interindividual absorption variability it has been troublesome to determine the drug dose needed to obtain an expected C(2)-CsA concentration. In this study data of 16 stable renal and renal/pancreas recipients treated with prednisone, azathioprine, and CsA (Neoral) managed by C(0) level was examined. CsA concentrations at time 0 (basal), 2, 6, and 12 hours post CsA (Neoral) intake were determined the day of the study. A significant linear regression level was established between C(2) (but not C(0), C(6) and C(12)) and the dosage expressed as mg/kg/d (P = 0.0113, correlation coefficient r = 0.573018). Subsequently, another 27 renal transplant recipients were studied retrospectively and divided into three groups according to posttransplant period: 1 to 6, 7 to 12, and beyond 12 months after transplant. Equations derived from the relationship between C(2) and dose (mg/kg/d) were similar between the three groups and when compared with the first study. A formula obtained from the 27 patients in the whole posttransplant period (mg/kg/d = C(2) x 0.0010208 + 1.86125) was applied to patients of the first study obtaining a regression coefficient between actual and calculated CsA dose of 0.6145 (P = 0.01). A more accurate equation (P = 0.0001, r = 0.5925) was obtained by analyzing 145 C(2) determinations covering a period from 1 month to 8 years following transplant which gave a linear regression line defined by the equation C(2) x 0.001473 + 1.6673. This equation would permit the calculation mg/kg/d of CsA (Neoral) dose to obtain an expected C(2) level. The derived equation shown in this paper has a predictive value of 50% to 60% only, but can help to find adequate dosage in the presence of an inappropriate C(2) level.

[Epidemiology of hypertension in chronic hemodialysis]. / Epidemiología de la hipertensión en hemodiálisis crónica.

BACKGROUND: Hypertension is a common and important cardiovascular risk factor in patients on chronic hemodialysis. AIM: To report the prevalence and characteristics of hypertension among patients on chronic hemodialysis. PATIENTS AND METHODS: Cross sectional study of 313 patients (192 male, aged 57 +/- 18 years) dialyzed in 7 representative centers in Santiago, Chile. RESULTS: Patients were on hemodialysis for a mean of 68 +/- 53 months and 67 (21%) were diabetic. 230 (74%) were hypertensive and 223 of these (97%) had predialysis hypertension. A multivariate analysis showed that hypertension was associated with increased weight gain between dialysis, failure to achieve the postdialysis dry weight, increasing age and the presence of diabetes. Among hypertensive patients, 61% were receiving antihypertensive medications, compared with 27% of patients with normal blood pressure. CONCLUSIONS: High blood pressure is highly prevalent among patients on chronic hemodialysis and is associated to hypervolemia, age and the presence of diabetes.