[Clinical skills of Chilean general practitioners for the management of depressive disorders]. / Habilidades clínicas para el manejo de trastornos depresivos en médicos generales en Santiago de Chile.

BACKGROUND: Diverse and sustained efforts have been developed to improve the management of depression by general practitioners (GPs), but they have not improved treatment coverage and quality of services. AIM: To explore the level of knowledge and clinical skills to diagnose and treat depression by GPs in Primary Health Care (PHC) in the Metropolitan Area of Santiago de Chile (RM). MATERIAL AND METHODS: Theoretical knowledge (TK), diagnostic skills (DS) and treatment skills (TS) were evaluated in 56 GPs of the RM with a battery of specially designed instruments. RESULTS: In TK there were significant differences between GPs aged 31 years or less and their older counterparts and between Chilean and foreign doctors. Five percent of observed differences in TK were explained by age and nationality, respectively. Chilean GPs achieved higher scores in recognition of symptoms (RS), one of the dimensions of DS. No significant differences by age or nationality were observed for DS and TS. CONCLUSIONS: Achievement of GPs on tests measuring TK, DS, and TS was generally below 50%. This deficiency should be improved.

[Qualitative impact of a training program on depressive disorders for primary care physicians]. / Impacto de una capacitación en trastornos depresivos para médicos generales de atención primaria en salud: resultados cualitativos.

BACKGROUND: There are suggestions that, despite training efforts for Primary Health Care physicians, difficulties in making accurate diagnoses and timely treatments persist. AIM: To evaluate the impact of a new training model in Depressive disorders integrated with Mindful Practice, on the diagnostic and therapeutic skills of primary care general physicians. MATERIAL AND METHODS: A voluntary sample of 56 general physicians was studied. The design of this study was experimental and randomized, with two groups attending theoretical sessions followed by differing workshops that were carried out in a parallel fashion. The Quantitative phase of this study considered measuring the impact of training in physician's skills. The Qualitative phase included nine semi-structured interviews and Qualitative Content Analysis. This paper reports the results of the interviews. RESULTS: As a consequence of training sessions, physicians learned that above the mental health problems, other issues such as self-efficacy and self-confidence are important for the management of depressive patients. CONCLUSIONS: This qualitative study shows that physicians are obtaining significant benefits from their training sessions.

[A new proposal for the diagnosis of depression]. / La depresión como un diagnóstico complejo: Implicancias para el desarrollo de recomendaciones clínicas.

Depression has a high impact on mental health. However its diagnosis is a challenge even for specialists. This problem derives from a failure in an adequate description and differentiation of the disease. This inadequate conceptualization generates these difficulties. Our thesis is that depression should be understood as a complex phenomenon that can be analyzed from multiple perspectives, from genes to behavior, including personality and interaction with the sociocultural environment. The aim of this paper is to review the psychopathological construct of depression from a multidimensional point of view, considering clinical, sociocultural, characterological and pathogenic variables. Finally we provide a proposal for an adequate diagnostic approach.

[Characteristics of employment and wellbeing among physicians working in Santiago, Chile]. / Características del empleo y bienestar subjetivo en médicos de la Región Metropolitana.

BACKGROUND: Profound changes have been observed in medical practice during the last thirty years. This may be understood as a result of the influence of economic variables in health services management, among other probable causes. At the same time, doctors' work has been diversified, and a tendency to work in several paid jobs simultaneously has been observed. AIM: To describe the characteristics of employment in a representative sample of Chilean physicians. MATERIAL AND METHODS: A probabilistic sample of 414 physicians residing in Metropolitan Santiago answered a survey about their number and type of jobs and completed the BIS UMED questionnaire that measures the subjective wellbeing of physicians. RESULTS: Forty percent of surveyed physicians had three or more jobs (36.3% of men and 47.5% of women). There was a significant inverse association between the number of jobs, general wellbeing and facing medicine from a new perspective. CONCLUSIONS: The number of jobs is inversely related to the general wellbeing of physicians.

[A survey about physicians’ professional satisfaction]. / Percepción de cambios en la práctica médica y estrategias de afrontamiento.

BACKGROUND: A change in the social structure of medicine and its impact on clients has occurred in the last decades. AIM: To perform a survey about subjective wellbeing among physicians. MATERIAL AND METHODS: A physician’ professional satisfaction survey consisting in 90 questions, was applied to 580 physicians (70% males), working in Metropolitan Santiago. RESULTS: Physicians perceive changes in all the examined professional domains and approximately 50% of the changes are evaluated as negative. Change perception is a general phenomena among physicians, since there were no differences in relation to gender and only in few aspects with respect to age and medical specialty. There was a predominant positive attitude, based on the profession, to face changes. CONCLUSIONS: The positive evaluation of changes and the frequent use of managing strategies are associated with a higher satisfaction among physicians.

Application of a Prognostic Scale to Estimate the Mortality of Children Hospitalized with Community-acquired Pneumonia.

BACKGROUND: Pneumonia is a major cause of mortality in children. The objective of this study was to construct a prognostic scale for estimation of mortality applicable to children with community-acquired pneumonia (CAP). METHODS: This observational study included patients younger than 15 years with a diagnosis of CAP who were hospitalized between 2004 and 2013. A point-based scoring system based on the modification of the PIRO scale used in adults with pneumonia was applied to each child hospitalized with CAP. It included the following variables: predisposition (age <6 months, comorbidity), insult [hypoxia (O2 saturation < 90), hypotension (according to age) and bacteremia], response (multilobar or complicated pneumonia) and organ dysfunction (kidney failure, liver failure and acute respiratory distress syndrome). One point was given for each feature that was present (range, 0-10 points). The association between the modified PIRO score and mortality was assessed by stratifying patients into 4 levels of risk: low (0-2 points), moderate (3-4 points), high (5-6 points) and very high risk (7-10 points). RESULTS: Eight hundred sixty children hospitalized with CAP were eligible for study. The mean age was 2.8 ± 3.2 years. The observed mortality was 6.5% (56/860). Mortality ranged from 0% for a low PIRO score (0/708 pts), 18% (20/112 pts) for a moderate score, 83% (25/30 pts) for a high score and 100% (10/10 pts) for a very high modified PIRO score (P < 0.001). CONCLUSION: The present score accurately discriminated the probability of death in children hospitalized with CAP, and it could be a useful tool to select candidates for admission to intensive care unit and for adjunctive therapy in clinical trials.

Clinical Characteristics and Risk Factors of Dengue Shock Syndrome in Children.

BACKGROUND: Dengue shock syndrome (DSS) represents one of the most severe manifestations of dengue virus infection. The objective of the present study was to analyze the clinical and laboratory characteristics, risk factors and outcome of DSS in children. METHODS: Patients <15 years old admitted with DSS during the 2012 and 2013 outbreak of serotype 2 of dengue virus in Paraguay were included. Demographic, clinical and laboratory data of patients with/without DSS were analyzed. RESULTS: Of 471 children hospitalized with dengue, 354 patients (75%) presented with shock at admission or developed later. The mean age of patients with DSS was 10.2 ± 4 years (no difference with patients without shock), without gender preference. Rash (50% vs. 56%), myalgias (45% vs. 40%), vomiting (66% vs. 68%) and bleeding manifestations (24% vs. 21.2%) were similar for 2 groups. Similarly, there was no difference in the frequency of DSS between primary versus secondary infection cases (76.2% vs. 71.6%, P = 0.3). Age group >5 years [odds ratio (OR) 1.6, 95% confidence interval (CI): 1-2.8, P < 0.05), presence of abdominal pain (OR 2.5, 95% CI: 1.3-4.9, P = 0.006), an activated partial thromboplastin time prolonged (OR 4; 95% CI: 1.6-10, P < 0.001) and low fibrinogen level (OR 2.5; 95% CI: 1-5.9, P = 0.02) were found significantly associated with DSS. About 12% of patients required intensive care unit admission, and 2 patients died (lethality 0.35%). CONCLUSIONS: This study validated most of the clinical variables present in the current WHO guidelines as markers of severe disease and add additional variables that can help to predict the risk of progression to shock.

Modelo socio-pedagógico de formación del Técnico Superior en Enfermería para labor de prevención / Socio-pedagogical model in Higher Technician´s Nursing Training for prevention work

Introducción: En el perfil del Técnico Superior en Enfermería se establece la formación de un técnico consciente de su práctica social y comunitaria que contribuya a aportar a la sociedad una atención con calidad y calidez. Objetivo: Proponer un modelo socio-pedagógico de formación del Técnico Superior en Enfermería para la labor de prevención. Material y métodos: A partir de la consulta a artículos publicados en base de datos y documentos normativos del contexto ecuatoriano, se elaboró la propuesta del modelo. Se emplearon métodos del nivel teórico en la comprensión y explicación del proceso de formación del Técnico Superior en Enfermería. Desarrollo: Se propone un modelo cuya intencionalidad socio-pedagógica esté planteada desde la perspectiva de la comunidad a partir de una dirección pedagógica, una orientación epistemológica y criterios lógicos de sistematización de los contenidos y la práctica, y considerar las características inherentes a la lógica de formación profesional del TSE en el Instituto Superior Tecnológico Bolivariano de Tecnología (ITB). Conclusiones: Se reconocen como subsistemas de la modelación: el contexto escolar comunitario y el contexto preventivo comunitario, construido a partir del método sistémico estructural funcional desde un enfoque cualitativo. El modelo es resultado teórico de un proyecto de formación doctoral en Ciencias Pedagógicas a partir del convenio Cuba-Ecuador(AU)

Introduction: The technician´s awareness of its social and community practice that contributes to a higher quality and affectionate attention to society is established in the profile of the Higher Technician´s Nursing Training. Objective: To propose a socio-pedagogical model in the Higher Technician´s Nursing Training for prevention work. Material and methods: A model proposal was made after a review of articles published in the database, and normative documents in the Ecuadorian context. Theoretical methods were applied for the comprehension, and explanation in the training of the Higher Technician in Nursing. Development: A model is proposed, which socio-pedagogical intent is posed from the community perspective starting from a pedagogical direction, an epistemological approach, and logical systematization criteria of theory and practice, also considering the characteristics inherent to the sense of professional formation of the higher technician in nursing in the Bolivarian Technological Institute of Technology. Conclusions: Community and school context, and community preventive service, built from a functional-structural systemic method with a qualitative approach were recognized as modeling subsystems. The model is a theoretical result of a project on doctoral programs in Pedagogical Sciences from the Cuba-Equator Agreement(AU)

Factores pronósticos de mortalidad en la neumonía adquirida de la comunidad en niños que requieren hospitalización

Objetivo: Identificar los factores pronósticos de mortalidad en NAC en niños que requieren hospitalización. Método: Estudio observacional, que incluyó a pacientes (pts) <16 años que se hospitalizaron entre 2004-2008 por NAC, distribuyéndose en dos grupos según que hayan fallecido o sobrevivido durante la hospitalización. Se compararon variables demográficas, clínicas, laboratoriales, y evolutivas. La comorbilidad se definió en 3 categorías: I (sobrepeso, DCP I), II (cardiopatía congénita, Sindrome de Down) y III (VIH, cáncer hematológico, desnutrición grave). Se realizó análisis univariado y multivariado. Resultados: Se hospitalizaron 341 pts con NAC, (edad media 33,6+34,8 meses), de los cuales 37 (11%) fallecieron. La edad <6 meses (RR 0.12, IC 0.03-0.47, p=0.006), la presencia de comorbilidad II y III (RR 0.25, IC 0,14-0,45, p=0.00003), hipotensión (RR 0.05, IC 0.03-0.11, p=0.00001), convulsiones (RR 0.20, IC 0.10-0.39, p<0.05) o Glasgow<12 (RR 0.02, IC 0.01-0.05, p=0.00001) al ingreso se correlacionaron con mayor mortalidad. Laboratorialmente, la presencia de GB <4000 (RR 0.21, IC 0.07-0.07, p=0.02), pH<7.2, HCO3 <15 (RR 0.02, IC 0.01-0.06, p=0.00001), saturación de O2 <90% (RR 0.2, IC 0.11-0.36, p=0.0007), hiponatremia (RR 0.1, IC 0.04-0.23, p<0.05), y compromiso multilobar fueron significativamente más frecuentes en los que fallecieron (RR 0.06, IC 0.02-0.17, p<0.005). Durante la evolución clínica, el riesgo de morir se correlacionó con la necesidad de ARM y presencia de insuficiencia renal. (RR 0.04, IC 0.02-0.07, p=0.0001) Conclusiones. La mortalidad en NAC que se hospitaliza es significativa. Se han identificado condiciones predisponentes, variables demográficas, clínicas, de gabinete y evolutivas que son altamente predictivas de mortalidad.

Abstract Aim: To identify the prognostic factors of mortality in CAP in children requiring hospitalization. Method: An observational study, which included patients (pts) <16 years who were hospitalized between 2004-2008 for CAP, and distributed in two groups according to whether they died or survived during hospitalization. Demographic, clinical, laboratorial, and evolutionary variables were compared. Comorbidity was defined in 3 categories: I (overweight, DCP I), II (congenital heart disease, Down Sx) and III (HIV, hematologic cancer, severe malnutrition). Univariate and multivariate analyzes were performed. Results: 341 pts were hospitalized with CAP, (mean age 33.6 ± 34.8 months), of which 37 (11%) died. The presence of comorbidity II and III (RR 0.25, CI 0.14-0.45, p = 0.00003), hypotension (RR 0.05, CI 0.03-0.11, p = 0.00001), seizures (RR 0.20, IC 0.10-0.39, p <0.05) or Glasgow <12 (RR 0.02, IC 0.01-0.05, p = 0.00001) at admission were correlated with higher mortality. The presence of GB <4000 (RR 0.21, IC 0.07-0.07, p = 0.02), pH <7.2, HCO3 <15 (RR 0.02, IC 0.01-0.06, p = 0.00001), O2 saturation <90% (RR 0.16, p <0.05), and multilobar involvement were significantly more frequent in those who died (RR 0.06, CI 0.02-0.17, p <0.05) 0.005). During the clinical course, the risk of dying was correlated with the need for MRA and presence of renal failure. (RR 0.04, IC 0.02-0.07, p = 0.0001) Conclusions: Mortality in hospitalized CAP is significant. Predisposing conditions, demographic, clinical, cabinet and evolutionary variables that are highly predictive of mortality have been identified

Habilidades clínicas para el manejo de trastornos depresivos en médicos generales en Santiago de Chile / Clinical skills of Chilean general practitioners for the management of depressive disorders

Background: Diverse and sustained efforts have been developed to improve the management of depression by general practitioners (GPs), but they have not improved treatment coverage and quality of services. Aim: To explore the level of knowledge and clinical skills to diagnose and treat depression by GPs in Primary Health Care (PHC) in the Metropolitan Area of Santiago de Chile (RM). Material and Methods: Theoretical knowledge (TK), diagnostic skills (DS) and treatment skills (TS) were evaluated in 56 GPs of the RM with a battery of specially designed instruments. Results: In TK there were significant differences between GPs aged 31 years or less and their older counterparts and between Chilean and foreign doctors. Five percent of observed differences in TK were explained by age and nationality, respectively. Chilean GPs achieved higher scores in recognition of symptoms (RS), one of the dimensions of DS. No significant differences by age or nationality were observed for DS and TS. Conclusions: Achievement of GPs on tests measuring TK, DS, and TS was generally below 50%. This deficiency should be improved.

[Generation and validation of a scale to measure physicians' wellbeing]. / Validación de una escala para medir el bienestar subjetivo de los médicos (BISUMED).

BACKGROUND: the recent and ongoing changes in the structure and social organization of medicine have deeply transformed medical practice. AIM: to study the perception of these changes by physicians, the impact of these changes in their subjective wellbeing and their strategies of adjustment. MATERIAL AND METHODS: a scale, consisting of 54 items grouped in nine dimensions to measure physicians’ subjective wellbeing was devised. It was applied to a random sample of 580 physicians residing in Metropolitan Santiago and affiliated to the Colegio Médico de Chile (the Chilean Medical Association). RESULTS: the internal consistency analysis in the instrument showed a global Cronbach´s alpha of 90 percent. CONCLUSIONS: these results support our methodological approach based on an initial qualitative identification of relevant topics in our local context, which afterwards were included as items in the scale to measure specific components of subjective wellbeing.

La depresión como un diagnóstico complejo: Implicancias para el desarrollo de recomendaciones clínicas / A new proposal for the diagnosis of depression

Depression has a high impact on mental health. However its diagnosis is a challenge even for specialists. This problem derives from a failure in an adequate description and differentiation of the disease. This inadequate conceptualization generates these difficulties. Our thesis is that depression should be understood as a complex phenomenon that can be analyzed from multiple perspectives, from genes to behavior, including personality and interaction with the sociocultural environment. The aim of this paper is to review the psychopathological construct of depression from a multidimensional point of view, considering clinical, sociocultural, characterological and pathogenic variables. Finally we provide a proposal for an adequate diagnostic approach.

Factores pronósticos de mortalidad en la neumonía adquirida de la comunidad en niños que requieren hospitalización

Objective: To identify predictors of mortality in CAP in children requiring hospitalization. Method: observational study, which included patients (pacientes) <16 years who were hospitalized between 2004-2008 by the NAC, distributed into two groups depending on whether they died or survived hospitalization. Demographic, clinical, laboratory, and outcome variables were compared. Comorbidity was defined in 3 categories: I (overweight, DCP I), II (congenital heart disease, Down Sx) and III (HIV, blood cancer, severe malnutrition). Univariate and multivariate analysis. Results: 341 pts were hospitalized with CAP (mean age 33.6 + 34.8 months), of which 37 (11%) died. The age <6 months (RR 0.12, CI 0.03 to 0.47, p = 0.006), presence of comorbidity II and III (RR 0.25, CI 0.14 to 0.45, p = 0.00003), hypotension (RR 0.05, CI 0.03 to 0.11, p = 0.00001), seizures (RR 0.20, CI 0.10 to 0.39, p <0.05) or Glasgow <12 (RR 0.02, CI 0.01-0.05, p = 0.00001) on admission were correlated with higher mortality. Laboratorial, the presence of GB <4000 (RR 0.21, CI 0.07 to 0.07, p = 0.02), pH <7.2, HCO3 <15 (RR 0.02, CI 0.01-0.06, p = 0.00001), O2 saturation <90% (RR 0.2, CI from 0.11 to 0.36, p = 0.0007), hyponatremia (RR 0.1, CI 0.04 to 0.23, p <0.05), and multilobar involvement were significantly more frequent in patients who died (RR 0.06, CI .02-.17, p <0005). During the clinical course, the risk of dying was correlated with the need for ARM and presence of renal insufficiency. (RR 0.04, CI 0.02-0.07, p = 0.0001) Conclusions. The mortality in CAP who are hospitalized is significant. Have been identified predisposing conditions, demographic, clinical, and developmental cabinet that are highly predictive of mortality

Objetivo: Identificar los factores pronósticos de mortalidad en NAC en niños que requieren hospitalización. Material y métodos. Estudio observacional, que incluyó a pacientes (pts) <16 años que se hospitalizaron entre 2004-2008 por NAC, distribuyéndose en dos grupos según que hayan fallecido o sobrevivido durante la hospitalización. Se compararon variables demográficas, clínicas, laboratoriales, y evolutivas. La comorbilidad se definió en 3 categorías: I (sobrepeso, DCP I), II (cardiopatía congénita, Sx de Down) y III (VIH, cáncer hematológico, desnutrición grave). Se realizó análisis univariado y multivariado Resultados. Se hospitalizaron 341 pacientes con NAC, (edad media 33,6+/-34,8 meses), de los cuales 37 (11%) fallecieron. La edad <6 meses (RR 0.12, IC 0.03-0.47, p=0.006), la presencia de comorbilidad II y III (RR 0.25, IC 0,14-0,45, p=0.00003), hipotensión (RR 0.05, IC 0.03-0.11, p=0.00001), convulsiones (RR 0.20, IC 0.10-0.39, p<0.05) o Glasgow<12 (RR 0.02, IC 0.01-0.05, p=0.00001) al ingreso se correlacionaron con mayor mortalidad. Laboratorialmente, la presencia de GB <4000 (RR 0.21, IC 0.07-0.07, p=0.02), pH<7.2, HCO3 <15 (RR 0.02, IC 0.01-0.06, p=0.00001), saturación de O2 <90% (RR 0.2, IC 0.11-0.36, p=0.0007), hiponatremia (RR 0.1, IC 0.04-0.23, p<0.05), y compromiso multilobar fueron significativamente más frecuentes en los que fallecieron (RR 0.06, IC 0.02-0.17, p<0.005). Durante la evolución clínica, el riesgo de morir se correlacionó con la necesidad de ARM y presencia de insuficiencia renal. (RR 0.04, IC 0.02-0.07, p=0.0001) Conclusión. La mortalidad en NAC que se hospitaliza es significante. Se han identificado condiciones predispo-nentes, variables demográficas, clínicas, de gabinete y evolutivas que son altamente predictoras de mortalidad.

Características del empleo y bienestar subjetivo en médicos de la Región Metropolitana / Characteristics of employment and wellbeing among physicians working in Santiago, Chile

Background: Profound changes have been observed in medical practice during the last thirty years. This may be understood as a result of the influence of economic variables in health services management, among other probable causes. At the same time, doctors' work has been diversified, and a tendency to work in several paid jobs simultaneously has been observed. Aim: To describe the characteristics of employment in a representative sample of Chilean physicians. Material and Methods: A probabilistic sample of 414 physicians residing in Metropolitan Santiago answered a survey about their number and type of jobs and completed the BIS UMED questionnaire that measures the subjective wellbeing of physicians. Results: Forty percent of surveyed physicians had three or more jobs (36.3% of men and 47.5% of women). There was a significant inverse association between the number of jobs, general wellbeing and facing medicine from a new perspective. Conclusions: The number of jobs is inversely related to the general wellbeing of physicians.

Percepción de cambios en la práctica médica y estrategias de afrontamiento / A survey about physicians’ professional satisfaction

Background: A change in the social structure of medicine and its impact on clients has occurred in the last decades. Aim: To perform a survey about subjective wellbeing among physicians. Material and Methods: A physician’ professional satisfaction survey consisting in 90 questions, was applied to 580 physicians (70 percent males), working in Metropolitan Santiago. Results: Physicians perceive changes in all the examined professional domains and approximately 50 percent of the changes are evaluated as negative. Change perception is a general phenomena among physicians, since there were no differences in relation to gender and only in few aspects with respect to age and medical specialty. There was a predominant positive attitude, based on the profession, to face changes. Conclusions: The positive evaluation of changes and the frequent use of managing strategies are associated with a higher satisfaction among physicians.

Predicción de la mortalidad de la meningitis neumocóccica en niños / Predicting mortality from pneumococcal meningitis in children

Objetivo: Elaborar una escala pronóstica de mortalidad aplicable al ingreso en niños con meningitis neumocóccica (MN). Métodos: Estudio observacional, retrospectivo, realizado en el Servicio de Pediatría del Instituto de Medicina Tropical, en el que se incluyeron todos los pacientes (pts) <16 años internados entre los años 2000 y 2010 con diagnóstico confirmado por laboratorio de meningitis a Spn. La confirmación se basó en el aislamiento del microorganismo en LCR y/o hemocultivo. Se identificaron aquellos factores de riesgo significantes de mortalidad. Luego de identificados los factores asociados con mortalidad, se construyó una escala de puntuación en la que se asignó un puntaje de 0 a 3 a cada variable según el peso de significancia de las mismas. Resultados: 49 pts con MN se hospitalizaron en el periodo de estudio, siendo evaluables por expedientes completos 46 pts, de los cuales 19/46 (38 ) fallecieron y 27/46 (58) sobrevivieron. 8/19 de los pts fallecidos presentaron síntomas <48 hs vs 17/26 de los no fallecidos (p=0.1), constándose una tendencia a mayor frecuencia de convulsiones al ingreso o dentro de las 48 hs en los fallecidos [15/18 (83) vs 17/26 (65)]. 6/18 pts (33) de los óbitos vs 2/26 pts (7) de los no fallecidos ingresaron con un Glasgow ≤ 10 puntos (p=0.03), observándose valor de Hb ≤7mg/dl en 5/18 pts (28) fallecidos vs 0/26 pts sobrevivientes (p=0.04). Fueron igualmente factores de riesgo de mortalidad la presencia de hipoglucorraquia<20 mg/dl (94 vs 46, p<0.005), hiperalbuminorraquia ≥250 mg/dl (61 vs 30, p=0.04) y pleocitosis ≤ 200/mm3 (50 vs 23, p=0.06). La edad ≤6 meses, la condición de desnutrición o la presencia de bacteremia no fueron variables diferentes en ambos grupos. La escala de riesgo de mortalidad construída con hipoglucorraquia<20 mg/dl, Hb ≤7 gr/dl, Glasgow <10, albuminorraquia ≥250 mg/dl y pleocitosis ≤ 200/mm3 se correlacionó significantemente con mortalidad (p<0.001).

Estudio caso-control de infecciones que requieren Hospitalización en niños con Síndrome de Down

Objective. Identify the leading infectious causes of hospitalization of children with Down syndrome who are hospitalized in a referral hospital and assess whether conditions Down syndrome to a worse outcome for patients. Materials and Methods: A retrospective, case-control, of patients <15 years with Down syndrome hospitalized in the Institute of Tropical Medicine between 2000-2008 by infectious disease. The control group was formed by patients of the same sex, age and diagnosis without Down syndrome (ratio 1:3) in hospital, comparing the clinical, laboratory and evolution. Results were hospitalized in the study period 32 patients with Down syndrome control group, n = 96), with an average age of 39 + Male 48 months and relationship / Fem 1.7:1. Thirteen patients (41%) with Down syndrome had associated congenital heart disease. Pneumonia (n = 24, 75%) and infections of skin and soft tissue (n = 5, 15%) were the main causes of hospitalization. More Down syndrome patients admitted afebrile (28% vs. 2%, p <0.01), with normal blood leukocyte count or leukopenia (63% vs. 26%) (p = 0.0001) and bacteremic (16% vs. 4%, p <0.05). Patients with Down syndrome and pneumonia more often required admission to mechanical ventilation [8 / 21 (38%) vs. 8 / 63 (12%), p = 0.015)], more days of supplemental O2 (6.4 + 3 vs. 3 + 2, p <0.05) and longer hospital stay (10 + 6.5 vs. 6.4 + 3 days, p <0.05). The mortality rate observed in both groups was similar (3% in patients with Down syndrome vs. 1% in the control group). Conclusion: This study shows that Down syndrome patients who are hospitalized for infectious pictures most popular courses without fever, and less frequently reactive hematological changes, showing higher prevalence of bacteremia, and severity of respiratory infections

Objetivo.Determinar las principales causas infecciosas de hospitalización de niños con síndrome de Down que se hospitalizan en un hospital de referencia y evaluar si el síndrome de Down condiciona a una peor evolución de los pacientes. Materiales y Métodos Estudio retrospectivo, caso-testigo, de pacientes <15 años con síndrome de Down hospitalizados en el Instituto de Medicina Tropical entre 2000-2008 por patología infecciosa. El grupo testigo lo formaron pacientes del mismo sexo, edad y diagnóstico sin síndrome de Down (proporción 1:3) hospitalizados, comparándose las características clínicas, laboratoriales y evolución. Resultados: Se hospitalizaron en el periodo de estudio 32 pacientes con síndrome de Down (grupo testigo, n=96), con una edad media de 39 + 48 meses y relación Masc/Fem 1.7:1. Trece pacientes (41%) con síndrome de Down presentaban cardiopatía congénita asociada. Las neumonías (n=24, 75%) y las infecciones de piel y partes blandas (n=5, 15%) representaron las principales causas de hospitalización. Más pacientes con síndrome de Down ingresaron afebriles (28% vs 2%, p<0.01), con recuento leucocitario sanguíneo normales o leucopenia (63% vs 26%) (p=0.0001) y bacterémicos (16% vs 4%, p<0.05). Los pacientes con síndrome de Down y neumonía requirieron más frecuentemente ingreso a asistencia respiratoria mecánica [8/21 (38%) vs 8/63 (12%), p=0,015)], más días de suplemento de O2 (6.4 + 3 vs 3 + 2, p<0.05), y hospitalización más prolongada (10 + 6.5 vs 6.4 + 3 días, p<0.05). La tasa de mortalidad observada en ambos grupos fue similar (3% en pacientes con síndrome de Down vs 1% en el grupo control). Conclusión: El presente estudio demuestra que pacientes con síndrome de Down que se hospitalizan por cuadros infecciosos cursan más frecuentemente sin fiebre, y con menor frecuencia de cambios hematológicos reactivos, exhibiendo mayor prevalencia de bacteriemia, y severidad de las infecciones respiratorias.

Validación de una escala para medir el bienestar subjetivo de los médicos (BISUMED) / Generation and validation of a scale to measure physicians' wellbeing

Background: The recent and ongoing changes in the structure and social organization of medicine have deeply transformed medical practice. Aim: To study the perception of these changes by physicians, the impact of these changes in their subjective wellbeing and their strategies of adjustment. Material and Methods: A scale, consisting of 54 items grouped in nine dimensions to measure physicians’ subjective wellbeing was devised. It was applied to a random sample of 580 physicians residing in Metropolitan Santiago and affiliated to the Colegio Médico de Chile (the Chilean Medical Association). Results: The internal consistency analysis in the instrument showed a global Cronbach´s alpha of 90 percent. Conclusions: These results support our methodological approach based on an initial qualitative identification of relevant topics in our local context, which afterwards were included as items in the scale to measure specific components of subjective wellbeing.

Experiencia docente en interconsulta psiquiátrica en Atención Primaria de Salud para residentes / Teaching experience in Psychiatric Consultant-laison in Primary Care Setting

Se describe el proceso de implementación de programa de Interconsulta psiquiátrica docente para residentes, realizado por el Departamento de Psiquiatría y Salud Mental de la Facultad de Medicina de la Universidad de Chile entre 2003 y 2004. Método: Se establece programa preliminar, con objetivos y pautas de evaluación de cumplimiento de objetivos por parte de residentes. Resultados: Se destaca evaluaciones en el rango superior que los residentes hacen de objetivos docentes. Más bajos fueron evaluados los objetivos asistenciales. Supervisores evalúan positivamente el proceso en general, identificando las principales dificultades observadas: entre ellas la doble agenda presente en el proceso complejo propio de la actividad y de los objetivos docentes. Se destaca la importancia de la supervisión docente, la cual debería ser activa, vigilar las áreas que obstaculizan el proceso; mayores dificultades provenientes de demandas implícitas o explícitas subyacentes operaron como resistencias en los profesionales de salud general:"demandas urgentes" y "pacientes emocionalmente sobrepasados" postergarían la adecuada y oportuna acogida y tratamiento de los problemas de salud mental presentados. Tanto el docente - supervisor como el residente deberían advertir oportunamente estas resistencias para ayudar a superar estas barreras; entonces el profesional de salud general sería capaz de acoger y responder a las demandas emocionales explícitas o implícitas presentadas en la entrevista. Conclusión: No obstante la complejidad del proceso descrito, la interconsulta psiquiátrica es muy bien valorada por todos los actores involucrados en proveer atención a pacientes que presentan problemas de salud mental en servicios de salud general (AU)

Authors describe an initial program for training residents as consultants in Primary Care Settings. This program was developed and applied by the Department of Psychiatry and Mental Health of the Faculty of Medicine of the Universidad de Chile between 2003 and 2004. Method: Preliminary program was established, with objectives and evaluation schemes for the correct achievement of the objectives by the residents in two areas: learning and clinical work. Residents were assigned to different primary health centers, under a supervisor. Results: Good evaluations (superior rank) for residents' achievements in learning objectives were observed. Lower ratings were for clinical objectives. Supervisors evaluated the whole process positively; the main difficulty mentioned was the double work schedule required in the whole process of Psychiatry Consultant-laison in Primary settings. The discussion emphasizes the importance of supervision, which should be active in watching areas that hinder the process; making it necessary to detect problems in need of change to be established as soon as possible. Greater difficulties were originated on explicit and/or underlying medical or general health care team resistances. "Urgent demands” and emotionally overwhelming patients delayed competent reception and treatment. Supervisor and resident should offer proper and timely advice, to allow the overcoming of the difficulties, then general health professionals would be able to manage the emotional demands, explicit or tacit, presented in the interview. Some elements should be treated in the process, itself complex, of teaching consultant-liaison during the psychiatry resident program. Conclusion: Nevertheless, psychiatry consultant-liaison in primary care settings was highly appreciated as necessary by all the actors involved in providing care for patients presenting mental health problems in primary health care settings (AU)

Psicopatología en pacientes hospitalizados en un hospital general / Psychopatology of inpatients in a general hospital

Existen escasos estudios que evalúan la prevalencia de alteraciones psicopatológicas en pacientes hospitalizados por causas médicas, a pesar de la importancia de éstos sobre el diagnóstico, tratamiento, evolución y costos de atención. El presente estudio pretende detectar la presencia de alteraciones psicopatológicas en pacientes internados en el Hospital del Salvador de Santiago, utilizando como instrumento de detección el Cuestionario General de Salud de Goldberg, en su versión de 12 preguntas (GHQ-12). Un equipo de entrevistadores evaluó las consecuencias psicológicas del trauma infantil y recolectó los antecedentes sociodemográficos de los pacientes hospitalizados en los servicios de Medicina Interna, Cirugía, Oftalmología, Otorrinolaringología, Neurología, Urología, Traumatología y Ginecología durante el período comprendido durante un fin de semana de agosto de 2001. La muestra consideró a 362 pacientes, incorporándose en el estudio 297, mayoritariamente mujeres (61,5 por ciento). El promedio de edad en los hombres fue de 57,8 años y de 52,7 años en las mujeres. La prevalencia de alteraciones psicopatológicas (GHQ-12 con 5 puntos o más) fue de 46,4 por ciento. No se encontró una correlación entre el mayor puntaje en el GHQ-12 con variables tales como estado civil, ocupación o tipo de servicio (médico o quirúrgico). La alta prevalencia de comorbilidad encontrada confirma la importancia de la detección y adecuado manejo de los trastornos emocionales en pacientes con patologías físicas.