[Assessment of creative thinking among medical students]. / Determinación de pensamiento creativo en estudiantes de medicina de una universidad chilena.

BACKGROUND: Creativity is a highly valued quality in different fields. Despite this, it is rarely included in the curricula of medical careers. AIM: To assess creative thinking among undergraduate medical students. MATERIAL AND METHODS: Sixty-seven students aged 18 to 31 years (45% women) from the first (16), third (26) and seventh year (25) of medical school answered a sociodemographic questionnaire and the Torrance Test of Creative Thinking (TTCT). RESULTS: Median creativity index according to age was in percentile 52 (range 2-99). Percentiles for fluency, originality, elaboration, abstraction of titles and resistance for premature closure were 31, 32, 79, 53 and 17 respectively. There were no significant differences between students of different levels (p = 0.73). CONCLUSIONS: In this group of students, there is a high performance in elaboration and a low score in Resistance to premature closure.

Metabolic consequences of snoring in adolescents and younger adults: a population study in Chile.

STUDY OBJECTIVES: To investigate the potential association between snoring and other symptoms indicative of sleep-disordered breathing and metabolic syndrome (MetS) in Hispanic adolescents and younger adults using a large population-based survey. METHODS: Sleep-related information, anthropometric measurements and fasting blood samples markers of MetS were obtained from subjects aged 15-40 years collected through the 2nd Chilean Health Survey. Regression models were constructed to evaluate the associations of snoring with MetS, hypertension and serum cholesterol levels. The modulating effect of sleep duration was accounted for in the models. RESULTS: A total of 2147 subjects (42% males, mean age 27.9±7.6 years) were included. Snoring and short sleep duration were present in 43.5 and 25% of the entire population, respectively. MetS was detected in 19.5% of the subjects. In the adjusted regression model, the odds of MetS among snoring subjects were 2.13 times higher (95% confidence interval (CI): 1.52-2.99; P<0.01), and 1.53-fold higher odds of elevated cholesterol also emerged (95% CI: 1.12-2.10; P<0.01). However, the odds of hypertension were not increased by the presence of snoring after adjusting for confounders. In addition, snoring was associated with an increase of 7.26 and 6.56 mg dl-1 for total and low-density lipoprotein cholesterol, respectively, even after adjusting for age, sex and body mass index. Short sleep duration was associated with a small albeit significant risk increase for high systolic blood pressure. CONCLUSIONS: In this large population-based sample of young Hispanic adults and adolescents, snoring, but not sleep duration, emerged as an independent risk factor for dyslipidemia and MetS, but not for hypertension.

Wheat flour fortification with folic acid: changes in neural tube defects rates in Chile.

In January 2000, Chilean Ministry of Health mandated the addition of folic acid (FA) to wheat flour in order to reduce the risk of neural tube defects (NTDs). This policy resulted in significant increases in serum and red cell folate in women of fertile age 1 year after fortification. To evaluate the effect of wheat flour fortification on the prevalence of NTDs in Chile we designed a prospective hospital-based surveillance program to monitor the frequency of NTDs in all births (live and stillbirths) with birth weight≥500 g at the nine public maternity hospitals of Santiago, Chile from 1999 to 2009. During the pre-fortification period (1999-2000) the NTD rate was 17.1/10,000 births in a total of 120,566 newborns. During the post-fortification period (2001-2009) the NTD rate decreased to 8.6/10,000 births in a total of 489,915 newborns, which translates into a rate reduction of 50% (RR: 0.5; 95% CI: 0.42-0.59) for all NTDs. The rate reduction by type of NTD studied was: 50% in anencephaly (RR: 0.5; 95% CI: 0.38-0.67), 42% in cephalocele (RR: 0.58; 95% CI: 0.37-0.89), and 52% in spina bifida (RR: 0.48; 95% CI: 0.38-0.6). Rates showed significant reduction both in stillbirths and live births: 510.3 to 183.6/10,000 (RR=0.36; 95% CI: 0.25-0.53) and 13.3 to 7.5/10,000 (RR=0.56; 95% CI: 0.47-0.68), respectively. In Chile, fortification of wheat flour with FA has proven to be an effective strategy for the primary prevention of NTDs.

(-)-istanbulin a.

THE TITLE COMPOUND (SYSTEMATIC NAME: 9a-hydr-oxy-3,4a,5-trimethyl-4a,6,7,8a,9,9a-hexa-hydro-4H,5H-naphtho[2,3-b]furan-2,8-dione), C(15)H(20)O(4), is a sesquiterpene lactone showing the typical eremophilanolide skeleton, which has been isolated from the plant Senecio candidans collected in the Chilean Magallanes region. The present study confirms the atomic connectivity assigned on the basis of (1)H and (13)C NMR spectroscopy, as well as the relative stereochemistry of the 4α-methyl,5α-methyl,8ß-hydr-oxy,10ß-H unit. The crystal structure is stabilized by inter-molecular O-H⋯O hydrogen bonds involving the hydr-oxy group as donor and the oxo group as acceptor, giving chains along the a axis. The absolute structure was not determined because of the lack of suitable anomalous scatters.

Pregnancy outcomes and the use of two standards to assess adequacy of maternal body mass index in early gestation.

The maternal weight gain chart proposed by Rosso and Mardones (RM) was subsequently modified by Atalah et al. (AEA). Both charts are widely used in Latin America. The purpose of this study was to compare birth length (BL) and birth weight (BW) outcomes of both charts. A prospective study of pregnant women and their offspring's was performed in Santiago, Chile. From a total sample of 27,613 pregnant women a sub-sample of 11,465 term healthy singleton pregnant women was selected for additional analyses. κ statistics was used to study the degree of agreement of both charts in the diagnosis of maternal nutritional status. Obese and underweight women were classified using both standards at the beginning of pregnancy and compared in terms of BL4250 g proportions. Sensitivity and specificity values of at risk newborns, whose categories were considered as gold standard, were obtained for obese and underweight women of each chart. There was a moderate agreement in the nutritional classification of these charts. Proportions of BL4250 g were similar at each nutritional category; however, absolute figures for at risk newborns were much higher in the RM underweight and obese women. The RM chart showed higher sensitivity values than the AEA chart. The higher sensitivity of the RM chart would support its use for prevention purposes. This chart is advisable for Latin American countries and also for most developing countries.

Genetic variation in P450c11AS in Chilean patients with low renin hypertension.

Low renin hypertension (LRH), which accounts for 10-20% of patients with idiopathic "essential" hypertension, bears hormonal similarities to mineralocorticoid-induced hypertension, but elevated mineralocorticoid concentrations have not been found. Some patients with LRH have normal, rather than suppressed, plasma aldosterone concentrations, so that the ratio of aldosterone concentration to PRA (Aldo/PRA) is high, suggesting inappropriately increased aldosterone biosynthesis. We characterized the CYP11B2 gene that encodes the aldosterone synthase, P450c11AS, in hypertensive and control populations in a single clinic in Santiago, Chile. We directly sequenced the entire CYP11B2 gene in 12 patients with LRH, 2 high renin hypertensive controls, and 2 normotensive controls. All sequences were identical, except that 8 of 24 LRH alleles encoded arginine rather than lysine at position 173. The Arg173 and Lys173 variants were expressed in transfected MA-10 cells, and their ability to convert deoxycorticosterone to aldosterone was measured; the apparent Michaelis constant (Km) for Lys173 was 2.73 mumol/L; the Km for Arg173 was 2.53 mumol/L. The apparent maximal velocity (Vmax) for Lys173 was 6.5 x 10(-3) micrograms/mL.24 h; the Vmax for Arg173 was 7.8 x 10(-3) micrograms/mL.24 h. The first order rate constant, Vmax/Km was 2.38 for Lys173 and 3.08 for Arg173. As these values were not significantly different, we sought to determine whether Arg173 is a polymorphism linked to LRH. We examined position 173 in 52 unselected patients with idiopathic hypertension and 55 normotensive controls by PCR amplification of CYP11B2 exons 3-5 followed by digestion with Bsu361, which digests the Arg173 sequence, but not the Lys173 sequence. More of the hypertensive alleles (39 of 104, 37.5%) than normotensive alleles (25 of 110, 22.5%) carried Arg173 (chi 2 = 5.57; P < 0.02). Most of the Arg173 alleles (31 of 72, 43.1%) were from hypertensive patients with Aldo/PRA below 30, whereas only 5 of 24 (20.8%) Arg173 alleles were found in patients with Aldo/PRA greater than 30 (chi 2 = 3.79; P = 0.05) Thus, the ARg173 variant of CYP11B2 may be linked to LRH in Chilean patients.

T235 variant of the angiotensinogen gene and blood pressure in the Chilean population.

BACKGROUND: The angiotensinogen gene has recently been linked to essential hypertension. A variant within this gene, encoding threonine rather than methionine at amino acid position 235, was associated with essential hypertension. However, results of new studies have not confirmed this association, suggesting that ethnic differences may explain the different results. OBJECTIVE: To evaluate whether the T235 variant is associated with a higher incidence of essential hypertension among Hispanics (a group that has scarcely been evaluated) and to determine whether T235 is associated with variations in the plasma renin activity or the serum aldosterone level. PATIENTS AND METHOD: We studied 64 patients with essential hypertension and 62 normotensives, matched for age and sex. We obtained samples for determinations of plasma renin activity, serum aldosterone level and genome DNA from all subjects. The genomic DNA was amplified using the polymerase chain reaction technique and digested by the restriction enzyme streptococcus faecalis (Sfa NI) which cuts M235 only, not T235. RESULTS: The patients with essential hypertension had a higher prevalence of the risk variant T235 (alleles 77/128 = 60.2%) than did the normotensive controls (alleles 65/124 = 52.4%), but the difference was not statistically significant (chi2=1.53, P=0.22). The plasma renin activity levels in hypertensives were not statistically different for homozygous T235, heterozygous and homozygous M235 (1.0 +/- 0.96, 2.0 +/- 2.25 and 1.55 +/- 1.49 ng/ml per h, respectively, P=0.5 1). However, when we considered those hypertensives with low plasma renin activity levels (< 1 ng/ml per h), we found a high prevalence (72.7%) of subjects homozygous for the T235 variant. We found no association between the T235 variant and the serum aldosterone levels in hypertensive and normotensive subjects. CONCLUSIONS: We demonstrated that there is a high prevalence of T235 variant in our Hispanic population. The slight difference between prevalences of T235 variant among hypertensive and normotensive subjects that we found was not statistically significant and did not permit us to establish an association between T235 variant and essential hypertension. We believe that only studying a larger cohort of subjects could show whether there is a quantitative effect of the T allele on plasma renin activity levels.

Survival of Chilean patients with systemic lupus erythematosus.

Environmental, genetic, and ethnic factors seem to be involved in the expression of systemic lupus erythematosus (SLE). It has been reported that SLE in the Spanish-heritage population is more common and severe than in the white population in the United States. Data on the population with SLE in South America are scarce, however. The survival of 218 Chilean patients with SLE was studied. General features of the disease were similar to those in most reports. Survival at 10 years was 79%. Prognostic factors (P < .01) were the clinical markers of renal severity, including clinical stratification of renal disease, SLE disease activity index, thrombocytopenia, thromboembolism, and the use of "megadose" corticosteroids. Multivariate analysis suggested that the disease activity index had the strongest association with outcome (P = .0007); thrombocytopenia added a marginal risk (P = .04). Renal histology was analyzed in 127 patients. Risk factors for survival were clinical renal stage, elevated serum creatinine levels, and high activity index. Chronicity index was not a risk factor. Survival curves for World Health Organization types II and III were better than for type IV (P = .06). Multivariate analysis showed that creatinine levels correlated inversely with outcome (P = .0363). Disease expression of Chilean patients with SLE was similar to that in most reports. Survival was somewhat lower than in developed countries, which may be attributable to socioeconomic and racial factors.

Maternal body composition near term and birth weight.

OBJECTIVE: To assess the relative influence of maternal body composition at late gestation on birth weight. METHODS: Maternal body composition was estimated in 224 women near term using a deuterium dilution technique. Using a stepwise multiple linear regression analysis, we studied the association with birth weight of eight factors, including maternal fat-free mass and fat mass. RESULTS: Maternal fat-free-mass was the most important variable influencing birth weight (R2 = .144, P < .001), followed by maternal fat mass (R2 = .051, P < .001). Gestational age at delivery was the third strongest influence on birth weight (R2 = .047, P < .001). CONCLUSION: In late pregnancy, fat-free mass was the most important maternal body component associated with birth weight. The implementation of longitudinal studies could shed more light on the influence of maternal body composition on birth weight.

Diagnosis of typhoid fever by two serologic methods. Enzyme-linked immunosorbent assay of antilipopolysaccharide of Salmonella typhi antibodies and Widal test.

Serum samples from 85 patients with proven typhoid fever, 11 patients with p-typhoidal fever, 101 patients with febrile non-typhoidal, and 130 healthy subjects were tested for immunoglobulin G (IgG), IgA, and IgM antilipopolysaccharide (LPS) of Salmonella typhi antibodies by enzyme-linked immunosorbent assay (ELISA) and Widal test. The levels of all three classes of immunoglobulin anti-LPS of S. typhi were higher in typhoid patients than in healthy or febrile nontyphoidal groups; we selected various combinations between the three classes of immunoglobulin to obtain the best combination of sensitivity and specificity. The sum of the absorbance values obtained from the ELISA assay for IgG+IgA+IgM (sigma lgs) was the best choice for diagnostic utility for typhoid fever. We selected a positive test at a decision level of sigma lgs > or = 1.2 with a sensitivity of 94% and a specificity of 92% with a frequency of false negative of 5.9%. The frequency of false positives for healthy controls was 7.7% and, for the febrile nontyphoidal group, it was 7.9%. We also compared receiver (or relative) operating characteristic (ROC) curves for the diagnostic usefulness of the ELISA with that of the Widal test, whose merits and limitations, especially in endemic regions, are discussed. The ELISA assay was much more sensitive and specific than any combination of the Widal test, and hence it could be a useful tool for the serologic diagnosis of typhoidal fever with a single blood sample.

A risk prediction model for severe intraventricular hemorrhage in very low birth weight infants and the effect of prophylactic indomethacin.

OBJECTIVE: Develop a risk prediction model for severe intraventricular hemorrhage (IVH) in very low birth weight infants (VLBWI). STUDY DESIGN: Prospectively collected data of infants with birth weight 500 to 1249 g born between 2001 and 2010 in centers from the Neocosur Network were used. Forward stepwise logistic regression model was employed. The model was tested in the 2011 cohort and then applied to the population of VLBWI that received prophylactic indomethacin to analyze its effect in the risk of severe IVH. RESULT: Data from 6538 VLBWI were analyzed. The area under ROC curve for the model was 0.79 and 0.76 when tested in the 2011 cohort. The prophylactic indomethacin group had lower incidence of severe IVH, especially in the highest-risk groups. CONCLUSION: A model for early severe IVH prediction was developed and tested in our population. Prophylactic indomethacin was associated with a lower risk-adjusted incidence of severe IVH.

Determinación de pensamiento creativo en estudiantes de medicina de una universidad chilena / Assessment of creative thinking among medical students

Background: Creativity is a highly valued quality in different fields. Despite this, it is rarely included in the curricula of medical careers. Aim: To assess creative thinking among undergraduate medical students. Material and Methods: Sixty-seven students aged 18 to 31 years (45% women) from the first (16), third (26) and seventh year (25) of medical school answered a sociodemographic questionnaire and the Torrance Test of Creative Thinking (TTCT). Results: Median creativity index according to age was in percentile 52 (range 2-99). Percentiles for fluency, originality, elaboration, abstraction of titles and resistance for premature closure were 31, 32, 79, 53 and 17 respectively. There were no significant differences between students of different levels (p = 0.73). Conclusions: In this group of students, there is a high performance in elaboration and a low score in Resistance to premature closure.

Association of perinatal factors and school performance in primary school Chilean children.

The associations between school performance and cognitive abilities with birth characteristics have mostly been studied without taking into consideration the effects of gestational age (GA). Our aim was to study the association between prenatal growth and cognitive function in term-born Chilean school children. A cohort of over 200,000 term-born fourth graders who took the regular national test for school performance was studied. Outcome parameters were language and mathematics test scores in relation to prenatal growth. A total of 256,040 subjects took the test and 220,940 were included in the final study sample. Prenatal growth was modestly, but significantly, associated with school performance. Adjusted ß coefficients for 1 cm increase in birth length were 1.28 and 0.77 for mathematics and language, respectively; the corresponding values for 100 g increase in birth weight were 0.59 and 0.34, respectively. Increased GA was associated with lower test scores. Adjusted ß coefficients for the birth measurements generally had a lower strength of association than those of socio-economic factors. However, the confounders most strongly associated with educational achievements were socio-economic factors, known to be associated with birth size. Lower socio-economic status is known to negatively influence both prenatal growth and cognitive function, supporting the overall importance of prenatal growth in relation to cognitive outcomes.

Prenatal growth and metabolic syndrome components among Chilean children.

The association of prenatal growth with metabolic syndrome (MS) components and insulin resistance (IR) in children has not been studied in Chile and most developing countries. Some associations found in developed countries are controversial. A retrospective cohort study was designed linking present information on MS components and IR in children with register-based information on birth weight (BW), birth length (BL) and gestational age (GA). Examinations included anthropometry and blood pressure (BP), as well as self-report of pubertal status. A fasting blood sample was taken to determine lipids, glucose, insulin and homeostasis model assessment (HOMA)-IR was calculated. The study cohort of 2152 children was on average 11.4 ± 1.0 years old. The prevalence of MS, IR and overweight were 7.6%, 24.5% and 34%, respectively. Elevated BP was negatively associated with dichotomized risk categories of the perinatal factors studied (BW, BL and GA). Contingency tables showed that high waist circumference (WC) and elevated BP had a U-shaped association with various categories of BW and BL, respectively. Stepwise linear regressions selected: (a) WC as inversely associated to GA and directly associated to BW, (b) BP as inversely associated to GA and (c) HOMA-IR as inversely associated to BL. Non-optimal prenatal growth seems to predispose to high WC, elevated BP and IR in school-age children, supporting the early life origin of several non-communicable diseases. Those associations were rather weak as estimated by the slopes of the regressions and probably reduced by their U-shaped nature; they would reasonably become stronger with a longer follow-up.

Social capital and self-rated health in urban low income neighbourhoods in Chile.

OBJECTIVE: To examine the potential association between social capital and self-rated health within a low income community of Santiago, Chile. METHOD: Cross-sectional survey, based on in-home interviews in the municipality of Puente Alto in Santiago, Chile. The participants were 781 residents of four neighbourhoods within Puente Alto (mean age 45.5 years). RESULTS: Principal components analysis with varimax rotation identified five domains of social capital: perceived trust in neighbours, perceived trust in organisations, reciprocity within the neighbourhood, neighbourhood integration, and social participation (Cronbach alphas: 0.58 to 0.77). Trust and reciprocity were significantly associated with better self-rated health. For example, a one standard deviation increase in trust in neighbours was associated with an adjusted odds ratio of 1.10 (95% confidence interval, CI: 1.05 to 1.15) for reporting good self-rated health. By contrast, social participation was associated with a lower odds (0.89, 95% CI: 0.89 to 1.06) of reporting good health. CONCLUSION: Neighbourhood social cohesion, measured by trust and reciprocity, is associated with higher self-rated health. However, social participation did not appear to be associated with better health in this predominantly low income neighbourhood. These findings provide preliminary support to the relevance for social capital as a determinant of health in Chile.

[Predictors of readmission in patients with congestive heart failure]. / Predictores de rehospitalización en pacientes con insuficiencia cardíaca congestiva.

UNLABELLED: Repeated hospitalizations among patients (pts) with congestive heart failure (CHF) are common. PURPOSE: This retrospective study was designed to determine predictors of readmission. INCLUSION CRITERIA: admitted to University Hospital with a primary diagnosis of CHF between 10/1/94-9/30/95: lived in Jefferson county. EXCLUSIONS: cardiac transplant during study period; major comorbidity (e.g. malignancy, advanced renal failure). Predictors of readmission were determined by stepwise logistic regression analysis and predictor of time to readmission with Cox Proportionate Hazards modeling p < 0.05 was considered statistically significant. RESULTS: Mean age of the 237 pts was 66.5 yrs; 56% women. Mean left ventricular ejection fraction (LVEF) was 29%; 96% were in NYHA class III/IV. Mean length of stay was 5 days; 52 pts (22%) had > 1 admission. CHF etiologies: Ischemic (42%), hypertensive (37%), idiopathic (12%). Demographic characteristics and insurance status did not predict readmission risk. Predictors of readmission in the logistic and Cox models were similar. Increased risk of readmission was associated with myocardial ischemia (logistic OR 42.7), past NYHA Class III and IV (OR 32.8), plasmatic creatinine at discharge (OR 1.9) and continued smoking (OR 3.26). History of CABG was associated with a decreased risk of rehospitalization (OR 0.12). Beta-blocker use was associated with decreased risk, but did not achieve statistical significance. ACE-I use (prescribed in 78% of pts), did not contribute to the model. Diabetes Mellitus and a lower LVEF were more frequent in the readmitted group, but they did not predict readmission. CONCLUSION: CHF pts who have evidence of ischemia, advanced symptoms, renal dysfunction, and who continue to smoke are at increased risk for hospital readmission. Pts with these characteristics should be identified prior to hospital discharge and considered for intensive outpatient intervention.

[Prediction of fetal sex by ultrasonography]. / Predicción de sexo fetal por ultrasonografía.

Five hundred thirteen echographic reports are analyzed in order to predict fetal sex between 17 and 39 weeks of pregnancy. The diagnostic certainty was of 98.06%. The error was of 1.48% for masculine sex and 2.49% for feminine sex. Podalic presentation and early and late pregnancy influenced negatively in the prediction of the fetal sex. The amniotic fluid, placental localization, and any abnormality of the fetal anatomy, have no influence in the prediction of the sex. The best moment for sex prediction was between 28 and 36 weeks of pregnancy.