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Early detection of behavioral disorders in children is necessary for intervention. Available data show a high prevalence of child and adolescent psychiatric disorders in Chile (22.5%), but behavioral problems in younger children have not been evaluated. This work assesses behavioral disorders in preschoolers and their association with sociodemographic variables of the family and the child. The data was collected during the impact assessment of the Biopsychosocial Development Support Program "Chile Crece Contigo", using a multistage and representative random sample of 1377 preschoolers, aged between 30 and 48 months, who attended public health services. Homes were visited to apply a questionnaire and the Child Behavior Checklist (CBCL, 1.5-5 years). Results: Multivariable regression model for total raw scores shows that child's age, the number of chronic diseases in the child, and history of exposure to mother's alcohol consumption in pregnancy, remain significant when adjusted for all variables included (R2 of 17.8% and η2 of .19 (95% CI: .14-.22)). In externalizing and internalizing explanatory models, child's chronic diseases and a higher score of authoritarian beliefs about parenting show the two largest effect sizes. These results add to the evidence of urgent problems in preschool mental health.
La temprana detección de trastornos de comportamiento en los niños es necesaria para la intervención. La información disponible muestra una alta prevalencia de trastornos siquiátricos de niños y adolescentes en Chile (22.5%), pero no se han evaluado los problemas de comportamiento en niños más pequeños. Este trabajo evalúa trastornos de comportamiento en niños de edad prescolar y su asociación con variables sociodemográficas de la familia y del niño. La información se recogió durante la evaluación del impacto del Programa de Apoyo al Desarrollo Biosicosocial "Chile Crece Contigo," usando un grupo muestra de multiniveles representativo de 1,377 niños prescolares, de entre 30 y 48 meses de edad, quienes recibían servicios de salud pública. Se visitaron las casas para dar un cuestionario y la Lista de Comprobación del Comportamiento del Niño (CGCL, 1.5-5 años). Resultados: El modelo de regresión de variables múltiples para el total de la puntuación en bruto muestra que la edad del niño, el número de enfermedades crónicas en el niño, así como el historial de exposición al consumo de alcohol por parte de la madre durante el embarazo permanecen siendo significativos cuando se les ajusta para todas las variables incluidas (R2 de 17.8% y η2 de 0.19 (95% CI 0.14 a 0.22)). En los modelos explicativos de externalización e internalización, las enfermedades crónicas del niño y un más alto puntaje de creencias autoritarias acerca de la crianza demuestran ser las dos con la magnitud de efectos más extensa. Estos resultados contribuyen aun más a la evidencia sobre los problemas urgentes en la salud mental prescolar.
La détection précoce de troubles du comportement chez les enfants est nécessaire afin d'intervenir. Les données disponibles font état d'une forte prévalence de troubles psychiatrique de l'enfant et de l'adolescent au Chili (22,5%) mais les problèmes de comportement chez les plus jeunes enfants ne sont pas évalués. Ce travail évalue les troubles du comportement chez des enfants d'âge préscolaire et leur lien aux variables sociodémographiques de la famille et de l'enfant. Les données ont été recueillies durant l'évaluation de l'impact du programme de Soutien au Développement Biopsychosocial « Chile Crece Contigo ¼, en utilisant un échantillon aléatoire à plusieurs degrés et représentatif de 1 377 enfants d'âge préscolaire, âgés de 30 à 48 mois, qui participaient à des services de santé publique. Les domiciles ont été visités pour appliquer un questionnaire et la Checklist de Comportement de l'Enfant (CBCL, 1,5-5 ans). Résultats: Le modèle de régression multivariable pour les scores bruts totaux montre que l'âge de l'enfant, le nombre de maladies chroniques chez l'enfant et le passé d'exposition à la consommation d'alcool de la mère durant la grossesse restent importants après l'ajustement pour toutes le variables inclues (R2 de 17,8% and η2 de 0,19 (95% CI 0.14 à 0.22)). Dans les modèles explicatifs externalisant et internalisant les maladies chroniques de l'enfant et un score élevé de croyances autoritaire sur le parentage font preuves des plus grands effets de taille. Ces résultats s'ajoutent aux preuves sur les problèmes urgents de santé mentale préscolaire.
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Trastornos Mentales , Adolescente , Niño , Femenino , Embarazo , Humanos , Preescolar , Chile/epidemiología , Factores de Riesgo , Escolaridad , Salud MentalRESUMEN
INTRODUCTION: The prognosis of patients with cystic fibrosis (CF) has remarkably improved. The as sessment of the disease progression is based on the measurement of the FEV1 (Forced Expiratory Volume in one second). OBJECTIVES: 1. To describe forced expiratory flows and volumes and com pare their interpretation according to different reference standards (Knudson, Gutiérrez, and multi ethnic GLI); 2. To describe bronchodilator response. PATIENTS AND METHOD: The medical records and spirometries of all patients with CF controlled at the Dr. Sotero del Rio Hospital were reviewed. Demographic background, sweat test results, genetic study , and bacteriological study were obtained. In addition, Forced Vital Capacity (FVC) was recorded as well as FEV1 and FEV1/FVC ratio. Re sults: Data from 14 patients, were analyzed, seven males, aged 6-24 years, median 15 years, median BMI 18.15 (range 14.6-23.3), median sweat chloride test 76 mEq/l (range 50,2-119 mEq/l), seven patients with at least one F508del mutation. Using multi-ethnic and Gutierrez predictive formulas, lung function involvement occurred previously in relation to the use of Knudson equations. None of the patients had a significant bronchodilator response. CONCLUSION: The group of patients descri bed mostly presents functional respiratory involvement and had no bronchodilator response. The interpretation of functional respiratory involvement varies according to the theoretical values used.
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Broncodilatadores/uso terapéutico , Fibrosis Quística/diagnóstico , Fibrosis Quística/tratamiento farmacológico , Espirometría/normas , Adolescente , Niño , Femenino , Estudios de Seguimiento , Volumen Espiratorio Forzado , Humanos , Masculino , Estándares de Referencia , Estudios Retrospectivos , Resultado del Tratamiento , Capacidad Vital , Adulto JovenRESUMEN
Systemic lupus erythematosus (SLE) is an autoimmune disease with unrestrained T-cell and B-cell activity towards self-antigens. Evidence shows that apoptotic cells (ApoCells) trigger an autoreactive response against nuclear antigens in susceptible individuals. In this study, we focus on generating and characterizing tolerogenic dendritic cells (tolDCs) to restore tolerance to ApoCells. Monocyte-derived dendritic cells (DCs) from healthy controls and patients with SLE were treated with dexamethasone and rosiglitazone to induce tolDCs. Autologous apoptotic lymphocytes generated by UV irradiation were given to tolDCs as a source of self-antigens. Lipopolysaccharide (LPS) was used as a maturation stimulus to induce the expression of co-stimulatory molecules and secretion of cytokines. TolDCs generated from patients with SLE showed a reduced expression of co-stimulatory molecules after LPS stimulation compared with mature DCs. The same phenomenon was observed in tolDCs treated with ApoCells and LPS. In addition, ApoCell-loaded tolDCs stimulated with LPS secreted lower levels of interleukin-6 (IL-6) and IL-12p70 than mature DCs without differences in IL-10 secretion. The functionality of tolDCs was assessed by their capacity to prime allogeneic T cells. TolDCs displayed suppressor properties as demonstrated by a significantly reduced capacity to induce allogeneic T-cell proliferation and activation. ApoCell-loaded tolDCs generated from SLE monocytes have a stable immature/tolerogenic phenotype that can modulate CD4+ T-cell activation. These properties make them suitable for an antigen-specific immunotherapy for SLE.
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Células Dendríticas/trasplante , Terapia de Inmunosupresión/métodos , Lupus Eritematoso Sistémico/terapia , Monocitos/trasplante , Donantes de Tejidos , Adulto , Anciano , Autoinjertos , Células Dendríticas/inmunología , Femenino , Humanos , Interleucina-10/inmunología , Interleucina-12/inmunología , Interleucina-6/inmunología , Lipopolisacáridos/farmacología , Lupus Eritematoso Sistémico/inmunología , Lupus Eritematoso Sistémico/patología , Linfocitos/inmunología , Masculino , Persona de Mediana Edad , Monocitos/inmunología , Rayos UltravioletaRESUMEN
BACKGROUND: Traditionally, technical proficiency for spinal anesthesia has been assessed using observational scales such as global rating scales or task specific checklists. However more objective metrics are required in order to improve novice's training programs. The aim of this study is to validate the hand motion analysis of the Imperial College Surgical Assessment Device (ICSAD) in a simulated model of spinal anesthesia. METHODS: Three groups of physicians with different levels of experience were video recorded performing a spinal anesthesia in a simulated lumbar puncture torso. Participants' technical performance was assessed with ICSAD, a Global Rating Scale (GRS) and a specific Checklist. Differences between the 3 groups were determined by Kruskal-Wallis test with post hoc Dunn's correction for multiple comparisons. Spearman correlation coefficient between ICSAD variables and the scores of the observational scales were calculated to establish concurrent validity. RESULTS: Thirty subjects participated in the study: ten novice (first year residents), 10 intermediate (third year residents) and 10 experts (attending anesthesiologists). GRS scores were significantly higher in experts, than intermediates and novices. Regarding total path length, number of movements and procedural time measured with ICSAD, all groups had significant differences between them (p = 0.026, p = 0.045 and p = 0.005 respectively). Spearman correlation coefficient was -0,46 (p = 0.012) between total path length measured with ICSAD and GRS scores. CONCLUSIONS: This is the first validation study of ICSAD as an assessment tool for spinal anesthesia in a simulated model. Using ICSAD can discriminate proficiency between expert and novices and correlates with previously validated GRS. Its use in the assessment of spinal anesthesia proficiency provides complementary data to existing tools. Our results could be used to design future training programs with reliable goals to accomplish.
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Anestesia Raquidea/normas , Competencia Clínica/normas , Internado y Residencia/normas , Médicos/normas , Dispositivos Electrónicos Vestibles/normas , Adulto , Anestesia Raquidea/métodos , Femenino , Humanos , Internado y Residencia/métodos , Masculino , Persona de Mediana Edad , Grabación en Video/métodos , Grabación en Video/normas , Adulto JovenRESUMEN
CONTEXT: Pain is common among cancer patients. The evidence recommends using strong opioids in moderate to severe cancer pain. No conclusive evidence supports the effectiveness of adding acetaminophen to patients with cancer pain who are already using this regime. OBJECTIVES: To assess the analgesic efficacy of acetaminophen in hospitalized cancer patients with moderate to severe pain receiving strong opioids. METHODS: In this randomized blinded clinical trial, hospitalized cancer patients with moderate or severe acute pain managed with strong opioids were randomized to acetaminophen or placebo. The primary outcome was pain intensity difference between baseline and 48 hours using the Visual Numeric Rating Scales (VNRS). Secondary outcomes included change in morphine equivalent daily dose (MEDD), and patients' perception of improved pain control. RESULTS: Among 112 randomized patients, 56 patients received placebo, 56 acetaminophen. Mean (standard deviation [SD]) decrease in pain intensity (VNRS) at 48 hours were 2.7 (2.5) and 2.3 (2.3), respectively (95% Confidence Interval (CI) [-0.49; 1.32]; P = 0.37). Mean (SD) change in MEDD was 13.9 (33.0) mg/day and 22.4 (57.7), respectively (95% CI [-9.24; 26.1]; P = 0.35). The proportion of patients perceiving pain control improvement after 48 hours was 82% in the placebo and 80% in the acetaminophen arms (P = 0.81). CONCLUSION: Among patients with cancer pain on strong opioid regime, acetaminophen may not improve pain control, or decrease total opioid use. These results add to the current evidence available suggesting not to use acetaminophen as an adjuvant for advanced cancer patients with moderate to severe cancer pain who are on strong opioids.
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Dolor Agudo , Analgésicos no Narcóticos , Dolor en Cáncer , Neoplasias , Humanos , Acetaminofén/uso terapéutico , Analgésicos Opioides/uso terapéutico , Analgésicos no Narcóticos/uso terapéutico , Dolor en Cáncer/tratamiento farmacológico , Dolor en Cáncer/complicaciones , Morfina/uso terapéutico , Dolor Agudo/tratamiento farmacológico , Neoplasias/complicaciones , Neoplasias/tratamiento farmacológico , Método Doble Ciego , Dolor PostoperatorioRESUMEN
OBJECTIVE: Chile is one of the few high-income countries in Latin America, being a pioneer in implementing a national newborn screening (NBS) program in 1992. Currently, it covers 98% of the population, but no long-term outcomes have been described so far. The aim of this study was to report the neurocognitive outcomes of children with congenital hypothyroidism (CH) diagnosed by the NBS program in Chile between 2005 and 2012 and to identify variables associated with the outcomes. METHODS: We performed a case-control study in children with CH born in the two largest regions of the country. The Leiter-R and TEVI-R tests were administered at home to 69 children with CH and 68 matched control subjects. Other variables affecting cognition were obtained. Multivariate logistic regression analyses were performed for Leiter-R and TEVI-R tests, using a model for cases alone and another model for cases and controls. RESULTS: No differences in Leiter-R and TEVI-R results were observed between children with CH and the control group. Children who performed better, regardless of whether they had CH, had a higher family income and more assets. CONCLUSIONS: These results suggest that the Chilean NBS program strategy results in children with normal language, attention, and memory development. Socioeconomic disadvantage represents a significant detriment in cognitive function.
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Hipotiroidismo Congénito , Estudios de Casos y Controles , Niño , Cognición , Hipotiroidismo Congénito/diagnóstico , Hipotiroidismo Congénito/epidemiología , Humanos , Recién Nacido , Tamizaje Neonatal/métodos , Clase SocialRESUMEN
BACKGROUND: Cancer pain is one of the most frequent and relevant symptoms in cancer patients and impacts on patient's quality of life. International and local standards recommend as an initial strategy the use of an analgesic scheme composed of strong opioids associated with adjuvants such as acetaminophen, based upon the assumption that combining drugs could have a better analgesic effect, could allow lowering opioid dosing, and could prevent the occurrence of adverse effects of opioids. However, there is uncertainty about the impact of acetaminophen as an adjuvant in patients who use strong opioids for moderate to severe pain management in cancer patients. The aim of this study is to assess the efficacy and safety of intravenous acetaminophen associated with strong opioids in hospitalized adult cancer patients who have moderate to severe cancer-related pain. METHODS: We will perform a randomized double-blinded controlled study comparing intravenous acetaminophen 1 g 4 times a day versus placebo for 48 h as an adjuvant to strong opioids. We will assess pain intensity as a primary outcome, using the verbal numerical rating scale (VNRS, I0 to 10 scale with higher scores meaning higher pain intensity), and we will compare the mean difference in pain intensity between baseline and 48 h among the placebo and intervention groups. We estimate that a decrease of 1 point in the VNRS would be clinically significant. Assuming a standard deviation in pain intensity of 1.7 points, an alpha of 0.025, and a power of 0.8, we estimate a sample size of 112 patients, with 56 patients in each arm. Secondary outcomes include the difference in total opioid use between baseline and at 48 h among the groups, and adverse effects such as drowsiness, constipation, nausea, and vomiting would be evaluated. DISCUSSION: The randomized, double-blind, placebo-controlled design is the best strategy to assess the efficacy of acetaminophen as an adjuvant in adult cancer patients with moderate to severe pain who are receiving strong opioids. We expect to contribute to national and international guidelines with these results. TRIAL REGISTRATION: Clinicaltrials.gov NCT04779567 . Registered on March 3, 2021. Retrospectively registered.
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Dolor Agudo , Dolor en Cáncer , Neoplasias , Acetaminofén , Dolor Agudo/diagnóstico , Dolor Agudo/tratamiento farmacológico , Dolor Agudo/etiología , Adulto , Analgésicos/uso terapéutico , Analgésicos Opioides/efectos adversos , Dolor en Cáncer/diagnóstico , Dolor en Cáncer/tratamiento farmacológico , Humanos , Neoplasias/complicaciones , Neoplasias/tratamiento farmacológico , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
BACKGROUND & AIMS: Helicobacter pylori infection in children infrequently causes gastroduodenal mucosal ulceration. Because H pylori induces T-cell dependent gastric inflammation in adults and T regulatory (Treg) cells suppress T-cell-dependent pathology, we evaluated gastric histopathology and Treg cell responses in H pylori-infected children and adults. METHODS: Gastric tissue from 36 children and 79 adults with abdominal symptoms in Santiago, Chile, was evaluated prospectively for H pylori bacteria and histopathology using the Sydney classification and Treg responses using immunoassay, immunohistochemistry, and real-time polymerase chain reaction. RESULTS: Eighteen (50%) of the children and 51 (65%) of the adults were infected with H pylori. Children and adults were colonized with similar levels of H pylori. However, the level of gastritis in the children was reduced substantially compared with that of the adults (P < .05). Coincident with reduced gastric inflammation, the number of Treg cells and levels of Treg cytokines (transforming growth factor [TGF]-beta1 and interleukin-10) were increased markedly in the gastric mucosa of H pylori-infected children compared with that of infected adults (P < .03 and < .05, respectively). Also, H pylori infection in the children was associated with markedly increased levels of gastric TGF-beta1 and interleukin-10 messenger RNA. Importantly, gastric TGF-beta1 in H pylori-infected children localized predominantly to mucosal CD25(+) and Foxp3(+) cells, indicating a Treg source for the TGF-beta1. CONCLUSIONS: Gastric pathology is reduced and local Treg cell responses are increased in H pylori-infected children compared with infected adults, suggesting that gastric Treg cell responses down-regulate the inflammation and ulceration induced by H pylori in children.
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Gastritis/inmunología , Gastritis/virología , Infecciones por Helicobacter/inmunología , Helicobacter pylori/patogenicidad , Linfocitos T Reguladores/patología , Linfocitos T Reguladores/fisiología , Adolescente , Adulto , Envejecimiento/patología , Proliferación Celular , Niño , Chile , Regulación hacia Abajo , Femenino , Factores de Transcripción Forkhead/metabolismo , Mucosa Gástrica/metabolismo , Mucosa Gástrica/patología , Mucosa Gástrica/virología , Gastritis/etiología , Infecciones por Helicobacter/complicaciones , Infecciones por Helicobacter/patología , Humanos , Interleucina-10/metabolismo , Subunidad alfa del Receptor de Interleucina-2/metabolismo , Masculino , Estudios Prospectivos , ARN Mensajero/metabolismo , Linfocitos T Reguladores/virología , Factor de Crecimiento Transformador beta1/metabolismoRESUMEN
BACKGROUND: The effects of Roux-en-Y Gastric Bypass (RYGB) on bone in the long-term remains unclear. We assessed bone metabolism and bone mineral density (BMD) 1 to 5 years after RYGB. METHODS: We designed a retrospective cohort study in 26 postmenopausal women (58.0+/-3.9 years old) with RYGB 3.5+/-1.1 years before (body mass index (BMI) 29.5+/-3.8 kg/m2, presurgery 43.6+/-5.5 kg/m2) and 26 nonoperated women (57.5+/-4.7 years old, BMI 29.2+/-4.1 kg/m2) matched by age and BMI. The main measures were BMD, serum carboxy telopeptide (CTx), total alkaline phosphatases (ALP), parathyroid hormone (PTH), 25-hydroxyvitamin D (25OHD), and ghrelin. RESULTS: RYGB group, compared to nonoperated women, had higher CTx (0.71+/-0.21 vs. 0.43+/-0.15 ng/ml; P<0.01) and PTH (68.3+/-35 vs. 49.4+/-16 pg/ml; P=0.02). There were no differences between RYGB and nonoperated women in: calcium and vitamin D intake (759+/-457 vs. 705+/-460 mg/day; 176+/-160 vs. 111+/-86 UI/day), ghrelin (763+/-336 vs. 621+/-274 pg/ml), ALP (101+/-22 vs. 94+/-25 UI/l), 25OHD (18.8+/-7.6 vs. 17.4 +/- 5.9 ng/ml), lumbar spine BMD (1.059+/-0.32 vs. 1.071+/-0.207 g/cm2), or femoral neck BMD (0.892+/-0.109 vs. 0.934+/-1.1 g/cm2). CONCLUSIONS: RYGB is associated to high bone resorption and hyperparathyroidism prevalence in postmenopausal women in the long-term. This occurs independently of the intake of calcium, vitamin D status, or ghrelin and does not seem to affect BMD after RYGB.
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Resorción Ósea/metabolismo , Derivación Gástrica , Osteoporosis Posmenopáusica/etiología , Hormona Paratiroidea/sangre , Complicaciones Posoperatorias , Fosfatasa Alcalina/sangre , Densidad Ósea , Calcio de la Dieta/administración & dosificación , Colágeno Tipo I , Femenino , Estudios de Seguimiento , Ghrelina/sangre , Humanos , Persona de Mediana Edad , Obesidad/cirugía , Osteoporosis Posmenopáusica/metabolismo , Osteoporosis Posmenopáusica/prevención & control , Fragmentos de Péptidos/sangre , Péptidos , Posmenopausia , Procolágeno/sangre , Estudios Retrospectivos , Vitamina D/administración & dosificación , Vitamina D/análogos & derivados , Vitamina D/sangre , Salud de la MujerRESUMEN
BACKGROUND AND OBJECTIVE: Prophylaxis therapy is indicated in cirrhotic patients with large esophageal varices or small varices with red wale signs (high risk esophageal varices; HREV). Endoscopic surveillance to detect HREV is currently recommended. The objective of this study is to identify non-invasive predictors of HREV in cirrhotic patients. DESIGN AND METHODS: Adult cirrhotic patients without previous variceal bleeding were prospectively included. All patients underwent a complete biochemical workup, upper digestive endoscopy, and ultrasonographic measurement of spleen bipolar diameter. Platelet count/spleen diameter ratio (PC/SD) was calculated for all patients. The association of these variables with the presence of HREV in upper endoscopy was tested using univariate and multivariate analysis. Receiver operating characteristic (ROC) curves were constructed for variables associated with HREV. RESULTS: Sixty-seven patients were included. The prevalence rate of HREV was 50%. Age, gender (female), platelet count, spleen diameter, PC/SD ratio, total bilirrubin, prothrombin activity (INR), Child-Pugh score, clinical and ultrasonographic ascites were significantly associated with presence of HREV in univariate analysis. Age and PC/SD ratio were the parameters independently associated with HREV in a multivariate analysis, with OR 8.81 (CI 95%: 1.7-44.9) and OR 11.21 (CI 95%: 2.8-44.6) respectively. A PC/SD ratio cut-off value under 830.8 predicted HREV with 76.9% sensitivity, 74.2% specificity and 77.8% negative predictive value (ROC curve area: 0.78). CONCLUSIONS: The PC/SD ratio was significantly associated with HREV, but with suboptimal sensitivity and specificity. Therefore, the results of this study do not support the routine clinical use of PC/SD ratio for screening of HREV.
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Várices Esofágicas y Gástricas/epidemiología , Cirrosis Hepática/complicaciones , Modelos Estadísticos , Recuento de Plaquetas , Bazo/diagnóstico por imagen , Anciano , Endoscopía , Várices Esofágicas y Gástricas/diagnóstico , Femenino , Humanos , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Análisis Multivariante , Valor Predictivo de las Pruebas , Estudios Prospectivos , Curva ROC , Estudios Retrospectivos , Factores de Riesgo , Sensibilidad y Especificidad , Bazo/anatomía & histología , UltrasonografíaRESUMEN
CONTEXT: During the last decade a major curriculum reform was carried out at the Pontificia Universidad Católica de Chile Medical School. The process included changes in curriculum development, staff development and in the infrastructure. However, it is not known how students perceived the climate of their education within the new model. OBJECTIVES: To measure students' perceptions of the educational environment of the new curriculum and to evaluate the internal consistency of the 50-item Dundee Ready Education Environment Measure (DREEM) Spanish version questionnaire. METHODS: The DREEM Spanish version questionnaire was administered to undergraduate medical students in training years 3, 4 and 5. Internal consistency of the instrument and its subscales were measured with the method described by Cronbach, and the results were expressed with alpha coefficient ranging from 0 to 1. FINDINGS: Responses were received from 297 out of 328 students (90.5%). The 50-item DREEM Spanish version was found highly reliable with an alpha coefficient of 0.91. The subscale with the highest mean score was "Academic Self-Perceptions", which indicates students' perceptions of their academic achievements. Mean score of this subscale was 22.3 +/- 4.1 corresponding to 69.7% of the maximum score. The lowest mean score was for the Students' Perceptions of their Social Environment: 15.9 +/- 4.0 (56.8%). The overall mean score for the 50 items was 127.5 +/- 20.9 (63.8% of maximum). Scores observed in students in year 5 were significantly lower for several subscales, including Students' Perceptions of Learning, Students' Perceptions of Teachers, Students' Perceptions of the Learning Atmosphere and Students' Perceptions of the Social Environment, and also lower for the overall mean score (119.3 +/- 20.2) compared to scores in years 3 and 4 (128.8 +/- 21 and 132.5 +/- 19.7, respectively; p<0.001). CONCLUSIONS: The school's educational climate was generally perceived positively by students, although they viewed the school's social environment less favorably. Specific areas identified by students as needing improvement included an overloaded curriculum and inadequate student supports. The DREEM Spanish version proved generally reliable, by internal consistency scores based on ratings by Chilean undergraduate medical students; it should be a useful tool for assessing students' perceptions of the educational environments of other Latin American medical schools.
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Comportamiento del Consumidor , Curriculum , Educación de Pregrado en Medicina , Estudiantes de Medicina/psicología , Encuestas y Cuestionarios/normas , Chile , HumanosRESUMEN
BACKGROUND: Chile has broad variations in weather, economics and population from the far desert north (Region 1) to the cold, icy south (Region 12). A home-based self-collected vaginal sampling was nested in the 2003 Chilean population-based health survey in order to explore the possibility of a type-specific geographical variation for human papillomavirus METHODS: The population was a national probability sample of people 17 years of age and over. Consenting women provided self-collected cervicovaginal swabs in universal collection media (UCM). DNA was extracted and typed to 37 HPV genotypes using PGMY consensus PCR and line blot assay. Weighted prevalence rates and adjusted OR were calculated. RESULTS: Of the 1,883 women participating in the health survey, 1,219 (64.7%) provided a cervicovaginal sample and in 1,110 (56.2% of participants and 66.5% of those eligible) the samples were adequate for analysis. Refusal rate was 16.9%. HPV prevalence was 29.2% (15.1% high-risk HPV and 14.1% low-risk HPV). Predominant high-risk types were HPV 16, 52, 51, 56 and 58. Predominant low-risk HPVs were HPV 84, CP6108, 62, 53 and 61. High-risk and low-risk HPV rates were inversely correlated between the regions. High-risk HPV prevalence was highest among the youngest women, whereas low-risk HPV increased slightly with age. CONCLUSION: Self-obtained vaginal sampling is adequate for monitoring HPV in the community, for identifying high-risk areas, and for surveying the long term impact of interventions.
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Papillomaviridae/clasificación , Infecciones por Papillomavirus/epidemiología , Frotis Vaginal , Adolescente , Adulto , Chile/epidemiología , Femenino , Encuestas Epidemiológicas , Humanos , Persona de Mediana Edad , Papillomaviridae/aislamiento & purificación , Infecciones por Papillomavirus/diagnóstico , Infecciones por Papillomavirus/etiología , Prevalencia , Factores de RiesgoRESUMEN
The study was conducted to determine the combined effect of birthweight and gestational age at birth on neonatal mortality using individually-identified livebirths. Logistic regression was used for studying the interactive effect of birthweight and gestational age on the individual probability of neonatal death. All livebirths from Chile in 2000 were included in a linked file. Odds ratio models for birthweight and gestational age were developed for each sex. The probability of neonatal death by sex was presented using contour plots. The models were statistically significant, and odds ratios were different and non-linear for the effects of birthweight and gestational age. Contour plots of constant neonatal mortality according to birthweight and gestational age were presented; they were similar for each sex. A single graph for both sexes that estimates the survival potential of infants born too early or too small would improve neonatal care in developing countries.
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Peso al Nacer , Edad Gestacional , Cuidado del Lactante/normas , Mortalidad Infantil , Chile , Femenino , Humanos , Recién Nacido , Modelos Logísticos , Masculino , Análisis de SupervivenciaRESUMEN
Parkinson's disease (PD) is a neurodegenerative disorder, predominantly characterized by the presence of motor symptoms. However, the non motor manifestations (NMM) are a frequent complaint in the PD patients. There is a lack of information about the risk factors associated with the NMM in these patients. The aim of this study is to evaluate the prevalence of the more common NMM in a population of PD patients and to determine the features associated with its development. We studied 124 ambulatory PD patients. NMM were defined by the presence of neuropsychiatric manifestations, cognitive disorder, autonomic dysfunction or sleep related problems. In a multivariate analysis we found that the years of evolution of the PD and the presence of cognitive dysfunction are the risk factors for the neuropsychiatric and autonomic manifestations, whereas axial impairment is a risk factor for cognitive disorders and dyskinesias is for sleep related problems. In conclusion, this study shows that the features related to the PD progression appear as the main risk factors associated with NMM.
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Enfermedades del Sistema Nervioso Autónomo/etiología , Trastornos del Conocimiento/etiología , Enfermedad de Parkinson/complicaciones , Trastornos del Sueño-Vigilia/etiología , Anciano , Antiparkinsonianos/uso terapéutico , Femenino , Humanos , Masculino , Análisis Multivariante , Enfermedad de Parkinson/tratamiento farmacológico , Estudios Prospectivos , Factores de RiesgoRESUMEN
BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (LRYGB) has become the most common surgical treatment for morbid obesity. Intestinal obstruction and internal hernias are complications more commonly observed after LRYGB than after open RYGB. The aim of this study was to evaluate the incidence of these complications in patients who had undergone LRYGB using an antecolic versus a retrocolic technique. METHODS: From August 2001 to August 2005, LRYGB was performed in 754 patients. The retrocolic and antecolic technique was used in 300 and 454 consecutive patients, respectively. The mean patient age was 37 +/- 10 years, and 552 of the patients (73%) were women. The mean preoperative body mass index was 41.3 +/- 5 kg/m2. The median follow-up was 16 months. RESULTS: During follow-up, 36 patients (4.7%) underwent surgical exploration secondary to intestinal obstruction. This complication was observed in 28 (9.3%) and 8 (1.8%) patients in the retrocolic and antecolic technique groups, respectively (P <.001). In the retrocolic technique group, an internal hernia developed in 24 patients compared with 3 patients in the antecolic technique group. On multivariate analysis, the retrocolic technique was identified as a risk factor (P <.001). CONCLUSION: A greater incidence of intestinal obstruction and internal hernia was observed in the retrocolic technique group than in the antecolic technique group undergoing LRYGB. The results of our study have shown that the use of the retrocolic technique is a risk factor for intestinal obstruction after LRYGB.
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Derivación Gástrica/métodos , Obesidad Mórbida/cirugía , Adulto , Anastomosis en-Y de Roux , Distribución de Chi-Cuadrado , Femenino , Gastroscopía , Humanos , Incidencia , Obstrucción Intestinal/epidemiología , Obstrucción Intestinal/cirugía , Masculino , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/cirugía , Factores de Riesgo , Técnicas de Sutura , Resultado del TratamientoRESUMEN
BACKGROUND: Bites constitute a public health problem worldwide. AIM: To characterize epidemiologically bites by animals happened in the province of Los Andes (2005-2007). METHOD: Descriptive, retrospective epidemiological study. Studied variables: Bitten person (BP), accident by bite, biting animal and bite. It was not feasible to obtain more updated information by law of patient protection. RESULTS: 2,360 BP were assisted in the emergency unit of San Juan de Dios Hospital and Rio Blanco clinic. An annual average rate of 729 BP/100,000 inhabitants and 1.99 daily average was recorded. The male gender was most affected (53.5%) and the age group from 6 to 10 years old. (Rate: .521/100,000). Most frequent topographic location was the lower limb, except in children under 5 year olds in whom predominated head and neck. The biting animal according to frequency was: the dog (67.1%) spider (7.1%) and cat (3.9%). The animal property was 35.6% known and 30.7% own. The most frequent problems were: nonspecific allergy; toxic effect by spider bites and among the infections, the disease made by cats scratch stands out. Regarding the record system, the biting animal complaint was applied to 47.6% of the BP and the 92.8% of the recorded information was incomplete. CONCLUSIONS: Bites reported higher rates in the province of Los Andes than the average of the country (729 versus 188/100,000), standing out the higher magnitude in 6 to 10 year-old-children. It is noticed that the record is low and incomplete. In this province, no bite control programs or updated studies have been carried out.
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Mordeduras y Picaduras/epidemiología , Adolescente , Adulto , Distribución por Edad , Animales , Mordeduras y Picaduras/clasificación , Gatos , Niño , Preescolar , Chile/epidemiología , Perros , Servicios Médicos de Urgencia , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Conejos , Ratas , Estudios Retrospectivos , Estaciones del Año , Picaduras de Arañas/epidemiología , Adulto JovenRESUMEN
BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) are conditions gaining increasing recognition in hepatology as a potential cause of cirrhosis and end-stage liver disease. Obesity is one of the main risk factors. The aims of this study were to determine the frequency of NAFLD in obese patients and to identify variables that predict NASH. METHODS: A prospective study was conducted of obese patients undergoing gastric bypass over a 20-month period. Assessment included liver function tests and evaluation of insulin resistance with the homeostatic model assessment (HOMA-IR). Liver biopsy was performed in all patients at the time of surgery. Clinical and biochemical variables were analyzed using a multivariate analysis to identify independent predictors of NASH. RESULTS: 127 consecutive patients were included (62% female, 38% male, mean age 40+/-11 years, mean body mass index 42+/-6 kg/m(2)). Arterial hypertension was present in 52 patients (41%) and type 2 diabetes in 18 (14%). NAFLD was confirmed in 80 patients (63%), 47 (37%) had simple steatosis, and 33 (26%) had NASH. Cirrhosis was found in 2 patients corresponding to 1.6% of the total population. On multivariate analysis, AST >31 (IU/L) (OR 3.38, CI 1.17-9.8) and HOMA-IR >5.8 (OR 4.18, CI 1.39-12.49) independently predicted NASH. CONCLUSIONS: NAFLD is highly prevalent in morbidly obese patients. A high proportion of these patients exhibit NASH on histological examination. Insulin resistance represents the main predictor of NASH.
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Hígado Graso/etiología , Hígado/patología , Obesidad Mórbida/complicaciones , Adulto , Biopsia , Hígado Graso/epidemiología , Femenino , Derivación Gástrica , Humanos , Resistencia a la Insulina/fisiología , Masculino , Persona de Mediana Edad , Obesidad Mórbida/cirugía , Valor Predictivo de las Pruebas , Prevalencia , Estudios Prospectivos , Factores de RiesgoRESUMEN
UNLABELLED: Chronic hepatitis C is a major cause of liver-related morbidity and mortality. Epidemiological data regarding this infection in developing countries is scanty. METHODS: Prevalence of hepatitis C (HCV) infection was investigated in a random sample of Chilean general adult population older than 20 years of age. Additionally, frequency of HCV infection was assessed in group of native Chilean Amerindians (Mapuche Indians) living in an isolated locality of the Southern Chile. Incidence of HCV infection was estimated using serum samples separated by 7 years (1993-2000). RESULTS: Among 959 subjects, prevalence of anti-HCV antibodies was 1.15% (95% CI 0.48-1.82%) and 0.83% when only RIBA-confirmed cases were considered. Among these subjects, 62.5% had detectable HCV RNA in serum and 40% of them had a history of blood transfusion. Age distribution of cases showed a steadily increasing prevalence with age. Estimated incidence of new HCV infections was 15 per 100,000 subjects per year in the period 1993-2000. No cases were detected among the 145 Mapuche subjects studied. CONCLUSIONS: HCV infection is a prevalent disease in the Hispanic population of Chile with a low incidence in the last decade, whereas it was not detected in an isolated Mapuche Indian community. Age distribution of prevalence suggests that the peak of infection in Chile occurred 30 to 50 years ago.
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Hepatitis C/etnología , Indígenas Sudamericanos/estadística & datos numéricos , Salud Rural/estadística & datos numéricos , Salud Urbana/estadística & datos numéricos , Adulto , Distribución por Edad , Anciano , Chile/epidemiología , Estudios de Cohortes , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Seroepidemiológicos , Distribución por SexoRESUMEN
BACKGROUND: We previously conducted a population-based screening trial of high-risk human papillomavirus (hrHPV) testing and conventional cytology, demonstrating higher sensitivity (92.7 % vs 22.1 % for CIN2+) but lower positive predictive value (10.5 % vs 23.9 %) of hrHPV testing. Here we report the performance of HPV16/18 genotyping to triage the hrHPV positive participants. METHODS: Women aged 25 years and older received hrHPV (Hybrid Capture 2) and Papanicolaou testing; positives by either test underwent colposcopy and directed biopsy, as did a sample of double-negatives. hrHPV positive women were reflex-tested with HPV16/18 genotyping (Digene HPV Genotyping PS Test). RESULTS: Among the 8,265 participants, 10.7 % were hrHPV positive, 1.7 % had ASCUS+ cytology, 1.2 % had CIN2+; 776 (88 %) hrHPV positive women had complete results, of whom 38.8 % were positive for HPV16 (24.0 %), HPV18 (9.7 %) or both (5.1 %). CIN2+ prevalence in HPV16/18 positive women (16.3 %, 95 % CI 12.3-20.9) was twice that of HPV16/18 negative women (8.0 %, 95 % CI 5.7-10.8). HPV16/18 genotyping identified 40.5 % of CIN2, 66.7 % of CIN3 and 75.0 % of cancers. Compared to hrHPV screening alone, HPV16/18 triage significantly reduced the referral rate (10.7 % vs 3.7 %) and the number of colposcopies required to detect one CIN2+ (9 vs 6). When HPV16/18 negative women with baseline ASCUS+ cytology were also colposcopied, an additional 14 % of CIN2+ was identified; referral increased slightly to 4.2 %. CONCLUSIONS: HPV16/18 triage effectively stratified hrHPV positive women by their risk of high-grade lesions. HPV16/18 positive women must be referred immediately; referral could be deferred in HPV16/18 negative women given the slower progression of non-HPV16/18 lesions, however, they will require active follow-up.