[Alarming signals: Worsening obesity, physical inactivity and high perception of stress in first-year medical and dental students in Chile]. / Señales de Alarma: Empeoramiento de la Obesidad, Inactividad Física y Alta Percepción de Estrés en Estudiantes de Primer Año de la Facultad de Medicina y Odontología de la Universidad de Chile.

BACKGROUND: The high prevalence of obesity, smoking, and physical inactivity in Chile despite government-sponsored measures and campaigns, along with others in the last 30 years, suggests additional reinforcement of these efforts at the primary care level. OBJECTIVES: To determine if lifestyles and modifiable health risk factors in first-year students from the University of Chile Faculties of Medicine and Dentistry, potential future promoters of healthy lifestyles, show changes throughout their first academic year. METHODS: In a randomized stratified sample of 388 students according to sex and chosen career weight, height, waist circumference, waist circumference-weight ratio, food consumption, smoking prevalence and dependence, alcohol use, perceived stress level, and physical activity were measured at the first week, 3 and 6 months after their admission. The Cochrane test assessed dichotomic variables, and the Friedman test was used for nonparametric values. RESULTS: 253 students (186 women) completed the follow-up. A significant worsening of obesity (general and abdominal) and physical inactivity, persistent moderate and high-stress perception, and smoking prevalence were documented throughout the study period. CONCLUSIONS: The progressive obesity and physical inactivity, high-stress perception, and persistent smoking prevalence in the first year of academic life suggest considering measures in the curricular academic structure that facilitate adjustments in the student's lifestyles. Future follow-up of this cohort, increasing participants, and assessing students' mental health are planned.

Serum cytokeratin-18 fragment levels as noninvasive marker of nonalcoholic steatohepatitis in the chilean population. / Fragmento sérico de citoqueratina-18 como marcador no invasivo de esteatohepatitis no alcohólica en población chilena.

Nonalcoholic steatohepatitis (NASH) is the most aggressive form of nonalcoholic fatty liver disease (NAFLD) and involves the risk of progression to more advanced stages of liver disease. Non-invasive methods are needed to identify patients with NASH. OBJECTIVE: To evaluate the diagnostic performance of the determination of serum levels of cytokeratin-18 (CK-18) as a non-invasive marker of NASH in the Chilean population. METHODS: Serum CK-18 levels were determined in a group of 41 patients with biopsy-proven NAFLD. NASH diagnosis was based on Brunt's criteria (histological parameters and ballooning), and the NAFLD activity score (NAS) and the presence of fibrosis were determined. The correlation between the NAFLD activity score (NAS) and CK-18 was evaluated with Spearman's rank correlation coefficient. A ROC curve was produced to assess the diagnostic value of CK-18 for NASH. The NAFLD fibrosis score (NFS) (to predict fibrosis and NASH) was compared to CK-18 with simple linear regression. Data were expressed in median [25th-75th percentile] and evaluated with the Wilcoxon rank test. RESULTS: The mean age of the study group (23% male) was 50.4±11.1 years. 34.2% were diagnosed with NASH (NAS≥5). CK-18 levels were significantly higher in patients with NASH versus those without NASH (183.6 IU/l [97.4 to 734.4] vs. 117.2 IU/l [83.8 to 954.8], p= 0.016). CK-18 levels were a good predictor of NASH on biopsy with an area under the curve (AUC) of 0.732 (95% CI, 0.572 to 0.897). A CK-18 cut-off of 130.5 IU/l had a sensitivity of 92.9%, specificity of 63%, positive predictive value of 56.5% and negative predictive value of 94.4%, and was able to correctly classify 73.2% of patients with NASH. NFS identified advanced liver fibrosis (AUC 0.739, 95% CI, 0.56-0.91), but was of limited value to identify NASH (AUC 0.413, 95% CI, 0.21-0.61). CONCLUSION: CK-18 is a good non-invasive marker for NASH. Although NFS was found to be an accurate marker of advanced liver fibrosis, it was not of value to identify NASH. In patients with NAFLD, CK-18 and NFS could be useful in predicting NASH and liver fibrosis, respectively.

[Analysis of incident reports in an anesthesiology unit of a university hospital]. / De la anestesia a la seguridad de la atención: experiencia de 6 años en el análisis de reportes de incidentes en un hospital universitario.

BACKGROUND: Incident reporting is an effective strategy used to enhance patient safety. An incident is an event that could eventually result in harm to a patient. AIM: To classify and analyze incidents reported by an Anesthesiology division at a University hospital in Chile. MATERIAL AND METHODS: A retrospective analysis of the reported incidents registered in our institutional database from January 2008 to January 2014. They were classified according to three variables proposed by the World Health Organization system to determine the type of incident and patients’ potential harm. RESULTS: There were 297 reports registered. Etiologic classification according to the WHO system showed that 29% (n = 85) were related with management, 20% (59) with drugs, 20% (59) with medical devices, 16% (48) with procedures and 15% (46) with human factors. Seventy two percent (58) of incidents caused low or moderate harm and 28% (22) resulted in a severe adverse event or death. CONCLUSIONS: Our analysis highlights that a high rate of incidents are associated with management, the leading cause of reports in our center. Due to the low incident report rate in our country, it is difficult to perform appropriate comparisons with other centers. In the future, local incident reporting systems should be improved.

[Work activity of medical graduates at the University of Chile: Analysis per campus and graduation year]. / Actividad laboral de médicos egresados de la Universidad de Chile generaciones 2007 a 2010: análisis según sede y año de egreso.

BACKGROUND: The University promotes practices and values that influence their students in the pursuit of their occupational interests. AIM: To determine working activity features of medical graduates from the University of Chile and their relationship with undergraduate characteristics. MATERIAL AND METHODS: Medical graduates of the University of Chile were invited to complete a survey using a virtual server. The survey collected demographic, socioeconomic, work and guild characteristics. Undergraduate data, as campus and graduation years were obtained. RESULTS: The survey was completed by 333 physicians (167 men) aged 29 ± 2 years, graduated from 2007 to 2010. Ninety four percent had a paid work, 59% were employed in public hospitals and 28% in primary care health centers. The predominant type of work activity was performed in the public health service (55%), while 17% worked in private health services. Activity in public health services or primary care were significantly associated with the pursuit of undergraduate clinical activities in specific campuses of the University. CONCLUSIONS: The employment rate of medical graduates was high. Differences observed by graduation campus and type of work may be due to the modeling that students receive from teachers.

[Introduction of virtual patients to clinical case portfolios for undergraduate medical students]. / Incorporación de paciente virtual en portafolio de estudiantes de medicina de pregrado.

BACKGROUND: In 2007, a Clinical-Case-Portfolio (CCP) was introduced as a new assessment instrument for fourth grade undergraduate medical students. Since then, several changes have been implemented such as reduction on the number of clinical cases, peer review and the introduction of virtual patient to the portfolio. AIM: To describe the virtual patient model incorporated to the CCP and assess the perception of this change and its effects on the performance of undergraduate students. MATERIAL AND METHODS: Virtual patients were implemented based on prototype clinical cases with specific syndromes. Students’ perceptions about CCP before and after the introduction of virtual patients were evaluated using a validated questionnaire that was answered voluntarily and anonymously. RESULTS: Overall perception of CCP significantly improved after the incorporation of virtual patients (97.1 ± 24.9 and 111.3 ± 25.7 points; 57.8 and 66.2% respectively). The same improvements were observed for the domains “Student Learning”, “Organization and Evaluation”, “Teaching Methodology” and “Integration”. In both years, students obtained high grades in CCP evaluations. However CCP grades were not significantly correlated with integrated final grades. CONCLUSIONS: The incorporation of virtual patients improved undergraduate students’ perception of CCP.

[Influence of psychosocial factors on adherence to antihypertensive drug therapy: results from a Cardiovascular Health Program cohort followed in the Metropolitan Region of Santiago, Chile]. / Influencia de factores psicosociales en la adherencia al tratamiento farmacológico antihipertensivo: Resultados de una cohorte del Programa de Salud Cardiovascular de la Región Metropolitana, Chile.

BACKGROUND: Inadequate blood pressure control in hypertensive patients remains a persistent health problem in Chile and worldwide. Poor adherence to antihypertensive drug therapy is one of the frequently cited factors. OBJECTIVES: To determine the influence of psychosocial factors in the adherence to drug therapy in hypertensive patients followed through a Cardiovascular Health Program (CHP) that provides free access to primary care centers located in the Metropolitan Region of Santiago, Chile. METHODS: Cross sectional study. A randomized sample of 513 hypertensive patients (30 to 68 years) was obtained from a universe of 1.484 patients. Adherence to treatment was determined by the Morisky-Green-Levine test. Demographic, socioeconomic and average values of blood pressure were recorded. Validated questionnaires were utilized to assess the patient-physician relationship, awareness of being hypertensive, patient perception of social support, family cohesion, patient self-health assessment and symptoms of emotional stress and depression. RESULTS: The drug therapy adherence was 36.6%, higher in women (38.4% vs 28.9%; p < 0.001). After multivariate analysis, absence of adherence was associated with male gender (OR: 1.76 [95% CI 1.21-2.56]), low education (OR: 1.72 [95% CI 1.18 to 2.53]), inadequate patient-physician relationship (OR: 1.56 [95% CI 1.13 to 2.27]), and high level of emotional stress and depression (OR: 1.93 [95% CI 1.27 to 2.94]). CONCLUSIONS: Our study highlights the influence of inadequate patient-physician relation, high level of emotional stress and depression, low education level and income and male gender in the lack of adherence to antihypertensive drug therapy in hypertensive patients followed throughout the CHP.

[Literacy in sexual and reproductive health as well as associated variables: multicenter study]. / Alfabetización en salud sexual y reproductiva así como variables asociadas: estudio multicéntrico.

OBJECTIVE: Limited Health Literacy implies an insufficient understanding of relevant health information, being associated with various variables. The objective of the study was to measure the prevalence of the level of Limited Sexual and Reproductive Health Literacy (AS-SR), its associated variables and the differences in scores between levels of AS-SR, universities and science of study in Chilean university students. METHODS: A multicenter and cross-sectional study, which applied a validated scale to measure levels of AS-SR, was carried out in a sample of 2,186 Chilean university students, categorizing it as high, medium high, medium low and low. The level of Limited AS-SR was obtained by adding the medium-low and low categories. Tests were carried out: descriptive, psychometric and reliability; association, logistic regression and differences between variables of interest. RESULTS: The prevalence of Limited AS-SR was 52.7%. The variables most associated with the level of Limited AS-SR were: low interest in information about health care (OR=2.819; 95% CI: 2.132-3.726), prevention (OR=2.564; 95% CI: 1.941-3.388), sexuality (OR=2.497; 95% CI: 1.807-3.452) and health promotion (OR=1.515; 95% CI: 1.239-1.853); certain sources of Information (OR=1.915; 95% CI:1.614-2.272); low economic income (OR=1.661; 95% CI: 1.361-2.026), among others. There were statistically significant differences in scores between categories of AS-SR levels, universities and study science. The scale had a reliability of 0.940. CONCLUSIONS: More than half of the students have Limited AS-SR, mainly associated with low interest in health information. The scale presents excellent psychometric indicators, being recommended for diagnoses of health situations.

OBJECTIVE: La Alfabetización en Salud Limitada implica una comprensión insuficiente de la información relevante en salud, asociándose con diversas variables. El objetivo del estudio fue medir la prevalencia del nivel de Alfabetización en Salud Sexual y Reproductiva (AS-SR) Limitada, sus variables asociadas y las diferencias de puntajes entre niveles de AS-SR, universidades y ciencia de estudio en universitarios chilenos. METHODS: Se realizó un estudio multicéntrico y transversal, que aplicó una escala validada para medir niveles de AS-SR, en una muestra de 2.186 estudiantes universitarios chilenos, categorizándola en alta, media-alta, media-baja y baja. El nivel de AS-SR Limitada se obtuvo mediante el sumatorio de categorías media-baja y baja. Se realizaron pruebas: descriptivas, psicométricas y fiabilidad; asociación, regresión logística y de diferencias entre variables de interés. RESULTS: La prevalencia de AS-SR Limitada fue del 52,7%. Las variables mayormente asociadas al nivel de AS-SR Limitada fueron: bajo interés en información sobre atención en salud (OR=2,819; IC 95%:2,132-3,726), prevención (OR=2,564; IC 95%: 1,941-3,388), sexualidad (OR=2,497; IC 95%: 1,807-3,452) y promoción de la salud (OR=1,515; IC 95%: 1,239-1,853); ciertas fuentes de Información (OR=1,915; IC 95%:1,614-2,272); bajo ingreso económico (OR=1,661; IC 95%: 1,361-2,026), entre otras. Existieron diferencias estadísticamente significativas de puntajes entre categorías de niveles de AS-SR, universidades y ciencia de estudio. La escala presentó fiabilidad de 0,940. CONCLUSIONS: Más de la mitad de los estudiantes poseen AS-SR Limitada, asociada principalmente al bajo interés en información en salud. La escala presenta excelentes indicadores psicométricos, siendo recomendable para diagnósticos de situación de salud.

Aspirin desensitization in nonsteroidal anti-inflammatory exacerbated respiratory disease: The first prospective cohort in Chile.

Background: Nonsteroidal anti-inflammatory exacerbated respiratory disease (N-ERD) is characterized by the Samter triad: chronic rhinosinusitis with nasal polyps, asthma, and nonallergic hypersensitivity to NSAIDs. Its diagnosis is based on a complete clinical history and an aspirin (ASA) challenge test. Medical treatments include biological drugs and ASA desensitization. Objective: This study aims to evaluate the clinical response of patients with N-ERD undergoing functional endoscopic surgery (FES), followed by ASA desensitization and maintenance treatment, being the first prospective cohort study carried out in Chile. Methods: We conducted 1-year follow-up of 12 patients with N-ERD treated with FES, desensitization, and maintenance with ASA. For each control, the medication score, sinonasal symptomatology (SNOT-22), PEF (peak expiratory flow), nasal polyposis (Lildholdt score), and the appearance of adverse effects were recorded. Computed tomography (CT) of the paranasal cavities was performed at baseline and at the 12-month follow-up to calculate the Lund-Mackay score. Results: Patients presented a reduction of SNOT-22 after the FES, which was maintained at 12 months (p = 0.002); the symptoms that showed the greatest reduction were feeling embarrassed and nasal obstruction. The Lildholdt score was also significantly reduced (p = 0.001); in only three patients, the nasal polyps recurred, and all were small. The PEF showed a slight nonsignificant increase of 3.3%. In total, 75% of patients had an adverse effect, the most frequent being abdominal pain (66.7%), but none of the 12 patients required discontinuation of aspirin treatment in 1-year follow-up. The Lund-Mackay score had a significant reduction of 6.6 points (p < 0.001). Conclusion: ASA desensitization is safe and effective in reducing upper and lower respiratory symptoms in patients with N-ERD and delays the reappearance of nasal polyps, although it is not exempt from adverse effects, with the vast majority being mild.

Clinical, Socioeconomic, and Psychosocial Factors Associated with Blood Pressure Control and Adherence: Results from a Multidisciplinary Cardiovascular National Program Providing Universal Coverage in a Developing Country.

BACKGROUND: Limited information exists on blood pressure (BP) control factors and adherence to antihypertensive drug therapy (Rx) in developing countries. METHODS: Cross-sectional study in randomly selected 992 hypertensive patients under a Chilean national comprehensive Cardiovascular Health Program (CVHP). Association of education, income, diabetes, obesity, physical activity, psychosocial characteristics, smoking, and alcohol abuse with BP control and adherence were evaluated by multivariate logistic regression. RESULTS: BP control (<140/90 mmHg) was achieved in 63.1% of patients, with 38.4% adherent to Rx. Uncontrolled BP significantly associated with male sex (OR: 1.73 [95% CI 1.35-2.22]), low family income, high emotional-stress-depression score, body mass index, no adherence (OR: 1.83 [95% CI 1.44 - 2.32]), multiple Rx, baseline systolic BP value, and sedentary life style. Males (OR: 1.54 [95% CI 1.23 - 1.93]), low family income, high emotional stress-depression score (OR: 2.15 [95% CI 1.68 - 2.76]), low social support, and uncontrolled BP (OR: 1.52 [95% CI 1.22-1.90]) associated with no adherence. CONCLUSIONS: Comparable BP control (63.1%) to higher-income societies was observed. Uncontrolled BP associated significantly to no adherence and both to male sex, socioeconomic, and psychosocial factors. Global low adherence (38.4%) and improved BP control and adherence in diabetics were noted.

Señales de Alarma: Empeoramiento de la Obesidad, Inactividad Física y Alta Percepción de Estrés en Estudiantes de Primer Año de la Facultad de Medicina y Odontología de la Universidad de Chile

Background: The high prevalence of obesity, smoking, and physical inactivity in Chile despite government-sponsored measures and campaigns, along with others in the last 30 years, suggests additional reinforcement of these efforts at the primary care level. Objectives: To determine if lifestyles and modifiable health risk factors in first-year students from the University of Chile Faculties of Medicine and Dentistry, potential future promoters of healthy lifestyles, show changes throughout their first academic year. Methods: In a randomized stratified sample of 388 students according to sex and chosen career weight, height, waist circumference, waist circumference-weight ratio, food consumption, smoking prevalence and dependence, alcohol use, perceived stress level, and physical activity were measured at the first week, 3 and 6 months after their admission. The Cochrane test assessed dichotomic variables, and the Friedman test was used for nonparametric values. Results: 253 students (186 women) completed the follow-up. A significant worsening of obesity (general and abdominal) and physical inactivity, persistent moderate and high-stress perception, and smoking prevalence were documented throughout the study period. Conclusions: The progressive obesity and physical inactivity, high-stress perception, and persistent smoking prevalence in the first year of academic life suggest considering measures in the curricular academic structure that facilitate adjustments in the student's lifestyles. Future follow-up of this cohort, increasing participants, and assessing students' mental health are planned.

Corrección endoscópica del reflujo vesicoureteral. Revisión narrativa / Endoscopic correction of vesicoureteral reflux. Narrative review

En esta revisión narrativa se plantea como objetivo realizar una descripción amplia y específica acerca de los agentes abultantes utilizados para la corrección endoscópica del reflujo vesicoureteral disponibles en el mercado hasta la actualidad, sus tasas de éxito y de complicaciones. Este texto se realizó a partir de una búsqueda sistemática con las palabras clave enunciadas a continuación como términos MESH. Se describen los distintos tipos de sustancias y se exponen los resultados de los artículos revisados. Finalmente se plantean las conclusiones.

The objective of this narrative review is to describe in a broad and specific way all the bulking agents used in the endoscopic correction of vesicoureteral reflux currently available, their success and complication rates. This text was done by a systematic search with the keywords seen below in MESH terms. The different types of substances are described, and the results of the reviewed articles are presented. Finally, conclusions are made.

Overcoming barriers in the management of hypertension: the experience of the cardiovascular health program in chilean primary health care centers.

Objective. To assess the blood pressure control and cardiovascular risk factors (CVRFs) in a population of hypertensive patients with access to care under a government-financed program, the Cardiovascular Health Program (CHP). Design. A cross-sectional and multicenter study. Setting. 52 primary care centers, metropolitan area of Santiago, Chile. Participants. 1,194 patients were selected by a systematic random sampling from a universe of 316,654 hypertensive patients. Key Measurements. Demographic information, blood pressure (BP) measurements, and CVRF were extracted from medical records of patients followed for a 12-month period. Results. 59.7% of patients reached target BP <140/90 mmHg. More women were captured in the sampling (2.1 : 1), achieving better BP control than men. Diabetic patients (26.4%) had worse BP control than nondiabetics. Antihypertensive medications were used in 91.5%, with multidrug therapy more frequent in patients with higher BP and more difficult control. Conclusions. The success in improving the BP control to values <140/90 mmHg from 45.3% to 59.7% underscores the contribution of this program in the Chilean primary care cardiovascular preventive strategies. However, fewer hypertensive men than women were captured by this program, and it is of concern the underperforming of BP control observed in diabetics.

De la anestesia a la seguridad de la atención: experiencia de 6 años en el análisis de reportes de incidentes en un hospital universitario / Analysis of incident reports in an anesthesiology unit of a university hospital

Background: Incident reporting is an effective strategy used to enhance patient safety. An incident is an event that could eventually result in harm to a patient. Aim: To classify and analyze incidents reported by an Anesthesiology division at a University hospital in Chile. Material and Methods: A retrospective analysis of the reported incidents registered in our institutional database from January 2008 to January 2014. They were classified according to three variables proposed by the World Health Organization system to determine the type of incident and patients’ potential harm. Results: There were 297 reports registered. Etiologic classification according to the WHO system showed that 29% (n = 85) were related with management, 20% (59) with drugs, 20% (59) with medical devices, 16% (48) with procedures and 15% (46) with human factors. Seventy two percent (58) of incidents caused low or moderate harm and 28% (22) resulted in a severe adverse event or death. Conclusions: Our analysis highlights that a high rate of incidents are associated with management, the leading cause of reports in our center. Due to the low incident report rate in our country, it is difficult to perform appropriate comparisons with other centers. In the future, local incident reporting systems should be improved.

Fragmento sérico de citoqueratina-18 como marcador no invasivo de esteatohepatitis no alcohólica en población chilena / Serum cytokeratin-18 fragment levels as noninvasive marker of nonalcoholic steatohepatitis in the chilean population

La esteatohepatitis no alcohólica (EHNA) es la forma más agresiva de hígado graso no alcohólico (HGNA) e involucra el riesgo de progresión a etapas más avanzadas de enfermedad hepática. Se requieren métodos no invasivos para identificar a pacientes con EHNA. Objetivo: Evaluar el rendimiento diagnóstico de la determinación de los niveles séricos de citoqueratina-18 como marcador no invasivo de EHNA en población chilena. Métodos: Se determinaron los niveles séricos de CK-18 en un grupo de 41 pacientes con HGNAprobado por biopsia. El diagnóstico de EHNA se basó en los criterios histológicos recomendados (presencia de balonamiento) y se calculó el puntaje de actividad del HGNA (PAH) y grado de fibrosis. Mediante correlación de Spearman se evaluó la asociación entre CK-18 y PAH. Se confeccionó una curva ROC para evaluar la capacidad de CK-18 como test diagnóstico para EHNA. Además, se evaluó el rendimiento del puntaje de fibrosis en hígado graso no alcohólico (NFS) para pesquisa de fibrosis y EHNA y se lo comparó con CK-18 por regresión lineal simple. Los datos son expresados en medianas [percentil 25-75] y evaluados con test de rangos de Wilcoxon. Resultados: La edad promedio del grupo estudiado (23% hombres) fue de 50,4 ± 11,1 años. Un 34,2% fue diagnosticado con EHNA (PAH≥5). Los niveles de CK-18 fueron mayores en los pacientes con EHNA versus los sin EHNA (183,6 UI/l [97,4-734,4] vs. 117,2 UI/l [83,8-954,8], p = 0,016). Los niveles de CK-18 fueron buenos predictores de la presencia de EHNA en la biopsia con un área bajo la curva (AUC) de 0,732 (IC95% 0,572-0,897). Un punto de corte de 130,5 UI/l de CK-18 exhibió una sensibilidad de 92,9% y una especificidad de 63%, con un VPP de 56,5% y un VPN 94,4%, y clasificó correctamente al 73,2% de los pacientes con EHNA. El NFS tuvo un buen rendimiento para diagnóstico de fibrosis avanzada (AUC 0,739, IC95% 0,56---0,91), pero limitado para identificar EHNA (AUC 0,413, IC95% 0,21-0,61). Conclusión: La determinación de CK-18 es un buen marcador no invasivo de EHNA. Si bien, NFS tiene un buen rendimiento en la identificación de pacientes con fibrosis avanzada, no fue de utilidad para diagnosticar EHNA. En pacientes con HGNA, la determinación de CK-18 y NFS es útil en la pesquisa de EHNA y fibrosis hepática respectivamente (AU)

Nonalcoholic steatohepatitis (NASH) is the most aggressive form of nonalcoholic fatty liver disease (NAFLD) and involves the risk of progression to more advanced stages of liver disease. Non-invasive methods are needed to identify patients with NASH. Objective: To evaluate the diagnostic performance of the determination of serum levels of cytokeratin-18 (CK-18) as a non-invasive marker of NASH in the Chilean population. Methods: Serum CK-18 levels were determined in a group of 41 patients with biopsy-proven NAFLD. NASH diagnosis was based on Brunt’s criteria (histological parameters and ballooning), and the NAFLD activity score (NAS) and the presence of fibrosis were determined. The correlation between the NAFLD activity score (NAS) and CK-18 was evaluated with Spearman’s rank correlation coefficient. A ROC curve was produced to assess the diagnostic value of CK-18 for NASH. The NAFLD fibrosis score (NFS) (to predict fibrosis and NASH) was compared to CK-18 with simple linear regression. Data were expressed in median [25th-75th percentile] and evaluated with the Wilcoxon rank test. Results: The mean age of the study group (23% male) was 50.4 ± 11.1 years. 34.2% were diagnosed with NASH (NAS≥5). CK-18 levels were significantly higher in patients with NASH versus those without NASH (183.6 IU/l [97.4 to 734.4] vs. 117.2 IU/l [83.8 to 954.8], p= 0.016). CK-18 levels were a good predictor of NASH on biopsy with an area under the curve (AUC) of 0.732 (95% CI, 0.572 to 0.897). A CK-18 cut-off of 130.5 IU/l had a sensitivity of 92.9%, specificity of 63%, positive predictive value of 56.5% and negative predictive value of 94.4%, and was able to correctly classify 73.2% of patients with NASH. NFS identified advanced liver fibrosis (AUC 0.739, 95% CI, 0.56---0.91), but was of limited value to identify NASH (AUC 0.413, 95% CI, 0.21-0.61). Conclusion: CK-18 is a good non-invasive marker for NASH. Although NFS was found to be an accurate marker of advanced liver fibrosis, it was not of value to identify NASH. In patients with NAFLD, CK-18 and NFS could be useful in predicting NASH and liver fibrosis, respectively (AU)

Evaluación del control de la presión arterial y la adherencia terapéutica en hipertensos seguidos en el programa de salud cardiovascular (PSCV): asociación con características clínicas, socioeconómicas y psicosociales / Assessment of blood pressure control and adherence in hypertensive patients followed in the cardiovascular health program (CHP): association with clinical, socioeconomic and psychosocial characteristics

Antecedentes: Inadecuado control de presión arterial (PA) y baja adherencia a tratamiento farmacológico (Rx) en hipertensos son problemas persistentes globales y en Chile. Factores socioeconómicos y psicosociales han sido frecuentemente mencionados, pero escasamente en Chile. Objetivo: Evaluar control de la PA y adherencia a Rx en hipertensos seguidos en el Programa de Salud Cardiovascular (PSCV) y su asociación con factores clínicos, socioeconómicos y psicosociales. Métodos: Muestra randomizada de 1.794 hipertensos seguidos por 1 año en PSCV en Región Metropolitana. Se evaluó la asociación de edad, sexo, educación, ingreso familiar, Rx, diabetes, obesidad, tabaquismo, consumo problemático de alcohol y actividad física con el control de la PA (<140/90 mmHg) y adherencia. Además, en 600 pacientes, se evaluó la asociación con estrés emocional/depre-sión, relación médico-paciente y apoyo social. Se obtuvieron Odds Ratio (OR) mediante análisis de regresión logística multivariante. Resultados: PA controlada se comprobó en 56,5% y adherencia en 37,3% sin documentarse asociación entre ambas (OR 1,01 [IC 95% 0,78 - 1,32]). Factores asociados a PA no controlada y no adherencia fueron: edad, bajo ingreso familiar, inadecuada relación medico-paciente y alto nivel de estrés emocio-nal/depresión. Rx múltiple y obesidad se asociaron a PA no controlada; sexo masculino y baja educación a no adherencia. Conclusiones: El control de la PA (56,5%) fue similar a resultados de países desarrollados y supera ampliamente cifras de la Encuesta Nacional de Salud 2010 (16,9%). Estos resultados y la falta de asociación entre el control de la PA y la adherencia, sugieren la favorable influencia de otros factores posiblemente relacionados al PSCV.

Background: Unsatisfactory blood pressure (BP) control and low adherence to antihypertensive pharmacotherapy (Rx) in hypertensive populations are persistent problems worldwide and also in Chile. Socioeconomic and psychosocial factors have been frequently mentioned, but with limited contributions from Chile. Objective: The assessment of BP control and adherence to Rx in hypertensive patients followed in the Cardiovascular Health Program (CVHP) and to determine their association with clinical, socioeconomic and psychosocial characteristics. Methods: A randomized sample of 1,794 hypertensive patients followed for 1 year under the CVHP in Metropolitan Region. Association of BP control (<140/90 mmHg) and adherence with age, gender, education, income, Rx, diabetes, obesity, smoking, alcohol use problem and physical activity were analyzed. In a subgroup of 600 patients additional analysis included the association with emotional stress and depression, patient-physician relation and social support. Odds Ratio (OR) were obtained by multivariate logistic regression. Results: BP control was achieved in 56.5% and adherence in 37.3%. No association was found between them (OR 1.01 [CI 95% 0.78-1.32]). Uncontrolled BP and no adherence were associated to advanced age, low income, poor patient-physician relation and high stress-depression. Obesity and multiple Rx were associated to uncontrolled BP. Male gender and low education, were associated to no adherence. Conclusions: BP control (56.5%) was similar to results obtained in developed countries and is strikingly higher than the results reported in the 2010 Chilean National Health Survey (16.9%). These results and the lack of association between BP control and adherence suggest the favorable influence of unaccounted factors, possibly related to the CVHP.

Actividad laboral de médicos egresados de la Universidad de Chile generaciones 2007 a 2010: análisis según sede y año de egreso / Work activity of medical graduates at the University of Chile: Analysis per campus and graduation year

Background: The University promotes practices and values that influence their students in the pursuit of their occupational interests. Aim: To determine working activity features of medical graduates from the University of Chile and their relationship with undergraduate characteristics. Material and Methods: Medical graduates of the University of Chile were invited to complete a survey using a virtual server. The survey collected demographic, socioeconomic, work and guild characteristics. Undergraduate data, as campus and graduation years were obtained. Results: The survey was completed by 333 physicians (167 men) aged 29 ± 2 years, graduated from 2007 to 2010. Ninety four percent had a paid work, 59% were employed in public hospitals and 28% in primary care health centers. The predominant type of work activity was performed in the public health service (55%), while 17% worked in private health services. Activity in public health services or primary care were significantly associated with the pursuit of undergraduate clinical activities in specific campuses of the University. Conclusions: The employment rate of medical graduates was high. Differences observed by graduation campus and type of work may be due to the modeling that students receive from teachers.

Incorporación de paciente virtual en portafolio de estudiantes de medicina de pregrado / Introduction of virtual patients to clinical case portfolios for undergraduate medical students

Background: In 2007, a Clinical-Case-Portfolio (CCP) was introduced as a new assessment instrument for fourth grade undergraduate medical students. Since then, several changes have been implemented such as reduction on the number of clinical cases, peer review and the introduction of virtual patient to the portfolio. Aim: To describe the virtual patient model incorporated to the CCP and assess the perception of this change and its effects on the performance of undergraduate students. Material and Methods: Virtual patients were implemented based on prototype clinical cases with specific syndromes. Students’ perceptions about CCP before and after the introduction of virtual patients were evaluated using a validated questionnaire that was answered voluntarily and anonymously. Results: Overall perception of CCP significantly improved after the incorporation of virtual patients (97.1 ± 24.9 and 111.3 ± 25.7 points; 57.8 and 66.2% respectively). The same improvements were observed for the domains “Student Learning”, “Organization and Evaluation”, “Teaching Methodology” and “Integration”. In both years, students obtained high grades in CCP evaluations. However CCP grades were not significantly correlated with integrated final grades. Conclusions: The incorporation of virtual patients improved undergraduate students’ perception of CCP.

Influencia de factores psicosociales en la adherencia al tratamiento farmacológico antihipertensivo: Resultados de una cohorte del Programa de Salud Cardiovascular de la Región Metropolitana, Chile / Influence of psychosocial factors on adherence to antihypertensive drug therapy: Results from a Cardiovascular Health Program cohort followed in the Metropolitan Region of Santiago, Chile

Background: Inadequate blood pressure control in hypertensive patients remains a persistent health problem in Chile and worldwide. Poor adherence to antihypertensive drug therapy is one of the frequently cited factors. Objectives: To determine the influence of psychosocial factors in the adherence to drug therapy in hypertensive patients followed through a Cardiovascular Health Program (CHP) that provides free access to primary care centers located in the Metropolitan Region of Santiago, Chile. Methods: Cross sectional study. A randomized sample of 513 hypertensive patients (30 to 68 years) was obtained from a universe of 1.484 patients. Adherence to treatment was determined by the Morisky-Green-Levine test. Demographic, socioeconomic and average values of blood pressure were recorded. Validated questionnaires were utilized to assess the patient-physician relationship, awareness of being hypertensive, patient perception of social support, family cohesion, patient self-health assessment and symptoms of emotional stress and depression. Results: The drug therapy adherence was 36.6%, higher in women (38.4% vs 28.9%; p < 0.001). After multivariate analysis, absence of adherence was associated with male gender (OR: 1.76 [95% CI 1.21-2.56]), low education (OR: 1.72 [95% CI 1.18 to 2.53]), inadequate patient-physician relationship (OR: 1.56 [95% CI 1.13 to 2.27]), and high level of emotional stress and depression (OR: 1.93 [95% CI 1.27 to 2.94]). Conclusions: Our study highlights the influence of inadequate patient-physician relation, high level of emotional stress and depression, low education level and income and male gender in the lack of adherence to antihypertensive drug therapy in hypertensive patients followed throughout the CHP.

Control del Hipertenso, un desafío no resuelto: avances logrados en Chile mediante el Programa de Salud Cardiovascular / Blood Pressure control in Hypertension, an unresolved challenge. Improvements achieved throughout the Chilean Cardiovascular Health Program

Antecedentes: El control de la presión arterial (PA) es fundamental en reducir la morbi-mor-talidad en hipertensos, pero con resultados hasta la fecha insatisfactorios en Chile y en países de alto desarrollo socioeconómico. En Chile se inició en 2002 el Programa de Salud Cardiovascular (PSCV) intentando mejorar el manejo de estos pacientes. Objetivos: Evaluar características sociodemográ-ficas, clínicas, antropométricas, psicosociales y de estilos de vida de un grupo de pacientes participantes en el PSCV, y la influencia de estos factores en el control de la PA. Métodos: Se obtuvo una muestra aleatoria de 525 pacientes (380 mujeres) de un universo de 1.533 hipertensos entre 30 y 68 años bajo seguimiento en el PSCV. Se registraron datos sociodemográficos, clínicos, antropométricos, psicosociales y de estilos de vida a través de evaluación clínica y cuestionarios validados. La PA fue medida utilizando un protocolo estándar por personal entrenado. El análisis estadístico incluyó la predicción del riesgo (Odds RATIO) de PA no controlada por las diversas características estudiadas. Resultados: El 47 por ciento de los pacientes logró una PA controlada (<140/90 mmHg). La presencia de diabetes mellitus (DM) fue documentada en el 38,5 por ciento. Factores predictores significativos de PA no controlada fueron DM, baja educación, inadecuada relación médico paciente y alto nivel de estrés emocional/depresión. Conclusiones: El PSCV ha logrado un avance importante en el control de la PA resaltando la influencia significativa de factores psicosociales. Sin embargo es preocupante la alta proporción de hipertensos diabéticos, su inferior control de PA, y la limitada captación de hombres al programa.

Background: Blood pressure (BP) control is a necessary requirement to reduce cardiovascular events and mortality in hypertensive patients, but so far results have been disappointing in Chile and also in countries with advanced socioeconomic development. Since 2002 a Cardiovascular Health Program (CHP) was launched in Chile attempting to improve the outcomes in these patients. Objectives: To assess the influence of sociodemo-graphic, clinical, anthropometric, psychosocial, lifestyle habits characteristics upon BP control (<140/90 mmHg) in a group of hypertensive patients referred to the CHP. Methods: A cross sectional study of a random sample of 525 hypertensive patients (380 women) obtained from a universe of 1,533 patients with ages ranging from 30 to 68 years was performed. Socio-demographic, clinical, anthropometric, psychosocial and lifestyle habits data were collected through clinical evaluation and validated questionnaires. Trai-ned personnel using standard protocols recorded BP. Adjusted ODDS RATIOS were used to assess theinfluence of different population characteristics upon blood pressure control . Results: A controlled BP (<140/90 mmHg) was achieved in 47 percent of patients, and 38.5 percent presented diabetes mellitus (DM). Significant predictors of uncontrolled BP (>140/90 mmHg) were DM, low education, unsatisfactory patient-physician relation, and high score of emotional stress /depression. Conclusions: In Chile the CHP has achieved an important progress in BP control in hypertensive patients. Psychosocial factors influenced significantly these results. It is concern the high proportion of diabetics in this hypertensive population and their unsatisfactory BP control. The lower proportion of men enrolled in the CHP needs additional analysis and corrective actions.

Enfermedades músculo esqueléticas en población hipertensa y su asociación con obesidad: un estudio transversal en laRegión Metropolitana, Chile / Musculo and skeletal diseases in hypertensive subjects and their association with obesity: a cross sectional study in the Region Metropolitana, Chile

Antecedentes: Los hipertensos presentan elevada prevalencia de obesidad lo que puede predisponer para el desarrollo de enfermedades músculo-esqueléticas (EME). Actualmente se desconoce la magnitud de estas patologías en población hipertensa chilena. Objetivo: Determinar prevalencia de EME en hipertensos bajo control en el programa de salud cardiovascular de la Región Metropolitana y su posible asociación con obesidad. Método: Estudio transversal en una muestra aleatoria simple (n = 1194 sujetos) a partir del universo (N = 391.129) distribuida en 52 comunas de Santiago. Se registró diagnóstico de EME (CIE10, códigos MM00-99), edad, sexo, presión arterial, índice de masa corporal (IMC), obesidad (IMC ³ 30 kg/m2) y carga psicológica. La asociación con obesidad se exploró a través de regresión logística estimando odds ratio (OR) con intervalos de confianza al 95% (IC95%). Resultados: La prevalencia de EME fue 36,5% (39,9% mujeres y 28,3% hombres, p<0.01). En ambos sexos las patologías más frecuentes fueron lumbago, artrosis de rodilla y artralgias. La asociación de EME y obesidad presentó un OR crudo de 1,09 (1,06-1,19) en hombres y de 1,24 (1,22-1,26) en mujeres; luego de ajuste multivariante el OR fue de 1,19 (1,15-1,23) y 1,49 (1,46-1,52) respectivamente. Conclusiones: Además de la edad, sexo femenino y carga psicológica, la obesidad aparece como un factor de riesgo para EME en población hipertensa. La elevada prevalencia observada enfatiza la necesidad de acentuar el control de peso, incluir el ejercicio físico y brindar acceso a la kinesioterapia en la atención primaria chilena.

Background: Hypertensive subjects frequently are obese, which may lead to development of muscular and skeletal diseases (MSD). There is no data regarding the frequency of this complications in Chile. Aim: to determine the prevalence of MSD in hypertensive subjects being followed by the Cardiovascular Health Program in the Region Metropolitana; to determine the association of MSD to obesity in those subjects. Methods: Cross sectional study using a simple random sample of 1194 subjects from the population of 391,129 hypertensives distributed in 52 municipalities in Santiago, Chile. Diagnosis of MSD was established according to CIE 10 codes MM00-99). Age, sex, blood pressure, body mass index and psychological burden were determined. Obesity was defined as IMC ³ 30 kg/m2). Association of MSD with obesity was explored using logistic regression and OR with 95% confidence intervals (95% CI). Results: The prevalence of obesity was 36.5% (39.0% in women, 28.3% in males, p<0.01). In both sexes, lumbar pain, knee osteoarthritis and joint pain were the most common forms of MSD. OR for the association of MSD and obesity was 1.09 (95% CI 1.06-1.19) in males and 1.24 (1.22-1.26) in females. After multivariate adjustment the respective OR became 1.19 (1.15-1.23) and 1.49 (1.46-1.52). Conclusion: In addition to age, female sex and psychological burden, obesity is an independent risk factor for MSD en hypertensive patients. These findings stress the need for better weight control in hypertensives. Physical exercise and physical therapy should be helpful in the primary care of this population.