Results of the home mechanical ventilation national program among adults in Chile between 2008 and 2017.

BACKGROUND: Home mechanical ventilation (HMV) is a viable and effective strategy for patients with chronic respiratory failure (CRF). The Chilean Ministry of Health started a program for adults in 2008. METHODS: This study examined the following data from a prospective cohort of patients with CRF admitted to the national HMV program: characteristics, mode of admission, quality of life, time in the program and survival. RESULTS: A total of 1105 patients were included. The median age was 59 years (44-58). Women accounted for 58.1% of the sample. The average body mass index (BMI) was 34.9 (26-46) kg/m2. A total of 76.2% of patients started HMV in the stable chronic mode, while 23.8% initiated HMV in the acute mode. A total of 99 patients were transferred from the children's program. There were 1047 patients on non-invasive ventilation and 58 patients on invasive ventilation. The median baseline PaCO2 level was 58.2 (52-65) mmHg. The device usage time was 7.3 h/d (5.8-8.8), and the time in HMV was 21.6 (12.2-49.5) months. The diagnoses were COPD (35%), obesity hypoventilation syndrome (OHS; 23.9%), neuromuscular disease (NMD; 16.3%), non-cystic fibrosis bronchiectasis or tuberculosis (non-CF BC or TBC; 8.3%), scoliosis (5.9%) and amyotrophic lateral sclerosis (ALS; 5.24%). The baseline score on the Severe Respiratory Insufficiency questionnaire (SRI) was 47 (± 17.9) points and significantly improved over time. The lowest 1- and 3-year survival rates were observed in the ALS group, and the lowest 9-year survival rate was observed in the non-CF BC or TB and COPD groups. The best survival rates at 9 years were OHS, scoliosis and NMD. In 2017, there were 701 patients in the children's program and 722 in the adult´s program, with a prevalence of 10.4 per 100,000 inhabitants. CONCLUSION: The most common diagnoses were COPD and OHS. The best survival was observed in patients with OHS, scoliosis and NMD. The SRI score improved significantly in the follow-up of patients with HMV. The prevalence of HMV was 10.4 per 100,000 inhabitants. Trial registration This study was approved by and registered at the ethics committee of North Metropolitan Health Service of Santiago, Chile (N° 018/2021).

[Impact of the ERA and GES health programs on mortality from community-acquired pneumonia in persons aged ≥65 years in ChileImpacto do programa de saúde ERA e do GES na mortalidade por pneumonia adquirida na comunidade em indivíduos com idade acima de 65 anos no Chile]. / Impacto de los programas de salud ERA y GES en la mortalidad por neumonía adquirida en la comunidad en personas de 65 años o más en Chile.

OBJECTIVE: Evaluate the impact of the Adult Respiratory Diseases (ERA) Program and the General System of Explicit Health Guarantees (GES) on mortality from community-acquired pneumonia (CAP) in persons aged ≥65 years in Chile. METHODS: In this ecological study, annual and quarterly mortality rates from CAP were calculated in persons aged 65 to 79 years and ≥80 years from 1990 to 2014. Information was gathered from the databases of Chile's Department of Health Statistics and Information and its National Statistics Institute. The ERA Program (implemented in 2001) and the inclusion of CAP in the GES (starting in 2005) were evaluated as interventions. Data were analyzed using the interrupted time-series method, following the Prais-Winsten model, with a 5% significance level. RESULTS: The analysis showed that after the ERA Program began, significant reductions in CAP mortality were observed in the two age groups studied, whereas after CAP was added to the GES program, no statistically significant changes were found in those rates. CONCLUSIONS: Implementation of the ERA Program helped to reduce CAP mortality in persons aged ≥65 years in Chile, whereas inclusion of CAP in the GES program did not.

OBJETIVO: Avaliar o efeito do Programa Enfermidades Respiratorias del Adulto (doenças respiratórias do adulto, ERA) e do Régimen General de Garantías Explícitas en Salud (regime geral de garantias explícitas em Saúde, GES) na mortalidade por pneumonia adquirida na comunidade (PAC) em indivíduos acima de 65 anos no Chile. MÉTODOS: Estudo ecológico em que foram calculadas as taxas anuais e trimestrais de mortalidade por PAC em indivíduos de 65 a 79 anos e acima de 80 anos no período entre 1990 e 2014. Os dados foram obtidos dos bancos de dados do Departamento de Estatística e Informação em Saúde e do Instituto Nacional de Estatística do Chile. As intervenções avaliadas foram o Programa ERA (implantado em 2001) e a inclusão da PAC no GES (a partir de 2005). Os dados foram analisados com o método de séries temporais interrompidas segundo o modelo de Prais-Winsten. O nível de significância foi de 5%. RESULTADOS: A análise demonstrou que, após a implantação do Programa ERA, houve uma redução significativa na taxa de mortalidade por PAC nas duas faixas etárias consideradas. Por outro lado, a inclusão da PAC no GES não teve efeito estatisticamente significativo na taxa de mortalidade. CONCLUSÕES: A implantação do Programa ERA contribuiu para reduzir a taxa de mortalidade por PAC em indivíduos acima de 65 anos no Chile, porém o mesmo não ocorreu com a inclusão da PAC no GES.

Multiparametric MRI for Staging of Prostate Cancer: A Multicentric Analysis of Predictive Factors to Improve Identification of Extracapsular Extension before Radical Prostatectomy.

The correct identification of extracapsular extension (ECE) of prostate cancer (PCa) on multiparametric magnetic resonance imaging (mpMRI) is crucial for surgeons in order to plan the nerve-sparing approach in radical prostatectomy. Nerve-sparing strategies allow for better outcomes in preserving erectile function and urinary continence, notwithstanding this can be penalized with worse oncologic results. The aim of this study was to assess the ability of preoperative mpMRI to predict ECE in the final prostatic specimen (PS) and identify other possible preoperative predictive factors of ECE as a secondary end-point. We investigated a database of two high-volume hospitals to identify men who underwent a prostate biopsy with a pre-biopsy mpMRI and a subsequent RP. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of mpMRI in predicting ECE were calculated. A univariate analysis was performed to find the association between image staging and pathological staging. A multivariate logistic regression was performed to investigate other preoperative predictive factors. A total of 1147 patients were selected, and 203 out of the 1147 (17.7%) patients were classified as ECE according to the mpMRI. ECE was reported by pathologists in 279 out of the 1147 PS (24.3%). The PPV was 0.58, the NPV was 0.72, the sensitivity was 0.32, and the specificity was 0.88. The multivariate analysis found that PSA (OR 1.057, C.I. 95%, 1.016-1.100, p = 0.006), digital rectal examination (OR 0.567, C.I. 95%, 0.417-0.770, p = 0.0001), ratio of positive cores (OR 9.687, C.I. 95%, 3.744-25.006, p = 0.0001), and biopsy grade in prostate biopsy (OR 1.394, C.I. 95%, 1.025-1.612, p = 0.0001) were independent factors of ECE. The mpMRI has a great ability to exclude ECE, notwithstanding that low sensitivity is still an important limitation of the technique.

Ambient carbon monoxide and daily mortality: a global time-series study in 337 cities.

BACKGROUND: Epidemiological evidence on short-term association between ambient carbon monoxide (CO) and mortality is inconclusive and limited to single cities, regions, or countries. Generalisation of results from previous studies is hindered by potential publication bias and different modelling approaches. We therefore assessed the association between short-term exposure to ambient CO and daily mortality in a multicity, multicountry setting. METHODS: We collected daily data on air pollution, meteorology, and total mortality from 337 cities in 18 countries or regions, covering various periods from 1979 to 2016. All included cities had at least 2 years of both CO and mortality data. We estimated city-specific associations using confounder-adjusted generalised additive models with a quasi-Poisson distribution, and then pooled the estimates, accounting for their statistical uncertainty, using a random-effects multilevel meta-analytical model. We also assessed the overall shape of the exposure-response curve and evaluated the possibility of a threshold below which health is not affected. FINDINGS: Overall, a 1 mg/m3 increase in the average CO concentration of the previous day was associated with a 0·91% (95% CI 0·32-1·50) increase in daily total mortality. The pooled exposure-response curve showed a continuously elevated mortality risk with increasing CO concentrations, suggesting no threshold. The exposure-response curve was steeper at daily CO levels lower than 1 mg/m3, indicating greater risk of mortality per increment in CO exposure, and persisted at daily concentrations as low as 0·6 mg/m3 or less. The association remained similar after adjustment for ozone but was attenuated after adjustment for particulate matter or sulphur dioxide, or even reduced to null after adjustment for nitrogen dioxide. INTERPRETATION: This international study is by far the largest epidemiological investigation on short-term CO-related mortality. We found significant associations between ambient CO and daily mortality, even at levels well below current air quality guidelines. Further studies are warranted to disentangle its independent effect from other traffic-related pollutants. FUNDING: EU Horizon 2020, UK Medical Research Council, and Natural Environment Research Council.

The effects of aging on semen parameters and sperm DNA fragmentation.

INTRODUCTION: This study aimed to look into possible correlations between male age and different sperm parameters derived from semen analysis and sperm deoxyribonucleic acid (DNA) fragmentation. METHODS: This retrospective descriptive study included 2681 male patients who underwent semen analysis at Clínica Las Condes (CLC), Santiago, Chile, between January 2014 and May 2017; correlations between age and sperm parameters were analyzed. RESULTS: Males above the age of 50 were significantly more likely to present anomalies in semen volume, sperm concentration, and sperm DNA fragmentation; males aged 41+ years were more likely to have lower sperm concentration levels; males aged 31+ years were more likely to have decreased sperm motility; when concentration was constant, more volume and motility anomalies were seen as age increased; when volume was kept constant, more motility and concentration anomalies were seen as age increased; and when motility was constant, normal semen volumes decreased as age increased. CONCLUSION: Our study showed that male age significantly affects sperm parameters that might have an impact on male fertility.

Aspectos relacionados con el intento suicida en pacientes ingresados en el Centro Nacional de Toxicología / Aspects on suicidal attempts by patients admitted to the National Center of Toxicology

Se realizó una investigación en 96 pacientes ingresados en el Centro Nacional de Toxicología que cometieron intento suicida durante el año 2000. Predominó el sexo femenino, la raza blanca, en periodos de edades entre 20-29 años, en su mayoría solteros, con escolaridades de secundaria y preuniversitaria. Residían en zonas urbanas con antecedentes psiquiátricos personales y familiares, así como antecedentes personales de intentos. El conflicto inductor se relacionó con la ruptura de la línea vital, seguido de las descompensaciones de enfermedades psiquiátricas; se utilizó en primera opción los psicofármacos, seguidos de organofosforado, insecticidas y combustibles. Según el Programa Nacional de Prevención del Suicidio, el intento suicida se calificó como: “riesgoso potencialmente letal”, la gravedad de las circunstancias, “moderada”, y en cuanto a la seriedad de la intención, serio

Valoración de algunos aspectos relacionados con el intento suicida en pacientes jóvenes con trastornos de personalidad / Assessment of some features related to suicide attempt in young patients presenting personality disorders

Se efectuó una investigación prospectiva de 78 pacientes que realizaron intento suicida en el período comprendido de julio de 1996 a julio de 1998, ingresados en el Servicio de Psiquiatría del Hospital Militar Central “Dr Carlos J Finlay”. Predominó el grupo de edad de 18 a 20 años, de secundaria básica y solteros con antecedentes de intentos suicidas y antecedentes familiares de trastornos psiquiátricos. El conflicto inductor principal estuvo asociado con la adaptación al nuevo medio estresante. Según el Programa Nacional de Prevención del Suicidio, el intento suicida se calificó como letal, bajo y poco serio

Conducta suicida en pacientes atendidos en un Centro de Urgencias / Suicide conduct in patients attended at an emergency center

Se estudiaron 85 pacientes que realizaron intento suicida y se atendieron en el Centro de Urgencias del Hospital Militar Central "Dr. Carlos J. Finlay", durante enero y junio de 2003. Predominó el sexo femenino (57 %), con edades entre 10 y 19 años (35 %), pertenecientes a la raza blanca, escolaridades de secundaria terminada (49 %), seguidas del nivel medio superior, dedicadas preferentemente al estudio o como amas de casa. El conflicto inductor principal estuvo asociado con problemas relacionados con el grupo primario de apoyo (46 %), seguido de los problemas relacionados con el ambiente familiar, con antecedentes patológicos personales y familiares de trastornos psiquiátricos, así como de intentos suicidas. El método más empleado fue el uso de psicofármacos, seguido de otras sustancias, y después de realizado el acto, solicitaron ayuda. Como trastornos psiquiátricos predominaron los trastornos situacionales, seguidos de los trastornos de personalidad. La conducta tomada por el terapeuta en primera opción fue la de remitir al paciente a su área de atención primaria, seguida de la decisión de ingresarlo.

85 patients who attempted suicide and received attention at the Emergency Center of "Dr. Carlos J. Finlay" Military Central Hospital from January to June 2003, were studied. There was a prevalence of white females (57 %) with ages between 10-19 years old (35 %) and middle level education concluded (49 %), followed by higher middle level. Most of them were students or housewives. The main conflict inducing them to take this decision was associated with problems related to the primary support group (46 %), followed by the problems related to family environment, with personal and family pathological history of psychiatric disorders, as well as with suicide attempts. . The most used method was the use of psychotropic drugs and other substances. After attempting suicide, they asked for help. Among the psychiatric disorders, it was observed a predominance of the situational disorders , followed by the personality disorders. The first option used by the therapist was to refer the patient to his primary health care area, whereas the second one was to hospitalize him.