Tabaquismo activo y cancer pulmonar: determinación de fracciones atribuibles por sexo / Smoking and Lung Cancer: attributable risks according to gender

Background: The association between Lung Cancer and smoking is well documented. However there is less information about the estimation of its attributable fraction and population burden. Aim: To estímate the attributable risk and population attributable risk of smoking among Lung Cancer patients attended in Public Health Services at Santiago. Material and methods: A case control study matched by age was carried out. Crude and adjusted attributable and population attributable risks were estimated, controlling for potential confounders and interaction variables. Results: Mean age for cases was 63 years for women and 67 years for men. Lung Cancer patients had a higher smoking prevalence than controls (64.5 percent and 39.7 percent respectively among women; 95.8 and 67.1 respectively among men p <0.01). Heavy smoker proportion was 4 times higher among patients that smoked 5 to 10 years more (women and men respectively, p <0.01) and 3 times more cigarettes per day (p <0.01). Attributable risk for women was 64.4 percent and 90.4 percent for men. Population attributable fraction was 41.9 percent and 86.3 percent for women and men, respectively. Projecting these estimates to the Chilean population, approximately 1975 new cases per year of Lung Cancer caused by smoking will be diagnosed. Conclusions: Attributable risks of smoking for Lung Cancer are high and significant, even when they are adjusted by confounding variables.

Tabaquismo y enfermedad pulmonar obstructiva crónica: determinación de fracciones atribuibles / Smoking and chronic obstructive pulmonary disease: attributable risk determination

Background: Smoking is the main risk factor for Chronic Obstructive Pulmonary Disease (COPD), an important cause of morbidity and mortality. Aim: To estimate smoking attributable risk and population attributable risk in COPD patients attended in Public Health Services of Santiago. Materials and methods: A case control study matched by sex and age was carried out. Crude and adjusted attributable risks as well as population attributable risk were estimated, controlled by potential confounders and by interaction variables. Results: Mean ages for cases and controls were 68 and 67 years respectively. When compared to the control group, COPD patients had a higher smoking prevalence (at least 100 cigarettes in their life span: 89.7 percent vs 60.3 percent; p <0.01). Among COPD patients, heavy smokers proportion was 4 times higher than in controls, they smoked for more years (43 vs 31; p <0.01) and more cigarettes per day (18 vs 5; p <0.01). Adjusted attributable risk was 87 percent (95 percent Confidence Interval (CI): 63.7-94.8). If a patient smoked at least 100 cigarettes in his/her life span and this risk was 92.7 percent (CI: 82.4-96.9) for heavy smokers. Projecting this index to Santiago inhabitants, about 87,000 individuals older than 40 years would be suffering COPD due to smoking. Conclusions: This article confirms the strong association between smoking and COPD. Attributable risks are high and significant, even when they are adjusted by confounding variables. Women had a higher risk than men, at lower levels of tobacco consumption.

Evaluación de calidad de asistencia en obstetricia, periodo 2004-2005 en el Hospital Clínico de la Universidad de Chile / Evaluation of quality of attendance in obstetrics, period 2004-2005 in the Hospital Clínico de la Universidad de Chile

Existen numerosos indicadores de calidad de asistencia utilizados por organizaciones públicas, privadas y sin fines de lucro, que tienen por finalidad mejorar mejorar la práctica asistencial de maternidades. El objetivo de este trabajo fue comparar los estandares de dichos indicadores con los obtenidos en el Servicio de Maternidad del Hospital Clínico de la Universidad de Chile en el año 2004 y 2005.

Many public and private organizations use different obstetrical care quality indicators to improve medical care practice in maternity wards. The purpose of this study was to compare the available standards for those indicators, with the results obtained in the Obstetrics Service of the University of Chile's Clinical Hospital, for the 2004-2005 period.

Análisis de componentes principales aplicado a variables respecto a la mujer gestante en la Región de las Américas / Analysis of principal component respect of pregnant women in the Region of the Americas

Objetivo: Obtener índices comparativos entre países, respecto a la real situación de la mujer gestante _recursos utilizados y resultados obtenidos_ en la Región de las Américas. Material y Métodos: Se recopila información oficial de los países de la Región de las Américas, publicada por OMS y OPS, correspondiente a variables relacionadas con la mujer embarazada y los recursos potenciales utilizados en su atención, además de los resultados obtenidos en dicha atención. Se estudiaron 9 variables: tasa global de fecundidad, tasa de natalidad, razón de mortalidad materna, prevalencia de uso de anticonceptivos, proporción de población gestante atendida por personal capacitado durante el embarazo y partos atendidos por personal capacitado, gasto nacional en salud per cápita por año y como proporción del PIB y gasto público en salud como proporción del gasto nacional en salud. Aplicamos componentes principales a partir de la matriz de correlación R. Resultados: Se seleccionaron las dos primeras componentes principales, con un porcentaje acumulado de variabilidad explicada de 67,31 por ciento. Conclusiones: La primera componente tiene relación con la prevalencia de uso de anticonceptivos y la proporción de población gestante cuyo parto es atendido por personal capacitado. Existe una relación inversa de la primera componente con la tasa global de fecundidad, la tasa de natalidad y la razón de mortalidad materna. Orientaría esta primera componente a los resultados positivos que ofrecen estrategias adecuadas de servicios que privilegien la paternidad responsable. La segunda componente principal se relaciona con el gasto nacional en salud como proporción del PIB y en forma inversa con el gasto público en salud por año como proporción del gasto nacional en salud.

Indicadores de gestión de servicios de salud públicos y asignación de recursos desde el Ministerio de Salud de Chile / Indices of public health services and resource allocation from the Health Ministry of Chile

Background: Chile has a National Health Services System, formed by 29 Health Services. An efficient resource distribution among this services is crucial for an efficient health care delivery. Aim: To obtain indices from the Chilean Public Health Services, that could improve allocation of resources. Material and methods: Information from the Chilean Public Health Services, corresponding to activities during 2001 budgetary period, was collected. This is the latest complete and official information for the totality of Health Services in the country. Seventeen variables generated or monitored by the Instituto Nacional de Estadísticas (INE), the Ministerio de Salud (MINSAL), the Ministerio de Hacienda, the Ministerio de Planificación y Cooperación (MIDEPLAN) and the Fondo Nacional de Salud (FONASA) were studied. The Main Components Analysis (ACP) was used, obtained from the R correlation matrix. Results: The first two main components were selected, with an accumulated percentage of explained variability of 63.05 percent. The first component is related to the population assigned to each Health Service. This corresponds to the number of people needed to treat in the hospitals of these Services and their answer to this demand, justified by the expenses in which each Health Service incurs. There is an inverse relation of the first component with health indicators, measured by burden of disease and death. The second main component would represent the social and economic characteristics of the population, poor and ery poor populations and public health insurance beneficiaries, to take care of in each Health Service. Conclusions: Health indicators in each Health Service are not considered a priority for resource distribution among Health Services in the country. The transference is done considering the indices contained in the two main components defined.