Entrenamiento físico en personas con enfermedad renal crónica avanzada: beneficios de su implementación en la práctica clínica / Exercise training in advanced chronic kidney disease

Chronic kidney disease is associated with an increase in cardiovascular risk and mortality, and a decrease in the health-related quality of life. It is known that the physical capacity of patients with chronic kidney disease is lower than their healthy counterparts. It also decreases progressively after the start of hemodialysis, even leading to the loss of functional independence. There is a positive association between exercise and improvement of many targets in chronic kidney disease, especially in dialysis patients, such as cellular apoptosis, immune improvement and inflammation. In addition, several clinical studies and systematic reviews show an improvement in different clinical and laboratory variables and suggest a lower mortality, proving a reduction of health care economic costs. Exercise intervention in dialysis is safe. Although different guidelines promote exercise, it is necessary to work on its implementation on a large scale.

Resultados a 5 años de la revascularización exclusiva con dos arterias mamarias en pacientes con enfermedad coronaria multivaso / Exclusive coronary revascularization with both mammary arteries: analysis of 73 patients

Background: Exclusive coronary revascularization with both mammary arteries could result in lower rates of adverse events in the long term. Aim: To describe the five-year evolution of a cohort of patients operated on with this technique. Material and Methods: Follow up analyzing survival of 73 patients aged 59 ± 9 years (82% men) who underwent exclusive coronary surgery with two mammary arteries between December 1,2010 and April 12,2017. We studied their clinical characteristics, surgical results, operative morbidity and mortality and adverse events up to June 30, 2018. Results: Six patients had two-vessel lesions and 67 three-vessel lesions. The operative risk calculated by additive and logistic EuroSCORE was 2.5 and 2.3%, respectively. A mean of 3.75 anastomoses /patient were performed, 116 with left mammary artery (73 to the anterior descending artery, 38 to a diagonal artery and 5 for other objectives) and 158 with right mammary artery (69 to a first marginal artery, 23 to a second marginal artery and 64 to posterior descending artery). There was one case of mediastinitis and one (1.5%) patient died. The mean follow-up was 64.6 ± 23.7 months. The 5-year survival was 90.4%. Conclusions: Coronary revascularization with two exclusive mammary arteries allowed a complete revascularization of the heart with a low rate of complications and adverse effects at five years.

Diabetes Mellitus tipo 2: desafíos para los modelos de cuidados crónicos en Chile / Type 2 diabetes mellitus as a challenge for chronic disease care models in Chile

The increase in chronic noncommunicable diseases is one of the main concerns worldwide. Therefore, it is pertinent to ask how care system organizations responded to the requirements currently being posed by chronic diseases, specifically type 2 diabetes mellitus (T2DM). In the world, different models have been developed considering elements that transcend the biological stability of the disease. Chile has the great challenge of exploring new models that emphasize the promotion and prevention of health rather than the management of the disease. The impact of variables such as health literacy, self-efficacy and subjective well-being on T2DM should be explored. In addition, it is necessary to validate and implement guidelines and protocols of care that incorporate the aforementioned variables.

Implementación de la política pública para el cuidado de la primera infancia en el contexto chileno: una mirada desde salud al Chile Crece Contigo / Implementation of a policy for early childhood care in the Chilean context: a view from health to Chile Crece Contigo

RESUMEN En el campo del cuidado de la infancia Chile posee una larga historia de intervenciones que han apuntado hacia la disminución de la mortalidad infantil, la mayoría de ellas, con un fuerte enfoque biomédico. Estas han intentado dar respuesta a las demandas de la época en que han sido formuladas, reflejando la evolución de la historia socio-sanitaria del estado chileno y logrando un cometido exitoso durante el transcurso del pasado siglo. En este contexto emerge la política pública "Chile Crece Contigo", la cual ha apostado al abordaje biopsicosocial de la primera infancia mediante una serie de acciones tendientes a la protección y acompañamiento del desarrollo de los niños/as, con un especial énfasis en el apoyo a las familias más vulnerables. Este ensayo plantea antecedentes de la política pública para la protección de la primera infancia en el contexto chileno mirada desde el sector salud y presenta brevemente algunos aspectos relevantes del proceso de implementación de una de sus políticas más significativas.(AU)

ABSTRACT In the field of childhood care, Chile has a long history of interventions which have pointed to reduce infant mortality, most of them with a strong biomedical approach. These interventions have attempted to respond to the demands of the period when they were established, reflecting the evolution of social and health history of the Chilean State and achieving good results during the past century. In this context the Chile Crece Contigo (Chile grows with you) public policy was created to bet on a biopsychosocial approach to early childhood through a serie of actions aimed at protecting and accompanying children throughout their development, with special emphasis on support to the most vulnerable families. This essay presents the background of the public policy for early childhood protection in the Chilean context, from a health perspective, and also presents briefly some important aspects of the implementation process of one of its most significant policies.(AU)

Evaluación de la categorización de las urgencias gineco-obstétricas en un hospital del sur de Chile / Evaluation of the categorization of gynecological-obstetric emergencies in a hospital in southern Chile

OBJETIVO: Caracterizar las consultas de urgencias gineco-obstétricas de un Hospital del sur de Chile en el año 2013. MÉTODOS: Estudio descriptivo de corte transversal retrospectivo. Se analizaron los registros de la urgencia gineco-obstétrica (UGO) durante el primer semestre del 2013 que ascendieron a 4.898 consultas. RESULTADOS: Un 85% (n=4.155) de las consultas atendidas en UGO fueron pacientes que concurrieron directamente desde su domicilio. El 67,9% (n=3.495) de las atenciones en la UGO se otorgaron en horario diurno promediando 815 consultas por mes. Los principales motivos de consulta fueron otras patologías asociadas al embarazo tales como enfermedades respiratorias agudas, transgresión alimentaria, alergias, hiperémesis gravídica, molestias mecánicas (19,5%, n=897), el trabajo de parto y el parto (7,4%, n=342) y la vulvovaginitis (6,5%, n=302). El 65% (n=2.835) del total de las urgencias gineco-obstétricas con datos completos fueron bien categorizadas según el protocolo de priorización del hospital de estudio. Un 96,6% (n=167) de las pacientes no requirió trasladó a un centro hospitalario de mayor complejidad. CONCLUSIONES: Existe una sobre-utilización de la red de urgencia gineco-obstétrica por parte de las usuarias, colapsando el nivel terciario de atención con patologías que podrían ser resueltas en el nivel primario. Desde la matro-nería se debería liderar la instauración de un instrumento específico de TRIAGE gineco-obstétrico, como también la educación a la comunidad sobre uso adecuado de la red asistencial de nuestro país.

OBJETIVE: To characterize obstetric and gynecological consultations at the emergency department of a hospital in southern Chile in 2013. METHODS: Cross-sectional descriptive retrospective study. Obstetric and gynecological emergency department records (OGE) were analyzed during the first half of 2013 which amounted to 4,898. RESULTS: 85% (n=4155) of the consultations assisted at OGE were patients who attended directly from home. 67.9% (n=3,495) of attentions at the OGE were developed in daytime averaging 815 visits per month. The main reasons of consultation were other diseases of pregnancy such as acute respiratory diseases, food transgression, allergies, hyperemesis gravidarum, mechanical discomforts (19.5%, n=897), labor and delivery (7.4%, n=342) and vulvovaginitis (6.5%, n=302). 65% (n=2835) of all gynecological obstetric emergencies with complete data were well categorized according to protocol prioritization studied hospital. A 96.6% of the patients did not require transfer to a high complexity hospital.CONCLUSIONS: There is an over-utilization of the obstetric and gynecological emergency network by users, collapsing the tertiary level of care with diseases that could be resolved at the primary level. The midwifery should lead the creation of a specific instrument TRIAGE obstetrics and gynecology, as well as community education on proper use of the healthcare network in our country.