Salud mental en Chile y Finlandia: desafíos y lecciones / Mental health in Chile and Finland: challenges and lessons

This article analyses and compares the epidemiology of mental disorders and relevant public policies in Chile and Finland. In Chile, a specific mental health law is still lacking. While both countries highlight the role of primary care, Finland places more emphasis on participation and recovery of service users. Comprehensive mental health policies from Finland, such as a successful suicide prevention program, are presented. Both countries have similar prevalence of mental disorders, high alcohol consumption and high suicide rates. In Chile, the percentage of total disease burden due to psychiatric disorders is 13% and in Finland 14%. However, the resources to address these issues are very different. Finland spends 4.5% of its health budget on mental health, while in Chile the percentage is 2.2%. This results in differences in human resources and service provision. Finland has five times more psychiatric outpatient visits, four times more psychiatrists, triple antidepressant use and twice more clinical guidelines for different psychiatric conditions. In conclusion, both countries have similar challenges but differing realities. This may help to identify gaps and potential solutions for public health challenges in Chile. Finland's experience demonstrates the importance of political will and long-term vision in the construction of mental health policies.

Effects of 5-aza-2′deoxycytidine on RECK gene expression and tumor invasion in salivary adenoid cystic carcinoma

Reversion-inducing cysteine-rich protein with kazal motifs (RECK), a novel tumor suppressor gene that negatively regulates matrix metalloproteinases (MMPs), is expressed in various normal human tissues but downregulated in several types of human tumors. The molecular mechanism for this downregulation and its biological significance in salivary adenoid cystic carcinoma (SACC) are unclear. In the present study, we investigated the effects of a DNA methyltransferase (DNMT) inhibitor, 5-aza-2′deoxycytidine (5-aza-dC), on the methylation status of the RECK gene and tumor invasion in SACC cell lines. Methylation-specific PCR (MSP), Western blot analysis, and quantitative real-time PCR were used to investigate the methylation status of the RECK gene and expression of RECK mRNA and protein in SACC cell lines. The invasive ability of SACC cells was examined by the Transwell migration assay. Promoter methylation was only found in the ACC-M cell line. Treatment of ACC-M cells with 5-aza-dC partially reversed the hypermethylation status of the RECK gene and significantly enhanced the expression of mRNA and protein, and 5-aza-dC significantly suppressed ACC-M cell invasive ability. Our findings showed that 5-aza-dC inhibited cancer cell invasion through the reversal of RECK gene hypermethylation, which might be a promising chemotherapy approach in SACC treatment.

Analysis of steps adapted protocol in cardiac rehabilitation in the hospital phase / Análise do protocolo adaptado de steps na reabilitação cardíaca na fase hospitalar

Objective: To analyze a cardiac rehabilitation adapted protocol in physical therapy during the postoperative hospital phase of cardiac surgery in a service of high complexity, in aspects regarded to complications and mortality prevalence and hospitalization days. Methods: This is an observational cross-sectional, retrospective and analytical study performed by investigating 99 patients who underwent cardiac surgery for coronary artery bypass graft, heart valve replacement or a combination of both. Step program adapted for rehabilitation after cardiac surgery was analyzed under the command of the physiotherapy professional team. Results: In average, a patient stays for two days in the Intensive Care Unit and three to four days in the hospital room, totalizing six days of hospitalization. Fatalities occurred in a higher percentage during hospitalization (5.1%) and up to two years period (8.6%) when compared to 30 days after hospital discharge (1.1%). Among the postoperative complications, the hemodynamic (63.4%) and respiratory (42.6%) were the most prevalent. 36-42% of complications occurred between the immediate postoperative period and the second postoperative day. The hospital discharge started from the fifth postoperative day. We can observe that in each following day, the patients are evolving in achieving the Steps, where Step 3 was the most used during the rehabilitation phase I. Conclusion: This evolution program by steps can to guide the physical rehabilitation at the hospital in patients after cardiac surgery. .

Objetivo: Analisar o protocolo adaptado de reabilitação cardíaca na fisioterapia durante a fase hospitalar pós-operatória de cirurgia cardíaca em um serviço de alta complexidade, nos aspectos complicações e prevalência de mortalidade e dias de internação. Métodos: Estudo observacional transversal, retrospectivo, analítico. Realizado por meio da investigação de 99 prontuários de pacientes submetidos à cirurgia cardíaca de revascularização do miocárdio, troca de valva cardíaca ou associadas. Foi analisado um programa de step adaptado para reabilitação pós-operatória de cirurgia cardíaca executado pela equipe de Fisioterapia. Resultados: Em média, o paciente permanece dois dias na Unidade de Terapia Intensiva e de três a quatro dias no quarto, ficando, em média, seis dias internado no hospital. O óbito ocorreu em maior percentual no período hospitalar (5,1%) e até dois anos (8,6%) quando comparado ao período de 30 dias pós-alta hospitalar (1,1%). Dentre as complicações no pós-operatório, as hemodinâmicas (63,4%) e respiratórias (42,6%) foram as mais predominantes. De 36% a 42% das complicações ocorreram entre o pós-operatório imediato e o segundo dia pós-operatório. A alta hospitalar teve início a partir do quinto dia pós-operatório. Podemos observar que, com o passar dos dias, os pacientes vão evoluindo na realização dos steps, sendo que o mais utilizado durante a reabilitação na fase I foi o Step 3. Conclusão: Este programa de evolução por steps pode nortear a reabilitação fisioterapêutica nos pacientes no pós-operatório de cirurgia cardíaca na fase hospitalar. .

Evaluation of the predictive indices for candidemia in an adult intensive care unit

INTRODUCTION: To evaluate predictive indices for candidemia in an adult intensive care unit (ICU) and to propose a new index. METHODS: A prospective cohort study was conducted between January 2011 and December 2012. This study was performed in an ICU in a tertiary care hospital at a public university and included 114 patients staying in the adult ICU for at least 48 hours. The association of patient variables with candidemia was analyzed. RESULTS: There were 18 (15.8%) proven cases of candidemia and 96 (84.2%) cases without candidemia. Univariate analysis revealed the following risk factors: parenteral nutrition, severe sepsis, surgical procedure, dialysis, pancreatitis, acute renal failure, and an APACHE II score higher than 20. For the Candida score index, the odds ratio was 8.50 (95% CI, 2.57 to 28.09); the sensitivity, specificity, positive predictive value, and negative predictive value were 0.78, 0.71, 0.33, and 0.94, respectively. With respect to the clinical predictor index, the odds ratio was 9.45 (95%CI, 2.06 to 43.39); the sensitivity, specificity, positive predictive value, and negative predictive value were 0.89, 0.54, 0.27, and 0.96, respectively. The proposed candidemia index cutoff was 8.5; the sensitivity, specificity, positive predictive value, and negative predictive value were 0.77, 0.70, 0.33, and 0.94, respectively. CONCLUSIONS: The Candida score and clinical predictor index excluded candidemia satisfactorily. The effectiveness of the candidemia index was comparable to that of the Candida score. .

Lesiones focales hepáticas benignas: un hallazgo frecuente a la tomografía computada / Benign focal liver lesions detected by computed tomography: Review of 1,184 examinations

Background: Multidetector computed tomography (MDCT) of the abdomen, with use of contrast medium, is able to detect and differentiate most focal liver lesions. Aim: To determine the prevalence and features of benign focal liver lesions (BFLL) detected by abdominal MDCT. Patients and Methods: We reviewed the reports of contrast abdominal MDCT performed to outpatients between August 2011 and July 2012. Clinical data of examined patients and imaging findings in terms of description of the hepatic parenchyma and the presence of BFLL, were recorded. Results: Data from 1,184 studies were analyzed. Of these, 461 studies (38.4%) reported BFLL. The most prevalent lesions were simple cysts in 290 studies (24%) and hemangiomas in 61 studies (5.1%), granuloma-calcification in 39 (3.2%), focal nodular hyperplasia in 19 (1.6%) and one adenoma. If patients with known causes of liver disease were excluded, the prevalence of BFLL did not change substantially (lesions were found in 396 (37.5%) patients). Compared with livers with signs of damage, normal livers had more cystic lesions (27 and 16.2% respectively, p = 0.014) and hemangiomas (5.3 and 1.1% respectively, p = 0.043). Conclusions: BFLL are very common findings in MDCT studies. Most of these lesions are simple cysts and hemangiomas.

Examen de detección de virus papiloma humano en el tamizaje de cáncer cervicouterino en un Servicio de Salud de Santiago, Chile / Human papillomavirus testing in cervical cancer screening at a public health service of Santiago, Chile

Background: Molecular techniques for human papillomavirus (HPV) detection have a good performance as screening tests and could be included in cervical cancer early detection programs. We conducted a population-based trial comparing HPV detection and Papanicolaou as primary screening tests, in a public health service in Santiago, Chile. Aim: To describe the experience of implementing this new molecular test and present the main results of the study. Material and Methods: Women aged 25 to 64 enrolled in three public health centers were invited to participate. In all women, samples were collected for Papanicolaou and HPV DNA testing, and naked-eye visual inspection of the cervix with acetic acid was performed. Women with any positive screening test were referred to the local area hospital for diagnostic confirmation with colposcopy and biopsy of suspicious lesions. Results: Screening results were obtained for 8265 women, of whom 931 (11.3%) were positive to any test. The prevalence of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) was 1.1%; nine women had invasive cervical cancer. Sensitivities for the detection of CIN2+ were 22.1% (95% confidence interval (CI) 16.4-29.2) for Papanicolaou and 92.7% (95% CI 84.4-96.8) for HPV testing; specificities were 98.9% (95% CI 98.7-99.0) and 92.0% (95% CI 91.4-92.6) respectively. Conclusion: This experience showed that the implementation of a molecular test for cervical cancer screening is not a major challenge in Chile: it was well accepted by both the health team and the participants, and it may improve the effectiveness of the screening program.

Strengthening health system accountability: a WHO European Region multi-country study

This report takes stock of the measures that Member States of the WHO European Region have put in place to strengthen health system accountability since the Tallinn Charter: Health Systems for Health and Wealth (2008) and the Health 2020 policy framework (2012) were adopted. These last years have been undoubtedly marked by significant challenges facing the health systems in the Region, including international and national environments affected by an economic crisis, increased health needs, as well as resource scarcity. However, and in spite of the challenging context, Member States across the Region have taken abundant and significant steps to improve health system accountability. This report summarizes the experiences of Member States strengthening health system accountability in the context of the momentum created by the Tallinn Charter and Health 2020 through rigorous goal setting,as well as health system performance measurement and review.

Improving the lives of children and young people: case studies from Europe, volume 3: school

As part of the European review of social determinants of health and the health divide, experts were commissioned to write case studies addressing childhood and inequality. They identified promising developments with international resonance, described the issues they addressed and how they were led and put into operation, and set out the emerging evidence of their effectiveness.This diverse collection of case studies is presented in three volumes reflecting a “life-course” approach: Volume 3 addresses school, with examples from Croatia, Cyprus, Denmark, Finland, France, Germany, Italy, Lithuania, the Netherlands, Spain and Sweden. Volumes 1 and 2 address the early years and childhood. Some of the case studies review major national policy developments and frameworks, others deal with specific national initiatives or with local projects driven by community organizations, and a few focus on transnational initiatives. They are not necessarily a comprehensive overview of childhood and health in the WHO European Region, but provide examples of innovative practice that will inform and inspire policy-makers, practitioners, managers, educators and researchers, committed to improving the lives of children and young people at country and European levels.

Pharmaceutical policies in Finland: challenges and opportunities

Health systems are under continuous pressure to meet the demands of their populations. In Finland, one area currently under review is that of pharmaceutical policy. Following a request from the Health Department, Ministry of Health and Social Affairs, the European Observatory on Health Systems and Policies commissioned a review of the regulatory system of pharmaceutical policies in Finland. The assessment suggests that despite the challenges of a very developed system of pharmaceutical regulation, practical options exist to improve transparency and pricing policies, to strengthen the institutional environment and to improve the development of pharmacotherapy practices. The purpose of this book is not to prescribe solutions, but to suggest a range of options for policy-makers to reflect on so as to assist them in the process of policy review. Given this approach and the international perspective the report takes, it should stimulate further debate on the continuing development of pharmaceutical policies well beyond the confines of Finland's borders.

Closing the health inequalities gap : an international perspective : / written by Iain K. Crombie ... [et al.]

This report presents an analysis of official documents on government policies to tackle inequalities in health from 13 developed countries. All countries recognize that health inequalities are caused by adverse socioeconomic and environmental circumstances. However they differ in their definitions of inequalities and in their approaches to tackling the problem. Sweden and Northern Ireland have structured their overall public health policy to tackle the underlying determinants of inequalities in health. England is the only country with a separate comprehensive policy. Most countries also have policies on poverty, social inclusion, and social justice. These are motivated by a concern for human rights and dignity and deal primarily with the underlying causes of health inequalities. While broadly setting the same overarching goal, policies on health inequalities show many different features. Policymakers face two challenges: to ensure that strategies to tackle the macroenvironmental factors feature in policy on inequalities in health, and to ensure that health becomes a prominent issue in social justice policy. Few countries have a coordinated approach to tackling inequalities in health

European Advisory Group on the Expanded Programme on Immunization : report on the 12th meeting, Copenhagen, Denmark, 21 November 1996

At its twelfth meeting, the European Advisory Group (EAG) confirmed that the first priority for measles control was the achievement of high coverage with a single dose of vaccine, though this would not serve to eliminate the disease. The interruption of transmission needed to be maintained, and this could be achieved with supplementary vaccination, either through repeated campaigns or by the administration of second doses. Whichever approach was used, it was essential that the reaccumulation of susceptibles was prevented. The EAG endorsed the importance of achieving very high coverage of primary immunization with DTP vaccine. This should be completed before six months of age. The first booster could be given at 16-36 months of age, with another (DT) before school entry and a third (Td) on leaving school. This recommendation applied to all European countries. In a number of countries, especially those presently experiencing or having recently experienced epidemic diphtheria, a further booster should be given during the school years. Where the risk of diphtheria was considered high, periodic booster doses for adults would be necessary to prevent resurgence of the disease as immunity waned. On poliomyelitis, the EAG noted the significant impact of Operation MECACAR and the increasing awareness that remaining outbreaks of poliomyelitis in the Region had often followed importation of the disease. The EAG endorsed the plan of action for 1997 proposed by the Regional Office. In countries where poliomyelitis was still endemic or had become nonendemic within the past three years, the surveillance of acute flaccid paralysis (AFP) remained the recommended form of surveillance, especially for certification purposes. However, in countries where polioviruses had not been detected for many years, and AFP surveillance was not appropriate, other means of surveillance would need to be used. The EAG recommended that the Regional Office commission a position paper to review the options for laboratory-based or other surveillance techniques, so that appropriate guidelines could be issued