Impacto de la edad, las comorbilidades y las complicaciones en pacientes con COVID-19 con síndrome de dificultad respiratoria aguda en la ventilación mecánica invasiva. Estudio multicéntrico observacional / Impact of Age, Comorbidities and Complications in COVID-19 Patients with Acute Respiratory Distress Syndrome on Invasive Mechanical Ventilation. An Observational Multicenter Study

Objetivos: Millones de pacientes con COVID-19 fueron internados en terapia intensiva en el mundo, la mitad desarrollaron síndrome de dificultad respiratoria aguda (SDRA) y recibieron ventilación mecánica invasiva (VMI), con una mortalidad del 50%. Analiza-mos cómo edad, comorbilidades y complicaciones, en pacientes con COVID-19 y SDRA que recibieron VMI, se asociaron con el riesgo de morir durante su hospitalización.Métodos: Estudio de cohorte observacional, retrospectivo y multicéntrico realizado en 5 hospitales (tres privados y dos públicos universitarios) de Argentina y Chile, durante el segundo semestre de 2020.Se incluyeron pacientes >18 años con infección por SARS-CoV-2 confirmada RT-PCR, que desarrollaron SDRA y fueron asistidos con VMI durante >48 horas, durante el se-gundo semestre de 2020. Se analizaron los antecedentes, las comorbilidades más fre-cuentes (obesidad, diabetes e hipertensión), y las complicaciones shock, insuficiencia renal aguda (IRA) y neumonía asociada a la ventilación mecánica (NAV), por un lado, y las alteraciones de parámetros clínicos y de laboratorio registrados.Resultados: El 69% era varón. La incidencia de comorbilidades difirió para los diferentes grupos de edad. La mortalidad aumentó significativamente con la edad (p<0,00001). Las comorbilidades, hipertensión y diabetes, y las complicaciones de IRA y shock se asociaron significativamente con la mortalidad. En el análisis multivariado, sólo la edad mayor de 60 años, la IRA y el shock permanecieron asociados con la mortalidad. Conclusiones: El SDRA en COVID-19 es más común entre los mayores. Solo la edad >60 años, el shock y la IRA se asociaron a la mortalidad en el análisis multivariado.

Objectives: Millions of patients with COVID-19 were admitted to intensive care world-wide, half developed acute respiratory distress syndrome (ARDS) and received invasive mechanical ventilation (IMV), with a mortality of 50%. We analyzed how age, comor-bidities and complications in patients with COVID-19 and ARDS who received IMV were associated with the risk of dying during their hospitalization.Methods: Observational, retrospective and multicenter cohort study carried out in 5 hospitals (three private and two public university hospitals) in Argentina and Chile, during the second half of 2020.Patients >18 years of age with SARS-CoV-2 infection confirmed by RT-PCR, who devel-oped ARDS and were assisted with IMV for >48 hours, during the second half of 2020, were included. History, the most frequent comorbidities (obesity, diabetes and hyper-tension) and the complications of shock, acute renal failure (AKI) and pneumonia as-sociated with mechanical ventilation (VAP), on the one hand, and the alterations of re-corded clinical and laboratory parameters, were analyzed.Results: 69% were men. The incidence of comorbidities differed for different age groups. Mortality increased significantly with age (p<0.00001). Comorbidities, hyper-tension and diabetes, and complications of ARF and shock were significantly associat-ed with mortality. In the multivariate analysis, only age over 60 years, ARF and shock remained associated with mortality.Conclusions: ARDS in COVID-19 is more common among the elderly. Only age >60 years, shock and ARF were associated with mortality in the multivariate analysis

Abordaje endoscópico extendido del seno frontal: Experiencia en Hospital Clínico Universidad de Chile / Extended endoscopic approach of the frontal sinus: Experience at Hospital Clínico Universidad de Chile

Introducción: El seno frontal es una estructura compleja y desafiante en términos quirúrgicos, siendo descritas numerosas técnicas para su abordaje. Dentro de ellas se destaca el abordaje endoscópico extendido de seno frontal: Draf IIB y Draf III, como una importante alternativa para resolución de patología refractaria de seno frontal. Objetivo: Describir las características de pacientes sometidos a abordaje endoscópico extendido de seno frontal en Hospital Clínico Universidad de Chile (HCUCH). Material y Método: Estudio retrospectivo, descriptivo. Se incluyeron a pacientes sometidos a abordaje endoscópico extendido de seno frontal entre los años 2013 y 2021. Se analizaron variables clínicas, intraoperatorias y de seguimiento. Resultados: Se registraron 118 pacientes, de los cuales 64 cumplieron criterios de inclusión al estudio, con una edad promedio de 48 años. La patología más frecuente fue la rinosinusitis crónica poliposa (42%) seguido del mucocele (20%). Del total de pacientes, el 68% fue sometido a cirugía Draf IIB y el resto a Draf III. Todos los pacientes fueron estudiados con endoscopía e imágenes, y seguidos con parámetros clínicos y endoscópicos. El porcentaje de estenosis postoperatoria se estimó en 10%. Conclusión: El abordaje endoscópico nasal extendido figura como una alternativa útil para manejo de patología de seno frontal refractario a tratamiento. En nuestra experiencia las indicaciones, tipos de cirugía y tasa de complicaciones son concordantes con la literatura internacional.

Introduction: The frontal sinus is a complex and challenging structure in surgical terms, numerous techniques have been described for its approach, among them the extended endoscopic approach: Draf IIB and Draf III, figures as an important alternative for the resolution of refractory pathology of frontal sinus. Aim: To describe the characteristics of patients who underwent an extended endoscopic approach to the frontal sinus at the Hospital Clínico Universidad de Chile (HCUCH). Material and Method: A retrospective, descriptive study included patients who underwent an extended endoscopic approach to the frontal sinus between 2013 and 2021. Clinical, intraoperative, and follow-up variables were analyzed. Results: 118 patients were registered, of which 64 met the inclusion criteria for the study, with an average age of 48 years. The most frequent pathology was chronic polypous rhinosinusitis (42%), followed by mucocele (20%). Of the patients, 68% underwent Draf IIB surgery, while the rest received a Draf III type procedure. All patients were studied with endoscopy and images and followed up with clinical and endoscopic parameters. The percentage of post operatory stenosis was 10%. Conclusion: The extended nasal endoscopic approach appears as a valuable alternative for managing frontal sinus pathology refractory to treatment. In our experience, the indications, types of surgery, and rate of complications are consistent with the international literature.

Estudio de prevalencia de retinopatía diabética en pacientes diabéticos tipo 2 de la comuna de Puerto Montt y sus factores asociados / Frequency of diabetic retinopathy and associated factors in Puerto Montt, Chile

BACKGROUND: Diabetic retinopathy (DR) is an important cause of decreased visual acuity, whose prevalence has increased between 1990 and 2020. In Chile the prevalence of diabetic retinopathy was estimated at 24.8%. AIM: To assess the prevalence of DR in a southern Chilean city. MATERIAL AND METHODS: From a database of diabetic patients attending primary health care centers at Puerto Montt, Chile, 196 patients with DR and 392 patients without DR, matched by age and presence of chronic complications, were chosen for this case-control study. RESULTS: The prevalence of DR in the database of diabetic patients was 33.3%. glycated hemoglobin, the frequency insulin use, systolic blood pressure, HDL cholesterol, microalbuminuria, and proteinuria were significantly worse in cases. A multivariate analysis showed that retinopathy is much more likely to occur when the variables insulin use, neuropathy, and microalbuminuria concur. CONCLUSIONS: DR was associated with worse metabolic parameters and the presence of neuropathy in this case control study.

Cirugía de revascularización miocárdica: comparación de supervivencia a 10 años de la cirugía coronaria con y sin circulación extracorpórea mediante Propensity Score Matching / Ten-year survival after off-pump coronary artery bypass grafting compared with traditional bypass grafting

BACKGROUND: Long-term outcomes of Off-Pump Coronary Artery Bypass Grafting (OPCAB) as an alternative to the traditional Coronary Artery Bypass Grafting (CABG) technique with cardiopulmonary bypass (CPB) are not well defined. AIM: To compare 10-year survival of isolated OPCAB versus CABG with CPB. MATERIAL AND METHODS: Analysis of information obtained from databases, clinical records and surgical protocols of patients treated with isolated CABG between January 2006 and November 2008 at a Regional Hospital. Of 658 isolated CABG, 192 (29.2%) were OPCAB and 466 (79.9%) CPB. Propensity Score Matching (PSM) was performed to compare both groups. After PSM, two groups of 192 cases were obtained. Mortality data was obtained from the Chilean public identification service. Ten-year survival was calculated and compared with Kaplan-Meier and log-rank methods. RESULTS: Follow-up data was obtained in all cases. No statistically significant differences were found when comparing 10-year survival between OPCAB versus CPB (78.6% and 80.2% respectively, p 0.720). There was also no statistical difference in cardiovascular death free survival (90.1% with CPB versus 89.1% OPCAB, p 0.737). Survival was comparable when analyzing subgroups with diabetes mellitus, left ventricular dysfunction or chronic kidney disease, among others. CONCLUSIONS: In our series, OPBAB has a comparable 10-year survival with CABG with CPB.

Oral disorders among older Chileans: prevalence, incidence, and years lived with disability / Prevalência, incidência e anos vividos com incapacidade por doenças bucais no Chile

OBJECTIVE: Prior epidemiological surveys revealed that Chile experiences a high burden of oral diseases. However, no prior study has reported estimates of untreated dental caries, periodontitis, and edentulism over a three-decade period for the country. Using estimates of the Global Burden of Diseases Study (GBD) 2019, the objective of this study is to report the trends of prevalence, incidence, and years-lived with disability (YLDs) due to untreated dental caries, periodontitis, and edentulism in Chilean older adults between 1990 and 2019. METHODS: Estimates of prevalence, incidence, and YLDs due to dental caries, periodontitis, and edentulism were produced for Chile, by age and sex, between 1990 and 2019, using Dismod-MR 2.1. Trends of oral disorders were analyzed using generalized linear regression models applying the Prais-Winsten method. RESULTS: Untreated dental caries and periodontal disease showed an increase in prevalence and YLDs, whereas edentulism prevalence, incidence, and YLDs decreased in all older adults age groups. The incidence of dental caries decreased in the younger groups and increased in the older age groups; while the incidence of periodontal disease increased in the younger and decreased in the older age groups. CONCLUSIONS: Overall, the burden of oral diseases in older Chileans increased between 1990 and 2019. This was particularly relevant for untreated caries and periodontal disease. Future estimates of oral diseases burden in Chile require concerted efforts to produce national health surveys that incorporate oral diseases metrics. These estimates are essential to inform policy formulation, implementation and evaluation. (AU)

OBJETIVO: Pesquisas epidemiológicas anteriores revelaram que o Chile apresenta uma elevada carga de doenças bucais. No entanto, nenhum estudo anterior relatou estimativas de cárie dentária não tratada, periodontite e edentulismo ao longo de um período de três décadas para o país. Usando estimativas do Global Burden of Diseases Study (GBD) 2019, o objetivo deste estudo é relatar as tendências de prevalência, incidência e anos vividos com incapacidade (YLDs) devido a cárie dentária não tratada, periodontite e edentulismo em idosos chilenos entre 1990 e 2019. METODOLOGIA: Estimativas de prevalência, incidência e YLDs devido à cárie dentária, periodontite e edentulismo foram produzidas para o Chile, por idade e sexo, entre 1990 e 2019, usando o Dismod-MR 2.1. Tendências de distúrbios bucais foram analisadas usando modelos de regressão linear generalizada aplicando o método Prais-Winsten. RESULTADOS: A cárie dentária não tratada e a doença periodontal mostraram um aumento na prevalência e nos YLDs, enquanto a prevalência, incidência e YLDs do edentulismo diminuíram em todas as faixas etárias de idosos. A incidência de cárie dentária diminuiu nos grupos mais jovens e aumentou nos grupos etários mais velhos; enquanto a incidência de periodontite aumentou nos grupos mais jovens e diminuiu nos grupos etários mais velhos. CONCLUSÕES: No geral, a carga de doenças bucais em idosos chilenos aumentou entre 1990 e 2019. Isso foi particularmente relevante para cárie não tratada e periodontite. As estimativas futuras da carga de doenças bucais no Chile exigem esforços concentrados para produzir pesquisas nacionais de saúde que incorporem métricas de doenças bucais. Essas estimativas são essenciais para informar a formulação, implementação e avaliação de políticas. (AU)

COVID-19 y personas mayores en Chile: lecciones de dos años de pandemia / The impact of COVID-19 on the health status of older people in Chile

The article presents the main impact of COVID-19 pandemic on the health status of older people, systematizing the information about the direct impact of the pandemic in terms of number of cases, hospitalizations, deaths, the policies implemented for the prevention and management of COVID-19 in older people and the indirect impact of the two years of pandemic. Adopting a broad definition of health, the need to monitor and recover health care of older people is highlighted. The recovery of their functionality and mental health must be emphasized. The policies towards institutionalized older people must be revised. These areas should be the focus of health care policies for older people in Chile.

Asociación entre nivel educacional y sospecha de deterioro cognitivo en personas mayores chilenas: resultados de la Encuesta Nacional de Salud 2016-2017 / Association between educational level and suspicion of cognitive imparirment in Chilean older people

BACKGROUND: A low education level has been associated with cognitive impairment in older adults. AIM: To determine the association between educational attainment and suspicion of cognitive imparirment in older Chilean population. MATERIAL AND METHODS: Data from 2,005 adults aged ≥ 60 years assessed during 2016-2017 Chilean National Health Survey were included. Education was self-reported and categorized as primary: ≤ 8 years; secondary: 9 to 12 years and beyond secondary: > 12 years. suspicion of cognitive imparirment was assessed with the Mini-Mental questionnaire. RESULTS: Men and women with low education attainment had a higher prevalence of cognitive impairment (33% [95% confidence intervals (CI): 24; 41] and 27% [95% CI: 21; 33], respectively). Men who reported less schooling (≤ 8 years) were more likely to be at risk of suspicion of cognitive imparirment (Odds ratio (OR): 4.53 [95% CI: 1.10, 18.62]) compared to their peers. Women showed a substantially higher magnitude of association than men. The probability of suspicion of cognitive imparirment increased 9-times (OR: 9.96 [95% CI: 1.24; 79.6]) for 9-12 years and 18-times for ≤ 8 years of education (OR: 18.8 [95% CI: 2.42; 146.1]) compared to women with higher education. CONCLUSIONS: Older adults with low education attainment had an increased likelihood of developing suspicion of cognitive imparirment. However, the risk differs by sex, being higher in women than men.

Frecuencia de y cesáreas en establecimientos públicos y privados de la Provincia de Concepción, Chile, 2001-2019 / Caesareans section frequency in public and private establishments of the Province of Concepción, Chile, 2001-2019

Introducción: El porcentaje nacional de cesárea supera las recomendaciones internacionales, alcanzando altos niveles, con consecuencias significativas en la salud de la mujer. Por esta razón es un problema necesario de analizar. Objetivo: Describir la situación epidemiológica de las cesáreas en la Provincia de Concepción, periodo 2001-2019, según establecimiento y previsión. Material y métodos: Estudio observacional, descriptivo, ecológico, transversal. Incluye universo de partos en la Provincia de Concepción 2001-2019, datos del Departamento de Estadísticas e Información de Salud (DEIS). Recopilación y análisis según técnicas descriptivas en Microsoft Excel® Resultados: En establecimientos públicos, el número de partos disminuyó un 60.6%. En establecimientos privados aumentó 4.8 veces, junto al 39% de incremento en las cesáreas. Las pacientes pertenecientes al grupo A de menores ingresos de la aseguradora de salud pública, Fondo Nacional de Salud (FONASA), presentaron un porcentaje estable de cesáreas, en torno al 25%, mientras que el grupo D (de mayores ingresos) aumentó un 47.8% entre los años 2005 y 2009. Entre 2002 y 2019 el porcentaje promedio de cesáreas de pacientes pertenecientes a las aseguradoras privadas, Instituciones de Salud Previsional (ISAPRE), fue del 66.5%. Conclusiones: Se observó un aumento de cesáreas muy especialmente en recintos privados. La previsión de salud es un factor que considerar, particularmente el grupo FONASA-D, que presentó la mayor alza en las cesáreas, incluso más que las gestantes de ISAPRE. El porcentaje alarmante de cesáreas, especialmente en establecimientos privados, debe ser preocupación prioritaria para nuestro sistema de salud.

Introduction: The national caesarean section rate exceeds international recommendations, reaching elevated levels, with significant consequences on women's health. For this reason it is a necessary problem to analyze. Objective: To describe the epidemiological situation of caesarean sections in the Province of Concepción, period 2001-2019, according to establishment and forecast. Material and methods: Observational, descriptive, ecological, longitudinal study. Includes universe of births in the Province of Concepción 2001-2019, data from the Department of Statistics and Health Information (DEIS). Collection and analysis according to descriptive techniques in Microsoft Excel®. Results: In public establishments, the number of deliveries decreased by 60.6%. In private establishments it increased 4.8 times, together with the 39% increase in cesarean sections. Patients belonging to group A with the lowest income of the public health insurer, National Health Fund (FONASA), presented a stable percentage of caesarean sections, around 25%, while group D (with the highest income) increased 47.8% between 2005 and 2009. Between 2002 and 2019, the average percentage of caesarean sections of patients belonging to private insurers, Institutions of Social Security (ISAPRE), was 66.5%. Conclusions: An increase in caesarean sections was observed, especially in private facilities. Health insurance is a factor to consider, particularly the FONASA-D group, which presented the highest increase in cesarean sections, even more than ISAPRE pregnant women. The alarming percentage of caesarean sections, especially in private establishments, should be a priority concern for our health system.

Exploration of the motivations in the adherence of patients to periodontal maintenance therapy / Exploración de las motivaciones en la adherencia de los pacientes en la mantención periodontal

Introduction: Although it has been shown that the supportive periodontal therapy (SPT) is essential to maintain the results obtained by periodontal therapy, patient adherence to SPT is not usually satisfactory (4). The objective of this research is to explore the motivations in the adherence to periodontal maintenance of patients treated at Universidad Viña del Mar (UVM) during the year 2020. Material and Methods: A study based on the qualitative paradigm was carried out using a design based on discourse analysis through semi-structured interviews. A sample size of 10 participants was consolidated, by obtaining with them the saturation of data collected and of 4 main dimensions. Each interview was transcribed ad verbatim and later analyzed through the Atlas.ti 9 Software. Results: Four main categories or dimensions were created: Motivations of the patients to produce a change in their oral health; Information that the patients have regarding their oral health; Oral hygiene habits acquired after periodontal treatment; Situations that prevent adherence to periodontal treatment. Conclusion: The main motivations of patients to adhere to supportive periodontal therapy are related to the education and information they acquire in the first phase of periodontal treatment. Observing the changes during treatment, improving oral health, improving aesthetics and functionality, are other important motivations, as well as the patients' fear of losing their teeth and the desire to educate their family.

Introducción: Aunque se ha demostrado que la fase de mantención periodontal (TPS) es esencial para mantener los resultados obtenidos por la terapia periodontal, la adherencia del paciente a la TPS no es, en su mayoría, satisfactoria (4). El objetivo de esta investigación es explorar las motivaciones de los pacientes en la adherencia a la mantención periodontal, atendidos en la Universidad Viña del Mar (UVM), durante el año 2020. Material y Métodos: Se realizó una investigación basada en el paradigma cualitativo por medio de un diseño en base al análisis de discursos a través de entrevistas semiestructuradas. Se consolidó un tamaño muestral de 10 participantes, al obtener con ellos la saturación de datos recolectados y de 4 dimensiones principales, cada entrevista fue transcrita ad verbatim y posteriormente analizadas a través del Software Atlas.ti 9. Resultados: Se generaron cuatro categorías o dimensiones principales: Motivaciones del paciente para generar un cambio en su salud oral, Información que posee el paciente respecto a su salud oral, Hábitos de higiene oral adquiridos posterior al tratamiento periodontal y Situaciones que impiden la adherencia al tratamiento periodontal. Conclusión: Las motivaciones principales que presentan los pacientes para adherirse a la fase de mantención periodontal, están relacionadas con la educación e información que adquieren en la primera fase del tratamiento periodontal. Observar los cambios durante el tratamiento, adquirir salud oral, mejorar la estética y funcionalidad, son otras motivaciones de importancia, así como el miedo que presenta el paciente de perder sus dientes y las ganas de querer educar a su familia.

Virus linfotrópico humano de células T tipo 1 (HTLV-1) en el embarazo / Human lymphotropic virus in T-cell type 1 (HTLV-1) during pregnancy

El HTLV-1 es un retrovirus que afecta principalmente a los linfocitos T-CD4, causando enfermedades como paraparesia espástica o mielopatía, uveítis, dermatitis infecciosas, leucemia/linfoma de las células T del adulto, además de otras enfermedades. Causa una infección crónica de por vida en humanos y su transmisión ocurre a través de la lactancia materna, el contacto sexual y las transfusiones de sangre. En Chile actualmente ocupa el cuarto lugar en notificaciones entre el año 2014-2021, estimándose a nivel mundial más de 20 millones de portadores. El mayor riesgo de transmisión ocurre por lactancia mayor a seis meses y alta carga proviral y altos títulos de anticuerpos en la madre portadora. El objetivo consistió en analizar la situación de la portación del virus HTLV-1 durante el embarazo, determinando su prevalencia, vías de transmisión y complicaciones. Se realizó una revisión bibliográfica sistemática de artículos publicados en bases de datos científicas referidos al virus HTLV-1. Este virus está globalmente diseminado y se presenta en forma endémica en algunas regiones del mundo con prevalencias entre muy elevadas y bajas. En Chile la seroprevalencia en promedio es de 0,124% para HTLV-1. Esta infección no cuenta con tratamiento, solo se tratan los síntomas por lo que mientras esto no cambie, solo es factible reducir la transmisión, incidencia y la morbilidad del HTLV-1 incorporando medidas de control del virus en las intervenciones de control de enfermedades y estrategias de salud pública. La forma más eficiente de transmisión del virus madre-hijo es a través de la leche materna, es necesario implementar la detección prenatal de HTLV-1, en especial en las zonas endémicas, así como también asesorar a las madres HTVL-1 positivas sobre la lactancia materna.

HTLV-1 is a retrovirus that mainly affects CD4-T lymphocytes, causing diseases such as spastic paraparesis or myelopathy, uveitis, infectious dermatitis, adult T-cell leukemia/lymphoma, and other diseases. It causes a lifelong chronic infection in humans and its transmission occurs through breastfeeding, sexual contact and blood transfusions. In Chile, it currently ranks fourth in notifications between the years 2014-2021, with more than 20 million carriers being estimated worldwide. The greatest risk of transmission occurs by breastfeeding for more than six months and high proviral load and high antibody titers in the carrier mother. The objective consisted of analyzing the situation of the carriage of the HTLV-1 virus during pregnancy, determining its prevalence, transmission routes and complications. A systematic bibliographic review of articles published in scientific databases referring to the HTLV-1 virus was carried out. This virus is globally disseminated and occurs endemic in some regions of the world with prevalence between very high and low. In Chile, the average seroprevalence is 0.124% for HTLV-1. There is no treatment for this infection, only the symptoms are treated, so as long as this does not change, it is only feasible to reduce the transmission, incidence, and morbidity of HTLV-1 by incorporating virus control measures into disease control interventions and strategies. of public health. The most efficient form of mother-child transmission of the virus is through breast milk, it is necessary to implement prenatal screening for HTLV-1, especially in endemic areas, as well as counsel HTLV-1 positive mothers on breastfeeding

Tendencias en la mortalidad por neumonía en adultos en Chile, 2000-2016 / Trends in adult pneumonia mortality in Chile, 2000-2016

Objetivo: Analizar y modelar los cambios en la tendencia de la mortalidad por neumonía en la población mayor de 15 años de Chile, entre los años 2000 y 2016. Métodos: Estudio epidemiológico basado en información de bases de datos públicas de estadísticas vitales del Departamento de Estadística e Información en Salud (DEIS) y del Instituto Nacional de Estadística (INE) del Ministerio de Salud (MINSAL) de Chile. Los casos fueron identificados por los códigos CIE-10 J12-J18. Se calculó la tasa de mortalidad estandarizada por edad, según sexo y grupo etario. Se utilizó el análisis de regresión Joinpoint para modelar la mortalidad y estimar el porcentaje de cambio anual (CPA) en las tasas e identificar cambios significativos en las tendencias. Se utilizó el cambio del CPA como medida de resumen. Resultados: Durante el período de estudio, la tasa de mortalidad por neumonía en Chile disminuyó significativamente en un 61,9%, desde 56,3 muertes por 100.000 habitantes el año 2000 a 21,7 muertes por 100.000 habitantes en el año 2016, con un CPA de −4,2%, (p < 0,05). El 90% de los fallecidos tenían más de 65 años. Conclusiones: Las tasas de mortalidad por neumonía en Chile en mayores de 15 años muestran una tendencia a la disminución sostenida significativa en el período comprendido entre los años 2000 y 2016.

Objective: To analyze and model changes in the pneumonia mortality trend in the population over 15 years old of Chile, between 2000 and 2016. Methods: Epidemiological study based on information from public databases of vital statistics of the Department of Health Statistics and Information (DEIS) and the National Institute of Statistics (INE) of the Ministry of Health (MINSAL) of Chile. The cases were identified by the codes ICD-10 J12-J18. We calculated age-standardized overall mortality, according to sex and age group. Joinpoint regression analysis was used to model mortality and estimate the annual percentage of change (APC) in rates and identify significant changes in trends. APC was used as a summary measure. Results: During the period studied, the pneumonia mortality rate in Chile decreased significantly by 61.9%. Mortality rate diminished from 56.3 deaths per 100,000 inhabitants in 2000 to 21.7 deaths per 100,000 inhabitants in 2016 with an APC of −4.2%, (p < 0.05). Almost 90% of the deceased were over 65 years old. Conclusions: Mortality rates for pneumonia in Chile in people over 15 years of age show a significant sustained decreasing trend in the period between 2000 and 2016.

Fuerza de prensión manual. Un sencillo, pero fuerte predictor de salud en población adulta y personas mayores / Handgrip strength as a predictor of adverse health outcomes

Muscle strength can be measured through different methods and handgrip strength is one of the most used techniques in epidemiological studies. Given its easy application, high reliability, and low cost, it is considered an important health biomarker. Handgrip strength is associated with adverse health outcomes such as mortality and risk of developing chronic diseases, cardiovascular, respiratory, cancer and dementia. There is a paucity of evidence in Chile about the association of handgrip strength with these health outcomes limiting its visibility and implementation in clinical settings. Therefore, this narrative review summarizes the scientific evidence about the association of grip strength with non-communicable chronic diseases and mortality in middle age and older adults.

Urgencia odontológica ambulatoria en la población de la red pública de salud en Chile, 2017-2020 / Outpatient dental emergency in the population of the public health network in Chile, 2017-2020

OBJETIVO Describir la tendencia de las consultas de urgencia odontológica ambulatoria registrada en la población atendida en la red pública de salud en Chile entre los años 2017 y 2020. MATERIALES Y METODOS Diseño de estudio ecológico. Se evaluaron las consultas de urgencia odontológica ambulatoria obtenidas del Registro Estadístico Mensual (REM) del Ministerio de Salud de Chile entre los años 2017 y 2020. Se calculó la tasa de consulta por urgencia odontológica ambulatoria (UOA) considerando el total de consultas de urgencias con Garantía explícitas en salud en el numerador y la población beneficiaria registrada por el Fondo Nacional de salud en el denominador, amplificado por 1000 para cada año de estudio. Las tasas se especificaron por sexo, grupo etario (<20 años; 20 a 64 años y 65 y más años), y zona geográfica de Chile (zona norte, centro y sur). RESULTADOS Se registraron un total de 27.639.889 consultas odontológicas en la red pública de atención de salud en el país, de estas, 1.345.390 corresponden a consultas por UOA. Se observó una disminución de la tasa de consulta por urgencia odontológica ambulatoria hacia el año 2020 (variación porcentual de -17,93%). La tasa de consultas es levemente mayor en mujeres, en edades entre 20 a 64 años y en la zona norte y sur del país. CONCLUSION Se observa una disminución sostenida en la tasa de consultas por UOA en la red pública de salud del país, lo que podría reflejar la existencia de un mayor acceso de la población a resolver los problemas de salud bucal en el nivel primario de atención asociado al desarrollo de diferentes programas de alud bucal. Sin embargo hay que ser cautelosos con la interpretación considerando que durante el periodo Chile vivió un estallido social e hizo frente a la pandemia por COVID-19

AIM To describe the trend of outpatient dental emergency registered in the population attended in the public health system in Chile between 2017 and 2020. MATERIALS AND METODOS Ecological study design. Outpatient dental emergency obtained from the Statistical Registry (REM) of the Ministry of Health of Chile between 2017 and 2020 were evaluated. The consultation rate for outpatient dental emergency (OUA) was calculated considering the total number of emergency consultations with Explicit health guarantees in the numerator and the beneficiary population registered by the National Health Fund in the denominator, amplified by 1,000 for each year of study. The rates were specified by sex, age group (<20 years; 20 to 64 years and 65 years and over), and geographical area of Chile (north, center and south). RESULTS A total of 27,639,889 dental consultations were registered in the public health care network in the country, of these, 1,345,390 correspond to consultations by UOA. A decrease in the outpatient dental emergency consultation rate was observed towards the year 2020 (percentage variation of -17.93%). The consultation rate is slightly higher in omen, between the ages of 20 and 64, and in the north and south of the ountry.CONCLUSION A sustained decrease in the consultation rate for UOA in the country's public health system is observed, which could reflect the existence of a greater access of the population to solve oral health problems at the primary level of care associated to the development of different oral health programs. However, one must be cautious with the interpretation considering that during the period Chile experienced a social explosion and faced the COVID-19 pandemic

Desarrollo de ventiladores mecánicos en Chile. Crónica de la iniciativa "Un Respiro para Chile", durante la primera ola de la pandemia COVID-19 / Development of mechanical ventilators in Chile. Chronicle of the initiative "Un Respiro para Chile"

At the beginning of the COVID-19 pandemic in Chile, in March 2020, a projection indicated that a significant group of patients with pneumonia would require admission to an Intensive Care Unit and connection to a mechanical ventilator. Therefore, a paucity of these devices and other supplies was predicted. The initiative "Un respiro para Chile" brought together many people and institutions, public and private. In the course of three months, it allowed the design and building of several ventilatory assistance devices, which could be used in critically ill patients.

Concept of functional dentition and impact on the quality of life of partially edentulous patients / Concepto dentición funcional e impacto en la calidad de vida de los pacientes desdentados parciales

Main Objective: To compare, through the OHIP-7Sp, the impact on the quality of life of partially edentulous patients, according to WHO criteria "with functional dentition", 21 or more teeth and "without functional dentition", less than 21 teeth. Material and Methods: 97 partially edentulous patients were selected between 35 and 75 years old, ASA I or II with ≤ 28 teeth remaining. Were divided in two groups, non-functional dentition (NFD) n=47 and functional dentition (FD) n=50. OHIP-7Sp survey was applied to each patient to measure the impact on quality of life in the seven dimensions considered in this survey. The scale of measurement ranges from 0 to 4, in which 0 is "never" and 4 "always", with a maximum value of 28, considering the instrument in its entirety. Highest score indicates a greater impact on quality of life. For comparison of both groups, the non-parametric Mann-Whitney test was used with a level of 95% significance. Results: Concerning all patients evaluated through the OHIP-7Sp, the mean age was 53 years. There were significant differences in the total OHIP-7Sp score, with a mean and median for the NFD group of 9.53 and 9 and for the FD group 5.02 and 5, respectively. Disaggregating the analysis, significant differences emerged in dimensions 2, 3, 4, 5, and 6 (p<0.05). Conclusion: There was a significantly greater impact on the quality of life, measured with the OHIP-7Sp, in the NFD group compared to the FD group.

Objetivo Principal: Comparar mediante el OHIP-7Sp, el impacto en la calidad de vida de pacientes desdentados parciales, según criterio OMS "con dentición funcional", 21 o más dientes y "sin dentición funcional", menos de 21 dientes. 0 Material y Métodos: Fueron seleccionados 97 pacientes desdentados parciales entre 35 y 75 años, ASA I o II con remanencia de ≤ 28 dientes. Fueron divididos en 2 grupos, dentición no funcional (DNF) n=47 y dentición funcional (DF) n=50. Se aplicó encuesta OHIP-7Sp a cada paciente para medir el impacto en la calidad de vida en las 7 dimensiones que contempla esta encuesta. La escala de medición, abarca de 0 a 4, en la cual 0 es "nunca" y 4 "siempre", con un valor máximo de 28, considerado el instrumento en su totalidad. El puntaje más alto indica un mayor impacto en la calidad de vida. Para la comparación de ambos grupos se utilizó el test no paramétrico de Mann-Whitney con un nivel de significancia del 95%. Resultados: Del total de pacientes evaluados mediante el OHIP-7Sp, el promedio de edad fue de 53 años. Hubo diferencias significativas en el puntaje del OHIP-7Sp total, con una media y mediana para el grupo DNF de 9,53 y 9 y para el grupo DF de 5,02 y 5, respectivamente. Desagregando el análisis, emergieron diferencias significativas en las dimensiones 2, 3, 4, 5, y 6 (p<0,05). Conclusión: Hubo significativamente mayor impacto en la calidad de vida, medido con el OHIP-7Sp, en el grupo DNF comparado con el grupo DF.

Analysis of clinical indicators of teledentistry management for the elderly population during the covid-19 pandemic in Chile / Análisis de indicadores clínicos del manejo de la teleodontología para la población adulta mayor durante la pandemia del covid-19 en Chile

Objective: To analyze clinical indicators of teledentistry management for the elderly population during the COVID-19 pandemic in Chile. Material and Methods:A pilot teledentistry project was developed for dental care of the elderly in 5 regions of Chile. The data obtained were recorded on the TEGO Platform to be subsequently selected and analyzed by the researchers in terms of clinical management indicators: degree of installed occupancy, degree of available occupation, degree of real occupation, interconsultation indicator per patient attended, urgencies according to reason for consultations, unpostponable prosthetic treatment according to reason for consultations, prevention in relation to granted benefits, prevention in relation to the patients cared for, and project absenteeism indicator. Results: The clinical management indicators obtained were as follows: The average degree of installed occupancy was 67%. The average degree of available occupancy was 78%, which accounts for the clinical time in which there are dental chairs and dentists willing to work. The average real occupancy degree was 86%. The average interconsultation indicator per patient observed was 25%. The indicator of urgencies according to the reason for the consultation was 95%, which indicates that the purpose of the study was fulfilled. The average unpostponable prosthetic treatment according to the reason for consultations was 5%. The prevention in relation to granted benefits reached 39%. Finally, the average indicator of absenteeism was 17%. Conclusion: The measurement of clinical management indicators contributes to meet the Chilean Ministry of Health Explicit Health Guarantees (GES), which are: Access, Timely Attention, Quality and Financial Protection.

Objetivo: Analizar indicadores clínicos del manejo de la teleodontología para la población de adultos mayores durante la pandemia de COVID-19 en Chile. Material y Métodos: Se desarrolló un proyecto piloto de teleodontología para la atención odontológica del adulto mayor en cinco regiones de Chile. Los datos obtenidos fueron registrados en la plataforma TEGO para ser posteriormente seleccionados y analizados por los investigadores en cuanto a indicadores de gestión clínica: grado de ocupación instalada, grado de ocupación disponible, grado de ocupación real, indicador de interconsulta por paciente atendido, urgencias según motivo por consultas, tratamiento protésico improrrogable según motivo de consultas, prevención en relación a las prestaciones otorgadas, prevención en relación a los pacientes atendidos e indicador de ausentismo del proyecto. Resultados: Los indicadores de gestión clínica obtenidos fueron los siguientes: El grado medio de ocupación instalada fue del 67%. El grado medio de ocupación disponible fue del 78%, lo que da cuenta del tiempo clínico en el que hay sillones dentales y odontólogos dispuestos a trabajar. El grado de ocupación real promedio fue del 86%. El indicador medio de interconsultas por paciente observado fue del 25%. El indicador de urgencias según el motivo de la consulta fue del 95%, lo que indica que se cumplió con el propósito del estudio. El promedio de tratamientos protésicos impostergables según el motivo de consulta fue del 5%. La prevención en relación a las prestaciones otorgadas alcanzó el 39%. Finalmente, el indicador promedio de ausentismo fue de 17%. Conclusión: La medición de indicadores de gestión clínica contribuye a cumplir con las Garantías Explícitas en Salud (GES) del Ministerio de Salud de Chile, que son: Acceso, Oportunidad, Calidad y Protección Financiera.

Prevalencia y letalidad de enfermedades pulmonares intersticiales en la Región de Los Ríos, Chile / Prevalence and lethality of interstitial pulmonary diseases in the Region of Los Ríos, Chile

BACKGROUND: Idiopathic Pulmonary Fibrosis (IPF) is a subtype of interstitial lung disease (ILD) that significantly affects people's quality of life, whose prevalence and mortality has increased. AIM: To determine the prevalence and lethality of ILD in the Los Ríos Region between the years 2018 and 2019. MATERIAL AND METHODS: Review of a database of all patients attended at an outpatient clinic of the regional hospital. Those patients with the diagnosis of ILD and seen between 2018 and 2019 were selected. Mortality and its causes were verified with death certificates. RESULTS: In the study period, 339 cases with ILD, aged 71 ± 10 years (64% women) were identified. The calculated ILD prevalence was 84 cases per 100,000 inhabitants, with a higher predominancy in Futrono and Paillaco communes. IPF and Connective Tissue Diseases were the predominant subtypes. Overall lethality was 18%, with more deaths among patients with IPF (n = 31). CONCLUSIONS: In the Los Ríos Region, ILDs have a relevant prevalence and lethality.

Caracterización epidemiológica de pacientes diabéticos e hipertensos en consultorio en Quinta Normal, 2018-2019 / Epidemiological features of patients ascribed to a primary care cardiovascular health program in Santiago, Chile

BACKGROUND: Hypertension and diabetes are highly prevalent conditions in Chilean adults. AIM: To describe the demographic and clinical profiles, risk factors and complications associated with arterial hypertension (AH) and diabetes mellitus (DM) in patients ascribed to a cardiovascular health program at a public primary health care center in Santiago. MATERIAL AND METHODS: Review of medical records of 583 patients aged 37 to 95 years (56% women). Gender, age, smoking habits, blood pressure, glycated hemoglobin levels, LDL cholesterol and triglycerides levels, nutritional status in the last control carried out, and associated cardiovascular complications were recorded. RESULTS: Thirty four percent (201 participants) and 36% (210 participants) had a decompensated DM and AH, respectively. Dyslipidemia was the main associated cardiovascular risk factor. The prevalence of obesity was 43% (249 participants). Twenty percent had chronic kidney disease and 13% had diabetic retinopathy. CONCLUSIONS: These patients have a high frequency of obesity, dyslipidemia, and chronic kidney disease.

Inequidades y COVID-19 en 15 comunas de la Región Metropolitana: una mirada descriptiva de enfermería / Inequities and COVID-19 in 15 municipalities of the Metropolitan Region: a nursing ́s descriptive view / Desigualdades e COVID-19 em 15 municípios da Região Metropolitana: uma visão descritiva da enfermagem

INTRODUCCIÓN: La pandemia por COVID-19 ha impactado a Chile y particularmente a la Región Metropolitana, la que se caracteriza por ser un territorio desigual. La distribución de las infecciones por SARS-CoV2 no ha impactado a la población de forma equitativa y depende de algunos Determinantes Sociales de la Salud (DDSS). OBJETIVO: Describir la incidencia de casos COVID-19 notificados en comunas de la RM según etnia, años de escolaridad, pobreza, hacinamiento y movilidad. METODOLOGÍA: Estudio descriptivo, ecológico y transversal. Se escogieron grupos de comunas según el Índice de Prioridad Social y luego se seleccionaron 15 comunas de forma aleatoria por conglomerados. Se describió la situación epidemiológica según DDSS mencionados. RESULTADOS: Las comunas con mayor prioridad social y más vulnerables respecto a DDSS mostraron altas tasas de incidencia por COVID-19. Al mismo tiempo, aquellas con menor hacinamiento y movilidad evidenciaron las menores tasas de incidencia. CONCLUSIÓN: Para promover la salud y evitar enfermar es necesario comprender las discrepancias del contexto entre personas y comunidades. Las diferencias en las tasas de incidencia por comuna expresan también diferencias sociales que deben ser abordadas con el fin apuntar a las causas estructurales del proceso salud-enfermedad.

INTRODUÇÃO: A pandemia COVID-19 afetou o Chile, particularmente a Região Metropolitana, que se caracteriza como um território desigual. A distribuição do SARS-Cov2 não tem impactado a população de maneira igual e depende dos Determinantes Sociais da Saúde. OBJETIVO: Descrever a incidência do COVID-19 nos municípios da Região Metropolitana por etnia, anos de escolaridade, pobreza, superlotação e mobilidade. METODOLOGÍA: Estudo transversal, descritivo e ecológico. Grupos de municípios foram selecionados pelo Índice de Prioridade Social, em seguida, 15 municípios foram selecionados aleatoriamente. A situação epidemiológica foi descrita de acordo com oreferido Determinantes Sociais da Saúde. RESULTADOS: Municípios com maior prioridade social e mais vulneráveis apresentaram altas taxas de COVID-19. Ao mesmo tempo, municípios com menor superlotação e mobilidade apresentaram menores taxas de COVID-19. CONCLUSÃO:Para promover a saúde e evitar doenças é fundamental conhecer os diferentes contextos entre as pessoas e a comunidade. As diferenças nas taxas de COVID-19 pelos municípios, mostram desigualdades sociais que devem ser enfrentadas atendendo aos fatores estruturais da saúde.

To describe the COVID-19 incidence in the Metropolitan Region ́s municipalities by Etnia, years of education, poverty, overcrowding,and mobility. METHODOLOGY: Cross-sectional, descriptive,and ecological study. Social Priority Index selected groups of municipalities, then 15 municipalities were randomly selected. The epidemiological status was described by mentioned Social Determinant of Health. RESULTS: Municipalities with higher social priority and more vulnerable showed high rates of COVID-19.At the same time, municipalities with less overcrowding and mobility showed lower COVID-19 rates. CONCLUSION: In this way, promoting health and avoiding getting sick, it is necessary to understand the differences between people and communities. The different rates of COVID-19 by municipalities show social inequalities that must be tackled attending the structural factors of health

Comparación cesáreas de no emergencia y parto normal, en servicios públicos/privados durante los años 2016-2019 en Chile / Comparison of non-emergency cesarean section and normal childbirth, in public/private services during the years 2016-2019 in Chile

Introducción: La Organización Mundial de la Salud (OMS) propuso que el porcentaje de cesáreas debería ser entre un 10 y 15%. Sin embargo, en los últimos años, a nivel mundial, se ha visto un aumento en su realización. El objetivo de este estudio fue describir la población de embarazadas en Chile durante los años 2016-2019 que tuvieron parto vaginal (PV) o cesárea de no emergencia (CNE), y compararlos entre servicio público y privado. Material y Método: Estudio ecológico realizado en embarazadas que se sometieron a CNE o PV en Chile entre los años 2016-2019. Se obtuvieron datos del Departamento de estadística e información de Salud. No se requirió comité de ética. Resultados: Durante el periodo estudiado hubo 57,60% (339.592) de PV y 42,39% (249.925) de CNE. En el sistema público hubo una diferencia de 54,94% (187.046) de PV por sobre el sistema privado. Mientras que la diferencia de CNE en el sistema privado fue un 10,06% (25.153) por sobre el sistema público. Discusión: Durante los cuatro años, las PV superaron a las CNE, sin embargo, las CNE representaron más del 40% del total de nacimientos, superando ampliamente las recomendaciones de la OMS. Las falencias a nivel nacional en el sistema de clasificación, y en la recopilación de datos limitan el desarrollo de estudios más acabados. Conclusión: Para enfrentar las altas cifras de CNE, es necesario unificar, ampliar y regularizar un base de datos nacional que dé paso a la creación de guías y protocolos que limiten el uso mal justificado de CNE.

Introduction: The World Health Organization (WHO) proposed that the percentage of caesarean sections should be between 10 and 15%. However, in recent years, worldwide, there has been an increase in its realization. The objective of this study was to describe the population of pregnant women in Chile during the years 2016-2019 who had a vaginal delivery (VD) or non-emergency cesarean section (NECS), and to compare them between public and private services. Material and Method: Ecological study carried out in pregnant women who underwent NECS or VD in Chile between the years 2016-2019. Data were obtained from the Department of Statistics and Health Information. No ethics committee was required. Results: During the studied period there were 57.60% (339,592) of VD and 42.39% (249,925) of NECS. In the public system there was a difference of 54.94% (187,046) of VD over the private system. While the difference of NECS in the private system was 10.06% (25,153) over the public system. Discussion: During the four years, VD exceeded NECS, however, NECS represented more than 40% of all births, far exceeding the WHO recommendations. Shortcomings at the national level in the classification system and in data collection limit the development of more complete studies. Conclusion: To face the high numbers of NECS, it is necessary to unify, expand and regularize a national database that gives way to the creation of guides and protocols that limit the poorly justified use of NECS.