Cambios recientes en la mortalidad por cáncer de próstata en Chile: estudio de tendencias en el período 1955-2001 / Recent changes in prostate cancer mortality in Chile: trends analysis from 1955 to 2001

Background: By the year 2000, prostate cancer became the second leading cause of cancer death in Chilean men of all ages and is the leading cause of cancer deaths in men of eighty years of age or older. Aim: To analyze the trends in mortality rates from prostate cancer in Chile in a fifty years series, estimating the rate of increase of such rates and their changes in time. Material and methods: A trend analysis for age standardized mortality rates was performed, using join point regression analysis, which allows estimation of the annual percent change of rates and to find significant changes in such trend. Results: Age standardized mortality rates in Chile reached their peak value in 1996, becoming apparently stable from then on. Crude rates have had a steady increase during the whole period. The trends analysis identified three different periods in the growth of the age standardized rates: a first one of slow increase in rates between 1955 and 1981 (0.9 percent annual increase), a second one of more aggressive growth starting in 1981 (2.6 percent annual increase), and a third period starting in 1996, in which rates slowly decline at an annual rate of 1 percent. Conclusions: The tendency of prostate cancer seen in Chile resembles that of industrialized countries, with an increase in its age standardized death rates that suffers a downturn by the end of the past decade. Besides early detection techniques, a substantial part of the reduction in mortality from prostate cancer could be explained by therapeutic improvements (Rev MÚd Chile 2004; 132: 579-87).

Historia natural de la colelitiasis: incidencia de colecistectomía en un área urbana y una rural mapuche, en la última década / Natural history of cholelithiasis and incidence of cholecystectomy in an urban and a Mapuche rural area

Background: Cholelithiasis is the second cause of hospital admissions in Chile. Aim: To study the prevalence of symptomatic gallstone disease and opportunity of cholecystectomy in La Florida, Santiago and among Mapuche Indians in Huapi Island. Patients and methods: In the period 2000-2001, we contacted to 71 percent (1127 subjects) and to 61 percent (145 subjects) patients of La Florida and Huapi Island, respectively, that had previously participated in an epidemiological study on cholelithiasis in 1993. We defined symptomatic gallstone patients as those with a history of biliary colic. Each patient was subjected to gallbladder ultrasound. Results: In 1993, 30-35 percent of gallstone patients were symptomatic (&70 percent women). During the lapse 1993-2001, only 50 percent of subjects from La Florida and 25 percent of patients from Huapi Island were cholecystectomized (p <0.05). Fifty percent of cholecystectomies were emergency operations. In 38 symptomatic Mapuche Indians from Huapi, cholecystectomy was indicated in 2001. After five months of the indication, only one of these subjects had been operated. Laparoscopic cholecystectomy represented 40 percent of all cholecystectomies performed in the National Health Service Hospitals. Conclusions: This study demonstrates an unacceptable high prevalence of symptomatic gallstone patients remaining non-operated in both the urban and rural communities. This reciprocally correlates with the high frequency of emergency cholecystectomies and the high incidence of gallbladder cancer among Chileans. This study contrasts negatively with the situation of Scotland, where 73.5 percent of cholecystectomies were laparoscopic in 1998-1999. To reach Scotland standards, the Chilean Public Health System should increase the number of cholecystectomies from 27,000 in 2001 to 57,510

Estudio de la cinética de citoquinas en sepsis grave y su relación con mortalidad y score de disfunción orgánica / Cytokine kinetics in severe sepsis: its relationship with mortality and organic dysfunction

Background: The Infectious Systemic Inflammatory Response syndrome and multiple organic dysfunction have common physiopathological mechanisms. Multiple organic dysfunction can be assessed using severity scores. Aim: To relate cytokine kinetics with a multiple organic dysfunction score during sepsis. Material and methods : Tumor necrosis factor a (TNFa) and interleukin 6 (IL6) kinetics were studied in 25 patients with severe sepsis with less than 48 h of evolution and interleukin 1ß (ILß) kinetics was studied in 13 patients. Measurements were made at 0, 12, 24 and 48 hours after admission to the study, using an ELISA technique. These parameters were correlated with the Marshall multiple organic dysfunction score and survival. Results: Mean age of study subjects was 70 years, the APACHE II score was 16.9ñ6 and the Marshall score was 6.8ñ3.6. Sepsis was of pulmonary origin in 56 percent of patients and intra abdominal in 32 percent. Mortality was 36 percent. TNFa increased during the study period (24.1 pg/ml initially and 37.8 pg/ml at 24 hours, with a slight posterior reduction, p<0.02). These levels had no association with mortality or organic dysfunction. IL6 remained elevated during the first hours and had a tendency to decrease thereafter. Deceased patients had higher values than survivors (306 pg/ml and 55.4 pg/ml respectively, p=0.011). Its values were tightly correlated with Marshall score, with the number of failing organs, with the presence of shock and with probability of dying during hospitalization. IL1ß remained low and was not associated with clinical parameters. Conclusions: There is a tight correlation between the elevation of IL6 and the severity of the Systemic Inflammatory Response and mortality in these patients with sepsis

Número de médicos en Chile: estimaciones, proyecciones y comparación internacional / Number of physicians in Chile: current and prospective estimate and international comparison

Background: In the last decades, the number of Universities with medical schools has increased dramatically in our country. Aim: To introduce a conceptual model to estimate the number of physicians that are incorporated to the profession in Chile every year as well as the cumulative number of active physicians in specific time frame. To provide information about the number of available physicians in the country and compare it with the international context. Material and methods: This model includes information about the number of students that are admitted in all medical schools of the country, the dropout rate, the number of immigrant physicians from other countries, and the cumulative number of active physicians in the previous period. Results: There is an increased number of new medical students starting in 1994 that will produce, starting in 2001, a significant increased in the number of new physicians graduated from Chilean Universities. Meanwhile the increased number of new physicians in recent years is mainly explained by a significant increase in immigrant physicians. The number of active physicians estimated by the year 2000 is 18,549 and this number will be 25,704 by the year 2007. With these estimated numbers, we introduce a qualitative model that allowed us to compare the current number of active physicians in Chile with other countries, especially those with a comparable degree of development. This model uses first The Human Development Index and later the per capita income of different countries adjusted by purchasing power in USA. According to these calculations, Chile has a lower number of physicians than similar countries, and this difference will persist, even after the significant increase in the new physicians expected for the new future. Conclusions: Chile continues to have a lower number of physicians than countries with similar human development indices

Desempeño académico de los estudiantes de medicina: ¿un resultado predecible? / Academic performance of medical students: a predictable result?

Background: Traditionally, medical schools demand their students a high dedication in time, responsibility and integrity. Aim: To assess the predictive capacity of several specific variables, on the academic performance of medical students. Material and methods: All students who entered during 1984-1995 period were studied. The academeic performance was assessed using two indices: an overall evaluation of successfulness as determined by the approval rate in different courses and grade-point average obtained during the first three years at the Medical School. The variables used to predict academic performance were year of enrollment, high school grades, university admission test scores, biomedical and demographic characteristics. All these were meassured at the time when the student was enrolled. Results: Eight hundred and eight students were studied at the end of the third year. The most important predictive variables selected for both performance indices were: high school grades, admission biology test scores, place were high school studies were done, and previous university studies. In addition verbal and mathematics admission academic performance tests scores were selected for grade-point average index. Although, the overall admission score and high school academic performance were significantly associated with the two outcomes, they were not selected in the final models. Conclusions: The best predictors of an optimal academic performance in these medical students were high school grades, admission bilogy test scores, residing in Metropolitan Santiago and previous university studies