La investigación en salud en Chile / Health research in Chile

An analysis of health research in Chile is made, considering factors like exaggerated professional training during undergraduate studies and clinical residencies, and displacement of professionals from academic activities to more remunerative positions. Additionally, the limited role of the Ministry of Health in research promotion, evidenced by the almost absent participation of public hospitals in clinical research is discussed. Research investment, among a 0.6 to 0.8 percent of the GNP, is far from developed countries and Chile has not defined relevant health problems where a search effort would have an impact in public health. The marked centralism of the country attempts against regional application to financed projects. The following suggestions are made: to increase the financing for investigation, to reassign resources allowing the access of regional institutions, to financing, to discuss in the Chilean Association of Medical Faculties (ASOFAMECH) the creation of an academic degree by means of a thesis during the professional studies and to give facilities to develop research during clinical residencies. Also, the Ministry of Health should be involved, creating a national agenda or research priorities and increasing its association with Universities. Also training programs for professionals with a special interest in investigation should be devised

Niveles de lípidos y de presión arterial en población mapuche de la Región de la Araucanía, en Chile / Blood pressure and serum lipid levels in Chilean aboriginal populations (Mapuche) living in the Chilean region of Araucania

Background: Chilean aboriginal populations (Mapuche) predominantly live in the region of Araucanía, in the southern part of the country. Their cardiovascular risk factors have not been systematically assessed. Aim: To study the prevalence of cardiovascular risk factors in the Mapuche population. Subjects and methods: Blood pressure, weight, height, dietary habits, fasting serum total cholesterol, HDL cholesterol and triglycerides were measured in 1.948 adults living in 28 Mapuche communities. Results: Thirteen percent of males and 16 percent of females had high blood pressure. Body mass index was 25.5 kg/m2 in males and 28.1 kg/m2 in females. Forty five percent of women and 24 percent of men were classified as obese. Mean serum total cholesterol was 186.7ñ9.6 mg/dl, HDL cholesterol was 58.7ñ30.7 mg/dl, total cholesterol/HDL cholesterol was 3.4ñ2 and triglycerides were 155.2ñ91.2 mg/dl. Twenty eight percent of males and 9.6 percent of females smoked. Conclusions: Mapuche individuals have higher levels of HDL cholesterol, a better total cholesterol/HDL cholesterol ratio and lower frequency of smoking than non aboriginal Chileans subjects

Comparación de digoxina y enalapril en insuficiencia cardíaca secundaria a insuficiencia mitral / Comparison of the effects of digoxin or enalapril in the treatment of heart failure due to mitral insufficiency

Background: There is not much evidence about the usefulness of digoxin or enalapril in the treatment of heart failure due to mitral insufficiency. Aim: to compare digoxin and enalapril in the treatmen of heart failure due to mitral insufficiency. Patients and methods: Patients with mitral insufficiency, in sinus rhythm, with a heart failure grade II or III and with echocardiographic left ventricular dilatation were eligible for the study. They received sequentially, during 12 weeks each, digoxin 0.25 mg/day or enalapril in doses up to 20 mg/day, with a washout in-between period of 2 weeks. The order of the sequence was determined randomly. At the start and end of treatment, functional class according to NYHA and maximal exercise tolerance in the treadmil were assessed and a color Doppler echocardiogram was done to measure ventricular dimensions, function and degree of mitral insufficiency. Results: Nine patients on enalapril and 12 on digoxin improved their functional capacity. Digoxin improved exercise time in 76ñ168 sec (p= 0.022), whereas this change was not significant with enalapril (38ñ158 sec; p= 0.2). With enalapril treatmen, ventricular diastolic dimensiondecreased from 59.3ñ8.1 to 58ñ9.3 mm and the area of mitral insufficiency decreased from 8.1ñ3.5 to 6.6ñ3.1 cm2. Digoxin did not induce any significant echocardiographic change. Conclusions: In these patients, digoxin and enalapril improved functional class. Digoxin improved exercise time and enalapril reduced ventricular dimensions and mitral insufficiency

Facultad de Medicina de la Universidad de la Frontera / The Universidad de la Frontera School of Medicine

The School of Medicine of Universidad de la Frontera is the result of a tight relationship between teaching and patient care. Its recent development is based on the strengthening of international bonds. Curricular innovation is an important accomplishment, mandated by the strategic settign up of its academic corps. The aim of undergraduate teaching is to train health professionals able to successfully face prevalent health problems, with health team management capabilities, that work in close relationship with the community, with continuous educational, research, communicational and learning skills and with a solid ethical and humanitarian education. Student based education using prioriry health problems as models, small group tutorials and community training are the bases of medical training for the next century

Estudio colaborativo chileno-argentino, para evaluar nifedipina OROS en hipertensos esenciales / Collaborative Chilean-Argentinean study of nifedipine GITS in patients with essential hypertension

Ocho centros chilenos y 5 argentinos evaluaron eficacia, tolerabilidad y seguridad de Nifedipina Oros en 355 hipertensos esenciales durante 8 semanas de tratamiento, previo placebo. 67 por ciento pacientes respondieron a 30, y 33 por ciento a 60 mg/día. El descenso de presión arterial fue 23/15 ñ 0.6/0.3 (ES) mmHg (p < 0,0001). Las variaciones de presión fueron similares en decúbito y de pie,sin causar diferencias en frecuencia cardíaca en ambas posiciones. La relación trough: peak (28:6-8 h) varió entre 0,91-0,95 con dosis inicial o de mantención. Ochenta y cuatro por ciento de hipertensos leves y 93 por ciento de moderados respondieron con decrementos de 10 o más mmHg; 59 por ciento alcanzaron normotensión. No se observaron respuestas significativamente diferentes según edad y terciles de Na urinario nocturno al ingreso. No hubo modificación de parámetros de laboratorio. 29 por ciento de los pacientes presentaron efectos colaterales durante tratamiento activo; en 65 por ciento únicos, en 63 por ciento leves y bien tolerados. Los más frecuentes al final del tratamiento fueron cefaleas (4,7 por ciento) y edema (2,6 por ciento). Once pacientes fueron retirados por efectos que interferían la vida habitual y 4 abandonaron control. Concluimos que Nifedipina GITS posee alta eficacia, similar para distintos grupos etáreos e ingesta de sodio, un efecto mantenido a lo largo de las 24 horas y efectos colaterales mayoritariamente leves y bien tolerados

Comparación de digoxina y atenolol en fibrilación auricular crónica / Comparison between digoxin and atenolol in chronic atrial fibrillation

The benefits of digoxin in patients with atrial fibrillation may be reduced due to its limited effect on atrioventricular conduction. The aim of this work was to compare digoxin and etanolol on functional class, resting and exercise heart rate and exercise capacity in patients with atrial fibrillation. Thirteen subjects with this condition, normal echocardiographic left ventricular function and size, a resting heart rate less than 80 beats/min and with no contraindication for beta blocker or digoxin use, were studied. Patients were randomly assigned to receive initially digoxin 0.25 mg. o.d. or atenolol 100 mg o.d. in a double blind fashion. The doses were sdjusted to obtain a heart rate between 60 and 80 beats-min at the end of the first week of treatment. After 2 weeks of treatment, outcomes were assessed, patients were left without treatment for one week and crossed over to the other drug after that. Resting heart rates achieved with digoxin and atenolol were similar (67ñ11 and 65ñ23 beats/min respectively). However, maximal exercise heart rates and maximal exercise time were higher during digoxin treatment (166ñ23 vs 135ñ27 beats/min and 9.95ñ1.68 vs 8.5ñ2 min respectively). NYHA functional class deteriorated in 3 patients receiving atenolol. We conclude that atenolol achieves a better control of heart rate during exercise but also reduces maximal exercise capacity