Experiencias de salud mapuche en Atención Primaria de Salud desde trabajadores sanitarios y usuarios/as en zona urbana de Chile / Mapuche health experiences in Primary Health Care from health workers and users in urban Chile

Resumen Este estudio describe experiencias y percepciones sobre interculturalidad en Atención Primaria de Salud (APS) desde la perspectiva de trabajadores/as y usuarios/as de salud mapuche. Se realizó una sistematización cualitativa de experiencias de un Programa de Salud Intercultural en APS en una comuna urbana de Chile. Participaron 19 usuarios/as y 13 trabajadores/as en entrevistas individuales y tres entrevistas grupales, respectivamente. Se realizó un análisis de contenido semántico. Para los participantes, la salud mapuche es percibida positivamente, los/as usuarios/as la asimilan al concepto de interculturalidad, mientras que los/as trabajadores/as señalan que, si bien se respeta, no se promueve un trabajo integrado. Los/las participantes identifican como barreras aspectos administrativos, falta de integración y cuestionamientos científicos. Se requiere reconocimiento de la salud indígena y mayor formación de trabajadores/as sobre salud indígena e interculturalidad.

Abstract This study describes experiences and perceptions on interculturality in Primary Health Care (PHC) from the perspective of health workers and Mapuche health users. For this purpose, a qualitative systematization of these experiences was carried out in a PHC Intercultural Health Program at an urban commune in Chile. Data were collected by means of individual and group interviews, respectively, with 19 users and 13 professionals. The semantic content analysis was performed. While service users perceive Mapuche health positively, assimilating it to the concept of interculturality, health workers reported that Mapuche health is respected but no integrated work is promoted. As barriers, participants cited administrative aspects, lack of integration, and scientific issues. In conclusion, recognition of indigenous health and greater occupational training on indigenous health and interculturality is necessary.

Abordaje quirúrgico y protésico para resolución de defecto Clase IV C de Zucchelli en el maxilar anterior. Reporte de Caso

RESUMEN: Se describe el caso clínico de una paciente de 37 años, sexo femenino, sana, con sonrisa gingival, la cual presentaba problemas estéticos en relación, a un implante en la 1.1, instalado hace 7 años, el implante no presentaba una correcta posición tridimensional, correspondiendo a una Clase IVc de Zucchelli. El presente reporte clínico describe los pasos quirúrgicos y protésicos para resolver la estética del maxilar anterior pasando de un PES/WES inicial de 8 a un valor final de 16.

ABSTRACT: We describe the clinical case of a 37-year-old female patient, healthy, with a gingival smile, who had aesthetic problems in relation to an implant in 1.1, installed 7 years ago. The implant did not present a correct three-dimensional position, corresponding to a Class IVc according to Zucchelli. This clinical report describes the surgical and prosthetic steps to resolve the aesthetics of the anterior maxilla, going from an initial PES / WES of 8 to a final value of 16.

Tratamiento protésico y quirúrgico del maxilar atrófico / Prosthetic and surgical treatment of the atrophic maxilla

RESUMEN: Proponer un plan de tratamiento con técnicas quirúrgicas y protocolos protésicos predecibles representa un gran desafío profesional, especialmente en pacientes con un maxilar atrófico. Entre las alternativas terapéuticas, la prótesis híbrida sobre cuatro implantes dentales correctamente distribuidos permite formar un área de distribución de carga, la cual guarda relación con las necesidades biomecánicas del elemento protésico.

ABSTRACT: Proposing a treatment plan with surgical techniques and predictable prosthetic protocols means a great professional challenge, especially in patients with an atrophic maxilla. Among the therapeutic alternatives, the hybrid prosthesis on four correctly distributed dental implants, allows to form a load distribution area, which is related to the biomechanical needs of the prosthetic element.

Salud intercultural en Chile: desarrollo histórico y desafíos actuales / Intercultural health in Chile: historical development and current challenges

RESUMEN En 1992, Chile implementó por primera vez un programa de salud para los pueblos indígenas, el Programa de Salud para Población Mapuche (Promap), cuyo objetivo fue entregar una atención de salud con pertinencia cultural, favoreciendo la complementariedad entre los sistemas médico indígena y el sistema oficial. La versión actual de esa iniciativa - el Programa especial de Salud para Pueblos Indígenas (PESPI) - ha logrado llegar con este enfoque a casi la totalidad de los Servicios de Salud del país. La revisión que el mundo académico ha hecho de estas experiencias, basados en la salud pública o en la antropología médica, se ha centrado en el análisis de las iniciativas llevadas en contextos indígenas rurales, desde el punto de vista de las dificultades que han debido enfrentar y las nociones de interculturalidad en salud que han logrado consolidar. Sin embargo, poco se ha abordado este programa en los contextos urbanos (espacio en que mayoritariamente están ocupando hoy nuestros pueblos indígenas) o desde el punto de vista de las nociones de interculturalidad en salud que implican. Considerando lo anterior, el artículo ofrece una revisión temática de publicaciones científicas nacionales e internacionales acerca del tema, un análisis crítico de los programas de salud intercultural desarrollados en Chile y una reflexión acerca de sus desafíos en el marco de la dinámica indígena urbana.(AU)

ABSTRACT In 1992, Chile implemented for the first time a health program for indigenous peoples, the Health Program for the Mapuche Population (PROMAP), whose objective was to provide health care with cultural relevance, favoring the complementarity between the indigenous medical systems and the official system The current version of this initiative - named PESPI - has managed to reach almost all the Health Services in the country with this approach. The review that the academic world has made of these experiences, based on public health or medical anthropology, has focused on the analysis of the initiatives taken in rural indigenous contexts, from the point of view of the difficulties they have had to face and the meaning of the interculturality in health that they have managed to consolidate. However, little has been said about this program in urban contexts (currently, a space which our indigenous peoples are occupying progresively) or from the point of view of the notions of interculturality in health that they imply. Considering the above, the article offers a thematic review of national and international scientific publications on the subject, a critical analysis of intercultural health programs developed in Chile and a reflection on their challenges in the framework of urban indigenous dynamics.(AU)

Caracterización de la formación y el empleo de los kinesiólogos titulados de la Universidad de Chile en el período 2004 - 2006: una aplicación de la encuesta CHEERS / Characterization of training and employment of physical therapy graduate of the University of Chile in the period 2004 - 2006: an application of the CHEERS survey

Estudio descriptivo, transversal y no experimental, realizado entre julio y octubre de 2007, que buscó caracterizar a los alumnos de la carrera de Kinesiología de la Universidad de Chile, titulados entre 2004 y 2006, en tres niveles: su experiencia en la formación en el pregrado, su actual situación en el campo laboral y su incorporación o no al nivel de formación de postgrado. Para esto se aplicó la Encuesta CHEERS, sobre educación universitaria y empleo de los graduados. Los resultados mostraron que más del 97% trabaja actualmente en labores relacionadas con sus estudios; poco más del 65% posee simultáneamente más de dos trabajos. El nivel de ingresos mensuales que predomina es el de un millón de pesos o más. El 60%, trabaja entre 45 y 68 horas semanales. El 46.3% se desempeña exclusivamente en Kinesiología respiratoria. El 93.8% terminó la carrera Con distinción máxima o con distinción, demorando el 70% los cinco años correspondientes. Destaca un nivel de satisfacción alto y muy alto respecto de la calidad de la docencia en la carrera, al igual que en la valoración de los contenidos entregados. Sin embargo cerca del 90% considera que se le da demasiado énfasis a la enseñanza de teorías y conceptos en la formación de pre grado, a diferencia del grado de énfasis dado al aprendizaje basado en problemas y práctica clínica. Por último, el 80.8% ha seguido formación tras titularse, fundamentalmente cursos de post título, en temáticas predominantemente de la Kinesiología Respiratoria.

This descriptive study, cross-sectional and non experimental, looked for to characterize the students of the career of Kinesiology of the University of Chile, who obtained their professional title between 2004 and 2006, in three levels: their experience in the formation in the pre-degree, their present situation in the labor field and their incorporation or not at the later level of formation to the degree. CHEERS survey was applied, which includes information of the university education and the employment of the graduated ones. The results showed that more of 97% work at the moment in workings related to his studies; little more of 65% have simultaneously more than two jobs. The level of monthly income that predominates is the one million pesos or more. 60%, work between 45 and 68 hours to the week. 46,3% of them performance exclusively in the respiratory Kinesiology. 93,8% finished the career With maximum distinction" or distinction, delaying 70% the five corresponding years. It shows a high and too high level of satisfaction about the quality of teaching in the career, like in the valuation of the given contents. Nevertheless, near 90% consider that it gives too much emphasis to the education of theories and concepts in the formation of pre degree, to difference to the level of emphasis given to the learning based on problems and clinical practice. In last term, 80,8% have followed formation after being titled, fundamentally courses of post title, in thematic predominantly of Respiratory Kinesiology.

The Gonyautoxin 2/3 epimers reduces anal tone when injected in the anal sphincter of healthy adults

The primary clinical symptom of Paralytic Shellfish Poisoning is acute paralytic illness produced by paralyzing toxins. Paralytic shellfish poison is formed by a mixture of phycotoxins and their toxicity is due to its reversible binding to a receptor site on the voltage-gated sodium channel on excitable cells, thus blocking neuronal transmission. We studied the effect of the gonyautoxin 2/3 epimers by local infiltration in the anal internal sphincter of healthy voluntary adults in order to reduce anal tone. The toxin was injected after prior clinical evaluation, anoscopy and anorectal manometry. Post injection clinical examination, electromyography and anorectal manometry were performed. Resting and voluntary contraction pressures were measured and the anorectal inhibitory and anocortical reflexes were tested by manometry. Blood and urine samples were obtained from each participant, and hemogram, basic metabolic panel, and urinalysis were done both before and one week after the injection. This study shows, for the first time, that gonyautoxin 2/3 reduces the anal tone by relaxing the anal sphincters in 100 % of the participants. Manometric recordings showed a significant decrease in anal maximal voluntary contraction pressure after the toxin injection, dropping to 55.2 ± 6.2 % and 47.0 ± 6.8 % (Mean Value ± Std.Dev.) of the baseline values at 2 minutes and at 24 hours respectively after the injection. Post-injection electromyography showed that activity of the muscle was abolished. We conclude that local administration of gonyautoxin 2/3 to the anal sphincter produces immediate relaxation and a statistically significant decrease in the anal tone (p <0.001)..

Efecto de la implementación de recomendaciones de sedoanalgesia en una UCI general / Effect of the implementation of recommendations about sedoanalgesia in a general ICU

A great part of the patients in an Intensive Care Unit (ICU) need sedo-analgesia (SA), specially in mechanic ventilation (MV). Our unit is a general ICU where a diversity of therapeuticschemes and farmacological presentations have been used, without standard practices. At a first stage we introduced SA recommendations, reinforcing its use. We conducted the present study to evaluate its effect in our clinical practice. Methodology: Indicators of adverse incidents were registered, associated to MV, mortality, permanence in MV,hospitalization in ICU, use of medicines and cost, the results were measured during the 3 months prior to beginning and the 3 months following implementation of the SA recommendations, which ruled the use of the association of midazolam (MZ) (Dormonid (R), Laboratorio Roche (R) and morphine; in cases of the renal insufficiency, hemo-dynamic instability or allergic reaction it was chosen to associate MZ and fentanyl, both associations in continuous infusion and with suspension of morning sedation. The sedation level had to be evaluated with ramsay scale. Neurological patients were excluded. It was considered "strict compliance" when the recommended combination of medicines were utilized, adjusted by sedation scale and with matinal suspension; "partial compliance" when these were utilized without complying with the scale adjustement or the matinal suspension. The results obtained were analyzed utilizing the Primer(R) statistical program. Results: Before the introduction of the recommendations we observed an average MV duration of 5,8 days (Range: 1-82), duration of ICU hospitalization of 9,8 days (Range: 1-101), a mortality of 28 per cent, one case of auto-extubation, with the use of one average dose of MZ of 10±1,8 mg/hr, with a montly use of MZ in the unit of 22,2 g., a montly expense in sedatives, analgesics and relaxants of US$3018. After its introduction we observed an average duration at MV of 4,5 days (Range: 1-41) (NS), duration of hospitalization at ICU of 5,0 days (Range: 1-45) (p=0,001), a mortality of 22 per cent (NS), one case of auto-extubation, with an average dose of MZ of 4,2 g. (p=0,001), a montly expense in sedatives, analgesics and relaxants of US$809 (p=0,0001). Average compliance with the recommendations was 68 per cent (46 per cent partial, 22 per cent strict).

Infecciones respiratorias agudas de invierno en mayores de 65 años / Winter acute respiratory infections in people over 65 years old

Se analizan los resultados de un programa experimental de manejo de las infecciones respiratorias agudas de invierno en adultos mayores. Este programa se aplicó por 3 meses entre julio y septiembre de 1997. El material estuvo constituido por 49 pacientes mayores de 65 años (26 hombres y 23 mujeres); con edad promedio de 74,2 años; portadores de neumonías de más de un lóbulo (51 por ciento); con 2,1 factores de riesgo; con puntaje de gravedad de 5,59 y todos con patologías orgánicas previas de base. El tratamiento recomendado fue penicilina (2 millones cada 8 horas), ceftriaxona (1 gramo diario) y eventualmente cloxacilina (500 mg cada 6 horas). La mortalidad (6 mujeres y 4 hombres) fue de 20,4 por ciento. El promedio de días de hospitalización fue de 20,5 días y el de tratamiento antibiótico de 14 días. El costo de los antibióticos fue de 32.618 pesos por paciente y de 2.297 pesos diarios. La hospitalización por enfermo tuvo para el establecimiento un costo promedio de 800.000 pesos, del cual sólo el 5 por ciento corresponde a los antibióticos