ABSTRACT
La enfermedad renal crónica constituye una patología de prevalencia e impacto creciente en la población mundial por sus múltiples complicaciones, incluyendo un riesgo cardiovascular aumentado, que representa la principal causa de morbimortalidad en pacientes nefrópatas crónicos. Sin embargo, la relevancia de las dislipidemias, especialmente, la hipercolesterolemia LDL, en el deterioro de la función renal y desarrollo de ateroesclerosis en sujetos con daño renal crónico no ha sido claramente establecida. Esta situación ha generado controversia sobre el beneficio real del uso de hipolipemiantes en estos pacientes. En base a la evidencia disponible, incluyendo estudios clínicos recientes, la recomendación más apropiada sugiere que el uso de terapia hipolipemiante basada en estatinas (con o sin ezetimiba) es beneficioso desde un punto de vista cardiovascular en nefrópatas crónicos con insuficiencia renal leve a moderada antes de la diálisis. Por otro lado, no existe evidencia definitiva para apoyar el uso rutinario de este tipo de hipolipemiantes en el manejo del deterioro de la filtración glomerular y/o la proteinuria. Basándose en la evidencia analizada en esta revisión, las futuras guías clínicas para el manejo del daño renal crónico deberán incorporar el uso de estatinas y/o ezetimiba como un elemento más dentro del armamento terapéutico de este tipo de pacientes.(AU)
Chronic kidney disease is a condition of increasing prevalence and impact on the world population by its many complications, including increased cardiovascular risk that represents the leading cause of morbidity and mortality in chronic nephropathy patients. However, the relevance of dyslipidemia, especially high LDL cholesterol, in the impairment of renal function and development of atherosclerosis in subjects with chronic kidney disease has not been clearly established. This situation has generated controversy regarding the real benefit of use of lipid-lowering therapy in these patients. Based on available evidence, including recent clinical studies, the most appropriate recommendation suggests that the use of lipid-lowering therapy based on statins (with or without ezetimibe) is beneficial from a cardiovascular standpoint in chronic nephropathy with mild to moderate renal failure before dialysis. On the other hand, there is no definitive evidence to support the routine use of lipid lowering drugs in the management of impaired glomerular filtration and/or proteinuria. Based on the evidence discussed in this review, future clinical guidelines for management of chronic renal damage should incorporate the use of statins and/or ezetimibe as a key element in the therapeutic armamentarium to be applied in these patients.(AU)
Subject(s)
Humans , Male , Female , Hydroxymethylglutaryl-CoA Reductase Inhibitors , Renal Insufficiency, Chronic , Dialysis , Hypolipidemic AgentsABSTRACT
Background: Health-related quality of life (HRQOL) refers to individuals' perception of their subjective well-being, considering various aspects of their life and the impact on their health. Aim: To analyze gender differences in the HRQOL of adolescent students in Chile, by age, type of school attended, and area of residence. Material and Methods: Analytical cross-sectional study conducted in a population of 5th and 12th grade students attending municipal, subsidized and private schools in 11 regions of the country. HRQOL was assessed with the KIDSCREEN-52, an instrument that has been previously adapted and validated in Chile. The database obtained from that adaption and validation process was analyzed. Results: In total, 7,910 students (median age 14 years, 53% female) completed the questionnaire. Compared to males, females had lower HRQOL scores in most of the KIDSCREEN-52 dimensions. However, males were more likely to have lower scores in the Peers and Social Support and School Environment dimensions. These differences remained valid when the sample was stratified by age, type of school, and area of residence were analyzed. Conclusions: This study supports the existence of inequalities in the self-perceived HRQOL of Chilean adolescent students. The existing differences are not only related to gender but are also evident when stratifying by type of school attended.
Subject(s)
Humans , Male , Female , Child , Adolescent , Quality of Life , Self Concept , Students/statistics & numerical data , Child Welfare/statistics & numerical data , Peer Group , Socioeconomic Factors , Logistic Models , Chile , Sex Factors , Cross-Sectional Studies , Surveys and Questionnaires , Risk Factors , Age FactorsABSTRACT
La presente investigación aborda la temática Discapacidad y legislación laboral chilena, con el propósito de incorporar en el análisis la visión de sujetos en situación de discapacidad con experiencia organizativa y orientados a la acción política. El objetivo es analizar la visión respecto a la legislación laboral actual chilena desde sujetos en situación de discapacidad que participan activamente en política, pertenecientes al Colectivo Palos de Ciego durante el año 2014. Se utiliza una metodología participativa con enfoque cualitativo, orientada a la emancipación y con perspectiva etnográfica. La recolección de información se realiza a partir de la observación participante, notas de campo y entrevistas en profundidad. El análisis de la información se realiza mediante codificación abierta. Los resultados se estructuran a partir de tres ejes temáticos: visión política de la legislación laboral, limitantes percibidas y propuestas de transformación respecto de la inclusión laboral chilena. La problemática central tiene relación con la lógica dominante bajo la cual el Estado actúa de manera subsidiaria, no reconociendo los Derechos inherentes de los sujetos en situación de discapacidad. Los miembros del Colectivo proponen estrategias de transformación de orden político, con incidencia en aspectos globales y de acción política directa, destacándose la importancia de concientizar a la sociedad respecto a la comprensión de la discapacidad como problema político. Finalmente, se expresa el desafío de ampliar la Terapia Ocupacional al ámbito político, orientando la participación del profesional en los procesos de lucha política de los sujetos en situación de discapacidad.
This research is framed in the thematic Disability and Chilean labor legislation with the purpose of incorporating the vision of the subjects in disability situation with experience and political action. The aim of this research is to analyze the political vision regarding the current Chilean labor legislation, from the subjects in disability situation belonging to the group Palos de ciego during 2014. A participatory methodology with qualitative focusing is used, oriented to emancipation, with ethnographic perspective. Data gathering is from participant observation, field notes, and in-depth interviews. The analysis of information is done through open coding. Results are structured from three thematic axes: political vision of the labor legislation, limitations and proposals of transformation of the Chilean labor inclusion. The central issue is related to the dominant logic, under which the state acts on a subsidiary basis, not recognizing the inherent rights of the subjects in disability situation. The group proposes strategies of transformation of political order, with incidence in global and specific aspects, standing out the importance of awareness in society regarding compression of disability as a political problem. Finally, is expressed the challenge of enlarge occupational therapy to a political scope, encouraging the professionals participation in the processes of political struggle of the subjects in situation of disability, as well as political participation thereof.
Subject(s)
Humans , Male , Disabled Persons , Legislation, Labor , Occupational Therapy , Public Policy , Social Participation , Chile , Interviews as Topic , Qualitative ResearchABSTRACT
Background: KIDSCREEN-52, which assesses health related quality of life in adolescents, has been adapted and validated in Chile showing excellent psychometric properties. There is a shorter version of the instrument, whose psychometric properties must be assessed. Aim: To evaluate the psychometric properties of the instrument KIDSCREEN-27 in Chilean adolescents. Material and Methods: A secondary analysis of the database obtained for the adaptation and validation of KIDSCREEN-52. Results: The reliability, calculated through Cronbachs alpha, for the entire instrument (five dimensions) was 0.89. For physical well-being, psychological well-being, autonomy and relationship with parents and peer social support dimensions, scores were higher than 0.75 while for school environment, the score was 0.69. The confirmatory factor analysis showed that the indices obtained to assess the goodness of fit in this study were a χ2 (314) = 10521.4, a Root Mean Square Error of Approximation = 0.064 and a Comparative Fit index = 0.96. KIDSCREEN-27 scores were higher among men in the physical well-being, psychological well-being, autonomy and relationship with parents dimensions and among women in social support and peers and school environment dimensions. Scores were higher in younger age groups. Conclusions: The Chilean version of KIDSCREEN-27 instrument has adequate reliability and validity.
Subject(s)
Adolescent , Child , Female , Humans , Male , Quality of Life/psychology , Surveys and Questionnaires/standards , Age Factors , Chile , Cross-Cultural Comparison , Health Status , Psychometrics , Reproducibility of Results , Sex FactorsABSTRACT
El presente estudio exploratorio tiene como objetivo analizar la implementación de dos proyectos de SENADIS para la inclusión laboral de personas con discapacidad (CCR Integral y Proyecto Piloto de Profesionales de Apoyo) en base al relato de Terapeutas Ocupacionales que ejecutaron dichos proyectos en los municipios de Conchalí, Huechuraba, Independencia, La Pintana y Peñalolén entre los años 2011- 2013, contribuyendo a la generación de conocimiento en lo que respecta a políticas públicas de inclusión laboral para personas con discapacidad. Este estudio es de tipo cualitativo y está diseñado en base a la Teoría Fundamentada. La recolección de datos se realizó a través del diseño de una entrevista semi estructurada a las Terapeutas Ocupacionales ejecutoras y a los encargados de dichos proyectos en SENADIS. Las entrevistas abarcaron desde aspectos operativos de la ejecución de los proyectos, hasta refexiones personales en torno a la experiencia. Se identifcan como aspectos signifcativos las siguientes categorías: proceso de implementación de los proyectos en los Municipios, constitución del cargo de las Terapeutas Ocupacionales, equipo de trabajo, factores que facilitaron la implementación de los proyectos, factores que difcultaron la implementación de los proyectos y refexión de las Terapeutas Ocupacionales acerca de la experiencia. La presente investigación se centra en conocer el proceso de implementación de políticas públicas de inclusión laboral a nivel municipal, a partir de la experiencia de Terapeutas Ocupacionales ejecutoras de los proyectos ejecutados.
The aim of this exploratory study is to analyze the execution of two projects proposed by SENADIS for work inclusion, based on the Occupational Therapists report who participated in the execution of both projects in the local councils of: Conchalí, Huechuraba, Independencia, La Pintana and Peñalolén between 2011 and 2013, promoting the knowledge generation related to public policies of work inclusion. This qualitative study is based on Founded Theory. The data recollection was done through semi structured interviews to the Occupational Therapists and two SENADIS professionals in charge of both projects. The interviews included operative aspects like the execution of both projects and also personal thoughts about the experience. The next categories were considered meaningful for the study: The interviewed, execution process of both projects in local councils, Occupational Therapists position in both projects, work team, factors that collaborated in the execution, factors that interrupted the execution and personal thoughts about the experience. This study is to recognize the execution process of public policies in work inclusion, generating discussions from the Occupational Therapists experience that executed both projects.
Subject(s)
Humans , Disabled Persons , Employment , Job Application , Occupational TherapyABSTRACT
Background: KIDSCREEN-52 is an instrument to assess health related quality of life in children and adolescents. Aim: To culturally adapt and validate the KIDSCREEN-52 questionnaire in Chileans. Material and Methods: Two independent translations from the English Spanish language were conciliated and retranslated to English. The conciliated version was tested during a cognitive interview to adolescents of different socioeconomic levels. The final version was validated in 7,910 school attending adolescents. Results: In the cross-cultural adaptation, 50 of the 52 items presented low or medium levels of difficulty and a high semantic equivalence. Distribution according to gender, grades and types of schools was similar to the sample. Single ages were not affected by sex distribution. The Confirmatory Factor Analyses were: X² (1229) = 20996.7, Root Mean Square Error of Approximation = .045 and Comparative Fit Index = .96. The instrument had a Cronbach’s alpha of .93. The domains had scores over 0.70 points, with the exception of the "Selfperception" domain, with a score of 0.62. Conclusions: The Chilean version of KIDSCREEN-52 is culturally appropriate and semantically equivalent in its English and Spanish versions (from Spain). Its reliability and validity were adequate.
Subject(s)
Adolescent , Child , Female , Humans , Male , Health Status , Quality of Life , Chile , Cultural Characteristics , Interview, Psychological , Surveys and Questionnaires , Reproducibility of Results , Schools , TranslationsABSTRACT
El presente estudio ha tenido como propósito conocer los aspectos significativos en el proceso de inclusión laboral de dos profesionales universitarios con hipoacusia severa de la Región Metropolitana, por medio de la realización de entrevistas focalizadas en el desempeño laboral, de manera de avanzar en el conocimiento de estrategias que permitan mejorar las oportunidades de empleo para esta población. Es un estudio de tipo exploratorio, retrospectivo y transversal. Para la recolección de datos se diseñó una entrevista semiestructurada, solicitando previamente el consentimiento informado. La entrevista abarca sus trayectorias de vida focalizándola en el desempeño laboral. Se identifican como aspectos significativos las siguientes categorías: familia nuclear, familia de origen, déficit auditivo, desempeño educativo, desempeño laboral y redes de apoyo. En base a éstas se observa la importancia del capital cultural y económico, las estrategias personales para acceder a la información oral, el origen del déficit, el grado de interacción requerido en sus puestos de trabajo actuales, entre otros aspectos.
This study aims to know the meaningful aspects to the process of labor inclusion to two college graduates with several hypoacusis in the Metropolitan Region, through interviews focused on job performance to advance the understanding of strategies to improve employment opportunities for this population. It is an exploratory, retrospective and transversal study. It has designed a semistructured interview, previously requesting informed consent, for to collect the data. The interview covers their life trajectories focuses on job performance. They are identified as respects the following categories: nuclear family, family of origin, hearing loss, educational performance, work performance and their social support network. As a result of the former to emerge the importance of cultural and economic capital, personal strategies to access oral information, the source of the deficit, the degree of interaction required in their current jobs, among others.
Subject(s)
Humans , Universities , Employment , Hearing Loss , Professional Practice , Chile , Cross-Sectional Studies , Qualitative Research , Social Adjustment , Social Support , WorkABSTRACT
The aim of this study was to perform a descriptive study of the morphology, anatomical variations and morphometry of medial talocrural (or deltoid) ligament. We dissected 27 lower limbs obtained from amputations without histories of age, sex or disease. The measurements were made with a caliper, compass and ruler, expressing the results in millimeters. We described the superficial layer morphology of the medial ligament, measuring the size and ligament's thickness. For the deep layer we described and measured the length (l), width (w) and thickness (t). Results: Superficial layer: trapezoid form=66.7 percent (anterior margin=30.5 mm; posterior margin=27.6 mm; top margin=22.6 mm; bottom margin=50.5 mm), rectangular form=19 percent (anterior margin=19.3 mm; posterior margin=27.2 mm; top margin=24.4 mm; bottom margin=29.8 mm), triangular form=14.3 percent (anterior margin=37 mm; posterior margin=37.8 mm; bottom margin=48.3 mm). The average thickness of the superficial layer was 3.6 mm. Deep layer of the medial ligament: l=6.9 mm, w=11 mm, t=5.7 mm; presented rectangular form in 100 percent. In 76.2 percent of the specimens, the deep layer was covered completely by the superficial layer; however, in 23.8 percent the coverage is incomplete, showing the deep layer by posterior angle. The literature is contradictory regarding the anatomy and variations of the medial ligament of the ankle. There are important differences in morphology, attachments, subdivisions and relationships between the two layers of the deltoid ligament. Conclusions: We found significant anatomical variations in the morphology and the relationship between the superficial and deep layers of the deltoid ligament.
El objetivo fue realizar un estudio descriptivo de la morfología, variaciones anatómicas y la morfometría del ligamento talocrural medial (o deltoídeo). Se disecaron 27 miembros inferiores obtenidos de amputaciones sin antecedentes de edad, sexo, ni morbilidad. Las mediciones se realizaron con un pie de metro, regla y compás, expresando los resultados en milímetros. Se describió la morfología del ligamento medial en su capa superficial, midiendo el tamaño y grosor del ligamento. Para la capa profunda se describió y midió la longitud (l), ancho (a) y espesor (e). Resultados: En la capa superficial se observó: forma trapezoidal = 66,7 por ciento (margen anterior = 30,5 mm; margen posterior = 27,6 mm; margen superior = 22,6 mm; margen inferior = 50,5 mm), forma rectangular= 19 por ciento (margen anterior = 19,3 mm; margen posterior = 27,2 mm, margen superior = 24,4 mm; margen inferior = 29,8 mm), forma triangular = 14,3 por ciento (margen anterior=37 mm, margen posterior = 37,8 mm; margen inferior = 48,3 mm). El espesor promedio de la capa superficial fue de 3,6 mm. La capa profunda del ligamento medial: l = 6.9 mm, a = 11 mm, e = 5,7 mm, presentó forma rectangular en el 100 por ciento de los casos. En el 76,2 por ciento de las muestras, la capa profunda estaba completamente cubierta por la capa superficial, sin embargo, en 23,8 por ciento la cobertura fue incompleta, mostrando la capa profunda por el ángulo posterior. La literatura es contradictoria respecto a la anatomía y variaciones del ligamento medial del tobillo. Existen importantes diferencias en su morfología, inserciones, subdivisiones y las relaciones entre las dos capas del ligamento deltoídeo. Conclusiones: Se encontraron importantes variaciones anatómicas en la morfología y la relación entre las capas superficial y profunda del ligamento deltoídeo.
Subject(s)
Humans , Lateral Ligament, Ankle/anatomy & histology , Lateral Ligament, Ankle/innervation , Lateral Ligament, Ankle/blood supply , Ligaments/anatomy & histology , Ligaments/innervation , Deltoid Muscle/anatomy & histologyABSTRACT
Las lesiones del ligamento talofibular lateral son un problema común en traumatología. Éstas corresponden a la mayoría de los esguinces de tobillo, siendo el ligamento talofibular anterior el de mayor frecuencia, seguido del calcáneo fibular. Mediante nuestro estudio intentaremos describir la anatomía de estos ligamentos, teniendo así una herramienta para su enfrentamiento quirúrgico. Se realizó un estudio descriptivo morfométrico sobre los ligamentos talocrurales laterales, obteniéndose un promedio de sus medidas y frecuencia de variaciones anatómicas. Se disecaron 27 miembros inferiores obtenidos de amputaciones sin antecedentes de edad, sexo y morbilidad. Los ligamentos fueron medidos con un pie de metro, compás de puntas secas y regla milimetrada, expresando los resultados en milímetros. Se midió el largo(l), ancho(a), espesor(e), área de origen(ao) y área de inserción(ai). Se describieron las variaciones anatómicas que presentaron estos ligamentos. Los resultados fueron: Lig. calcáneo fibular (l=30,3mm; a=5,46mm; e=2,4mm; ao=46,17mm²; ai=66,59mm²). No presentó variaciones anatómicas. Lig. talofibular posterior (l=25,74mm; a=6,37mm; e=4,35mm; ao=40,1mm²; ai=80,19mm²). En 22,2 por ciento se describe una proyección de fibras accesorias (fascículo ascendente o tibial) que nacen del origen del ligamento, dirigiéndose hacia superior para insertarse en la caraarticular de la tibia. Lig. talofibular anterior (l=20,01mm; a=10,2mm; e=2,3mm; ao=60,03mm²; ai=66,96mm²). En 57 por ciento de los casos fue único, en 43 por ciento bifurcado y 0 por ciento trifurcado. Un 46,15 por ciento posee fibras arciformes que unen los orígenes de los ligamentos fibulotalar anterior y fibulocalcáneo. En conclusión se encontraron importantes variaciones anatómicas que no son aisladas, sino forman distintos grupos anatómicos de cada ligamento.
The lateral talofibular ligament injuries are a common problem in trauma. These correspond to the majority of ankle sprains, anterior talofibular ligament being the most frequent, followed by the calcaneal fibular. Through our study we will try to describe the anatomy of these ligaments, thus having a surgical tool for confrontation. A descriptive study was conducted on the morphometric lateral talocrural ligaments, resulting in an average of their measurements and frequency of anatomical variations. Were dissected 27 limbs from amputation with no history of age, sex and morbidity. The ligaments were measured with a tube foot, dry dividers and millimeter ruler, expressing the results in millimeters. We measured the length (l), width (a), thickness (e), area of origin (o) and insertion site (i). Described the anatomic variations presented these ligaments. The results were: fibulocalcaneal ligaments (l = 30.3 mm, a = 5.46 mm, e = 2.4 mm, ao = 46.17 mm²; ai = 66.59 mm²). No anatomic variations presented. Posterior talofibular ligament (l = 25.74 mm, a = 6.37 mm, e = 4.35 mm, ao = 40.1 mm²; ai = 80.19 mm²). In 22.2 percent described a projection accessory fiber (fascicle up or fibular) arising from the origin of the ligament, superior heading to attach to the articular surface of the fibula. Anterior talofibular ligament (l = 20.01 mm, a = 10.2 mm, e = 2.3 mm, ao = 60.03 mm²; ai = 66.96 mm²). In 57 percent of cases was unique, bifurcated in 43 percent and 0 percent triple-barbed. A 46.15 percent have arcuate fibers connecting the origins of the anterior fibulotalar and fibulocalcaneal ligaments. In conclusion important anatomical variations were found are not isolated, but form distinct anatomical groups each ligament.