Educación en pacientes adultos mayores sometidos a endoprótesis total de cadera: Un enfoque centrado en las preferencias de los pacientes / Education in older patients undergoing total hip endoprosthesis: An approach focused on patient preferences

Propósito del estudio: Explorar las preferencias educativas de los beneficiarios adultos de las Garantías Explicitas en Salud (GES) sometidos a una cirugía de endoprótesis total de cadera. Material y método: Estudio descriptivo de carácter mixto. Se diseñó una encuesta que exploró las preferencias educativas referentes a cada etapa del proceso quirúrgico de adultos mayores sometidos electivamente a endoprótesis total de cadera en un centro hospitalario universitario. La encuesta se aplicó retrospectivamente de manera telefónica por un encuestador entrenado. El tiempo transcurrido entre la aplicación de la encuesta y la cirugía fue entre 2 y 14 meses. Resultados: Se incluyeron 63 pacientes, cuya edad promedio fue 72,5 años y el 69,8% correspondía al sexo femenino. Con respecto a su previsión de salud el 57,2% era beneficiario de FONASA y el 42,7% de ISAPRE. Las preferencias de información descritas en nuestra muestra con respecto al proceso quirúrgico desde su inicio a fin, señalan a la cirugía propiamente tal (40,4%) y los cuidados post operatorios (29,3%) como los temas de más interés. Los temas de menor interés fueron los relacionados con cuidados preoperatorios (45,2%) y al proceso de hospitalización (31,7%). Los pacientes encuestados valoraron la información entregada previa a su cirugía como adecuada, útil y fácil de entender. Conclusiones: Los adultos mayores sometidos a endoprótesis señalaron la información específica referente a la cirugía y los cuidados post operatorios como los temas educativos de mayor interés. La información estándar entregada por los médicos tratantes fue bien recibida por los pacientes.

Purpose of the study: To explore the educational preferences of adults aged 65 years and older with hip osteoarthritis undergoing total hip replacement (THA). Methods: Mixed descriptive study. A survey was designed to explore the educational preferences regarding each stage of the surgical process in elderly patients undergoing electively THA for osteoarthritis in a university-affiliated hospital. The survey was applied retrospectively and telephonically by a trained interviewer between 2 and 14 months after the surgery.Results: Sixty-three patients were surveyed, whose average age was 72.5 years, and 69.8% corresponded to females. Regarding their health coverage, 57.2% were beneficiaries of FONASA and 42.7% of ISAPRE. The educational preferences described in our sample regarding the surgical process from its beginning to the end indicate that surgery (40.4%) and post-operative care (29.3%) as the most relevant topics. The topics of least interest were preoperative care (45.2%) and information related to hospitalization (31.7%). The surveyed pa-tients rated their treating physician's education as adequate, helpful, and easy to understand before their surgery. Conclusions: Elderly patients undergoing THA indicated that specific surgery and post-operative care information are the most relevant educational topics.

Genetic variants associated with neurodegenerative Alzheimer disease in natural models

The use of transgenic models for the study of neurodegenerative diseases has made valuable contributions to the field. However, some important limitations, including protein overexpression and general systemic compensation for the missing genes, has caused researchers to seek natural models that show the main biomarkers of neurodegenerative diseases during aging. Here we review some of these models-most of them rodents, focusing especially on the genetic variations in biomarkers for Alzheimer diseases, in order to explain their relationships with variants associated with the occurrence of the disease in humans.

Nivel sérico de folato y vitamina B12 en adultos mayores chilenos: Resultados de la Encuesta Nacional de Salud ENS 2009-2010 / Serum folate and vitamin B12 in older people: Results from the Chilean national health survey 2009-2010

Supraphysiological levels (SFL) of serum folate (SF) derived from flour fortification with folic acid (FA) could be risky among older adults with low vitamin B12 (B12) levels. Aim: To describe and analyze SF and B12 levels in older Chileans and to identify risk groups. Material and Methods: Participants were 1.043 older people aged ≥ 65 years from the National Health Chilean Health Survey 2009-2010 (ChNHS 2009-10), a multistage stratified random sample, representative of the national population. SF (µg/L) and B12 (pg/ml) were determined in fasting samples by competitive chemoluminescence immunoassay. Mean, deciles and percentiles 5 and 95th were calculated. We defined SF categories: < 4.4 (deficit); 4.41-20 (normal) and SFL: 20.01-25.6; 25.6-29 and > 29 µg/L (80th percentile of the distribution) and vitamin B12 categories: ≤ 200 (deficit); 200.1-299.5 (marginal deficit) and > 299.5 (normal). Prevalence rates, multiple and logistic regression models were used and adjusted by sex and age, educational level and residence area. Results: SF and B12 mean and 95th percentiles were 21.2 ± 0.56/38.6 µg/L and 348.4 ± 7.6/637(pg/ml) respectively. Forty nine percent of participants had SFL. Folate and B12 deficiency were present in 0.3 and 8.1% of participants, respectively. Men had significantly lower prevalence of SFL > 29 µg/L (OR adjusted odds ratio 0.47 95% confidence intervals: 0.26-0.84). B12 showed no significant variation by age and sex. The prevalence of SFL associated with B12 deficiency was 4.1%. No statistically significant association was observed between levels of folate and B12. Conclusions: Folate deficit is almost inexistent, but a significant percentage of participants had SFL suggesting the need for revising the current wheat flour fortification levels.

Aproximación al patrón de normalidad de TSH para la población chilena según Encuesta Nacional de Salud 2009-2010 / Thyroid stimulating hormone reference values derived from the 2009-2010 Chilean National Health Survey

Background: The determination ofthyroid stimulating hormone (TSH) reference values is critical for the diagnosis ofthyroid diseases. Aim: To explore and discuss different definitions to establish TSH reference values using a Chilean national survey sample. Material and Methods: The 2009-2010 Chilean National Health Survey recruited 5,416participants between the ages of 15 and 96years, from all geographic regions of Chile, including urban and rural zones. TSH was measured in a random subsample of 2,785 adults. Median value, 2.5 and 97.5 percentiles were described in three different populations: total survey population, "disease-free population" and the "laboratory kit disease free population". Results: TSH values were higher among women, the elderly and the less educated population. The 97.5 percentile value in the disease-free population was 7.46 uUl/ml. Using this value as a cut-off, hypothyroidism prevalence would be 4.8% in Chile and estimated pharmacological treatment coverage would be 58%. When laboratory kit cut-offs are used, prevalence rises to 22% and treatment coverage drops to 12%. The 2.5 percentile value in the disease-free population was 0.83 uUl/ml, which yields an estimated hyperthyroidism prevalence of3.89%. Conclusions: Median TSH concentration values in the Chilean "disease-free population" are higher than those proposed by laboratory kits and those of developed countries. TSH values in the general population of Chile are also higher in women, the elderly and the less educated population.

Análise de um sistema de avaliação de aprendizagem para internato em pediatria baseado em exame clínico objetivo estruturado, observação de prática clínica e exame escrito / Analysis of a learning assessment system for pediatric internship based upon objective structured clinical examination, clinical practice observation and written examination

OBJETIVO: Descrever e analisar três ferramentas usadas no sistema de avaliação aplicado ao internato em pediatria por um período de 7 anos na Faculdade de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile. MÉTODOS: Pesquisa observacional retrospectiva projetada para as modalidades de avaliação usadas de 2001 a 2007 que foram implementadas no internato em pediatria. As ferramentas foram as seguintes: exame clínico objetivo estruturado (objective structured clinical examination, OSCE), exame escrito e diretrizes de observação de prática clínica diária (DOPCD). Os métodos de avaliação foram aplicados ao internato em pediatria do sexto ano, com um total de 697 alunos. A análise estatística incluiu uma avaliação descritiva, com correlação e regressões linear simples e múltipla (ANOVA), teste de Bonferroni e coeficiente alfa de Cronbach. O nível de significância foi de 5 por cento. RESULTADOS: Escores de sucesso com a OSCE foram atingidos em 75,7±8 por cento, com melhor média entre o sexo feminino (p < 0,001). Os escores de OSCE melhoraram após o terceiro ano de implementação. O coeficiente alfa de Cronbach foi de 0,11-0,78. O exame escrito teve escore médio de 79,8±10 por cento, e não houve diferenças quanto a gênero. O escore médio de DOPCD 97,1±3 por cento, com melhores resultados entre as mulheres (p < 0,005). A correlação entre os três métodos de avaliação mostrou uma relação positiva moderada, exceto no ano de 2007, quando a correlação foi maior (p < 0,001). CONCLUSÕES: Análise do sistema de avaliação da aprendizagem foi realizada usando OSCE, exame escrito e DOPCD, que são complementares entre si, gerando bons resultados.

OBJECTIVE: To describe and analyze three tools used in the assessment system applied to the pediatric internship over a 7-year period at the School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile. METHODS: Retrospective observational research design for the assessment modalities implemented in the pediatric internship from 2001 through 2007. The tools were as follows: objective structured clinical examination (OSCE), written examination and daily clinical practice observation guidelines (DCPOG). The assessment methods were applied to the sixth-year pediatric internship with a total of 697 students. Statistical analysis included a descriptive assessment, with correlation and simple linear and multiple regressions (ANOVA), Bonferroni test and Cronbach's alpha coefficient. Significance level was set at p < 0.05. RESULTS: OSCE success scores were reached in 75.7±8 percent, with a better mean among females (p < 0.001). OSCE scores improved after the third year of implementation. Cronbach's alpha coefficient was 0.11-0.78. Written examination had a mean score of 79.8±10 percent and there were no sex differences. Mean DCPOG score was 97.1±3 percent and the results were better among females (p < 0.005). Correlation between the three assessment methods showed a moderate positive relationship except in the year of 2007, where the correlation was higher (p < 0.001). CONCLUSIONS: Analysis of the learning assessment system was performed using OSCE, written examination and DCPOG, which are complementary to each other, and yielded good results.

Influencia de la obesidad en los costos en salud y en el ausentismo laboral de causa médica en una cohorte de trabajadores / Influence of obesity on health care costs and absenteeism among employees of a mining company

Background: The health associated costs of obesity can represent between 2 percent and 9 percent of the total health costs of a given country. Aim: To assess the impact of obesity on health care costs and absenteeism in a cohort of mine workers. Patients and wethods: Prospective study of 4.673 men, employees of a mining company, aged 49 ± 7 years that were followed for 24 ± 11 months. Total health care cost and days of sick leave were recordedfor each individual. The association between obesity and these variables was analyzed by logistic regression adjusting for co-morbidities, age and other variables. Results: Mean annual health care costs for obese workers were 17 percent higher (p <0.001) compared to workers with normal weight and 58 percent higher (p <0.001) for workers with severe and morbid obesity. Mean annual days of sick leave increased by 25 percento in the obese (p =0.002) and by 57 percento in subjects with severe and morbid obesity (p <0.001). For health care costs the most significant predictors were: presence of diabetes mellitus (Odds ratio (OR) 6.21, 95 percento confidence intervals (95 percent CI) 4.9 to 7.9), hypertension (OR 3-99; 95 percent CI3-4 to 4.6) and severe and morbid obesity (OR 2.55, 95 percento CI 1.9 to 3-4). For absenteeism the most significant predictors were: presence of diabetes mellitus (OR 1.58, 95 percent> CI 1.2 to 2.0), hypertension (OR 1,34, 95 percent> CI 1.2 to 1.6) and severe and morbid obesity (OR 1.50, 95 percento CI 1.1 to 2.1). Conclusions: Obesity increases significantly health care costs and absenteeism.

Asociación de la región microsatélite AGAT del gen receptor de mineralocorticoides con los niveles de actividad renina en hipertensos esenciales / Microsatellite marker AGAT of the mineralocorticoid receptor gene is associated with plasma renin activity in patients with essential hypertension

Background: Hypertensive states could result from constitutive activation of mineralorticoid receptor (MR) that generates salt retention and blood pressure elevation. Moreover, microsatellite regions can be associated to the regulation of the gene expression, producing subtle pathologies. Aim: To determine the influence of microsatellite marker AGAT of the mineralocorticoid receptor gene in the plasma renin activity (PRA) and serum aldosterone (SA) levels of essential hypertensives (HT). Patients and Methods: We studied 292 HT patients and 57 normotensive (NT) controls. Blood samples were collected for PRA, SA and DNA isolation. Subjects were genotyped according to the length of the tetranucleotide AGAT repeat using polymerase chain reaction and polyacrylamide gel electrophoresis. Based on the normal distribution, we considered 13 to 15 repeats as a habitual (H) length and less than 13 or more than 15 repeats, as non-habitual (non-H). Results: We detected 8 different lengths in the AGAT repeat (allele) in both groups, ranging from 9-17 repeats, where the allele 11 was not detected in either hypertensive or normotensive groups. The allelic distribution was different in both groups (c2=37.57, 4GL, p <0.001). In hypertensive patients, the H group showed higher PRA levels (median (Q1-Q3)) than the non-H group: 1.3 (0-7-3.5) vs 1.0 (0.5-2.3) ng/mL*h, p <0.05. The SA levels did not show differences between both groups, but the SA*PRA product was higher in the H group than the no-H group: 9.3 (3.0-24.6) vs 6.5 (2.5-14.6) p <0.05. In normotensive patients, no differences were observed in PRA, SA and SA*PRA between both groups. Conclusion: These results show association between the length of the AGAT repeat with the PRA in HT, suggesting a plausible role in the control of the MR gene expression, and secondarily in the regulation of blood pressure .

Consumo de tabaco en población menor de 18 años: estudio de prevalencia en escolares de Chile / Smoking habit in school age children, in Chile

Background: In Chile, there is no information about the prevalence of smoking among basic and high school students. Aim: To study the prevalence of smoking among school age population. Material and Methods: A cross sectional survey was conducted during 2001, assessing tobacco use and smoking habit in a representative sample of 15.119 randomly selected students. Results: Sixty four percent of students had smoked at least once in their lifetime. Eighteen percent of students smoked daily and 15 percent, occasionally. The figures for women were higher (19 and 18 percent respectively). The mean age for the first contact with smoking was 12.3 years and, for starting the smoking habit, 13.2 years. Smokers increased the amount of cigarettes during weekends. Higher prevalence rates of smoking were observed in students from the Southern region of the country and of lower socioeconomic levels. From the 3rd grade on, there is an increased risk of having contact with tobacco and smoking for the first time and from 6th grade on, this risk becomes permanent. The adjusted Odds Ratio to be a smoker is significantly higher when the mother is a current or irregular smoker (OR 1.9 95 CI; 1.7-2.0). Conclusions: High smoking prevalence rates were detected in this survey, mainly in women. The risk for smoking starts early during school life. Therefore, health promotion programs must include elementary and high school students.

Tendencias de la mortalidad por cáncer de piel en Chile, 1987-1998 / Trends of skin cancer mortality in Chile, 1987-1998

En los últimos años se ha documentado en la población caucásica un aumento en la incidencia y mortalidad por cáncer de piel. Nos planteamos investigar la magnitud de este problema analizando los cambios experimentados por la mortalidad por melanoma cutáneo (MC), cáncer no-melanoma (CNM) y ambos agrupados como cáncer de piel (CP). Se consideraron las muertes por dichas causas informadas por el instituto nacional de estadísticas entre los años 1987 y 1998, se calcularon tasas de mortalidad por 100.000 habitantes y se ajustaron por edad. Se analizó la tendencia por sexo y grupos de edad. La tendencia de la tasa de mortalidad por, MC y CNM es ascendente, determinando un aumento de la mortalidad por CP de un 62 porciento. La mortalidad por MC es mayor que la por CNM, sin embargo, esta última experimenta un mayor ascenso. Proporcionalmente la mortalidad por CP crece como subgrupo dentro de la mortalidad general y por tumores malignos. La mortalidad por CNM es mayor en hombres y la diferencia por sexos en la mortalidad por MC no demuestra un claro predominio. A medida que aumenta la edad, aumenta la tasa de mortalidad y el grupo que experimentó un mayor ascenso en el período fueron los mayores de 75 años. Estos resultados son importantes proyectando la tendencia de estas tasas a futuro, deben considerarse para implementar políticas a escala nacional de control de factores de riesgo modificables y de detección precoz