Traducción al español, retraducción y validación de contenido de la escala Quality of Life in Alzheimer's Disease en pacientes con demencia Alzheimer / Spanish translation, retranslation, and content validation of the Quality of Life in Alzheimer's Disease scale in patients with Alzheimer's dementia

Introducción Se estima que para el año 2050 los mayores de 60 años corresponderán al 22% de la población mundial y con ello aumente la incidencia y prevalencia de enfermedad de Alzheimer. Uno de los pilares del tratamiento de esta condición es mejorar la calidad de vida, en este sentido surgen herramientas como la Quality of Life in Alzheimer's Disease Scale que permite medir calidad de vida en pacientes y sus cuidadores. Objetivo Realizar la traducción al español chileno y validación de contenido de la Quality of Life in Alzheimer's Disease Scale en pacientes con demencia por Alzheimer del Hospital Guillermo Grant Benavente de Concepción, Chile. Métodos Se llevó a cabo la traducción, retraducción y validez de contenido por juicio experto, utilizando el análisis Lawshe, pre-test y validación semántica usando la estrategia de respondent debriefing. Resultados Las versiones traducidas y retraducidas fueron comparadas entre ellas y con la versión original. Lawshe indica que una razón de validez de contenido de 0,49 es adecuado para considerar aceptable el ítem cuando en el proceso de validación de contenido han participado 15 expertos como en este estudio. El análisis arrojó una razón de validez de contenido mayor a 0,49 en 11 de los 13 ítems de la escala. De estos, ocho obtuvieron un valor superior a 0,8 y tres entre 0,49 y 0,79. En la validación semántica mediante la estrategia de se aplicó la escala a cinco personas con enfermedad de Alzheimer y a sus respectivos cuidadores. Con los datos obtenidos, se generaron modificaciones en aquellos ítems que obtuvieron una razón de validez de contenido menor a 0,49. Conclusión La versión obtenida en español de la resulta ser válida desde el punto de vista de su contenido y equivalente a su versión original.

Introduction It is estimated that by the year 2050, persons over 60 will account for 22% of the world population. Consequently, the incidence and prevalence of Alzheimer's disease will increase correspondingly. One of the pillars of the treatment of this condition is to improve the quality of life. In this sense, questionnaires such as the Quality of Life in Alzheimer's Disease allow us to measure the quality of life in patients and caregivers. Objective To translate into Chilean Spanish and carry out the content validation of the Quality of Life in Alzheimer's Disease scale in patients with Alzheimer's dementia at the Guillermo Grant Benavente Hospital in Concepción, Chile. Methods Translation, back-translation and content validity were carried out by expert judgment, using Lawshe analysis, pre-test and semantic validation using the respondent debriefing strategy. Results The translated and retranslated versions were compared with each other and with the original version. Lawshe indicates that a Content Validity Ratio equal 0.49 is adequate to consider the item valid when 15 experts participated in the content validation process, as in our study. The analysis yielded a content validity ratio greater than 0.49 in 11 of the 13 items on the scale. Of these, 8 obtained a value greater than 0.8 and 3 between 0.49 and 0.79. In semantic validation using the respondent debriefing strategy, the scale was applied to five people with Alzheimer's and their respective caregivers. With the data obtained, modifications were generated in those items that obtained a content validity ratio of less than 0.49. Conclusions The version obtained in Spanish of the Quality of Life in Alzheimer's Disease scale is valid from the point of view of its content and equivalent to its original version.

Resultados a siete años de la cirugía de reemplazo valvular aórtico en mayores de 80 años / Seven-year results of aortic valve replacement surgery in patients over 80 years of age

Resumen Objetivo: Describir las características clínicas y los resultados operatorios y a siete años del reemplazo valvular aórtico en una cohorte de pacientes mayores de 80 años. Materiales y métodos: Estudio descriptivo retrospectivo de 75 pacientes consecutivos mayores de 80 años, intervenidos de reemplazo valvular aórtico exclusivo entre 2007 y 2019 en el Hospital Guillermo Grant Benavente. Se estudian sus características demográficas, clínicas, ecocardiográficas, riesgo operatorio, cirugías, complicaciones y mortalidad operatoria y supervivencia alejada hasta el 15 de marzo 2021. Resultados: La edad media de la cohorte fue 83,05 ± 2,9 años (rango 80-95) y 43 pacientes eran mujeres (57,3%). La lesión valvular predominante fue la estenosis aórtica (89,3%). 10 pacientes tenían enfermedad coronaria asociada (13,3%) y 2 endocarditis activa. El riesgo de mortalidad operatoria calculado por EuroSCORE aditivo, logístico, II y STS score fue 7,58 ± 1,8; 9,88 ± 6,5%; 3,72 ± 3,5% y 4,27 ± 3,2%, respectivamente. Se utilizó prótesis biológica en 70 (92%) pacientes. Hubo 29 complicaciones operatorias y fallecieron 11 (14,7%) pacientes. El seguimiento promedio fue 7,1 años (rango 2-14), durante el cual fallecen 28 pacientes. La supervivencia a uno, tres y cinco años fue 82, 76, 66 y 48% respectivamente. Conclusiones: La cirugía de reemplazo valvular aórtico en octogenarios en nuestro medio es un procedimiento poco frecuente. La mortalidad observada fue mayor que la estimada por las escalas de riesgo. El reemplazo valvular quirúrgico es una alternativa de tratamiento de la enfermedad de la válvula aórtica en pacientes seleccionados. Se deben evaluar estrategias para mejorar los resultados.

Abstract Objective: To describe the clinical characteristics and operative and 7-year results of aortic valve replacement in a cohort of patients older than 80 years. Materials and methods: Retrospective descriptive study of 75 consecutive patients older than 80 years of age who underwent exclusive aortic valve replacement between 2007 and 2019 at the Guillermo Grant Benavente Hospital. Demographic, clinical, echocardiographic characteristics, operative risk, surgeries, complications and operative mortality and long-term survival until March 15, 2021 are studied. Results: The mean age of the cohort was 83.05 ± 2.9 years (range 80-95) and 43 patients were women (57.3%). The predominant valve lesion was aortic stenosis (89.3%). Ten patients had an associated coronary artery disease (13.3%) and 2 had active endocarditis. The risk of operative mortality calculated by EuroSCORE additive, logistic, II and STS score was 7.58 ± 1.8; 9.88 ± 6.5%; 3.72 ± 3.5% and 4.27 ± 3.2%, respectively. A biological prosthesis was used in 70 (92%) patients. There were 31 operative complications and 11 (14.7%) patients died. The mean follow-up was 7.1 years (range 2-14), during which 28 patients died. Survival at 1, 3, and 5 years was 82, 76, 66 and 48%, respectively. Conclusions: Aortic valve replacement surgery in octogenarians in our setting is a rare procedure. The observed mortality was higher than that estimated by the risk scales. Surgical valve replacement is an alternative treatment for aortic valve disease in selected patients. Strategies to improve results should be evaluated.

Intercambio plasmático terapéutico por plasmafiltración: experiencia de 11 años de un centro / Therapeutic plasma exchange: experience in 102 patients

BACKGROUND: Therapeutic Plasma Exchange (TPE) is a procedure in which plasma and harmful macromolecules are separated from the rest of the blood components by centrifugation or filtration through membranes and are replaced with solutions with albumin and/or plasma. AIM: To communicate our experience using TPE by filtration. MATERIAL AND METHODS: Review of records of 655 TPE sessions performed in 102 patients aged 50 ± 18 years (64% women). The requirement of renal replacement therapy (RRT) and seven days and one year mortality were recorded. RESULTS: Forty five percent of patients had hypertension or diabetes. The main indications for TPE were pulmonary-renal syndrome (PRS) (62%) and antibody mediated graft rejection (29%), followed by neurological diseases (36%). Fifteen percent of patients required RRT for one year. Mortality at seven days and one year was 20 and 30%, respectively. Out of the total of deaths associated with kidney diseases, 88% corresponded to PRS and ANCA vasculitis. The main complications were thrombocytopenia in 41%, hypocalcemia in 18%, and hypotension in 16%. CONCLUSIONS: In our experience, TPE by filtration is a safe technique, with mild and preventable complications. Despite this, the reported mortality is high, which reflects the severity of the diseases that motivated the indication for TPE.

Resultados de la cirugía de reparación valvular mitral en el Hospital Guillermo Grant Benavente de Concepción (2009-2020) / Results of surgical mitral valve repair at Guillermo Grant Benavente Hospital, Concepción, Chile

Resumen: Objetivo: Describir las características clínicas, resultados operatorios inmediatos y a 5 años de la cirugía de reparación valvular mitral. Material y métodos: Estudio retrospectivo de la cohorte de pacientes operados de reparación valvular por insuficiencia mitral (IM) en el Hospital Guillermo Grant Benavente desde el 2009 hasta marzo 2020 (N=206). Se comparan los pacientes con IM primaria y secundaria en sus características clínicas, ecocardiográficas, técnicas quirúrgicas empleadas, cirugías asociadas, morbimortalidad operatoria, sobrevida y reintervenciones hasta el 30 de mayo de 2020. Resultados: 124(60,2%) hombres. Edad media 62,6±10,5 años. La IM fue primaria en 134 y secundaria en 72. En comparación con los pacientes portadores de IM primaria, aquellos con IM secundaria tuvieron más enfermedad coronaria (69,4% versus 11,9%; p<0,001) y mayor riesgo operatorio (EuroSCORE logístico 7,7±6,7 versus 5,2±7,3; EuroSCORE II 3,4±4,8 versus 2,4±4,7; p<0,001). El mecanismo más frecuente de IM primaria fue tipo II (65,7%) y en las secundarias fue el tipo III (48,6%) seguido del tipo I (30,6%). Las IM primarias se corrigieron principalmente con procedimientos para disminuir el prolapso (76,1%). En las secundarias la técnica más utilizada fue el implante de un anillo exclusivo (76,4%). Hubo 116 cirugías asociadas y 10 (4,9%) conversiones a reemplazo valvular. Hubo 57 complicaciones operatorias y fallecieron 12 (5,8%) pacientes, 5 (3,7%) con IM primaria y 7(9,7%) con IM secundaria. La sobrevivencia global a 5 años fue 83,5% (90% en las primarias y 78% en las secundarias) y hubo 6 reintervenciones. Conclusiones: La cirugía de reparación valvular, tanto en pacientes con IM primaria como secundaria, tuvo una baja mortalidad operatoria y excelentes resultados a 5 años.

Abstract: Aim: To describe the clinical characteristics, operative and long term results of surgical mitral valve repair. Material and methods: Retrospective study of the cohort of patients undergoing valve repair due to mitral regurgitation (MR) at the Guillermo Grant Benavente Hospital from 2009 to March 2020 (N = 206). Patients with primary and secondary MR were compared on clinical and echocardiographic characteristics, surgical techniques, associated surgeries, operative morbidity and mortality, survival and reinterventions up to May 30, 2020. Results: 124 (60.2%) were men. The average age was 62.6±10.5 years. Type of MR was primary in 134 and secondary in 72. Compared to patients with primary MR, those with secondary MR had more coronary artery disease (69.4% versus 11.9%; p <0.001) and greater operative risk (logistic EuroSCORE 7.7±6, 7 versus 5.2±7.3; EuroSCORE II 3.4±4.8 versus 2,4±4.7; p<0.001). The most frequent mechanism of MR was type II in primary (65.7%) and type III (48.6%) followed by type I (30.6%) in secondary MR. Primary MR was corrected mainly with procedures to decrease prolapse (76.1%). In secondary MR the main technique used was the implantation of an exclusive ring (76.4%). There were 116 associated surgeries and 10(4.9%) conversions to valve replacement. There were 57 operative complications and 12(5.8%) patients died, 5 (3.7%) with primary MR and 7 (9.7%) with secondary MR. Overall survival at 5 years was 83.5% (90% in primary MR and 78% in secondary MR) and there were 3 reoperations. Conclusions: Valve repair surgery in both primary and secondary MR patients was associated to a low operative mortality and excellent results at 5 year post surgery.

Resultados de la cirugía coronaria sin circulación extracorpórea en dos períodos de uso de la técnica / Off pump coronary artery surgery: comparison of two consecutive periods with the technique

OBJETIVO: Describir los resultados inmediatos y alejados de la cirugía coronaria sin circulación extracorpórea (CEC) y comparar los resultados de la estrategia de indicación de la técnica en dos períodos. PACIENTES Y MÉTODOS: Estudio retrospectivo de 428 pacientes intervenidos de cirugía coronaria sin CEC entre 2004 y 2019 en el Hospital Guillermo Grant Benavente. Se dividen en Grupo 1, período 2004-2008 (N=216) y Grupo 2, período 2009-2019 (N=212). Se estudiaron sus características clínicas, resultados quirúrgicos, morbi-mortalidad operatoria y eventos adversos al 31 de junio de 2019 y se compararon los resultados de los grupos a 5 años. RESULTADOS: No hubo diferencias en la distribución por sexo, edad, factores de riesgo y patologías asociadas entre los grupos. Hubo diferencias en las lesiones coronarias entre los Grupos 1 y 2: lesión de un vaso en 45 (20,4%) versus 125 (59%) y tres vasos en 75 (34,5%) versus 19 (9%) respectivamente (p<0,001). El riesgo operatorio por EuroSCORE logístico fue 3,3±3,95 versus 5,4±7,7 (p<0,001). Se confeccionaron 2,3±0,9 anastomosis distales en el Grupo 1 versus 1,3±0,6 en Grupo 2 (p<0,001). La tasa de complicaciones fueron 17,6% en el Grupo 1 y 5,7% en el 2 (p<0,001). La mortalidad operatoria globral fue 4 pacientes (0,9%). El seguimiento comprendió 9,2±3,8 años. La sobrevida a 10 años fue 76,9% y tasa de eventos cardiovasculares mayores 37,6%. No hubo diferencia entre los grupos a los 5 años. CONCLUSIONES: La selección de pacientes con anatomía más favorables o de mayor riesgo operatorio tuvo tasas de sobrevida y eventos similares a los observados con la estrategia menos selectiva a 5 años de seguimiento.

AIM: To describe the immediate and long-term results of off pump coronary artery surgery without cardiopulmonary bypass (OPCABG) comparing the results observed in two consecutive periods. PATIENTS AND METHODS: A retrospective study of 428 patients undergoing OPCABG between 2004 and 2019 at the Guillermo Grant Benavente Hospital. Group 1 patients operated between 2004 - 2008 (N = 216) and Group 2 operated between 2009 and 2019 (N = 212). RESULTS: There were no differences in sex, age, risk factors and co morbidities between groups. There were differences in the number of coronary lesions between groups: one vessel disease in 45 (20.4%) versus 125 (59%) and three vessels in 75 (34.5%) versus 19 (9%) in Group 1 vs Group 2, respectively (p <0.001). The operative risk for logistic EuroSCORE was 3.3 ± 3.95 in Group 1 versus 5.4 ± 7.7 in Group 2 (p <0.001). 2.3 ± 0.9 distal anastomoses were performed in Group 1 compared to 1.3 ± 0.6 in Group 2 (p<0.001). Adverse events occurred in 17.6% o patients in Group 1 compared to 5.7% in Group 2 (p<0.001). Overall, 4 patients died (0.9%). Mean overall survival at 10 years was 76.9% and the rate of major cardiovascular events was 37.6%, no differences being observed between groups. CONCLUSIONS: At 5 years of follow-up the selection of patients with more favorable anatomy or greater operative risk had similar survival rates and events than those observed with the least selective strategy.

Factores asociados a respuesta favorable de tratamiento corticoidal en pacientes con polirradiculoneuropatía desmielinizante inflamatoria crónica / Variables associated with a good response to steroids in chronic inflammatory demyelinating polyradiculoneuropathy

Background: The treatment of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is based on corticosteroids, immunoglobulin and plasmapheresis. In our Health System, corticosteroids are commonly used as first line therapy for economic reasons and accessibility. However, the factors associated with a good response are not well known. Aim: To assess the association of demographic, clinical and laboratory variables with a favorable response to corticosteroid therapy in patients with CIDP. Material and Methods: Observational, descriptive, longitudinal and retrospective study of 33 patients with a diagnosis of typical, definitive or probable CIDP, treated with corticosteroids for at least six months. Results: Twenty-three patients had a good clinical response to corticosteroid treatment and 10 were non-responders. The variables significantly associated with a good response to steroids were a disease lasting less than 1 year prior to the start of treatment, the absence of axonal damage in electromyography a relapsing-recurrent course and a favorable response within two months of treatment. Conclusions: Most of these patients with CIDP had good response to corticosteroid therapy.

Impacto de diferentes medidas de mitigación en el curso de la pandemia de COVID-19 en Chile: proyección preliminar para el período del 14 de abril al 14 de mayo / Impact of mitigation measures on the COVID-19 pandemic in Chile: preliminary data for the period April 14 to May 14

RESUMEN Objetivo Modelar el curso de la pandemia COVID-19 en Chile y proyectar la demanda de recursos hospitalarios y letalidad en escenarios simulados: primero, recurriendo a distintas medidas de mitigación para contener la propagación en un mes -desde el 14 de abril hasta el 14 de mayo del 2020- y, segundo, en el supuesto contagio del 70% de la población, según edad, sin límite de tiempo. Métodos Utilizamos como base el número de contagios confirmados con SARS-CoV-2 en Chile hasta el 14 de abril del 2020 (8 273 casos, 94 muertes). Para los distintos escenarios, asumimos un número reproductivo básico que va desde R0=2,5 hasta R0=1,5. La proyección de la demanda hospitalaria y letalidad por edad se fundamentaron en reportes italianos y británicos. Resultados Estimamos que para el 14 de mayo del 2020 habría en Chile 2 019 775 contagiados y 15 068 fallecidos en ausencia de medidas de mitigación (R0=2,5). Al implementar medidas que reduzcan R0 a 1,5 (detección temprana y aislamiento de casos, cuarentena y distanciamiento social de mayores de 70 años), el número de contagios y letalidad disminuirían a 94 235 y 703 respectivamente. Sin embargo, la demanda hospitalaria aún sobrepasaría la capacidad de respuesta. La población de mayor riesgo la componen los mayores de 60 años. Conclusión Encontramos evidencia a favor de las medidas de mitigación implementadas por el Gobierno chileno. Sin embargo, medidas más estrictas son necesarias para no colapsar el sistema sanitario, que cuenta con menos recursos hospitalarios que los proyectados. Es esencial aumentar la capacidad hospitalaria en términos de equipamiento y entrenamiento del personal de salud.(AU)

ABSTRACT Objetive To model disease progression, healthcare demand and case fatality rate attributed to COVID-19 pandemic that may occur in Chile in 1-month time, by simulating different scenarios according to diverse mitigation measures hypothetically implemented. Furthermore, we aimed to estimate the same outcomes assuming that 70% of the population will be infected by SARS-CoV-2, with no time limit assumption. Methods We based on the number of confirmed COVID-19 cases in Chile up to April 14th 2020 (8 273 cases and 94 deaths). For the simulated scenarios we assumed basic reproduction numbers ranging from R0=2.5 to R0=1.5. The estimation of the number of patients that would require intensive care and the age-specific case fatality rate were based on data provided by the Imperial College of London and the Instituto Superiore di Sanità en Italia. Results If no mitigation measures were applied (R0=2.5), by May 25, Chile would have 2 019 775 cases and 15 068 deaths. If mitigations measures were implemented to decrease R0 to 1.5 (early detection of cases, quarantine, social distancing of elderly), the number of cases and deaths would importantly decrease. Nonetheless, the demand for in-hospital care including intensive care would exceed the available resources. Our age-specific analysis showed that population over 60 years are at higher risk of needing intensive care and death. Conclusion Our evidence supports the mitigation measures implemented by the Chilean government. Nevertheless, more stringent measures are needed to prevent the health care system's collapse due to shortfall of resources to confront the COVID-19 pandemic.(AU)

Enfermedad coronaria en mujeres pre y postmenopáusicas y su relación con la diabetes mellitus tipo 2 / Coronary artery disease in pre and postmenopausal women. The influence of type 2 diabetes mellitus

Background: Postmenopausal women have higher severity of coronary heart disease (CHD) than premenopausal women and type 2 diabetes mellitus (T2DM) is an independent risk factor. Aim: To assess the severity of CHD in pre and postmenopausal patients undergoing coronary angiography and the impact of T2DM in both groups. Material and Methods: A coronary angiography was performed to 707 women due to suspected CHD during 2013 and 2014. Of these, 579 were older than 55 years and were considered as postmenopausal. Factors such as hypertension, obesity, smoking, creatinine and T2DM were registered. The severity of CHD in coronary angiography was evaluated according to the number of vessels with more than 50% stenosis. Results: Compared to their postmenopausal counterparts, premenopausal women had less frequency of T2DM (31% and 42% p < 0.033), hypertension (52 and 78%, p < 0.001) and alteration of renal function (11 vs. 39%, p < 0.001). Absence of coronary lesions was found in 44 and 32% of premenopausal and postmenopausal women, respectively (p < 0.01). Premenopausal women with T2DM had a higher frequency of multi-vessel disease than those without the disease (25 and 4.5%, p < 0.001). The frequency of multi-vessel disease was higher in postmenopausal than premenopausal women (24 and 11%, p < 0.01). Hypertension, T2DM and renal involvement were associated with a higher frequency multiple vessel disease. Conclusions: The severity of CHD is higher in postmenopausal women and T2DM is associated with the disease.

¿Son efectivas las intervenciones psicológicas para mejorar el control de la Diabetes Mellitus tipo 2 en adultos?: una revisión sistemática y metaanálisis / Psychological interventions for patients with type 2 diabetes mellitus. A systematic review and meta-analysis

Background Affordable interventions to improve metabolic control of Type 2-Diabetes Mellitus are increasingly necessary. Aim To review systematically the existing literature on the effects of psychological interventions on Type-2 Diabetes Mellitus compensation. Material and Methods We performed a systematic literature review and meta-analysis on the effectiveness of psychological interventions implemented for Type-2 Diabetes Mellitus patients. Research included the following electronic databases: PubMed, Bireme, Web of Science, SciELO, Embase, EBSCOhost, SCOPUS, Psychology Database. Results Most studies showed a decrease in the level of glycated hemoglobin after interventions, which applied different initiatives complementary to standard medical treatment. Mainly, these interventions encompassed training for self-monitoring and control of diabetes based on cognitive behavioral psychology, counseling, self-assessment and physical-spiritual work based on transpersonal psychology. Conclusions Psychological tools could be an adjunct to the standard medical treatment for patients with Type-2 Diabetes Mellitus, reducing glycated hemoglobin levels and improving self-regulation, disease awareness and adherence from the self-efficacy perception perspective.

Entrenamiento físico en personas con enfermedad renal crónica avanzada: beneficios de su implementación en la práctica clínica / Exercise training in advanced chronic kidney disease

Chronic kidney disease is associated with an increase in cardiovascular risk and mortality, and a decrease in the health-related quality of life. It is known that the physical capacity of patients with chronic kidney disease is lower than their healthy counterparts. It also decreases progressively after the start of hemodialysis, even leading to the loss of functional independence. There is a positive association between exercise and improvement of many targets in chronic kidney disease, especially in dialysis patients, such as cellular apoptosis, immune improvement and inflammation. In addition, several clinical studies and systematic reviews show an improvement in different clinical and laboratory variables and suggest a lower mortality, proving a reduction of health care economic costs. Exercise intervention in dialysis is safe. Although different guidelines promote exercise, it is necessary to work on its implementation on a large scale.

Resultados a 5 años de la revascularización exclusiva con dos arterias mamarias en pacientes con enfermedad coronaria multivaso / Exclusive coronary revascularization with both mammary arteries: analysis of 73 patients

Background: Exclusive coronary revascularization with both mammary arteries could result in lower rates of adverse events in the long term. Aim: To describe the five-year evolution of a cohort of patients operated on with this technique. Material and Methods: Follow up analyzing survival of 73 patients aged 59 ± 9 years (82% men) who underwent exclusive coronary surgery with two mammary arteries between December 1,2010 and April 12,2017. We studied their clinical characteristics, surgical results, operative morbidity and mortality and adverse events up to June 30, 2018. Results: Six patients had two-vessel lesions and 67 three-vessel lesions. The operative risk calculated by additive and logistic EuroSCORE was 2.5 and 2.3%, respectively. A mean of 3.75 anastomoses /patient were performed, 116 with left mammary artery (73 to the anterior descending artery, 38 to a diagonal artery and 5 for other objectives) and 158 with right mammary artery (69 to a first marginal artery, 23 to a second marginal artery and 64 to posterior descending artery). There was one case of mediastinitis and one (1.5%) patient died. The mean follow-up was 64.6 ± 23.7 months. The 5-year survival was 90.4%. Conclusions: Coronary revascularization with two exclusive mammary arteries allowed a complete revascularization of the heart with a low rate of complications and adverse effects at five years.

Prevalencias de complicaciones asociadas a la instalación de catéter venoso central para hemodiálisis / Prevalence of complications associated with central venous catheter instalation for hemodyalisis

Background: Placing central venous lines under ultrasonographic guidance reduces the complications of the procedure. Aim: To compare prevalences of complications of central venous line placements with or without ultrasonographic guidance. Material and Methods: Descriptive study that contemplated the comparison of two groups of patients subjected to a central venous line placement at a nephrology service for renal replacement therapy. In one group of 100 patients, the line was placed without ultrasonographic guidance between 2008 and 2012. Between 2015 and 2017 the line was placed in 138 patients using ultrasonographic guidance. The prevalences of complications with both types of procedures were recorded. Results: The frequency of complications of procedures with and without ultrasonographic guidance was 0.7 and 18% respectively (prevalence ratio 0.04, 95% confidence interval 0-0.3). Ninety five percent of recorded complications were arterial puncture, followed by hematomas in 10% and pneumothorax in 5%. The higher prevalence of complications was observed in emergency line placement without ultrasonographic guidance. There was a direct association between the number of line placement attempts in a single procedure and the prevalence of complications. Conclusions: Ultrasonographic guidance is associated with a reduction in the prevalence of central venous line complications.

Efectividad de intervenciones basadas en Mindfulness para mejorar el control de la Diabetes Mellitus tipo 2: una revisión sistemática e integración metanalitica preliminar / Effectiveness of Mindfulness-based interventions to improve control of type 2 diabetes mellitus: a systematic review and preliminary meta-analytic integration

Resumen El propósito de este trabajo fue estudiar la efectividad de intervenciones basadas en Mindfulness sobre el nivel de hemoglobina glicada —HbA1c— en pacientes con diabetes mellitus tipo 2 —DM2—. Se realizó una revisión sistemática e integración metanalítica preliminar. La búsqueda de los estudios se realizó en las siguientes bases: PubMed, Bireme, Web of Science, SciELO, Embase, EBSCOhost, SCOPUS, Psychology Database. Se identificaron 10 artículos: cuatro fueron llevados a cabo en Estados Unidos, dos en Irán, uno en Alemania, uno en Australia, uno en Tailandia y uno en Inglaterra. Se observó una reducción en los niveles de la HbA1c utilizando Mindfulness en comparación a los grupos controles (p < 0,02). Además, se observó un efecto diferenciado al analizar según número de participantes, sexo y tiempo de seguimiento. Se concluyó que el uso de intervenciones basadas en Mindfulness tendría un efecto indirecto sobre la reducción de la hemoglobina glicada.

Abstract The purpose of this paper was to study the effectiveness of Mindfulness-based interventions on the level of glycated hemoglobin —HbA1c— in patients with type 2 diabetes mellitus —DM2—. A systematic review and preliminary meta-analytic integration was performed. The search of the studies was carried out in the following bases: PubMed, Bireme, Web of Science, SciELO, Embase, EBSCOhost, SCOPUS, Psychology Database. Ten articles were identified: four were published in the United States, two in Iran, one in Germany, one in Australia, one in Thailand and one in England. A reduction in HbA1c levels was observed using Mindfulness compared to control groups (p <0,02). In addition, according to the number of participants, sex and time of follow-up a differentiated effect was found. It was concluded that the use of interventions based on Mindfulness would have an indirect effect on the reduction of glycated hemoglobin (HbA1c).

Diabetes Mellitus tipo 2: desafíos para los modelos de cuidados crónicos en Chile / Type 2 diabetes mellitus as a challenge for chronic disease care models in Chile

The increase in chronic noncommunicable diseases is one of the main concerns worldwide. Therefore, it is pertinent to ask how care system organizations responded to the requirements currently being posed by chronic diseases, specifically type 2 diabetes mellitus (T2DM). In the world, different models have been developed considering elements that transcend the biological stability of the disease. Chile has the great challenge of exploring new models that emphasize the promotion and prevention of health rather than the management of the disease. The impact of variables such as health literacy, self-efficacy and subjective well-being on T2DM should be explored. In addition, it is necessary to validate and implement guidelines and protocols of care that incorporate the aforementioned variables.

Percepción de stakeholders de Chile Crece Contigo, acerca de su implementación en la comuna de Concepción, Chile / Perception of Chile Crece Contigo stakeholders on its implementation in the Commune of Concepción, Chile

RESUMEN Objetivo Explorar la percepción de los stakeholders vinculados al subsistema de protección de la infancia "Chile Crece Contigo" en lo que respecta a su implementación en la comuna de Concepción, Chile. Métodos Estudio cualitativo. Se utilizaron entrevistas semiestructuradas y un focus group como técnicas de recolección de información. Se realizó un muestreo teórico en base a la representación de los niveles de decisión y poder respecto a la implementa-ción de Chile Crece Contigo en la comuna de Concepción. Los datos fueron analizados con el software ATLAS.ti 6.2. Resultados Destacaron como logros la alta valoración de Chile Crece Contigo, junto con, la capacidad de instalar temas tan relevantes como el cuidado de la primera infancia. El aspecto no logrado más importante fue el aprovechamiento de los beneficios entregados y la difusión de la política. El mayor facilitador de la implementación fue el compromiso con el Chile Crece Contigo, mientras la mayor barrera, la situación contractual de los profesionales. Finalmente, como aspectos a mejorar se apuntaron la infraestructura, la articulación de la red Chile Crece Contigo y los recursos asociados a la política. Conclusión La implementación de Chile Crece Contigo en la comuna de Concepción ha alcanzado una alta valoración y reconocimiento en la comunidad, sin embargo, aún se requiere trabajar en el logro de aspectos relacionados con la articulación de los distintos stakeholders que componen la red Chile Crece Contigo, la difusión de la política en todos los niveles y el mejor aprovechamiento de los beneficios entregados a la población.(AU)

ABSTRACT Objective To explore the perception of stakeholders on the implementation policy of the childhood protection subsystem "Chile Crece Contigo" in the Commune of Concepción, Chile. Materials and Methods Qualitative study. Semi-structured interviews and a focus group were used as information gathering techniques. A theoretical sampling was carried out based on the representation of decision and power levels with regard to the implementation of Chile Crece Contigo in the Commune of Concepción. The data were analyzed with the ATLAS.ti 6.2 software. Results The most notable achievements highlighted by interviewees were the high valuation of Chile Crece Contigo, along with the possibility of placing relevant subjects such as first childhood care into the agenda. On the contrary, taking advantage of benefits delivered by the program and the dissemination of the policy were deemed as not achieved. The main facilitator of the implementation was the commitment of the beneficiaries to Chile Crece Contigo, while the most important barrier identified was the contract modality of professionals. Finally, aspects to be improved included infrastructure of facilities, the Chile Crece Contigo network articulation and the funds to secure sustainability of the program over time. Conclusion The implementation of Chile Crece Contigo in the Commune of Concepción has achieved high recognition in the community, however, it is still necessary to work on the achievement of aspects related to the articulation of the different stakeholders that make up the Chile Crece Contigo network, the diffusion of politics at all levels, and the best use of the benefits delivered to the population.(AU)

Implementación de la política pública para el cuidado de la primera infancia en el contexto chileno: una mirada desde salud al Chile Crece Contigo / Implementation of a policy for early childhood care in the Chilean context: a view from health to Chile Crece Contigo

RESUMEN En el campo del cuidado de la infancia Chile posee una larga historia de intervenciones que han apuntado hacia la disminución de la mortalidad infantil, la mayoría de ellas, con un fuerte enfoque biomédico. Estas han intentado dar respuesta a las demandas de la época en que han sido formuladas, reflejando la evolución de la historia socio-sanitaria del estado chileno y logrando un cometido exitoso durante el transcurso del pasado siglo. En este contexto emerge la política pública "Chile Crece Contigo", la cual ha apostado al abordaje biopsicosocial de la primera infancia mediante una serie de acciones tendientes a la protección y acompañamiento del desarrollo de los niños/as, con un especial énfasis en el apoyo a las familias más vulnerables. Este ensayo plantea antecedentes de la política pública para la protección de la primera infancia en el contexto chileno mirada desde el sector salud y presenta brevemente algunos aspectos relevantes del proceso de implementación de una de sus políticas más significativas.(AU)

ABSTRACT In the field of childhood care, Chile has a long history of interventions which have pointed to reduce infant mortality, most of them with a strong biomedical approach. These interventions have attempted to respond to the demands of the period when they were established, reflecting the evolution of social and health history of the Chilean State and achieving good results during the past century. In this context the Chile Crece Contigo (Chile grows with you) public policy was created to bet on a biopsychosocial approach to early childhood through a serie of actions aimed at protecting and accompanying children throughout their development, with special emphasis on support to the most vulnerable families. This essay presents the background of the public policy for early childhood protection in the Chilean context, from a health perspective, and also presents briefly some important aspects of the implementation process of one of its most significant policies.(AU)

Características de los comités paritarios y accidentalidad: un estudio exploratorio utilizando árboles de clasificación / Characteristics of joint committees and accidentability: an exploratory study using classification trees

Propósito. El objetivo de este estudio fue realizar un análisis exploratorio de las relaciones entre distintos indicadores del funcionamiento de los Comités Paritarios de Higiene y Seguridad (CPHS) como predictores de las variaciones en la accidentalidad. Diseño. Este artículo presenta una investigación cuantitativa, exploratoria-descriptiva. Muestra. Participaron del estudio 322 integrantes de Comités Paritarios, principalmente de la Región Metropolitana, pertenecientes a rubros de servicio, agroindustria y manufactura. Instrumento. El instrumento utilizado para recabar la información fue el Cuestionario para evaluar “Funcionamiento de Comités Paritarios de Higiene y Seguridad” deBlamey (Blamey et al. 2005), y los índices de accidentalidad de las empresas involucradas en el estudio. Variables. Las variables del estudiofueron: el índice de accidentalidad, diversas actividades de prevención,autoridad del comité, nivel de compromiso de la empresa y trabajadores, entre otras. Procedimiento. Para el análisis de la información se realizaron modelamientos empleando la técnica de análisis no paramétrico de Árboles de Clasificación. Resultados. Se encontró que los principales predictores de accidentalidad pueden variar según el rubro, como, por ejemplo, para el Agroindustrial y Servicios fue la capacitación; para el Industrial fue el seguimiento de los acuerdos del Comité,entre otros. Conclusiones. Los perfiles no necesariamente se condicen con lo esperado desde la teoría; esto podría ser indicativo de que los integrantes de los comités están percibiendo de manera distinta algunos aspectos relacionados con la disminución de la accidentalidad.Probablemente en cada CPHS por rubro hay variabilidad en las percepcionesrespecto de las conceptualizaciones de accidentalidad y sus causas relacionales. El método del Árbol de Clasificación nos permitió explorar perfiles para lograr identificar diferentes atributos de los gruposque se vinculan al aumento.

Purpose. The purpose of this study was to carry out an exploratory analysis of relations between various indicators of the functioning of the Joint Committees on Industrial Hygiene (JHSC) as predictors of changes in accidentability. Design. This article presents a quantitative, exploratory and descriptive research. Sample. 322 members of jointcommittees, mainly from the metropolitan area, pertaining to theservices, agroindustry and manufacturing sectors participated in thestudy. Instrument. The instrument used to collect data was a questionnaire to assess "Operation of the Joint Committee on Health and Safety" of Blarney (Blamey et al. 2005), and accidentability indexes of the companies involved in the study. Variables. The study variables were: The accidents index, various prevention activities, theauthority of the committee, the level of commitment of the company and workers, among others. Procedure. For the analysis of information modellings were performed using the technique of nonparametric analysis of Classification Trees. Results. It was found that the main predictors of accidentability may vary according to sectors, for example, for the agroindustrial and services sectors it was training, and for the industrial sector it was the follow-up of agreements of the Committee, among others. Conclusions. The profiles are not necessarily consistent with which was expected from theory, this could be anindication that the committee members are perceiving some aspects related to the decrease of accidents in a different way. Probably in every JHSC per sector, there is variability in the perceptions of the conceptualizations of accidentability and their relational causes. The classification tree method allowed us to explore profiles in order to identify different characteristics of the groups that are linked to the increase or decrease in accidentability.

El estudio de la percepción del riesgo y salud ocupacional: una mirada desde los paradigmas de riesgo / Study of the perception of risk and occupational health: a view from the paradigms of risk

Por medio de este trabajo se aborda la temática de la percepción del riesgo el cual en las últimas décadas ha provocado bastante investigación, pues se le concibe como un elemento que puede potenciar y mejorar las políticas de prevención. El objetivo de este artículo fue abordar brevemente cuál es el estado del debate metodológico en torno al riesgo, y asu vez, dar cuenta de los paradigmas y teorías existentes que predominan en la reflexión sobre el riesgo, por último, se propone un esquema que intentará rescatar aquellos elementos que a nuestro parecer pueden contribuira una comprensión global del riesgo en el mundo del trabajo y, en particular, en el ámbito de las intervenciones en seguridad, salud ocupacional y en la prevención de riesgos laborales. En conclusión, este trabajo permitirá ampliar la mirada del riesgo, mezclando elementos de la teoría macrosocial, realizando una integración a su vez con elementos provenientes desde lo microsocial, lo cual enriquecerá la perspectiva de la prevención del riesgo en el ámbito laboral y organizacional. En torno a las prácticas investigativas se recomienda unir las metodologías cualitativas y cuantitativas con el propósito de perfeccionar la gestión en su totalidad.

This paper addresses the issue of risk perception which in recent decades has led to considerable research, as it is conceived as an element that can enhance and improve prevention policies. The objective of this paper is to briefly review the state of the methodological debate on risk and, in turn, account for existing paradigms andtheories that dominate thinking about the risk. Finally, we propose a scheme that will attempt to rescue those elements that we believe can contribute to an overall understanding of risk in the world of work and, in particular, in the field of interventions in safety, occupational health and the prevention of occupational hazards. Thus, this study will broaden the view of risk, combining elements of macro theory, integrating elements the micro social. This will enhance the perspective of risk prevention in the workplace and organizations. Regarding the research practices, we recommend the integrated use of qualitative and quantitative methodologies for the purpose of improving management as a whole.

Prevalencia del síndrome de quemarse por el trabajo (burnout) en una muestra de profesionales que trabajan con personas con discapacidades en Chile / Burnout prevalence in professionals working with physically impaired Chilean people

Objetivo: Analizar la prevalencia del Síndrome de Quemarse por el Trabajo, SQT, (burnout) en profesionales de atención a personas con discapacidad física siguiendo criterios de diferentes países, y su posterior comparación. Método: estudio transversal, no aleatorio, realizado en Chile, en 2006. La muestra la formaron 277 profesionales que trabajaban en centros de atención a personas con discapacidad, 75.09 por ciento (n = 208) fueron mujeres y 24.91 por ciento (n = 69) hombres. Los datos fueron recogidos mediante dos cuestionarios de forma anónima y autoadministrada. El SQT fue diagnosticado utilizando el Maslach Burnout Inventory (MBI-HSS) y el cuestionario para la Evaluación del Síndrome de Quemarse por el Trabajo (CESQT-PD), con diferentes criterios para establecer su prevalencia. Resultados: La prevalencia del SQT varió en función del criterio utilizado: siguiendo los puntos de corte del manual de Estados Unidos, la prevalencia fue del 7.6 por ciento de 9 por ciento siguiendo los criterios de España, 6.9 por ciento siguiendo los criterios de Chile y considerando los criterios clínicos establecidos en Holanda, el porcentaje fue del 3.2 por ciento. Discusión: Los niveles de prevalencia variaron significativamente en función de los criterios aplicados. El MBI-HSS y el CESQT-PD pueden ser considerados instrumentos útiles para realizar una primera medida del SQT.

Objective: To assess the prevalence of the burnout syndrome in professionals working with physically impaired people. Method: Non–randomized cross–sectional study carried out in Chile, in2006. The study sample comprised 277 professionals working at care centers for physically disabled people, 75.09 percent (n = 208) were women and 24.91 percent (n = 69) were men. Data were gathered through an anonymous, self-administrated questionnaire. The Burnout was measured using the Maslach Burnout Inventory (MBI-HSS) and the Burnout Syndrome Evaluation Questionnaire (CESQT-PD from the Spanish – “Cuestionario para la Evaluación del Síndrome de Quemarse por el Trabajo”), and different approaches were employed to estimate burnout prevalence. Results: The prevalence of burnout was different according to the approach used: the prevalence was 7.6 percent by the United States criteria; 9 percent by the Spanish criteria; 6.9 percent by the Chilean criteria and 3.2 percent by the Dutch clinical criteria. Discussion: Burnout prevalence varied significantly depending on the approach used. The MBI-HSS y el CESQT-PD can be considered reliable means for an initial measurement of Burnout. Descriptors: Burnout, prevalence, professionals caring for physically impaired people.