Nivel de conocimiento de los pacientes con artritis reumatoide acerca de su enfermedad y tratamiento / Knowledge about their disease and treatment among patients with rheumatoid arthritis

Background:The transfer of information in the physician-patient relationship is important, especially in chronic diseases such as Rheumatoid Arthritis (RA), since it influences the perception and behavior that the patient has about his or her illness. Aim: To evaluate the level of knowledge and concern of their illness and treatment and their relationship with functional disability, perception of the pain and global assessment of disease activity, in patients with RA. Patients and Methods: Cross sectional study of 104 patients (mean age 56 years, 100 women) with RA. Demographic and clinical variables were registered. The knowledge about their illness and requirement of further information and concern about aspects of the illness and treatment, were assessed. Physical functioning was measured using the Health Assessment Questionnaire (HAQ). A visual analogue (VAS) and Likert scales were used for a global assessment of disease activity. Results: Sixty percent of patients had only primary school studies. The median evolution of the illness was 14 years. Ninety eight percent knew their diagnosis and 91 percent required further information. There was a high degree of concern about the disease and treatment. The average HAQ score was 0.9. There was a statistically significant relationship between HAQ score and pain VAS (r =0.41, p <0.01). There was a moderate agreement between the global assessment of disease activity made by patients and physicians (Kappa =0.499; p =0.000). Conclusions: Even though patients with RA are informed about their disease, they require further information. Their highest concern is about the functional consequences of RA and they perceive a higher activity of the disease than their treating physicians.

Análisis de las interconsultas de pacientes nuevos recibidas en un policlínico de reumatología de un hospital terciario / Analysis of referrals of new patients to the rheumatology section of a tertiary hospital

Background: The prevalence of rheumatic diseases is approximately 15 percent in the general population. Aim: To assess the concordance between the original and final diagnosis of patients referred to a rheumatology unit. Patients and methods: During 2000, all new patients referred to the rheumatology section of Temuco General Hospital were recorded. The concordance between the referral diagnosis given by general practitioners or general internists and the final diagnosis reached at the rheumatology unit was analyzed using the Kappa index. The modified version of the American College of Rheumatology nomenclature was used as reference. Results: The clinical records of 787 outpatients, 83 percent females, aged 54.7ñ14 years old, were analyzed. Twenty seven percent of patients were referred with the diagnosis of connective tissue diseases, 26 percent with extra articular diseases and 24 percent with osteoarthritis. The concordance between referral and final diagnosis reached at the rheumatology unit had a kappa of 0.6 for general practitioners and 0.72 for general internists. Conclusions: Although the overall concordance between referral diagnosis, given by general practitioners or general internists, and final rheumatological diagnosis is good, there are still major discrepancies that should be improved

Toxicidad en las aguas y su impacto en la salud pública / Water toxicity and it impact on public health

Actualmente, la pureza de las aguas es uno de los bienes más preciados, sin embargo, cada día, la contaminación va en aumento siendo un problema mundial. Entre los contaminantes se encuentran múltiples compuestos, produciendo algunos de ellos graves situaciones de toxicidad para la vida acuática y la salud de las personas, cuando ésta se utiliza para la bebida. En este trabajo se presentan algunas de las principales contaminantes, así como los sistemas que son necesarios para detectar el daño real que estarían produciendo en la masa acuática. Es imperativo el implementar sistemas de igilancia eficientes, que permitan prevenir adecuadamente cualquier efecto nocivo a la salud de la población