Escala numérica para evaluar síntomas espirituales en cuidados paliativos / A scale to assess spiritual symptoms in palliative care

Background: Spiritual issues are an important dimension of health care, but seldom addressed by professionals. Thus, a scale that assesses the presence and intensity of seven spiritual symptoms was developed. Aim: To validate the instrument in palliative care settings. Material and Methods: The spiritual symptoms scale was applied to 103 patients, aged 59 ± 17 years (58% women), admitted to hospice care in two centers located in Santiago. The reproducibility of the scale was evaluated in 33 patients and its internal consistency and liability in 70. Results: The Fleiss Kappa to assess reproducibility was 0.82 and the analysis of variance had a p of 0.94. Cronbach alpha to assess internal consistency was 0.74. Conclusions: The scale renders similar results when applied by different evaluators and has a good liability. Therefore, it can be a reliable instrument to assess spiritual symptoms in palliative care settings. Further studies would be needed to verify its utility in other settings.

Rememorando la contribución de Goldstein y Brown al estudio del metabolismo del colesterol: a un cuarto de siglo del Premio Nobel de Medicina / The contribution of Goldstein and Brown to the study of cholesterol metabolism

Background: In December 1985, the Nobel Prize of Medicine was awarded to Drs. Joseph L. Goldstein and Michael S. Brown for their fundamental scientific work on the regulation of cholesterol metabolism mediated by the low density lipoprotein receptor pathway. This article briefly reviews the academic and research accomplishments of Drs. Brown and Goldstein as a tribute to these physician-scientists for their well-deserved award and enormous contribution to biomedical science worldwide.

Frecuencia y pesquisa de síntomas en pacientes crónicos en fases avanzadas en un hospital clínico: ¿Existe concordancia entre pacientes y médicos? / Frequency and assessment of symptoms in hospitalized patient with advanced chronic diseases: Is there concordance among patients and doctors?

Physicians tend to over or underestimate symptoms reported by patients. Therefore standardized symptom scoring systems have been proposed to overcome this drawback. Aim: To estimate the prevalence and the diagnostic accuracy of physical and psychological symptoms and delirium in patients admitted to an internal medicine service at a university hospital. Material and Methods: We studied 58 patients, 45 with metastasic cancer and 13 with other advanced chronic diseases. The following scales were used: the Confusion Assessment Method for the diagnosis of delirium; the Edmonton Symptom Assessment Scale (ESAS) for pain and other physical symptoms; the Hospital Anxiety and Depression Scale to assess anxiety and depression. The ESAS was simultaneously applied to patients without delirium and their doctors to assess the level of diagnostic concordance. Results: Twenty two percent of patients had delirium. Among the 45 patients without delirium, 11 (25 percent) had at least eight symptoms and 39 (88.6 percent) had four symptoms. The prevalence of symptoms was very high, ranging from 22 to 78 percent. Pain, restlesness, anorexia and sleep disorders were the most common. The concordance between symptoms reported by patients and those recorded by doctor was very low, with a Kappa index between 0.001 and 0.334. Conclusions: In our sample of chronic patients, there is a very high frequency of psychological and physical symptoms that are insufficiently recorded by the medical team.

Evolución de la frecuencia de factores de riesgo cardiovascular en dos poblaciones chilenas / Changes in cardiovacular risk factors in two chilean populations

Objetivos: Establecer cambios en la frecuencia de factores de riesgo cardiovascular entre 1993 y 2001 en dos poblaciones étnicas chilenas. Materiales: En los años 1993 y 2001, se estudiaron 960 individuos adultos (625 mujeres y 335 hombres) de la comuna de la Florida (Santiago) y 113 habitantes (63 mujeres y 50 hombres) de la Isla Huapi (X región). Se estableció la frecuencia de: diabetes mellitus (DM): dos glicemias en ayuno ≥126 mg/dl o antecedente clínico de diabetes, obesidad: IMC ≥30 kg/mt², hipertensión arterial (HTA): PAS ≥140 y/o PAD ≥90 o tratamiento antihipertensivo, hipercolesterolemia: colesterol total ≥200 mg/dl y tabaquismo: consumo de al menos un cigarrillo en el último mes. Resultados: En el año 2001 en comparación a 1993, se detectó en la población de La Florida, un incremento significativo de la frecuencia de obesidad (13 por ciento), de DM (63 por ciento), de hipercolesterolemia (24 por ciento) y un leve pero significativo aumento de la HTA (3 por ciento). El tabaquismo disminuyó significativamente en un 8 por ciento. En la Isla Huapi se observó un incremento significativo de la frecuencia de obesidad (22 por ciento), de DM (105 por ciento) y de hipercolesterolemia (9 por ciento). No se detectaron cambios en la frecuencia de HTA. El tabaquismo disminuyó significativamente en alrededor de un 50 por ciento. Conclusiones: En los últimos años, la población chilena presenta un aumento progresivo de la frecuencia de obesidad, DM y dislipidemia, lo cual favorecería el aumento de la morbimortalidad cardiovascular.