Un fondo competitivo de desarrollo para el fomento de la calidad de la educación superior en Chile: área de la salud / A competitive fund to improve the quality of university education in the area of health care in Chile

In 1997, the Chilean Government and the International Bank for Development convened on a strategy to improve Chilean university education. It was based on quality improvement, effectiveness, relevancy and innovation on university education programs. A US$ 245 millions fund was afforded, for a five years competitive grants program, among certain traditional Universities and Technical Education Institutes. The authors reviewed the projects that won the contests during the first three years in the health area, to determine their impact, demands supported, difficulties and assets. These projects obtained 13.6 percent of the assigned funds (a total of US$ 16.5 millions). Funds were requested mostly to build spaces, obtain equipment, laboratories and computational support. Funds were also requested to carry out methodological changes and teaching improvements. The importance of teaching health sciences in locations outside the Metropolitan area of Santiago, the modification of undergraduate medical curriculum and the development of post graduate networks are emphasized

Formación profesional y su acreditación en medicina, un paradigma en garantía de la fe pública / Professional training and accreditation in medicine: a paradigm to sustain public confidence

Sustaining quality control of learning programs for health professions has become a central issue in university systems, under the pressure of an unexpected merging of new medical schools in Chile, during the last decade, and the massive arrival of other Latin American physicians. Accreditation of institutions and programs represents valid safeguards used in most countries where professional training processes take place. Due guarantee of its quality is required to assure proper health care to people. The authors provide specific arguments to support systematic evaluation and accreditation processes, as those introduced in our country to fulfill the requirements of a high level medical practice

Investigación clínica en Chile: ¿cómo superar una inquietante evolución? / Clinical research in Chile: how to improve its worrying evolution?

There is still great collective paucity in our society in appreciating the importance of scientific work for the devolopment of the nation. In this context, relevant clinical research has ben greatly discouraged. The Ministry of Education and the National Comission for Technical and Scientific research (CONICYT) have been committed, with no outstanding results however, to encourage these activities, specially sustaining individual projects originated in the tradicional universities. Precarious conditions persist as manifested by meager budgets for investigation. Public health policies and organization are scarcely endorsed in locally generated clinical or public health knowledge. Postgraduate training programs, specially doctorates, needed to increase the academic human resources with a consistent scientific potential, are very limited. Recent governmental initiatives, altogether with specific proposals waiting for implementation, would certainly contribute to optimize and promote the revival of our impoverished scenarios in clinical research

Síndrome nefrótico en el primer año de vida / Nefrotic syndrome in the first year of life

En un estudio colaborativo de 99 niños con síndrome nefrótico en un período de 30 meses, 8 (5 mujeres) eran menores de un año (mediana 7,5 meses) y constituyen el motivo de esta comunicación. Los niños cuyo síndrome nefrótico se expresa antes del cuarto mes de vida tienen mal pronóstico, pues morfológicamente sus lesiones se relacionan con esclerosis mesangial difusa o el tipo finlandés y fallecen precozmente de complicaciones infecciosas severas. Los pacientes menores de 1 año con glomeruloesclerosis focal y segmentaria o cambios mínimos se comportan como los de edades posteriores

Cuadro inicial del síndrome nefrósico primario del niño: evaluación a 18 meses de dos esquemas de tratamiento con prednisona / Initial status of primary nephrotic syndrome in children: assessment at 18 months of 2 treatment schemes with prednisone

Ninety six patients agred from 6 months to 16 years old were admitted to chilean hospitals with the diagnosis of primary nephrotic syndrome in a period of 30 months. These patients were randomly separated in 2 groups, group A received prednosone for 8 weeks and group B received the same drug during 12 weeks. All patients were evaluated at 6, 12 and 18 months after the end of treatment. The moment and number of relapses per patient, accumulated percentage of relapses, relapse rate per 100 patients, total number of relapses and complications were assessed. Frequent relapsers were subjected to a kidney biopsy, leaving in the protocol only those patients that had minimal changes. Patients resistent or dependant to steroid therapy were discarded. Thus we report the results of 56 treated poatients followed during 18 months. No differences in analyzed parameters were observed between the 2 treatment groups. It is concluded that these preliminary results do not support the prolongation of prednisone treatment in children with primary nephrotic syndrome

Raquitismo hipofosfatémico familiar / Familial hypophosphatemic rachitism

El raquitismo hipofosfatémico familiar (raquitismo hipofosfémico familiar) se caracteriza por alteración del transporte renal de fosfatos, hipofosfatemia difícil de tratar, raquitismo, normocalcemia y talla baja final. La hipofosfatemia se transmite por herencia dominante ligada al cromosoma X. El calcitriol 1,25 (OH)2 D3 plasmático es inapropiadamente bajo para la magnitud de la hipofosfatemia, por lo que se postula un defecto en su síntesis. El tratamiento incluye dosis orales altas de fosfato y calcitriol, a pesar de lo cual persiste la hipofosfatemia y tallas finales resultan bajas en la mayoría de los pacientes