Corrección endoscópica del reflujo vesicoureteral. Revisión narrativa / Endoscopic correction of vesicoureteral reflux. Narrative review

En esta revisión narrativa se plantea como objetivo realizar una descripción amplia y específica acerca de los agentes abultantes utilizados para la corrección endoscópica del reflujo vesicoureteral disponibles en el mercado hasta la actualidad, sus tasas de éxito y de complicaciones. Este texto se realizó a partir de una búsqueda sistemática con las palabras clave enunciadas a continuación como términos MESH. Se describen los distintos tipos de sustancias y se exponen los resultados de los artículos revisados. Finalmente se plantean las conclusiones.

The objective of this narrative review is to describe in a broad and specific way all the bulking agents used in the endoscopic correction of vesicoureteral reflux currently available, their success and complication rates. This text was done by a systematic search with the keywords seen below in MESH terms. The different types of substances are described, and the results of the reviewed articles are presented. Finally, conclusions are made.

De la anestesia a la seguridad de la atención: experiencia de 6 años en el análisis de reportes de incidentes en un hospital universitario / Analysis of incident reports in an anesthesiology unit of a university hospital

Background: Incident reporting is an effective strategy used to enhance patient safety. An incident is an event that could eventually result in harm to a patient. Aim: To classify and analyze incidents reported by an Anesthesiology division at a University hospital in Chile. Material and Methods: A retrospective analysis of the reported incidents registered in our institutional database from January 2008 to January 2014. They were classified according to three variables proposed by the World Health Organization system to determine the type of incident and patients’ potential harm. Results: There were 297 reports registered. Etiologic classification according to the WHO system showed that 29% (n = 85) were related with management, 20% (59) with drugs, 20% (59) with medical devices, 16% (48) with procedures and 15% (46) with human factors. Seventy two percent (58) of incidents caused low or moderate harm and 28% (22) resulted in a severe adverse event or death. Conclusions: Our analysis highlights that a high rate of incidents are associated with management, the leading cause of reports in our center. Due to the low incident report rate in our country, it is difficult to perform appropriate comparisons with other centers. In the future, local incident reporting systems should be improved.

Actividad laboral de médicos egresados de la Universidad de Chile generaciones 2007 a 2010: análisis según sede y año de egreso / Work activity of medical graduates at the University of Chile: Analysis per campus and graduation year

Background: The University promotes practices and values that influence their students in the pursuit of their occupational interests. Aim: To determine working activity features of medical graduates from the University of Chile and their relationship with undergraduate characteristics. Material and Methods: Medical graduates of the University of Chile were invited to complete a survey using a virtual server. The survey collected demographic, socioeconomic, work and guild characteristics. Undergraduate data, as campus and graduation years were obtained. Results: The survey was completed by 333 physicians (167 men) aged 29 ± 2 years, graduated from 2007 to 2010. Ninety four percent had a paid work, 59% were employed in public hospitals and 28% in primary care health centers. The predominant type of work activity was performed in the public health service (55%), while 17% worked in private health services. Activity in public health services or primary care were significantly associated with the pursuit of undergraduate clinical activities in specific campuses of the University. Conclusions: The employment rate of medical graduates was high. Differences observed by graduation campus and type of work may be due to the modeling that students receive from teachers.

Evaluación del control de la presión arterial y la adherencia terapéutica en hipertensos seguidos en el programa de salud cardiovascular (PSCV): asociación con características clínicas, socioeconómicas y psicosociales / Assessment of blood pressure control and adherence in hypertensive patients followed in the cardiovascular health program (CHP): association with clinical, socioeconomic and psychosocial characteristics

Antecedentes: Inadecuado control de presión arterial (PA) y baja adherencia a tratamiento farmacológico (Rx) en hipertensos son problemas persistentes globales y en Chile. Factores socioeconómicos y psicosociales han sido frecuentemente mencionados, pero escasamente en Chile. Objetivo: Evaluar control de la PA y adherencia a Rx en hipertensos seguidos en el Programa de Salud Cardiovascular (PSCV) y su asociación con factores clínicos, socioeconómicos y psicosociales. Métodos: Muestra randomizada de 1.794 hipertensos seguidos por 1 año en PSCV en Región Metropolitana. Se evaluó la asociación de edad, sexo, educación, ingreso familiar, Rx, diabetes, obesidad, tabaquismo, consumo problemático de alcohol y actividad física con el control de la PA (<140/90 mmHg) y adherencia. Además, en 600 pacientes, se evaluó la asociación con estrés emocional/depre-sión, relación médico-paciente y apoyo social. Se obtuvieron Odds Ratio (OR) mediante análisis de regresión logística multivariante. Resultados: PA controlada se comprobó en 56,5% y adherencia en 37,3% sin documentarse asociación entre ambas (OR 1,01 [IC 95% 0,78 - 1,32]). Factores asociados a PA no controlada y no adherencia fueron: edad, bajo ingreso familiar, inadecuada relación medico-paciente y alto nivel de estrés emocio-nal/depresión. Rx múltiple y obesidad se asociaron a PA no controlada; sexo masculino y baja educación a no adherencia. Conclusiones: El control de la PA (56,5%) fue similar a resultados de países desarrollados y supera ampliamente cifras de la Encuesta Nacional de Salud 2010 (16,9%). Estos resultados y la falta de asociación entre el control de la PA y la adherencia, sugieren la favorable influencia de otros factores posiblemente relacionados al PSCV.

Background: Unsatisfactory blood pressure (BP) control and low adherence to antihypertensive pharmacotherapy (Rx) in hypertensive populations are persistent problems worldwide and also in Chile. Socioeconomic and psychosocial factors have been frequently mentioned, but with limited contributions from Chile. Objective: The assessment of BP control and adherence to Rx in hypertensive patients followed in the Cardiovascular Health Program (CVHP) and to determine their association with clinical, socioeconomic and psychosocial characteristics. Methods: A randomized sample of 1,794 hypertensive patients followed for 1 year under the CVHP in Metropolitan Region. Association of BP control (<140/90 mmHg) and adherence with age, gender, education, income, Rx, diabetes, obesity, smoking, alcohol use problem and physical activity were analyzed. In a subgroup of 600 patients additional analysis included the association with emotional stress and depression, patient-physician relation and social support. Odds Ratio (OR) were obtained by multivariate logistic regression. Results: BP control was achieved in 56.5% and adherence in 37.3%. No association was found between them (OR 1.01 [CI 95% 0.78-1.32]). Uncontrolled BP and no adherence were associated to advanced age, low income, poor patient-physician relation and high stress-depression. Obesity and multiple Rx were associated to uncontrolled BP. Male gender and low education, were associated to no adherence. Conclusions: BP control (56.5%) was similar to results obtained in developed countries and is strikingly higher than the results reported in the 2010 Chilean National Health Survey (16.9%). These results and the lack of association between BP control and adherence suggest the favorable influence of unaccounted factors, possibly related to the CVHP.

Incorporación de paciente virtual en portafolio de estudiantes de medicina de pregrado / Introduction of virtual patients to clinical case portfolios for undergraduate medical students

Background: In 2007, a Clinical-Case-Portfolio (CCP) was introduced as a new assessment instrument for fourth grade undergraduate medical students. Since then, several changes have been implemented such as reduction on the number of clinical cases, peer review and the introduction of virtual patient to the portfolio. Aim: To describe the virtual patient model incorporated to the CCP and assess the perception of this change and its effects on the performance of undergraduate students. Material and Methods: Virtual patients were implemented based on prototype clinical cases with specific syndromes. Students’ perceptions about CCP before and after the introduction of virtual patients were evaluated using a validated questionnaire that was answered voluntarily and anonymously. Results: Overall perception of CCP significantly improved after the incorporation of virtual patients (97.1 ± 24.9 and 111.3 ± 25.7 points; 57.8 and 66.2% respectively). The same improvements were observed for the domains “Student Learning”, “Organization and Evaluation”, “Teaching Methodology” and “Integration”. In both years, students obtained high grades in CCP evaluations. However CCP grades were not significantly correlated with integrated final grades. Conclusions: The incorporation of virtual patients improved undergraduate students’ perception of CCP.

Influencia de factores psicosociales en la adherencia al tratamiento farmacológico antihipertensivo: Resultados de una cohorte del Programa de Salud Cardiovascular de la Región Metropolitana, Chile / Influence of psychosocial factors on adherence to antihypertensive drug therapy: Results from a Cardiovascular Health Program cohort followed in the Metropolitan Region of Santiago, Chile

Background: Inadequate blood pressure control in hypertensive patients remains a persistent health problem in Chile and worldwide. Poor adherence to antihypertensive drug therapy is one of the frequently cited factors. Objectives: To determine the influence of psychosocial factors in the adherence to drug therapy in hypertensive patients followed through a Cardiovascular Health Program (CHP) that provides free access to primary care centers located in the Metropolitan Region of Santiago, Chile. Methods: Cross sectional study. A randomized sample of 513 hypertensive patients (30 to 68 years) was obtained from a universe of 1.484 patients. Adherence to treatment was determined by the Morisky-Green-Levine test. Demographic, socioeconomic and average values of blood pressure were recorded. Validated questionnaires were utilized to assess the patient-physician relationship, awareness of being hypertensive, patient perception of social support, family cohesion, patient self-health assessment and symptoms of emotional stress and depression. Results: The drug therapy adherence was 36.6%, higher in women (38.4% vs 28.9%; p < 0.001). After multivariate analysis, absence of adherence was associated with male gender (OR: 1.76 [95% CI 1.21-2.56]), low education (OR: 1.72 [95% CI 1.18 to 2.53]), inadequate patient-physician relationship (OR: 1.56 [95% CI 1.13 to 2.27]), and high level of emotional stress and depression (OR: 1.93 [95% CI 1.27 to 2.94]). Conclusions: Our study highlights the influence of inadequate patient-physician relation, high level of emotional stress and depression, low education level and income and male gender in the lack of adherence to antihypertensive drug therapy in hypertensive patients followed throughout the CHP.

Control del Hipertenso, un desafío no resuelto: avances logrados en Chile mediante el Programa de Salud Cardiovascular / Blood Pressure control in Hypertension, an unresolved challenge. Improvements achieved throughout the Chilean Cardiovascular Health Program

Antecedentes: El control de la presión arterial (PA) es fundamental en reducir la morbi-mor-talidad en hipertensos, pero con resultados hasta la fecha insatisfactorios en Chile y en países de alto desarrollo socioeconómico. En Chile se inició en 2002 el Programa de Salud Cardiovascular (PSCV) intentando mejorar el manejo de estos pacientes. Objetivos: Evaluar características sociodemográ-ficas, clínicas, antropométricas, psicosociales y de estilos de vida de un grupo de pacientes participantes en el PSCV, y la influencia de estos factores en el control de la PA. Métodos: Se obtuvo una muestra aleatoria de 525 pacientes (380 mujeres) de un universo de 1.533 hipertensos entre 30 y 68 años bajo seguimiento en el PSCV. Se registraron datos sociodemográficos, clínicos, antropométricos, psicosociales y de estilos de vida a través de evaluación clínica y cuestionarios validados. La PA fue medida utilizando un protocolo estándar por personal entrenado. El análisis estadístico incluyó la predicción del riesgo (Odds RATIO) de PA no controlada por las diversas características estudiadas. Resultados: El 47 por ciento de los pacientes logró una PA controlada (<140/90 mmHg). La presencia de diabetes mellitus (DM) fue documentada en el 38,5 por ciento. Factores predictores significativos de PA no controlada fueron DM, baja educación, inadecuada relación médico paciente y alto nivel de estrés emocional/depresión. Conclusiones: El PSCV ha logrado un avance importante en el control de la PA resaltando la influencia significativa de factores psicosociales. Sin embargo es preocupante la alta proporción de hipertensos diabéticos, su inferior control de PA, y la limitada captación de hombres al programa.

Background: Blood pressure (BP) control is a necessary requirement to reduce cardiovascular events and mortality in hypertensive patients, but so far results have been disappointing in Chile and also in countries with advanced socioeconomic development. Since 2002 a Cardiovascular Health Program (CHP) was launched in Chile attempting to improve the outcomes in these patients. Objectives: To assess the influence of sociodemo-graphic, clinical, anthropometric, psychosocial, lifestyle habits characteristics upon BP control (<140/90 mmHg) in a group of hypertensive patients referred to the CHP. Methods: A cross sectional study of a random sample of 525 hypertensive patients (380 women) obtained from a universe of 1,533 patients with ages ranging from 30 to 68 years was performed. Socio-demographic, clinical, anthropometric, psychosocial and lifestyle habits data were collected through clinical evaluation and validated questionnaires. Trai-ned personnel using standard protocols recorded BP. Adjusted ODDS RATIOS were used to assess theinfluence of different population characteristics upon blood pressure control . Results: A controlled BP (<140/90 mmHg) was achieved in 47 percent of patients, and 38.5 percent presented diabetes mellitus (DM). Significant predictors of uncontrolled BP (>140/90 mmHg) were DM, low education, unsatisfactory patient-physician relation, and high score of emotional stress /depression. Conclusions: In Chile the CHP has achieved an important progress in BP control in hypertensive patients. Psychosocial factors influenced significantly these results. It is concern the high proportion of diabetics in this hypertensive population and their unsatisfactory BP control. The lower proportion of men enrolled in the CHP needs additional analysis and corrective actions.

Enfermedades músculo esqueléticas en población hipertensa y su asociación con obesidad: un estudio transversal en laRegión Metropolitana, Chile / Musculo and skeletal diseases in hypertensive subjects and their association with obesity: a cross sectional study in the Region Metropolitana, Chile

Antecedentes: Los hipertensos presentan elevada prevalencia de obesidad lo que puede predisponer para el desarrollo de enfermedades músculo-esqueléticas (EME). Actualmente se desconoce la magnitud de estas patologías en población hipertensa chilena. Objetivo: Determinar prevalencia de EME en hipertensos bajo control en el programa de salud cardiovascular de la Región Metropolitana y su posible asociación con obesidad. Método: Estudio transversal en una muestra aleatoria simple (n = 1194 sujetos) a partir del universo (N = 391.129) distribuida en 52 comunas de Santiago. Se registró diagnóstico de EME (CIE10, códigos MM00-99), edad, sexo, presión arterial, índice de masa corporal (IMC), obesidad (IMC ³ 30 kg/m2) y carga psicológica. La asociación con obesidad se exploró a través de regresión logística estimando odds ratio (OR) con intervalos de confianza al 95% (IC95%). Resultados: La prevalencia de EME fue 36,5% (39,9% mujeres y 28,3% hombres, p<0.01). En ambos sexos las patologías más frecuentes fueron lumbago, artrosis de rodilla y artralgias. La asociación de EME y obesidad presentó un OR crudo de 1,09 (1,06-1,19) en hombres y de 1,24 (1,22-1,26) en mujeres; luego de ajuste multivariante el OR fue de 1,19 (1,15-1,23) y 1,49 (1,46-1,52) respectivamente. Conclusiones: Además de la edad, sexo femenino y carga psicológica, la obesidad aparece como un factor de riesgo para EME en población hipertensa. La elevada prevalencia observada enfatiza la necesidad de acentuar el control de peso, incluir el ejercicio físico y brindar acceso a la kinesioterapia en la atención primaria chilena.

Background: Hypertensive subjects frequently are obese, which may lead to development of muscular and skeletal diseases (MSD). There is no data regarding the frequency of this complications in Chile. Aim: to determine the prevalence of MSD in hypertensive subjects being followed by the Cardiovascular Health Program in the Region Metropolitana; to determine the association of MSD to obesity in those subjects. Methods: Cross sectional study using a simple random sample of 1194 subjects from the population of 391,129 hypertensives distributed in 52 municipalities in Santiago, Chile. Diagnosis of MSD was established according to CIE 10 codes MM00-99). Age, sex, blood pressure, body mass index and psychological burden were determined. Obesity was defined as IMC ³ 30 kg/m2). Association of MSD with obesity was explored using logistic regression and OR with 95% confidence intervals (95% CI). Results: The prevalence of obesity was 36.5% (39.0% in women, 28.3% in males, p<0.01). In both sexes, lumbar pain, knee osteoarthritis and joint pain were the most common forms of MSD. OR for the association of MSD and obesity was 1.09 (95% CI 1.06-1.19) in males and 1.24 (1.22-1.26) in females. After multivariate adjustment the respective OR became 1.19 (1.15-1.23) and 1.49 (1.46-1.52). Conclusion: In addition to age, female sex and psychological burden, obesity is an independent risk factor for MSD en hypertensive patients. These findings stress the need for better weight control in hypertensives. Physical exercise and physical therapy should be helpful in the primary care of this population.