Impacto de las políticas de educación sexual en la salud sexual y reproductiva adolescente en el sur de chile, período 2010 - 2017 / Impact of sexual education policies on adolescent sexual and reproductive health in southern Chile, period 2010 - 2017

RESUMEN Antecedentes: Desde los años 2001 y 2012 se incorporan contenidos sobre sexualidad en el currículum de 6º/7º básico y 2º/3o medio. A partir del año 2010 se legaliza que la población adolescente debe recibir educación sexual. Se propusieron siete programas en esta materia para establecimientos educacionales. Su implementación y sus resultados no han sido evaluados. Objetivo: Evaluar el impacto de las políticas de educación sexual implementadas en Chile, en la salud sexual y reproductiva de la población adolescente de la comuna de Concepción entre los años 2010 y 2017. Material y método: Estudio ecológico en establecimientos educacionales e indicadores de salud sexual y reproductiva en adolescentes. Incluyó 51 establecimientos y estadísticas de embarazo, uso de métodos anticonceptivos (MAC), casos de infecciones de transmisión sexual (ITS) y violencia sexual. Resultados: El 43% de éstos implementaron algún programa de educación sexual; El 80% ha incorporado los contenidos curriculares, y la misma cifra ha ejecutado iniciativas propias de sexualidad y asesorías externas con un alcance del 84%. Se observa un descenso del embarazo adolescente, aumento del uso de MAC, pero disminuyó el uso de condón masculino, y un aumento de los casos de gonorrea y VIH, así como las cifras de violencia sexual hacia adolescentes. Conclusiones: A pesar del descenso de algunos indicadores de salud sexual y reproductiva en adolescentes, es preocupante el aumento de las ITS y la disminución del uso de métodos que previenen su contagio, así como la violencia sexual que también es un riesgo para adquirir ITS.

ABSTRACT Background: In 2001 and 2012, contents on sexuality were added to the curriculum of the 6th and 7th grades of primary school, and to the 2nd and 3rd grades of secondary school. In 2010, sex education became compulsory for adolescents. There are seven sex education programs for schools, but their implementation and results have not been evaluated. Objective: To evaluate the impact of Chilean sex education policies on the sexual and reproductive health of teenagers from the commune of Concepción between 2010 and 2017. Material and methods: Ecological study, using schools and teenagers' sexual and reproductive health indicators. 51 schools were included in this study, and the indicators used were pregnancy statistics, use of contraceptives, cases of sexually-transmitted diseases (STDs), and sexual violence. Results: 43% of schools have implemented a sex education program. 80% have included the curriculum content. The same percentage of schools has implemented their own initiatives on the topic, while an 84% has asked for external counsel. Teenage pregnancy rates have decreased and the use of contraceptives has increased, but we also observed a decrease in the use of male condom and a higher rate of gonorrhea and HIV cases. The cases of sexual violence against adolescents have increased as well. Conclusions: Despite the decrease seen in some indicators, the higher rate of STDs and the lower use of methods to prevent them are alarming. The higher rate of sexual violence is worrying as well, as it is associated with STDs.

Cariology Curriculum in Chilean Universities

ABSTRACT: Aim: To describe the current state of undergraduate Cariology teaching in Chilean universities. Material and Methods: A previously content-validated questionnaire was used to conduct a cross-sectional study including all private/public universities. Statistical analysis was performed determining frecuency distributions of categorical variables with the Stata Data Analysis and Statistical Software 13.1®. Results: Cariology is a key issue in undergraduate education, and in most universities, is taught as key axis of courses, in various departments, for more than one year. Consistency was found in Cariology topics taught. The clinical threshold for surgical treatment is roughly divided into thirds (33.3% enamel microcavitation, 38.9% underlying shadow and 27.8% dentin cavity), no university indicated operative treatment for non cavitated lesions. Radiographic threshold for surgical treatment is the external dentinal third (66.7%). Conclusions: Answers revealed a mix of traditional and modern Cariology concepts. Depite some encouraging results, half of Chilean universities considered that Cariology is not appropriately implemented and no standardization exists between theoretical teaching and clinical management, nonoperative management is not properly clinically implemented, students are evaluated for tissue damage restoration and resistance to non-invasive philosophy adoption remains.

¿Es importante la experiencia del cirujano en el porcentaje de márgenes positivos en la prostatectomía radical? / Correlation between the surgeons experience and the rate of positive surgical margins in radical prostatectomy

Los márgenes positivos son un factor de riesgo de recurrencia después de una prostatectomía radical. La experiencia del cirujano sería fundamental para prevenirlos. Estudiamos el impacto de los márgenes positivos en la recurrencia y la experiencia del cirujano como factores predictores de márgenes positivos. Material y método: Revisión de pacientes de bajo a intermedio riesgo (estadio T2 o menos, APE 10 o menos y Gleason 7 o menos) sometidos a prostatectomía radical entre enero de 1999 y diciembre de 2008 (n= 498). Edad promedio 61+/-7 años, 83 por ciento estadio clínico T1c, 17 por ciento T2. APE promedio de6,2+/-1,9 ng/ml. Promedio de seguimiento de 30+/-20 meses. Se evaluó la sobrevida libre de recurrencia bioquímica (APE >0,2), con un modelo de Cox de riesgos proporcionales. Como cofactores estudiamos, la edad, el estadio clínico, el APE, el score de Gleason, el volumen tumoral, compromiso de vesículas seminales, y margen positivo. Se realizó un análisis de regresión múltiple para evaluar el impacto de estos factores en los márgenes positivos, considerando también la experiencia del cirujano (se calculó una mediana de cirugías promedio por año y se dividió el grupo de cirujanos en de alto volumen (mayor a la mediana) o bajo volumen y cirugías realizadas primariamente por residentes. Resultados: El porcentaje de márgenes positivos bajó significativamente durante el periodo 39 por ciento vs 28 por ciento (p<0,05 primeros vs segundos 5 años). El porcentaje de márgenes positivos por cirujano varió entre 4 por ciento y 47 por ciento. Los márgenes positivos (p <0,0003 IC 1,7-6,8) y el compromiso de vesículas seminales (p <0,001 IC2-20,1) predijeron una mayor recurrencia. El volumen del tumoral y la edad se correlacionaron con mayores márgenes positivos no así la experiencia del cirujano o que la cirugía fuera realizada por un residente. Conclusión: El margen positivo es un factor de riesgo significativo para recidiva bioquímica en pacientes...

Positive surgical margins (SM) are a risk factor for recurrence following radical prostatectomy (RP).The surgeon’s experience seems to be fundamental to avoid positive SM. We studied the surgeon’s experience as a predictor for finding positive SM and the impact of positive SM in recurrence rates. Material and method: We reviewed patients with low to intermediate risk (stage < T2, < PSA level of 10 and Gleason < 7) submitted to radical prostatectomy between January 1999 and December 2008 (n =498).Average age was 61 years, 83 percent were stage T1c and 17percent was stage T2. Average PSA level was 6.2 ng/ml. Average follow up was 30 months. The COX model for proportional risks was used to evaluate biochemical recurrence free survival (PSA >0.2). As cofactors, we studied age, clinical stage, PSA level, Gleason score, tumor volume, involvement of seminal vesicles and positive SM. We used multiple regression analysis to evaluate the impact of these factors on positive SM, adding the surgeon’s experience. We calculated a median of average surgeries per year and divided the surgeons into high volume or low volume. Surgeries performed by residents were recorded separately. Results: The percentage of positive SM decreased significantly during the study period: 39 percent vs 28 percent (p <0.05). Percentage of positive SM per surgeon ranged from 4 percent to 47 percent. Positive SM (p <0.0003 CI1.7-6.8) and seminal vesicles involvement (p <0.001 CI 2-20.1) predicted a higher recurrence rate. Tumor volume and age correlated with higher rates of positive SM. However there was no correlation between recurrence rate and the surgeon’s experience. Conclusion: Positive SM is a risk factor for biochemical recurrence in low to intermediate risk patients. This fact does not appear to be related to the surgeon’s experience or to tumor volume.