Conocimiento sobre el ácido fólico en la prevención de defectos de cierre del tubo neural: una encuesta a mujeres que viven en Santiago de Chile / Awareness of post partum women on the effects of folie acid in the prevention of congenital anomalies

Background: Wheat flour in Chile is fortified with folie acid and pregnant women are also supplemented with the vitamin, but the population level of knowledge or awareness about this vitamin and its use by pregnant women is unknown. Aim: To assess the level of knowledge that postpartum women from Santiago de Chile have about folie acid. Material and methods: A questionnaire about folie acid and its efects on the prevention of neural tube defects was developed adapting questionnaires designed abroad. It was applied by medical students to puerperal women, hospitalized in public hospitals. Results: The questionnaire was applied to 342 women aged 26 ± 7 years. Sixty one percent were housewives and 55 percent completed high school education. Forty seven percent of these women had heard about folie acid, 9.6 percent knew that it was able to prevent congenital defects and only one received an adequate supplementation during pregnancy. Women aged 25 to 34 years and those with an adequate medical care during pregnancy had a significantly better knowledge about folie acid and its role in the prevention of congenital anormalies. The more commom means to receive information about folie acid were midwifes (34 percent), mass media (28 percent) and doctors (20 percent). Two hundred eleven women (62 percent) agreed to take folie acid in a future gestation and 58 percent preferred to do so using fortified foods. Conclusions: Post partum women from Santiago have a poor knowledge about the relevance of folie acid supplementation.

Conocimiento y uso de ácido fólico periconcepcional: estudio comparativo entre puérperas adolescentes y adultas en Santiago de Chile / Knowledge and use of periconceptional folic acid

Introduction: intake of Folic Acid (FA) before conception and during early pregnancy reduces the incidence of neural tube defects (NTD). In Chile the management of the pregnant adolescent women is a relevant public health problem. So, the aim of this study was to determine the level of knowledge and intake of FA in a sample of adolescent and older parturient. Methods: a survey was conducted in one group of teenagers (group A) and another group of older puerperal (group B) corresponding to four public maternities of Santiago. Results: finally, 79 teenagers and 263 older women were surveyed. Both groups showed a poor knowledge about the benefit of intake of FA during this period. Regarding the control before pregnancy, we found an attendance of 10.1 percent in the group A and 24.7 percent in the group B, whereas only 5.1 percent of the group A and 1.9 percent of the group B had an intake of FA according to the medical recommendation. Conclusion: our patients have scanty information about the benefits of the periconceptional intake of FA. It seems necessary to design new methods and tools in order to increase the use of the FA in women of childbearing age, especially in the groups at risk for NTD.

Seguimiento clínico al año de angioplastias coronarias exitosas en pacientes no seleccionados / One year follow up of successful coronary angioplasty in non selected patients

Background:Re-stenosis after percutaneous Coronary Angioplasty (PTCA) is related to clinical and angiographic features. Aim: To describe the clinical and angiographic characteristic of our patients with coronary cardiopathy subjected to PTCA and the predictor factors for re-stenosis. Material and methods: We gathered the clinical and angiographic characteristics of all patients who underwent a successful PTCA of a native coronary artery. All patients had a clinical assessment one year after the procedure. Patients were classified in Group 1, if they did not have angina or coronary events after the angioplasty or Group 2, if they had angina or a coronary event after the procedure. Only Group 2 patients were subjected to a coronary angiogram. Results: We collected 383 PTCA procedures. Follow up information was obtained in 92.2 percent. Three hundred forty two patients (89.3 percent) were assessed one year the procedure. Nine patients (2.3 percent) died of a cardiovascular cause. Ninety patients (26.3 percent) were classified in Group 2. In 65 patients, angiographic re-stenosis was demonstrated (19 percent). Re-stenosis occurred in 36 and 13 percent of patients with an without Diabetes Mellitus, respectively (p <0.01). The other clinical predictor variables were a history of myocardial infarction (p =0.007), obesity (p =0.041) and hypercholesterolemia (p =0.050). None of the angiographic characteristics predicted restenosis. Stents were protective factors against restenosis (15.6 percent in stented lesions vs 25.4 percent in nonstented; p =0.01). Conclusions: Re-stenosis after angioplasty occured in 19 percent of our patients with angina or coronary events. The clinical variables associated with a higher risk of re-stenosis were diabetes (the main risk factor), previous myocardial infarction, obesity and hypercholesterolemia. Angiographic variables were not associated with re-stenosis. The use of stents decreases the incidence of re-stenosis in all groups).

Morbi-mortalidad de la hipertensión arterial según magnitud del cambio de los factores de riesgo: seguimiento a 30 años / Morbimortality of arterial systemic hypertension according to risk factor control: a 30 years follow up study

Antecedentes: El tratamiento integral de la hipertensión arterial esencial involucra el tratamiento farmacológico y el control de los factores de riesgo cardiovascular. Objetivo: Estudiar a largo plazo la magnitud y frecuencia del cambio de los factores de riesgo, incluida la presión arterial, sobre la morbi-mortalidad de la hipertensión. Método: Estudio observacional durante 30 años de una cohorte de 1.360 hipertensos esenciales tratados con fármacos habituales (tiazidicos, B-bloqueadores, antagonistas del Ca++ e inhibidores ECA) y medidas dietéticas, educacionales y farmacológicas tendientes a mejorar el estilo de vida (cigarrillo, alcohol y sedentarismo) y controlar adecuadamente las enfermedades concomitantes (diabetes, dislipidemia, obesidad, gota). Se analizó el cambio individual de los 8 factores de riesgo fijando como éxito: PA <140/90 mmHg, cero consumo de cigarrillos, alcohol > 2 vasos de vino al día, colesterol total <200 mg por ciento, glicemia < 120mg por ciento e índice de masa corporal <30 peso/talla². De acuerdo al éxito individual, se separaron dos grupos: B con cambio adecuado de 4 o más FR y M, sin ese resultado. Se comparó la morbi-mortalidad entre ellos, en total y en forma separada para pacientes complicados y no complicados al ingreso. Estadística según tasas acumulativas y diferencias según método de Cox. Resultados: mortalidad general 0.91 por ciento/año y morbilidades comparables a las de la literatura reciente. Cambio de los factores de riesgo inferior al 50 por ciento, en especial diabetes (26 por ciento) obesidad (18 por ciento) y sedentarismo (15 por ciento). El grupo B con control adecuado de más de 4 factores de riesgo presentó significativamente una menor mortalidad, menor morbilidad total y menor incidencia de Infarto miocárdico, tanto en pacientes previamente complicados como sin ellas al ingreso. Conclusión: Este resultado positivo, a pesar del moderado control de los FR, enfatiza la necesidad de realizar no solo prevención primaria sino también secundaria en forma más intensa y agresiva.

Caries dentaria en Chile y su relación con contenido natural de fluoruros en las aguas de consumo / Dental caries in Chile and its relation to the natural fluoride contents in the drinking waters

Con el propósito de analizar el efecto del contenido natural de fluoruros en la prevalencia de caries, se estudiaron 118 jóvenes (20,2 +- 1,5 años) de dos niveles socioeconómicos que habían nacido y residido en ciudades con distintos niveles de fluoruros (< 0,3 ppm n = 72 y > 0,3 ppm n = 46). En condiciones estandarizadas se midió el COPD y el índice de Grainger que evalúa la severidad del ataque de caries. En ambos grupos el COPD refleja una morbilidad muy alta, pero significativamente mayor en las localidades con menor nivel de fluoruros (11,13 +- 3,53 y 9,82 +- 4,12 p < 0,05). La protección atribuible a los fluoruros fue mayor en el grupo socioeconómico medio-bajo (p<0,05). El padrón de ataque de caries no mostró asociación con el nivel de fluoruros. Se concluye que los fluoruros naturales ejercen una acción protectora, aunque inferior a la descrita en los estudios iniciales sobre el tema