Contribución de una estrategia de atención centrada en la persona con multimorbilidad al Modelo de Atención Integral de Salud Familiar y Comunitario en Chile / Contribution of a multimorbidity person-centered care strategy to the Comprehensive Family and Community Healthcare Model in Chile

BACKGROUND: The Multimorbidity Person-Centered Care Model allows to customize care according the needs of each person. AIM: To characterize the perception of health teams about the contribution of the Multimorbidity Person-Centered Care Model (MACEP) to the development of the key principles of the Comprehensive Family and Community Health Care Model (MAIS). MATERIAL AND METHODS: A qualitative collaborative study with 35 interviews and the participation of 67 professionals from the primary healthcare network. Content analysis using mixed code system with MAXQDA2020 program. RESULTS: The innovations and complex interventions that positively affect the development and implementation of the essential principles of MAIS were recognized by participants as a contribution of the central elements of MACEP. CONCLUSIONS: This contribution is an opportunity for the expeditious implementation of Family Health principles in the health network. Incorporating the vision of implementers and users, who are part of these changes, is essential. It is necessary to establish, project and evaluate innovations to identify, implement and promote learning at Health Services throughout the country.

Rendimiento de dos índices predictores de mortalidad (PSI y CURB-65) en pacientes adultos inmunocompetentes hospitalizados por neumonía adquirida en la comunidad / Yield of two mortality predictors in immunocompetent patients with community acquired pneumonia

Background: The severity of community acquired pneumonia (CAP) can be evaluated by the PSI and CURB-65 scales. However, it is unknown whether their predictive capacity varies according to the etiology of the disease. Aim: To compare the performance of these scales in adults with viral, bacterial, mixed, and no agent detected CAP. Material and Methods: We studied 725 patients hospitalized for CAP aged 18 to 95 years (47% females) Urinary S. pneumoniae and Legionella antigens were detected by immuno-chromatography (Binax®). Respiratory viruses and bacteria were detected by PCR in nasopharyngeal smears. The proportions of deaths, admission to the intensive care unit (ICU), and oxygen therapy were compared between mild and non-severe patients defined by PSI (I/II and I-III) and CURB-65 (1 and 1-2), according to the causative agent. Results: Ten percent of patients died. A causative agent was detected in 65%. The proportion of mild and non-severe patients according to PSI and CURB-65, and of deceased patients, admitted to the ICU and with oxygen therapy was similar in the four categories per agent. There were no deaths among non-severe patients with bacterial CAP. However, 6% of patients with CAP caused by virus or without causative agents, died. No deaths occurred among mild patients with bacterial CAP. In viral CAP, no deaths occurred among patients classified as mild only by PSI. The yields of PSI were greater than those of CURB-65 in non-severe patients who died and were admitted to the ICU with bacterial and viral CAP (5 and 14%; 7 and 12% respectively, p = 0.04). Conclusions: The prognostic performance of PSI in CAP varies according to the causative agent in adults. It is higher in non-severe bacterial cases, and superior to CURB-65.

El maltrato infantil y su rol en el curso clínico de pacientes con trastorno bipolar / History of child abuse among patients with bipolar disorders

Background: A history of child abuse is common and has a significant impact in the clinical course of patients diagnosed with bipolar disorders (BD). Aims: To assess the frequency of child abuse experiences in patients BD type I and to evaluate its association with clinical course and cognitive functioning variables. Material and Methods: 117 patients with BD aged 45 ± 14 years (66% women) answered the Childhood Trauma Questionnaire (CTQ). The clinical course (illness onset, history of suicide attempts and number of hospitalizations) was obtained from medical records. Cognitive functioning was evaluated through social and non-social cognition tasks. Results: 64% of participants reported some type of child abuse. This variable was associated with an early onset of the disease (Odds ratio (OR) = 3.3; p < 0.02), increased risk of suicide attempts (OR = 2.4; p < 0.04) and specific disturbances in social cognitive tasks. Conclusions: Our study supports evidence of a common history of child abuse in patients with BD. Although child abuse predicts a worse clinical course, major clinical practice guidelines, as well as research designs, do not highlight this evidence.

Percepción de las motivaciones en el ingreso a una carrera del área de la salud / Perception of the motivational factors for pursuing a career in healthcare

Interpretar la percepción de las motivaciones que presentan estudiantes a ingresar en una carrera del área de la salud en la Facultad de Medicina de la Universidad Católica de la Santísima Concepción, Chile durante el año 2015. Material y Métodos: A través de un diseño cualitativo y utilizando un enfoque fenomenológico, se aplica entrevista semiestructurada a 55 estudiantes que ingresan a la carrera de Medicina, Enfermería, Nutrición y Dietética, Kinesiología o Tecnología Médica de la Facultad de Medicina de la Universidad Católica de la Santísima Concepción, Chile, durante el año 2015. Los resultados, sometidos a triangulación de informantes, son analizados utilizando la técnica de análisis de discurso. Resultados: La vocación de servicio público, el campo laboral una vez egresados o la vivencia de experiencias personales y/o familiares frente a una condición de salud se perciben como parte importante en las motivaciones de ingreso a una carrera del área de salud. La familia, el establecimiento educacional de procedencia o los amigos no se identifican como influyentes en la selección de la carrera de formación profesional a seguir. Esta situación es identificada independiente de la disciplina seleccionada. Conclusiones: El altruismo y la vocación de servicio público son percibidos como el principal factor condicionante al momento de ingresar a una carrera del área de salud...

To interpret the perception of the motivational factors presented by students who decide to pursue a career in healthcare in the Faculty of Medicine at the Catholic University of the Most Holy Conception, Chile during 2015. Material and Methods: Through a qualitative design and using a phenomenological approach, a semi-structured interview was applied to 55 new students. They were all pursuing a degree in the fields of Medicine, Nursing, Nutrition and Dietetics, Physical Therapy or Medical Technology of the School of Medicine at Universidad Católica de la Santísima Concepción, Chile, in 2015. The results were subject to triangulation of informants, and were analyzed using the technique of discourse analysis. Results: Vocation for public service, the career field once graduated or the experience of personal /familiar experiences when facing a health condition are perceived as an important part of the motivational factors for pursuing a degree in healthcare. Family, school where they graduated from or friends are not identified as an influence when deciding what professional field to pursue. This situation is not necessarily linked to a specific area of expertise. Conclusions: Altruism and vocation for public service are perceived as the main conditioning factor when deciding to pursue a degree in healthcare...

Differential expression and localization of ADAM10 and ADAM17 during rat spermatogenesis suggest a role in germ cell differentiation

BACKGROUND: Extracellular metolloproteases have been implied in different process such as cell death, differentiation and migration. Membrane-bound metalloproteases of the ADAM family shed the extracellular domain of many cytokines and receptor controlling auto and para/juxtacrine cell signaling in different tissues. ADAM17 and ADAM10 are two members of this family surface metalloproteases involved in germ cell apoptosis during the first wave of spermatogenesis in the rat, but they have other signaling functions in somatic tissues. RESULTS: In an attempt to further study these two enzymes, we describe the presence and localization in adult male rats. Results showed that both enzymes are detected in germ and Sertoli cells during all the stages of spermatogenesis. Interestingly their protein levels and cell surface localization in adult rats were stage-specific, suggesting activation of these enzymes at particular events of rat spermatogenesis. CONCLUSIONS: Therefore, these results show that ADAM10 and ADAM17 protein levels and subcellular (cell surface) localization are regulated during rat spermatogenesis.

Detección de trastornos del hábito del comer en una población estudiantil de la V región / Detection of eating behavior disorders in a school population of V region

Los jóvenes adolescentes en edad escolar han sido consideradas como una población de alto riesgo para desarrollar eventualmente un trastorno del hábito del comer, sea éste anoréctico y/o bulímico. A 570 estudiantes de sexo femenino de III y IV año de enseñanza media de la V Región y a 30 pacientes con diagnóstico de desorden alimentario, se les administró el Test de Actitudes Alimentarias (EAT40), resultando un subgrupo denominado potencialmente patológico (n: 103), que representó el 18,1 por ciento de la muestra estudiantil y que obtuvo puntajes en el rango patológico del EAT40. Del análisis factorial del EAT40 emergió una útil subescala abreviada: el EAT22. Se comparan los hallazgos más relevantes entre los grupos, confrontándolos con la literatura especializada y se sugieren medidas preventivas apropiadas