El Modelo Transteórico y la Teoría del Automanejo Individual y Familiar como paradigma para comprender el cambio de comportamiento y el automanejo en personas con enfermedades crónicas / The Transtheoretical Model and the Individual and Family Self-Management Theory as a paradigm to understand behavior change and self-management in people with chronic diseases

INTRODUCCIÓN: El automanejo y el cambio de conducta siguen siendo retos para quienes padecen enfermedades crónicas. Para su abordaje existen modelos y estrategias que orientan a alcanzar mejores resultados en salud. OBJETIVO: Analizar la Teoría del Automanejo Individual y Familiar junto con el Modelo Transteórico como paradigmas para comprender los desafíos e identificar factores involucrados en el cambio conductual y el automanejo de personas con enfermedades crónicas. DESARROLLO: El Modelo Transteórico comprende cinco etapas que explican el proceso cíclico de cambio. Por otro lado, la Teoría del Automanejo Individual y Familiar se distingue por tres dimensiones: contexto, proceso y resultados. Al interrelacionar ambos modelos, se observa que el contexto dado por la Teoría del Automanejo Individual y Familiar puede determinar la etapa del cambio. Los procesos, como la autoeficacia, la facilitación social o la autorregulación, son implementados de formas distintas según la etapa del cambio en la que la persona se encuentre. CONCLUSIÓN: La integración de ambos modelos potencia la comprensión acerca del cambio de conducta en personas con enfermedades crónicas. Esta articulación favorece enfoques más personalizados, lo que permitiría que los profesionales de enfermería reconocer la etapa de cambio en la que se encuentra la persona y, con base en la Teoría del Automanejo, atender las necesidades del individuo y familia, propiciando un cuidado integral.

INTRODUCTION: Self-management and behavioral change continue to be challenges for those suffering from chronic diseases. There are models and strategies for approaching them that aim to achieve better health outcomes. OBJECTIVE: Analyze the Individual and Family Self-Management Theory together with the Transtheoretical Model as paradigms to understand the challenges and identify factors involved in behavioral change and self-management of people with chronic diseases. DEVELOPMENT: The Transtheoretical Model comprises five stages that explain the cyclical process of change. On the other hand, the Individual and Family Self-Management Theory is distinguished by three dimensions: context, process and outcomes. By interrelating both models, it is observed that the context given by the Individual and Family Self-Management Theory can determine the stage of change. Processes, such as self-efficacy, social facilitation or self-regulation, are implemented in different ways depending on the stage of change the person is in. Finally, outcomes, such as self-management, emerge from the effective joint application of both models. CONCLUSION: The integration of both models enhances the understanding of behavior change in people with chronic diseases. This articulation favors more personalized approaches, which would allow nursing professionals to recognize the stage of change in which the person is and, based on the Self-Management Theory, address the needs of the individual and family, promoting comprehensive care.

Seroprevalencia de Toxoplasma gondii en un hospital universitario en Chile / Toxoplasma gondii seroprevalence in a university hospital in Chile

Resumen La toxoplasmosis es una enfermedad zoonótica causada por Toxoplasma gondii. Se estima que afecta a un tercio de la población mundial. En Chile, en 1996, se reportó que la seroprevalencia de anticuerpos del tipo IgG contra T. gondii fue 36,9%, la cual aumentaba progresivamente de norte a sur del país. Hasta el momento, no existe información actualizada sobre la seroprevalencia de T. gondii en la Región Metropolitana. En el presente estudio, se determinó la seroprevalencia de IgG anti T. gondii en el periodo 2013-2018 en un centro universitario de Santiago. De un total de 1.666 resultados, 386 (23,2%) fueron positivos. No se encontraron diferencias según sexo y hubo un incremento significativo según el rango etario. No se observó una disminución de la seroprevalencia en los últimos seis años; sin embargo, los resultados señalan una reducción significativa con respecto a investigaciones previas realizadas en la Región Metropolitana.

Abstract Toxoplasmosis is a zoonotic disease caused by Toxoplasma gondii. It is estimated to affect a third of the world's population. In Chile, in 1996, a seroprevalence of IgG antibodies against T. gondii of 36.9% was reported, which progressively increased from north to south of the country. There are no updated reports of the seroprevalence of T. gondii in the Metropolitan Region. In the present study, we determined the seroprevalence of anti T. gondii IgG in the 2013-2018 period at the Clinical Hospital University of Chile. Of a total of 1,666 results, 386 (23.2%) were positive, without gender differences, but with a significant increase with age. A decrease in seroprevalence was not observed in the last six years, however the results obtained show a significant reduction compared to previous research carried out in the Metropolitan Region.

Cirugía en el paciente cirrótico: características clínicas y complicaciones en una cohorte de pacientes chilenos / Surgical complications in cirrhotic patients: analysis of 102 cases

Background: Cirrhotic patients have an increased surgical risk due to potential intra and postoperative complications. Aim: To describe the clinical characteristics and surgical complications of cirrhotic patients undergoing surgery in a Chilean university hospital. Patients and Methods: Review of medical records of 102 cirrhotic patients aged 60 ± 11 years (52% males) who underwent elective or urgency surgery at an university hospital between 2010 and 2016. General, pre-surgical, and post-surgical complications were recorded. Results: The main etiologies of cirrhosis were non-alcoholic steatohepatitis (31%), and alcoholic cirrhosis (28%). Child-Pugh scores were A, B and C in 50, 28 and 22% of cases respectively. Median MELD (Model for End-stage Liver Disease) score was 11 (interquartile range: 10-15). The surgical procedure was elective in 71% of cases, with predominance of abdominal surgery (86%). The American Society of Anesthesiologists (ASA) score was three or more in 52% of patients. The frequency of any adverse outcome was 62%. The frequency increased along with the severity of cirrhosis and when surgery was urgent. The most common complications were acute renal failure (24%), increased ascites (23%) and encephalopathy (22%). Admission to intensive care unit occurred on 26% of patients, with six hospital deaths. Conclusions: In these patients, surgical complications were common, although with low mortality.

Seroprevalencia de virus hepatitis E en donantes de sangre en un hospital universitario en Chile / Hepatitis E virus seroprevalence in blood donors in a university hospital in Chile

Resumen En Chile, existen escasos estudios de seroprevalencia de anticuerpos IgG anti virus hepatitis E (VHE) en bancos de sangre, entre 4 y 8%. El desarrollo de nuevas técnicas con mayor sensibilidad y especificidad, dan cuenta de un aumento de la seroprevalencia de VHE en diversos países, siendo desconocido el estado actual en Chile. En el presente estudio, determinamos la seroprevalencia de IgG anti VHE en donantes de sangre del Hospital Clínico Universidad de Chile, con técnicas de ELISA de última generación. De un total de 186 muestras, recolectadas el año 2014, 56 (30,1%) resultaron positivas, sin diferencias de género, pero con un incremento significativo con la edad (p < 0,001). Estos resultados muestran un aumento en la seroprevalencia de VHE en donantes de sangre realizados con inmunoensayos de mayor sensibilidad.

In Chile, there are few studies about seroprevalence of IgG antibodies against hepatitis E virus (HEV) in blood banks, between 4 and 8%. The development of new techniques with greater sensitivity and specificity, account for an increase in the seroprevalence of HEV in various countries, the current status in Chile being unknown. In the present study, we determined the seroprevalence of anti-HEV IgG in blood donors of the Clinical Hospital University of Chile, with last generation ELISA techniques. Out of a total of 186 samples, collected in 2014, 56 (30.1%) were positive, without gender differences, but with a significant increase with age (p < 0.001). These results show an increase in the seroprevalence of HEV in blood donors performed with immunoassays of greater sensitivity.

Influencia del polimorfismo genético rs2927488 de Bcl3 en el síndrome de intestino irritable / Influence of genetic polymorphism rs2927488 of the Bcl3 irritable bowel syndrome

Irritable Bowel Syndrome (IBS) is a functional disorder characterized by abdominal discomfort associated with changes in bowel habit and increased intestinal sensitivity. It is one of the most common disorders of digestive health in Chile as well as in the world. Although the pathophysiological mechanisms of IBS have yet to be fully established, it is known that (epi-) genetic factors are involved in the development of the disorder. Bcl3 (B-cell leukemia/lymphoma 3) is a regulatory protein of the intestinal inflammatory response, specifically, with regard to the signaling pathways of NF-kB (Nuclear Factor-kB). Among the variability of the human genome, the gene encoding Bcl3 contains the polymorphism SNPs rs2927488 (variants A/G) which has been associated with susceptibility to developing Inflammatory Bowel Disease (IBD). Furthermore, the presence of this polymorphic variant has been correlated with increased levels of Bcl3 gene expression in patients with Crohn’s Disease. Our laboratory is focused on understanding the potential relationship between Bcl3 and IBS. Our preliminary studies describe an increased expression of Bcl3 at the intestinal mucosal epithelium in IBS patients with a diarrheal-phenotype (IBS-D). We are now interested to investigate if the presence of the variant SNP rs2927488(A/G) is a susceptibility factor for IBS development and to understand the significance of its relationship with Bcl3 expression, in Chilean IBS patients. In this review, we focus primarily on the relationship between rs2927488(A/G) polymorphism of Bcl3 gene, its protein expression and its mechanisms of control over the inflammatory response...

Terapia con baños de PUVA en eccema crónico / Therapy with PUVA baths in chronic eczemas

La terapia con PUVA tópica se ha usado desde la década de los 70 (1) en los países escandinavos y estados unidos, como una alternativa para disminuir los efectos adversos sistémicos de la terapia con PUVA oral, manteniendo la eficacia clínica. Los baños de PUVA son una excelente forma de PUVA tópica que permite una distribución homogénea del psoraleno, prácticamente sin exposición sistémica (2). Se ha usado en dermatosis tan variadas como la psoriasis, el liquen plano, el granuloma anular (3), el eccema crónico (4), el eccema atópico (5), la micosis fungoide, etc. Presentamos dos pacientes con eccema crónico refractario a tratamientos habituales que respondieron satisfactoriamente a los baños de PUVA