Factores que influyen en la cancelación de cirugías programadas: una revisión de la literatura / Factors influencing the cancellation of scheduled surgeries: a literature review

Introduction: Scheduled surgery cancellation is a major problem in healthcare provision, negatively affecting patients and their families, the healthcare staff, and the healthcare institution itself. It carries an increase in hospital costs, lost time, and creates physical issues for healthcare staff. Methodology: A narrative review of the literature was carried out based on concepts that specified the meaning of the search in the PubMed, Scielo, and Google academic databases. The inclusion criteria were all articles, on the topic, published between 2014 and 2021, in Spanish and English, including an abstract, and that could be accessed for free. Results: the main causes for surgery cancellation were identified and grouped as patient-related factors, administrative aspects, logistics failures, such as lack of medical/surgical devices, and surgeon-related or anesthesiologist-related causes. Conclusion: this topic will always be valid and a subject of continuous analysis, due to the repercussions on patients, the institution, costs, and the operating room staff. To review the causes for surgery cancellation, is important, so they may be addressed when detected, and may contribute to improve the quality of healthcare

Introducción: la cancelación de una cirugía es un tema relevante en la asistencia en salud, debido a las consecuencias en los pacientes y su familia, el personal de salud y la institución. Está implícita el alza en los costos hospitalarios, el tiempo perdido y las repercusiones físicas para el personal de salud. Metodología: revisión narrativa de la literatura sobre conceptos que precisan el sentido de la búsqueda con herramientas en las bases de datos PubMed, Scielo y Google académico. Los criterios de inclusión de los artículos fueron aquellos publicados desde 2014 hasta 2021 en español e inglés, que tuvieran resumen y fueran accesibles sin algún tipo de pago. Resultados: las causas más frecuentes para cancelar las cirugías están enmarcadas en factores propios del paciente, en la parte administrativa, en fallas de la logística como la ausencia de dispositivos médico-quirúrgicos, y a la cancelación por el especialista y el anestesiólogo. Conclusión: esta temática siempre estará vigente y en continuo análisis debido a las repercusiones en los pacientes, la institución, los costos y el personal del quirófano. Es importante revisar las causas de la cancelación de cirugías, que al ser detectadas puedan solucionarse y contribuyan a la mejora de la calidad de atención en la salud

Valores de referencia y factores de riesgo de la condición física en personas mayores chilenas físicamente activas / Reference values and risk factors in the deterioration of the physical fitness of physically active older chilean adults

BACKGROUND: Physical fitness assessment of older adults is essential because it is a key component of functional independence and healthy aging. AIM: To establish physical fitness reference values for physically active older Chilean adults of both sexes and identify the variables associated with the deterioration of their physical condition. MATERIAL AND METHODS: Cross-sectional study that included 342 older adults aged 60 and over. Their physical fitness was assessed with the Senior Fitness Test (SFT). The timed up and go (TUG), chair stand (CS), arm curl (AC), and aerobic resistance (2 min) tests were evaluated. RESULTS: Performance in the physical fitness tests by age group decreased in all tests as older adults advanced in age. Scores for men were more evenly distributed across the different age groups. The main risk factors for the deterioration of physical fitness were age, sex, and body mass index (BMI) (p-value < 0.05). The primary risk factor for men was age and for women age and BMI. CONCLUSIONS: Performance of both men and women in the different SFT tests decreased as older adults aged. Age, sex, and BMI were the main risk factors for the deterioration of the physical fitness of physically active older adults.

Factores clínicos asociados con mortalidad y multirresistencia en pacientes quirúrgicos de un hospital de alta complejidad / Clinical factors associated with mortality and multi-drug-resistance among surgical patients at a high complexity hospital

Introducción: el aumento de la morbimortalidad causada por gérmenes multirresistentes debido a la dicultad cada vez mayor para encontrar opciones de tratamiento, hace que hoy sea importante la identicación de los principales factores clínicos que se asocian con multirresistencia en pacientes quirúrgicos. Objetivo: determinar los factores clínicos relacionados con mortalidad y multirresistencia en quienes se someten a procedimientos quirúrgicos en un hospital de alta complejidad en Cartagena, Colombia. Materiales y Métodos: estudio descriptivo de corte transversal retrospectivo, con muestra proyectada de 150 pacientes quirúrgicos que cumplieran con los criterios de elegibilidad, a quienes se realizaron análisis uni y bivariados para establecer asociación entre muerte e infección por bacterias multirresistentes. Resultados y discusión: los factores clínicos asociados estadísticamente con mortalidad, en su mayoría se relacionan con antecedentes como hipertensión (p=0,001), anemia (p=0,044) e inmunosupresión (p=0,012), y con la multirresistencia son anemia (p=0,009), insuciencia cardiaca (p=0,017) y ser de procedencia urbana (p=0,013) Conclusiones: la mortalidad de pacientes quirúrgicos se asocia de manera importante con los antecedentes clínicos y la multirresistencia no está determinada por los procedimientos médicos, ni por el tipo de intervención quirúrgica.

Introduction: the increase of morbidity and mortality caused by multi-drug-resistant bacteria due to the expanding difficulty in finding treatment options, makes identifying the main clinical factors associated with multi-drug -resistance among surgical patients, important. Objective: to determine the clinical factors related to mortality and multi-drug ­ resistance (MDR) in patients who undergo surgical procedures at a high complexity hospital in Cartagena, Colombia. Materials and Methods: a descriptive retrospective cross-sectional study, including a projected sample size of 150 surgical patients who met the eligibility criteria, using univariate and bivariate analyses to establish the association between death and infection by multi-resistant bacteria. Results and Discussion: the leading clinical factors statistically associated with mortality are antecedent hypertension (p=0.001), anemia (p=0.044) and immunosuppression (p=0.012), and factors associated with the development of MDR are anemia (p=0.009), heart failure (p=0.017) and urban origin (p=0.013) Conclusions: mortality among surgical patients is significantly associated with past clinical history. MDR is not determined by medical procedures, nor by the type of surgical intervention.

The role of motivation and life satisfaction on chilean university students' physical activity and sedentary behavior / O papel da motivação e satisfação com a vida na atividade física e comportamento sedentário de estudantes universitários chilenos

ABSTRACT Motivation is a fundamental element for the practice of physical activity and the feeling of satisfaction with life. However, little is known about the role of such psychological variables in the lifestyle of Chilean university students. This study aimed to analyse the relationship between life satisfaction and the regulations of motivation and to compare such variables by physical activity level and sedentary behaviour of university students. The sample comprised 95 Chilean university students (63.2% female), with a mean age of 20.92 ± 1.98 years. The instruments were the IPAQ, the Satisfaction with Life Scale, and the Behavioural Regulation in Exercise Questionnaire. Descriptive measures, Pearson's correlation coefficient, and Student's t-tests were used to analyse the data. The results revealed positive and significant correlations between life satisfaction and intrinsic (r = 0,44), integrated (r = 0,38), and identified (r = 0,41) regulation. Students with high levels of physical activity scored higher for intrinsic, integrated, and identified regulation. Those who reported low sedentary behaviour showed higher identified regulation. Therefore, it is suggested that students' motivational regulation may differ on some dimensions as those with higher levels of physical activity show more adaptive motivational regulation. Identified regulation also seems to play an important role in decreasing sedentary behaviour.

RESUMO A motivação é elemento fundamental para a prática de atividade física e o sentimento de satisfação com a vida. Contudo, pouco se sabe sobre o papel de tais variáveis psicológicas no estilo de vida de estudantes universitários chilenos. Este estudo teve como objetivos analisar as relações entre a satisfação com a vida e as regulações da motivação, e comparar tais variáveis em função do nível de atividade física e do comportamento sedentário de estudantes universitários. A amostra foi composta por 95 estudantes universitários chilenos (63,2% do gênero feminino), com idade média de 20,92 ± 1,98 anos. Os instrumentos avaliados foram o IPAQ, a Escala de Satisfação com a Vida e o Questionário de Regulação do Comportamento do Exercício. Medidas descritivas, coeficientes de correlação de Pearson e testes t de Student foram utilizados para analisar os dados. Os resultados revelaram correlações positivas e significativas entre satisfação com a vida e regulação intrínseca (r = 0,44), integrada (r = 0,38) e identificada (r = 0,41). Os estudantes com alto nível de atividade física obtiveram maiores pontuações para regulação intrínseca, integrada e identificada. Os indivíduos que reportaram menor comportamento sedentário possuíam maior regulação identificada. Desse modo, sugere-se que a regulação motivacional dos estudantes pode ser diferente em algumas dimensões, sendo que os indivíduos com maior nível de atividade física semanal demonstram regulações motivacionais mais adaptativas. A regulação identificada também parece desempenhar um papel importante para a redução do comportamento sedentário.

A Six-Minute Walk Test: Oxygen Uptake and Distance Predicted / Prueba de Caminata de Seis Minutos: Consumo de Oxígeno y Distancia Predicha

Abstract Background: Maximum oxygen consumption is an indicator of cardiorespiratory fitness. Aim: The purpose was, first, to relate and compare the V̇O2max as the dependent variable with the estimated distance in the six-minute walk test (SMWT) as the independent variable in university students and, secondly, to relate the distance (dependent) with demographic and anthropometric variables (independents). Methodology: A correlational, descriptive, and quantitative study with a non-experimental design was conducted on 110 university students. In the study, basic anthropometry and vital signs were measured. A direct method of V̇O2max (Bruce test) on a treadmill was applied. Then, the distance covered in the SMWT was evaluated with two equations available in the scientific literature. Differences between men and women were measured in the tests, the correlation between the distances estimated with V̇O2max and anthropometric variables, and repeated ANOVA measurement tests between V̇O2max and estimated distance were analyzed with the SPSS v.22 program (p<0.05). Results: Significant correlations were found between V̇O2max and estimated distances (p<0.05) in the total sample, men and women, and in some cases, the distance correlated with gender, age, weight, height, and BMI (p<0.05). However, there were differences between V̇O2max and distances estimated in the SMWT (p<0.001). Conclusions: The V̇O2max measurement method is different from the distance prediction equations, although they have a significant relationship.

Resumen Antecedentes: El consumo máximo de oxígeno es un indicador de la aptitud cardiorrespiratoria. Objetivo: El objetivo fue relacionar y comparar el V̇O2máx. como variable dependiente con la distancia estimada en la prueba de caminata de seis minutos (PC6M) como variable independiente en estudiantes universitarios, a la vez relacionar la distancia (dependiente) con variables demográficas y antropométricas (independientes). Metodología: Estudio cuantitativo, no experimental, transversal, y descriptivo-correlacional en el que participaron 110 estudiantes universitarios. Se midió antropometría básica y signos vitales, y se aplicó un método directo de V̇O2máx. (Test de Bruce) en cinta rodante, luego se estimó la distancia recorrida en PC6M con dos ecuaciones disponibles en la literatura. Diferencias entre hombres y mujeres en las pruebas aplicadas, correlación entre las distancias estimadas con el V̇O2máx. y variables antropométricas, y la prueba de ANOVA de medidas repetidas entre el V̇O2máx. y las distancias estimadas fueron utilizadas con el programa SPSS v.22 (p<0,05). Resultados: Se encontró correlaciones significativas entre el V̇O2máx. y distancias estimadas (p<0,05) en la muestra, en hombres y mujeres, y en algunos casos la distancia se correlacionó con el sexo, la edad, el peso, la estatura y el IMC (p<0,05). Sin embargo, hubo diferencias entre el V̇O2máx. y las distancias estimadas en la PC6M (p<0,001). Conclusiones: El método directo de V̇O2máx. es distinto de las ecuaciones de predicción de distancia, aunque tienen relación significativa.

Resumo Antecedentes: O consumo máximo de oxigênio é um indicador de aptidão cardiorrespiratória. Objetivo: O objetivo é relacionar e comparar a V̇O2 máx. como variável dependente com a distância estimada no teste de caminhada de seis minutos (TC6M) como uma variável independente em estudantes universitários, ao mesmo tempo, relacionar a distância (dependente) com variáveis demográficas e antropométricas (independente). Metodologia: Estudo quantitativo, não-experimental, transversal, descritivo-correlativo, no qual participaram 110 estudantes universitários. Antropometria básica e sinais vitais foram medidos, e um método direto de V̇O2 máx. (teste Bruce) foi aplicado na esteira, então a distância coberta em TC6M foi estimada com duas equações disponíveis na literatura. Diferenças entre homens e mulheres nos testes aplicados, correlação entre distâncias estimadas com V̇O2 máx. e variáveis antropométricas, e medidas repetidas teste ANOVA entre V̇O2 máx. e distâncias estimadas foram usadas com SPSS v.22 (p<0,05). Resultados: Foram encontradas correlações significativas entre V̇O2 máx. e distâncias estimadas (p<0,05) na amostra, em homens e mulheres, e em alguns casos a distância correlacionada com sexo, idade, peso, altura e IMC (p<0,05). Entretanto, houve diferenças entre V̇O2 máx. e distâncias estimadas em TC6M (p<0,001). Conclusões: O método direto de V̇O2 máx. é diferente das equações de previsão de distância, embora elas tenham relações significativas.

Tendencia de consejerías en actividad física y enfermedades cardiometabólicas en el Maule, Chile: estudio previo a pandemia por COVID-19 entre 2012 y 2019 / Trend in Physical Activity Counseling and Cardiometabolic Diseases in Maule, Chile: COVID-19 Pre-Pandemic Study between 2012 and 2019

BACKGROUND: Physical activity (PA) practice reduces the adverse effects of COVID-19. PA counseling promotes healthy lifestyles and prevents cardiometabolic diseases. AIM: To assess the trend in cases of PA counseling and the cardiometabolic disease between 2012 and 2019 (before COVID-19) in a southern Chilean region. MATERIAL AND METHODS: Records of Maule Region Health Service for 731.163 men, and 829.097 women aged < 10 to ≥ 65 years were analyzed. The average annual percentage change (AAPC) during the study period and the annual percentage change (APC) during intermediate periods, were calculated. RESULTS: There was a significant decrease in PA counseling in women in the study period (AAPC: −13.6%). In the 2012-2017 period a significant decrease in counseling for total, men and women were observed (APC: −18.1, −16.5 and −19.1%, respectively). Obesity increased significantly in total, men and women in the 2012-2019 period (AAPC: 10.1, 8.5 and 10.7%, respectively). The same trend was observed for hypertension (AAPC: 8.1, 8.5 and 7.6% respectively) and elevated blood glucose (AAPC: 10, 11.5 and 9.6%, respectively). CONCLUSIONS: In the study period PA counseling decreased along with an increase in obesity, hypertension and high blood glucose. Increasing PA counseling is a mainstay in the prevention of cardiometabolic diseases and probably to prevent contagion and complement the treatment of COVID-19.

Controversias en neuroinmunología: esclerosis múltiple, vacunación, SARS-CoV-2 y otros dilemas / Controversies in neuroimmunology: multiple sclerosis, vaccination, SARS-CoV-2 and other dilemas

La neuroinmunología es una disciplina que cada vez amplía más sus horizontes en la comprensión de las enfermedades neurológicas. Contemporáneamente, y a la luz de los nexos fisiopatológicos de las enfermedades neurológicas y la inmunología, se han planteado enfoques diagnósticos y terapéuticos específicos. A pesar de los importantes avances de esta disciplina, existen múltiples dilemas que le conciernen y se filtran en la práctica clínica. En esta revisión, se presentan y discuten 15 controversias, las cuales se construyen con la información clínica disponible más actualizada. Los temas incluidos son: disminución de esteroides en recaídas de esclerosis múltiple; recomendaciones terapéuticas en esclerosis múltiple a la luz de la pandemia por el SARS-CoV-2; evidencia de vacunación en esclerosis múltiple y en otras enfermedades desmielinizantes; panorama actual del síndrome clínico y radiológico aislado; y fallas terapéuticas en esclerosis múltiple; además, criterios para suspender las terapias modificadoras de la enfermedad; evidencia del manejo en recaídas leves; recomendaciones para la profilaxis contra Strongyloides stercolaris; utilidad de un segundo ciclo de inmunoglobulina en el síndrome de Guillain-Barré; criterios para diferenciar una polineuropatía crónica desmielinizante inflamatoria de inicio agudo de un síndrome de Guillain-Barré y, utilidad de la enzima convertidora de angiotensina en neurosarcoidosis. En cada una de las controversias, se presenta la problemática general y se ofrecen recomendaciones específicas que pueden adoptarse en la práctica clínica diaria.

Neuroimmunology is a discipline that increasingly broadens its horizons in the understanding of neurological diseases. At the same time, and in front of the pathophysiological links of neurological diseases and immunology, specific diagnostic and therapeutic approaches have been proposed. Despite the important advances in this discipline, there are multiple dilemmas that concern and filter into clinical practice. This article presents 15 controversies and a discussion about them, which are built with the most up-to-date evidence available. The topics included in this review are: steroid decline in relapses of multiple sclerosis; therapeutic recommendations in MS in light of the SARS-CoV-2 pandemic; evidence of vaccination in multiple sclerosis and other demyelinating diseases; overview current situation of isolated clinical and radiological syndrome; therapeutic failure in multiple sclerosis, as well as criteria for suspension of disease-modifying therapies; evidence of the management of mild relapses in multiple sclerosis; recommendations for prophylaxis against Strongyloides stercolaris; usefulness of a second course of immunoglobulin in the Guillain-Barré syndrome; criteria to differentiate an acute-onset inflammatory demyelinating chronic polyneuropathy versus Guillain-Barré syndrome; and, the utility of angiotensin-converting enzyme in neurosarcoidosis. In each of the controversies, the general problem is presented, and specific recommendations are offered that can be adopted in daily clinical practice.

Asociación del fitness cardiorrespiratorio con marcadores de adiposidad corporal: estudio de corte transversal de la Encuesta Nacional de Salud Chile 2016-2017 / Association of cardiorespiratory fitness with adiposity markers

BACKGROUND: Cardiorespiratory fitness (CRF) is inversely associated with metabolic diseases and adiposity markers. Aim: To assess the association of CRF with body mass index (BMI), waist circumference (WC) and obesity in a representative sample of the Chilean population. MATERIAL AND METHODS: Data from 5,958 participants in the Chilean National Health Survey 2016-1027 aged 15 years or above were analyzed. CRF was estimated by an equation that included sociodemographic, anthropometric and health-related data and expressed in metabolic equivalent units (METs). The association between CRF and adiposity was assessed using linear and Poisson regression models and the results were presented as Prevalence Ratio (PR). RESULTS: One MET increment in CRF was associated with a 3.27 kg/m2 (95% confidence intervals (CI): -3.35; -3.2) and 4.56 kg/m2 (95% CI: -4.67; -4.46) lower BMI in men and women, respectively. Waist circumference was 6.7 cm [95% CI: -6.98; -6.42] and 9 cm [95% CI: -9.33; -8.67] lower per 1-MET increment in CRF. With one MET increment, the probability of being obese was 34% (PR = 0.66 [95%CI: 0.63; 0.69]) and 36% (PR = 0.64 [95%CI: 0.61; 0.67]) lower in men and women, respectively. The probability of having a central obesity was 26% (PR = 0.74 [95%CI: 0.71; 0.77]) and 30% (PR = 0.70 [95%CI: 0.68; 0.73]) lower in men and women, respectively. Conclusions: A higher estimated CRF was associated with lower adiposity levels and a lower risk of being obese in both men and women. Public health policies aiming to increase physical activity are needed to increase the CRF of the Chilean population.

Relación entre fuerza de prensión manual, función física y riesgo de caídas en personas mayores / Relationship between handgrip strength, physical function, and risk of falls in older people

RESUMEN Introducción: La fuerza de prensión manual permite evaluar debilidad muscular en personas mayores y presenta correlación con la fuerza general y masa muscular, por lo que podría ayudar en la detección precoz del deterioro de la función física y riesgo de caídas. Objetivo: Relacionar la fuerza de prensión manual con la función física y riesgo de caídas en personas mayores. Métodos: Estudio descriptivo, correlacional. Evaluó 87 personas mayores (24 hombres y 63 mujeres) entre 65 y 75 años, de 4 organizaciones sociales de Talca, Chile, seleccionados por un muestreo no probabilístico por conveniencia. Para medir la fuerza de prensión manual se utilizó́ un dinamómetro de mano, para valorar la función física se usó la prueba Short Physical Performance Battery; con las pruebas de estación unipodal y time up and go se evaluó riesgo de caídas. Resultados: Se observaron relaciones significativas moderadas entre la fuerza de prensión manual y el test Short Physical Performance Battery (p= 0,001; r= 0,473) y con todas las pruebas que componen esta batería. Se evidenció una relación entre la fuerza de prensión y la prueba de estación unipodal (p= 0,001; r= 0,472), mientras que la relación con la prueba time up and go fue inversa débil (p= 0,002; r= -0,398). Conclusión: Existe relación entre la fuerza de prensión manual con la función física y el riesgo de caídas personas mayores. Este hallazgo sugiere que la fuerza de prensión manual podría usarse en la práctica clínica como instrumento de detección precoz de la pérdida de la función física y riesgo de caídas.

ABSTRACT Introduction: Handgrip strength is a way to evaluate muscle weakness in older people and it has been seen to show a high correlation with general strength and body muscle mass, which is why it could help in the early detection of deterioration in physical function. loss of lower limb strength and risk of falls. Objective: To relate handgrip strength with physical function and risk of falls in older people. Methods: Descriptive, correlational study. It evaluated 87 older people (24 men and 63 women) between 65 and 75 years old, from 4 social organizations in the city of Talca, Chile, selected through a non-probabilistic convenience sampling. To measure the handgrip strength, a hand dynamometer was used, to assess physical function the Short Physical Performance Battery test was used, and the unipodal station and time up and go tests were used to evaluate balance static and dynamic respectively. Results: Moderately significant relationships were observed between the handgrip strength in the Short Physical Performance Battery test (p = 0.001; r = 0.473) and with all the tests that make up this battery. A moderate one was also evidenced between the grip strength and the unipodal station test (p = 0.001; r= 0.472), while the relationship with the time up and go test was weak inverse (p = 0.002; r = -0.398). Conclusion: There is a relationship between handgrip strength with physical function and the risk of falls in older people. This finding is important because it suggests that handgrip strength could be used in clinical practice as an indirect indicator or as an early detection tool for loss of general strength capacity, physical fitness, and risk of falls.

Niveles de actividad física y tiempo sedente según ingreso económico en Chile: resultados de la Encuesta Nacional de Salud 2016-2017

Background: The Chilean population reports high levels of physical inactivity. The relationship between income level, physical activity (PA) and sedentary behaviors is not well known. Aim: To describe the levels of PA and sedentary time, according to income levels in the Chilean population. Material and Methods: Analysis of data from the Chilean National Health Survey 2016-2017, which included 5,130 participants (52.9% women). The levels of PA and sedentary time were measured by the Global Physical Activity Questionnaire. Income levels were established according to the self-reported income per capita of the households and presented as quintiles. PA levels according to income levels were estimated by linear regression analyses. Results: Transport-related PA was higher in the lowest income quintiles (p = 0.039). There were no trends for income levels and PA domains including moderate, vigorous, total, occupational and leisure PA. The prevalence of leisure and occupational physical inactivities were higher in the lowest quintiles of income. Sitting time was higher in the higher income levels (p < 0.01). Conclusions: People in the lowest quintile for income spent more time in transport-related PA and less time sitting. However, physical inactivity prevalence during leisure and work time were higher in people with lower income.

Mortalidad por COVID-19 y diagnóstico tardío en las primeras etapas de la pandemia en Bolívar-Colombia / Mortality from COVID-19 and late diagnosis in the early stages of the pandemic in Bolívar-Colombia

Introducción: Los pacientes fallecidos por COVID-19 al inicio de la pandemia evidencian características clínico-epidemiológicas particulares y su identificación, lo mismo que los aspectos asociados a su diagnóstico son fundamentales para la implementación de estrategias en salud pública que permitan la protección sanitaria de los grupos más vulnerables. Objetivo: Determinar las características clínico epidemiológicas de los pacientes fallecidos por COVID-19 y su asociación con el diagnóstico tardío en las primeras etapas de la pandemia en el departamento de Bolívar-Colombia. Materiales y Métodos: Estudio descriptivo de corte transversal con una muestra de 51 pacientes fallecidos por COVID-19; se calculó la frecuencia relativa de los factores de riesgo clínico epidemiológicos de estos pacientes y se realizó un análisis bivariado para evidenciar la asociación con la posibilidad de ser diagnosticado después de la muerte, usando la razón de disparidad (OR) con su intervalo de confianza Resultados: El 47,2 por ciento de los diagnósticos se hicieron después de la muerte; el promedio entre el inicio de los síntomas y la muerte fue aproximadamente 13 días, en los que se evidencia como comorbilidades importantes las enfermedades cardíacas (58,5 por ciento) y la hipertensión (35,8 por ciento). La asociación con el diagnóstico después de la muerte se relaciona con los casos notificados en abril y mayo (p=0,03), ser mayor de 80 años (p=0,03) y tener malnutrición (p=0,04). Conclusión: En el contexto del departamento de Bolívar se observan fallas en el diagnóstico oportuno de algunos grupos poblacionales vulnerables y a los pacientes con enfermedades cardíacas se debe prestar atención para evitar la alta mortalidad(AU)

Introduction: Patients who died from COVID-19 at the beginning of the pandemic show particular clinical-epidemiological characteristics and their identification as well as the aspects associated with the diagnosis are fundamental for the implementation of public health strategies that allow the sanitary protection of the most vulnerable groups. Objective: To determine the clinical-epidemiological characteristics of patients who died from COVID-19 and its association with late diagnosis in the early stages of the pandemic in the department of Bolívar-Colombia. Material and Methods: Descriptive cross-sectional study with a sample of 51 patients who died from COVID-19; the relative frequency of the clinical-epidemiological risk factors of these patients was calculated and a bivariate analysis was performed to show the association with the possibility of being diagnosed after death, using the disparity ratio (OR) with its confidence interval. Results: The 47,2 percent of the diagnoses were made after death; the average between the onset of symptoms and death was approximately 13 days, in which heart disease (58,5 percent) and hypertension (35,8 percent) were evidenced as important comorbidities. The association with diagnosis after death is related to the cases reported in April and May (p = 0.03), being older than 80 years (p = 0.03) and having malnutrition (p = 0.04). Conclusion: In the context of the department of Bolívar, failures are observed in the timely diagnosis of some vulnerable population groups, thus special attention should be paid to patients with heart disease to avoid high mortality(AU)

Factores pronósticos de mortalidad por agente infeccioso en un hospital de alta complejidad de Cartagena-Colombia / Prognostic factors for mortality caused by an infectious agent in a high complexity hospital in Cartagena-Colombia

Introducción: La identificación de los principales factores clínico-epidemiológicos que determinan causas de mortalidad en pacientes hospitalizados es una necesidad apremiante, principalmente cuando los esfuerzos realizados en la actualidad no permiten asumir acciones fundamentadas en la identificación de las causas de dicho evento. Objetivo: Establecer cuáles son los factores pronósticos de mortalidad por agente infeccioso en un hospital de alta complejidad de la ciudad de Cartagena- Colombia. Material y Métodos: Se realizó un estudio de casos y controles retrospectivo, con muestra proyectada de 86 casos y 258 controles, en una relación 1:3, que cumplieron con los criterios de elegibilidad respectivos y en los que realizaron análisis bivariados y posteriormente un análisis multivariado que incluyó métodos de regresión logística binaria. Resultados: El riesgo de mortalidad en el análisis multivariado está determinado por variables como sexo masculino (ORa 1,695 IC 95 por ciento: 1,005-2,856); Cáncer (ORa 2,389 IC 95 por ciento 1,230-4,642); inmunosupresión (ORa 3,211 IC 95 por ciento 1,004-10,26); Ventilación mecánica (ORa 2,541 IC 95 por ciento 1,128-5,722); Estancia en la UCI (ORa 2,331 IC 95 por ciento1,227-4,425) e Infección por bacterias productoras de carbapenemasas (ORa 4,778 IC95 por ciento 1,313-17,38). Conclusiones: En pacientes masculinos con cáncer o cualquier otra forma de inmunosupresión, en los que se requiera el uso del ventilador mecánico o estancia en la unidad de cuidado intensivo y que además desarrollen infecciones por bacterias productoras de carbapenemasas existe mayor riesgo de muerte por agente infeccioso(AU)

Introduction: The identification of the main epidemiological clinical factors that determine the causes of mortality in hospitalized patients is a pressing need, mainly when the efforts made at present do not allow us to take actions based on the identification of the causes of the aforementioned event. Objective: To identify the prognostic factors for mortality caused by infectious agents in a high complexity hospital in the city of Cartagena, Colombia. Material and Methods: A retrospective case-control study was conducted in 86 cases and 258 control samples that met the eligibility criteria, at the 1: 3 ratio. Bivariate analyses and a subsequent multivariate analysis that included binary logistic regression methods were also performed. Results: In the multivariate analysis, the risk of mortality is determined by variables such as male sex (ORa 1,695 95 percent CI: 1.005-2.856); cancer (ORa 2,389 95 percent CI 1,230-4,642); immunosuppression (ORa 3.211 95 percent CI 1.004-10.26); mechanical ventilation (ORa 2.541 95 percent CI 1.128-5.722); stay in the ICU (ORa 2,331 95 percent CI 1,227-4,425) and infection caused by carbapenemase-producing bacteria (ORa 4,778 95 percent CI 1,313-17.38). Conclusions: Male patients with cancer or any other form of immunosuppression who require the use of a mechanical ventilator or admission to the intensive care unit who also develop infections caused by carbapenemase-producing bacteria, are at greater risk of death from an infectious agent(AU)

¿Cuál es la asociación entre actividad física, sedentarismo y riesgo de desarrollar cáncer en población adulta? Una revisión de la literatura

RESUMEN La práctica regular de actividad física (AF) ha sido asociada a importantes beneficios metabólicos, como también a la disminución del riesgo de desarrollar algunos tipos de cáncer. El objetivo de esta revisión especial es sintetizar la evidencia científica existente sobre la asociación de los niveles de AF y el riesgo de desarrollar cáncer. Esto permitirá una mejor orientación a futuras políticas públicas destinada a aumentar los niveles de AF en la población chilena. Se buscaron los últimos reportes mundiales y nacionales sobre AF y cáncer en conjunto con una búsqueda de artículos científicos en las bases de datos de Pubmed, Web of Sciences, Scopus, Medline, Scielo y Google Scholar utilizando las siguientes palabras claves: "Exercise», «Neoplasms», "Cancer", "Colorectal", "Breast", "Endometrium", "Physical activity", "Exercise", "Sedentary" and "Sports". Esta revisión entrega evidencia sobre la asociación de la AF con un menor riesgo de múltiples tipos de cáncer, incluyendo cáncer colorrectal, mama y endometrio, pero aún se necesita más investigación con relación a la asociación entre AF y otros tipos de cáncer.

ABSTRACT Regular physical activity (PA) has been associated with important metabolic benefits, as well as a decreased risk of developing some types of cancer. The objective of this scoping review is to synthesize the existing scientific evidence on the association of PA levels and the risk of developing cancer. This will allow a better orientation to future public policies aimed at increasing PA levels in the Chilean population. We searched for the latest global and national reports on PA and cancer as well as scientific databases (Pubmed, Web of Sciences, Scopus, Medline, Scielo and Google Scholar) using the following keywords: "exercise", "neoplasms", "cancer", "colorectal", "breast", "endometrium", "physical activity", "exercise", "sedentary lifestyle" and "sports". Our review supports the protective association between PA and a lower risk of several cancers including colorectal, breast and endometrial cancer. However, more research is still needed to elucidate the role of PA on the risk for other common cancers.

Asociación del estado nutricional y factores clínicos con muerte relacionada con tuberculosis en Colombia / Association of nutritional status and clinical factors with tuberculosis related death in Colombia

INTRODUCCIÓN: Estudios relacionan la tuberculosis (TBC) con características socio-demográficas de las poblaciones humanas y la presencia de co-morbilidades en estos pacientes. Hoy, una de las co-morbilidades más importantes en Colombia es la desnutrición; sería importante verificar su relación con el tema de mortalidad, independientemente de las demás variables presentes en los pacientes. OBJETIVO: Determinar la asociación del estado nutricional y los principales factores clínicos con la muerte relacionada a TBC en Colombia. PACIENTES Y MÉTODOS: Se realizó un estudio descriptivo de corte transversal sobre un total de 12.778 pacientes con acotados criterios de inclusión y exclusión. Se realizó análisis bivariado y se construyó modelo multivariado de regresión logística. RESULTADOS: Las variables socio-demográficas asociadas con muerte por TBC fueron: sexo masculino (OR 1,49 IC 95% 1,14-1,95); población indígena (OR 1,76 IC 95% 1,09-2,85). Las variables clínicas: bajo peso (OR 1,32 IC 95% 1,04-1,68) y co-infección por VIH (OR 1,46 IC 95% 1,06-2,00) se asociaron a mayor mortalidad; como factor protector detectamos tener formas de TBC extra-pulmonar (OR 0,44 IC 95% 0,29-0,67) CONCLUSIONES: En pacientes con bajo peso, co-infección por VIH, sexo masculino y población indígena se presentó un alto riesgo de muerte por TBC, por lo que se hace necesario implementar estrategias de abordaje integral.

BACKGROUND: Studies link tuberculosis (TB) with sociodemographic characteristics of human populations and the presence of comorbidities in these patients. Today one of the most important comorbidities in Colombia is malnutrition; it would be important to verify its relationship with the mortality issue independently of the other variables present in the patients. AIM: To determine the association of nutritional status and the main clinical factors with death related to TB in Colombia. METHODS: A descriptive cross-sectional study was carried out in a total of 12,778 patients who met defined inclusion and exclusion criteria. Bivariate analysis was performed and a multivariate logistic regression model was constructed. RESULTS: The sociodemographic variables associated with death from TB were: male sex (OR 1.49 95% CI 1.14-1.95); indigenous population (OR 1.76 95% CI 1.09-2.85). The clinical variables: low weight (OR 1.32 95% CI 1.04-1.68) and clothing for HIV (OR 1.46 95% CI 1.06-2.00) were related to mortality and having forms of extrapulmonary TB were as a protective factor (OR 0.44 95% CI 0.29-0.67). CONCLUSIONS: In patients with low weight, HIV coinfection, male sex, and indigenous population presented a high risk of death from TB, making it necessary to implement comprehensive approach strategies.

Composición corporal y somatotipo del equipo de gimnasia rítmica, tricampeón del torneo nacional universitario FENAUDE Chile / Body composition and somatotype of the rhythmic gymnastics team, champion for three years of the national university tournament FENAUDE Chile

RESUMEN. El objetivo del presente estudio fue determinar la Composición corporal y somatotipo del equipo de gimnasia rítmica, Tricampeón del torneo nacional universitario FENAUDE Chile. Para el logro de este objetivo se realizó una toma de mediciones antropométricas a las 9 deportistas que participaron del torneouniversitario las cuales tenían edades entre 22,17±1,91años. Se evaluó utilizando el protocolo de marcaje y medición de la International Society for the Avancement in Kine anthropometric (ISAK), y se aplicaron los métodos de Composición Corporal de Deborah Kerr y de Somatotipo de Heath-Carter. Para el análisis estadístico se utilizó el paquete estadístico IBM SPSS V.18 y adicionalmente, para generar la gráfica de la somatocarta se utilizó una planilla realizada en elprograma Microsoft Excel. Se determinó talla de 159,00±6,19 cm, Talla Sentado 33,38±1,48, Peso 56,98±8,96kg, además del somatotipo predominante para el grupo de deportistas estudiado es el Endomorfo-Mesomorfo (3,88-3,60-1,78) y la composición corporal, los valores medios fueron: Mg= 30,42%, Mm=47,12%; Mr=4,28% Mo=11,68% y Mp=6,51.

ABSTRACT. The objective of this study was to determine the body composition and somatotype of the rhythmic gymnastics team,three-time champion of the national university tournament FENAUDE Chile. To achieve this objective, anthropometric measurements were taken to the 9 athletes who participated in the university tournament, who were between 22.17 ± 1.91 years old. It was evaluated using the marking and measurement protocol of the International Society for the Advancement in Kine anthropometric (ISAK), and the Deborah Kerr Body Composition and Heath-Carter Somatotype methods were applied. For the statistical analysis, the statistical package IBM SPSS V.24 was used and additionally, to generate the graph of the somatochart, a spreadsheet created in the Microsoft Excel program was used. Height of 159.00 ± 6.19 cm was determined, Sitting Height 33.38 ± 1.48, Weight 56.98 ± 8.96kg,in addition to the predominant somatotype for the group of athletes studied is the Endomorph-Mesomorph (3, 88-3.60-1.78) and body composition, the mean values were: Mg = 30.42%, Mm = 47.12%; Mr = 4.28% Mo = 11.68% and Mp = 6.51.

Fitness cardiorrespiratorio estimado mediante ecuación y su caracterización sociodemográfica en población chilena: Resultados de la Encuesta Nacional de Salud 2016-2017

Background: Cardiorespiratory fitness is a strong predictor of mortality and chronic diseases. However, its estimation is costly and time consuming which may limit it broad use in population-based studies. Aim: To estimate the cardiorespiratory fitness of the Chilean population by using equations and to characterize fitness levels of the Chilean population by sociodemographic factors. Material and Methods: This cross-sectional study included 5,958 adults from the Chilean Health Survey conducted between 2016 and 2017. Cardiorespiratory fitness was estimated from sex-specific equations for men and women and expressed as METs (Energy Metabolic Equivalent). Fitness levels were characterized by sociodemographics factors (age, sex, education, income and area of residency). Results: Fitness levels were higher in men (9.01 METs) than in women (6.76 METs) and in average decrease by 0.59 and 0.34 METs per each year increment in age for men and women, respectively. Fitness levels were 12.7 METs and 7.8 METs for 20-year-old men and women, respectively. However, fitness levels decreased to 7.8 METs and 4.3 METs in 90-year-old men and women, respectively. Fitness levels were also higher in individuals living in urban setting, those with higher education or income levels and lean individuals. Conclusions: This study reports fitness levels in a nationally representative sample of Chile. Fitness levels were higher in men than women however, its decline with age was more pronounce in men than women.

Capacidad cardiopulmonar en sujetos sanos medida por método directo y prueba de campo / Cardiopulmonary capacity in healthy subjects measured by direct method and field test

Resumen La prueba de caminata de seis minutos se ha aplicado generalmente en enfermos, y algunos estudios han propuesto modelos para predecir el consumo máximo de oxígeno. Nuestro objetivo fue elaborar una ecuación para predecir el consumo máximo de oxígeno en la prueba de caminata de seis minutos para estudiantes universitarios. Participaron 140 estudiantes. Se aplicó el test de marcha y después se realizó una prueba de ejercicio gradual para determinar el consumo máximo de oxígeno. Se elaboró una ecuación multivariada y el análisis se hizo con el programa SPSS v.22 (p < 0.05). El modelo predictivo incluyó el sexo, edad, índice de masa corporal, distancia recorrida y la frecuencia cardíaca de recuperación (r = 0.83; p < 0.001). La ecuación cumplió con los supuestos de independencia (p = 0.13), de normalidad (p = 0.49) y de homocedasticidad (p = 0.64). El diagrama de Bland-Altman indicó que no hubo diferencias significativas entre la ecuación y la medición del consumo máximo de oxígeno (p = 0.89), con un intervalo de confianza de 0.054 ml·kg·min-1 (95% IC [-0.72; 0.83]). La ecuación predice el consumo máximo de oxígeno. Se sugiere evaluar estudiantes universitarios considerando diferencias biológicas y ambientales entre países.

Abstract The six-minute walk test has been generally applied in people with pathologies and some studies have proposed models to predict maximum oxygen consumption. Our objective was to elaborate on an equation to predict the maximum oxygen consumption in the six-minute walking test for university students. A hundred and forty people participated in this study. The six-minute walking test was applied and after on a gradual exercise test was performed to determine the maximum oxygen consumption. A multivariate equation was developed and the analysis was done using the SPSS v.22 program (p < 0.05). The predictive model include gender, age, body mass index, distance performed and heart rate recovery (r = 0.83; p < 0.001). The equation fulfilled the assumptions of independence (p = 0.13), normality (p = 0.49) and homoscedasticity (p = 0.64). The Bland-Altman diagram indicated that there were no significant differences between the equation and the measurement of the maximum oxygen consumption (p = 0.89), with a confidence interval of 0.054 ml·kg·min-1 (95% CI [-0.72; 0.83]). The equation predicts the maximum oxygen consumption. It is suggested to evaluate university students considering biological and environmental differences between countries.

Factores sociodemográficos y obstétricos relacionados con aplicación del consentimiento informado en procedimientos de oclusión tubárica. Cartagena-Colombia / Sociodemographic and obstetric factors related to the application of informed consent in procedures of tubal occlusion. Cartagena-Colombia

Introducción: La forma como se aplica el consentimiento informado (CI) en algunas instituciones prestadoras de salud, donde se realizan procedimientos de oclusión tubárica bilateral (OTB) en Cartagena, podría verse influenciado por factores de tipo sociodemográfico y factores de tipo obstétrico, que al final determinan la forma como se aplica el Consentimiento informado y que este sea más que un requisito para desligar responsabilidades por parte de profesionales en su relación médico- paciente. Objetivo: Determinar la influencia de los factores sociodemográficos y obstétricos en la aplicación del consentimiento informado, en procedimientos de OTB, en centros de salud de Cartagena. Material y Métodos: Se realizó un estudio descriptivo transversal prospectivo. Las fuentes de información consultadas son fuentes primarias; se encuestaron 196 pacientes que se realizaron procedimientos de cesárea por urgencias más oclusión tubárica bilateral. Se efectuó análisis Univariado y Bivariado para establecer tendencia a la asociación mediante la prueba de Chi cuadrado. Resultados: Dentro de las características sociodemográficas y obstétricas asociadas estadísticamente con conocer lo que es el consentimiento informado están tener más de 24 años (p= 0,033); ser de procedencia urbana (p=0,046); vivir en estrato superior a estrato 1 y 2 (p=0,0001), tener estudios superiores a primaria (p=0,0001); no tener más de dos embarazos (p=0,029) y asistir a control prenatal (p=0,0001). Conclusiones: La mayoría de las pacientes poseen en términos generales desconocimiento sobre el CI. El estrato socioeconómico, el nivel de escolaridad y la procedencia influyen en el nivel de conocimiento que tienen del CI, lo mismo que algunos factores obstétricos(AU)

Introduction: The way in which informed consent (IC) is applied in some healthcare institutions where bilateral tubal occlusion (OTB) procedures are performed in Cartagena could be influenced by sociodemographic and obstetric factors which ultimately determine the way at which informed consent is applied, being this more than a requirement for the professionals to be free of liability in their doctor-patient relationship. Objective: To determine the influence of sociodemographic and obstetric factors on the application of informed consent in OTB procedures in health centers in Cartagena. Material and Methods: A prospective cross-sectional descriptive study was carried out. Primary sources of information were consulted; a total of 196 patients who underwent cesarean section procedures for emergencies plus bilateral tubal occlusion were surveyed. Univariate and bivariate analyzes were performed to establish a tendency to association using the Chi-square test. Results: Some sociodemographic and obstetric characteristics statistically associated with knowledge about informed consent are to be over 24 years old (p=0.033); to be of urban origin (p=0.046); to live in stratum higher than stratum 1 and 2 (p=0.0001), to have higher education than primary (p=0.0001); not to have more than two pregnancies (p=0.029) and to attend prenatal care (p=0.0001), among others. Conclusions: Most patients are generally unaware of IC. The socioeconomic stratum, level of schooling, origin and some obstetric factors have an influence on their level of knowledge of IC(AU)