[Clinical features and prognostic factors of meningococcal disease: a case series study in Chile during the 2012-2013 outbreak]. / Características clínicas y factores pronósticos de la enfermedad meningocóccica: un estudio de serie de casos en Chile durante el brote 2012-2013.

INTRODUCTION: Meningococcal disease (MD) is a major global problem because of its case fatality rate and sequels. Since 2012 cases of serogroup W have increased in Chile, with nonspecific clinical presentation, high case fatality rate and serious consequences. OBJECTIVE: To characterize the evolution and outcome of MD cases between January 2012 and March 2013 in Chile. MATERIAL AND METHODS: Case series considering 149 MD cases of 7 regions. A questionnaire was applied and clinical records were reviewed, including individual, agent, clinical course and healthcare process variables. The analysis allowed to obtain estimates of the OR as likelihood of dying. RESULTS: 51.5% was meningococcemia, the case fatality rate reached 27%, prevailing serogroup W (46.6%). Factors that increased the probability of dying: > age, belonging to indigenous people, having lived a stressful event, having diarrhea, impaired consciousness, cardiovascular symptoms, low oxygen saturation and low Glasgow coma scale score. DISCUSSION: The case fatality rate exceeded normal levels and was higher in serogroup W. Increasing in this serogroup, associated to the increased presence of nonspecific symptoms or rapid progression to septicemia, hit a health system accustomed to more classic meningococcal disease presentation, which could partly explain the observed increased fatality rate.

Características clínicas y factores pronósticos de la enfermedad meningocóccica: un estudio de serie de casos en Chile durante el brote 2012-2013 / Clinical features and prognostic factors of meningococcal disease: a case series study in Chile during the 2012-2013 outbreak

Introduction: Meningococcal disease (MD) is a major global problem because of its case fatality rate and sequels. Since 2012 cases of serogroup W have increased in Chile, with nonspecific clinical presentation, high case fatality rate and serious consequences. Objective: To characterize the evolution and outcome of MD cases between January 2012 and March 2013 in Chile. Material and Methods: Case series considering149 MD cases of 7 regions. A questionnaire was applied and clinical records were reviewed, including individual, agent, clinical course and healthcare process variables. The analysis allowed to obtain estimates of the OR as likelihoodof dying. Results: 51.5% was meningococcemia, the case fatality rate reached 27%, prevailing serogroup W (46.6%). Factors that increased the probability of dying: > age, belonging to indigenous people, having lived a stressful event, having diarrhea, impaired consciousness, cardiovascular symptoms, low oxygen saturation and low Glasgow coma scale score. Discussion: The case fatality rate exceeded normal levels and was higher in serogroup W. Increasing in this serogroup, associated to the increased presence of nonspecific symptoms or rapid progression to septicemia, hit a health system accustomed to more classic meningococcal disease presentation, which could partly explain the observed increased fatality rate.

Introducción: La enfermedad meningocóccica (EM) es un importante problema mundial por su letalidad y secuelas. Desde 2012 aumentaron en Chile los casos por serogrupo W, con presentación clínica inespecífica, elevada letalidad y secuelas graves. Objetivo: Caracterizar la evolución y desenlace de EM en casos desde enero de 2012 a marzo de 2013 en Chile. Material y Método: Serie de 149 casos de EM de siete regiones. Se aplicó un cuestionario y se revisaron registros clínicos, incluyendo variables del individuo, agente, curso clínico y proceso de atención. Los análisis permitieron obtener OR como estimadores de la probabilidad de fallecer. Resultados: El 51,5% se presentó como meningococcemia, la letalidad alcanzó a 27%, predominando el serogrupo W (46,6%). Aumentaron la probabilidad de fallecer: una mayor edad, pertenencia a pueblos originarios, haber vivido evento estresante, presentar diarrea, compromiso de conciencia, síntomas cardiovasculares, baja saturación de oxígeno y bajo puntaje de Glasgow. Discusión: La letalidad superó las frecuencias habituales y fue mayor en el serogrupo W. El aumento de este serogrupo, asociado a la mayor presencia de síntomas inespecíficos o a la rápida progresión a septicemia, impactó en un sistema de salud habituado a cuadros más clásicos de EM, lo que podría explicar en parte, la mayor letalidad observada.

Barreras y facilitadores para el control prenatal en adolescentes: resultados de un estudio cualitativo en Chile / Barriers and facilitators to antenatal care in adolescents: results of a qualitative study in Chile

Objetivo. Analizar barreras y facilitadores de acceso a control prenatal en adolescentes urbanas de 15-19 años en Santiago, Chile. Material y métodos. Estudio cualitativo con 17 madres adolescentes basado en la teoría fundamentada. Se realizaron 11 entrevistas semiestructuradas y un grupo focal. Resultados. La negación y ocultamiento del embarazo es la principal barrera para ingresar a control en el grupo de acceso tardío; no se identificaron facilitadores. Para mantenerse en control, todas las participantes identifican como facilitador contar con una figura de apoyo. La vulnerabilidad familiar y social explica que algunas adolescentes ingresen a control tardíamente. Conclusión. La presencia de facilitadores es determinante para el ingreso oportuno y mantenerse en control, ya que reduce o anula el efecto de las barreras. El sistema de salud debe constituirse en un facilitador que acompañe desde muy temprano a las adolescentes favoreciendo un vínculo de confianza y respeto.

Objective. Analyze barriers and facilitators of access to prenatal care in pregnant urban adolescents between 15-19 years of age in Santiago, Chile. Materials and methods. Qualitative study based on grounded theory with 17 adolescent mothers. Eleven semi-structured interviews and one focus group were conducted. Results. The denial and concealment of pregnancy is the main barrier to start the prenatal care in the "delayed access group". This group does not identify facilitators. For maintenance in antenatal care, all participants identified a support figure as a facilitator. Family and social vulnerabilities explain why some adolescents start the prenatal care late. Conclusion. The presence of facilitators is crucial for both, the timely entry and the maintenance in antenatal care because they reduce or nullify the effect of barriers. The health system must become a facilitator to accompany adolescents and promote a bond of trust and respect.

[Barriers and facilitators to antenatal care in adolescents: results of a qualitative study in Chile]. / Barreras y facilitadores para el control prenatal en adolescentes: resultados de un estudio cualitativo en Chile.

OBJECTIVE: Analyze barriers and facilitators of access to prenatal care in pregnant urban adolescents between 15-19 years of age in Santiago, Chile. MATERIALS AND METHODS: Qualitative study based on grounded theory with 17 adolescent mothers. Eleven semi-structured interviews and one focus group were conducted. RESULT: . The denial and concealment of pregnancy is the main barrier to start the prenatal care in the "delayed access group". This group does not identify facilitators. For maintenance in antenatal care, all participants identified a support figure as a facilitator. Family and social vulnerabilities explain why some adolescents start the prenatal care late. CONCLUSION: The presence of facilitators is crucial for both, the timely entry and the maintenance in antenatal care because they reduce or nullify the effect of barriers. The health system must become a facilitator to accompany adolescents and promote a bond of trust and respect.

[Evaluation of the Program for Depression Detection, Diagnosis, and Comprehensive Treatment in primary care in Chile]. / Evaluación del Programa para la Detección, Diagnóstico y Tratamiento Integral de la Depresión en atención primaria, en Chile.

OBJECTIVE: To conduct a preliminary evaluation of the Program for Depression Detection, Diagnosis, and Comprehensive Treatment, which was developed by the Ministry of Health of Chile. MATERIAL AND METHODS: A group of women who had entered the Depression Program in eight primary care centers in three regions of Chile were monitored for three months. The initial sample was made up of 229 women, of whom 169 were able to be interviewed at the end of the three months. Sociodemographic variables, psychosocial risk factors, anxiety and somatic symptoms, and the degree of satisfaction with the care received were studied. Depressive symptoms were evaluated with the Beck Depression Inventory (BDI). The treatments prescribed for the women were also analyzed. RESULTS: The clinicians' decision to enroll the patients in the Depression Program was appropriate, with 95.2% of the women having depressive symptoms, according to the BDI. The accuracy in the clinical assessment of the severity of the symptoms was around 50%, with a tendency to underestimate the severity of the depression. The dropout rate for the women was 19.5% at the end of three months of monitoring. Those who dropped out tended to present less severe clinical symptoms (less intense anxiety and somatic symptoms), a smaller number of psychosocial risk factors, and a lower level of satisfaction with the care received. The patients showed good adherence (73.3%) with the pharmacological treatment, but less with the individual psychotherapy (47.4%) and the group psychotherapy (37.8%). A significant decline was seen in the intensity of the depressive symptoms by the end of the three months, with the decline being greater among the women with more serious symptoms. There was also a significant decline in anxiety and somatic symptoms. CONCLUSIONS: The preliminary evaluation indicates that the Depression Program is meeting the proposed objectives, although there appears to be a need to develop specific strategies to improve the accuracy of the clinical diagnosis as well as compliance with the treatments that are offered.

Evaluación del Programa para la Detección, Diagnóstico y Tratamiento Integral de la Depresión en atención primaria, en Chile / Evaluation of the Program for Depression Detection, Diagnosis, and Comprehensive Treatment in primary care in Chile

OBJETIVO: Realizar una evaluación preliminar del Programa para la Detección, Diagnóstico y Tratamiento Integral de la Depresión, instituido por el Ministerio de Salud de Chile. MÉTODOS: Se realizó un seguimiento de tres meses de un grupo de mujeres que ingresaron en este programa en ocho centros de atención primaria de tres regiones de Chile. La muestra inicial estuvo constituida por 229 personas, de las cuales 169 pudieron entrevistarse a los tres meses. Se estudiaron variables sociodemográficas, factores de riesgo psicosocial, síntomas ansiosos y somatomorfos y el grado de satisfacción con la atención recibida. El cuadro depresivo se evaluó con el Inventario de Depresión de Beck. Se analizaron los tratamientos e intervenciones prescritos a las mujeres. RESULTADOS: La decisión de ingresar a las pacientes en el programa resultó pertinente, ya que 95,2 por ciento tenían un cuadro depresivo. La concordancia en cuanto a la gravedad del cuadro clínico fue cercana a 50 por ciento, con una tendencia a subestimarla. La tasa de abandono del programa fue de 19,5 por ciento a los tres meses de seguimiento. Las mujeres que se retiran tienden a presentar un cuadro clínico menos complejo (síntomas ansiosos y somatomorfos menos intensos), así como un menor número de factores de riesgo psicosocial y una menor satisfacción con la atención recibida. Entre las pacientes del programa se observó buena adherencia al tratamiento farmacológico (73,3 por ciento) y regular a la psicoterapia individual (47,4 por ciento) y a la intervención grupal (37,8 por ciento). Se observó un descenso significativo en la intensidad de los síntomas depresivos a los tres meses, el cual fue mayor entre las que presentaban cuadros más graves. Se encontró también un descenso significativo de los síntomas ansiosos y somatomorfos. CONCLUSIÓN: La evaluación preliminar indica que el programa está cumpliendo con los objetivos propuestos, si bien parece necesario desarrollar estrategias específicas para mejorar la precisión en el diagnóstico clínico y el cumplimiento de los tratamientos ofrecidos.