[Epidemiological difference could explain the higher infant mortality in Chile compared with Cuba]. / Diferencias epidemiológicas podrían explicar la mayor mortalidad infantil de Chile comparada con Cuba.

INTRODUCTION: Cuba has the lowest infant mortality rate in Latin America, while Chile has an infant mortality rate above the average of Organization for Economic Cooperation and Development (OECD) countries. OBJECTIVE: To compare the epidemiology of infant mortality between Chile and Cuba in order to find characteristics that may explain the differences found. METHOD: Comparative analysis between Chile and Cuba of infant mortality rate, causes of mortality, live birth weight, and maternal age, in 2015. RESULTS: Cuba had a lower infant, neonatal, early and late mortality than Chile, with no differences in post-neonatal mortality. Chile had a higher infant mortality due to, alterations of the nervous system, urinary system, chromosomal alterations, respiratory distress syndrome, and disorders related to the short duration of gestation. Chile had a higher frequency of mothers ≥ 35 years old and live births weighing <2,500 g. The possible effects of health inequities could not be analyzed due to lack of data. CONCLUSIONS: It is possible to attribute the lower infant mortality rate in Cuba to: selective abortion due to congenital malformations and chromosomal anomalies, lower epidemiological risk of the Cuban pregnant population, and lower frequency of live births with low birth weight.

Desaceleración en la reducción de la mortalidad materna en Chile impide alcanzar el 5° Objetivo de Desarrollo del Milenio / Slowdown in reducing maternal mortality in Chile prevents reach the 5th Millennium Development Goal

Antecedentes: en Chile, a pesar de la importante reducción de la mortalidad materna en la década de los 90, los avances distan de los objetivos comprometidos. Objetivos: analizar la tendencia de la razón de mortalidad materna (RMM) en Chile desde 1990 al 2015 y de factores epidemiológicos que afectan el cumplimiento del 5° Objetivo del Mileno (5°OM). Métodos: estudio observacional a nivel nacional. Analizamos la tendencia del cambio porcentual anual promedio (CPAP) y puntos de inflexión de la RMM junto con la evolución de los nacimientos, muertes maternas y sus causas. Además, analizamos los nacimientos por edad y la distribución de la razón de mortalidad materna por edad y por causa de muerte materna. Resultados: en Chile la RMM se redujo un 61% entre 1990 y 2015, con una inflexión desde el 2001 (IC 95% 1997 a 2004) demostrando dos periodos: 1990-2001 (CPAP -6,97%; IC 95% -8,63 a -5,29) y 2001-2015 (CPAP -0,66%; IC 95% -2,40 a 1,10). En el segundo período la tasa de natalidad disminuyó con menor pendiente, los nacimientos de madres de 15-29 años disminuyeron, mientras que en los otros estratos de edad los nacimientos aumentaron. En ambos períodos las primeras causas de muerte fueron hipertensión arterial, enfermedades concurrentes y aborto. En el segundo período la muerte materna por hipertensión arterial y aborto se redujo, mientras que por enfermedades concurrentes aumentó. Conclusiones: en Chile la RMM es estacionaria desde el 2001 y se asocia a cambios en la distribución en la edad materna y causas de muerte. (AU)

Background: in Chile, despite the significant reduction in maternal mortality in the 1990s, the advances are far from the committed objectives. Aim: To analyze trends of the maternal mortality ratio (MMR) in Chile from 1990 to 2015 and epidemiologic factors that threaten the5th Millennium Goal. Methods: an observational study at the country level. We performed a trend analysis of the average annual percent change (AAPC) and models for joint point analyses for MMR, births, maternal deaths and their causes. In addition, we assessed the Odds Ratios for births by maternal age and the distribution of the maternal mortality rate by maternal age and main death causes. Results: in Chile, a reduction of 61% in MMR was observed from 1990 to 2015 with a trend join point in 2001 (CI 95% 1997 to 2004) indicating two periods: 1990-2001 (AAPC -6.97%; 95% CI -8.63 to -5.29) and 2001-2015 (AAPC - 0.66%; 95% CI -2.4 to 1.10). In the second period the birth rate decreased with a lower slope, the births of mothers in the age group 15-29 decreased, while in the other age groups the births increased. In both periods, main maternal death causes were hypertension, concurrent illness, and abortion. In the second period, maternal deaths associated to hypertension and abortion decreased, whereas deaths associated to concurrent illness increased. Conclusions: in Chile, MMR has been stationary since 2001 and is associated with changes in the distribution of maternal age and causes of death.(AU)

Mayor mortalidad materna por aborto en Cuba que en Chile, 2000-2015 / Higher maternal mortality from abortion in Cuba than in Chile, 2000-2015

RESUMEN Antecedentes: La muerte materna por aborto inseguro es un severo problema de salud pública, países con leyes de aborto liberales tendrían menor riesgo de aborto inseguro y de mortalidad por aborto. Cuba tiene una legislación que no penaliza el aborto inducido, mientras en Chile es ilegal en todos los casos hasta su reciente despenalización en 3 causales. Objetivo: Se postula que Cuba tendría una menor mortalidad materna por aborto que Chile, por lo que se propone comparar la evolución de la razón de mortalidad materna por aborto entre ambos países, en el período 2000-2015. Material y Método: Los datos crudos de muertes asociadas al aborto y nacidos vivos se obtienen de las bases de datos de estadísticas vitales de ambos países. La oportunidad relativa de muerte se estima según Odds Ratio (OR) con intervalo de confianza del 95% (IC 95%) de las razones de mortalidad materna. Resultados: La razón de muerte materna asociada al aborto fue mayor en Cuba que en Chile (OR: 1,91; IC 95%: 1,331 a 2,739; p=0,0004). Se observa una tendencia al descenso en Cuba y mientras no se observan cambios en Chile. Conclusiones: Contrario a lo postulado basado en las diferentes legislaciones de ambos países, en el período 2000-2015, Cuba presentó mayor razón de mortalidad materna asociada al aborto que Chile. Se comentan posibles condicionantes de la diferencia encontrada.

ABSTRACT Background: Maternal death due to unsafe abortion is a severe public health problem; countries with liberal abortion laws would have a lower risk of unsafe abortion and abortion mortality. Cuba has a legislation that does not penalize induced abortion, while in Chile it is illegal in all cases until its recent decriminalization in 3 grounds. Objective: It is postulated that Cuba would have a lower maternal mortality due to abortion than Chile, for which purpose it is proposed to compare the evolution of the maternal mortality by abortion between both countries, in the period 2000-2015. Material and Method: Raw data on deaths associated with abortion and live births are obtained from the vital statistics databases of both countries. The relative chance of death is estimated according to the Odds Ratio (OR) with a 95% confidence interval (95% CI) of the maternal mortality. Results: The maternal death rate associated with abortion was higher in Cuba than in Chile (OR: 1.91, 95% CI: 1.331 to 2.739; p = 0.0004). A downward trend is observed in Cuba and without changes in Chile. Conclusions: Contrary to the postulate based on the different legislations of both countries, in the period 20002015, Cuba had a higher maternal mortality associated with abortion than Chile. Possible conditioning factors of the difference found are discussed.

Burnout syndrome prevalence in physiotherapists.

OBJECTIVE:: To evaluate burnout syndrome in its three aspects, jointly as well as independently, in physiotherapists from the Extremadura region (Spain). METHOD:: Analytic descriptive epidemiological transversal trial in primary care and institutional practice, with physiotherapists practicing in Extremadura who met the inclusion criteria, after having signed an informed consent form. Emotional exhaustion, depersonalization and low professional accomplishment were the outcomes measured. RESULTS:: Physiotherapists from Extremadura show a 65.23 point level of burnout syndrome, according to the Maslach Burnout Inventory questionnaire. Therefore, they are positioned in the middle of the rating scale for the syndrome, and very near to the high level at starting score of 66 points. CONCLUSION:: Physiotherapists in Extremadura present moderate scores for the three dimensions of burnout syndrome, namely, emotional exhaustion, depersonalization and low professional accomplishment. For this reason, they are in the moderate level of the syndrome and very near to the high level, which starts at a score of 66 points. No relation between burnout syndrome and age has been found in our study.

Burnout syndrome prevalence in physiotherapists

Summary Objective: To evaluate burnout syndrome in its three aspects, jointly as well as independently, in physiotherapists from the Extremadura region (Spain). Method: Analytic descriptive epidemiological transversal trial in primary care and institutional practice, with physiotherapists practicing in Extremadura who met the inclusion criteria, after having signed an informed consent form. Emotional exhaustion, depersonalization and low professional accomplishment were the outcomes measured. Results: Physiotherapists from Extremadura show a 65.23 point level of burnout syndrome, according to the Maslach Burnout Inventory questionnaire. Therefore, they are positioned in the middle of the rating scale for the syndrome, and very near to the high level at starting score of 66 points. Conclusion: Physiotherapists in Extremadura present moderate scores for the three dimensions of burnout syndrome, namely, emotional exhaustion, depersonalization and low professional accomplishment. For this reason, they are in the moderate level of the syndrome and very near to the high level, which starts at a score of 66 points. No relation between burnout syndrome and age has been found in our study.

Aumento de la mortalidad infantil en niños con síndrome de Down: Chile 1997-2013 / Rising infant mortality in down syndrome in Chile from 1997 to 2013

Background: Down syndrome (DS) is associated with higher child mortality especially due to cardiac malformations. Aim: To describe the trend in Chilean infant mortality in DS in the period 1997-2013 as compared to the general population without DS. Material and Methods: Raw data on infant deaths were extracted from the yearbooks of vital statistics of the National Institute of Statistics. The mortality risk associated to DS, relative to population without DS was estimated. Results: There were 456 deaths in infants with DS during the study period (59 early neonatal deaths, 70 late neonatal deaths and 327 post-neonatal deaths). The trend in infant mortality rate in DS was ascending (r: 0.53, p = 0.03), with an average annual percentage change of 4.6% (95% confidence interval (CI) 0.4-9.0%; p < 0.01). Compared to the population without DS, the risk of early neonatal death was lower in DS (Odds ratio (OR) 0.14, 95% CI 0.11-0.19; p < 0.01) whereas the risk of post-neonatal death was higher (OR 4.74, 95% CI 3.85-5.85; p < 0.01). Conclusions: Infant mortality in Down syndrome has an increasing trend. We postulate that these children are not accessing timely cardiac surgery, the main therapeutic tool to reduce the death risk in the first year of life.

[Rising infant mortality in down syndrome in Chile from 1997 to 2013]. / Aumento de la mortalidad infantil en niños con síndrome de Down: Chile 1997-2013.

BACKGROUND: Down syndrome (DS) is associated with higher child mortality especially due to cardiac malformations. AIM: To describe the trend in Chilean infant mortality in DS in the period 1997-2013 as compared to the general population without DS. MATERIAL AND METHODS: Raw data on infant deaths were extracted from the yearbooks of vital statistics of the National Institute of Statistics. The mortality risk associated to DS, relative to population without DS was estimated. RESULTS: There were 456 deaths in infants with DS during the study period (59 early neonatal deaths, 70 late neonatal deaths and 327 post-neonatal deaths). The trend in infant mortality rate in DS was ascending (r: 0.53, p = 0.03), with an average annual percentage change of 4.6% (95% confidence interval (CI) 0.4-9.0%; p < 0.01). Compared to the population without DS, the risk of early neonatal death was lower in DS (Odds ratio (OR) 0.14, 95% CI 0.11-0.19; p < 0.01) whereas the risk of post-neonatal death was higher (OR 4.74, 95% CI 3.85-5.85; p < 0.01). CONCLUSIONS: Infant mortality in Down syndrome has an increasing trend. We postulate that these children are not accessing timely cardiac surgery, the main therapeutic tool to reduce the death risk in the first year of life.

[Women age as a risk factor for maternal, fetal, neonatal and infant mortality]. / La edad de la mujer como factor de riesgo de mortalidad materna, fetal, neonatal e infantil.

BACKGROUND: Adolescent pregnancy and advanced maternal age are associated with increased risk for maternal, perinatal and infant death. However, the maternal age with the lowest reproductive risk has not been established. AIM: To determine the range of maternal age with the lowest reproductive risk. MATERIAL AND METHODS: A population-based study (2005-2010) was performed analyzing raw data from vital statistics yearbooks of the National Institute of Statistics of Chile. The association of maternal, fetal, neonatal and infant mortality with maternal age was analyzed. The latter was stratified in quinquenniums, between ages 10 and 54 years. Maternal, fetal, neonatal and infant mortality rates were calculated for each quinquennium. The lowest rate was selected as a control group for risk analysis, which was estimated according to Odds Ratio with 95% confidence intervals. RESULTS: Women of 20-29, 25-34 and under 30 years, had the lowest rate of fetal, neonatal/infant and maternal death, respectively. Women aged 45-49 years had the higher rate of maternal, fetal, neonatal and infant mortality. The risk of fetal, neonatal and infant mortality doubled from 40-44 years onwards, and maternal mortality from the age of 30-34 years. CONCLUSIONS: Our results suggest that the maternal age range with the lesser general reproductive risk is between 20-29 years. This finding should be considered in future studies of reproductive risk and for an appropriate counseling about conception.

La edad de la mujer como factor de riesgo de mortalidad materna, fetal, neonatal e infantil / Women age as a risk factor for maternal, fetal, neonatal and infant mortality

Background: Adolescent pregnancy and advanced maternal age are associated with increased risk for maternal, perinatal and infant death. However, the maternal age with the lowest reproductive risk has not been established. Aim: To determine the range of maternal age with the lowest reproductive risk. Material and Methods: A population-based study (2005-2010) was performed analyzing raw data from vital statistics yearbooks of the National Institute of Statistics of Chile. The association of maternal, fetal, neonatal and infant mortality with maternal age was analyzed. The latter was stratified in quinquenniums, between ages 10 and 54 years. Maternal, fetal, neonatal and infant mortality rates were calculated for each quinquennium. The lowest rate was selected as a control group for risk analysis, which was estimated according to Odds Ratio with 95% confidence intervals. Results: Women of 20-29, 25-34 and under 30 years, had the lowest rate of fetal, neonatal/infant and maternal death, respectively. Women aged 45-49 years had the higher rate of maternal, fetal, neonatal and infant mortality. The risk of fetal, neonatal and infant mortality doubled from 40-44 years onwards, and maternal mortality from the age of 30-34 years. Conclusions: Our results suggest that the maternal age range with the lesser general reproductive risk is between 20-29 years. This finding should be considered in future studies of reproductive risk and for an appropriate counseling about conception.

[Fecundity reduction and aging in fertile women population in the period 1990-2004 in Chile]. / Reducción de la fecundidad y envejecimiento de la población de mujeres chilenas en edad fértil: 1990-2004.

BACKGROUND: Chile is in the advanced stage of demographic transition with a low natural growth and a progressively aging population. AIM: To analyze births by range of maternal age and to establish if population aging is expressed in the women's fertile age range. MATERIAL AND METHODS: Trend analysis of births and age-specific birth rates in the period 1990-2004, in the Chilean women population of reproductive age. Raw data were obtained from the Vital Statistics Yearbooks of the National Institute of Statistics. Trends were studied by linear regression and Generalized Estimating Equation (GEE). RESULTS: The general trend of births descended significantly from 1999 to 2004 (r: -0.996; p <0.001). Births significantly decreased in the range of ages from 20 to 34 years. There was an increase in the range of ages from 35 to 44 and from 10 to 14 years. The age-specific birth rate declined in all ranges, with the exception of women aged 10 to 14 years. The number of women increased significantly at all age ranges, except for the 20-24 year-old range where no significant change was observed and the 25-29 year-old range that experienced a significant reduction. CONCLUSIONS: In the period from 1990 to 2004, there was a significant reduction of births and age-specific birth rates in Chile. There was also an increased birth rate among women aged 35 to 44 years and an aging of the fertile women population.

Maternal, perinatal and infant outcome of spontaneous pregnancy in the sixth decade of life.

UNLABELLED: Pregnancy in the older woman is a well-known risk factor for perinatal morbidity and mortality. OBJECTIVE: To evaluate perinatal and infant morbidity and mortality in women 50 or more years old. METHODS: A retrospective population based study (1990-2004) evaluating spontaneously pregnant Chilean women more than 50 years old (217 live or stillbirths) compared to women 20-34 years old (2,817,742 neonates, control group). The comparison was performed using Chi Square with Yates's correction or exact Fisher test as appropriate. The risk analysis was performed by odds ratio (OR) and confidence interval of 95% (CI 95%). RESULTS: Women over 50 had a significantly greater risk of fetal (OR: 3.7; CI 95%: 1.2-10.5), neonatal (OR: 10.4; CI 95%: 5.7-18.7), post-neonatal (OR: 9.5; CI 95%: 4.6-19.1) and infant death (OR: 10.5; CI 95%: 6.6-16.7). There were no differences between groups in the incidences of low and very low birth weight. CONCLUSION: Pregnancy over 50 years of age entails a very high risk of fetal, neonatal and early childhood death. Unprotected sexual life for these women should be considered only after evaluation of their potential fertility.

[Inequalities in infant mortality in Santiago]. / Desigualdad en mortalidad infantil entre las comunas de la provincia de Santiago.

BACKGROUND: Social and economical inequalities have an adverse effect on infant mortality. AIM: To test if the poorest communities of Santiago have the highest rates of infant mortalilty. MATERIAL AND METHODS: Variables were obtained from the year 2000 Vital Statistics yearbook and the National Socioeconomic Characterization inquiry. Infant mortality was correlated with the mean income of households, the population below the threshold of poverty and the unemployed population of the 32 municipalities of the Santiago Province. The ratio and the difference in mortality rates between the communities with the higher and lower incomes and the attributable population risk for infant mortality in the Province of Santiago was calculated. RESULTS: Infant mortality was positively correlated with the population below the threshold of poverty (r=0.383; p=0.03) and the unemployed population (r=0.437; p=0.012) and inversely correlated with the mean household income (r=-0.522; p=0.002). Infant mortality in the poorest community was 2.2 times higher than in the richest one. The difference in rates was 6.6/1000 live births. The attributable population risk determined that it is possible to reduce infant death by 57.8%. CONCLUSIONS: In the Province of Santiago, the poorest communities have the highest infant mortality.

[Reproductive risk of women over 40 years old]. / Edad materna avanzada y riesgo reproductivo.

BACKGROUND: Pregnancy at extreme ages is a risk factor for maternal, perinatal and infantile death. AIM: To assess the obstetric risk of women over 40 years old. MATERIAL AND METHODS: The risk of maternal, late fetal, neonatal and infantile deaths and the risk of low birth weight was assessed in women over 40 years old and compared to the risk of women aged 20-34 years. Data was obtained from the 1999 Annual Report of the National Statistics Institute and the odds ratios (OR) with a 95% confidence interval were calculated. RESULTS: Women over 40 years had a higher risk of maternal death (OR 7.13, 3.31-14.97), late fetal death (OR 2.19, 1.69-2.85), neonatal death (OR 1.8, 1.4-2.32), infantile death (OR 1.8, 1.49-2.18) and low birth weight (OR 1.72, 1.58-1.88). CONCLUSIONS: The higher reproductive risk of women over 40 years is confirmed. Better birth control programs at this age will reduce this risk.

Infecciones por chlamydia en el embarazo: detección por ensayo inmuno-enzimático / Chlamydia infection in pregnancy: enzymatic immunoassay detection

En 80 madres se encontró una incidencia de 11,3 por ciento de infección por Chlamydia trachomatis. El método utilizado fue de ensayo inmunoenzimático, que al correlacionarlo con cultivo se encuentra un 66,6 por ciento de positividad. Se trató a las pacientes y a su pareja una vez hecho el diagnóstico. No se observó complicaciones obstétricas o neonatales atribuibles a infección por Chlamydia trachomatis. No se encontró lesiones citológicas en los extendidos de Papanicolau sugerentes de infección por Chlamydia trachomatis

Obesidad y riesgo obstétrico en una población chilena / Obesity and obstetric risk in chilean women

Se comparó las características evolutivas del embarazo, parto y recién nacido entre un grupo de 163 embarazadas obesas (índice peso para la talla mayor de 120%) y 163 controles (índice peso para la talla entre 94 y 106%) pareadas por edad y paridad. Las embarazadas obesas presentaron una significativa mayor frecuencia de hipertensión arterial (p<0,005), de preeclamsia (p<0,05), de cesáreas (p<0,027) y de infección puerperal (p<0,01) que el grupo control. No se encontró diferencia en la incidencia de diabetes gestacional y hemorragias postparto. El peso de nacimiento fue significativamente superior en los hijos de madres obesas (p<0,004), al igual que la incidencia de niños grandes para la edad gestacional (p<0,037). No se observaron diferencias en la morbilidad neonatal ni en las características de la lactancia al mes de edad entre ambos grupos. Se concluye que la obesidad durante el embarazo, aún de intensidad moderada, constituye un importante riesgo obstétrico

Estudio serologico citomegalovirus, virus del herpes simple y de la rubiola, hepatitis B y toxoplasma gondii en dos poblaciones de gestantes en Santiago, Chile / Serological study for cytomegalovirus, herpes simplex virus rubeolla virus, hepatitis B virus and Toxoplasma gondii in 2 populations of pregnant women in Chile

Se llevó a cabo una encuesta serológica de gestantes de estratos socieconómicos mediano (372) y bajo (461) de Santiago, Chile, durante su primera o segunda consulta prenatal, con el fin de determinar la prevalencia de infección por citomegalovirus (CMV), virus de rubéola, herpes simple (HSV) y hepatitis B (HBV), y Toxoplasma gondii en las primeras fases de la gestación. Las muestras se analizaron por ELISA utilizando reactivos comerciales. En la cohorte de bajos ingresos, la tasa de seropositividad fue del 96,5% para CMV, del 97,2% para HSV, del 94,8% para rubéola, del 68,2% para T. gondii y del 1,4% para HBV. En el grupo de medianos ingresos, la tasa de seropositividad fue del 86,8% para CMV, del 87,9% para HVS, del 94,4% para rubéola, del 48,4% para T. gondii y del 1,4% para HBV. Solo las diferencias en la prevalencia de CMV, HSV y T gondii fueron significativas. Los resultados revelan que, en Santiago, las infecciones por CMV, HSV, rubéola y T. gondii se contraen en edad temprana en ambos grupos analizados. A pesar del alto grado de inmunidad resultante, es posible que el riesgo de infecciones congénitas y perinatales por esos agentes sea alto, debido a la constante oportunidad de reactivación y reinfección que se producen con frecuencia en el caso de CMV y HSV. Además, las gestantes susceptibles, aunque son relativamente pocas, están en constante riesgo de contraer esas infecciones tan difundidas en la comunidad. La prevalencia de la hepatitis B, por otra parte, es mucho menor en Chile que en otros países con un grado de desarollo económico similar. Esto parecería indicar que los casos de infección por HBV en neonatos deben ser infrecuentes