Mortalidad por sepsis neonatal entre los años 2016 y 2020 en Chile: una mirada nacional / Mortality due to neonatal sepsis between 2016 and 2020 in Chile: a national perspective

Introducción: La sepsis neonatal (SN) es una infección sistémica que ocurre antes de los 90 días de vida y que representa una amenaza potencialmente mortal. Esta investigación busca describir la tendencia de defunción por SN en Chile, durante el periodo 2016-2020. Materiales y métodos: Estudio descriptivo observacional, que incluyó a niños fallecidos por SN (n=249) en el periodo 2016-2020 en Chile según datos del departamento de estadísticas e información de salud de Chile. Las variables estudiadas fueron: año de fallecimiento, grupo etario, sexo, región y agente etiológico. No se requirió comité de ética. Resultados: El 2020 tuvo la menor tasa de mortalidad por SN (0,17) y el 2017 la mayor (0,31). El grupo etario de 0-2 días de nacido tuvo la mayor tasa de mortalidad (0,07), mientras que el grupo de 27-28 días corresponde a la menor (0,00). La región de Antofagasta tuvo la mayor mortalidad (0,44) y la región de Magallanes la menor (0,11). La tasa de mortalidad promedio en hombres corresponde a 0,12 y en mujeres a 0,10. En el 89,16% de los casos no se identificó el agente etiológico. Discusión: La mayor mortalidad en 2017 podría deberse a una proporción más alta de nacimientos pretérmino en dicho año. La mayor cantidad de defunciones a menor edad cronológica estaría relacionada con su inmadurez inmunológica. La no detección del agente etiológico pudo deberse al bajo rendimiento de los hemocultivos. Sin embargo, faltan más investigaciones acerca de la incidencia y mortalidad por sepsis neonatal.

Introduction: Neonatal sepsis (NS) is a systemic infection that occurs before 90 days of life and represents a life-threatening threat. This research seeks to describe the trend of death by NS in Chile, during the period 2016-2020. Materials and methods: Observational descriptive study, which included children who died due to NS (n=249) in the period 2016-2020 in Chile, according to data from the Department of Statistics and Health Information of Chile. The variables studied were: year of death, age group, sex, region and etiological agent. No ethics committee was required. Results: 2020 had the lowest mortality rate due to NS (0.17) and 2017 the highest (0.31). The age group of 0-2 days of birth had the highest mortality rate (0.07), while the group of 27-28 days corresponds to the lowest (0.00). The Antofagasta region had the highest mortality (0.44) and the Magallanes region the lowest (0.11). The average mortality rate in men corresponds to 0.12 and in women to 0.10. In 89.16% of the cases, the etiological agent was not identified. Discussion: The higher mortality in 2017 could be due to a higher proportion of preterm births in that year. The greater number of deaths at a lower chronological age would be related to their immunological immaturity. The non-detection of the etiological agent could be due to the low yield of the blood cultures. However, more research on the incidence and mortality from neonatal sepsis is lacking.

Dominican Provider Attitudes Towards HPV Testing for Cervical Cancer Screening and, Current Challenges to Cervical Cancer Prevention in the Dominican Republic: a Mixed Methods Study.

Creating effective programs for cervical cancer prevention is essential to avoid premature deaths from cervical cancer. The Dominican Republic has persistently high rates of cervical cancer, despite the availability of Pap smear screening. This study explored Dominican provider attitudes towards human papillomavirus (HPV) testing and current challenges to effective cervical cancer prevention. In this Consolidated Framework for Implementation Research (CFIR)-driven mixed methods study, we conducted in-depth interviews (N = 21) and surveys (N = 202) with Dominican providers in Santo Domingo and Monte Plata provinces regarding their perspectives on barriers to cervical cancer prevention and their knowledge and attitudes towards HPV testing as an alternative to Pap smear. Providers believed the main barrier to cervical cancer prevention was lack of cervical cancer awareness and resulting inadequate population screening coverage. Providers felt that Pap smear was widely available to women in the Dominican Republic and were unsure how a change to HPV testing for screening would address gaps in current cervical cancer screening programs. A subset of providers felt HPV testing offered important advantages for early detection of cervical cancer and were in favor of more widespread use. Cost of the HPV test and target age for screening with HPV testing were the main barriers to acceptability. Providers had limited knowledge of HPV testing as a screening test. The group was divided in terms of the potential impact of a change in screening test in addressing barriers to cervical cancer prevention in the Dominican Republic. Findings may inform interventions to disseminate global evidence-based recommendations for cervical cancer screening.

Dominican Provider Practices for Cervical Cancer Screening in Santo Domingo and Monte Plata Provinces.

Cervical cancer is the second leading cause of cancer death for women in the Dominican Republic. Pap smear screening in the Dominican Republic has not achieved adequate reduction in cervical cancer mortality. The purpose of this study was to examine Dominican provider practices for cervical cancer screening and the use of national or international screening guidelines. We surveyed 101 gynecology specialists, 50 non-specialists, and 51 obstetrics-gynecology residents in the Santo Domingo and Monte Plata provinces of the Dominican Republic regarding their cervical cancer screening practices and use of guidelines. Bivariate (chi-square) analyses were conducted to compare screening practices by demographic and practice characteristics. The majority of providers followed WHO guidelines (62.9%) and/or Dominican national norms (59.4%). The majority (87%) of providers use time since first sexual activity as the basis for screening initiation; 96% advise screening every 6-12 months. The most commonly used screening test is the conventional Pap smear. Colposcopy was recommended most often for all abnormal Pap results. Dominican providers report they follow national and/or international cervical cancer screening guidelines. They do not follow age-based screening guidelines, nor have they adopted an extended interval for screening and continue to recommend screening at least annually. A culture of early and frequent screening has consequences in terms of cost, high demand for follow-up services, and reduced capacity to reach the populations at highest risk. Early screening also may challenge the acceptability of adopting alternative screening technologies such as HPV testing.

Parent-Level Barriers and Facilitators to HPV Vaccine Implementation in Santo Domingo, Dominican Republic.

Cervical cancer is the second leading cause of cancer death for women in the Dominican Republic. Vaccination against human papillomavirus (HPV) could reduce mortality from cervical cancer globally by as much as 90%. The purpose of our study was to explore multi-level barriers and facilitators to implementation of a national HPV vaccine program in the Dominican Republic; this article focuses on parent-level barriers and facilitators. In this qualitative study, we conducted six focus groups (N = 64) with parents of school-age children in the Santo Domingo area of the Dominican Republic, representing diverse socioeconomic groups and geographic settings. Thematic content analysis, using inductive and deductive approaches, was done following transcription and translation of audio-recordings from focus group discussions. Among this group of parents in the Santo Domingo area, facilitators to vaccine uptake were favorable attitudes towards vaccines in general and concern about cervical cancer as a health issue. Barriers found were low to moderate knowledge of HPV and cervical cancer, especially in the rural and suburban groups, and cost and lack of public awareness of the vaccine. This study identified key barriers and facilitators to HPV vaccine implementation in the Dominican Republic. Health messaging, incorporating specialist providers as opinion leaders, will need to be tailored to broad audiences with varying levels of information and awareness, anticipating misinformation and concerns, and will need to emphasize HPV vaccine as a method to prevent cancer.

Barriers to Cervical Cancer Screening and Treatment in the Dominican Republic: Perspectives of Focus Group Participants in the Santo Domingo Area.

Introduction: Cervical cancer is the second leading cause of cancer death among women in the Dominican Republic, and high rates persist despite existing Pap smear screening programs. The purpose of this study was to explore Dominican women's knowledge and attitudes regarding human papillomavirus (HPV) and cervical cancer, cervical cancer screening practices, and perceived barriers and facilitators to early detection of cervical cancer. Method: Six focus groups (N = 64) were conducted in Spanish in urban, suburban, and rural locations, in private and public school settings, community and workplace settings, in or near Santo Domingo, as part of a larger study on barriers and facilitators to HPV vaccine implementation. Audio recordings were transcribed verbatim and translated from Spanish to English. Qualitative data analysis used inductive and deductive approaches. Results: Knowledge regarding HPV and cervical cancer varied across groups, but all agreed there was significant stigma and fear regarding HPV. Most women reported having Pap screening at least yearly. Follow-up of abnormal Pap testing was less consistent, with cost and uncertainty about provider recommendations identified as barriers. Discussion: Broader examination of provider-level and health system barriers and facilitators to cervical cancer prevention in the Dominican Republic is essential, in order to inform interventions to improve the effectiveness of cervical cancer screening and treatment programs and reduce preventable deaths.

Insuficiencia renal aguda en adultos críticamente enfermos en dos instituciones hospitalarias / Acute kidney failure in critically ill adults from two health care institutions / Insuficiência renal aguda em adultos criticamente doentes em duas instituições hospitalares

Objetivo: Cuantificar la incidencia y los factores de exposición relacionados con el desarrollo de la insuficiencia renal aguda en pacientes hospitalizados en unidades de cuidados intensivos adulto durante tres meses. Materiales y métodos: se realizó un estudio epidemiológico de tipo cuantitativo con dos componentes: descriptivo longitudinal y de cohorte histórica, se emplearon los criterios de AKIN, participaron dos instituciones de salud, una de orden privado y otra de orden público. Resultados: Se incluyeron 186 pacientes, con una edad promedio de 56,2 +/- 20,14 años. Se encontró una incidencia del 21,6 % (IC 95 % 17-30) de insuficiencia renal aguda y una tasa de incidencia de 29,2 por cada 100 pacientes año exposición. En promedio la elevación de creatinina fue 0,47 mg/dL y el gasto urinario de 0,37 cc/kg/h, los días en ocurrir el evento 3,1 (IC 95 % 2,48-3,74). Se encontró relación estadísticamente significativa entre insuficiencia cardíaca aguda 6,84 días (IC 95 % 4,21-9,48) (p=0,026), posoperatorios 9,82 días (IC 95 % 8,42-11,2) (p=0,04) y trauma craneoencefálico 4,5 días (IC 95 % 1,56-7,44) (p=0,043) como causas de ingreso y la aparición de insuficiencia renal aguda Conclusiones: La proporción de incidencia de insuficiencia renal aguda identificada en el presente estudio, es similar a estudios realizados en Colombia, sin embargo, difiere de otros realizados en el exterior. La sepsis fue el diagnóstico con mayor frecuencia entre los pacientes con insuficiencia renal aguda, seguido de la insuficiencia cardíaca aguda. Se encontró significancia estadística en el desarrollo de la insuficiencia renal aguda y la administración de nitroglicerina.

Objective: To quantify the incidence and factors of exposure related to the development of acute kidney failure in hospitalized patients in the adult intensive care unit during three months. Materials and methods: An epidemiological study of quantitative type with two components was performed: descriptive longitudinal study and a retrospective cohort study, AKIN criteria were used, two health care institutions (one private and one public) participated. Results: 186 patients were included with an average age of 56.2 +/- 20,14 years. An incidence of 21.6% was found (IC 95 % 17-30) of acute kidney failure and a rate of incidence of 29.2 for every 100 patients / year of exposure. On average the creatinine elevation was of 0.47 mg/dL and the urine output was of 0.37 cc/kg/h, days of event occurrence 3.1 (IC 95 % 2.48-3.74). A significant statistical relationship was found between acute heart failure 6.84 days (IC 95% 4.21-9.48) (p=0.026), post-operatives 9.82 days (IC 95 % 8.42-11.2) (p=0.04) and traumatic brain injury 4.5 days (IC 95 % 1.56-7.44) (p=0.043), as causes of admission and appearance of acute kidney failure. Conclusions: The incidence proportion of acute kidney failure identified in the present study, is similar to other studies performed in Colombia, however, it differs from studies performed in other countries. Sepsis was the most frequent diagnosis among patients with acute kidney failure, followed by acute heart failure. Statistical significance was found in the development of acute kidney failure and the intake of nitroglycerin.

Objetivo: Quantificar a incidência e os fatores de exposição relacionados com o desenvolvimento da Insuficiência Renal Aguda (IRA) em pacientes adultos hospitalizados em unidades de terapia intensiva durante três meses. Materiais e métodos: realizou-se um estudo epidemiológico de tipo quantitativo com dois componentes: descritivo longitudinal e de coorte histórica, empregaram-se os critérios de AKIN (Acute Kidney Injury Network), participaram duas instituições de saúde, uma de ordem privado e outra de ordem pública. Resultados: Incluíram-se 186 pacientes, com uma idade média de 56,2 ± 20,14 anos. Encontrou-se uma incidência do 21,6 % (IC 95 % 17-30) de insuficiência renal aguda e uma taxa de incidência de 29,2 por cada 100 pacientes ano exposição. Em média a elevação de creatinina foi de 0,47 mg/dL e o gasto urinário de 0,37 cc/kg/h, os dias em ocorrer o evento 3,1 (IC 95 % 2,48-3,74). Encontrou-se relação estatisticamente significativa entre insuficiência cardíaca aguda (ICA) 6,84 dias (IC 95 % 4,21-9,48) (p=0,026), pós-operatórios 9,82 dias (IC 95 % 8,42-11,2) (p=0,04) e traumatismo cranioencefálico (TCE) 4,5 dias (IC 95 % 1,56-7,44) (p=0,043) como causas de ingresso e a aparição de insuficiência renal aguda Conclusões: A proporção de incidência de insuficiência renal aguda identificada no presente estudo, é similar a estudos realizados na Colômbia, no entanto, difere de outros realizados no exterior. A sepse foi o diagnóstico com maior frequência entre os pacientes com insuficiência renal aguda, seguido da insuficiência cardíaca aguda. Obteve-se significância estadística no desenvolvimento da insuficiência renal aguda e a administração de nitroglicerina.

The use of long-acting reversible contraceptives in Latin America and the Caribbean: current landscape and recommendations.

STUDY QUESTION: Can the high rate and associated burden of unintended pregnancy (UP) and adolescent pregnancy in Latin America and the Caribbean (LAC) be reduced through wider access to and use of long-acting reversible contraceptive (LARC) methods? SUMMARY ANSWER: Studies show that impoved access to and use of LARC methods is an effective tool for reducing the high rates of UP, unsafe abortion and abortion-related complications, and maternal deaths (as well as reducing their social and financial burden), and we have provided recommendations to help achieve this in LAC. WHAT IS KNOWN ALREADY: LAC comprises 46 countries with 650 million inhabitants, and shows large disparities in socioeconomic development, access to health services and attention to sexual and reproductive health rights. The exercise of these rights and universal access to sexual and reproductive health (SRH) programmes is a key strategy for improving maternal health by reducing the number of UPs, the rate of women's and child mortality and morbidity, and the number of unsafe abortions. The implementation of SRH programmes in the region has contributed to a decrease in pregnancy rates of more than 50% over 40 years. However, despite this progress, the numbers of UP and adolescent pregnancies are still among the highest worldwide, which can be attributed in large part to the low prevalence of use of LARC methods. STUDY DESIGN SIZE DURATION: This is a position paper with the objective of reviewing the magnitude and burden of UP in LAC, as well as available LARC methods and barriers to their access, with the goal of increasing knowledge and awareness among healthcare professionals (HCP), policymakers and the general public about the potential to reduce UP rates through the increased use of LARC. PARTICIPANTS/MATERIALS SETTING METHOD: We searched the electronic databases of PubMed and EMBASE to identify studies published up to May 2017. We also searched for websites regarding LAC, LARC methods, and UP including, for example, those from the United Nations, the World Health Organization, Pan American Health Organization, the Alan Guttmacher Institute and the United States Agency for International Development. Studies were included if they investigated mainly UP and their consequences as well as the use of LARC methods in the region. During 3 days of meetings, the importance of the studies identified and the appropriateness of inclusion were discussed. MAIN RESULTS AND THE ROLE OF CHANCE: LAC is not one unit and shows great ethnic diversity as well as economic and cultural differences among the various countries. These differences must be taken into account when developing policies related to disseminating information and combatting misinformation regarding the use of LARC among different audiences, such as adolescents and young women, nulligravidas, indigenous populations and women with disabilities. Furthermore, only some governments have made efforts to increase accessibility to LARC methods, and there is a need to implement training programmes for HCPs, launch education campaigns for the general public, increase access and review the cost-benefit analyses specific to LARC, which have already demonstrated that the upfront cost of LARC is less than the cummulative expense of short-term contraceptives. Recommendations to achieve these goals are presented. LIMITATIONS REASONS FOR CAUTION: Knowledge and awareness of the contraceptive method itself and of the mix of individual countries in the region is essential to the development of specific strategies and actions, tailored to each particular country situation, aimed at increasing access to modern contraceptive methods, especially LARC. WIDER IMPLICATIONS OF THE FINDINGS: Healthcare systems in LAC should consider LARC as a primary option for decreasing UP and adolescent pregnancy. Disseminating information, increasing awareness of their efficacy, removing barriers and improving access to LARC methods are the urgent actions recommended for government, academia, professional organizations, insurance companies and policymakers in order to address this major public health problem in LAC. STUDY FUNDING/COMPETING INTERESTS: This manuscript was supported by a grant from the Americas Health Foundation (AHF), a 501(c)3 nonprofit organization dedicated to improving healthcare throughout the Latin American Region. LB and IM received additional support from the São Paulo Research Foundation (FAPESP) award # 2015/20504-9. The authors declare no conflict of interest.

Efectos de la desnutrición calórico-proteica temprana en el estado nutricional y atributos del síndrome metabólico en una cohorte de adultos jóvenes / Effect of early protein-calorie malnutrition on nutritional status and attributes of the metabolic syndrome in young adults

Introducción: estudios consistentes durante los últimos años han caracterizado la relación entre la desnutrición calórico-proteica (DCP) y el desarrollo de enfermedades no transmisibles en la adultez, como el Síndrome Metabólico (SM). Objetivo: analizar la relación entre SM en la adultez y la DCP durante los primeros 1.000 días de vida en una cohorte de adultos recientemente generada en Curicó, Chile. Material y métodos: se analizaron 49 sujetos adultos jóvenes que durante sus primeros dos años de vida sufrieron desnutrición calórico-proteica moderada a severa mediante la realización de antropometría, medición de la presión arterial y exámenes de laboratorio. Se determinó la prevalencia del SM y la carga de sus atributos. Resultados: se obtuvo una prevalencia de SM del 14,3% sin diferencias significativas por género, con una asociación directa y notable entre la carga de SM, el índice de masa corporal (IMC), el índice cintura/talla, presión arterial y niveles plasmáticos de glicemia y triglicé- ridos (TG), y una asociación inversa con colesterol HDL. Conclusión: la presión arterial sistólica y el valor plasmático de TG representaron los factores de riesgo más importantes del SM en esta cohorte. No se encontró asociación entre la DCP en los 1.000 primeros días de vida y el SM en la adultez (AU)

Background: during recent years consistent studies have characterized the relationship between moderate and severe protein-calorie malnutrition and the appearance of non-communicable diseases in adulthood like metabolic syndrome (MS). Aim: to analyze the relationship between moderate and severe protein-calorie malnutrition during the first 1 000 days of life and the MS in a cohort of adults from Curicó, Chile. Material and methods: we studied 49 young adults who had suffered moderate to severe protein-calorie malnutrition during their first two years of life. Anthropometry, blood pressure measurement and laboratory tests were performed, and the burden of MS attributes was determined. Results: the prevalence of MS was 14.3% with no significant differences by gender, showing a direct and significant association between burden of MS and body mass index, waist / height index, blood pressure, plasma levels of glucose and triglyceride, and an inverse association with HDL. Conclusion: systolic blood pressure and plasma level of triglyceride represented the most important risk factors for SM in this cohort. We found no association between the presence of protein-calorie malnutrition and MS (AU)

[EFFECT OF EARLY PROTEIN-CALORIE MALNUTRITION ON NUTRITIONAL STATUS AND ATTRIBUTES OF THE METABOLIC SYNDROME IN YOUNG ADULTS]. / EFECTOS DE LA DESNUTRICIÓN CALÓRICO-PROTEICA TEMPRANA EN EL ESTADO NUTRICIONAL Y ATRIBUTOS DEL SÍNDROME METABÓLICO EN UNA COHORTE DE ADULTOS JÓVENES.

BACKGROUND: during recent years consistent studies have characterized the relationship between moderate and severe protein-calorie malnutrition and the appearance of non-communicable diseases in adulthood like metabolic syndrome (MS). AIM: to analyze the relationship between moderate and severe protein-calorie malnutrition during the first 1 000 days of life and the MS in a cohort of adults from Curicó, Chile. MATERIAL AND METHODS: we studied 49 young adults who had suffered moderate to severe protein-calorie malnutrition during their first two years of life. Anthropometry, blood pressure measurement and laboratory tests were performed, and the burden of MS attributes was determined. RESULTS: the prevalence of MS was 14.3% with no significant differences by gender, showing a direct and significant association between burden of MS and body mass index, waist / height index, blood pressure, plasma levels of glucose and triglyceride, and an inverse association with HDL. CONCLUSION: systolic blood pressure and plasma level of triglyceride represented the most important risk factors for SM in this cohort. We found no association between the presence of protein-calorie malnutrition and MS.

Introducción: estudios consistentes durante los últimos años han caracterizado la relación entre la desnutrición calórico-proteica (DCP) y el desarrollo de enfermedades no transmisibles en la adultez, como el Síndrome Metabólico (SM). Objetivo: analizar la relación entre SM en la adultez y la DCP durante los primeros 1.000 días de vida en una cohorte de adultos recientemente generada en Curicó, Chile. Material y métodos: se analizaron 49 sujetos adultos jóvenes que durante sus primeros dos años de vida sufrieron desnutrición calórico-proteica moderada a severa mediante la realización de antropometría, medición de la presión arterial y exámenes de laboratorio. Se determinó la prevalencia del SM y la carga de sus atributos. Resultados: se obtuvo una prevalencia de SM del 14,3% sin diferencias significativas por género, con una asociación directa y notable entre la carga de SM, el índice de masa corporal (IMC), el índice cintura/talla, presión arterial y niveles plasmáticos de glicemia y triglicéridos (TG), y una asociación inversa con colesterol HDL. Conclusión: la presión arterial sistólica y el valor plasmático de TG representaron los factores de riesgo más importantes del SM en esta cohorte. No se encontró asociación entre la DCP en los 1.000 primeros días de vida y el SM en la adultez.

Evidencia de validez en Chile del Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) / Validity evidence of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in Chile

El objetivo del estudio fue analizar la validez de la versión chilena de un instrumento para la identificación de diferentes niveles de riesgo asociado al consumo de alcohol, tabaco, marihuana y cocaína(Alcohol, Smoking and Substance Involvement Screening Test, ASSIST).Se evaluó la fiabilidad y consistencia del instrumento además dela validez concurrente y discriminante. La muestra fue de 400usuarios de servicios de tratamiento drogas y alcohol ambulatorios y residenciales de la atención primaria de salud, comisarías y empresas. La consistencia interna obtenida fue alta (Alcohol α= .86. marihuana α= .84 y cocaína α= .90). El coeficiente de correlación intraclase (CCI) con la comparación test-retest fue buena para Alcohol (CCI = .66), marihuana (CCI = .74) y cocaína (CCI =.80). Se observó una buena correlación entre los puntajes del ASSIST el puntaje del AUDIT (r de Pearson = .85), ASI-Lite (r entre .66 y .83 para tabaco, alcohol, marihuana y cocaína) y SDS (r = .65). El punto de corte original para la detección del riesgo alto es de 27 puntos, sin embargo, considerando un mejor balance entre sensibilidad y especificidad se modificó ese corte a 21. Los resultados obtenidos en éste estudio demostraron las buenas propiedades psicométricas del ASSIST para la detección de distintos niveles de riesgo asociados al consumo de sustancias en población general de Chile

This study aims to psychometrically validate the Chilean version of the Alcohol, Smoking and Substance Involvement Screening Test ASSIST. Specifically, this study is interested in evaluating the reliability, consistency and concurrent and discriminant validity of this instrument. The sample was composed for a total of 400 people from four different settings: treatment centers (residential and ambulatories), primary health care, police stations and companies. The reliability of the ASSIST was high (α = .86 for Alcohol, α = .84 for marijuana and α = .90 for cocaine). The intra class correlation coefficient (ICC) with test-retest comparison was statistically significant for Alcohol (ICC = .66), marijuana (ICC = .74) and cocaine (ICC = .80). There were statistically significant correlations between the ASSIST and the AUDIT score (Pearson’s r = .85), the ASSIST and the ASI-Lite score (r between .66 and .83 for tobacco, alcohol, marijuana and cocaine), and the ASSIST and the SDS score (r = .65). The original cutoff point for high risk detection was 27 points, however, in order to have a better balance between sensitivity and specificity the cut was changed to 21 points. The ASSIST presents good psychometric properties and therefore is a reliable and valid instrument to be used as a mechanism to detect risk levels of substance use in the Chilean population

[Validity evidence of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in Chile]. / Evidencia de validez en Chile del Alcohol, Smoking and Substance Involvement Screening Test (ASSIST).

This study aims to psychometrically validate the Chilean version of the Alcohol, Smoking and Substance Involvement Screening Test ASSIST. Specifically, this study is interested in evaluating the reliability, consistency and concurrent and discriminant validity of this instrument. The sample was composed for a total of 400 people from four different settings: treatment centers (residential and ambulatories), primary health care, police stations and companies. The reliability of the ASSIST was high (α = .86 for Alcohol, α = .84 for marijuana and α = .90 for cocaine). The intra class correlation coefficient (ICC) with test-retest comparison was statistically significant for Alcohol (ICC = .66), marijuana (ICC = .74) and cocaine (ICC = .80). There were statistically significant correlations between the ASSIST and the AUDIT score (Pearson’s r = .85), the ASSIST and the ASI-Lite score (r between .66 and .83 for tobacco, alcohol, marijuana and cocaine), and the ASSIST and the SDS score (r = .65). The original cutoff point for high risk detection was 27 points, however, in order to have a better balance between sensitivity and specificity the cut was changed to 21 points. The ASSIST presents good psychometric properties and therefore is a reliable and valid instrument to be used as a mechanism to detect risk levels of substance use in the Chilean population.

Detección de Chlamydia pneumoniae en tejido aórtico humano: amplificación del gen kdtA e hibridación in vitro / Detection of Chlamydia pneumoniae in human aortic tissue: kdtA gene amplification and in vitro hybridization

Introducción. La ateroesclerosis es la principal causa de enfermedad coronaria y cerebrovascular, las cuales, a su vez, son las causas más comunes de mortalidad y morbilidad n el mundo occidental. Publicaciones recientes sugieren que ciertos microorganismos infecciosos podrían jugar un papel importante en la génesis y progresión de la aterosclerosis. De acuerdo con reportes seroepidemiológicos y de detección directa, Chlamydia pneumoniae podría ser el candidato más plausible. No obstante, no se ha determinado su papel específico en el proceso aterogénico, por lo cual en los últimos años ha surgido la necesidad de explorar diversas técnicas de detección de C. pneumoniae en arterias. Objetivo. El propósito de este estudio fue investigar la presencia de C. pneumoniae en muestras de tejido aórtico de catorce pacientes sometidos a cirugía de reemplazo aórtico, utilizando la amplificación del gen kdtA por PCR acoplada a un ensayo de hibridación in vitro. Materiales y métodos. De cada uno de catorce segmentos de aorta se obtuvo una muestra al azar para la extracción de ADN y la detección de C. pneumoniae por PCR-hibridación in vitro. Resultados. Doce (85,7 por ciento) de catorce muestras de tejido de aorta resultaron positivas para C. pneumoniae. Conclusión. Los resultados encontrados en este estudio sugieren que la presencia de C. pneumoniae es frecuente en el tipo de muestras analizado. En estudios posteriores resultaría importante examinar si esta proporción se mantiene en una muestra poblacional mayor

Disfunción edoltelial inducida por hipercolesterolemia: esudio in vitroen un modelo animal / Endothelial dysfunction induced by hypercholesterolemia: in vitro study ina animal model

Los factores de riesgo tradicionales como hipercolesterolemia afectan la producción endotelial o acción de sustancias vasoactivas fundamentales como el óxido nítrico (NO). Este fenómeno tiene efectos proa terogénicos y protombóricos. El objetivo del presente estudio fue evaluar los efectos in vitro de la hipercolesterolemia sobre la función endotelial y la formación de placa ateroesclerótica en tejido aórtico proveniente de conejos hipercolesterolémicos.Los resultados encontrados sugieren que los niveles elevados de colesterol sérico producen una alteración en la vasodilatación arterial dependiente de endotelio funcional, la cual se presenta sin cambios morfológicos de las células endoteliales. Se corrobora que la hipercolesterolemia es un factor de riesgo independiente de ateroesclerosis el cual contribuye a la disfunción como evento inicial en la génesis del proceso

[Detection of Chlamydia pneumoniae in human aortic tissue: kdtA gene amplification and in vitro hybridization]. / Detección de Chlamydia pneumoniae en tejido aórtico humano: amplificación del gen kdtA e hibridación in vitro.

INTRODUCTION: Atherosclerosis is the main cause of coronary and cerebrovascular disease which, in turn, are the most common causes of mortality and morbidity in the western world. Recent publications suggest that infective microorganisms may play an important role in the genesis and progression of atherosclerosis. According to seroepidemiological and direct detection reports, Chlamydia pneumoniae is the most plausible candidate. Nevertheless, the mechanisms by which the microorganism induces its pathological effect have not yet been conclusively determined; hence, the need exists to explore different detection techniques of C. pneumoniae on arteries. OBJECTIVE: The purpose of the current study was to detect the presence of C. pneumoniae in aortic tissue samples from 14 patients submitted to aortic replacement surgery. Detection method involved kdtA gene amplification coupled with an in vitro hybridization assay. MATERIALS AND METHODS: Samples of aortic tissue for DNA extraction and C. pneumoniae detection by PCR-in vitro hybridization were randomly obtained from each of 14 aorta specimens. RESULTS: C. pneumoniae was detected in 12 (85.7%) of the 14 aortic tissue samples. CONCLUSIONS: This result indicates a frequent association of C. pneumoniae with aortic tissue disease. Further studies are required to determine if this proportion of positive samples persists within larger samples.