Características de la demanda asistencial en la unidad de salud mental de la infancia y la adolescencia del área sanitaria de Santiago: análisis evolutivo / Characteristics of the demand in the mental health unit of children and the adolescence of the Santiago sanitary area (public health system): evolutionary analysis

INTRODUCCIÓN: El análisis y la evaluación de la demanda que se realiza en este servicio resulta fundamental para mejorar la calidad de la atención profesional y la eficacia de los tratamientos. En este trabajo presentamos los datos de una evaluación realizada durante quince años en esta Unidad. OBJETIVOS: Determinar las características sociodemográficas y clínicas de los niños y adolescentes que consultaron en la USM de la Infancia y la Adolescencia del Área de Santiago durante el periodo 2000-2015. Analizar las diferencias, respecto de las variables sociodemográficas y clínicas, entre los primeros años de este periodo 2000-2012, con los resultados observados en los últimos años (2013-2015) y su relación con el incremento de la demanda. Material y MÉTODO: La muestra utilizada es de 6026 sujetos consultados. Las variables estudiadas: sociodemográficas y clínicas. Analizamos estas variables en dos tramos temporales para evaluar si existe una demanda diferente con el paso de los años. Resultados Encontramos un notable incremento de la demanda asistencial en los últimos 3 años, no existen diferencias en cuanto al perfil sociodemográfico. Respecto de las características clínica sí obtenemos diferencias en cuanto a la prevalencia de los diagnósticos y en el seguimiento de los pacientes. CONCLUSIONES: La diferencia fundamental entre los dos períodos se concreta en el incremento de la demanda que determina una mayor prevalencia de Ausencia de Diagnóstico Psiquiátrico y mayor número de altas que sugieren un uso poco adecuado de la demanda asistencial

INTRODUCTION: The analysis and evaluation of the demand that is carried out in a Mental Health Unit of Childhood and Adolescence (MHUCA) is fundamental to improve the quality of the professional attention and the effectiveness of the treatments. In this paper we present the data of an evaluation performed during fifteen years in a MHUCA. OBJECTIVES: To determine the sociodemographic and clinical characteristics of the children and adolescents who consulted in the MHUCA of the Santiago Area during the period 2000-2015. Analyze the differences between sociodemographic and clinical variables between the first years of this period (2000-2012), with the results observed in the last years (2013-2015) and their relationship with the increase in demand. MATERIAL AND METHODS: The sample used is 6026 subjects consulted. The studied variables: sociodemographic and clinical. We analyze these variables in two time sections to evaluate if there is a different demand over the years. RESULTS: We found a notable increase in the demand for care in the last 3 years, there are no differences in the sociodemographic profile. Regarding the clinical characteristics, we obtained differences in the prevalence of the diagnoses and in the follow-up of the patients. CONCLUSIONS: The fundamental difference between the two periods is determined by the increase in demand that determines a higher prevalence of Absence of Psychiatric Diagnosis and a higher number of discharges that suggest an inadequate use of the demand for care

[Extrapulmonary and extraspinal presentation of osteoarticular tuberculosis]. / Tuberculosis osteoarticular de presentación extrapulmonar y extraespinal.

BACKGROUND: How to overcome the difficulty in diagnosing extrapulmonary and extraspinal osteoarticular tuberculosis? What is the most appropriate way to manage the patient? MATERIAL AND METHODS: Retrospective series of four cases of extrapulmonary and extraspinal osteoarticular tuberculosis (two patients with knee involvement, one patient with involvement of the carpus, and a fourth patient who presented with tenosynovitis of the anterior tibial tendon of the ankle). The time elapsed from the onset of the clinical picture to the diagnosis ranged between 7 months and 2 years. The definitive diagnosis resulted from the presence of caseating granulomas in the biopsy (3 cases), and the isolation of the bacillus in culture (3 cases) or with staining (one case). Only in one case was there lung involvement after the extrapulmonary presentation. One patient had spinal involvement in the form of epidural abscess months after the extraspinal presentation. All patients received chemotherapy. Surgery was performed in 3 of the 4 cases. The Martini assessment was used to evaluate the functional outcome. RESULTS: In all patients the lesion was cured, with two excellent and two poor functional outcomes. CONCLUSIONS: A high clinical suspicion index is needed to prevent a delayed diagnosis. Chemotherapy is the cornerstone of treatment. Surgery is indicated mainly as a diagnostic procedure, but partial resection of the lesion may be performed at the same time.