RESUMEN

BACKGROUND: One-third of people with gastrointestinal disorders, including functional dyspepsia, use some form of complementary and alternative medicine, including herbal medicines. OBJECTIVES: The primary objective is to assess the effects of non-Chinese herbal medicines for the treatment of people with functional dyspepsia. SEARCH METHODS: We searched the following electronic databases on 22 December 2022: Cochrane Central Register of Controlled Trials, MEDLINE, Embase, Allied and Complementary Medicine Database, Latin American and Caribbean Health Sciences Literature, among other sources, without placing language restrictions. SELECTION CRITERIA: We included RCTs comparing non-Chinese herbal medicines versus placebo or other treatments in people with functional dyspepsia. DATA COLLECTION AND ANALYSIS: Two review authors independently screened references, extracted data and assessed the risk of bias from trial reports. We used a random-effects model to calculate risk ratios (RRs) and mean differences (MDs). We created effect direction plots when meta-analysis was not possible, following the reporting guideline for Synthesis without Meta-analysis (SWiM). We used GRADE to assess the certainty of the evidence (CoE) for all outcomes. MAIN RESULTS: We included 41 trials with 4477 participants that assessed 27 herbal medicines. This review evaluated global symptoms of functional dyspepsia, adverse events and quality of life; however, some studies did not report these outcomes. STW5 (Iberogast) may moderately improve global symptoms of dyspepsia compared with placebo at 28 to 56 days; however, the evidence is very uncertain (MD -2.64, 95% CI -4.39 to -0.90; I2 = 87%; 5 studies, 814 participants; very low CoE). STW5 may also increase the improvement rate compared to placebo at four to eight weeks' follow-up (RR 1.55, 95% CI 0.98 to 2.47; 2 studies, 324 participants; low CoE). There was little to no difference in adverse events for STW5 compared to placebo (RR 0.92, 95% CI 0.52 to 1.64; I2 = 0%; 4 studies, 786 participants; low CoE). STW5 may cause little to no difference in quality of life compared to placebo (no numerical data available, low CoE). Peppermint and caraway oil probably result in a large improvement in global symptoms of dyspepsia compared to placebo at four weeks (SMD -0.87, 95% CI -1.15 to -0.58; I2 = 0%; 2 studies, 210 participants; moderate CoE) and increase the improvement rate of global symptoms of dyspepsia (RR 1.53, 95% CI 1.30 to 1.81; I2 = 0%; 3 studies, 305 participants; moderate CoE). There may be little to no difference in the rate of adverse events between this intervention and placebo (RR 1.56, 95% CI 0.69 to 3.53; I2 = 47%; 3 studies, 305 participants; low CoE). The intervention probably improves the quality of life (measured on the Nepean Dyspepsia Index) (MD -131.40, 95% CI -193.76 to -69.04; 1 study, 99 participants; moderate CoE). Curcuma longa probably results in a moderate improvement global symptoms of dyspepsia compared to placebo at four weeks (MD -3.33, 95% CI -5.84 to -0.81; I2 = 50%; 2 studies, 110 participants; moderate CoE) and may increase the improvement rate (RR 1.50, 95% CI 1.06 to 2.11; 1 study, 76 participants; low CoE). There is probably little to no difference in the rate of adverse events between this intervention and placebo (RR 1.26, 95% CI 0.51 to 3.08; 1 study, 89 participants; moderate CoE). The intervention probably improves the quality of life, measured on the EQ-5D (MD 0.05, 95% CI 0.01 to 0.09; 1 study, 89 participants; moderate CoE). We found evidence that the following herbal medicines may improve symptoms of dyspepsia compared to placebo: Lafonesia pacari (RR 1.52, 95% CI 1.08 to 2.14; 1 study, 97 participants; moderate CoE), Nigella sativa (SMD -1.59, 95% CI -2.13 to -1.05; 1 study, 70 participants; high CoE), artichoke (SMD -0.34, 95% CI -0.59 to -0.09; 1 study, 244 participants; low CoE), Boensenbergia rotunda (SMD -2.22, 95% CI -2.62 to -1.83; 1 study, 160 participants; low CoE), Pistacia lenticus (SMD -0.33, 95% CI -0.66 to -0.01; 1 study, 148 participants; low CoE), Enteroplant (SMD -1.09, 95% CI -1.40 to -0.77; 1 study, 198 participants; low CoE), Ferula asafoetida (SMD -1.51, 95% CI -2.20 to -0.83; 1 study, 43 participants; low CoE), ginger and artichoke (RR 1.64, 95% CI 1.27 to 2.13; 1 study, 126 participants; low CoE), Glycyrrhiza glaba (SMD -1.86, 95% CI -2.54 to -1.19; 1 study, 50 participants; moderate CoE), OLNP-06 (RR 3.80, 95% CI 1.70 to 8.51; 1 study, 48 participants; low CoE), red pepper (SMD -1.07, 95% CI -1.89 to -0.26; 1 study, 27 participants; low CoE), Cuadrania tricuspidata (SMD -1.19, 95% CI -1.66 to -0.72; 1 study, 83 participants; low CoE), jollab (SMD -1.22, 95% CI -1.59 to -0.85; 1 study, 133 participants; low CoE), Pimpinella anisum (SMD -2.30, 95% CI -2.79 to -1.80; 1 study, 107 participants; low CoE). The following may provide little to no difference compared to placebo: Mentha pulegium (SMD -0.38, 95% CI -0.78 to 0.02; 1 study, 100 participants; moderate CoE) and cinnamon oil (SMD 0.38, 95% CI -0.17 to 0.94; 1 study, 51 participants; low CoE); moreover, Mentha longifolia may increase dyspeptic symptoms (SMD 0.46, 95% CI 0.04 to 0.88; 1 study, 88 participants; low CoE). Almost all the studies reported little to no difference in the rate of adverse events compared to placebo except for red pepper, which may result in a higher risk of adverse events compared to placebo (RR 4.31, 95% CI 1.56 to 11.89; 1 study, 27 participants; low CoE). With respect to the quality of life, most studies did not report this outcome. When compared to other interventions, essential oils may improve global symptoms of dyspepsia compared to omeprazole. Peppermint oil/caraway oil, STW5, Nigella sativa and Curcuma longa may provide little to no benefit compared to other treatments. AUTHORS' CONCLUSIONS: Based on moderate to very low-certainty evidence, we identified some herbal medicines that may be effective in improving symptoms of dyspepsia. Moreover, these interventions may not be associated with important adverse events. More high-quality trials are needed on herbal medicines, especially including participants with common gastrointestinal comorbidities.

Asunto(s)

RESUMEN

El envejecimiento del sistema inmune o «inmunosenescencia» afecta a la respuesta inmune viral en el adulto mayor, sobre todo si existe fragilidad. Algunos hallazgos destacan un desbalance en los mecanismos pro- y antiinflamatorios, una menor producción y diversificación de linfocitos T, alteración de la inmunovigilancia y en la síntesis de anticuerpos ante la inmunización. En este contexto, la nutrición cobra gran importancia al combatir la sarcopenia y la fragilidad. Algunos componentes alimentarios que contribuyen en la inmunocompetencia son las proteínas, la vitamina D, los ácidos grasos n-3, las vitaminas antioxidantes (vitaminas C y E), el cinc, el selenio y el hierro. En tiempos de pandemia, las recomendaciones nutricionales que apunten a la inmunocompetencia en el adulto mayor deben basarse en estudios clínicos. En este artículo se abordan la inmunosenescencia y su relación con la nutrición, incluyendo intervenciones estudiadas en el contexto de la pandemia por COVID-19. (AU)

Aging of the immune system, or immunosenescence, alters the viral immune response in the elderly, especially when frailty exists. Research findings have demonstrated an imbalance in pro- and anti-inflammatory mechanisms, reduced production and diversification of T lymphocytes, and an alteration in immunovigilance and antibody synthesis. In this context, nutrition has a role in combating sarcopenia and frailty. Some food components that contribute to immune-competence are protein, vitamin D, n-3 fatty acids, antioxidant vitamins (vitamins C and E), zinc, selenium and iron. In times of a pandemic, nutritional recommendations for immune-competence in the elderly should be based on clinical studies. In this article, immunosenescence and its relationship to nutrition are addressed, including interventions studied in the context of the COVID-19 pandemic. (AU)

Asunto(s)

RESUMEN

Aging of the immune system, or immunosenescence, alters the viral immune response in the elderly, especially when frailty exists. Research findings have demonstrated an imbalance in pro- and anti-inflammatory mechanisms, reduced production and diversification of T lymphocytes, and an alteration in immunovigilance and antibody synthesis. In this context, nutrition has a role in combating sarcopenia and frailty. Some food components that contribute to immune-competence are protein, vitamin D, n-3 fatty acids, antioxidant vitamins (vitamins C and E), zinc, selenium and iron. In times of a pandemic, nutritional recommendations for immune-competence in the elderly should be based on clinical studies. In this article, immunosenescence and its relationship to nutrition are addressed, including interventions studied in the context of the COVID-19 pandemic.

Asunto(s)

RESUMEN

BACKGROUND: Postoperative pain management contributes to reducing postoperative morbidity and unscheduled readmission. Compared to other opioids that manage postoperative pain like morphine, few randomized trials have tested the efficacy of intraoperatively administered methadone to provide evidence for its regular use or be included in clinical guidelines. METHODS: We conducted a randomized clinical trial comparing the use of intraoperative methadone to assess its impact on postoperative pain. Eighty-six patients undergoing elective laparoscopic cholecystectomy were allocated to receive either methadone (0.08 mg/kg) or morphine (0.08 mg/kg). RESULTS: Individuals who received methadone required less rescue morphine in the Post Anesthesia Care Unit for postoperative pain than those who received morphine (p = 0.0078). The patients from the methadone group reported less pain at 5 and 15 minutes and 12 and 24 hours following Post Anesthesia Care Unit discharge, exhibiting fewer episodes of nausea. Time to eye-opening was equivalent between the two groups. CONCLUSION: Intraoperative use of methadone resulted in better management of postoperative pain, supporting its use as part of a multimodal pain management strategy for laparoscopic cholecystectomy under remifentanil-based anesthesia.

INTRODUCCIÓN: El manejo del dolor postoperatorio contribuye a reducir la morbilidad postoperatoria y los reingresos no programados. Pocos ensayos clínicos aleatorizados han evaluado la eficacia de la administración intraoperatoria de metadona en comparación con otros opioides como morfina, para el tratamiento del dolor postoperatorio, como para proporcionar evidencia de su uso regular o incluirse en guías clínicas. MÉTODOS: Realizamos un ensayo clínico aleatorizado comparando el uso de metadona intraoperatoria para evaluar su impacto sobre el dolor postoperatorio. Ochenta y seis pacientes sometidos a colecistectomía laparoscópica electiva fueron asignados para recibir metadona (0,08 mg/kg) o morfina (0,08 mg/kg). RESULTADOS: El grupo de pacientes que recibió metadona requirió menos morfina de rescate en la unidad de cuidados post-anestésicos para el manejo del dolor posoperatorio, en comparación con el grupo morfina (p = 0,0078). Los pacientes del grupo metadona reportaron menos dolor a los 5 y 15 minutos, y a las 12 y 24 horas postoperatorias, además de presentar menos episodios de náuseas. El tiempo de despertar entre ambos grupos fue equivalente. CONCLUSIÓN: El uso intraoperatorio de metadona es superior a morfina en el manejo del dolor postoperatorio, apoyando su uso como parte de la estrategia de manejo multimodal del dolor para colecistectomía laparoscópica bajo anestesia total endovenosa con remifentanilo.

Asunto(s)

RESUMEN

INTRODUCTION: Chile has an incipient policy regarding humanized birth practices. Obstetric violence is becoming an issue in the public discussion, as brought up by women. Despite this advancement, no initiatives were observed to overcome the conflict. Questions arise from the different points of view of the main stakeholders involved. These questions help identify strategies contributing to the development of health policies that consider influencing actors. OBJECTIVES: To identify stakeholders' perceptions of humanized care in childbirth and obstetric violence. METHODS: We conducted a scoping review that included articles and analysis of texts reflecting the scientific communities' point of view. We included statements from governmental, social, professional, and political actors as expressed in institutional websites. Moreover, we performed a qualitative inductive, thematic content analysis. RESULTS: We included seventy documents. The scientific community is visualized as aligned with ministerial recommendations for personalized childbirth. Several researchers analyze the difficulties for its improvement due to the historical, socio-cultural, and economic construction of the predominantly biomedical model for birthing. Convergence is observed among the scientific community and other stakeholders in recognition of humanized birth benefits and the need to overcome institutional obstacles within the health sector. However, the progress of the proposed change is slow, and health professionals' resistance to address women's complaints towards obstetric violence and claim of quality care is observed. This discussion finds its reflection in a parliamentary discussion. CONCLUSIONS: The stakeholders' analysis reflects areas of conflict and consensus, as well as the diverse interacting dimensions that hinder the advance of humanized care in childbirth. This broad analysis strategy contributes to identifying critical aspects to be addressed in the development of integral and effective health policies.

Asunto(s)

RESUMEN

INTRODUCCIÓN: Chile tiene una política incipiente en relación con prácticas de parto humanizado y la violencia obstétrica es una materia de creciente discusión pública levantada por las mujeres. A pesar de este avance, no se han observado iniciativas para superar el conflicto. Surge la pregunta acerca de los diferentes puntos de vista de los principales actores involucrados, con el fin de identificar estrategias que contribuyan al desarrollo de políticas públicas de salud que consideren a los actores influyentes. OBJETIVO: Identificar la percepción de actores acerca del parto humanizado y la violencia obstétrica. MÉTODO: Se condujo una revisión panorámica (scoping review) que incluyó la descripción y el análisis de artículos y textos de análisis que reflejaran la visión de la comunidad científica y declaraciones de actores del sector gubernamental, social, profesional y político expresados en sitios web institucionales. Se desarrolló un análisis de contenido temático cualitativo, de naturaleza inductiva. RESULTADOS: Se incluyeron setenta documentos. La comunidad científica se visualiza alineada con las recomendaciones ministeriales de parto personalizado. Varios investigadores analizan las dificultades de implementación debido a la construcción histórica, sociocultural y económica del modelo biomédico de atención del parto predominante. Se observa convergencia entre la comunidad científica y otros actores en torno al reconocimiento de los beneficios del parto humanizado, así como acerca de la necesidad de superar obstáculos institucionales del sector de salud. No obstante, el proceso de cambio propuesto es lento y se observan resistencias entre profesionales de la salud para abordar las quejas de las mujeres frente a la violencia obstétrica y su demanda de atención de calidad. Esta situación se refleja a nivel parlamentario. CONCLUSIONES: El análisis de actores identifica áreas de conflicto y de consenso, así como diversas dimensiones interactuantes que obstaculizan el avance hacia la humanización de la atención del parto. Esta estrategia amplia de análisis contribuye a la identificación de aspectos críticos a ser abordados para un desarrollo de políticas sanitarias integrales y efectivas.

INTRODUCTION: Chile has an incipient policy regarding humanized birth practices. Obstetric violence is becoming an issue in the public discussion, as brought up by women. Despite this advancement, no initiatives were observed to overcome the conflict. Questions arise from the different points of view of the main stakeholders involved. These questions help identify strategies contributing to the development of health policies that consider influencing actors. OBJECTIVES: To identify stakeholders' perceptions of humanized care in childbirth and obstetric violence. METHODS: We conducted a scoping review that included articles and analysis of texts reflecting the scientific communities' point of view. We included statements from governmental, social, professional, and political actors as expressed in institutional websites. Moreover, we performed a qualitative inductive, thematic content analysis. RESULTS: We included seventy documents. The scientific community is visualized as aligned with ministerial recommendations for personalized childbirth. Several researchers analyze the difficulties for its improvement due to the historical, socio-cultural, and economic construction of the predominantly biomedical model for birthing. Convergence is observed among the scientific community and other stakeholders in recognition of humanized birth benefits and the need to overcome institutional obstacles within the health sector. However, the progress of the proposed change is slow, and health professionals' resistance to address women's complaints towards obstetric violence and claim of quality care is observed. This discussion finds its reflection in a parliamentary discussion. CONCLUSIONS: The stakeholders' analysis reflects areas of conflict and consensus, as well as the diverse interacting dimensions that hinder the advance of humanized care in childbirth. This broad analysis strategy contributes to identifying critical aspects to be addressed in the development of integral and effective health policies.

Asunto(s)

RESUMEN

OBJECTIVES: The Chilean health system mandates providers to ensure assistance under a guaranteed system, the Explicit Guarantees in Healthcare (EGH) program. The Health Ministry has developed clinical practice guidelines (CPGs), but independent assessment of their quality is lacking. STUDY DESIGN AND SETTING: We assessed all CPGs of the EGH program using Appraisal of Guidelines for Research & Evaluation II (AGREE II) tool for appraising quality, validity period, and last update. RESULTS: Eighty-six CPGs were published between 2005 and 2016. Only 15 (17.4%) were updated. The overall mean raw score was 4.18 (±0.98). The scaled scores for each domain were: Scope and objectives 79.7%, Stakeholder involvement 46.2%, Rigor of development 36.3%, Clarity of presentation 82.8%, Applicability 23.5%, and Editorial independence 39.2%. The highest items were: overall objectives described, population described, options for management clearly presented, and key recommendations easily identifiable. The worst evaluated items were: views and preferences of the target population, strengths and limitations of the body of evidence, methods for formulating the recommendations, external review by experts, and description of facilitators and barriers to application. CONCLUSION: Most Chilean CPGs included in the EGH program are outdated and show items that should be improved, mainly through a more rigorous methodology, the inclusion of patients in its development, and appropriate consideration of its applicability.

Asunto(s)

RESUMEN

In experimental studies, researchers apply an intervention to a group of study participants and analyze the effects over a future or prospective timeline. The prospective nature of these types of studies allows for the determination of causal relationships, but the interventions they are based on require rigorous bioethical evaluation, approval from an ethics committee, and registration of the study protocol prior to implementation. Experimental research includes clinical and preclinical testing of a novel intervention or therapy at different phases of development. The main objective of clinical trials is to evaluate an interventions efficacy and safety. Conventional clinical trials are blinded, randomized, and controlled, meaning that participants are randomly assigned to either the study intervention group or a comparator (a control group exposed to a placebo intervention or another non-placebo or active interventionor not exposed to any intervention) to reduce selection and confounding biases, and researchers are also unaware of the type of intervention being applied. Intention-to-treat analysis (inclusion of all originally randomized subjects) should be done to avoid the effects of attrition (dropout) and crossover (variance in the exposure or treatment over time). A quasi-experimental design and external controls may also be used. Metrics used to measure the magnitude of effects include relative risk, absolute and relative risk reductions, and numbers needed to treat and harm. Confounding factors are controlled by randomization. Other types of bias to consider are selection, performance, detection, and reporting. This review is the fifth of a methodological series on general concepts in biostatistics and clinical epidemiology developed by the Chair of Scientific Research Methodology at the School of Medicine, University of Valparaíso, Chile. It describes general theoretical concepts related to randomized clinical trials and other experimental studies in humans, including fundamental elements, historical development, bioethical issues, structure, design, association measures, biases, and reporting guidelines. Factors that should be considered in the execution and evaluation of a clinical trial are also covered.

En los estudios experimentales, el investigador aplica una intervención sobre los participantes, por lo que su eje temporal es prospectivo. Estas características permiten probar relaciones causales, pero implican una rigurosa evaluación bioética y una inscripción previa del protocolo de estudio. Entre las investigaciones experimentales se encuentran los estudios preclínicos y diversos ensayos con objetivos distintos según la fase de desarrollo en que se encuentre. Entre ellos se incluyen los ensayos clínicos, cuyo objetivo principal es evaluar la eficacia y la seguridad de alguna intervención o terapia. El diseño convencional de ensayo clínico es aleatorizado controlado enmascarado, donde se asigna aleatoriamente a los participantes a una intervención y a sus comparadores (otra intervención, placebo o nada); lo que permite controlar el sesgo de selección y el de confusión. Asimismo, los participantes y los investigadores no conocen la intervención que fue asignada. El análisis de sus resultados debe considerar a todos los sujetos originalmente aleatorizados, lo que se conoce como análisis por intención de tratar. Otros tipos de estudios experimentales incluyen los estudios cuasiexperimentales y los estudios experimentales con controles externos. Las medidas de magnitud del efecto utilizadas son el riesgo relativo, las reducciones absolutas y relativas de riesgo y los números necesarios a tratar y dañar. Si bien los factores de confusión son controlados por el proceso de aleatorización, otros sesgos que hay que considerar son los de selección, desarrollo, detección, desgaste y reporte. En este artículo, se abordan los conceptos teóricos generales sobre los estudios experimentales en seres humanos, fundamentalmente sobre los ensayos clínicos aleatorizados, considerando sus elementos fundamentales, desarrollo histórico, aspectos bioéticos, construcción, variantes en el diseño, medidas de asociación, sesgos y pautas de reporte. Finalmente, se sintetizan algunas consideraciones que siempre hay que tener en mente durante la ejecución y la evaluación de un ensayo clínico. Esta revisión es la quinta entrega de una serie metodológica sobre conceptos generales en bioestadística y epidemiologia clínica desarrollada por la Cátedra de Metodología de la Investigación Científica de la Escuela de Medicina de la Universidad de Valparaíso, Chile.

Asunto(s)

RESUMEN

Gender is a psychosocial construct referring to the socially built roles, behaviors, expressions and identities of girls, women, boys, men and people with gender diversity, while sex is related to the biological attributes of a woman or a man. Even though the terms sex and gender are often used in a binary way, there is considerable diversity in the way individuals and groups understand, experiment and express them. This narrative review describes some relevant aspects of the subjective difference that exists and favors men over women in the fields of sciences and research, starting from a historical perspective in the light of feminist movements. In particular, women are described as researchers - crea-tors of scientific knowledge, as well as the subjects of analysis. Some conflicts arising from sex bias, applied to biomedical research, are also analyzed, and cases are delivered that exemplify the disarray that has historically accompanied the female gender in this area, its ignorance and little cultural recognition. This review is the last article in a methodological series on general concepts in biostatistics and clinical epidemiology developed by the Chair of Methodology of Scientific Research of the School of Medicine of the Universidad de Valparaiso, Chile, which aims to address a contingent and cross-cutting theme to all scientific research.

El género es una construcción psicosocial referida a los roles, comportamientos, expresiones e identidades socialmente construidos de niñas, mujeres, niños, hombres y personas con diversidad de género, mientras que el sexo se relaciona con los atributos biológicos de una mujer o un hombre. Aun cuando los términos “sexo” y “género” suelen utilizarse de forma binaria, existe una diversidad considerable en la forma en que los individuos y los grupos los entienden, experimentan y expresan. En esta revisión narrativa se describen algunos aspectos relevantes acerca de la diferencia subjetiva que existe y favorece a los hombres frente a las mujeres en el ámbito de las ciencias e investigación, iniciando desde una perspectiva histórica a la luz de los movimientos feministas. En particular, se describe a la mujer en cuanto investigadora y creadora de conocimiento científico, como también en su calidad de sujeto de análisis. Se analizan además algunos conflictos derivados del sesgo de sexo aplicados a la investigación biomédica, y se entregan casos que ejemplifican el desmedro que ha acompañado históricamente al género femenino en este ámbito, su desconocimiento y poco reconocimiento cultural. Esta revisión es la última entrega de una serie metodológica sobre conceptos generales en bioestadística y epidemiología clínica desarrollada por la Cátedra de Metodología de la Investigación Científica de la Escuela de Medicina de la Universidad de Valparaíso, Chile, que pretende abordar una temática contingente y transversal a toda la investigación científica.

Asunto(s)

RESUMEN

INTRODUCCIÓN: El uso de condones masculinos permite la prevención de infecciones de transmisión sexual y de embarazo, pero su uso en estudiantes de carreras sanitarias ha sido poco estudiado en Chile. El objetivo del presente estudio es evaluar el uso de condón y caracterizar la actividad sexual y el antecedente de infección de transmisión sexual en estudiantes de la Facultad de Medicina de la Universidad de Valparaíso, Chile. MATERIALES Y MÉTODOS: Se desarrolló un estudio transversal. Se aplicó el Cuestionario Confidencial Sobre Vida Sexual Activa. Para el análisis inferencial se usaron las pruebas de Fisher y Kruskal-Wallis. RESULTADOS: Se incluyeron 143 estudiantes (69% mujeres). El promedio de edad de la primera relación sexual fue de 17+1,8 años. Durante los últimos 12 meses, 6,3% siempre uso condón en las relaciones sexuales penetrativas, 69,2% a veces y 24,5% nunca (91,6% de ellas fueron heterosexuales); de acuerdo con el tipo de práctica sexual, 41,9% declaró siempre usar condón en las relaciones anales, 25,8% en las vaginales y 0,8% en las orales; 3,5% había presentado alguna infección de transmisión sexual. No se encontraron asociaciones entre el uso de condón y el sexo de los participantes, el antecedente de infección de transmisión sexual, el promedio de edad de inicio de la actividad sexual o la carrera universitaria. DISCUSIÓN: Un pequeño número de participantes reportó el antecedente de infección de transmisión sexual. Una baja proporción de los estudiantes de carreras sanitarias usa constantemente condón, mayormente en las relaciones anales, lo que podría asociarse con una baja percepción de riesgo del no uso de condón. (AU)

INTRODUCTION: The use of male condoms assists in the prevention of sexually transmitted in-fections and pregnancy. However, their use among health students has been scarcely studied in Chile. The objective of this study is to evaluate the use of condoms and to characterize the sexual activity and history of sexually transmitted infections among students of the Faculty of Medicine of Universidad de Valparaíso in Chile. MATERIALS AND METHODS: We conducted a cross-sectional study. The Confidential Questionnaire of Active Sexual Life was administered, and the Fisher's exact test and Kruskal-Wallis test were used for inferential analysis. RESULTS: A total of 143 students (69% women) were included in the study. The students' average age when they first had sexual intercourse was 17+1,8 years. During the last 12 months, 6.3% always used a condom, 69.2% sometimes used a condom, and 24.5% never used a condom during penetrative sex (91.6% of the sexual encounters were heterosexual); in terms of the type of sexual practice, 41.9% declared always using condoms in anal intercourse, 25.8% in vaginal, and 0.8% in oral intercourse; 3.5% had a history of having a sexually transmit-ted infection. No associations were found between the use of condom and the participants' sex, history of sexually transmitted infections, average age of their first sexual intercourse, or university career. DISCUSSION: A small number of participants reported a history of sexually transmitted infections. A low proportion of health students of consistently use condoms, with a higher proportion in anal intercourse, which might be related to a low-risk perception of not using a condom. (AU)

Asunto(s)

RESUMEN

Case-control studies have been essential to the field of epidemiology and in public health research. In this design, data analysis is carried out from the outcome to the exposure, that is, retrospectively, as the association between exposure and outcome is studied between people who present a condition (cases) and those who do not (controls). They are thus very useful for studying infrequent conditions, or for those that involve a long latency period. There are different case selection methodologies, but the central aspect is the selection of controls. Data collection can be retrospective (obtained from clinical records) or prospective (applying data collection instruments to participants). Depending on the objective of the study, different types of case-control studies are available; however, all present a particular vulnerability to information bias and confounding, which can be controlled at the level of design and in the statistical analysis. This review addresses general theoretical concepts concerning case-control studies, including their historical development, methods for selecting participants, types of case-control studies, association measures, potential biases, as well as their advantages and disadvantages. Finally, concepts about the relevance on this study design are discussed, with a view to aid comprehension for undergraduate and graduate students of the health sciences. This is the third of a methodological series of articles on general concepts in biostatistics and clinical epidemiology developed by the Chair of Scientific Research Methodology at the School of Medicine, University of Valparaíso, Chile.

Los estudios de casos y controles han sido esenciales en el desarrollo de la epidemiología y de la salud pública. En este diseño, el análisis de los datos se realiza desde el desenlace hacia la exposición, es decir, retrospectivamente, ya que se estudia la asociación entre factores de exposición y un desenlace conocido entre personas que ya presentan una condición (casos) y quienes no la presentan (controles). Por lo tanto, son muy útiles en condiciones infrecuentes o que requieren una larga latencia para ocurrir. Existen distintas metodologías de selección de casos, pero el aspecto central es la adecuada selección de controles. La recolección de los datos puede ser retrospectiva (desde de registros clínicos) o prospectiva (mediante la aplicación de instrumentos de recolección de datos a los participantes). En función del objetivo del estudio, se dispone de distintos tipos de estudios de casos y controles, pero todos presentan una vulnerabilidad particular al sesgo de información y de confusión, los que pueden controlarse a nivel del diseño y del análisis estadístico. En este artículo se abordan conceptos teóricos generales sobre los estudios de casos y controles, considerando aspectos históricos, metodología de selección de participantes, tipos estudios de casos y controles, medidas de asociación, potenciales sesgos, ventajas y desventajas. Finalmente, se discuten algunos conceptos de relevancia sobre este diseño para los estudiantes de pre y posgrado de ciencias de la salud. Esta revisión es la tercera entrega de una serie metodológica sobre conceptos generales en bioestadística y epidemiología clínica desarrollada por la Cátedra de Metodología de la Investigación Científica de la Escuela de Medicina de la Universidad de Valparaíso, Chile.

Asunto(s)

RESUMEN

Observational studies evaluate variables of interest in a sample or a population, without intervening in them. They can be descriptive if they focus on the description of variables, or analytical when comparison between groups is made to establish associations through statistical inference. Cross-sectional studies and ecologicalalso called correlationalstudies are two observational methodological designs. Cross-sectional studies collect the data of the exposure variable and the outcome at the same time, to describe characteristics of the sample or to study associations. Ecological studies describe and analyze correlations among different variables, and the unit of analysis is aggregated data from multiple individuals. In both types of studies, associations of interest for biomedical research can be established, but no causal relationships should be inferred. This is the second of a methodological series of articles on general concepts in biostatistics and clinical epidemiology developed by the Chair of Scientific Research Methodology at the School of Medicine, University of Valparaíso, Chile. In this review, we address general theoretical concepts about cross-sectional and ecological studies, including applications, measures of association, advantages, disadvantages, and reporting guidelines. Finally, we discuss some concepts about observational designs relevant to undergraduate and graduate students of health sciences.

Los estudios observacionales analizan las variables de interés en la muestra o en la población, sin intervenir en ellas. Pueden ser meramente descriptivos si se focalizan en la descripción de las variables, o analíticos, en el caso de presentar grupos de comparación para establecer asociaciones mediante la inferencia estadística. Los estudios transversales y los estudios ecológicos, también llamados correlacionales, son dos diseños metodológicos observacionales. Los estudios transversales recogen los datos de la variable exposición y desenlace en un mismo momento, para describir sus características y eventualmente estudiar asociaciones. Los estudios ecológicos describen y analizan las correlaciones entre distintas variables, pero su unidad de análisis corresponde a datos agregados de múltiples individuos. En ambos casos no puede inferirse una relación causal, pero sí pueden establecerse asociaciones de gran interés para la investigación biomédica. Esta revisión es la segunda entrega de una serie metodológica sobre conceptos generales en bioestadística y epidemiología clínica desarrollada por la Cátedra de Metodología de la Investigación Científica de la Escuela de Medicina de la Universidad de Valparaíso, Chile. En este artículo se abordan conceptos teóricos generales sobre estudios transversales y estudios ecológicos, considerando sus aplicaciones, medidas de asociación, ventajas, desventajas y reporte. Finalmente, se discuten algunos conceptos de relevancia sobre diseños observacionales para los estudiantes de pre y posgrado de ciencias de la salud.

Asunto(s)

RESUMEN

Biomedical research, particularly when it involves human beings, is always subjected to sources of error that must be recognized. Systematic error or bias is associated with problems in the methodological design or during the execu-tion phase of a research project. It affects its validity and is qualitatively ap-praised. On the other hand, random error is related to variations due to chance. It may be quantitatively expressed, but never removed. This review is the first of a methodological series on general concepts in biostatistics and clin-ical epidemiology developed by the Chair of Scientific Research Methodology at the School of Medicine, University of Valparaíso, Chile. In this article, we address the theoretical concepts of error, its evaluation, and control. Finally, we discuss some current controversies in its conceptualization that are relevant to undergraduate and graduate students of health sciences.

La investigación biomédica, particularmente la que involucra a seres humanos, está siempre sometida a fuentes de error que deben ser reconocidas. El error sistemático o sesgo, se asocia con debilidades en el diseño metodológico o de la fase de ejecución del estudio. Éste afecta su validez y se valora cualitativamente. Por su parte, el error aleatorio se relaciona con las variaciones producidas por el azar, el cual puede expresarse cuantitativamente, pero nunca eliminarse. Esta revisión es la primera entrega de una serie metodológica sobre conceptos generales en bioestadística y epidemiología clínica desarrollada por la Cátedra de Metodología de la Investigación Científica de la Universidad de Valparaíso, Chile. En este artículo se abordan los conceptos teóricos asociados al error, su evaluación y control. Finalmente, se discuten algunas controversias actuales en cuanto a su conceptualización, de relevancia para estudiantes de pre y posgrado de ciencias de la salud.

Asunto(s)

RESUMEN

Cohort studies evaluate the relationship between exposure to a specific event or phenomenon and the occurrence of an associated out-come of interest (or lack thereof). This methodological design has been widely used in certain areas of medicine, such as the study of cardiovascular risk factors and the effects of ionizing radiation in humans. It is a useful study design, especially for research involving low-occurrence exposures, because it can be easily adapted to various contexts. This article, which provides an overview of observational cohort studies, is part of a methodology series on general concepts in biostatistics and clinical epidemiology developed by the Chair of Scientific Research Methodology at the University of Valparaísos School of Medicine in Chile. It describes historical, practical, and theoretical concepts related to cohort studies; essential elements in cohort study design, and variations and derivations of it; potential types and sources of bias in these types of observational/longitudinal studies, and various methods researchers can use to address/minimize them.

Los estudios con diseño de cohorte evalúan la relación entre una exposición y la ocurrencia o no de un evento de interés, comenzando el análisis desde la exposición. Habiendo sido diseños muy utilizados en algunas áreas de la medicina, como la descripción de factores de riesgo cardiovascular o los efectos de la radiación ionizante en humanos, representan una herramienta con características atractivas debido a su adaptabilidad a numerosos contextos, sobre todo en el estudio de exposiciones de baja ocurrencia. Esta revisión es la cuarta entrega de una serie metodológica sobre conceptos generales en bioestadística y epidemiología clínica desarrollada por la Cátedra de Metodología de la Investigación Científica de la Escuela de Medicina de la Universidad de Valparaíso, Chile. En este artículo, se abordan conceptos teóricos generales sobre los estudios de cohorte, considerando aspectos históricos, generalidades sobre la construcción de un estudio utilizando este diseño, presentando distintas variantes y diseños derivados de interés, y potenciales sesgos a los que se puede ver enfrentado el investigador.

Asunto(s)

RESUMEN

Introducción: La terapia anticoagulante oral es una herramienta esencial para prevenir eventos tromboembólicos. Los fármacos más utilizados para este propósito son los antagonistas de vitamina K, cuyo efecto se monitoriza con el International Normalized Ratio (INR). Existen varios factores que afectan el nivel de anticoagulación. Objetivo: Identificar los factores asociados a un INR fuera de rango terapéutico. Metodología: Estudio observacional de corte transversal que analizó los datos de pacientes en TACO, controlados en un policlínico especializado del Hospital Naval Almirante Nef. Resultados: Se analizaron los datos de 374 pacientes, correspondiendo 196 a hombres (52,4 por ciento). La edad promedio fue de 74 +/- 12 años. Un total de 272 pacientes presentaron un INR en rango terapéutico (72,7 por ciento), 102 usuarios tenían un INR no adecuado para su patología (27.3 por ciento). Los principales motivos asociados a un INR fuera de rango fueron: Olvido en la toma de medicamentos (35,3 por ciento), alteraciones dietarias (16,7 por ciento) e interacciones farmacológicas (14,7 por ciento). Se encontró asociación estadísticamente significativa con una edad > 80 años y un INR fuera de rango terapéutico (p=0,03). Discusión: Los pacientes en TACO controlados en el policlínico especializado del Hospital Naval Almirante Nef, presentan una frecuencia mayor de INR dentro de rango terapéutico que lo reportado por la literatura. Los factores reportados como probables causas de presentar un nivel de anticoagulación fuera de rango terapéutico coinciden con los descritos en diversos estudios. Finalmente, queda de manifiesto la importancia del cuidado de los adultos mayores, dado que son los más susceptibles de presentar un control inadecuado, particularmente aquellos que tienen 80 o más años.

Introduction: Oral anticoagulant therapy is an essential tool for prevention of thromboembolic events. The drugs most commonly used for this purpose are the vitamin K antagonists, which are monitored through the International Normalized Ratio (INR). Several factors affect the level of anticoagulation. Aim: To identify factors associated with an INR outside the therapeutic range. Methods: Cross-sectional observational study that analyzed data from patients in oral anticoagulant therapy, controlled at the anticoagulant clinic of the Almirante Nef Naval Hospital. Results: We analyzed data from 374 patients, 196 of them men (52.4 percent). Mean age was 74 +/- 12 years. 272 patients (72.7 percent) had an INR within the therapeutic range; 102 (27.3 percent) had an inadequate INR. Major factors associated with an INR out of range were: forgetting to take the medication (35.3 percent), alterations in diet (16.7 percent) and drug interactions (14.7 percent). A statistically significant association was found between age over 80 years and an INR outside the therapeutic range (p = 0,03). Conclusions: Patients followed for oral anticoagulant therapy at a specialized clinic have an INR within therapeutic range most of the time. Factors reported as probable causes of inadequate INR were consistent with those described in several studies. Special attention should be paid to elderly patients, as they are the most susceptible to inadequate control.

Asunto(s)

Asunto(s)

RESUMEN

BACKGROUND: Patients requiring prolonged invasive mechanical ventilation are prone to complications, such as infections, tracheal stenosis and death. It has been proposed that early tracheostomy could have a role in preventing these outcomes, but the proper identification of patients at risk can be difficult. PURPOSE: The aim of this study was to develop a multivariate model that allows the early detection of patients that will require prolonged ventilatory support. PATIENTS AND METHODS: A retrospective cohort study was undertaken in the intensive care unit of the Hospital Naval Almirante Nef, Chile, between June 2011 and June 2012. The charts of all intubated patients were reviewed in search for early predictors of prolonged intubation (>7 days). Multivariate logistic regression analysis was used to detect statistically significant associations and to assess potential confounders. RESULTS: A total of 349 patients were admitted to the intensive care unit during the study period and 142 (40.7%) required invasive mechanical ventilation. Most of them were male (60.5%), with a mean age of 65.8 ± 16.7 years. Thirty-five patients (24%) required to be ventilated for 7 days or more, and 16 (46%) were tracheostomized for this reason. The regression model showed that older age (p=0.026), a Pa/Fi ratio of less than 200 (p=0.046), and the presence of chronic pulmonary disease (p=0.035) or hypernatremia (p=0.012) on intubation day were significantly associated with the requirement of prolonged intubation. DISCUSSION: Invasive mechanical ventilation is a common reason for admittance to the ICU. The abovementioned predictors can be of assistance when selecting patients that could benefit from early tracheostomies, and are in agreement with earlier reports. Although the model's discriminating capacity was good, it is necessary to formally validate it before recommending its widespread use.

Asunto(s)