RESUMO
Introducción: El cáncer de mama constituye la primera causa de muerte en los cánceres en Chile según Globocan 2018. Dentro de los factores que explican esta alta mortalidad encontramos una baja tasa de detección y de realización de mamografías en los niveles socioeconómicos altos. Es por esto que comprender las causas de defunción y los factores que afectan en la mortalidad y letalidad por cáncer de mama en los últimos 17 años nos permitirá enfocar las políticas públicas de los próximos 50 años. Los objetivos generales de este trabajo fueron caracterizar los egresos hospitalarios en los pacientes por cáncer de mama según la edad, el sexo, la previsión, el nivel socioeconómico y educacional en Chile durante los años 2001 al 2016 y calcular la mortalidad y letalidad específica en estas mismas variables durante los años 2001 a 2016. El objetivo específico es asociar las variables socioeconómicas y educacionales, estimando los Odd's ratios de las variables en los egresos hospitalarios por cáncer de mama en Chile durante los años 2001 al 2016. Materiales y Métodos: Estudio de cohorte longitudinal retrospectivo en 81,072 egresos hospitalarios y 20,220 defunciones obtenidas de la página DEIS MINSAL, años 2001-2016. Para el análisis univariado se efectuó una regresión de ajuste de tasas Prais-weinstein según edad y sexo según modelo OMS de ajuste de tasas. Para las variables de tipo discreta se describieron mediante porcentajes y tasas y para las variables de tipo continua se utilizó mediana y desviación estándar. Se efectuó un test de smirnov-kolmolgorov para determinar el tipo de distribución y de normalidad de las muestras. Para las variables de tipo dicotómica se utilizó un modelo de regresión logística binaria para describir estas variables y determinar la posible asociación entre el nivel socioeconómico y educacional de las pacientes diagnosticadas por cáncer de mama. Resultados: Murieron 1,88 veces más personas de nivel socioeconómico alto con un IC entre 1,83- 1,94 con respecto a la población de nivel socioeconómico bajo. En cambio, las personas con un mayor nivel educacional murieron 0,5 veces menos según la regresión realizada respecto al bajo nivel educacional con un IC entre 0,47- 0,52, pero a menor nivel educacional aumentó 20 veces la mortalidad, constituyendo una causa inversa. Respecto al sexo las mujeres murieron 2,08 veces más que los hombres. Para el nivel socioeconómico alto en relación al bajo un OR [1.88 (1.83 a 1,94)], p<0,0001], para el nivel educacional alto en relación al bajo fue a favor del mayor nivel educacional con OR [0,5 (0,47 - 0,52)] y en cuanto a la comparación de sexos un OR [1,04 (1,03-2,17), p=0,039]. Es decir, la diferencia entre mortalidad que hubo fue significativa para todos los intervalos tanto para sexo, nivel educacional como para nivel socioeconómico. Se encontró una constante de 0,013 de mortalidad basal, es decir, todos tienen 1,3% de riesgo de morir por cáncer de mama independiente del nivel socioeconómico, educacional y del sexo. Conclusión: Existen diferencias estadísticamente significativas respecto a la mortalidad entre los niveles socioeconómicos altos y bajos y también en nivel educacional, sin embargo, al realizar los métodos de regresión se obtuvo una mayor mortalidad y mayor riesgo de morir por cáncer de mama en los niveles socioeconómicos más altos asociados a, probablemente, la menor cantidad de tamizajes y realización de mamografías en este estrato. A partir del año 2008 se observó un incremento a los niveles originales observados al inicio del segundo milenio incrementando las diferencias existentes en los índices de desigualdad tanto por nivel educacional como por nivel socioeconómico incrementando en 20 veces respecto al nivel educacional, y 1.88 respecto al nivel socioeconómico.
Introduction: Breast cancer is the leading cause of death in cancers in Chile according to Globocan 2018. Among the factors that explain this high mortality, we find a low rate of detection and performance of mammograms in high socioeconomic levels. This is why understanding the causes of death and the factors that affect mortality and fatality from breast cancer in the last 17 years will allow us to focus on public policies for the next 50 years Materials and Methods: Retrospective longitudinal cohort study in 79,996 hospital discharges and 20,220 deaths obtained from the DEIS MINSAL page, years 2001 -2016. For the univariate analysis, a Prais-Weinstein rate adjustment regression was performed according to age and sex according to the WHO rate adjustment model. For discrete type variables, they were described by percentages and rates, and median and standard deviation were used for continuous type variables. A smirnov-kolmolgorov test was performed to determine the type of distribution and normality of the samples. For dichotomous variables, a binary logistic regression model was used to describe these variables and determine the possible association between the socioeconomic and educational level of the patients diagnosed with breast cancer. Abstract: In this observational, longitudinal and retrospective study with 101.292 patients that includes men and women of all ages with diagnosis of breast cancer all along Chile, we´ll analyze the impact of socioeconomic level, evaluated through educational level and money income, into the prevalence, mortality and lethality of breast cancer in the years 2001 to 2016. Results: People with a high socioeconomic level died 1.88 times more, with a CI between 1.83 and 1.94, than those with a low socioeconomic level. On the other hand, people with a higher educational level died 0.5 times less according to the regression carried out with respect to the low educational level with a CI between 0.47 and 0.52, but the lower the educational level the mortality increased 20 times, constituting an inverse cause. Regarding sex, women died 2.08 times more than men. For the high socioeconomic level in relation to the low one an OR [1.88 (1.83 to 1.94)], p<0.0001], for the high educational level in relation to the low one it was in favor of the higher educational level with OR [0.5 (0.47 - 0.52)] and as for the comparison of sexes an OR [1.04 (1.03-2.17), p=0.039]. In other words, the difference between mortality was significant for all the intervals for sex, educational level and socioeconomic level. A constant baseline mortality of 0.013 was found, i.e., everyone has a 1.3% risk of dying from breast cancer regardless of socioeconomic level, educational level and sex. Conclusions: There are statistically significant differences in mortality between high and low socioeconomic levels and also in educational level; however, when regression methods were used, a higher mortality and higher risk of dying from breast cancer was obtained in the higher socioeconomic levels, probably associated with the lower number of screenings and mammograms performed in this stratum. As of 2008, an increase to the original levels observed at the beginning of the second millennium was observed, increasing the existing differences in the inequality indexes both by educational level and socioeconomic level, increasing by 20 times with respect to educational level, and 1.88 times with respect to socioeconomic level.
Assuntos
Humanos , Masculino , Feminino , Classe Social , Neoplasias da Mama/epidemiologia , Mortalidade , Escolaridade , Neoplasias da Mama/diagnóstico , Distribuição de Poisson , Chile/epidemiologia , Distribuição por Idade e SexoRESUMO
Diffuse Lung Disease (DLD) is an important cause of morbidity and mortality, however in Chile we are lacking of epidemiological data on this condition. Our aim is communicate the first report of a prospective registry of DLD patients treated at bronchopulmonary unit of DIPRECA hospital. Methods: Cross-sectional study in patients referred to our bronchopulmonary unit under suspicion of DLD. Diagnosis was confirmed by chest computed tomography and informed consent was approved by patients. Data regarding clinical, serological, pulmonary function tests and echocardiography were collected from 2014 up to date. Results: 30 patients were analysed, their median of age was 76.5 years-old (Interquartile Range 68-80), 56.7% were women, median duration of disease: 4 years (IQR 1-10.6) and 43% has smoking history Most frequent signs and symptoms were crackles (97%), dyspnoea (90%) and cough (57%). Comorbidities: 3% had asthma, 3% chronic obstructive pulmonary disease and 6.7% connective tissue diseases. Radiological findings: 20% had DLD with usual interstitial pneumonia pattern (UIP), 23% DLD possible UIP, 30% DLD inconsistent with UIP, 14% chronic hypersensitivity pneumonitis and 13% nonspecific interstitial pneumonia. Serology: 18% had positive rheumatoid factor of which only one case had rheumatoid arthritis, 67% had positive antinuclear antibodies (ANA), 17% ANCA positive of which only one case of clinical vasculitis. Spirometry was mainly normal (52%) or restrictive (45%). Echocardiography showed pulmonary hypertension mainly mild in 52% of patients. No significant association was found between titles of ANA ≥ 1/320 and gender, smoking or radiological pattern. Conclusions: Our demographic and radiological findings are similar to those reported in literature; however, the highlights in our cohort are the increased frequency of female gender and positive ANA without history or clinical manifestation of connective tissue diseases.
La enfermedad pulmonar difusa (EPD) es causa importante de morbimortalidad; a pesar de esto no tenemos datos epidemiológicos en Chile. Nuestro objetivo es comunicar el primer reporte del registro prospectivo de pacientes con EPD atendidos en la unidad de broncopulmonar del hospital DIPRECA. Métodos: Estudio de corte transversal en pacientes derivados alpoliclínico broncopulmonar del hospital DIPRECA por sospecha de EPD. En caso de confirmación diagnóstica por tomografía computada de tórax y consentimiento informado aprobado por los pacientes, se compilaron datos clínicos, serológicos, pruebas de función pulmonar y ecocardiografía, desde 2014 hasta la fecha. Resultados: Se analizaron 30 pacientes la mediana de su edad fue 76,5 años (rango intercuartílico 68-80), 56,7% eran mujeres, duración mediana de la enfermedad: 4 años (RIC 1-10,6)y 43% con antecedentes de tabaquismo. Los síntomas y signos más frecuente fueron crujidos (97%), disnea (90%) y tos (57%). Comorbilidades: 3% tenía asma, 3% enfermedad pulmonar obstructiva crónica y 6,7% enfermedades del tejido conectivo. Hallazgos radiológicos: 20% tenía EPD con patrón de neumonía intersticial usual (UIP), 23% EPD posible UIP, 30% EPD inconsistente con UIP, 14% neumonitis por hipersensibilidad crónica y 13% neumonía intersticial no específica. Serología: 18% tenía factor reumatoide positivo de ellos sólo uno de los casos tenía artritis reumatoide, el 67% tenía anticuerpos antinucleares (ANA) positivos, 17% ANCA positivo de ellos sólo un caso tenía historia de vasculitis clínica. La espirometría fue mayoritariamente normal (52%) o restrictiva (45%). Ecocardiografía detectó hipertensión pulmonar mayoritariamente leve en 52% de los pacientes. No se encontró asociación significativa entre los títulos de ANA ≥ 1/320 en relación a género, tabaquismo o patrón radiológico. Conclusiones: Nuestros hallazgos demográficos y radiológicos son similares a los de la literatura; sin embargo, destaca en nuestra cohorte la mayor frecuencia de género femenino y ANA positivos sin historia o manifestación clínica de enfermedades del tejido conectivo.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Doenças Pulmonares Intersticiais/patologia , Fibrose Pulmonar/patologia , Anticorpos Antinucleares , Autoimunidade , Estudos Transversais , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Doenças Pulmonares Intersticiais/imunologia , Fibrose Pulmonar/diagnóstico por imagem , Fibrose Pulmonar/imunologia , Fatores Sexuais , Tomografia Computadorizada por Raios XRESUMO
Microfluidic devices have grown significantly in the number of applications. Microfabrication techniques have evolved considerably; however, electric stimulation systems for microdevices have not advanced at the same pace. Electric stimulation of micro-fluidic devices is an important element in particle manipulation research. A flexible stimulation instrument is desired to perform configurable, repeatable, automated, and reliable experiments by allowing users to select the stimulation parameters. The instrument presented here is a configurable and programmable stimulation system for electrokinetic-driven microfluidic devices; it consists of a processor, a memory system, and a user interface to deliver several types of waveforms and stimulation patterns. It has been designed to be a flexible, highly configurable, low power instrument capable of delivering sine, triangle, and sawtooth waveforms with one single frequency or two superimposed frequencies ranging from 0.01 Hz to 40 kHz, and an output voltage of up to 30 Vpp. A specific stimulation pattern can be delivered over a single time period or as a sequence of different signals for different time periods. This stimulation system can be applied as a research tool where manipulation of particles suspended in liquid media is involved, such as biology, medicine, environment, embryology, and genetics. This system has the potential to lead to new schemes for laboratory procedures by allowing application specific and user defined electric stimulation. The development of this device is a step towards portable and programmable instrumentation for electric stimulation on electrokinetic-based microfluidic devices, which are meant to be integrated with lab-on-a-chip devices.
Assuntos
Estimulação Elétrica/instrumentação , Técnicas Analíticas Microfluídicas/instrumentação , Análise de Sequência com Séries de Oligonucleotídeos/instrumentação , Simulação por Computador , DNA/química , Desenho de Equipamento , Cinética , Dispositivos Lab-On-A-Chip , Técnicas Analíticas Microfluídicas/métodos , Saccharomyces cerevisiae/metabolismoRESUMO
La fibrilación durante un estudio electrofisiológico en pacientes con síndrome de Wolff-Parkinson-White es un problema relativamente frecuente que requiere en muchas ocasiones, de la administración de antiarrítmicos o cardioversión eléctrica, prolongando el tiempo del procedimiento. El propósito de este reporte es demostrar que es factible el mapeo y la ablación de una vía accesoria manifiesta durante fibrilación auricular y que así se puede acortar la duración del estudio. Durante el estudio electrofisiológico del paciente desapareció la pre-excitación y espontáneamente o por la manipulación de los catéteres, presentó fibrilación auricular pre-excitada. Decidimos realizar el mapeo de la vía durante esta arritmia porque mostraba máxima pre-excitación y pensamos que esto pudiera facilitar el registro del potencial de Kent y el sitio de éxito de la ablación. Con el catéter de ablación en la posición lateral izquierda y subvalvular se obtuvo un electrograma ventricular precoz y una deflexión rápido previa a la actrivación ventricular que corresponde al potencial del haz de Kent y que no observamos durante latidos no pre-excitados. Al aplicar la radiofrecuencia con control de temperatura al 70ºC, se eliminó la conducción anterógrada de la vía en los primeros tres segundos y continuamos la radiofrecuencia durante 2 minutos. El tiempo del procedimiento fue de 60 minutos. Concluimos que realizar el mapeo y ablación de una vía accesoria manifiesta durante fibrilación auricular es posible y que además de acortar la duración del procedimiento de ablación puede evitar cardioversiones eléctricas repetidas
Assuntos
Humanos , Masculino , Adulto , Ablação por Cateter/instrumentação , Ablação por Cateter/métodos , Eletrocardiografia/instrumentação , Eletrocardiografia/métodos , Fibrilação Atrial/cirurgia , Fibrilação Atrial/fisiopatologia , Sistema de Condução Cardíaco/anormalidades , Sistema de Condução Cardíaco/fisiopatologia , Sistema de Condução Cardíaco/cirurgia , Síndrome de Wolff-Parkinson-White/cirurgia , Síndrome de Wolff-Parkinson-White/fisiopatologiaRESUMO
Recent studies have revealed that binding of annexin I to phospholipids induces the formation of a second phospholipid binding site. It is shown that the N terminus on the concave side of membrane-bound annexin I is cleaved much faster by trypsin or cathepsin than the N terminus of the free protein. The reactivity of the unique disulfide bond located near the concave face was similarly increased by membrane binding. These results demonstrate that Ca(2+)-dependent membrane binding induces a conformational change on the concave side of the annexin I molecule and support the notion that this face of the molecule may contribute to the formation of the secondary membrane-binding site.
Assuntos
Anexina A1/química , Lipossomos , Fosfatidilserinas , Conformação Proteica , Anexina A1/metabolismo , Sítios de Ligação , Cloreto de Cálcio/farmacologia , Cinética , Fosfatidiletanolaminas , Conformação Proteica/efeitos dos fármacos , Tripsina/metabolismoRESUMO
El objetivo del estudio ha sido el peso de nacimiento, importante condición pronóstica de la morbilidad del recién nacido. Sus determinantes son biológicas, obstétricas y ambientales, entre las cuales se encuentra el nivel socioeconómico, variable poco estudiada. Se han comparado los pesos de nacimiento de 19.578 y 3.115 niños nacidos durante 1984 en 2 hospitales públicos y 2 privados, en una muestra aleatoria de 5 por ciento y 20 por ciento para cada universo. La condición socioeconómica fue claramente inferior en las maternidades públicas, así como el peso promedio de sus recién nacidos en ese año: 3.181 g, en comparación con 3.317 g en las privadas. Se observó un incremento en el peso, paralelo con la edad de las madres, la cual fue superior en cuatro años en las maternidades privadas, 30 y 26 años respectivamente. Este análisis debería ser completado con el estudio del factor paridad y otras variables obstétricas y biológicas para conclusiones más definidas
Assuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Adulto , Peso ao Nascer , Hospitais Públicos/estatística & dados numéricos , Hospitais Privados/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Idade Materna , Parto/estatística & dados numéricos , Cobertura de Serviços Privados de Saúde , Amostragem Aleatória Simples , Classe Social , Cobertura de Serviços Públicos de SaúdeRESUMO
De agosto de 1988 a octubre de 1993, 19 pacientes portadores de coartación aórtica nativa (CoAo) fueron sometidos a angioplastía transluminal percutánea con balón (ATPB). Doce fueron hombres (63.1 por ciento) y 7 mujeres (36.9 por ciento), con edad promedio de 22 ñ 7.7 años (extr. 16-52). Todos eran portadores de hipertensión arterial al momento del procedimiento, con una presión sistólica de 190 ñ 32.3 mmHg (extr. 160-240). El gradiente de presión sistólica (GPS) fue de 77 ñ 24 mmHg (extr. 45-130), un diámetro del anillo de coartación de 4.2 ñ 0.9 mm, el diámetro promedio de los catéteres balón utilizados fue de 18.3 ñ 1.7 mm (extr. 15-20). En todos los pacientes, el procedimiento se efectuó bajo anestesia local y con la técnica habitual de Seldinger. Después de efectuar el procedimiento, el GPS así como la presión arterial descendieron a 5.0 ñ 4.1 mmHg y 130 ñ 20.6 mmHg respectivamente y la ampliación del anillo presentó un aumento de 4.2 ñ 0.9 a 14.1 ñ 1.6 mm. En ninguno de los procedimientos se presentaron complicaciones: en el seguimiento 11 pacientes se han vuelto a cateterizar en un lapso de 24.7 ñ 12.6 meses (extr. 10-48) con un GPS de 5 ñ 2 mmHg y se observó un aumento en el diámetro del anillo a 15.4 ñ 1.2 mm. En estos sujetos vueltos a estudiar no se evidenciaron aneurismas en el sitio de la dilatación; el resto de los sujetos intervenidos llevan un control por consulta externa: 17 de ellos se mantienen normotensos sin tratamiento médico y dos únicamente han requerido de terapia antihipertensiva con mejor control a dosis bajas. Nuestra experiencia sugiere que la ATPB en CoAo tipo diafragma a cualquier edad es segura y muy efectiva con mejoría sostenida a mediano y largo plazo
Assuntos
Adolescente , Adulto , Humanos , Masculino , Feminino , Angioplastia com Balão/instrumentação , Angioplastia com Balão/métodos , Angioplastia com Balão/reabilitação , Coartação Aórtica/terapiaRESUMO
All sick leaves during 1989 among academics and students of a Faculty of Medicine were analyzed. Twenty three percent of academics and 60.5% of students had at least one sick leave during the year. The mean general rate of absenteeism among academics was 3.55% (1.6% among men and 8.09% among women). The mean length of sick leaves was 13.5 days. Eighteen percent of lost working days were due to pregnancy, lactation or care needs of less than one year children. Tumors, trauma, respiratory, digestive and mental illnesses accounted for 72.8% of lost working days. Medical students had a mean general absenteeism rate of 2.66% (ranging between 1.8% among male sixth year and 4.8% among female fourth year students). Mean length of sick leaves was 3.5 days (ranging from 2.98 among female fifth year and 6.7 among male sixth year students). Respiratory, digestive and infectious diseases accounted for 74% of lost days. No sick leaves were observed, due to pregnancy or lactation among students or due to occupational diseases among academics.
Assuntos
Absenteísmo , Docentes de Medicina/estatística & dados numéricos , Saúde Ocupacional/estatística & dados numéricos , Faculdades de Medicina , Estudantes de Medicina/estatística & dados numéricos , Chile/epidemiologia , Feminino , Humanos , Incidência , Masculino , Prevalência , Estudantes de Medicina/psicologia , Fatores de TempoRESUMO
Fifty-five patients totaling 98 hips afflicted by Dysplasia Capitis Femoris (DFC), monitored between 1960 and 1983, were analyzed. Mean follow-up: 8 years and 4 months (minimum 2 years, maximum 22 years and 2 months). Forty-three (78%) patients were males; fourteen (25%) were females. Non displayed any alteration in other osteoarticular segments. In 24 of the 98 affected hips it was possible to determine the exact radiological age appearance of the Epiphyseal Nucleus. Thirty-seven of the 55 patients had moderate signs and symptoms which were of short evolution. According to presence or absence of necrotic signs of the femoral epiphysis, two types of lesions were classified: Type 1: Pure Dysplasia Capitis Femoris (88 hips). Type 2: Dysplasia Capitis Femoris with unequivocal signs of necrosis (10 hips). Upon review of the 98 diseased hips, 80 (81.63%) had been fully repaired, while 18 (18.37%) were in reparatory stage. From the 80 fully healed hips, 56 were normal; 18 exhibited a Spherical Coxa Magna and 6 had a non-spherical epiphysis. As treatment concerns, patients with D.C.F. Type 1-A or Type 1-B only require observation and periodical control in addition to moderate restrictions in physical activities upon presence of symptomatic pain that is transitional. Patients with D.C.F. Type 2 must be treated as a classic case of Perthes Disease. Finally, a hypothesis of their etiopathogenis and its relationship to Perthes Disease is brought forth.
Assuntos
Cabeça do Fêmur/diagnóstico por imagem , Luxação Congênita de Quadril/complicações , Doença de Legg-Calve-Perthes/etiologia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Cabeça do Fêmur/crescimento & desenvolvimento , Luxação Congênita de Quadril/diagnóstico por imagem , Humanos , Lactente , Doença de Legg-Calve-Perthes/diagnóstico por imagem , Masculino , RadiografiaRESUMO
Se presentan 30 pacientes sometidos a una resección hepática entre enero de 1982 y mayo de 1991. En 17 de ellos (56,7%) se utilizó isquemia normotérmica. Las indicaciones más frecuentes de resección hepática fueron un hepatocarcinoma en 16 pacientes (53,3%), metástasis hepática de otro tumor primario en 7 (23,3%) y una enfermedad de Caroli en 3 (10%). Las resecciones hepáticas que se practicaron fueron la lobectomía derecha en 10 pacientes y la lobectomía derecha extendida en 6, la lobectomía izquierda en 3 y otras en 11. La duración promedio del período de isquemia normotérmica fue de 43 min, y disminuyó el sangrado intraoperatorio sin consecuencias sobre la función hepática. Las complicaciones más frecuentes fueron las pleuropulmonares (23,2%). Ictericia en el postoperatorio se constató en 12 pacientes (40,0%), 8 de ellos (66,7%) en el grupo no sometido a isquemia. Encefalopatía portal grado 1-2 se presentó en 6 enfermos (20,0%), 3 de ellos en el grupo sometido a isquemia. La mortalidad fue 6,5%. Se concluye que las resecciones hepáticas pueden efectuarse actualmente con baja mortalidad y que el uso de isquemia normotérmica selectiva contribuye a disminuir la hemorragia y las complicaciones en estos pacientes
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Carcinoma Hepatocelular/cirurgia , Hepatectomia , Neoplasias Hepáticas/cirurgia , alfa-Fetoproteínas/análise , Angiografia/estatística & dados numéricos , Antígeno Carcinoembrionário/sangue , Seguimentos , Complicações Pós-OperatóriasRESUMO
PIP: Using Bolivia as the example, the author critiques international organization and health professional emphasis upon providing family planning services as inadequate to meet the needs and interests of poor women. The feminist and women's movements should be expected to fight to regain the right of self-determination, and to demand integral health care for women. Contraception will constitute but a component of this holistic approach. Poverty, natalism, development, and population policies are all interrelated issues in Bolivia as the country proceeds through a period of democratization. Where total fertility averages 5 children/women as it does in Bolivia, women should certainly have the right to choose contraception in the control of fertility. Simple provision of such services and supplies will not, however, suffice to solve more deeply rooted social and economic problems faced by those women. The author further fears that some parts of the feminist movement have forgotten that population and related policies developed and imposed by other cultures have little interest in respecting the self-determination of women as individuals. Support for these policies by movement members only reinforces and helps to reproduce existing conditions of poverty and unequal rights.^ieng
Assuntos
Publicidade , Economia , Estudos de Avaliação como Assunto , Planejamento em Saúde , Direitos Humanos , Organizações , Filosofia , Política , Pobreza , Poder Psicológico , Política Pública , Fatores Socioeconômicos , Esterilização Reprodutiva , América , Bolívia , Países em Desenvolvimento , Serviços de Planejamento Familiar , América Latina , Marketing de Serviços de Saúde , América do SulRESUMO
After 6 years of operation of a National (autonomous) Board for Certification of Medical Specialists, the number, distribution and training of medical specialists is analyzed. Problems regarding significant differences in the quality of training and imbalance among different specialties are identified. The medical profession has expressed its confidence and feels supported by the activities of the Board. However, health care deliverers and users in general are expected to increase their support and consideration for the information provided by the Board, in order to fulfill the purpose for which it was established.
Assuntos
Medicina/normas , Especialização , Conselhos de Especialidade Profissional/normas , Chile , HumanosRESUMO
This is a current status of diagnosis and management in intestinal obstruction. The importance of a very carefully clinic history and medical examination is discussed, and the relation of them in morbidity and mortality in this problem. Sub acute, recurrent and chronic cases must be carefully studied, after and acute episode.
Assuntos
Obstrução Intestinal , Emergências , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/etiologia , Obstrução Intestinal/terapiaRESUMO
We analyzed causes of death before and after the March 1985 earthquake in Valparaíso, Chile. Causes of death were obtained from death certificates. Apart from death directly due to trauma during the earthquake, a significant increase was observed in deaths due to accidents (+51), cardiovascular disease (+38), malnutrition (+13) and psychiatric disorders (+13). Retired males over age 65 were most affected.
Assuntos
Desastres , Mortalidade , Adolescente , Adulto , Fatores Etários , Idoso , Causas de Morte , Criança , Pré-Escolar , Chile/epidemiologia , Desastres/estatística & dados numéricos , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Fatores SexuaisRESUMO
We surveyed a probabilistic sample of 1383 school children attending elementary school (5th to 8th grade) in La Pincoya, a neighborhood of northern Santiago. 53.7% had smoked at least once, and 1 out of 5 were regular smokers of 1-4 cigarettes (72%) or more than 5 cigarettes a day (14%). The incidence of smoking was higher among boys and increased with age. Smoking occurs in different places including the street (19%). About 60% of children get their cigarettes from other children or adults. Those who buy, do so by units rather than packs. The incidence of smoking raised to 64% among children of parents who smoked. Pleasure or imitation were quoted as main reasons for smoking.
Assuntos
Fumar/epidemiologia , Estudantes , Adolescente , Fatores Etários , Criança , Chile/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Fatores SocioeconômicosRESUMO
UNLABELLED: 166 patients with congenital dislocation of the hip, ranging from 10 months to 5 years old, were operated between 1958 and 1971. 140 patients were women (84%) and 26 patients were men (16%). 96 patients had unilateral and 70 patients had bilateral dislocation; that makes a total of 236 dislocated hips. 61 patients with bilateral hip dislocation were operated simultaneously on both hips. All the patients were treated with adductor tenotomy and open reduction through Smith Petersen incision with section or elongation of the psoas tendon. The postoperative immobilization consisted in a period of one month pelvic toecast followed by 2 plaster casts with abduction rod during 3 to 5 months. The postoperatory follow-up ranged from 9 years to 26 years, 2 months; average 14 years, 5 months. The clinical evaluation comprises pain, hip mobility, gait and muscle power. RESULTS: excellent 138 (59%); good 66 (28%); fair 29 (12%); and poor 3 (1%). The radiological evaluation considered: Mose; acetabular femoral head index; Wiberg's CD-angle; cervico-diaphysiary angle and radial quotient. RESULTS: normal 5 (2%); excellent 44 (19%); good 78 (33%); subtotal 54%; fair 90 (38%), and poor 19 (8%). Complications (hips); infections 12 (5%); 3 of them deep ones (1%); residual subluxation 19 (8%); reluxation 1 (0.5%). Isquemic necrosis Grade II of Tönnis 31 (13%); Grade III 2 (1%) and Grade IV 1 (0.5%).