Luis Villarroel D

Bienestar materno durante el proceso de parto: desarrollo y aplicación de una escala de medición

RESUMEN Objetivo: Disenar y validar un instrumento objetivo y autoaplicable para evaluar el nivel de bienestar que experimentan las mujeres en situacion de parto. Metodo: Se considero la combinacion de las metodologias cualitativas y cuantitativas. A traves de grupos de focos y entrevistas individuales, se recogio la percepcion subjetiva del bienestar materno, sus indicadores y sus distintas dimensiones. En la tapa cuantitativa, a traves de un diseno correlacional de corte transversal, se valido la escala y se exploro el nivel de bienestar materno en 303 mujeres puerperas que tuvieron su parto en un hospital publico del area sur oriente de Santiago. Resultados: La Escala de Bienestar Materno en Situacion de Parto BMSP, exploro el bienestar materno en tres niveles: optimo, adecuado y malestar; mas de un 60% de las mujeres reportaron un nivel de bienestar adecuado u optimo, referido al “buen trato”, asociandose significativamente al tipo de parto y la paridad de la mujeres. El puntaje de bienestar no se relaciona con la hora del turno, con la situacion de pareja, ni con el nivel educacional y socioeconomico de las mujeres. La dimension que mejor se correla-ciona con el bienestar corresponde al cuidado profesional de calidad, la que reporto mejor puntaje como subescala. Conclusion: El instrumento permitio evaluar el bienestar materno durante el parto.PALABRAS CLAVES: Bienestar materno, satisfaccion de usuaria, parto, escala, puntajeSUMMARY Objective: To design and test an objective and self-administered instrument in order to evaluate the wellbe-ing of women during childbirth. Method: Combinations of qualitative and quantitative methodologies were considered. Using focus groups and individual interviews, the subjective perception of maternal wellbeing in its distinct dimensions was explored. In the quantitative phase, using a cross sectional correlational design, the scale was tested and validated in 303 women post-partum in a public hospital in the south west section of Santiago, and at the same time the level of wellbeing of women in childbirth was explored. Results: The Scale of Maternal Wellbeing in Childbirth, explored maternal wellbeing in three levels: optimal, adequate and unpleasant; more than 60% of the women reported their level of wellbeing as adequate or optimal, significantly associated with the type of delivery and parity of the women. The score of wellbeing was not associated with time of shift, partner status, level of education, or socio-economic status of the women. The dimension that significantly correlated with the wellbeing score was the quality of professional care, this one reported de highest score as a subscale. Conclusion: The instrument allow to evaluate the maternal wellbeing during childbirth. KEY WORDS: Maternal wellbeing, patient satisfaction, childbirth, scale, score

Diseño de un índice pronóstico clínico para el manejo de la neumonía del adulto adquirida en la comunidad

2 days, altered mental status, absence of cough, fever and chills; low bloodpressure, tachypnea, hypoxemia and multilobar radiographic pulmonary infiltrates. A clinicalprognostic index derived from a logistic regression analysis including five independent variablesassociated with mortality (confusion, comorbidity, low systolic blood pressure, temperature <37.5

Proposición de nuevas ecuaciones para calcular valores espirométricos de referencia en población chilena adulta: Sociedad Chilena de Enfermedades Respiratorias (SER)

BACKGROUND To correctly interpret spirometric results, reference values should come from the same population. Current spirometric reference equations have been under scrutiny due to deficiencies to fit adequately for Chilean population, specially, for those aged over 65 years old. AIM To develop new spirometric reference values for Chilean adults, based on national studies in which spirometries were performed in healthy non-smoker adults. MATERIAL AND METHODS A standardized database of spirometric values was developed combining spirometric data collected from five population-based studies, in which healthy nonsmoker adults participated. Spirometries from 448 males aged 19 to 84 years and from 726 females aged 19 to 94 years, obtained according to guidelines from the American Thoracic and European Respiratory Societies, were analyzed. Using multiple regression models, which included height, gender, and age, the theoretical value and inferior limits of normality were calculated for 1st second (FEV1), forced vital capacity (FVC), FEV1/FVC, and forced mid-expiratory flow rate (FEF25-75). RESULTS Reference values and lower limits of normality (LLN) were constructed for Chilean adults of both genders. The new proposed set of equations had a better fit, when compared with the current reference values used in Chile. CONCLUSIONS The new spirometric references values derived from this study, fit better than currently used ones. Therefore, they should be used as new references values for Chilean adults.

Riesgo de delirium durante la hospitalización en personas mayores: desarrollo y validación de un modelo de predicción clínica

BACKGROUND Delirium is a prevalent problem among older patients and it is frequently underdiagnosed. AIM To develop and validate a clinical predictive model to identify patients at high risk of delirium. MATERIAL AND METHODS Two consecutive prospective cohort studies were used to develop and validate the model. The development cohort included 542 consecutive medical inpatients, 65 years or older. The validation cohort included 85 comparable patients. A predictive score was constructed with a multivariate analysis, using variables independently associated with delirium and subsequently tested in the new cohort. Patients were assessed within the first 48 hours of admission, and every 48 hours thereafter, using the Confusion Assessment Method to diagnose delirium, evaluating also the severity of underlying disease, comorbidities, functionality, and laboratory data. RESULTS Delirium occurred in 192 patients (35.4%) of the development cohort and was independently associated with age and functional status assessed using the Barthel Index. With these two variables, the predictive score for delirium was developed and tested rendering an area under the receiver operating characteristic (ROC) of 0.80 (confidence intervals 0.77-0.85). Cut-off points were chosen to establish low, intermediate, and high-risk groups for delirium. According to these cut-off points, delirium frequencies in the development cohort were 8%, 23%, and 69%, and in the validation cohort 5%, 34%, and 66%, respectively (c² p<0.05). CONCLUSIONS This simple predictive model based on age and functional status may be a useful tool for identifying older patients risking delirium.: Two consecutive prospective cohort studies were used to develop and validate the model. The development cohort included 542 consecutive medical inpatients, 65 years or older. The validation cohort included 85 comparable patients. A predictive score was constructed with a multivariate analysis, using variables independently associated with delirium and subsequently tested in the new co-hort. Patients were assessed within the first 48 hours of admission, and every 48 hours thereafter, using the Confusion Assessment Method to diagnose delirium, evaluating also the severity of underlying disease, comorbidities, functionality, and laboratory data.

Efecto del contacto piel con piel sobre la presencia de síntomas depresivos post parto en mujeres de bajo riesgo obstétrico

Background: Postpartum depression can interfere with bonding between the mother and the child. The skinto- skin contact is defined as the contact of the new born, dry and naked, prone on the mother’s bare chest and with a warm blanket placed across the infant’s back; this contact takes place immediately after delivery, for at least an hour. Objective: To examine the relationship between skin-to-skin contact and the incidence of depressive symptoms in women with low risk pregnancies. Patients and Method: A prospective analytical study was performed in 393 postpartum women with low obstetric risk in order to evaluate the postpartum depressive symptomatology and its association with biodemographic and skin-to-skin contact variables. Data were collected through a questionnaire at 24 to 48 hours postpartum and through telephone follow-up, at 8 weeks postpartum, in order to screen depressive symptoms using the Edinburgh Depression Scale. Results: 29% of women reported depressive symptoms. The analysis showed that skin-to-skin contact and early initiation of breastfeeding are significantly associ ated with the absence of postpartum depressive symptomatology. Conclusion: Skin-to-skin contact was the only variable in this study that can explain the absence of depressive symptoms in women with low risk pregnancies. Skin-to-skin contact implementation is suggested as a preventive strategy.

Clima laboral en una escuela de medicina. Estudio de seguimiento

A standardized survey was applied to faculty members andDepartament chairs of the academic units of our Medical School. The survey used the Likert scalefrom 1 to 5 and included 59 items, distributed in 8 factors. Additionally, there were two groups ofstatements, indicating the priorities for the School and for the academic departments.

Adaptación y validación de la escala de bienestar materno en situación de parto: segunda versión para escenarios de asistencia integral

Antecedentes: La literatura actual ha mostrado escasa informacion respecto del bienestar materno durante el proceso de parto. Objetivo: Mejorar la exigencia de la Escala Bienestar materno en Situacion de Parto (BMSP1), para ser utilizada en modalidades integrales de asistencia, se adapta la version inicial y se valida estadisticamente. Metodo: Se utiliza una muestra no probabilistica de 223 puerperas de bajo riesgo, que participan como grupo control, previo a la implementacion del Centro de Asistencia Integral del Parto en un hospital publico de Santiago. A la escala BMSP1 se agregan 10 afirmaciones alineadas con las politicas de parto integral y, posteriormente, se le aplica dos pruebas psicometricas que permiten evaluar su consistencia interna y reagrupar los items en nuevas dimensiones-subescalas. Resultados: Se obtiene un instrumento valido y fiable, apto para recoger la percepcion de bienestar en modalidades de asistencia integral del parto. Se compone de 7 dimensiones que agrupan a 47 afirmaciones de bienestar o malestar. La primera, referida al cuidado relacional de calidad, concentra la mayor cantidad de afirmaciones. El resto de las dimensiones agrupan, cada una, a lo menos 4 items de bienestar o malestar, y se refieren a las condiciones ambientales, a la percepcion de contacto precoz con el hijo, al acompanamiento familiar, a las medidas de autocuidado y confort, al cuidado oportuno y respetuoso; asimismo, la que tiene relacion con la despersonalizacion del cuidado. Conclusion: La escala BMSP2 es aplicable para evaluar bienestar materno en escenarios de parto con las exigencias de un proceso integral, de calidad y seguridad.

Determinación de péptidos solubles relacionados a mesotelina para la detección precoz del mesotelioma maligno

Resumen Introduccion: El Mesotelioma Maligno (MM) es un tumor de las celulas mesoteliales relacionado a la exposicion a asbesto, altamente agresivo, con pobre respuesta al tratamiento y con una sobrevida promedio de 8 meses despues del diagnostico. Sin embargo, nuevos agentes quimioterapeuticos yprotocolos de terapia trimodal han logrado sobrevidas de hasta 40% en etapas iniciales. La deteccion en sangre periferica de Peptidos Solubles Relacionados a Mesotelina (SMRP) podria ser util para el diagnostico precoz de MM. Utilizando el test MESOMARK® para la determinacion de SMRP, 53% de los pacientes con MM tenian valores mayores a 1,5 nM mientras que 99% de los controles mostraron valores inferiores. El objetivo delpresente trabajo es evaluar la implementacion de este test en Chile y determinar su utilidad para el diagnostico precoz en MM. Metodos: Medicion cuantitativa de SMRP en suero humano por test MESOMARK®. Se realizaron mediciones en forma ciega a 8 trabajadores con exposicion a asbesto, a 5 pacientes con MMy a 14 voluntarios sin exposicion. Todos los participantes fueron informados del estudio. Resultados: Elpromedio ± desviacion estandar de SMRP en el grupo control fue de 0,53 ± 0,4 nM, de 0,89 ± 0,46 nM en los expuestos sin MMy de 10,68 ± 10,28 nM en el grupo con MM; encontrandose una diferencia estadisticamente significativa entre los valores de estos tres grupos (p = 0,02). En el grupo con MM, 3 pacientes tuvieron concentraciones mucho mayores a 1,5 nM (17,27 nM; DS 6,95) y 2 valores normales (0,79 nM; DS 0,32). Utilizando un valor de 1,5 nM como punto de corte, la sensibilidad fue de 60% y la especificidad de 100%. Conclusiones: La medicion de SMRP permitio diferenciar a los pacientes con MM, presentando 3 de ellos concentraciones muy elevadas. La sensibilidad y especificidad encontrada es similar con datos previamente reportados. De confirmarse estos resultados en estudios con mayor numero de pacientes este test podria ser implementado para el diagnostico precoz de MM.