Luis Villarroel del P

Edad materna avanzada y riesgo reproductivo

Background: Pregnancy at extreme ages is a risk factor for maternal, perinatal and infantile death. Aim: To assess the obstetric risk of women over 40 years old. Material and methods: The risk of maternal, late fetal, neonatal and infantile deaths and the risk of low birth weight was assessed in women over 40 years old and compared to the risk of women aged 20-34 years. Data was obtained from the 1999 Annual Report of the National Statistics Institute and the odds ratios (OR) with a 95% confidence interval were calculated. Results: Women over 40 years had a higher risk of maternal death (OR 7.13, 3.31-14.97), late fetal death (OR 2.19, 1.69-2.85), neonatal death (OR 1.8, 1.4-2.32), infantile death (OR 1.8, 1.49-2.18) and low birth weight (OR 1.72, 1.58-1.88). Conclusions: The higher reproductive risk of women over 40 years is confirmed. Better birth control programs at this age will reduce this risk (Rev Med Chile 2003; 131: 55-59)

Aumento de la mortalidad por cáncer de colon en Chile, 1990-2003

Background: In Chile, colorectal cancer is the third cause of mortality due to digestive cancer. Aim: To assess the evolution of colon cancer mortality rates in the period 1990-2003. Material and methods: Information was obtained from demography and vital statistics yearbooks, published by the Chilean National Statistics Institute. Mortality tendecies and slopes, were calculated using Pearson correlation analysis and linear regression. Proportions were compared using Chi square. Results: There was a significantly rising tendency in mortality for colon cancer in the general population (r= 0.964, p <0.001), in men (r=0.926, p <0.001) and in women (r=0.943, p <0.001). This tendency was not modified if rates were corrected by age. Mortality among women was significantly higher in all study years. The increase in mortality rates in the period was 0.175/100,000 inhabitants per year. The higher mortality rates were observed during 2003, reaching 6.2/100,000 inhabitants. Conclusions: There was a steady increase in colon cancer mortality during the studied period

REDUCCIÓN DE LA MORTALIDAD POR CÁNCER CÉRVICO UTERINO EN CHILE, 1990-2003

SUMMARY Objective: To analyze the effect of the National Program for Cervical Cancer on the mortality trend due to this cancer in Chile during 1990-2003, and the feasibility to achieve a 40% reduction in mortality rate at the year 2010. Methods: The number of deaths due to cervical cancer, the age interval of the deceased women, and the estimate of women population were obtained from the Year Book edited by the National Institute of Statistics of Chile. The gross and age-adjusted mortality rates were calculated using year 2003 as a standard of population number. The trend and the slope for the period, and the estimated number of deaths at year 2010 were calculated using linear regression. Results: A significant descending trend for the adjusted death rate was observed when comparing years 1990 and 2003 (from 14.3/100,000 in 1990 to 8.5/ 100,000 in 2003, r=‐0.977; p<0.001). The slope for the period showed a yearly reduction in rate of 0.463/ 100,000 women, estimating for year 2010 a mortality rate about 4.8/100,000 women, lower than the objective proposed by the Public Health Ministry of Chile. Conclusions: The introduction of a National Program for Cervical Cancer has allowed reducing significantly the mortality rate due to this cancer between

Desempeño académico de los estudiantes de medicina: ¿Un resultado predecible?

Aceptado en version corrBackground: Traditionally, medical schools demand their students a high dedication in time, responsibility and integrity. Aim: To assess the predictive capacity of several specific variables, on the academic performance of medical students. Material and methods: All students who entered during 1984-1995 period were studied. The academeic performance was assessed using two indices: an overall evaluation of successfulness as determined by the approval rate in different courses and grade-point average obtained during the first three years at the Medical School. The variables used to predict academic performance were year of enrollment, high school grades, university admission test scores, biomedical and demographic characteristics. All these were meassured at the time when the student was enrolled. Results: Eight hundred and eight students were studied at the end of the third year. The most important predictive variables selected for both performance indices were: high school grades, admission biology test scores, place were high school studies were done, and previous university studies. In addition verbal and mathematics admission academic performance tests scores were selected for grade-point average index. Although, the overall admission score and high school academic performance were significantly associated with the two outcomes, they were not selected in the final models. Conclusions: The best predictors of an optimal academic performance in these medical students were high school grades, admission bilogy test scores, residing in Metropolitan Santiago and previous university studies. (Rev Med Chile 2000; 128: 671-8).

Anemia en las embarazadas de la comuna de Puente Alto, Chile

Background: Micronutrient deficiencies, specially iron, render pregnant women as one of the most vulnerable groups to have anemia. Aim: To report the prevalence of anemia during pregnancy and its associated features in women attending public clinics in the Puente Alto County. Material and methods: We studied 1683 pregnant women aged 18 years old or more. Hemoglobin concentration was determined using the cianmetahemoglobin method. Anemia was defined using the 5th percentile cut-off for each week of gestational age as proposed by R Yip from the Centers of Disease Control, 1989. The influence of maternal age, parity, nutritional status classified using weight/height, diseases and smoking habits on hemoglobin concentration were analyzed using logistic regression with a stepwise procedure. Results: Thirteen percent of the study population was anemic. The single factor significantly associated with anemia was nutritional status. Twenty one percent of women with a low weight for height were anemic. Conclusions: These results support the concept that pregnant women with a low weight for height have the greatest risk for anemia and should be specially benefited with preventive or treatment programs to avoid this problem (Rev Med Chile 2003; 131: 520-525).

CARACTERÍSTICAS Y EVOLUCIÓN DE LA SEXUALIDAD EN MUJERES HISTERECTOMIZADAS

RESUMENEstudio analitico longitudinal prospectivo, sobre caracteristicas de sexualidad y su evolucion a los 6meses en 104 mujeres histerectomizadas de un hospital publico de Santiago. La recoleccion de los datosfue a traves de una entrevista. Para el analisis se utilizo t Student, Q de Cochrane y Kappa. El reinicio dela vida sexual fue en promedio a los 52,7 + 27 dias posthisterectomia. No hubo diferencias significativasen la frecuencia de relaciones sexuales; presencia y frecuencia de orgasmo; percepcion de deseo sexualy grado de excitacion sexual. La prevalencia de incontinencia y dispareunia disminuyeron significativamentey la satisfaccion sexual de la mujer mejoro a los seis meses. Se concluye que al igual que en estudiosinternacionales, la sexualidad de las mujeres no se afecta negativamente despues de la histerectomia y seplantea la importancia de la educacion sexual en estas mujeres.PALABRAS CLAVES: Sexualidad, histerectomiaSUMMARYProspective longitudinal analytic study on sexuality characteristics and its evolution within 6 months ina group of 104 hysterectomized women from a public hospital in Santiago. Data compilation was done bymeans of an interview. For the analysis, t Student test, Q Cochrane and Kappa test were used. The newbeginning of sexual life started at an average of 52.7 + 27 days after hysterectomy was done. There wasno significant change in sexual intercourse frequency, presence and orgasm frequency, perception of sexualdesire and degree of sexual excitement. Incontinence prevalence and dyspareunia decreased dramaticallyand womens sexual satisfaction improved after 6 months. Therefore, just like some international studies,womens sexuality is not negatively affected after hysterectomy and the issue on sexual educationsignificance in those women raises.KEY WORDS: Sexuality, hysterectomy

INGESTA DE MACRONUTRIENTES Y PREVALENCIA DE MALNUTRICIÓN POR EXCESO EN ESCOLARES DE 5º Y 6º BÁSICO DE DISTINTO NIVEL SOCIOECONÓMICO DE LA REGIÓN METROPOLITANA

El sobrepeso y la obesidad infantil se han transformado en un importante problema en salud publica. Objetivo: evaluar la ingesta de macronutrientes y determinar la prevalencia de malnutricion en escolares de 5° y 6o ano basico de distintos niveles socioeconomicos de 6 comunas de la Region Metropolitana. Sujetos y metodo: se evaluaron 1732 ninos de ambos sexos de 9 a 12 anos de edad. La evaluacion antropometrica incluyo peso, talla, pliegue tricipital y subescapular. La ingesta de macronutrientes se evaluo mediante la aplicacion de una encuesta recordatorio de 24 hrs; el nivel socioeconomico se evaluo mediante la aplicacion la encuesta ESOMAR. Resultados: la prevalencia de malnutricion por exceso fue de 40%, siendo mas importante en hombres de los estratos socioeconomicos de menores ingresos. Encontramos un mayor consumo de proteinas y grasas totales en el nivel socioeconomico mas alto, mientras que el nivel de menores ingresos tuvo una mayor ingesta de carbohidratos. Tanto hombres como mujeres presentaron una adecuacion superior al 75% en todos los macronutrientes con excepcion de la fibra. Conclusion: El estudio arrojo una elevada prevalencia de malnutricion por exceso en ambos sexos con un mejor patron de alimentacion en los ninos de nivel socioeconomico alto.

Cardiovascular prevention and attitude of people towards behavior changes: state of the art

In recent years the main focus of cardiovascular prevention hasbeen to identify people without clinical evidence of coronary disease, but with a high risk ofdeveloping a clinical event. Long term follow up studies show that a young person with a high“Relative Risk” of presenting a cardiovascular event becomes an adult with a high “AbsoluteRisk” of suffering it. The aim of primary prevention is to avoid the appearance of cardiovasculardiseases, delaying the development of atherosclerosis and its consequences. In this scenario, thefirst step is to increase awareness among healthy people of their own cardiovascular risk,enhancing their knowledge of their risk parameter values and generating a correct perceptionof the risk burden that those values mean. Literature review reveals that significant percentagesof healthy individuals are unaware of their own values of blood pressure, total cholesterol andblood glucose. Furthermore, people aware of having abnormal parameters have low treatmentcompliance rates or evidence inconsistency between knowledge and behavior. This paperreviews educational strategies and other factors that influence this knowledge-behavior gap,such as the stages of behavior changes of the Prochaska and Diclemente Model. Evidence hasshown that knowledge about cardiovascular risk factors is not enough to influence behaviorand that the degree of preparation of people towards behavior changes is a strong predictor ofthe success of educational and counseling interventions. Local Chilean data from the RICARproject also shows that the profile of behavior change is different for each modifiablecardiovascular risk factor (Rev Med Chile 2006; 134: 223-30).(

MORTALIDAD PERINATAL E INFANTIL Y EL BAJO PESO AL NACER EN CHILE Y CUBA EN EL PERIODO 1991-2001

RESUMENObjetivo. Comparar entre Chile y Cuba, paises con diferentes sistemas de salud y realidadessocioeconomicas, los indicadores de morbimortalidad perinatal e infantil. Material y metodo. En el periodo1991-2001, se comparan entre Chile y Cuba, las tasas de mortalidad fetal tardia, neonatal precoz,perinatal e infantil y el bajo peso al nacer. La tendencia de las variables se estudia mediante analisis decorrelacion de Pearson. Los promedios y las causas de muerte se analizan segun t de Student y Chicuadrado, respectivamente. La informacion se obtuvo de las bases de estadisticas vitales de Chile yCuba. Resultados. Cuba tuvo tasas de mortalidad neonatal precoz e infantil significativamente menoresque Chile y mayores de mortalidad fetal tardia y perinatal y de bajo peso al nacer. En Chile, la tendenciadescendente de la mortalidad fetal tardia, neonatal precoz, perinatal e infantil fue significativa; similartendencia presento en Cuba la mortalidad neonatal precoz, perinatal e infantil y el bajo peso al nacer. Lamortalidad fetal tardia en Cuba y el bajo peso al nacer en Chile, no presentaron cambios significativos.En Cuba, la mortalidad infantil por afecciones perinatales, malformaciones congenitas y neumonia fueronsignificativamente menores que en Chile y mayores por accidentes y sepsis. Conclusiones. Chile y Cuba,en el periodo 1991-2001, redujeron significativamente la mortalidad perinatal e infantil, de acuerdo a susrealidades historicas, sociales, economicas y principios eticos vigentes.KEY WORDS: Mortalidad perinatal, mortalidad infantil, bajo peso al nacer, estadisticas vitaleslatinoamericanasSUMMARYObjective. To compare perinatal and infant mortality rate and low birth weight between Chile and Cuba.Method. Fetal, early neonatal, perinatal and infant mortality rate for Chile and Cuba for the period between1991 to 2001 were analyzed. The information was obtained from the National Vital Statistical Records fromthe respective countries. Pearson correlation, T student and Chi square test were used for comparison.Results. Early neonatal and infant mortality rate were significantly lower for Cuba compared with Chile. Latefetal mortality rate, perinatal mortality rate and low birth weight were significantly lower for Chile comparedwith Cuba. There was a similar trend to decrease in all the indices analyzed for both countries. Infantmortality in Cuba was more related to accidents and sepsis and less due to perinatal factors, congenitalanomalies, pneumonia or congenital anomalies compared to Chile. Conclusion. Both Chile and Cubashowed a significant reduction in perinatal and infant mortality for the period between 1991 to 2001.KEY WORDS. Perinatal mortality, infant mortality, low birth weight, latinamerican vital statistics

INFLUENCIAS SOCIOECONÓMICAS Y ÉTNICAS SOBRE LA TALLA DE MUJERES CHILENAS.

Introduccion: No se ha estudiado recientemente la influencia socioeconomica en la talla de mujeres adultas chilenas. Objetivo: Estudiar la posible asociacion entre la talla femenina media e indicadores socioeconomicos y etnicos en muestras de diferentes comunas. Metodos: Se analizaron datos de embarazadas adultas atendidas en el sistema publico de salud en 13 comunas. Se realizaron analisis de regresion multiple para identificar posibles asociaciones de diversos indicadores de pobreza, educacion y etnia sobre la talla. Resultados: Pertenencia a etnia originaria fue la unica variable seleccionada en el modelo paso a paso (R2 = 0,64). Al excluir el procedimiento paso a paso en el analisis de regresion, la presencia de analfabetismo suprimio la asociacion significativa con la etnia. Discusion: Estos resultados apoyan la hipotesis que la influencia de la etnia en el crecimiento estaria mediada por factores socioeconomicos (en este caso especificamente educativos) y no por factores geneticos.