Oscar Román A

PERFIL Y NÚMERO DE MÉDICOS GENERALES QUE REQUIERE EL PAÍS

Medical schools curricular planning aim to obtain a physician trained to work as general practitioner and the Chilean health reform, considers ambulatory primary care as the main axis of health care. However there is still a low interest among physicians to work in primary health care, where there are problems related to a low level of clinical resolution, clinical and administrative management deficiencies and a low level of leadership in health promotion. The causes of these deficiencies stem from university training, government policies and the great attraction that exerts the technological and specialized model of secondary and tertiary health care. We analyze the ideal profue that the general practitioner should have in our health care system and the possible solutions to primary health care problems. We also emphasize the need to coordinate the professional resource needs with university training, to reduce the existing gaps between medical training and professional practice

Disponibilidad de médicos en Chile al año 2004

: The total number of physicians licensed to practice was 25,542, ofwhom 2,700 are immigrants. The physician/inhabitant ratio increased from 1/921 in 1998 to 1/612 in 2004.The greater impact in the increment of available physicians was given by the immigration of professionals andby the increase in the number of physicians graduated from national universities, mainly from the newprivate universities. Forty two percent of physicians work at public services and 61% of these are certifiedspecialists. The regional distribution of general practitioners and basic specialists is adequate. Along thecountry, the mean physician/beneficiary ratio is 8.45/10,000, the specialist/beneficiary ratio is 4.9/10,000 andthe general practitioner/beneficiary ratio is 2.3/10,000.

Optimización de la reducción de la presión arterial en hipertensos esenciales

Background: A blood pressure below or equal to 140/90 mmHg, the aim of antihypertensive treatment, is rarely achieved. Only 16% of patients controlled by our group reach this goal. Aim: To analyze the causes of suboptimal treatment and to assess the effects of an optimization of antihypertensive therapy. Patients and methods: A random sample of 160 patients was analyzed and followed during one year. Results: Sixty six patients (41%) had a normal blood pressure, maintained during the first three months of follow up. The main causes of suboptimal reduction of blood pressure in the remaining 94 patients were an incorrect prescription or dosage of medications in 37.5%, lack of compliance in 34%, insufficient delivery of medications by the health service in 24% and secondary effects of drugs in 5%. When these factors were corrected, blood pressure normalized in 41 of them. In other 37, a reduction of 5 mmHg or more in blood pressure, was obtained. The most frequent changes introduced were modifications in dosage and addition of a new medication. Therefore, in 90% of these patients, blood pressure was reduced or normalized. Conclusions: A correct identification of the cause of antihypertensive treatment failure is imperative. The correction of this cause leads to a further reduction in blood pressure in 90% of those subjects with suboptimal treatment (Rev Med Chile 2002; 130: 519-26)

Recomendaciones sobre el uso de la monitorización ambulatoria de presión arterial.: Documento de consenso de la Sociedad Chilena de Hipertensión

Continuous ambulatory blood pressure monitoring is a diagnostic technique devised as a consequence of the great variations in blood pressure measurements. It allows multiple daily measurements, nocturnal monitoring, avoids the stress of blood pressure measurements, gives a picture of pressure behavior during 24 hours and reduces observer related errors. The equipment used must be accurate and validated using international protocols. Accepted indications for continuous ambulatory blood pressure monitoring are white coat hypertension, episodic hypertension, resistance to medications and assessment of symptoms or autonomic dysfunction. Other indications with less clear cut usefulness, are high risk cardiac, renal or pregnant patients and an accurate blood pressure control. We describe equipment calibration, elements that must be considered in the reports, result interpretation and conclusions. Normal blood pressure ranges for children and pregnant women are also reported.

Daño cardiovascular por material particulado del aire. Puesta al día 2008

A clear cut relationship between particulate matter aircontamination and the mortality and morbidity due to respiratory disease has been observed inthe last decades. However there is also a relationship between air pollution and cardiovasculardiseases. In big cities, a big or small particle concentration increase of 10

Las nuevas escuelas de medicina en el panorama médico actual

There is concern about the possible consequences caused by the proliferation of private Medical Schools in Chile. Most of these schools have consolidated as health professional training centers, but its presence is changing the scenario of public health and medical profession. The most important consequence is the increase in the number of physicians that will occur, that may exceed the demand of the Chilean population and generate medical unemployment or emigration. There is also concern about the quality of the training process and the preparation and experience of teachers, that derives in the need for accreditation of medical schools. Private Universities are aware of these problems and are working on them. The struggle for clinical fields in the Public Health System has been regulated by an administrative norm of the Ministry of Health.

Contaminación atmosférica y daño cardiovascular

The damaging effect of atmospheric pollution with particulate matter and toxic gases on the respiratory system and its effect in the incidence and severity of respiratory diseases, is well known. A similar effect on the cardiovascular system is currently under investigation. Epidemiological studies have demonstrated that the inhalation of particulate matter can increase cardiovascular disease incidence and mortality, specially ischemic heart disease. The damage would be mediated by alterations in the autonomic nervous system, inflammation, infections and free radicals. In human studies, environmental pollution is associated with alterations in cardiac frequency variability and blood pressure and with changes in ventricular repolarization. Experimentally, an enhancement of ischemia, due to coronary obstruction, has been demonstrated. The study of the toxic effects of environmental pollution over the cardiovascular system, is an open field, specially in Chile, were the big cities have serious contamination problems.

Aumento del riesgo de consultas cardiovasculares por contaminación atmosférica por partículas: Estudio en la ciudad de Santiago

ResumenIntroduccion: En la literatura se reconoce que la contaminacion del aire por particulas en diversasciudades determina un exceso del riesgo de enfermedades cardiovasculares. Santiago es una de las urbes conmayor polucion de particulas MP 10 y MP 2,5 en el mundo. Objetivo: Estudiar la asociacion entre la concentracion diaria de particulas y la morbilidad cardiovascular en los6 Servicios de Urgencia de la ciudad. Metodos: Se consideraron el numero total de consultas cardiovasculares en el ano 2007, el Infarto miocardico,accidente cerebro-vascular y crisis hipertensiva. La concentracion de particulas se obtuvo de los registrosde 7 centros de la red de Monitoreo de la Calidad del Aire de la Region Metropolitana (MACAM) y lasvariables temperatura y humedad, del Instituto de Meteorologia de Chile. Estadisticamente se implementoun modelo de regresion multiple GAM. Resultados: Se observo que para todo el ano 2007 las concentraciones de particulas ambientales MP 10estuvieron altas, sobre la norma recomendada por la OMS. Ello se asocio a un incremento del 10% del riesgode consultas cardiovasculares durante todo el ano 2007. Para las particulas MP 2,5 el riesgo aumento en un17%. En los meses invernales Junio y Julio, el riesgo aumento en 15% y 28% respectivamente. Todas las cifrasresultaron altamente significativas (p< 0.001). Para la crisis hipertensiva, los aumentos del riesgo fueron 4 y13% , tambien significativos.

Actualización de las recomendaciones sobre el uso de la monitorización ambulatoria de presión arterial. Documento de consenso de la Sociedad Chilena de Hipertensión

Ambulatory blood pressure monitoring (ABPM) is a valuable toolto evaluate the blood pressure pattern, to identify hypertensive patients, to diagnose white coatand masked hypertension and in situations in which a tight control of hypertension is crucial.This is an update of 1999 consensus recommendations about the use to ABPM, considering thatthere is new evidence concerning its benefits, and the clinical experience with its applicationhas increased. Equipment programming, its installation, the interpretation and analysis of thedata are described, and a report sheet for patients is included. New recommendations havebeen added to the accepted indications. Normal blood pressure ranges for children andpregnant women have been replaced by new data (Rev Med Chile 2009; 137: 1235-47).(

Una mirada crítica en torno al plan AUGE. Algunos aspectos generales y valóricos

The health reform in Chile established a health plan called AUGE that guarantees an access to diagnosis and treatment of certain specific diseases within a time frame that must be respected. This article reviews and analyzes the general provisions of this plan and its management of values. Aspects that were implemented by the reform are discussed, especially those that refer to direct care of the population. The positive and negative aspects of the reform are balance and are contrasted with eventual changes that should be made from an ethical point of view.