Inequidad en el acceso a salud en Chile: estudio multifactorial basado en la Encuesta CASEN del año 2013

Objetivo: El estudio busca describir la inequidad en el acceso a salud entre los Servicios de Salud de Chile, evidenciando posibles estructuras de inequidad a nivel territorial mediante análisis multifactoriales. Método: Corresponde a un estudio descriptivo de corte cuantitativo. Se emplea una estrategia estadística exploratoria basada en Análisis de Correspondencias Múltiples (ACM) con los datos de la Encuesta CASEN del año 2013. La unidad de información del estudio es el servicio de salud. El análisis de la inequidad se hizo empleando los indicadores de acceso al sistema de salud y a prestaciones de salud incluidos en la medida multidimensional de pobreza, incorporada en esta versión de la encuesta CASEN. Como indicadores de desigualdad social, se utilizó el quintil de ingreso de la población y la medida de pobreza por ingresos. Resultados: Si bien hay diferencias estadísticamente significativas en las características demográficas y socioculturales de la población que habita las áreas de cobertura de los servicios de salud a lo largo del país, existe poca claridad en la conformación de estructuras de inequidad, lo que se aleja de lo buscado inicialmente. Lo anterior se confirma en los Análisis de Correspondencias Múltiples. Conclusiones: Los datos sectoriales de salud, provenientes de la CASEN 2013, no permiten establecer la existencia de inequidad en acceso a salud a nivel de los servicios de salud del país.

Validación de la Escala Subjetiva de Carga mental de trabajo (ESCAM) en profesionales de la salud de Chile

El objetivo de este estudio es confirmar las características psicométricas de la Escala Subjetiva de Carga Mental de Trabajo (ESCAM) en trabajadores sanitarios de hospitales chilenos. Participaron en este estudio 379 trabajadores de tres hospitales. Los instrumentos utilizados fueron: (a) ESCAM; y (b) cuestionario SUSESO-ISTAS 21. Los resultados indican que ESCAM se estructura en cinco dimensiones: Demandas cognitivas y complejidad de la tarea, Características de la tarea, Organización temporal, Ritmo de trabajo y Consecuencias para la salud. Asimismo, se observan correlaciones significativas entre la puntuación total de ESCAM y sus dimensiones con los factores de SUSESO-ISTAS 21. Además, se comprobó la validez de la escala mediante el análisis de perfiles de carga mental con diferentes grupos profesionales.

Long-term follow-up of radiation accident patients in Peru: review of two cases

Overexposure to radioactive sources used in radiotherapy or industrial radiography may result in severe health consequences. This report assesses the initial clinical status and the medical and psychological long-term follow-up of two radiation accident patients from Peru during the mid-to-late 1990s: one patient exposed to a radiotherapy (60)Co source in Arequipa, the other patient to a (192)Ir source in Yanango. Commonalities and differences are described. The main causes in both accidents were human error and the failure to apply appropriate safety guidelines and standard operating procedures. Education and training of the personnel working with radiation sources are essential to prevent accidents. The experience gained from the medical management of the two patients is valuable for future treatment of such patients.

Validation of Collett-Lester's Fear of Death Scale in a sample of nursing students

This study aims to evaluate the psychometric properties of Collett-Lester's Fear of Death Scale. A sample of 349 nursing students answered Fear of Death and Attitude toward death scales. Content validity was checked by expert review; reliability was proven using Cronbach's alpha; statistical analysis of the items, correlation between items and construct validity were checked by the correlation of the Scale with the Attitude toward death Scale. The multidimensionality of the scale was reviewed through factor analysis with varimax rotation. The Fear of Death Scale possesses good internal consistency and construct validity, confirmed by the significant correlation with the Attitude toward death Scale. Factor analysis partially supports content validity of the subscale items, but presented a modified multidimensional structure that points towards the reconceptualization of the subscales in this sample.

[General self-efficacy scale validation in Chile]

BACKGROUND

Self efficacy refers to an individuals belief in his or her capability to produce given achievements and the individuals perception of his or her ability to perform an action.

AIM

To evaluate the psychometric properties of the General Self-efficacy Scale in Chilean population.

MATERIAL AND METHODS

The study was carried out in 360 subjects, both sexes, 15-65 years of age, from Concepción, Chile, who answered Self-efficacy, Self-esteem and Health Status Perception instruments. Reliability was verified by Cronbachs alpha coefficient and validity by expert re-vision, univariate statistics, correlations among items, item-scale correlations, and correlations with Self-esteem and Perception of Health Status constructs.

RESULTS

The structure of the scale is uni-dimensional, homogenous and positively related with the constructs examined.

CONCLUSIONS

The General Self-efficacy Scale is a reliable and valid measure of the perception of self-efficacy in the Chilean population.

[Serologic evidence for human Ehrlichiosis in Chile]

BACKGROUND

Ehrlichiosis is a non contagious infectious disease, mainly transmitted by thick bites. In 1998, this infection was detected in dogs, for the first time, in Chile.

AIM

To establish if there is human exposure to Ehrlichia sp in Chile.

MATERIAL AND METHODS

Blood samples from 17 dogs with ehrlichiosis and 19 humans who had contact with them were studied to determine human exposure to Ehrlichia equi and Ehrlichia chaffeensis in Chile. Samples were analyzed by indirect immunofluorecence and by polymerase chain reaction (PCR).

RESULTS

Six dogs had positive titers against both species of ehrlichia; 2 with titers of 1/256; 3 with titers over 1/512 to Ehrlichia equi and titers of 1/256, 1/128 and 1/64 to Ehrlichia chaffeensis respectively, and 1 with titers of 1/256 to Ehrlichia equi and titers of 1/128 to Ehrlichia chaffeensis. Two of the 19 humans, had positive titers against both antigens (1/128). PCR reactions were negative in both human and canine sera.

CONCLUSIONS

These results confirm that human exposure to Ehrlichia sp. Epidemiological surveillance for human ehrlichiosis should be implemented in the country.

Ifosfamide plus cisplatin as primary chemotherapy of advanced ovarian cancer

We have performed a phase II study to evaluate the activity and toxicity of ifosfamide and cisplatin as first-line treatment for advanced ovarian cancer. Patients were treated with cisplatin 100 mg/m2 on day 1 and ifosfamide 5 g/m2 in 18-hr continuous infusion on day 1 or 1.5 g/m2 bolus on days 1-5. Between August 1988 and March 1990, 30 women were entered in the trial, 26 of them with measurable disease. The overall clinical response rate was 69% (95% CI: 48-85%), including 34.6% complete responses (95% CI:17-55%). Reassessment laparotomy was performed in 12 cases, and 4 (33%) exhibited a pathologic complete response. For all patients, the median duration of progression-free survival was 14 months, and the median overall survival was 25 months. There were no major differences in the response rate or survival between the two ifosfamide administration modalities. Relevant toxicities were grade IV hematologic toxicity in 11/30 patients and grade IV renal toxicity in 2/30 patients. A patient with grade IV encephalopathy developed a trauma-related cerebral hemorrhage and died 2 months later. The combination of ifosfamide and cisplatin is active in first-line therapy in advanced ovarian cancer, although it does not seem to improve the efficacy or toxicity profile of conventional combinations.

Hyalomma ticks: bovine resistance under field conditions as related to host age and breed

Field collection of ticks from two breeds of cattle [Native breed (local) and purebred [Friesian)], showed that the number of ticks was higher on purebred than on native cattle. The susceptibility seemed to increase with the age of the animals. Furthermore, breed appeared to exert more influence than age. There was no correlation between the number of ticks associated with each animal, the antibody production and antigens recognized. The immune response under field condition looked more like immune suppression than immune protection.

One-session management of cervical intraepithelial neoplasia: a solution for developing countries

Six hundred thirty-nine patients with CIN on referral Pap were evaluated cytocolposcopically at the first visit and decided whether to be treated the same day or not. One hundred ninety-two patients (30%) were considered negative. Follow-up evidenced later appearance of CIN in five of them. One hundred fifty-three (24%) were candidates for delayed treatment due to conditions contraindicating same-day treatment. Two hundred ninety-four patients (46%) were randomly allocated in LEEP (149) or excisional laser (145) arms, and treated the same day under local anesthesia. Both arms were comparable. There were three microinvasive carcinomas diagnosed in the surgical specimen. LEEP was faster and produced less bleeding than laser, although required a mean of four slices to remove the lesion. Arterial hypertension after anesthetic infiltration was detected in 26% of cases. Two intraoperative and two delayed bleeders required surgery. The size of lesion and surgical defect were larger than those reported in the literature. Margins were involved in 8 patients (2.7%). Only 4.7% (7/149) of patients randomized to LEEP and 3.4% (5/145) with excisional laser had persistent or recurrent CIN on follow-up. Factors predisposing to failure included depth of surgical defect, grade of lesion, and operator's expertise. With this approach, 69% of patients referred for cytology of CIN were adequately managed in the first visit, which contrasts to classical management that reaches the state of treatment in 30% of patients. LEEP appears to be faster, less costly, and requires less expertise. Its use in conjunction with adequate screening is recommended for developing countries.