Revista medica de Chile最新文献

With the growing access to higher education, the university population has become increasingly heterogeneous. This situation has forced educational institutions to rethink their work. Health schools, specifically, must not only ensure the acquisition of technical-professional competencies, but also promote comprehensive training in students in this area.

Aim: To understand the diversity in health students and the institutional implications for educational training.

Method: Qualitative study, based on Grounded Theory. Group interviews and semi-structured interviews were conducted with 11 teachers and 25 students of health careers. An analysis was performed through constant comparison method up to axial coding level, using Atlas-ti 7.5.2.

Results: A central phenomenon emerges around the institution's valuation of diversity, which should have didactic and curricular adaptations, as well as the necessary accompaniments for them.

Discussion: Institutions must guarantee access, full participation, and meaningful learning for all their students. To this end, a culture that values diversity and translates into institutional policies.

The mental health of healthcare workers is strongly affected, and more evidence is needed to determine the dimensions of risk and protection related to the presence of anxious and depressive symptomatology.

Aim: To determine whether working conditions, social support and socio-occupational characteristics are associated with anxious and depressive symptoms reported by healthcare workers during the pandemic in Chile.

Methods: Observational, correlational and cross-sectional study. A survey was applied to 875 healthcare workers (76% women) through SurveyMonkey between 2020-2021. It included mental health (depressive and anxious symptomatology), related to the pandemic working conditions (i.e., insufficient masks, contact with patients with COVID-19, reassignment of work/place/area, confidence in governmental management to protect personnel), social support (from peers, superiors, and outside work) and socio-occupational variables (sex, occupational status). Bivariate analyses and logistic regressions were conducted to examine the association of pandemic working and socio-occupational conditions on the odds of anxious and depressive symptomatology, and sensitivity analyses to underrepresentation (via post-stratification), missing data and measurement errors (using Rogan-Gladen correction) with 95% confidence intervals(95%CI).

Results: Forty-four point five percent (95% CI 35.6-53.8) [crude percentage: 46%] and 41,4% (95% CI 34.5-48.6) [36%] of the respondents reported scores indicative of anxious and depressive symptoms, respectively. Greater superior support was associated with lower odds of anxious (aOR [adjusted Odds ratio]= 0.87 95%CI 0.79-0.96) and depressive (aOR= 0.86 95%CI 0.78-0.94) symptoms. Also, women had twice the odds of anxious symptomatology versus men (aOR= 2.00 95%CI 1.28-3.19), and those who mistrust the government had twice the odds of depressive symptomatology vs. those who did not (aOR= 1.98 95%CI 1.34-2.94).

Conclusions: Superior support emerges as a critical factor in the mental health of personnel in health crises. Prioritizing the protective role of organizational and social support over individual or psychological support in similar contexts is suggested. Urgent measures are needed to prevent anxiety symptoms in female workers, who report them more.

Before 1990, Chile showed fewer medical schools, six in total, increasing to 13 by 2000. From then on, there was an explosive increase, reaching 29 faculties or schools by 2024. Medical students increased from 1,816 in 2010 to 3,000 by 2024. The number of doctors in the country in 2010 was 24,455, rising to 65,737 by 2023, of which 25% are foreign professionals. In 2010, there was a ratio of 1.43 doctors per 1000 inhabitants, increasing to 3.13 by 2024, with a reasonable projection for 2034 close to 6, in other words, one doctor for every 170 inhabitants, reaching the OECD curve, surpassing WHO recommendations, and continuing to rise non-linearly. By 2024, one in two doctors practicing in Chile has one or more medical specialties. The Public Health System reported that in 2023, approximately one-third of the total available registered professionals working hours hired represented medical specialists (61%). Specialist doctor rates by region, as of September 2023, are relatively homogeneous, with higher rates tending to be in the southern part of the country. There is underrepresentation in non-metropolitan regions of specialties such as infectious diseases, emergency medicine, adult intensive care, neonatology, hematology, and pediatric neurology. However, for most specialties, this asymmetry is not observed. Compared to other countries, Chile, with a rate of 28.4 between 2012-2020, ranks 57 out of 200 countries with available data, presenting a rate of 1.64 specialist doctors per 1000 inhabitants, while the OECD average was 2.35. This strongly suggests that Chile will likely end up with an excessive number of doctors overall but with room to grow in specialist doctors. It is possible to envision interactions and coordination that could benefit the country without exceeding a regulated system; however, professional training should be avoided to continue unregulated and subject only to free will based on marketing strategies and demand rules. National and international studies assessing healthcare challenges for the coming decades and the professional capacities required to address them at the level of general medicine, primary specialties, and derived specialties are urgently needed. Regarding clinical fields, conducting a relevant study to determine the total public and private sector training capacity that may be part of the training system for the necessary clinical competencies is essential. Forming a working group with relevant stakeholders with knowledge, concern, and involvement would be significant, e.g., the Academy of Medicine, ASOFAMECH, medical schools, Ministry of Health, Ministry of Education, and community representatives. From our higher education perspective, with a nationwide vision, universities should start a joint reflection on our role in this critical topic with a future-oriented view.

Coronary angiography (CA) is the gold standard for identifying the presence and extent of atherosclerotic coronary artery disease or dynamic stenosis of the arteries.

Aim: Review of the literature and international clinical guidelines on the evidence of its indications in different clinical scenarios.

Method: Qualitative study through a narrative review of the current indications of the technique, limitations, possible complications and contraindications.

Results: Information on the different scenarios in which CA is requested is extensive, ranging from expert recommendations to evidence-based clinical guidelines that support its performance. Undoubtedly, technological advances have led to the understanding of coronary pathology with the contribution of complementary techniques that contribute not only to the diagnosis but also to its treatment. It is important to understand its potential complications in order not only to plan a procedure and avoid them, and not to subject patients to tests that will not contribute in their clinical context.

Conclusions: Since the first CA, performed by Mason Sones in 1958, there has been an exponential growth in interventional cardiology, where CA has improved its technique generating more evidence in its indications.

Encephalitis due to Epstein-Barr Virus (EBV) is a rare condition that primarily affects children and immunosuppressed patients. Diagnosing EBV encephalitis can be challenging due to its nonspecific clinical presentation and the lack of confirmatory tests. We present the case of a 66-year-old woman with a history of kidney transplantation who was admitted due to progressive subacute mental deterioration, preceded by vertigo and without fever. Physical examination revealed no cranial nerve abnormalities, focal neurological deficits, or meningeal signs. Cerebrospinal fluid (CSF) analysis showed a mild increase in protein and pleocytosis (13/µL) without hypoglycorrhachia. Brain magnetic resonance imaging (MRI) revealed multiple bi-hemispheric supratentorial hyperintensities associated with mild vasogenic edema, most prominent at the cortico-subcortical interface, hippocampal regions, and basal ganglia. An extensive search for microorganisms identified EBV by RT-PCR in the CSF (1,650 copies/mL). The patient initially received acyclovir without improvement but achieved rapid recovery after switching to ganciclovir. The patient was discharged, and outpatient follow-up visits demonstrated full recovery. This case supports the effectiveness of ganciclovir, as observed in previous reports. Overall, patients with EBV encephalitis generally have a benign course with complete recovery or mild sequelae.

Alcohol consumption by older adults has been called the "silent epidemic." An aging population and high levels of alcohol consumption increase the future challenge for epidemiology and public health. In addition, the misuse of prescription drugs is a growing public health problem associated with increased hospitalizations and health complications in older adults.

Aim: To analyze the social determinants associated with problematic alcohol and prescription drug use in the older adult population in the country.

Methods: Analysis of SENDA's population-based survey of drug and alcohol use in older adults from 2021. A multivariate statistical model was used to identify the factors that increase or decrease the probability of occurrence of the phenomenon.

Results: The prevalence of alcohol and prescription drug use in older adults in Chile reached 12.8%. At the multivariate level, it is men, with less social support and without sentimental cohabitation, who have a higher probability of combining alcohol consumption with prescription drugs.

Conclusions: The combination of alcohol and medicine without medical prescription is a potential public health problem, especially among older adults. This study represents a national effort to understand this phenomenon, identifying the most vulnerable groups with the highest prevalence of consumption to which public prevention policies should give special attention.

In the prevailing medical pluralism of contemporary society, alternative and complementary medicine occupy a relevant place, comprising a heterogeneous group of practices with different values depending on tradition and social acceptance. Their scarce regulation and growing use, facilitated by promotion through social networks and distrust of the dominant biomedical model, have generated interest among medical organizations and health authorities in their use and consequences. Appreciations vary from outright rejection to interest in its adoption by public health systems as part of their services. Its growing use, however, contrasts with an incipient development of the scientific evidence supporting its use and, consequently, a scarce representation of its curricular teaching in our medical schools. The use of CAM by patients cannot be ignored in the therapeutic encounter. Physicians must be prepared to discuss their possible benefits and risks with their patients and to make recommendations in accordance with the principles of medical professionalism: the good of the patient must take precedence over other interests, taking into account the scarce scientific evidence of their efficacy and safety, the imperfect regulation to which they are subject and the lack of pharmacovigilance on their effects. The patient's autonomy over his or her health care, considerations regarding the use of scarce health care resources, and the due compassion and empathy owed to the patient as a suffering being cannot be ignored.