Medwave最新文献

The article analyzes the arrival of attending physicians in the province of Coquimbo between 1840 and 1870. Through communication with the physicians assigned to the San Juan de Dios Hospital of La Serena, the modernization of the medical practice in a local space is confirmed, characterized by the gradual installation of sanitary taxation. The study's methodology was based on direct research in documents from the National Historical Archive of Chile. Thus, it was found that in the context of a mining export boom, it was necessary to modernize an infrastructure that would accompany the welfare policies before consolidating the republic. Based on the evidence, it is postulated that the political authorities and the physicians in charge of the hospital tended to control and eradicate the informal practice of medicine and pharmacology. Finally, we note the intention of the physicians to generate an orderly public healthcare system.

Qualitative research plays an essential role in health sciences, aiming to achieve a deep understanding of phenomena, experiences, perceptions, and behaviors in their natural contexts. In this article, we outline essential aspects to consider when conducting qualitative research, starting from formulating the research question to analyzing and reporting the obtained data. We present the main qualitative design methods and sampling techniques, emphasizing the importance of reaching data saturation and the data production methods. This article offers a roadmap for conducting qualitative research in health care, contributing to a more humanized and evidence-based clinical practice.

Introduction: The Long Coronavirus Disease (COVID) Symptom and Impact Tools (ST and IT) were published in English in 2022 to monitor the symptoms and impact of persistent COVID-19. ST includes 53 symptoms selected by the patient. IT includes six aspects of life that the patient must rate from 1 to 10 points. We aim to report the results of the cultural adaptation of both instruments for the Chilean population, together with the content validity of the adapted instrument.

Methods: The cultural adaptation was carried out in five steps: 1) translation from English to Spanish, 2) synthesis, 3) back-translation, 4) review by the editorial board, and 5) testing the questionnaire with ten patients; they answered both questionnaires and seven questions assessing their understanding of the TI and their opinion on whether the instrument reflected the impact of prolonged COVID-19 on their lives. The content validity of the final version of the IT was assessed by 14 experts.

Results: The main outcome is the two final questionnaires adapted for use in Chile. Most patients responded with the best concept or approval for all items. Content validity showed acceptable results, with an average content validity index of 0.9 and Aiken's V for the relevance of the questionnaire in general of 0.83 (95% CI 0.69 to 0.92). For one item, Aiken's V was less than 0.7 (95% CI 0.5 to 0.8).

Conclusions: This study provides Chilean health authorities and health providers with an instrument for assessing the impact of prolonged COVID-19 on core aspects of people's lives.

Forensic medicine is of enormous importance in the functioning of contemporary justice systems worldwide. Therefore, in order to characterize the current state of medicolegal and forensic activity in Chile, a non-systematic review of the biomedical and legal literature on the subject was carried out. An analysis of open sources of information was also incorporated, including the National Registry of Individual Health Care Providers, the latest public accounts of the Forensic Medical Service, relevant background information available on the active transparency portal of that institution, exempt resolutions included in the "Chile Law" database (of the Department of Legislative and Documentary Services of the Library of the National Congress) and the lists of judicial experts appointed by the Courts of Appeals of the country for the biennium 2024 to 2025. We note that Chile maintains an unacceptable historical debt in terms of academic development and training of qualified professionals in forensic matters. Likewise, national scientific productivity in this field is practically null. Currently, forensic medicine is the medical specialty with the deepest shortage of professionals nationwide. Consequently, as in the early part of the last century, medical expert opinions are frequently performed by professionals untrained in forensic medicine. This scenario, taking into account the attitudes of certain lawyers and judges (detailed in the article), increases the risk of a miscarriage of justice. National public policies must take urgent action to address the deficits and provide solutions.

Introduction: The rapid emergence of COVID-19 urged policy responses worldwide, focusing on vaccination and mobility restrictions. Chile represents a unique scenario for analyzing personal preventive measures amid intensive communication and vaccination campaigns. This study aims to explore changes in population adherence to non-pharmacological preventive measures during the pandemic and the factors that explain this adherence each year.

Methods: 386 individuals who participated in two population-based studies (2021 and 2022) were considered. An interview was conducted to measure adherence to self-care practices, and case and contact tracing by the health authorities. The Wilcoxon signed-rank test was performed to measure change between 2021 and 2022, bivariate analysis, and a linear regression model for each year were performed.

Results: Mask-wearing in public places was the most commonly used measure (95.9% in 2021, 89.9% in 2022). Follow-up of cases and cases contacts by the health authority had high coverage in 2021 (94.3% and 83% respectively). A greater decrease was observed in contact tracing in 2022 totaling 33.3%. An increase in the score of adherence to preventive practices was observed in 2022 (p < 0.00). The regression model showed in 2021 that women were more likely to adopt preventive behaviors (95% confidence interval: 0.27 to 1.13) and the overweight/obese had higher adherence compared to normal body mass index (95% confidence interval: 0.06 to 0.98). In 2022 being a young adult (30 to 49 years) predicted the adoption of behavioral precautions (95% confidence interval: 0.00 to 1.32).

Conclusions: Adherence to preventive measures increased even with high vaccination coverage, likely due to the epidemiological situation with the Omicron variant circulating in 2022.

Introduction: In Chile, there is a high prevalence of obesity, and most people have an inadequate quality of food. Food environments can constitute barriers that prevent healthy food choices and lead to overweight and obesity, as well as diet-related non-communicable diseases. There are international instruments that allow the characterization of food environments. In Chile, there are no studies on the perception of food environments. This study aimed to characterize the perception of obesogenicity of food environments in the urban Chilean population using an instrument previously validated in Chile.

Methods: This is a cross-sectional study with probabilistic sampling. The "Perceived Nutrition Environment Measures Survey", based on the Chilean model of food environments, was applied to 256 participants from two urban communities of the Metropolitan Region. Scores were calculated for the instrument items, which allowed calculating scores by environments included in the Chilean model of Food Environments. Negative scores were related to a higher obesogenic level.

Results: The results show that the domestic food environment is perceived as less obesogenic (median of 15.8 points), with more than 90% of households having fruits, vegetables, and legumes, even though the supply food environment was negative (median -0.19 points). However, about 50% of households had ultra-processed foods. The street food environment was perceived as the most obesogenic (median -1.91 points), with more than 60% of the participants indicating difficulty finding healthy options.

Conclusions: According to the level of obesogenicity of the environments studied, it is necessary to have public policies that improve them and ensure the availability and physical and economic access to healthy food, particularly in the food supply and public road environments.

Introduction: Orthognathic surgery is widely accepted for correcting dentofacial deformities. Due to the rich blood supply in the head and neck region, considerable bleeding can occur from the incised soft tissues and bone during orthognathic surgery. Hypotensive anesthesia is a method used in surgical practice by which blood pressure is decreased predictably and deliberately to reduce blood loss and improve surgical field. However, there is still uncertainty regarding its effectiveness and safety in orthognathic surgery.

Methods: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis, and generated a summary of findings table using the GRADE approach.

Results and conclusions: We identified three systematic reviews, including 11 studies overall, which are randomized trials. We concluded that hypotensive anesthesia may reduce intraoperative blood loss and may improve the quality of surgical field, however, the certainty of the evidence has been assessed as low. On the other hand, orthognathic surgery with HA may make little or no difference in surgical time (low certainty evidence). Finally, no studies were found that reported adverse effects or mortality.