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[Intersections between climate change and mental health: New challenges for the development of care services]. 气候变化与心理健康之间的交叉:护理服务发展的新挑战。
IF 1.2 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-01-30 DOI: 10.5867/medwave.2024.01.2809
Camila Solis Araya
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引用次数: 0
Validation of questionnaires for the measurement of health variables: Fundamental concepts. 健康变量测量问卷的验证:基本概念。
IF 1.2 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-01-23 DOI: 10.5867/medwave.2024.01.2746
Natalia Riva, Diego Grandi, Benjamín Cruzat, Ruben Alvarado

In clinical practice and population health, it is common to use questionnaires to assess conditions or variables that are not directly observable. However, the construction and validation of these instruments or questionnaires are often poorly understood. This narrative review aims to summarize in a general way the process of construction and validation of these questionnaires in order to have a better understanding of this process, the aspects that are evaluated, and the best way to use them. The validation of questionnaires corresponds to a process of analysis of the questionnaire, aiming to measure a latent variable and its dimensions, which cannot be observed directly. A latent variable can be inferred through a set of specific attributes that are part of it, such as the items of a questionnaire, which are observable. Through a narrative review, this article addresses the fundamental concepts of questionnaire or test validation, latent variables or constructs, reliability and validity studies, and the factors that theoretically affect the latter two characteristics. Examples of these concepts are presented in the text.

在临床实践和人口健康中,使用问卷来评估无法直接观察到的情况或变量是很常见的。然而,人们对这些工具或问卷的构建和验证往往知之甚少。这篇叙述性综述旨在对这些问卷的制作和验证过程进行概括总结,以便更好地了解这一过程、评估的方面以及使用问卷的最佳方式。问卷验证相当于对问卷进行分析的过程,旨在测量无法直接观察到的潜在变量及其维度。潜变量可以通过作为其一部分的一系列特定属性来推断,比如问卷中的项目,这些属性是可以观察到的。本文通过叙述性综述,阐述了问卷或测试验证、潜变量或建构、信度和效度研究的基本概念,以及理论上影响后两个特征的因素。文中举例说明了这些概念。
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引用次数: 0
[Climate change and malnutrition are a public health challenge]. 气候变化和营养不良是一项公共卫生挑战。
IF 1.2 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-01-22 DOI: 10.5867/medwave.2024.01.2806
Lorena Rodríguez-Osiac, Ignacio Silva-Santa Cruz
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引用次数: 0
[Climate change impacts childhood]. 气候变化影响童年。
IF 1.2 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-01-15 DOI: 10.5867/medwave.2024.01.2805
Karla Yohannessen
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引用次数: 0
Healthcare payment mechanism: Execution results of bundled payment program for bariatric surgery diagnosis in its first year of implementation in Chile. 医疗支付机制:在智利,减肥手术诊断捆绑支付计划在实施第一年的执行结果。
IF 1.2 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-01-03 DOI: 10.5867/medwave.2024.01.2762
Daniela Paredes Fernández, Rodrigo Muñoz Claro, Patricio Lamoza Kohan

Introduction: More than 600 thousand people in Chile live with morbid obesity. Effective, safe, cost-effective therapeutic interventions are critical for healthcare systems and insurance schemes. In 2022, two bundled payment codes for bariatric surgery (gastric bypass and gastric sleeve) were incorporated into the National Health Fund's free-choice modality fee scheme. The objective was to characterize the execution of this payment mechanism program associated with bariatric surgery diagnosis in its first year of implementation.More than six hundred thousand people in Chile are estimated to live with morbid obesity. Effective, safe, cost-effective therapeutic interventions are critical for health systems and insurance schemes. In 2022, FONASA incorporated two Bariatric Surgery codes into the Free Choice Modality: Gastric Bypass and Sleeve Gastrectomy. Our objective was to characterize the execution of the Bariatric Surgery Bundled Payment Program in its first year of implementation.

Methods: Descriptive and observational study of the pragmatic approach of the national execution of the payment associated with diagnosis in bariatric surgery. We examined sociodemographic variables (sex, age brackets, and National Health Fund tranches) and characterization of surgeries by code broken down by public or private provider, period of issue, unit cost, co-payment, and medical loans between March and December 2022.

Results: We recorded n = 13 118 surgeries (45.81% bypass versus 54.19% sleeve), of which n = 2424 (18.48%) used medical loans. A total of 85.01% (p = 0.01) of the procedures were in women, in people between 35 and 39 years of age (20.15%), and 45.12% in beneficiaries of tranche B. Private providers performed a total of 99.21% of the surgeries. Ten accounted for 50% of the activity (range n = 1200 to 426 surgeries per year; n = 4.8 to 1.7 surgeries per working day). Total program expenditure was $71 626 948 350 CLP, accounting for 5.04% of the total activity of the national Diagnosis Associated Payment Program.

Conclusions: The implementation of this bariatric surgery voucher benefited more than 13 thousand people living with obesity, mostly women of productive ages and with purchasing capacity. As an equity strategy, regardless of the access route through the voucher, it will be important to safeguard the activity in the public network.

引言智利有 60 多万人患有病态肥胖症。对于医疗系统和保险计划而言,有效、安全、具有成本效益的治疗干预措施至关重要。2022 年,减肥手术(胃旁路手术和胃袖状手术)的两个捆绑支付代码被纳入国家卫生基金的自由选择方式收费计划。这项研究的目的是对这一与减肥手术诊断相关的支付机制计划在实施第一年的执行情况进行分析。据估计,智利有超过 60 万人患有病态肥胖症。据估计,智利有 60 多万人患有病态肥胖症。有效、安全、具有成本效益的治疗干预措施对医疗系统和保险计划至关重要。2022 年,FONASA 将两个减肥手术代码纳入自由选择模式:胃旁路术和袖状胃切除术。我们的目标是描述减肥手术捆绑支付计划实施第一年的执行情况:对减肥手术诊断相关付款的国家执行情况进行描述性和观察性研究。我们研究了社会人口学变量(性别、年龄段和国家卫生基金分档)以及 2022 年 3 月至 12 月期间按公立或私立医疗机构、发放时间、单位成本、共同支付和医疗贷款细分的手术代码特征:我们记录了 n = 13 118 例手术(45.81% 为旁路手术,54.19% 为袖状手术),其中 n = 2424 例(18.48%)使用了医疗贷款。85.01%(P = 0.01)的手术是在女性、35 至 39 岁的人群(20.15%)和 45.12%的 B 级受益人中进行的。十家医疗机构的手术量占总手术量的 50%(每年手术量从 1200 例到 426 例不等;每个工作日手术量从 4.8 例到 1.7 例不等)。项目总支出为 71 626 948 350 美元,占全国诊断相关付费项目总活动的 5.04%:减肥手术代金券的实施使 1.3 万多名肥胖症患者受益,其中大部分是有生育能力的妇女。作为一项公平战略,无论通过何种途径获得优惠券,都必须保障公共网络中的活动。
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引用次数: 0
Cognitive clinical intervention in a patient with schizoid personality disorder: Case report. 对精神分裂型人格障碍患者进行认知临床干预:病例报告。
IF 1.2 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-12-26 DOI: 10.5867/medwave.2023.11.2757
Julio Cesar Suarez Luna, María Alejandra Bazan Marquez

The present case report describes a 19-year-old male patient whose main symptoms were emotional coldness, absence of close relationships, difficulty experiencing pleasure with other people, and lack of motivation to work or to continue his studies. A schizoid personality disorder was diagnosed as a product of early maladaptive patterns such as inhibition, emotional deprivation, social isolation, and inadequacy. Likewise, a rigid and fragmented family context was evidenced, with an affective absence of parents and a focus on strict behavioral rules. The study aimed to intervene, from a cognitive clinical approach, the early maladaptive patterns and symptoms that maintained the features of schizoid personality disorder in the patient. For this purpose, cognitive behavioral therapy was carried out, with techniques such as debates, images to reparentalize, assignment of tasks, use of humor, and social skills training, among others. In conclusion, it can be stated that the early maladaptive patterns maintained the schizoid personality symptomatology. Finally, it was demonstrated through clinical and psychometric criteria that cognitive behavioral therapy decreased schizoid personality behaviors in the patient.

本病例报告描述了一名 19 岁的男性患者,他的主要症状是情感冷漠、缺乏亲密关系、难以体验与他人相处的快乐,以及缺乏工作或继续学习的动力。他被诊断为分裂型人格障碍,这是早期不良适应模式的产物,如抑制、情感匮乏、社交孤立和不足。同样,他的家庭环境也很僵化、支离破碎,父母情感缺失,注重严格的行为规范。该研究旨在从认知临床方法入手,对维持患者分裂型人格障碍特征的早期适应不良模式和症状进行干预。为此,采用了认知行为疗法,包括辩论、图像再认、分配任务、使用幽默和社交技能培训等技术。总之,可以说早期的不良适应模式维持了分裂型人格症状。最后,通过临床和心理测量标准证明,认知行为疗法减少了患者的分裂型人格行为。
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引用次数: 0
Time to treat the climate and nature crisis as one indivisible global health emergency. 是时候将气候和自然危机作为一个不可分割的全球健康紧急事件来对待了。
IF 1.2 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-12-21 DOI: 10.5867/medwave.2023.11.2900
Kamran Abbasi, Parveen Ali, Virginia Barbour, Thomas Benfield, Kirsten Bibbins-Domingo, Stephen Hancocks, Richard Horton, Laurie Laybourn-Langton, Robert Mash, Peush Sahni, Wadeia Mohammad Sharief, Paul Yonga, Chris Zielinski
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引用次数: 0
SARS-CoV-2 humoral immune response in patients with cardiovascular risk factors: The COmmunity Cohort Study. 有心血管风险因素患者的 SARS-CoV-2 体液免疫反应:社区队列研究
IF 1.2 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-12-20 DOI: 10.5867/medwave.2023.11.2787
Vivienne C Bachelet, Ignacio Silva-Ayarza, María S Navarrete

Based on the recommendations of the Vaccine Advisory Committee and the National Immunization Program, Chile implemented an early vaccination process of the population with vaccines from different laboratories. The study of neutralizing antibody levels in different population subgroups contributes to the establishment of correlates of protection against SARS-CoV-2 infection. In 2022 and 2023 we set up a community cohort of 914 adults with cardiovascular risk factors. In this cohort we are measuring the humoral immune response to exposure to SARS-CoV-2 antigens, either by vaccines or infection, as well as the incidence of COVID-19 and other adverse events. This cohort, which we call The COmmunity Cohort, is providing us with valuable information on the levels of neutralizing antibodies in these individuals and their degree of protection against COVID-19.

根据疫苗咨询委员会和国家免疫计划的建议,智利使用来自不同实验室的疫苗对人口进行了早期接种。对不同人群亚群中的中和抗体水平进行研究,有助于建立预防 SARS-CoV-2 感染的相关机制。2022 年和 2023 年,我们建立了一个由 914 名具有心血管风险因素的成年人组成的社区队列。在这个队列中,我们将测量通过疫苗或感染接触 SARS-CoV-2 抗原后的体液免疫反应,以及 COVID-19 和其他不良事件的发生率。我们称之为 "社区队列",它为我们提供了有关这些人体内中和抗体水平及其对 COVID-19 保护程度的宝贵信息。
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引用次数: 0
Education on pain disciplines in physical therapy in Chile: In need of change. 智利物理治疗中的疼痛学科教育:需要改变。
IF 1.2 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-12-07 DOI: 10.5867/medwave.2023.11.2713
José Alfredo Órdenes-Mora, Laiza Moura Almeida-Terassi, Manuel Ahumada Wartemberg, Felipe J J Reis

Pain is a major public health concern associated with emotional disorders and physical disability and generates increased sick leave and healthcare expenditures. However, despite its social impact and the high pain-related costs, the training of healthcare professionals, such as physical therapists, in pain management is insufficient, leading to an inadequate therapeutic approach. This study aimed to determine the existence of a specific program on pain within the curricula of physical therapy careers in accredited universities in Chile. Out of 40 physical therapy careers, we analyzed 38 curricula. None of them had a specific discipline on pain management in their curricula. Although there is no concrete definition of the best modality for pain education in undergraduate students, it has been shown that following the International Association for The Study of Pain curricula improves students' knowledge and awareness of pain management.

疼痛是一个主要的公共健康问题,与情绪障碍和身体残疾有关,并导致病假和医疗支出的增加。然而,尽管疼痛对社会造成了影响,而且与疼痛相关的费用也很高,但对物理治疗师等专业医护人员在疼痛管理方面的培训却不足,导致治疗方法不够完善。本研究旨在确定智利认可大学的物理治疗专业课程中是否有专门针对疼痛的课程。在 40 个物理治疗专业中,我们分析了 38 个专业的课程。其中没有一个专业在其课程中设有专门的疼痛管理学科。虽然对本科生进行疼痛教育的最佳模式还没有具体的定义,但事实证明,按照国际疼痛研究协会的课程设置,可以提高学生对疼痛管理的知识和认识。
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引用次数: 0
Oral atenolol compared to oral propranolol for infantile hemangioma 口服阿替洛尔与口服普萘洛尔治疗婴儿血管瘤的比较
IF 1.2 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-12-07 DOI: 10.5867/medwave.2023.11.2753
Victor Meza Viteri, Ligia Aranibar
Introduction Infantile hemangioma is the most frequent benign vascular tumor in childhood, with an incidence of 3 to 10%. When patients require treatment, oral propranolol, a non-selective lipophilic beta-blocker, is usually considered the therapy of choice. However, its use has been associated with several adverse events related to its β-2 action and its ability to cross the blood-brain barrier. Because of this, oral atenolol, a hydrophilic β-1 receptor-selective beta-blocker, may represent a valid treatment alternative. Nonetheless, there is still controversy regarding the efficacy and safety of atenolol when compared with propranolol as monotherapy for this condition. Methods We searched Epistemonikos, the largest database of systematic reviews in health science, which is maintained by screening multiple sources of information, including MEDLINE/PubMed, EMBASE, and Cochrane, among others. Data were extracted from the identified reviews, data from the primary studies were analyzed, a meta-analysis was performed, and a summary table of the results was prepared using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. Results Nine systematic reviews were identified, including 10 primary studies and three randomized trials. The three randomized trials were included in the analysis of this investigation. Conclusion The use of oral atenolol compared with oral propranolol as monotherapies may result in little or no difference in terms of likelihood of complete remission, decrease in Hemangioma Activity Score, likelihood of post-treatment relapse, and risk of adverse events and severe adverse events, in infantile hemangioma (low certainty of evidence).
婴儿血管瘤是儿童期最常见的良性血管肿瘤,发病率为3% ~ 10%。当患者需要治疗时,口服普萘洛尔(一种非选择性亲脂受体阻滞剂)通常被认为是治疗的选择。然而,它的使用与若干不良事件有关,这些不良事件与它的β-2作用及其穿过血脑屏障的能力有关。正因为如此,口服阿替洛尔,一种亲水性β-1受体选择性β受体阻滞剂,可能是一种有效的治疗选择。尽管如此,阿替洛尔与心得安作为单药治疗此病的疗效和安全性仍存在争议。方法检索最大的健康科学系统综述数据库Epistemonikos,该数据库通过筛选多种信息来源(包括MEDLINE/PubMed、EMBASE和Cochrane等)来维护。从已识别的综述中提取数据,对主要研究的数据进行分析,进行荟萃分析,并使用分级推荐评估、发展和评价(GRADE)方法编制结果汇总表。结果共纳入9项系统评价,包括10项初步研究和3项随机试验。这三个随机试验被纳入本调查的分析。结论口服阿替洛尔与口服心得安单药相比,在婴幼儿血管瘤的完全缓解可能性、血管瘤活动评分降低、治疗后复发可能性、不良事件和严重不良事件风险方面差异不大或无差异(证据确定性低)。
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引用次数: 0
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Medwave
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