Revista medica de Chile最新文献

{"title":"[Availability of Urban Green Spaces and the Incidence of Breast Cancer at the Community Level in Chile: An Ecological Study].","authors":"Marta Fernández Nazal, Felipe Medina Marín, Dante Cáceres Lillo","doi":"10.4067/s0034-98872025000200119","DOIUrl":"https://doi.org/10.4067/s0034-98872025000200119","url":null,"abstract":"<p><p>Breast cancer is the most frequent and the main cause of death from cancer in women, which has been associated with biological, genetic, and socio-environmental factors. Living in urban green spaces has been widely related to health benefits.</p><p><strong>Aim: </strong>To explore the association between exposure to urban green spaces and the incidence of breast cancer in Chile in an ecological design at the community level.</p><p><strong>Methods: </strong>As exposure to green spaces, the following metrics were used separately: meeting the standard of green areas (10 m2/Inh), the Normalized Difference Vegetation Index (NDVI), the distance to the census block, and the quality index for squares and parks. The association was evaluated with the incidence ratio [IRR] and confidence interval (95% CI)] using negative binomial regression models adjusting for sociodemographic covariates.</p><p><strong>Results: </strong>We found a significant negative statistical association of breast cancer with green areas [IRR (95%): 0.84 (0.70-0.95)] and a positive association with high NDVI [IRR (95%CI): 1.27 (1.04-1.55)] was positively associated. A moderate NDVI, the distance to the census block, and the quality index to public squares and parks were not associated with the disease.</p><p><strong>Conclusions: </strong>Complying with the green area standard at the community level would be a protective factor for the CaM. In contrast, the NDVI vegetation index was associated with a higher risk. To assess the health impact of urban green spaces, more detailed measurements are required that can more accurately characterize exposure spatially and temporally, as well as individual-level analytical epidemiological studies.</p>","PeriodicalId":101370,"journal":{"name":"Revista medica de Chile","volume":"153 2","pages":"119-129"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[The Impact of Early Distribution of Slides on Medical Education: Experiences at a Medical School].","authors":"Brigith Avila-Lucas, Fritz Fidel Váscones-Román, Sol Bautista-Vásquez, Alonso F Ayque-Goicochea, Ulises Chávez-Casimiro, María Retiz-Rodríguez, Niels Pachecho-Barrios","doi":"10.4067/s0034-98872025000200158","DOIUrl":"https://doi.org/10.4067/s0034-98872025000200158","url":null,"abstract":"","PeriodicalId":101370,"journal":{"name":"Revista medica de Chile","volume":"153 2","pages":"158-161"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Mental Illness in Chile: Institutional Framework from 1852 to 1928].","authors":"José Ramos-Vera, Elizabeth Pardo-González, Hernán Scholten, Josefina Henríquez-Canales","doi":"10.4067/s0034-98872025000200096","DOIUrl":"https://doi.org/10.4067/s0034-98872025000200096","url":null,"abstract":"<p><p>In recent decades, sustained historiographical work has been evident across various disciplines, including medicine. In this regard, studies have focused on the historical development of treatments, objects, tools in the field, pathologies, among others.</p><p><strong>Aim: </strong>This research, continuing the reported trend, analyzed the evolution of mental institutions in Chile during the period 1852-1928.</p><p><strong>Method: </strong>Access to the past was achieved through a historiographical approach, involving archival work that prioritized the use of primary sources.</p><p><strong>Results: </strong>First, there is clear evidence of considerable foreign influence in the establishment of mental health institutions in Chile, as well as in the advances, trends, and methods of care and treatment of mental disorders. Second, a shift was observed in the perception of individuals with mental disorders: initially, they were subject to punitive measures, often associated with confinement or abandonment, but later, a more humanitarian view emerged, recognizing them as individuals with rights, leading to changes in their treatment, the infrastructure of asylum institutions, and the treatments themselves, among other aspects. Third, during this period, three institutions for the mentally ill were established; however, these lacked the space and resources needed to provide adequate treatment to all citizens with psychopathologies. Nonetheless, there was a growing focus on their care, as evidenced by the evolution of services offered within these establishments and the enactment of laws aimed at supporting people with mental illnesses.</p><p><strong>Conclusions: </strong>The results help to understand the current state of mental health in Chile, highlighting a concern for this area but also pointing out a budgetary and institutional deficit that dates back to its foundational milestones in the 19th century.</p>","PeriodicalId":101370,"journal":{"name":"Revista medica de Chile","volume":"153 2","pages":"96-103"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Therapeutic Adequacy in Nine Emergency Departments in Chile: When and How It Is Applied in Emergency Care].","authors":"Diego Escudero, Consuelo Torres, Javier Pascual, David Acuña","doi":"10.4067/s0034-98872025000200111","DOIUrl":"https://doi.org/10.4067/s0034-98872025000200111","url":null,"abstract":"<p><p>Therapeutic Adequacy (TA) in Emergency Departments (EDs) aims to avoid futile medical interventions in terminally ill or critically ill patients, prioritizing their quality of life. This descriptive, cross-sectional, observational study analyzed the criteria used by physicians in high-complexity EDs in Chile to indicate TA, while also assessing their preparedness and ethical perceptions.</p><p><strong>Aim: </strong>Examine the criteria that physicians in high-complexity Emergency Departments (EDs) in Chile use to determine Therapeutic Adequacy (TA) in terminally ill or critically ill patients, while also assessing their level of preparedness and ethical perceptions regarding these decisions.</p><p><strong>Methods: </strong>A 14-item closed survey, based on previous studies, was distributed among physicians from 9 high-complexity EDs between February and October 2023. A total of 70 responses were collected.</p><p><strong>Results: </strong>TA was performed more than once a month by 83% of respondents, with patient functionality (97%), chronic diseases (84%), and age (69%) being the most frequently considered criteria. The most common measures included refraining from resuscitation (97%) and mechanical ventilation (94%). While 65% of participants felt prepared to make these decisions, this figure increased to 85% among emergency specialists. However, 67% reported no formal training in bioethics, and 55% expressed discomfort with withdrawing therapeutic measures.</p><p><strong>Conclusions: </strong>TA is a frequent practice in EDs, mainly involving decisions not to initiate treatments. Despite this, there is limited formal training in bioethics, and individual decision-making predominates. This highlights the need to enhance bioethics education, foster collaborative decision-making, and implement hospital protocols that involve patients and their families to ensure an ethical, patient-centered approach.</p>","PeriodicalId":101370,"journal":{"name":"Revista medica de Chile","volume":"153 2","pages":"111-118"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Epidemiological and Functional Characterization of Older Adults in the Cardiovascular Health and Elderly Programs in Primary Care Centers in Chile].","authors":"María Victoria Valenzuela Barrios, Marisa Torres Hidalgo, Angélica Domínguez","doi":"10.4067/s0034-98872025000200130","DOIUrl":"https://doi.org/10.4067/s0034-98872025000200130","url":null,"abstract":"<p><p>The rapid increase in the older adult population (OA) in Chile will present challenges associated with chronic diseases and dependency. It is projected that by 2050, older adults will represent 32% of the country's population, with those over 80 years old experiencing the highest growth.</p><p><strong>Aim: </strong>Characterize chronic non-communicable diseases (CNCD) and functionality in older adults of the third and fourth age seeking care at Primary Health Care (PHC) Centers within the public system during the year 2018 in Chile.</p><p><strong>Material and methods: </strong>The study design was an analytical cross-sectional observational study. The P series of Monthly Statistical Records from 2018 of older adults aged 65 and over consulting PHC centers nationwide was used. Third age was defined as 65-79 years old, and fourth age as 80 years and older.</p><p><strong>Results: </strong>Out of 1.780.439 elderly individuals studied, 76% belonged to the third age group (65-79 years), with 58% being women. The fourth age group (80 years and older) showed a higher prevalence of chronic diseases. Both groups predominantly exhibited self-sufficiency (no risk, at risk, and risk of dependency), with 91,05% in the third age and 67,54% in the fourth age. This represents a dependency 3,63 times higher in the fourth age compared to the third age.</p><p><strong>Conclusions: </strong>This study reveals significant differences between the third and fourth age. Recognizing these disparities is crucial for planning interventions and policies that promote better quality of life and autonomy for older adults.</p>","PeriodicalId":101370,"journal":{"name":"Revista medica de Chile","volume":"153 2","pages":"130-140"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Increase in intentional paracetamol poisoning in Chile (2019-2023): A study from the UC Toxicology Information Center].","authors":"Pablo Iturra, Lorena Silva, Marli Bettini, Patricio Medel, Sandra Solari, Juan Carlos Ríos","doi":"10.4067/s0034-98872025000200085","DOIUrl":"https://doi.org/10.4067/s0034-98872025000200085","url":null,"abstract":"<p><p>Paracetamol (acetaminophen) is one of the most widely used analgesics and antipyretics in the world. It's easy acquisition, however, has frequently involved it in accidental and intentional poisonings, which, depending on the dose ingested, could lead to liver damage. To counteract this problem, several countries and agencies have regulated the sale and use of paracetamol. Even so, recent studies have shown an increase in suicidal intoxications using paracetamol or other drugs, especially since the COVID-19 pandemic.</p><p><strong>Aim: </strong>Characterize the variation in the number of paracetamol poisonings in Chile, registered by the Poison Control Center of the Pontifical Catholic University of Chile (CITUC), during the last 5 years.</p><p><strong>Methods: </strong>Observational study of the calls for cases of paracetamol ingestion, admitted to CITUC, between 2019 and 2023.</p><p><strong>Results: </strong>eleven thousand thirty-nine cases of paracetamol exposure were recorded, where 68.8% of these were related to suicidal ideation. This type of poisoning showed an 11% increase as of 2020. Female patients accounted for 80.3% of the cases of paracetamol ingestion for suicidal purposes, while in 56.6% of the cases of suicidal ideation, the patients reached potentially hepatotoxic doses of paracetamol.</p><p><strong>Conclusions: </strong>Paracetamol poisoning with suicidal intent has progressively and significantly increased in Chile since the onset of the coronavirus pandemic. It is therefore necessary to replicate and implement preventive measures used by other countries to reduce poisonings related to this drug, in addition to taking steps to optimize the management of these cases.</p>","PeriodicalId":101370,"journal":{"name":"Revista medica de Chile","volume":"153 2","pages":"85-95"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Chronic Pruritus: A Review of Its Pathophysiology and Current Treatments].","authors":"Alejandro Oyarzún, Amparo Muñoz, Sebastián Oyarzún, Javier Arellano","doi":"10.4067/s0034-98872025000200141","DOIUrl":"https://doi.org/10.4067/s0034-98872025000200141","url":null,"abstract":"<p><p>Pruritus is defined as an unpleasant somatic sensation that persists for more than 6 weeks. It involves sensory, emotional, and motivational components that drive scratching. It is the most common cutaneous symptom. Its prevalence ranges from 8% to 25.5% in the European population.</p><p><strong>Aim: </strong>Describe the current evidence-based therapeutic options for chronic pruritus, including innovative alternatives, based on a review of the pathophysiological mechanisms involved in the production of the symptom.</p><p><strong>Methods: </strong>A Scoping Review of the literature on the pathophysiology and treatments of chronic pruritus was conducted, covering studies from March 2013 to May 2023. The review included 24 articles from MEDLINEplus and SciELO, of which 17 met the inclusion criteria and were selected for in-depth analysis. The focus was on pathophysiology, diagnosis, and therapeutic options, with the aim of improving the clinical management of chronic pruritus.</p><p><strong>Results: </strong>Chronic pruritus involves both histaminergic and non-histaminergic pathways, mediated by G protein-coupled receptors and transient receptor potential channels. Interleukins 4, 13, 21, and thymic stromal lymphopoietin play a crucial role, offering new therapeutic perspectives. Management should be holistic and multidisciplinary. Topical treatments are suggested for localized pruritus, while systemic therapy (antihistamines, immunosuppressants, and biologics) is recommended for generalized pruritus or localized pruritus refractory to topical treatments. Currently, various biological agents, such as dupilumab, tralokinumab, and lebrikizumab, have demonstrated efficacy in atopic dermatitis, whereas the anti-interleukin 31 monoclonal antibody, nemolizumab, shows promise as an alternative in the management of chronic pruritus.</p><p><strong>Conclusions: </strong>A stepped pharmacological approach, tailored to the individual symptomatology of each patient, facilitates the treatment of chronic pruritus. Although progress has been made in understanding the pathophysiology and pharmacology associated with pruritus management, this symptom still requires further national epidemiological studies to determine its prevalence and to objectively assess its impact on the quality of life of affected individuals.</p>","PeriodicalId":101370,"journal":{"name":"Revista medica de Chile","volume":"153 2","pages":"141-154"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144014757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Eye Involvement and Risk of Blindness in Sarcoidosis].","authors":"Beatriz Urrutia, Romina Barrueto, Karina Barrueto, Alejandro Badilla, Enzo Castiglione","doi":"10.4067/s0034-98872025000200078","DOIUrl":"https://doi.org/10.4067/s0034-98872025000200078","url":null,"abstract":"<p><p>Sarcoidosis is a multisystemic inflammatory disease of unknown etiology characterized by granulomas formation. Pulmonary involvement is the most frequent manifestation but the eye is frequently affected and, in some cases, it may be the debut of the disease. In Chile there are few data on this subject.</p><p><strong>Aim: </strong>To describe the ocular involvement of patients with sarcoidosis and to evaluate the relationship between presentation patterns and decreased visual acuity (VA).</p><p><strong>Material and methods: </strong>Descriptive retrospective study of subjects aged 18 years or older with ocular sarcoidosis treated between January 2014 and March 2023 in two health centers. Epidemiological information and the clinical and imaging characteristics of ocular involvement were recorded.</p><p><strong>Results: </strong>Of 13 patients with sarcoidosis nine had ocular involvement; 78% were women and the average presentation age was 55 years. All cases presented as bilateral uveitis. The most frequent subtypes were Panuveitis (PU) (44%) and Anterior Uveitis (AU) (33%). Posterior pole involvement occurred in older patients (mean age 70 years) and was associated with a higher risk of blindness.</p><p><strong>Conclusions: </strong>Ocular involvement was frequent in our population and behaved as described in international literature. Age seems to be associated with uveitis subtype and posterior pole involvement could identify a higher risk of non-recoverable decrease in VA. Our findings suggest that older patients should be treated vigorously due to their increased risk of irreversible visual loss and reinforce the need for collaborative work between specialties.</p>","PeriodicalId":101370,"journal":{"name":"Revista medica de Chile","volume":"153 2","pages":"78-84"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[45% of Dementia Cases Are Attributed to 14 Modifiable Risk Factors].","authors":"Carlos Celis-Morales, Claudia Troncoso-Pantoja, Ana María Leiva, Gabriela Nazar","doi":"10.4067/s0034-98872025000200155","DOIUrl":"https://doi.org/10.4067/s0034-98872025000200155","url":null,"abstract":"","PeriodicalId":101370,"journal":{"name":"Revista medica de Chile","volume":"153 2","pages":"155-157"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144034492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Clinical, Demographic, and Anatomopathological Profile of Patients with Lung Cancer at Temuco Hospital (2019-2023)].","authors":"Carolina Orrego V, Fernando Vega G, Juan Pablo Cuevas T, Angélica Arias A, Luis Bustos-Medina","doi":"10.4067/s0034-98872025000200104","DOIUrl":"https://doi.org/10.4067/s0034-98872025000200104","url":null,"abstract":"<p><p>Lung cancer is the leading cause of cancer-related death worldwide and in Chile, especially among young women due to increased tobacco consumption. In Chile, the incidence and mortality of this disease have risen in recent years. Most cases are diagnosed at advanced stages, limiting treatment options to palliative care.</p><p><strong>Aim: </strong>characterize adult patients with histologically confirmed lung cancer at the Regional Hospital of Temuco between October 2019 and June 2023, and to analyze factors such as smoking, biomass exposure, symptoms at diagnosis, and molecular mutations.</p><p><strong>Material and methods: </strong>A cross-sectional study was conducted on adult patients with histologically confirmed lung cancer at the Regional Hospital of Temuco between October 2019 and June 2023. Data was collected on biosociodemo-graphic characteristics, medical history, smoking, biomass exposure, symptoms at diagnosis, performance status, biopsy type, pathological results, and molecular mutation studies.</p><p><strong>Results: </strong>Out of 256 patients diagnosed with lung cancer, 220 met the inclusion criteria for histo-logical confirmation. 55.3% were male, with a mean age of 68 ± 9.5 years. 67.7% had a history of smoking, and 30.1% were exposed to biomass. 98.6% presented symptoms at diagnosis, with cough being the most common. The majority (81.9%) were diagnosed at advanced stages (III-IV). 63.9% of diagnoses were adenocarcinomas, with EGFR mutations found in 13.6% and ALK mutations in 2.1%. PDL-1 expression was detected in 18.8% of cases. Significant associations were found between EGFR and ALK mutations, which were more predominant in non-smokers, and between PDL-1 expression and biomass exposure.</p><p><strong>Conclusions: </strong>Lung cancer primarily affects men, with a mean age at diagnosis similar to that reported in other studies. Smoking remains the main risk factor, while biomass exposure also contributes to risk in the region. Most patients were diagnosed at advanced stages of the disease. Adenocarcinoma was the most frequent subtype, with EGFR and ALK mutations found at lower rates than in other national studies. PDL-1 expression showed a significant association with bio-mass exposure and advanced stages of the disease.</p>","PeriodicalId":101370,"journal":{"name":"Revista medica de Chile","volume":"153 2","pages":"104-110"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}