Public Hospital In Santiago Research Articles

Does “good acting requires a good cast”? A replication study of how team deep acting dispersion influence individual outcomes

Previous research shows that emotional labor, or having to display certain emotions in the workplace, has significant implications for employees and their working environments. In this study, we replicate the claim from Becker and Cropanzano (2015) who suggests that the effect of individual deep acting on job performance would be moderated by team-level deep acting dispersion, such that the relationship between deep acting and performance would be positive and stronger in teams with low dispersion. Our replication included 130 participants with complete data, nested in 23 teams, in a high complexity and high demand public hospital in Santiago, Chile. We collected data in December-January of 2021. We focused on testing the interaction term alone but we also replicated the entire original model from Becker and Cropanzano (2015). Although the targeted interaction effect was not significant in our study (not replicated effect), it is interesting to note that other hypotheses in Becker and Cropanzano (2015) were indeed replicated. For example, team-level deep acting dispersion was indeed a significant cross-level moderator of the relationship between individual deep acting and emotional exhaustion. We discuss the main results, the replication conditions, and the managerial implications for a Chilean population.

The Successful Implementation of a Laparoscopic Simulation Training Program in the Dominican Republic

IntroductionMount Sinai Hospital in New York introduced a laparoscopic surgery simulation center to a public hospital in Santiago, Dominican Republic to determine the feasibility of training programs in low-and-middle income countries (LMICs). MethodsIn August 2018, recruitment and preliminary data were collected at the Hospital Jose Maria Cabral y Báez in Santiago, Dominican Republic. The simulation room consists of three simulation stations. Residents were required to practice 1 h/wk guided by a general surgery postgraduate year 3 (PGY3) Mount Sinai resident. Number of hours practiced was self-reported and follow-up data was collected in June 2019. The study endpoints include times on three simulated laparoscopic tasks including peg-transfer, precision cutting, and intracorporeal knot tying. Wilcoxon-signed rank tests were used for statistical analysis. ResultsThe partnership between hospitals allowed for successful integration into the Dominican general surgery training. Over 10 mo, residents averaged 25 h of practice (range: 8-35 h; SD 9.95 h). In total, 85% of the residents participated in the study (5 postgraduate year 1 [PGY1], 2 postgraduate year 2 [PGY2], and 4 postgraduate year 3 [PGY3]). Resident median simulation times significantly improved for precision cutting (3:49 min versus 2:09 min, P = 0.002) and intracorporeal knot tying (5:20 min versus 2:47 min, P = 0.037). There was neither significant difference in peg-transfer times nor performance between resident years (P = 0.12). ConclusionsThis study demonstrates the successful integration of a laparoscopic simulation program into an LMIC surgical resident training program. With commitment from local institutions and external resources, establishing laparoscopic simulation centers are feasible and expandable, thereby allowing general surgery residents in other LMICs, the opportunity to improve their laparoscopic skills.

Evaluación de la calidad de vida de pacientes chilenos en diálisis peritoneal mediante el cuestionario KDQOL-36

Health-related quality of life (HRQoL) is an important predictor of health outcomes in chronic kidney disease (CKD) including those patients in renal replacement therapy. Its evaluation through validated questionnaires is essential for comprehensive care in people undergoing renal replacement therapy.To evaluate the quality of life in patients with CKD on peritoneal dialysis.Descriptive cross-sectional study. The KDQOL-36 quality of life questionnaire was applied to 67 patients aged 55 ± 15 years, in peritoneal dialysis at a public hospital in Santiago. Scores range from 0 to 100, values greater than 50 represent a better HRQoL.The burden, symptoms, and effects of kidney disease component of the survey had scores over 50. Women, people without diabetes, those actively working and those with better incomes reported a better HRQoL.These patients on peritoneal dialysis report a good quality of life, especially in the specific components of kidney disease.

Transcend the Death of Child with Cancer: Professional Health Experiences

Objective: To reveal the perception of grief support of professionals in pediatric oncology units, after the death of the patients. Method: Qualitative phenomenological study. 22 in-depth interviews were conducted with professionals from 5 pediatric oncology units of public hospitals in Santiago. Once the narratives were transcribed, the comprehensive analysis and subsequent triangulation of the data was performed, achieving saturation. Results: Professionals perceive themselves supported in their grief by being able to experience the losses in a protected environment and feeling supported by their surroundings. They recognized the existence of external and internal factors that facilitated the process of grief. However, this support is perceived as insufficient, as there is a lack of formal support from the institution, as well as a protected grief period, or support from mental health professionals to the teams. All death experiences allow professionals to transcend their pain based on lifelong learning and to give meaning to their work. Conclusion: Grief support felt by the professionals is generated from their own initiatives of re-encounter within the teams, which is insufficient. Therefore, training in coping with death is necessary from undergraduate level, which would allow greater cohesiveness in coping and greater self-care within the teams.

Intensive chemotherapy with tyrosine kinase inhibitors in philadelphia-positive acute lymphoblastic leukemia

Before the advent of tyrosine kinase inhibitors (TKIs), patients with Philadelphia-positive Acute Lymphoblastic Leukemia (Ph+ALL) had a poor prognosis. The association of TKIs to intensive chemotherapy (CT) improved outcome. To evaluate results of an intensive CT protocol including TKI in a public hospital in Santiago, Chile. All patients with Ph+ALL diagnosed between January 2010 and February 2019, and who met inclusion criteria for intensive CT, received the Ph+ALL national protocol in association with imatinib and were included in this analysis. Thirty-five patients aged 15 to 59 years received treatment. Complete response (CR) was obtained in 97%. Measurable residual disease (MRD) was negative in 61% (19/31 evaluable cases) during follow-up, and 55% (16/29) were MRD (-) before three months. Relapse was observed in 13 cases. Three patients underwent allogeneic hematopoietic stem cell transplant (HSCT), two in CR1. The overall survival (OS) and event-free survival (EFS) at three years were 52 and 34%, respectively. In patients who achieved MRD negativity before three months, no statistically significant differences in OS (64 and 42% respectively, p = 0.15) or EFS (35 and 32% respectively, p = 0.37) were observed. The prognosis of Ph+ALL improved with the association of imatinib to intensive CT. MRD-negative status before three months in this series was not significantly associated with better outcomes. Our series suggests that the Ph+ALL national protocol associated to TKI is a therapeutic alternative with high CR and aceptable MRD (-) rates.

Impact of Shift Work on the Eating Pattern, Physical Activity and Daytime Sleepiness Among Chilean Healthcare Workers.

We evaluated the eating pattern, physical activity, and daytime sleepiness level in Chilean shift workers. Fifty, middle-aged adult health workers from a public hospital in Santiago, Chile, were included: a group undergoing shift work (shift workers, including at least one “night shift” and one “long day”, n = 33), and day workers under traditional schedule (from 8:00 to 17:00h, n = 17). Body composition, physical activity, and daytime sleepiness levels, and diet characteristics (diet composition, meals' timing, and diet quality) were assessed. Despite similar total energy intake, shift worker showed lower carbohydrate (% of energy) and higher protein intake (both P < 0.01), decreased diet quality, an irregular eating pattern, and delayed meal timing (all P < 0.05). Physical activity and daytime sleepiness levels did not differ between groups. Findings from this first Chilean study in healthcare shift workers support the fact that meal timing and diet quality appear as critical factors for upcoming intervention studies in this group.

Digital revolution in healthcare: are stroke patients ready?

The digital revolution is creating opportunities and challenges in the field of medicine and the Digital Hospital could be a benefit for patients, if they are able to use the Internet. Identify the barriers that limit Internet use among stroke patients treated in a public hospital in Santiago. Sociodemographic, clinical and functional variables that could influence the use of the Internet were collected in 107 patients with stroke. Seventy five percent of patients had access to the Internet, but only 29% knew how to use it before their hospitalization. Seventy five percent were older adults, 74% had a low level of education, 78% had an income below the minimum Chilean salary and 56% were discharged with a severe disability (modified Rankin Scale 4 or 5). There was a significant relationship between Internet use and the level of education, income and age. Income levels, age, schooling and stroke related disability limit Internet use in this population.

Does educational level predict hearing aid self-efficacy in experienced older adult hearing aid users from Latin America? Validation process of the Spanish version of the MARS-HA questionnaire.

Hearing aids are the most common rehabilitation strategy for age-related hearing loss. However, 25% to 50% of older adults fitted with hearing aids do not wear them post-fitting. Hearing aid self-efficacy has been suggested as one of the key factors that may explain adherence to hearing aids in older adults. The primary aim of this study was to determine a possible association between educational level and hearing aid self-efficacy in older adult hearing aid users from a Latin American country (i.e., Chile). The secondary aim was to determine if in this sample of older adults, hearing aid self-efficacy predicted hearing aid adherence as previously suggested by other studies. The MARS-HA (Measure of Audiologic Rehabilitation Self-Efficacy for Hearing Aids) questionnaire was used to measure hearing aid self-efficacy. This questionnaire was initially adapted into Spanish (S-MARS-HA) using forward and backward translations by bilingual English-Spanish speakers. A sample of 252 older adults fitted with hearing aids at a public hospital in Santiago, Chile, was investigated. Educational level was measured as the number of years of formal education. Participants responded to the S-MARS-HA along with questions exploring social support, attitudes in using hearing aids, participation in social events, and vision and joint problems. Hearing aid adherence was investigated with the use of a question from the International Outcome Inventory for Hearing Aids. All these procedures were conducted at the participants' homes. Pure-tone average (PTA; 500-4000 Hz) in the fitted ear was obtained from the participants' medical records. Univariate and multivariate regression models were constructed to investigate the association between educational level and hearing aid self-efficacy controlling for the covariates of interest (e.g., social support, attitudes in using hearing aids, PTA). The S-MARS-HA showed an adequate construct validity along with a good reliability. Results of the multivariate regression analyses showed that educational level significantly predicted hearing aid self-efficacy. Covariates significantly associated with this outcome included attitudes in using hearing aids and PTA in the fitted ear. Finally, a significant association between hearing aid self-efficacy and adherence to hearing aid use was observed. In conclusion, this study showed a significant association between educational level and hearing aid self-efficacy in older adults from a developing Latin American country. Thus, this variable should be considered when designing and delivering aural rehabilitation programs such as hearing aids to older adults, especially those from developing countries.

ASSOCIATIONS BETWEEN SMOKING CONSUMPTION, TOBACCO CESSATION ATTITUDES, AND AGE AMONG LATINO HEALTHCARE PROVIDERS

Hospitalization is a good opportunity to offer smoking cessation programs to smokers. Healthcare providers′ (HCP) tobacco consumption and cessation attitudes are known to affect the provision of cessation interventions. Lesser known are Latino HCP’s tobacco intervention attitudes. This study aimed to examine the associations between tobacco cessation attitudes (TCA), levels of consumption, and demographics among Latino HCP’s. A quantitative, correlational, cross-sectional design was used. 66 HCP’s working in a public hospital in Santiago, Chile self-reported demographics (age, gender, profession), tobacco consumption, and TCA. TCA’s include questions regarding Acceptability of Brief Counseling (ABC), belief whether smoking is harmful for patients, and duty to aid patients quit smoking. Majority of HCP’s (34 years old, 83% female, 58.5% technical nurses, 38.5% nurses, 3.1% Kinesiologists) did not consume tobacco (67%). Pearson’s correlation revealed that greater HCP age was significantly associated with less belief that smoking is harmful for their patients (r = -.36, p. = .004). ABC (M = 22, SD = 5.5) was positively associated with the belief that smoking is harmful for patients (r = .306, p = .016) and duty to help patients quit smoking (r = .574, p = .000). Findings provide evidence that HCP’s TCA’s are important factors to consider during implementation of a brief counseling for tobacco cessation. Further research should focus on increasing HCP’s acceptability of providing cessation care to their patients. Specifically, tailoring education and interventions by age might serve useful to address the differences in TCA’s which may subsequently influence their tobacco cessation practices.

Perception of support in professional's and technician's grief of pediatric intensive care units in public hospitals.

Death in childhood is a reality faced by health professionals, especially in highly com plex units such as intensive care ones. This leads to feelings of helplessness and frustration in health professionals, compromising their physical, emotional, and mental health, which is worsened by the feeling of low social support and poor preparation for coping with death and support for the patient's family. To expose the perception of sorrow support of professionals and techni cians in pediatric intensive care units of public hospitals, after the death of the patients. Qualitative study with a phenomenological approach. 16 in-depth interviews were conduc ted with pediatric intensive care professionals and technicians from five public hospitals in Santiago, Chile. Inclusion criteria considered working for more than a year in the Unit, having experienced the death of patients, and recognizing that they have gone through a professional sorrow. The in terview focused on the following question: How have you experienced the sorrow support received after the death of patients in your unit? Once the narratives were transcribed, the phenomenological analysis and subsequent data triangulation were carried out, achieving saturation. It was observed that the participants feel little supported in their sorrows after the death of the patients, where there are obstacles to face the situation. Although facing death is something complex for the participants, they recognize that they can generate protection strategies and also feel supported by the people around them. Despite the complexity of this experience, the participants consider that there are lessons learned in facing death which leads them to give meaning to their professional work. Professionals need the recognition of deaths in the workplace and, therefore, formal and continuous support from their work team and institution.

Delayed child bearing in a Chilean public hospital

Postponement of motherhood is one of the most striking sociodemographic changes of modernity. To evaluate the age of primiparous women giving birth at a public hospital in Santiago, Chile. Retrospective study, assessing the age and nationality of all women whose delivery occurred between 2009 and 2017 in a single hospital. A total of 49,254 deliveries were registered: 43% were in primiparous women (73% Chilean and 27% foreign women). The proportion of foreign women increased from 12% in 2009 to more than 60% of total deliveries in 2017. Four percent of primiparous women were aged over 35 years of age and there was a steady increase in the age increase of primiparous women in the nine years of study. There was a higher proportion of normal-weight newborns among foreign women compared to their Chilean counterparts (86 and 81% respectively). In this sample of women attended at a public hospital, a steady increase in the age at first delivery was noted in a period of nine years. There was also a constant increase in the proportion of foreign women giving birth.

Assistive Devices for Older Adults: A Longitudinal Study of Policy Effectiveness, Santiago, Chile, 2014-2016.

INTRODUCTION Population aging is a worldwide phenomenon. It is estimated that by 2050, one of five persons will be aged ≥60 years. In Chile, 15.8% of the population is now aged ≥60 years, and this figure will reach 30.7% by 2050. In 2006, a national program was implemented to provide assistive devices to older adults aged ≥65 years with limited mobility or difficulty performing activities of daily living. To date, there have been no assessments of the program's effectiveness. OBJECTIVE Assess the effectiveness of an assistive devices policy in Chile on improving functional capacity of older adults aged ≥65 years, and beneficiaries' perceptions of the services received, including changes in their quality of life. METHODS This was a before-after longitudinal study. A cohort of 309 persons was recruited, consisting of patients who received care at a public hospital in Santiago, Chile during 2014-2015. They were assessed before delivery of assistive devices, then followed for seven months, with repeated evaluations made in their homes. The following indicators were measured: functional capacity (Tinetti scale and Barthel Index); changes in perceived quality of life related to use of assistive devices; and other sociodemographic, clinical and protocol-compliance variables. A longitudinal analysis of before-after progress was carried out, as well as a description of service delivery and medical followup. RESULTS Sixty-eight percent of those surveyed were women; median age was 74 years, average schooling was 6 years, and 93% had low income (monthly income <US$398). Assistive devices increased independence in activities of daily living, improved mobility and perceived quality of life, and decreased fall risk and pain. One hundred percent felt satisfied with the service received, 91% were trained in use of the device, and delivery deadlines were met in 83% of cases, but only 2% were followed up. One negative aspect is that the program covers only 25% of estimated need. CONCLUSIONS This assistive device program helps improve functional capacity and perceived quality of life in vulnerable patients who are able to access it. It addresses a real need and is highly valued by patients. Although delivery schedules were fulfilled, followup care schedules were not. KEYWORDS Aging, mobility limitation, assistive devices, activities of daily living, health care system, health care reform, quality of life, Chile.

Operationalization and inter-rater reliability of a set of relevant ICF categories for adult patients treated for cancer at hospital discharge

The biopsychosocial model of the ICF comprises more than 1400 categories. These categories need to be operationalized, to guarantee clinical applicability, through the development of instruments that describe the functioning and disability of patients in different contexts or health conditions. Aim: To describe the process of operationalization and subsequent verification of the inter-rater reliability of a set of ICF categories for adult patients treated for cancer at hospital discharge. Corresponds to an observational validation study. A previous process of systematic review and expert consensus selected 24 ICF categories, which were operationalized in a formal decision-making consulting different experts in the subject - health professionals with experience in the clinical management of patients with cancer. Subsequently, these operationalized categories were exposed to verification of inter-rater reliability by two trained raters in a sample of 31 patients with different types of cancer in two public Hospitals in Santiago, Chile. This study was approved by the Ethics Committee. 24 CIF categories were operationalized using a scale of 0 to 4 corresponding to the CIF scale.The average age of the participants was 54.2 (of = 19) years. In relation to inter-rater reliability, the only item that did not present a correlation between both evaluations was d240 regarding stress management. In this way, this item was excluded from the instrument because it was very ambiguous. The other items obtained significant correlations that varied from r = .916 to r = 1.0 (perfect correlation). This process resulted in the operationalization of 23 CIF categories relevant to the context of patients hospitalized for cancer, which obtained good inter-rater reliability. More research is suggested investigating other psychometric properties of this set of operationalized categories.

Avoiding Small Intestinal Biopsies for Diagnosis of Celiac Disease in Children: A Reliable Strategy for All Patients?

Current reports applying ESPGHAN exception criteria (EEC) to diagnose celiac disease (CD) without duodenal biopsies indicate that a high percentage of patients with CD may be identified when applied correctly in specialized settings. Application of the EEC, however, in "daily life conditions" at the different levels of medical services is not clear. EEC was applied to 130 pediatric patients evaluated for CD at 5 public hospitals in Santiago, Chile, during 2010 to 2015. Clinical presentation, serum anti-tissue transglutaminase 2 and anti-endomysium antibodies (EMA), genotyping, and small intestinal histology were obtained from clinical charts. A total of 78 of 130 patients reviewed had some of the data required for analysis, but EMA was determined in 54% and genotyping in 2.3% of patients, limiting the study. After offering free genotyping, only 12 of 78 (15%) had all data required for EEC application. In this small group, 10 of 12 (83.3%) patients could avoid duodenal biopsies and 2 (16.7%) with potential CD were misdiagnosed. Main reasons for not doing EMA and genotyping were that they are expensive, unavailable in the local health care center, and considered "not necessary" for diagnosis. Limited resources in clinical settings reduce availability of EMA and genotyping, making application of EEC criteria difficult and only possible only in 15% of our patients. Within this subgroup, biopsies could be avoided in 83.3%, and 16.7% of patients with potential CD were misdiagnosed. Insufficient studies and incorrect interpretation of EEC contributed to incomplete assessment in 52 of 130 (40%) patients. The Chilean public health system is likely representative of several others present in developing and developed countries.

Factors associated with quality of life in a cohort of patients with palliative advanced cancer from a developing country: Relevance of perception of cancer curability.

93 Background: Improving quality of life (QOL) is a key goal in palliative care for patients with advanced cancer. Most studies about QOL in palliative care patients have been performed in the developed world. However, little is known about the factors that influence patients QOL in developing countries. The aim of this study is to describe factors associated with QOL in a cohort of patients with advanced cancer who were enrolled in the outpatient clinic public hospital in Santiago, Chile. Methods: Patients with advanced cancer admitted to the National Program of Palliative Care at a public Hospital in Santiago, Chile were prospectively enrolled in a study to assess QOL longitudinally. QOL was assessed with the EORTC-QLQ-PAL 15 questionnaire. Demographics, symptom intensity, depression and anxiety were assessed. Descriptive statistics and regression analysis were performed. Information about cancer curability and perception of personal health were also included. Results: In this preliminary report, the first 37 patients were included. Baseline characteristics were: mean patient age was 64, 21 (57%) females, 14 (38%) had GI cancer, 7 (19%) lung cancer, 4 (11%) breast cancer and 12 (22%) other. Mean (SD) QOL was 63 (34) in a 0 to 100 scale. QOL was not associated with age, gender, functionality, depression, anxiety, spiritual pain or financial distress. QOL was negatively associated with total symptom burden (coef -.53, p = .48), and positively associated with believing that cancer was curable (coef 33.3, p = .003). In a multivariate analysis, QOL was independently associated with both lower overall symptom burden (coef -.55, p = .38) and believing that cancer was curable (coef 28.6, p = .009). Conclusions: In palliative care patients with advanced cancer from a developing country, QOL was associated with lower overall symptom burden and with believing that cancer was curable. Further studies are needed to explore whether clarifying prognostic information about cancer curability in developing countries may impact patients’ QOL.

Caregivers' accuracy in reporting patients' symptom: A preliminary report.

64 Background: Improving symptom control during end of life (EOL) is a core goal of palliative care. When patients are not able to report their symptoms, caregivers (CG) report symptom intensity as surrogates. Data show that there is good agreement between patients and CG in reporting symptom intensity. However, little is known about factores that influence CGs’ accuracy. The aim of the study was to determine CG accuracy of advanced cancer patients’ symptoms and to identify CG factors that could modify it. Methods: In this prospective study, patients with advanced cancer enrolled in the National Program of Palliative Care at a public Hospital in Santiago, Chile and their CGs independently scored ten patients’ symptoms using the Edmonton Symptom Assessment Scale (ESAS). Correlation between patient and CG scores were estimated for each symptom. Differences between patient and CG scores were calculated for each symptom and were transformed into positive values. A continuous variable was created with the sum of all the differences as an indicator of caregiver overall accuracy, with smaller scores meaning better accuracy. CG depression, anxiety (HADS) and burden (ZARIT) were also assessed. Results: 36 patients and their CG were included in this preliminary analysis. Mean patient age was 64, 20 (56%) females, 13 (36%) had GI cancer, 7 (19%) lung cancer and 16 (45%) other. Mean caregiver age was 53, 25 (69%) female. We found positive correlations between patients’ and caregivers’ assessment of pain, fatigue, nausea, anorexia, dyspnea, depression and insomnia (r &gt; 0.3 and p &lt; .05 for each symptom). CG accuracy ranged between 10 and 44 points (mean 25, standard deviation 9) and was not associated with CG age, gender, depression, anxiety or burden. CG accuracy was negatively associated with CG worrying thoughts as assessed by one of the HADS questions (Coef -3.99, p = .015), meaning that CG were more accurate when their worrying thoughts were higher. This association remained significant when adjusted by CG depression, anxiety and burden. Conclusions: CG are more accurate in reporting patient symptoms when their levels of worrying thoughts are higher. This information may have implications in interpreting CG report during EOL.

Medication Overdoses at a Public Emergency Department in Santiago, Chile.

IntroductionWhile a nationwide poison control registry exists in Chile, reporting to the center is sporadic and happens at the discretion of the treating physician or by patients’ self-report. Moreover, individual hospitals do not monitor accidental or intentional poisoning in a systematic manner. The goal of this study was to identify all cases of intentional medication overdose (MO) that occurred over two years at a large public hospital in Santiago, Chile, and examine its epidemiologic profile.MethodsThis study is a retrospective, explicit chart review conducted at Hospital Sótero del Rio from July 2008 until June 2010. We included all cases of identified intentional MO. Alcohol and recreational drugs were included only when they were ingested with other medications.ResultsWe identified 1,557 cases of intentional MO and analyzed a total of 1,197 cases, corresponding to 0.51% of all emergency department (ED) presentations between July 2008 and June 2010. The median patient age was 25 years. The majority was female (67.6%). Two peaks were identified, corresponding to the spring of each year sampled. The rate of hospital admission was 22.2%. Benzodiazepines, selective serotonin reuptake inhibitors, and tricyclic antidepressants (TCA) were the causative agents most commonly found, comprising 1,044 (87.2%) of all analyzed cases. Acetaminophen was involved in 81 (6.8%) cases. More than one active substance was involved in 35% of cases. In 7.3% there was ethanol co-ingestion and in 1.0% co-ingestion of some other recreational drug (primarily cocaine). Of 1,557 cases, six (0.39%) patients died. TCA were involved in two of these deaths.ConclusionSimilar to other developed and developing nations, intentional MO accounts for a significant number of ED presentations in Chile. Chile is unique in the region, however, in that its spectrum of intentional overdoses includes an excess burden of tricyclic antidepressant and benzodiazepine overdoses, a relatively low rate of alcohol and recreational drug co-ingestion, and a relatively low rate of acetaminophen ingestion.

Hypertension and its association with shift work, sleep-disordered breathing and place in the organizational hierarchy

Introduction Hypertension (HT) is a highly prevalent cardiovascular disease and a risk factor for coronary heart disease, stroke, and heart and kidney failure, among others. The obstructive sleep apnea (OSA) is a well-known causative factor of hypertension, but less known is the role of shift work systems and the place in the hierarchy of social organization. Objective: To study the risk factors associated with hypertension in a group of health workers. Materials and methods We conducted a cross-sectional study in a group of health workers, as part of an occupational health program in a public hospital in Santiago, Chile. All subjects underwent a medical evaluation, which included anthropometric parameters, blood pressure measurement, a battery of laboratory tests, and surveys of sleep by Berlin Questionnaire. According to this questionnaire went classified in Low or High Risk of OSA. According to the work schedule, the workers were classified into Daytime work, 3rd Shift, and 4th Shift; and as the plant to which they belonged within the organization in Professional, Administrative, Paramedical technician, and Auxiliary. We examined the association of hypertension with shift work, the risk of OSA, and place within the organizational hierarchy using a logistic regression model adjusted for sex, age, BMI, and smoking. Results The study group consisted of 353 workers, with an average age of 44.2 ± 12.6 years (IQ = 31.8–54.7), of which 266 (75.4%) were women, and 87 (24.6%) were men. Of the total, 87 (24.6%) had hypertension. On the other hand, as the result of the Berlin Questionnaire, 151 (42.8%) had High Risk of OSA. According to the work schedule, 194 (55%) worked in daytime, and 159 (45%) were shift workers (114 in 4th Shift, and 45 in the 3rd Shift). Of the total, 44 (12.5%) were Professionals, 78 (22.1%) Administrative, 148 (41.9%) Paramedical technicians, and 83 (23.5%) Auxiliary. According to logistic regression, the 4th Shift had an OR = 2.03 (95% CI, 0.9–4.58; p = 0.088), 3rd Shift an OR = 4.23 (95% CI, 1, 51–11.83; p = 0.006); the trend test was significant with an OR = 2.05 (95% CI, 1.23–3.41; p = 0.006). The High Risk of OSAS an OR = 4.1 (95% CI, 1.89–8.9; p 0.001). Regarding the location in the organization, the Administrative had an OR = 10.1 (95% CI, 1.76–57.88; p 0.001), Paramedical technicians OR = 5.55 (95% CI, 1.1–28.27; p = 0.039), and the Auxiliary an OR = 5, 76 (95% CI, 1.11–29.86; p = 0.037). Interactions between stratum and shift work and risk of OSA, were not significant in the multiplicative scale. The age variable reached statistical significance ( p = 0.018). The factors sex, BMI, and smoking showed no increased risk associated. Conclusion According to our results, the place within the organizational hierarchy, shift work and sleep-disordered breathing, are independent risk factors of hypertension in health workers. These results also suggest that sex, overweight and obesity, and smoking act through independent risk factors and not by themselves. Acknowledgements To health workers of Felix Bulnes Hospital.

Anxiety and depression associated with sleep disturbances in shift workers

There is increasing evidence that shift work has negative consequences for cardiovascular and metabolic level, and is associated with an increased risk of accident. These consequences would be mediated primarily by chronic sleep deprivation and circadian misalignment suffered by these workers. However, there is less evidence on the impact on the mental health of shift workers. Objective: Studying the effects of rotating night shift work on levels of anxiety and depression in health care workers. As a part of an occupational health program, we conducted a cross-sectional study among workers at a public hospital in Santiago, Chile. According to their work schedule they were classified in daytime work (DW) or shift work (SW). The whole group underwent a medical evaluation that included measurement of weight and height, and they were given a battery of questionnaires: Berlin Questionnaire (BQ), Hospital Anxiety and Depression Scale (ADS) and Pittsburgh’s Sleep Quality Index (PSQI). The BQ classifies subjects into Low Risk (LR) or High Risk (HR) of suffering from obstructive sleep apnea syndrome (OSAS). According to their work schedule and outcome of BQ, they were classified into 4 groups: DW/LR (Group 1, n = 40), DW/HR (Group 2, n = 33), SW/LR (Group 3, n = 28) and SW/HR (Group 4, n = 34). ANOVA test was applied. The study group consisted of 136 workers, of whom 110 (80.9%) were women and 26 (19.1%) were men. Of the total, 74 (54.4%) were working in daytime, and 62 (45.6%) at night in a rotating shift system (37 in 4th Shift and 25 in 3rd Shift). The results according to age were: Group 1 = 39.41 ( ± 13.27), Group 2 = 44.34 ( ± 10.43), Group 3 = 42.34 ( ± 14.25), and Group 4 = 49.25 ( ± 12.51) ( p = 0.011). For BMI, the results were: Group 1 = 24.63 ( ± 6.65), Group 2 = 31.19 ( ± 4.65), Group 3 = 28.87 ( ± 4.99), and Group 4 = 33.49 ( ± 8.56) ( p < 0.001). The anxiety score was: Group 1 = 6.73 ( ± 3.90), Group 2 = 10.39 ( ± 5.25), Group 3 = 7.39 ( ± 3.55), and Group 4 = 10.94 ( ± 5.09) ( p < 0.001). The depression score was: Group 1 = 4.08 ( ± 3.49), Group2 = 6.79 ( ± 4.00), Group 3 = 4.14 ( ± 3.11), and Group 4 = 8.06 ( ± 4.82) ( p < 0.001). The average hours of sleep reported were: Group 1 = 5.96 ( ± 1.21), Group 2 = 5.92 ( ± 1.13), Group 3 = 5.87 ( ± 1.77), and Group 4 = 5.85 ( ± 1.66) ( p = 0.988). The PSQI score was: Group 1 = 7.95 ( ± 3.29), Group 2 = 9.15 ( ± 4.85), Group 3 = 9.50 ( ± 4.99), and Group 4 = 11.29 ( ± 4.93); ( p = 0.019). In the group studied one can see a level of anxiety and depression significantly higher in subjects with HR of OSAS, which is even greater when this condition is associated with SW. In addition, there was a reduced time spent sleeping in the entire studied group. Sleep, in general, is poor and worsens when subjects with HR of OSAS work in SW. These results suggest that the SW is associated with increased anxiety and depression, and exacerbates the negative consequences of OSAS on mental health. Workers at the Felix Bulnes Hospital

Características de los pacientes traumatizados que ingresan a la UCI de un hospital general en Chile

Trauma is an important cause of death among young adults. To determine the characteristics, treatments and evolution of trauma patients admitted to an intensive care unit (ICU) of a public hospital in Santiago, Chile. All polytrauma (PT) and severely traumatized (ST) patients admitted to ICU were included. We recorded the type of trauma along with demographic and hemodynamic variables, treatments and complications. The evolution and treatments received by PT and ST patients were compared. We recorded data from 72 patients aged 43 ± 21 years (93% males). Sixty two percent were PT and 24% had penetrating injuries. TBI (Trauma Brain Injury) was the most common trauma. On admission, acute Physiology and Chronic Health Evaluation II (APACHE II) score was 18.7 + 7.3, and Injury Severity Score (ISS) was 32.8 + 20.1. ICU stay was 7.8 + 6 days. Sixty seven per cent of patients required surgery and 58% received blood transfusions. No differences were found between PT and ST. ICU and hospital mortality rates were 15 and 25% respectively. The characteristics and evolution of PT and ST of this series of patients are similar to those described abroad. Mortality was in agreement with ISS and APACHE II scores.