Resumo A pesquisa está interessada tanto nas variáveis ecológicas quanto nas variáveis de identidade (sociais) envolvidas no aumento do envolvimento ambiental no cuidado antártico. Dois estudos com habitantes do sul de duas cidades, e outro com uma amostra nacional de três áreas geográficas diferentes (norte, centro e sul) participaram respondendo a uma pesquisa auto-administrada. Os instrumentos mediram a percepção de responsabilidade pessoal pelos cuidados antárticos no presente e no futuro, a valorização antártica, a identidade ecológica regional antártica e as crenças ambientais. Os resultados centrais mostram que a identificação com o território antártico é importante para determinar a percepção de responsabilidade e o compromisso com seu cuidado, e que este processo é mediado pelo valor colocado no continente congelado. Tal mediação foi observada tanto na amostra de locais como de nacionais. Estes resultados são discutidos em relação à importância de considerar as variáveis de identidade ao desenvolver modelos destinados a promover uma atitude pró-ecológica.

Abstract The research is interested in both ecological and identity (social) variables involved in increasing environmental commitment to Antarctic care. Two studies with inhabitants of two cities in the extreme south, and another with a national sample from three different geographical areas (north, center and south) participated by answering a self-administered survey. The instruments measured the perception of personal responsibility for Antarctic care in the present and future, Value of Antarctica, Antarctic regional ecological identity, and environmental beliefs. The core results show that identification with the Antarctic territory is important in determining the perception of responsibility and commitment to its care, and that this process is mediated by the value given to the polar continent. This mediation was observed in both the sample of locals and nationals. These results are discussed in relation to the importance of considering identity variables when developing models that aim to promote a pro-ecological attitude.

Resumen La investigación se interesa tanto en variables ecológicas como identitarias (sociales) que participan en el aumento del compromiso ambiental en el cuidado antártico. Dos estudios con habitantes del sur austral de dos ciudades, y otro con una muestra nacional de tres zonas geográficas diferentes (norte, centro y sur) participaron contestando una encuesta autoaplicada. Los instrumentos midieron la percepción de responsabilidad personal en el cuidado antártico en el presente y futuro, la valoración antártica, la identidad regional ecológica antártica y creencias ambientales. Los resultados centrales muestran que la identificación con el territorio antártico resulta importante para determinar la percepción de responsabilidad y compromiso en su cuidado, y que este proceso es mediado por el valor que se le otorga al continente helado. Dicha mediación se observó tanto en la muestra de locales como de nacionales. Se discuten estos resultados en torno a la importancia de considerar variables identitarias al desarrollar modelos orientados al fomento de la actitud proecológica.

Abstract The evidence is inconclusive regarding the effect of periodontal treatment on glycemic control and systemic inflammation in patients with type 2 diabetes (T2D) and periodontitis Objective: To evaluate the effect of scaling and root planing (SRP) on the metabolic control and systemic inflammation of patients with type 2 diabetes (T2D). Methodology: A literature search was conducted using the MEDLINE database via PubMed and the Cochrane Central Register of Controlled Trials, from their oldest records up to July 2018. Only randomized clinical trials (RCT) were considered eligible for evaluating the effect of periodontal treatment on markers of metabolic control [glycated hemoglobin (HbA1C)] and systemic inflammation [C-reactive protein (CRP)] in patients with T2D. The quality of the studies was evaluated using the Cochrane Collaboration risk assessment tool. Meta-analyses were performed for HbA1c and CRP using random effects models. The size of the overall intervention effect was estimated by calculating the weighted average of the differences in means (DM) between the groups in each study. Heterogeneity was assessed using the Q-statistic method (x2 and I²). The level of significance was established at p<0.05. Results: Nine RCT were included. SRP was effective in reducing HbA1c [DM=0.56 (0.36-0.75); p<0.01] and CRP [DM=1.89 (1.70-2.08); p<0.01]. No heterogeneity was detected (I2=0%, p>0.05). Conclusions: SRP has an impact on metabolic control and reduction of systemic inflammation of patients with T2D.

ABSTRACT Introduction: Worldwide there is a need to reduce the use of excessive technology during childbirth. Consequently, there is an interest to develop respectful and personalized models of care. Chile has one of the highest C-section rates in the region, many of which are not needed. A FONDEF project developed and tested a comprehensive health care model in childbirth (MASIP), considering active participation of women and families and less unneeded clinical interventions. Objective: to evaluate the effectiveness of MASIP in comparison with standard care. Methods: a randomized controlled experiment was conducted in one public hospital in Santiago Chile. Two arms were compared: MASIP vs. standard care. Low obstetric risk women were included. Variables of interest included quality and safety measures. Results: MASIP had better quality results, such as maternal wellbeing and less clinical interventions. During the study c-section was lower in both arms in comparison to a historical record of the same population. Safety outcomes were similar in both arms. Conclusion: MASIP is as safe as the standard care but it has better quality of care. Interventions to improve users’ satisfaction and experience should consider the components of MASIP.

RESUMEN Introducción: A nivel internacional existe un interés por disminuir el uso excesivo de tecnologías durante el parto, inclinándose hacia el desarrollo de modelos de atención personalizados y respetuosos. Chile concentra una de las tasas de cesáreas más altas en la región, muchas de ellas sin justificación clínica. En este contexto, un proyecto FONDEF desarrolló y probó un modelo de asistencia integral del parto (MASIP), considerando la participación activa de la mujer y familia y menos intervenciones innecesarias. Objetivo: evaluar la efectividad de MASIP en comparación con el cuidado estándar del parto. Metodología: A través de un diseño experimental aleatorizado y controlado, se compararon los resultados de calidad y seguridad de MASIP con la modalidad habitual de asistencia del sistema público en Santiago de Chile, para la población de embarazadas de bajo riesgo. Resultados: MASIP resultó ser más efectiva que la asistencia tradicional en términos de calidad con los indicadores de bienestar materno, disminución de medidas de conducción y de atención de parto innecesarias. La frecuencia de cesárea disminuyó durante el período del estudio en ambos grupos, en comparación con un registro histórico de la misma población. En términos de seguridad, los indicadores mantuvieron el estándar alcanzado en las últimas décadas en ambas modalidades, pese a que el modelo integral se caracteriza por tener menos intervención. Conclusión: MASIP es un modelo seguro y de mejor calidad para mujeres de bajo riesgo del sistema público de Chile que el cuidado estándar. Intervenciones futuras para mejorar la experiencia de las mujeres y familias, deben incluir en su diseño los componentes de MASIP.

Introduction: Air pollution by particulate matter (PM) is a major public health problem. In Chile, the study has focused on outdoor air and PM10, rather than indoor air and PM2.5. Because newborns and infants spend most of their time at home, it is necessary to evaluate the exposure to indoor air pollution in this susceptible population. Objective: To determine concentration of PM2.5 in the homes of newborns and identify the emission sources of the pollutants. Patients and Method: The PM2.5 concentration ([PM2.5]) was collected over a 24 hour period in 207 households. Baseline sociodemographic information and environmental factors (heating, ventilation, smoking and house cleaning), were collected. Results: The median [PM2.5] was 107.5 μg/m³. Family history of asthma was associated with lower [PM2.5] (P = .0495). Homes without heating showed a lower median [PM2.5], 58.6 μg/m³, while those using firewood, kerosene, and electricity ranged between 112.5 and 114.9, and coal users’ homes reached 162.9 μg/m³. Wood using homes had significant differences (P = .0164) in median [PM2.5] whether the stove had complete combustion (98.2 μg/m³) vs. incomplete (112.6 μg/m³), or a salamander stove (140.6 μg/m³). Cigarette smoking was reported in 8.7% of the households, but was not associated with the [PM2.5]. Ventilation was associated with a higher median [PM2.5] (120.6 vs. 99.1 μg/m³, P = .0039). Conclusion: We found homes with high [PM2.5]. Residential wood consumption was almost universal, and it is associated with the [PM2.5]. Natural ventilation increased MP2.5, probably due to infiltration from outside.

Introducción: La contaminación de aire por material particulado (MP) es un importante problema de salud pública. En Chile se ha estudiado la contaminación atmosférica y MP10, y escasamente aire interior y MP2,5. Como los recién nacidos y los lactantes pasan la mayoría del tiempo en el hogar, es necesario evaluar la exposición a la contaminación intradomiciliaria en esta población susceptible. Objetivo: Determinar la concentración de MP2,5 en hogares de recién nacidos e identificar las fuentes de emisión contaminante. Pacientes y método: En 207 hogares se recolectó la concentración de MP2,5 ([MP2,5]) por 24 h y se evaluó la información sociodemográfica y los factores ambientales (calefacción, ventilación, tabaquismo intradomiciliario y aseo del hogar). Resultados: La [MP2,5] mediana fue 107,5 μg/m³. El antecedente «asma familiar» se asoció a menor [MP2,5] (p = 0,0495). Hogares sin uso de calefacción mostraron la menor [MP2,5] mediana, 58,6 μg/m³, mientras los que usaron leña, parafina, electricidad entre 112,5 y 114,9 μg/m³ y brasero 162,9 μg/m³. Hogares que usaron leña tuvieron diferencias significativas en [MP2,5] mediana (p = 0,0164) al usar estufa de combustión completa (98,2 μg/m³) versus cocina a leña (112,6 μg/m³) y salamandra (140,6 μg/m³). En el 8,7% de los hogares se reportó consumo de cigarrillos, no asociándose a [MP2,5]. La ventilación se asoció a mayor [MP2,5] mediana (120,6 vs. 99,1 μg/m³; p = 0,0039). Conclusión: Hubo hogares con [MP2,5] elevada, siendo el consumo residencial de leña casi universal y asociado a [MP2,5]. La ventilación natural incrementó el MP2,5 interior, probablemente por infiltración desde el exterior.

Introduction: The hospital water supply is a reservoir of a variety of potentially pathogenic microorganisms that can particularly affect children and immunocompromised patients. Potentially pathogenic Microsporidium spp. have been identified in water. Microsporidiosis is an emerging parasitic and opportunistic infection in immunocompromised patients. Objective and Method: to describe an outbreak of nosocomial diarrhea due to Microsporidium, species Encephalitozoon intestinalis. Results: Seven cases of E. intestinalis associated diarrhea were reported between november 2012 and february 2013, in a unit of immunocompromised patients in L. Calvo Mackenna Children's Hospital. Microsporidium spp. was found in the hospital water supply and water reservoir tank. Secondary cases were transmitted by contact. Control measures included contact precautions, not to use faucet water for hand washing, bottled water for drinking and water reservoir tank sanitation. Conclusions: This research is about a nosocomial outbreak associated with water supply. Water quality in Chilean hospitals is an unresolved issue, especially in immunocompromised patient areas. Compliance of cleaning and disinfection of water supply systems in hospitals must be ensured.

Introducción: Los sistemas de suministro de agua potable de los hospitales constituyen un reservorio de una variedad de microorganismos potencialmente patógenos que pueden afectar especialmente a niños y pacientes inmunocomprometidos. Especies de Microsporidium spp. potencialmente patógenos para el hombre han sido identificadas en el agua potable. La microsporidiosis es una infección parasitaria oportunista en pacientes inmunocomprometidos. Objetivos y Método: Describir un brote de diarrea nosocomial por Microsporidium de la especie Encephalitozoon intestinalis. Resultados: Se registraron siete casos de diarrea por E. intestinalis, entre noviembre de 2012 y febrero de 2013, en una unidad de pacientes inmunocomprometidos del Hospital de Niños Luis Calvo Mackenna, comprobándose la presencia de Microsporidium spp. abundante en el agua potable y estanques del hospital. Los casos secundarios pudieron transmitirse por contacto. Las medidas de control fueron precauciones de contacto, no usar agua de grifos para lavado de manos, ingesta de agua envasada y desinfección de estanques. Conclusiones: Esta investigación corresponde a un brote nosocomial transmitido por agua potable. La importancia de la calidad del agua en los hospitales de nuestro país es un tema no resuelto, especialmente en áreas que atienden pacientes inmunocomprometidos. Debe asegurarse el cumplimiento de limpieza y desinfección de los sistemas de suministro de agua en los hospitales.

Background: The effect of food fortification with folic acid on the incidence of lip-palate fissures (FLP) is under discussion. Aim: To calculate the rate of hospital discharges due to cleft lip and palate (CLP) and explore whether they decreased after the start of folic acid fortification in Chile. Material and Methods: The hospital discharge databases published by the Chilean Ministry of Health were analyzed. The trends of discharge rates due to CLP of children of less than one year of life (ICD-10 Q350-379 code) and live births (lb) were calculated from 1986 to 2012. Variables such as incidence of rubella, poverty rate, obesity in pregnant women, and percentage of women who smoked or drank alcohol in the last month were included. The relative risk (RR) of CLP pre-fortification (1986-1999) and post-fortification (2000-2010) was calculated. Mixed and Prais-Winsten models were used to adjust other variables. Results: The hospital discharge rate due to CLP decreased from 1.88 x 1,000 lb during 1986-1996 to 1.68 x 1,000 lb (RR = 1.09 (95% CI 1.05-1.14, p < 0.001). Prais-Winsten and Mixed models, determined that folic acid fortification is the variable explaining this decrease. During 2004-2011, hospital discharge rates for cleft lip decreased but there was an increase in the figures for cleft lip and palate. Conclusions: The 9% decrease in hospital discharge rates for CLP is concomitant with wheat folic acid fortification.

Background: Smear forms (BK) should provide some crucial patient's information that permits the laboratory to select the appropriate bacteriological techniques for each case, a process that would fail if such information was inaccurate or omitted. Objective: To evaluate the quality of information contained in BK forms sent to laboratory for individual's diagnosis or treatment monitoring of tuberculosis (TB) in the Chilean Health Services. Methods: Descriptive study based on secondary data of all forms of smear-positive (BK+) in 2012 (n = 232) obtained from the population allocated to the South Metropolitan Health Service. BK+ forms were matched to BK+ cases handled in the TB program to assess the validity or omission of information on treatment situation (previous or current) and the current follow-up time. Results: Diagnostic BK were 62.9% (16.4% with previous treatment); of these 74.7% correctly reported a history of TB treatment but in patients previously treated the percentage falls to 66.7%. Among those under treatment control 26.7% were classified as previously treated and 43% did not recorded the follow-up time. Discussion: BK forms omit or incorrectly recorded fundamental information that should lead the laboratory procedures. As the finding of TB involves each and every one in the health personnel, we recommend continuous training stressing the inclusion of treatment's history and risk factors while the forms should avoid ambiguity.

Introducción: El formulario de baciloscopía (BK) debe aportar información esencial para que el laboratorio seleccione las técnicas bacteriológicas correspondientes, las cuales dejan de realizarse si ésta es incorrecta u omitida. Objetivo: Evaluar la calidad de la información contenida en los formularios de BK enviados al laboratorio para diagnóstico o control de tratamiento de la tuberculosis (TB) en los servicios de salud en Chile. Métodos: Estudio descriptivo con datos secundarios, de todos los formularios de BK con resultado positivo (BK+) en 2012 (n = 232), obtenidos de la población asignada al Servicio de Salud Metropolitano Sur. Los formularios de BK+ del laboratorio se cotejaron con los casos BK+ manejados en el programa-TB, para evaluar la validez u omisión de la situación de tratamiento (previo o actual) y el tiempo de tratamiento. Resultados: Las BK+ de diagnóstico fueron 62,9% (16,4% con tratamiento anterior); 74,7% reporta correctamente el antecedente de tratamiento antituberculoso, pero en los pacientes tratados anteriormente esa proporción baja a 66,7%. De las BK+ de control de tratamiento (37,1%), el 26,7% se catalogan como pacientes antes tratados y el 43% no registra el tiempo que está bajo tratamiento. Discusión: En los formularios de BK se omite o registra erróneamente información clave para el proceder del laboratorio. Puesto que la pesquisa de casos involucra a todo el personal de salud, se recomienda un entrenamiento constante que preconice la inclusión de antecedentes de tratamiento y de factores de riesgo en los formularios, al tiempo que estos deben evitar ambigüedades.

In public health there is a growing appreciation for the advantage of the additive scale to better understand the impacts of factors involved in a health event. It is necessary to always remember that the concept of statistical interaction is scale dependent. In the causal relationship between a response and the presence of two or more factors, the concepts interaction, synergy and antagonism are the key ideas. The aim of this note is to show an application of the concepts interaction, synergy and antagonism in prospective studies from a public health perspective. We present three scenarios that illustrate analyses of interaction, independence, synergy and antagonism. Stata 12 software was used for fitting models (log-binomial model and Poisson) and estimating parameters. Appendixes are provided with concepts and Stata commands used in the processes of simulation and parameter estimation.

En Salud Pública existe una creciente conciencia sobre las ventajas de las escalas aditivas para una mejor comprensión del impacto de los factores involucrados en un evento de salud. Es necesario siempre recordar que el concepto de interacción estadística es escala dependiente. En la relación causal entre una respuesta y la presencia de dos o más factores de exposición los conceptos de interacción, sinergia y antagonismo cobran protagonismo. El objetivo de este documento es mostrar una aplicación de los conceptos interacción, sinergia y antagonismo en estudios prospectivos con una mirada de la salud pública. Se presentan tres situaciones que ilustran dichos conceptos. Se utiliza Stata 12 para el ajuste de modelos (log-binomial y Poisson) y estimación de parámetros. Se aportan anexos con conceptos y comandos de Stata usados en los procesos de simulación y estimación de parámetros.

In public health there is a growing appreciation for the advantage of the additive scale to better understand the impacts of factors involved in a health event. It is necessary to always remember that the concept of statistical interaction is scale dependent. In the causal relationship between a response and the presence of two or more factors, the concepts interaction, synergy and antagonism are the key ideas. The aim of this note is to show an application of the concepts interaction, synergy and antagonism in prospective studies from a public health perspective. We present three scenarios that illustrate analyses of interaction, independence, synergy and antagonism. Stata 12 software was used for fitting models (log-binomial model and Poisson) and estimating parameters. Appendixes are provided with concepts and Stata commands used in the processes of simulation and parameter estimation.

En Salud Pública existe una creciente conciencia sobre las ventajas de las escalas aditivas para una mejor comprensión del impacto de los factores involucrados en un evento de salud. Es necesario siempre recordar que el concepto de interacción estadística es escala dependiente. En la relación causal entre una respuesta y la presencia de dos o más factores de exposición los conceptos de interacción, sinergia y antagonismo cobran protagonismo. El objetivo de este documento es mostrar una aplicación de los conceptos interacción, sinergia y antagonismo en estudios prospectivos con una mirada de la salud pública. Se presentan tres situaciones que ilustran dichos conceptos. Se utiliza Stata 12 para el ajuste de modelos (log-binomial y Poisson) y estimación de parámetros. Se aportan anexos con conceptos y comandos de Stata usados en los procesos de simulación y estimación de parámetros.

Background: Diabetes mellitus (DM) could be an important factor in identifying people with a high risk of tuberculosis (TB) in Chile, thus, we aim at studying the force of the relationship of these two pathologies. Methods: A case-control study was undertaken using secondary data from the SSMS population group. The cases (n = 473) were defined as first episodes of confirmed TB patients 15 years and older, registered between 2006 and 2009. The controls (n = 507) were non TB cases, residents in the same Health Service area, randomly selected from the population registered under the public health care system. Risk factors were taken from SIGGES (system for health information and management) files. Logistic regression adjusting for age and social vulnerability was used to estimate the OR (± CI 95%). Results: The higher frequency of DM among cases OR = 3.3 (95% CI 2.2-5.0) was confirmed. The inclusion of confounders -age, health insurance and residence in poorer counties- in the model yields produced an adjusted OR = 2.3 (95%CI 1.5-3.6). Conclusions: DM is strongly associated with TB in Chilean settings, therefore it may be anticipated that adding this diabetes criteria in screening of TB would help to increase earlier and inclusive diagnosis.

Introducción: La diabetes mellitus (DM) puede ser un importante factor para la identificación de personas con alto riesgo de tuberculosis (TBC) en Chile, por lo que se pretende estudiar la asociación entre estas dos patologías. Métodos: Se efectuó un estudio de caso-control con datos secundarios, obtenidos ambos de la población asignada al Servicio de Salud Metropolitano Sur. Los casos (n = 473) son pacientes de 15 o más años con un primer episodio de tuberculosis confirmada, entre los años 2006y 2009. Los controles (n = 507) son residentes del mismo Servicio, pero sin diagnóstico de TBC, seleccionados aleatoriamente de la población de inscritos en el Sistema Público de atención. Los factores de riesgo considerados son los consignados en el sistema de información para la gestión de garantías en salud (SIGGES). La estimación de asociación entre TBC y DM se efectuó mediante regresión logística, ajustando por edad y vulnerabilidad social para la estimación del OR (± IC95%). Resultados: Se confirma la mayor frecuencia de diabetes mellitus entre los casos, OR = 3,3 (IC95% 2,2-5,0). La inclusión en el modelo de las variables de confusión: edad, riesgo previsionaly residencia en una comuna más pobre que la Región Metropolitana, identifica un estimador (OR) ajustado de 2,3 (IC95% 1,5-3,6). Conclusiones: La DM se asocia con un mayor riesgo de enfermar de TBC. Orientando intervenciones diagnósticas, con pesquisa dirigida a los diabéticos aumentaría el diagnóstico precoz de la tuberculosis.

El objetivo de este trabajo fue evaluar la relación existente entre la concentración de N, P y K del extracto peciolar, la lámina y la raíz, para determinar el estado nutricional de la vid. El ensayo se desarrolló entre diciembre de 2006 y febrero de 2007. Se validó la metodología de extracto peciolar para Vitis vinifera 'Red Globe', en plantas de un año de edad autoenraizadas, creciendo en macetas, a partir de tres ensayos de fertilización utilizando N, P2O5 y K2O. En el extracto peciolar, se evaluó nitrato, fosfato y potasio, y en láminas y raíces, nitrógeno, fósforo y potasio. El análisis del extracto peciolar fue más sensible que el de la lámina y la raíz para determinar el estatus de nitrato y nitrógeno. Mientras que el análisis de la lámina representa mejor la respuesta de la planta a la fertilización con fósforo y potasio. El extracto peciolar puede detectar antagonismos entre elementos en altas dosis de fertilización.

The objective of this work was to evaluate the relationship between N, P and K concentration in petiole extract, blades and roots, to determine the nutritional status in grapevine. The experiment was done between December 2006 and February 2007. Three fertilization trials with N, P2O5 and K2O in one-year-old Vitis vinifera 'Red Globe' plants, grown in containers, were established. Nitrate, phosphate and potassium concentration were evaluated in the petiole extract, and nitrogen, phosphorus and potassium were determined in blades and roots. Petiole extract analysis was more sensitive than blade and root analysis to determine nitrate and nitrogen status. Meanwhile, blade analysis showed better plant response to fertilization with phosphorus and potassium. Petiole extract analysis can indicate the antagonism between nutrients under high doses of fertilization.

Background: Petcoke is a remmant of the oil refiningprocess that contains Ni and other heavy metáis. Undesired human exposure to these compounds may result from petcoke combustión in plants located in the vicinity ofthe cities. Aim: To compare levéis of urinary Ni in schoolchildren residing in cities exposed and not exposed to petcoke pollution. Material and methods: A cross sectional study was done in schoolchildren aged 7 to 8 years oíd in two cities in northern Chile: Mejillones (n = 59), near to a petcoke plant and Tocopilla (n = 56) as the reference city. First, morning urinary samples were collected and urinary Ni was determined by Atomic Absorption Spectrometry. Socioeconomic and environmental exposure information of families was obtained applying a questionnaire to parents. Múltiple linear regression was performed to identify other variables that may explain urinary Ni differences among the cities. Results: Median level of Ni was higher in Mejillones (4.9 fig/L) than in Tocopilla (3.9 fig/L). Residing in the exposed city was the most important explaining factor (B = 0.26; IC 0.107 - 0.428). Additionally years of residency was associated with urinary Ni (B = 0.03; IC 0.004 - 0.060). Conclusions: Urinary Ni in schoolchildren is higher in the city exposed to petcoke emissions. The difference does not imply that there are concrete hazards for the population s health. However, it warns about the existence of a higher exposure in places where petcoke is used.

Background: Sedatives and analgesic drugs give comfort and allow adequate respiratory support to critically ill patients in mechanical ventilation (MV). Its improper use may increase the duration of MV. Clinical guidelines suggest implementation of protocols, however this is seldom done in clinical practice. Aun: To compare in MV patients, nurse-applied guided by protocol administration of sedatives and analgesic drugs (protocol: group P) with the habitual practice using physicians criteria (control: group C). Material and methods: Inclusión criteria was the need of MV more than 48 h. The exclusión criteria were acute neurological diseases, hepatic cirrhosis, chronic renal failure and limitation of therapeutic efforts. Midazolam and fentanyl were used in both groups. The level of sedation was monitored with the Sedation Agitation Scale (SAS). In the P group, trained nurses applied algorithms to adjust the sedative doses according to a predefined SAS goal. Results: Forty patients were included, 22 aged 65±19 years in group P and 18 aged 54±21 years in group C. Apache II scores were 16±8 and 19±8 in each group. SAS score was more frequently evaluated within goal boundaries in group P than in group C (44% and 32%, respectively p =0.001). No differences in the proportion of patients with inadequate sedation were observed between treatment groups. Midazolam doses were lower in P than in C group (0.04 (0.02-0.07) and 0.06 (0.03-0.08) mg/kg/h respectively, p =0.005). Conclusions: The implementation of sedation protocol applied by nurses improved the quality of sedation and reduced the doses of Midazolam in mechanically ventilated patients

Objective: Characterize mortality and associated factors in Chilean prematures born < 32 weeks of gestational age (GA) and treated with exogenous surfactant. Method: Cohort of newborns (n = 2 868) registered between 1998-2005 in the database of the Surfactant National Program. The association of gestational and neonatal variables with mortality was estimated through survival analysis and logistic regression. Results: Global mortality was 35%, varying by GA from 86.7% (< 25 weeks) to 12.6% (32 weeks). There was a clear decrease of mortality during the study period, along with a fall in the gestational age and birth weight (BW) of the patients who died (1 021 g ± 295 to 854 g ± 258) and GA (27.7 ± 2.1 to 26.5 ± 23) during this period. Pulmonary hemorrhage (PH) was the most important factor associated to mortality, so we decided to stratify the analysis by this condition. In children with PH, the mortality estimated risk lower as the GA increased (OR= 0.73; CI95 0.57-0.93) and every 100 g of additional BW (OR= 0.74; CI95 0.63-0.88). Children not affected by PH also had their OR diminished with major GA (OR= 0.82; CI95 0.76-0.90) and more BW (OR= 0.84; CI95 0.79 - 0.89). In addition, the OR decreased with better Apgar 5 min score (OR= 0.80; CI95 0.75-0.85), use of prenatal corticoids (OR= 0.71; CI95 0.56-0.90) and was higher in boys (OR= 1.36; CI95 1.08-1.71). Conclusions: Mortality in premature newborns decreased 15% during this period. Inmaturity and extreme low birth weight factors constitute a challenge to improve survival and avoid further complications like PH

Objetivo: Caracterizar la mortalidad y factores asociados en prematuros chilenos < 32 semanas de edad gestacional (EG) receptores de surfactante exógeno. Pacientes y Métodos: Cohorte de neonatos 1998-2005 (n = 2 868) de la base de datos del Programa Nacional de Surfactante. Se estimó la mortalidad y su relación con variables maternas, del embarazo y neonatales mediante análisis de sobrevida y regresión logística. Resultados: La mortalidad global fue 35%, variando por EG entre 86,7% (< 25 semanas) y 12,6% (32 semanas). La mortalidad descendió en el período, reduciéndose también el peso de nacimiento (PN) de los fallecidos (1 02 lg ± 295 a 854 g ± 258) y su EG (27,7 ± 2,1 a 26,5 ± 2,3). La hemorragia pulmonar (HP) fue el factor más importante asociado a mortalidad, por lo que se estratificó el análisis por esa condición. En niños con HP, cada semana adicional de EG disminuye el riesgo de morir (OR: 0,73; IC95 0,57-0,93), así como por cada 100 g de peso adicional (OR: 0,74; IC95 0,63-0,88). Sin HP, el riesgo disminuye con mayor EG (OR: 0,82; IC95 0,76-0,90), mayor PN (OR: 0,84; IC95 0,79-0,89), mejor puntuación Apgar 5 minutos (OR: 0,80; IC95 0,75-0,85) y uso de corticoide prenatal (OR: 0,71; IC95 0,56-0,90), siendo significativamente mayor en varones (OR: 1,36; IC(95)1,08-1,71). Conclusiones: En el período, la mortalidad en prematuros disminuyó en 15%. La inmadurez y extremo bajo peso de niños actualmente viables, plantean importantes desafíos para mejorar su sobrevida y evitar complicaciones, entre ellas, la HP