Abstract Concrete soldier piles anchored in multiple levels are the most common method for supporting deep excavations in gravel. Their static design is based on limit equilibrium principles, although these procedures were originally developed for sheet piles or anchored walls on shallow excavations supporting medium-dense sand. The present study draws on the applicability of current design tools to model the static response of deep excavations in stiff gravels and their implications for design. For this purpose, the static response of an anchored pile system was evaluated with a detailed finite element model of a case study, and the results are compared with simplified hand-calculation procedures. The study unit was the 28 m deep excavation of the Beauchef Poniente building located in the fluvial deposits of the Mapocho River in Santiago. A plain strain model was developed in PLAXIS using the Hardening Soil constitutive model, with parameters determined from large-scale triaxial tests of local gravels, and the computed pile displacement were compared to actual displacement profiles measured with inclinometers. The analysis shows that the simplified procedures provide a reasonably good approximation to the computed earth pressures, internal forces on the piles, and stress in the anchors.

Resumen Los pilotes de hormigón anclados en múltiples niveles son el método más común para sostener excavaciones profundas en grava. Su diseño estático se basa en principios de equilibrio límite, aunque estos procedimientos se desarrollaron originalmente para tablestacas o muros anclados en excavaciones poco profundas que soportan arena de densidad media. El presente estudio se basa en la aplicabilidad de las herramientas de diseño actuales para modelar la respuesta estática de excavaciones profundas en gravas rígidas y sus implicaciones para el diseño. Para este propósito, la respuesta estática de un sistema de pilote anclado de un estudio de caso se evaluó con un modelo detallado de elementos finitos, y los resultados se comparan con los procedimientos simplificados de cálculo manual. La unidad de estudio fue la excavación de 28 m de profundidad del edificio Beauchef Poniente ubicado en los depósitos fluviales del río Mapocho en Santiago. Se desarrolló un modelo de deformación plana en PLAXIS utilizando el modelo constitutivo de “Hardening Soil”, con parámetros determinados a partir de pruebas triaxiales a gran escala de gravas locales, y el desplazamiento del pilote calculado se comparó con los perfiles de desplazamiento reales medidos con inclinómetros. El análisis muestra que los procedimientos simplificados proporcionan una aproximación razonablemente buena a las presiones de tierra calculadas, las fuerzas internas en los pilotes y la tensión en los anclajes.

Caries continue to be a public health problem, due to their high prevalence and their severe effect on people. Currently in Chile, adding fluoride to water and milk are public health measures to prevent caries that are distributed in urban and rural areas respectively. Scientific evidence supports the availability of fluoride in saliva and bacterial plaque being the most effective prevention against caries. The goal was to compare the levels of fluoride in saliva and bacterial plaque before and after drinking milk, among school-children who consume fluoridated milk and those who consume un-fluoridated milk prepared with fluoridated drinking water, in the La Araucanía Region of Chile. A study was conducted of repeated samples of saliva and bacterial plaque in 165 children within the PAE program at 16 rural and urban schools. Saliva and bacterial plaque samples were taken before breakfast, saliva samples were taken 60 minutes after breakfast and bacterial plaque samples were taken 120 min after breakfast. The concentration of fluoride in saliva was found to be very similar regardless of the manner in which it was administered. So it was similar in children drinking fluoridated milk and un-fluoridated milk prepared with fluoridated water, and similar both before and after breakfast. In contrast, we found small differences for bacterial plaque, that are statistically significant. However, they may not be clinically significant as they are too small. These results reinforce the hypothesis that the strategy of adding fluoride to milk has similar results to adding fluoride to water.

La caries sigue siendo un problema de Salud Pública, por la alta prevalencia y severidad que afecta a la población. En Chile, la incorporación de flúor en el agua y la leche, son medidas de salud pública en la prevención de caries que se distribuye en zonas urbanas y rurales respectivamente. La evidencia científica nos permite sostener que el fluoruro disponible en saliva y placa bacteriana es el principal responsable del efecto preventivo de este compuesto en el proceso de caries. El objetivo fue comparar los niveles de flúor en saliva y placa bacteriana, antes y después de la ingesta de leche, de los escolares que consumen leche fluorurada y de los que consumen leche sin flúor preparada con agua potable fluorurada de la Región de la Araucanía de Chile. Se realizó un estudio de muestras repetidas de saliva y placa bacteriana en 165 niños(as) incorporados(as) en el Programa PAE de 16 escuelas rurales y urbanas. Se tomaron muestras de saliva y placa bacteriana antes del desayuno, muestras de saliva 60 min después y muestras de placa bacteriana 120 minutos después del desayuno. La concentración de fluoruro en saliva se observa muy similar sin importar el vehículo a través del cual se le administre, sea este leche fluorurada o leche sin fluor preparada con agua fluorurada, tanto en las muestras basales como en las muestras obtenidas después del desayuno. En cambio en placa bacteriana si se observan pequeñas diferencias que, siendo estadísticamente significativa, pueden no tener mucha relevancia clínica por ser demasiado pequeñas. Estos resultados refuerzan la hipótesis de que la estrategia de leche fluorurada tiene resultados similares al agua fluorurada.

Introduction: Meningococcal disease (MD) is a major global problem because of its case fatality rate and sequels. Since 2012 cases of serogroup W have increased in Chile, with nonspecific clinical presentation, high case fatality rate and serious consequences. Objective: To characterize the evolution and outcome of MD cases between January 2012 and March 2013 in Chile. Material and Methods: Case series considering149 MD cases of 7 regions. A questionnaire was applied and clinical records were reviewed, including individual, agent, clinical course and healthcare process variables. The analysis allowed to obtain estimates of the OR as likelihoodof dying. Results: 51.5% was meningococcemia, the case fatality rate reached 27%, prevailing serogroup W (46.6%). Factors that increased the probability of dying: > age, belonging to indigenous people, having lived a stressful event, having diarrhea, impaired consciousness, cardiovascular symptoms, low oxygen saturation and low Glasgow coma scale score. Discussion: The case fatality rate exceeded normal levels and was higher in serogroup W. Increasing in this serogroup, associated to the increased presence of nonspecific symptoms or rapid progression to septicemia, hit a health system accustomed to more classic meningococcal disease presentation, which could partly explain the observed increased fatality rate.

Introducción: La enfermedad meningocóccica (EM) es un importante problema mundial por su letalidad y secuelas. Desde 2012 aumentaron en Chile los casos por serogrupo W, con presentación clínica inespecífica, elevada letalidad y secuelas graves. Objetivo: Caracterizar la evolución y desenlace de EM en casos desde enero de 2012 a marzo de 2013 en Chile. Material y Método: Serie de 149 casos de EM de siete regiones. Se aplicó un cuestionario y se revisaron registros clínicos, incluyendo variables del individuo, agente, curso clínico y proceso de atención. Los análisis permitieron obtener OR como estimadores de la probabilidad de fallecer. Resultados: El 51,5% se presentó como meningococcemia, la letalidad alcanzó a 27%, predominando el serogrupo W (46,6%). Aumentaron la probabilidad de fallecer: una mayor edad, pertenencia a pueblos originarios, haber vivido evento estresante, presentar diarrea, compromiso de conciencia, síntomas cardiovasculares, baja saturación de oxígeno y bajo puntaje de Glasgow. Discusión: La letalidad superó las frecuencias habituales y fue mayor en el serogrupo W. El aumento de este serogrupo, asociado a la mayor presencia de síntomas inespecíficos o a la rápida progresión a septicemia, impactó en un sistema de salud habituado a cuadros más clásicos de EM, lo que podría explicar en parte, la mayor letalidad observada.

Objective. Analyze barriers and facilitators of access to prenatal care in pregnant urban adolescents between 15-19 years of age in Santiago, Chile. Materials and methods. Qualitative study based on grounded theory with 17 adolescent mothers. Eleven semi-structured interviews and one focus group were conducted. Results. The denial and concealment of pregnancy is the main barrier to start the prenatal care in the "delayed access group". This group does not identify facilitators. For maintenance in antenatal care, all participants identified a support figure as a facilitator. Family and social vulnerabilities explain why some adolescents start the prenatal care late. Conclusion. The presence of facilitators is crucial for both, the timely entry and the maintenance in antenatal care because they reduce or nullify the effect of barriers. The health system must become a facilitator to accompany adolescents and promote a bond of trust and respect.

Objetivo. Analizar barreras y facilitadores de acceso a control prenatal en adolescentes urbanas de 15-19 años en Santiago, Chile. Material y métodos. Estudio cualitativo con 17 madres adolescentes basado en la teoría fundamentada. Se realizaron 11 entrevistas semiestructuradas y un grupo focal. Resultados. La negación y ocultamiento del embarazo es la principal barrera para ingresar a control en el grupo de acceso tardío; no se identificaron facilitadores. Para mantenerse en control, todas las participantes identifican como facilitador contar con una figura de apoyo. La vulnerabilidad familiar y social explica que algunas adolescentes ingresen a control tardíamente. Conclusión. La presencia de facilitadores es determinante para el ingreso oportuno y mantenerse en control, ya que reduce o anula el efecto de las barreras. El sistema de salud debe constituirse en un facilitador que acompañe desde muy temprano a las adolescentes favoreciendo un vínculo de confianza y respeto.

Objective. Analyze barriers and facilitators of access to prenatal care in pregnant urban adolescents between 15-19 years of age in Santiago, Chile. Materials and methods. Qualitative study based on grounded theory with 17 adolescent mothers. Eleven semi-structured interviews and one focus group were conducted. Results. The denial and concealment of pregnancy is the main barrier to start the prenatal care in the "delayed access group". This group does not identify facilitators. For maintenance in antenatal care, all participants identified a support figure as a facilitator. Family and social vulnerabilities explain why some adolescents start the prenatal care late. Conclusion. The presence of facilitators is crucial for both, the timely entry and the maintenance in antenatal care because they reduce or nullify the effect of barriers. The health system must become a facilitator to accompany adolescents and promote a bond of trust and respect.

Objetivo. Analizar barreras y facilitadores de acceso a control prenatal en adolescentes urbanas de 15-19 años en Santiago, Chile. Material y métodos. Estudio cualitativo con 17 madres adolescentes basado en la teoría fundamentada. Se realizaron 11 entrevistas semiestructuradas y un grupo focal. Resultados. La negación y ocultamiento del embarazo es la principal barrera para ingresar a control en el grupo de acceso tardío; no se identificaron facilitadores. Para mantenerse en control, todas las participantes identifican como facilitador contar con una figura de apoyo. La vulnerabilidad familiar y social explica que algunas adolescentes ingresen a control tardíamente. Conclusión. La presencia de facilitadores es determinante para el ingreso oportuno y mantenerse en control, ya que reduce o anula el efecto de las barreras. El sistema de salud debe constituirse en un facilitador que acompañe desde muy temprano a las adolescentes favoreciendo un vínculo de confianza y respeto.

Background: In 2005 the Chilean government started a health care reform (AUGE) that guarantees medical treatment for acute myocardial infarction. Aim: To quantify the impact ofAUGE on the management and inhospital mortality of STEMI in a group of Chilean hospitals. Material and methods: Three thousand five hundred and forty six patients with STEMI from 10 hospitals that perform thrombolysis as the main reperfusion therapy were analyzed. We compared demographic and clinical characteristics, hospital treatments and revascularization proceduresin two periods: before (2,623 patients) and after AUGE implementation (906 patients). Logistic regression was used to assess inhospital mortality according to AUGE in the entire sample and stratified by risk groups. Results: We found no differences in demographic and clinical characteristics between the two groups. During AUGE threre was a significant increase in the use of thrombolysis (50% to 60.5%), which was associated to an increase of hypotension from 29% to 35% (p <0.02) and minor bleedings, from 1.6% to 3.4% (p <0.001). After A UGE there was a significant increase in the use ofbeta blockers (65% to 75%), angiotensin converting enzyme inhibitors (70% to 76%), statins (48% to 58%), and aspirin (96% to 97.5%) (p <0.05). Global inhospital mortality decreased from 12.0% to 8.6% (p <0.003) and from 10.6% to 6.8% (p <0.005) in patients treated with thrombolytics. The adjusted odds ratio for inhospital mortality comparing after and before AUGE, was 0.64 (IC 95%, 0,47-0.86). Conclusions: The implementation ofAUGE has been successful in reducing inhospital mortality of STEMI This has been achieved through a better use of evidence based medicine and reperfusion strategies .

Background: Despite a better management of the variables that influence the development of diabetic nephropathy there is a progressive increase in the prevalence of terminal renal failure among diabetics, whose cause is not clear. Aim: To study in a group of patients in hemodialysis, the quality of diabetes control previous to the entry to dialysis, their physical condition and their evolution. Material and methods: Diabetic patients with at least three months of hemodialysis answered a questionnaire about diabetes control quality previous to dialysis and had physical and laboratory assessment. They were followed for at least four years thereafter. Results: Fifty seven patients aged 62±11 years were studied. Eighty four percent had some degree of disability. Eighty seven percent had high blood pressure and 73% had to enter dialysis as an emergency. Mean glycosilated hemoglobin was 7.7% and 58% had a dialysis dose with a Kt/Vofless than 1.2. Fifty eight percent died during follow up. No relationship between mortality and age, blood pressure, glycosilated hemoglobin of Kt/V, was observed. Conclusions: There is an inadequate management of blood glucose and blood pressure of diabetic patients before entry to dialysis. They are referred ¡ate to the nephrologist, the dialysis dose is insufficient and they have a high mortality

Primary angioplasty is considered the best reperiusion therapy in the treatment of ST-segment elevation myocardial infarction (STEMI). However, thrombolysis is the reperiusion method most commonly used, due to its wide availability, reduced costs and ease of administration. Aim: To compare inhospital mortality in STEMI patients according to reperiusion therapy. Material and Methods: Patients admitted to Chilean hospitals participating in the GEMI network, from 2001 to 2005, with STEMI were included. They were divided in three groups: a) treated with thrombolytics, b) treated with primary angioplasty, c) without reperiusion procedure. Inhospital mortality according to gender, was analized in each group, using a logistic regression method, to assess risk factors associated with mortality. Results: We included 3,255 patients. Global mortality was 9.9% (7.5% in men and 16.7% in women, p <0.001). Mortality in patients treated with thrombolytics, was 10.2% (7.6% in men and 18.7% in women, p <0.01). The figure for patients treated with primary angioplasty, was 4.7% (2.5% in men and 13% in women, p <0.01), and in patients without reperiusion, was 11.6% (9.8% in men and in 15.4% women, p <0.01). In each group women were older, had a higher prevalence of hypertension and a higher percentage of Killip 3-4 infarctions. Logistic regression showed that angioplasty, compared with no reperiusion, was associated with a reduced mortality only in men. The use oí thrombolytics in women was associated with a higher mortality. Conclusions: Primary angioplasty was the reperiusion therapy associated to the lower mortality in STEMI. Use of thrombolytics in women was associated with a higher mortality rate than in non reperfused women

OBJECTIVE: To conduct a preliminary evaluation of the Program for Depression Detection, Diagnosis, and Comprehensive Treatment, which was developed by the Ministry of Health of Chile. MATERIAL AND METHODS: A group of women who had entered the Depression Program in eight primary care centers in three regions of Chile were monitored for three months. The initial sample was made up of 229 women, of whom 169 were able to be interviewed at the end of the three months. Sociodemographic variables, psychosocial risk factors, anxiety and somatic symptoms, and the degree of satisfaction with the care received were studied. Depressive symptoms were evaluated with the Beck Depression Inventory (BDI). The treatments prescribed for the women were also analyzed. RESULTS: The clinicians' decision to enroll the patients in the Depression Program was appropriate, with 95.2% of the women having depressive symptoms, according to the BDI. The accuracy in the clinical assessment of the severity of the symptoms was around 50%, with a tendency to underestimate the severity of the depression. The dropout rate for the women was 19.5% at the end of three months of monitoring. Those who dropped out tended to present less severe clinical symptoms (less intense anxiety and somatic symptoms), a smaller number of psychosocial risk factors, and a lower level of satisfaction with the care received. The patients showed good adherence (73.3%) with the pharmacological treatment, but less with the individual psychotherapy (47.4%) and the group psychotherapy (37.8%). A significant decline was seen in the intensity of the depressive symptoms by the end of the three months, with the decline being greater among the women with more serious symptoms. There was also a significant decline in anxiety and somatic symptoms. CONCLUSIONS: The preliminary evaluation indicates that the Depression Program is meeting the proposed objectives, although there appears to be a need to develop specific strategies to improve the accuracy of the clinical diagnosis as well as compliance with the treatments that are offered.

OBJETIVO: Realizar una evaluación preliminar del Programa para la Detección, Diagnóstico y Tratamiento Integral de la Depresión, instituido por el Ministerio de Salud de Chile. MÉTODOS: Se realizó un seguimiento de tres meses de un grupo de mujeres que ingresaron en este programa en ocho centros de atención primaria de tres regiones de Chile. La muestra inicial estuvo constituida por 229 personas, de las cuales 169 pudieron entrevistarse a los tres meses. Se estudiaron variables sociodemográficas, factores de riesgo psicosocial, síntomas ansiosos y somatomorfos y el grado de satisfacción con la atención recibida. El cuadro depresivo se evaluó con el Inventario de Depresión de Beck. Se analizaron los tratamientos e intervenciones prescritos a las mujeres. RESULTADOS: La decisión de ingresar a las pacientes en el programa resultó pertinente, ya que 95,2% tenían un cuadro depresivo. La concordancia en cuanto a la gravedad del cuadro clínico fue cercana a 50%, con una tendencia a subestimarla. La tasa de abandono del programa fue de 19,5% a los tres meses de seguimiento. Las mujeres que se retiran tienden a presentar un cuadro clínico menos complejo (síntomas ansiosos y somatomorfos menos intensos), así como un menor número de factores de riesgo psicosocial y una menor satisfacción con la atención recibida. Entre las pacientes del programa se observó buena adherencia al tratamiento farmacológico (73,3%) y regular a la psicoterapia individual (47,4%) y a la intervención grupal (37,8%). Se observó un descenso significativo en la intensidad de los síntomas depresivos a los tres meses, el cual fue mayor entre las que presentaban cuadros más graves. Se encontró también un descenso significativo de los síntomas ansiosos y somatomorfos. CONCLUSIÓN: La evaluación preliminar indica que el programa está cumpliendo con los objetivos propuestos, si bien parece necesario desarrollar estrategias específicas para mejorar la precisión en el diagnóstico clínico y el cumplimiento de los tratamientos ofrecidos.