Notes

Fatal Multisystem Inflamed Malady in Grownup following SARS-CoV-2 Natural Contamination and also COVID-19 Vaccine.
This work analyzes the demand subsidies to access health care and their relationship with large private corporations in Chile, through the transfer of public funds through the modality of freedom of choice (MLE) from 2000 to 2018. Therefore, we analyzed the expansion of the health market and the strengthening of health care corporations, identifying the distribution of resources according to type of health provider. We reviewed the annual reports of private health care corporations. We also analyzed billing data according to the provider through the freedom of choice modality from the year 2000 to the year 2018. We identified an increasing transformation of medical work from free exercise to become dependent on private health corporations, and an increase in public dependence on private providers to meet health demands. There is a growing capture of public funds by these holdings, using the strategy of increasing provider property concentration and a trans nationalization of the health market in Chile.Cancer is a chronic non-communicable disease associated with a high mortality burden. The prevalence of cancer is increasing rapidly worldwide. However, this scenario will be worse in low and middle-income countries such as Chile, where 70% of cancer deaths occur. The aim of this review was to assess the epidemiological scenario of cancer and its projection for the Chilean population. In Chile, 53,365 new cases of cancer were diagnosed in 2018, led by prostate, colorectal, breast, stomach, lung and gallbladder cancer. From 1986 to 2016, cancer increased by 109%. When we reviewed mortality by sex, stomach and prostate cancer were responsible for more than 30% of cancer deaths among men. However, for women the first three places were occupied by breast, colorectal and lung cancer, as in the rest of the world. Considering that 40% of cancers are related to unhealthy lifestyles, working on the prevention of modifiable risk factors represents an opportunity for the creation of public health policies that allow changes at the environmental and individual level.On March 11, 2020, the World Health Organization (WHO) stated that the number of cases of COVID-19 multiplied by 13 outside China, with a threefold increase in the number of affected countries. The WHO expressed its concern about the alarming levels of spread and severity of the outbreak, declaring the pandemic. This pandemic context is generating a social pact that seeks to ensure collective protection over individual freedoms. To meet the challenge, Governments must make decisions based on the principles that govern the State- These should consider the differences and particularities of those affected, without diverting attention from collective social protection. The following is a proposal on the ethical principles that should guide a State that makes decisions in public health emergencies.Von Willebrand factor (vWf) is a fundamental multimeric plasma glycoprotein in the coagulation process. Its function is to mediate platelet adhesion and to stabilize circulating factor VIII. A functional or quantitative alteration of vWf gives rise to von Willebrand disease (vWD). The association between vWD and angiodysplasia was described in 1967, but it was only until 2011 that Starke et al demonstrated the in vitro and in vivo role of vWf in angiogenesis. Congenital or acquired vWf deficiency, especially of high molecular weight multimeters, not only favors bleeding, but also contributes to increased angiogenesis in these patients. The treatment should be focused both on the control of the acute episode of gastrointestinal bleeding, with vWf replacement therapy and local endoscopic treatment, as well as on the prevention of the progression of angiodysplasia and future bleeding. There are different published therapeutic approaches using vWf replacement that are not effective in all patients. Recently, angiogenesis inhibitor medications have been used.Coronavirus disease 19 is characterized by an intense inflammatory response and a high incidence of thrombotic events. Autopsy studies show severe endothelial injury associated with thrombosis of the alveolar capillaries of the lungs and other organs. In the pathophysiology of this disease endothelial injury and dysfunction, inflammation and thrombosis are key factors for the development of severe phenotypes. Therefore, we should consider this entity as a systemic endothelial disease in which an obstructive microvascular syndrome secondary to an intense thrombo-inflammatory response leads to acute respiratory insufficiency and multiorgan failure. Heparin is an excellent drug to treat Covid-19 patients due to its anticoagulant, anti-inflammatory, antiviral and endothelial effects. Clinical guidelines agree that the use of heparin thromboprophylaxis is a component of Covid-19 coagulopathy treatment, even though the dose and duration of treatments are not well defined.
The suspension of face-to-face teaching activity due to the COVID-19 pandemic forced an abrupt transition to distance learning in Spanish universities.

To know how medical students value distance learning in the context of COVID-19 pandemic.

Undergraduate medical students from first to fifth year in Barcelona (Spain) were invited to answer an anonymous online survey about their perceptions and level of satisfaction with virtual learning.

Of 483 students invited to the survey, 244 (50.5%) answered it. Respondents from the first and second year rated distance learning as acceptable (mean 3.1) on a Likert scale from 1 to 5. Those from third to fifth years rated distance learning as unsatisfactory (mean 2.7). The best evaluated aspects were synchronous lectures (3.9) and lectures based on cases (3.4). The worst evaluated issues were motivation (2.3), interaction with faculty (2.1), and additional workload (0.7).

The perceptions expressed by these students reinforce the importance of facilitating communication, motivation and participation of students in distance learning in Medicine.
The perceptions expressed by these students reinforce the importance of facilitating communication, motivation and participation of students in distance learning in Medicine.
Self-efficacy is a psychological variable closely related to healthy behaviors. One of the most widely used instruments to measure this variable is the general self-efficacy scale (GSES). In Chile, the only psychometric study of this scale has important analytical limitations.

To assess reliability and validity of GSES in a large Chilean sample.

The GSES and a self-esteem scale were applied to 2995 participants aged 11 to 76 years (60% women).

The scale showed optimal levels of homogeneity and internal consistency. The exploratory factor analysis and the parallel analysis suggested a one-dimensional internal structure. However, this model showed a mediocre fit in the confirmatory factor analysis due to the residual correlation between a pair of items with high semantic similarity. A one-dimensional model specifying this residual correlation attained an acceptable fit in a new confirmatory factor analysis. The new model reached strict invariance according to sex, and partial strict invariance according to age. The latent factor of the GSES showed a positive association with the latent factor of a self-esteem scale.

The GSES is an adequate scale to measure general self-efficacy in the Chilean population and allows unbiased comparisons based on sex or age.
The GSES is an adequate scale to measure general self-efficacy in the Chilean population and allows unbiased comparisons based on sex or age.
International evidence shows that there are organizational factors and nurse job outcomes that may negatively affect healthcare quality.

To measure and analyze associations between nurse organizational factors, such as staffing ratios and skill mix, and job outcomes in public hospitals in Chile.

An observational, cross-sectional study of 1,855 registered nurses working in medical-surgical units in 37 public hospitals was conducted. XST14 Data collection followed the RN4CAST research protocol. Inferential analyses used logistic regression models.

The survey was answered by 1,395 registered nurses in 34 hospitals. The average staffing ratio was 14 patients-per-nurse, and the average skill mix was 31% registered nurses. Of all nurses, 35% reported burnout, 22% were dissatisfied, and 33% intended to leave. Being burned out increased by 9 and 6% the odds of being dissatisfied and the intent to leave, respectively (Odds ratio (OR) 1.09, p < 0.01 and 1.06, p < 0.01). Being dissatisfied increased by five times the odds of intent to leave (OR 5.19, p < 0.01).

Staffing levels, burnout, and intent to leave warrant healthcare and governmental authorities' attention. All these factors may be threatening healthcare quality and safety.
Staffing levels, burnout, and intent to leave warrant healthcare and governmental authorities' attention. All these factors may be threatening healthcare quality and safety.
Equations for the evaluation of fat-free mass (FFM) and fat mass (FM) with Bioelectrical impedance analysis (BIA) were formulated in Caucasian populations. International recommendations suggest that population-specific equations should be formulated.

To validate an equation previously formulated in Chileans adults and compare it to a new equation generated on an independent sample.

In 108 adult volunteers aged 38.1±14.1 years (44% males), with a body mass index (BMI) of 25.1± 4.1 kg/m2, body composition was measured by BIA (Bodystat) and dual X-ray absorptiometry (DXA Lunar Prodigy). Body composition estimated using Schifferli equation and BIA were compared with DEXA, by the Bland-Altman method and simple linear regression.

FFM and FM measured by DXA were 45.2 ± 9.8 kg and 29.6 ± 11.7 % respectively. Resistance was 467.7 ± 76.3 ohm. Schifferli equation and BIA significantly overestimated FFM by 7.3 and 7.4 kg, respectively. The error was higher for high levels of FFM (slope β < 1, p < 0.01). Both equations underestimated FM measured by DXA (averages of 7.5 and 7.8%, respectively, p < 0.01), without a differential bias for Schifferli equation, but with a bias in low levels of FM measured with BIA (slope β < 1, p < 0.01). Estimation biases could be eliminated using the regression coefficients.

Both equations behave similarly and have biases, although less with Schifferli. Statistically correcting for biases, the new adjusted equations provide clinically valid estimates of FFM and FM. Equations should not only be population-specific, but also device-specific.
Both equations behave similarly and have biases, although less with Schifferli. Statistically correcting for biases, the new adjusted equations provide clinically valid estimates of FFM and FM. Equations should not only be population-specific, but also device-specific.
Boot camps are used to acquire skills in simple surgical procedures, such as sutures, in a short period of time.

To assess the retention of the procedural skills of medical students who participated in a simulation-based suture workshop.

One hundred five medical students were trained using the EPROBA methodology (Entrenamiento PROcedimental BAsico), with prior informed consent. The instrument "Objective Structured Assessment Of Technical Skills" (OSATS) was applied prior to and after the workshop, and during retention module, which was carried out between three and four months after the suture workshop. Participants were classified according to the level of previous knowledge in sutures.

The students showed significant improvement in their scores after the workshop (improvement from 12.9 to 28.5 points, p < 0.001). No significant differences were found between scores after the workshop and those obtained in the retention module (28.5 to 28.1 points, respectively, p = 0.235). No difference in scores were observed when retention was evaluated according to previous knowledge levels.
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