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Browsing by Author "Domínguez, Angélica"

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“Appagalo” a Customized Mobile Health Intervention (mHealth) for Smoking Cessation in Women: A Randomized Controlled Trial
(2023) Martínez-Gutiérrez, Javiera; Domínguez, Angélica; López, Carolina; Alcántara, Juan; Althausen, Carolina; Rojas, Mildred; Véjar, Leonardo; Bambs, Claudia
Ateroesclerosis subclínica y síndrome metabólico en niños
(2013) Arnáiz Gómez, Pilar; Barja Y., Salesa; Villarroel del Pino, Luis A.; Domínguez, Angélica; Godoy J., Iván; Castillo Valenzuela, Oscar; Farías Jofré, Marcelo Enrique; Mardones, Francisco
Clinical characteristics and outcomes of people living with HIV hospitalized with COVID-19: a nationwide experience
(2021) Ceballos, Maria Elena; Ross, Patricio; Lasso, Martin; Dominguez, Isabel; Puente, Marcela; Valenzuela, Pablo; Enberg, Margarita; Serri, Michel; Muñoz, Rodrigo; Pinos, Yazmin; Silva, Macarena; Noguera, Matías; Domínguez, Angélica; Zamora, Francisco; Chilean HIV/COVID-19 Study Group
In this prospective, multicentric, observational study, we describe the clinical characteristics and outcomes of people living with HIV (PLHIV) requiring hospitalization due to COVID-19 in Chile and compare them with Chilean general population admitted with SARS-CoV-2. Consecutive PLHIV admitted with COVID-19 in 23 hospitals, between 16 April and 23 June 2020, were included. Data of a temporally matched-hospitalized general population were used to compare demography, comorbidities, COVID-19 symptoms, and major outcomes. In total, 36 PLHIV subjects were enrolled; 92% were male and mean age was 44 years. Most patients (83%) were on antiretroviral therapy; mean CD4 count was 557 cells/mm3. Suppressed HIV viremia was found in 68% and 56% had, at least, one comorbidity. Severe COVID-19 occurred in 44.4%, intensive care was required in 22.2%, and five patients died (13.9%). No differences were seen between recovered and deceased patients in CD4 count, HIV viral load, or time since HIV diagnosis. Hypertension and cardiovascular disease were associated with a higher risk of death ( p = 0.02 and 0.006, respectively). Compared with general population, the HIV cohort had significantly more men (OR 0.15; IC 95% 0.07–0.31) and younger age (OR 8.68; IC 95% 2.66–28.31). In PLHIV, we found more intensive care unit admission (OR 2.31; IC 95% 1.05–5.07) but no differences in the need for mechanical ventilation or death. In this cohort of PLHIV hospitalized with COVID-19, hypertension and cardiovascular comorbidities, but not current HIV viro-immunologic status, were the most important risk factors for mortality. No differences were found between PLHIV and general population in the need for mechanical ventilation and death.
Enfermedad de Chagas en Chile: caracterización epidemiológica en base a notificaciones obligatorias y egresos hospitalarios (2010-2019)
(2022) Atero Fredericksen, Nicolhole Alejandra; Torres Hidalgo, Marisa; Domínguez, Angélica; Pontificia Universidad Católica de Chile. Facultad de Medicina
Antecedentes: La Enfermedad de Chagas (ECh) es una zoonosis causada por el parásito Trypanosoma cruzi. En Chile es considerada endémica, los casos son de notificación obligatoria y se realiza pesquisa en embarazadas y donantes de sangre. Sin embargo, no se ha realizado una caracterización epidemiológica de los casos graves que han requerido hospitalización, los que producen un alto costo en el sistema sanitario, económico y social. Objetivo: Caracterizar la magnitud y distribución de la presencia y gravedad de la enfermedad de Chagas en Chile en el periodo 2010-2019. Materiales y métodos: Con datos de notificación obligatoria y egresos hospitalarios se caracterizó la distribución espacial de la enfermedad mediante Sistemas de Información Geográfica, y temporal por medio de modelos de regresión Joinpoint. Asimismo, se identificó factores asociados a las hospitalizaciones mediante análisis de regresión multivariados, entre ellos, edad, sexo, diagnóstico, intervención quirúrgica, condición de egresos, entre otros. Resultados: Durante el periodo se observó un total de 13.329 notificaciones sin cambios en la tendencia, y 680 egresos hospitalarios con tendencia a la disminución (12,2% solo en el sexo femenino). La ocurrencia de notificaciones se observó en todas las regiones del país, sin embargo tres clusters de alto riesgo fueron identificados en la zona norte. Mientras que las hospitalizaciones se concentraron en la zona de alta endemia, con un gran cluster de alto riesgo en las regiones de Coquimbo y Atacama. La mayor proporción de notificaciones se observó en mujeres en edad fértil (61,4%), mientras que los egresos se registraron mayormente en hombres de edad avanzada (56,8%). El 14% de los egresos hospitalarios reingresó por diagnóstico de ECh, un 33,2% recibió intervención quirúrgica y el 9,6% falleció. Los principales diagnósticos fueron ECh que afecta al sistema digestivo (49,3%) y que afecta al corazón (36,5%). La probabilidad de fallecer de un hospitalizado se asoció significativamente con la edad (OR=1.05), recibir intervención quirúrgica (OR=0.45) y diagnóstico crónico digestivo (OR=0.45). Asimismo, la chance de recibir IQ fue menor en el sexo femenino (OR=0.65) y en aquellos con diagnóstico crónico al corazón (OR=0.21). La probabilidad de reingresar al hospital se asoció significativamente con un diagnóstico digestivo (OR=2,87). Conclusión: Se notifican casos de ECh todos los años y en todas las regiones del país, mientras que las hospitalizaciones se concentran en zona de alta endemia. La edad y el sexo son factores clave en el acceso a diagnóstico y tratamiento. Sin embargo, existen múltiples factores que determinan el curso de la enfermedad en etapas graves, por lo que es imprescindible estudiarla de manera transdisciplinaria. Este estudio permitió comprender el comportamiento de los casos notificados y hospitalizados de la enfermedad de Chagas en tiempo, lugar y persona. Este análisis es una primera aproximación al conocimiento de los casos graves de la enfermedad y sus factores asociados, y será útil tanto para prevenir complicaciones, así como para facilitar su tratamiento en zonas de alta y baja endemia.
Growth of Very Low Birth Weight Infants Who Received a Liquid Human Milk Fortifier: A Randomized, Controlled Multicenter Trial
(2022) Masoli, Daniela; Mena, Patricia; Domínguez, Angélica; Ramolfo, Pamela; Vernal, Patricia; Pantoja, Miguel Angel; Esparza, Ruth; Hübner, Maria Eugenia; Ríos, Antonio; Faunes, Miriam; Uauy, Ricardo; Tapia, Jose L.; Neocosur Network
Objectives: To evaluate growth (weight, length, head circumference, and knee–heel length [KHL]) in very low birth weight (VLBW) infants (500–1500 g) who received human milk with a liquid fortifier (LHMF) with high protein and fatty acid content versus a traditional powder fortifier (PHMF) for 45 days or until discharge. Methods: This was a multicenter, randomized, controlled trial. An intention-to-treat analysis was performed to determine adverse events and withdrawal causes. We also performed an efficacy analysis involving the infants who completed at least 2 weeks of study. Results: Of the 158 infants enrolled in the study, 146 completed at least 2 weeks, and 125 completed the entire study. The biodemographic characteristics were similar between groups, with no differences in increments of weight (22.9 vs 22.7 g kg−1 day−1), length (1.03 vs 1.09 cm/week), head circumference (0.91 vs 0.90 cm/week), or KHL (3.6 vs 3.3 mm/week). The KHL increment was greater in infants weighing >1 kg receiving LHMF (3.7 vs 3.2 mm/week, P = 0.027). Although there were no significant differences in serious adverse events, the incidence difference of the composite outcome death/necrotizing enterocolitis between groups warrants attention (1.3% with LHMF and 8.1% with PHMF). Conclusion: There were no differences in the overall growth between VLBW infants receiving either fortifier.
Growth patterns in infants born to women with pregestational overweight/obesity supplemented with docosahexaenoic acid during pregnancy
(2024) De Toro Navarrete, Valeria Francisca; Alberti, Gigliola; Domínguez, Angélica; Carrasco Negüe, Karina Andrea; Ferrer, Pedro; Valenzuela, Rodrigo; Garmendia. María Luisa; Casanello Toledo, Paola Cecilia
Background: Previous studies of maternal docosahexaenoic acid (DHA) supplementation during pregnancy have controversial and contrasting results on the short and long-term effects on early child growth. The impact of this nutritional intervention on the postnatal growth patterns in the offspring of women with pregestational overweight/obesity (PGO) also remains controversial. Objective: To analyze the postnatal growth patterns during the first 4 months of life in the offspring of women with PGO randomly supplemented with 800 mg/day (PGO-800) compared with normative doses of 200 mg/day (PGO-200) of DHA during pregnancy (<15 weeks of gestation until delivery). Methods: This study evaluated the growth patterns during the first 4 months of life of 169 infants of the women that participated in the MIGHT study (NCT02574767). We included the infants of women from the PGO-200 (n = 81) and PGO-800 group (n = 88). The growth patterns (weight, length, and head circumference) and change in z-score (WHO charts) were evaluated. Results: Throughout the first 4 months of life, the infants of the PGO-800 group had lower weight-for-length z-score (coef. −0.65, 95% confidence interval [CI] −1.07, −0.22, p = 0.003) and lower body mass index-for-age z-score (coef. −0.56, 95% CI −0.99, −0.12, p = 0.012) compared with the PGO-200 group adjusted by maternal body mass index, gestational weight gain, gestational age, insulin in cord blood and infant feeding (exclusive breastfed, not breastfed, and partially breastfed). Conclusions: Maternal supplementation with DHA during pregnancy could beneficially limit the offspring's postnatal weight gain during the first 4 months of life.
Historia natural de retinopatía diabética en un estudio a largo plazo en pacientes con diabetes tipo 1. Factores de riesgo para progresión a enfermedad proliferante
(2009) Verdaguer, J.; Zanolli, M.; Sepúlveda, G.; García de los Ríos, M.; Domínguez, Angélica
Background: Diabetic retinopathy is one of the most common causes of blindness among adults. Aim: To report the natural history of diabetic retinopathy among Chilean patients with type 1 diabetes followed for a mean of 18 years. Material and methods: Retrospective review of medical records of 39 patients aged 26 to 70 years, (20 females, 78 eyes) with type 1 diabetes controlled by the same ophthalmologist from 1971 to 2008. A questionnaire was sent to each patient and their treating physician to request information about the evolution of the disease and metabolic control. Results: The questionnaire was answered by 24 patients (62%) and 21 attending physicians (54%). Small hard drusen were observed in 25 patients (64%). In 12 cases the drusen were detected before the development of any type of retinopathy. Eleven women became pregnant and retinopathy progressed in four of them. Twently three patients (59%) developed proliferative diabetic retinopathy (PDR). Patients with PDR had a significantly longer duration of diabetes and worse glycemic control. There was a higher frequency of diabetic nephropathy in the PDR group, but only 13 patients out of 23 with PDR had nephropathy. The retinopathy progressed to high risk PDR two years after successful kidney-pancreas transplantation in one patient. Conclusions. In patients with type 1 diabetes mellitus, small hard drusen may be the initial manifestation of diabetic retinopathy. Risk factors for progression to PDR were duration of diabetic and poor glycemic control. Nephropathy was more prevalent in patients with PDR, but a significant group of PDR patients did not have demonstrable nephropathy (RevMéd Chile 2009; 137:1145-52).
Malnutrición por exceso y sospecha de retraso del desarrollo psicomotor entre 11 y 24 meses de edad en Chile: un estudio preliminar
(2023) Cerda Vásquez, Francisco Ignacio; Domínguez, Angélica; Soto Sánchez, Johana Patricia; Pontificia Universidad Católica de Chile. Escuela de Medicina
Se analizó la asociación entre malnutrición por exceso y sospecha de retraso del desarrollo psicomotor en una muestra de 411 niños y niñas de 11-24 meses, a partir de la Encuesta Longitudinal de la Primera Infancia 2017 (ELPI-III 2017). No se encontró asociación entre malnutrición por exceso y sospecha de retraso del desarrollo psicomotor (X2=1.61, p=0.20). Se encontró significativamente menor tiempo de lactancia materna en quienes tuvieron retraso del desarrollo psicomotor comparado con quienes no lo presentaron (3.97±3 vs. 5.16±3.27 meses, p≤0.05). Conclusión: Entre los 11-24 meses de edad, la malnutrición por exceso no se asocia con la sospecha de retraso del desarrollo psicomotor según este estudio, sin embargo, un mayor tiempo de exposición a lactancia materna es un factor protector.
Mechanical ventilation and survival without major morbidities in Very-Low-Birth-Weight Infants: a multicenter study
(2023) Toso, Alberto; Kuzmanic, Daniela; Domínguez, Angélica; González, Álvaro; Herbozo, Cecilia; Brener Dik, Pablo Hernán; Ahumada, Luis Alberto; Méndez, Álvaro; Aburto, Claudia; Tapia Illanes, José Luis
Past trends and future projections of palliative care needs in Chile: analysis of routinely available death registry and population data
(2024) Léniz Martelli, Javiera; Domínguez, Angélica; Bone, Anna E.; Etkind, Simon; Pérez Cruz, Pedro; Sleeman, Katherine E.
The number of people with palliative care needs is projected to increase globally. Chile has recently introduced legislation for universal access to palliative care services for patients with severe and terminal illnesses, including non-cancer conditions. We aimed to estimate the number of people afected by serious health-related suf‑fering and need for palliative care in Chile to 2050. We used data on all deaths registered in Chile between 1997-2019 and population estimates for 1997–2050. We used Poisson regression to model past trends in causes of death adjusted by age, sex and population estimates, to project the number of deaths for each cause from 2021 to 2050. We applied the Lancet Commission on Palliative Care and Pain Relief weights to these projections to identify decedents and non-decedents with palliative care needs. Population palliative care needs in Chile are projected to increase from 117 (95% CI 114 to 120) thousand people in 2021 to 209 (95% CI 198 to 223) thousand people in 2050, a 79% increase (IRR 1.79; 95% CI 1.78–1.80). This increase will be driven by non-cancer conditions, particularly dementia (IRR 2.9, 95% CI 2.85–2.95) and cardiovascular conditions (IRR 1.86, 95% CI 1.83–1.89). By 2050, 50% of those estimated to need palliative care will be non-decedents (not expected to die within a year). Chile will experience a large increase in palliative care needs, particularly for people with dementia and other non-cancer conditions. Improved availability of high-quality services, expanded clinician training and new sustainable models of care are urgently required to ensure universal access to palliative care. We aimed to estimate the number of people affected by serious health-related suffering and need for palliative care in Chile to 2050.
Prenatal Growth and Metabolic Syndrome Components in Children
(2011) Mardones S., Francisco; Villarroel del Pino, Luis A.; Barja, Salesa; Arnaíz, Pilar; Castillo, Oscar; Farías, Marcelo; Domínguez, Angélica
Producción de leche materna y estado emocional en madres de recién nacidos de muy bajo peso
(2021) Wormald, Francisca; Tapia, José L.; Domínguez, Angélica; Cánepa, P.; Miranda, Ángela; Torres, G.; Rodríguez, D.; Acha, L.; Fonseca, R.; Ovalle, N.; Luisa Anchorena, M.; Danner, M.
Introducción. Existe poca evidencia de la influencia de variables emocionales en la lactancia de madres de recién nacidos de muy bajo peso al nacer (RNMBPN). El objetivo de este estudio fue medir la producción de leche materna (PLM) en dos momentos de la internación neonatal y su asociación con los niveles de ansiedad, depresión y autoeficacia en lactancia en madres de RNMBPN. Población y métodos. Estudio prospectivo, observacional, multicéntrico en madres de RNMBPN (500-1500 g), en 9 centros de la Red NEOCOSUR. La PLM se obtuvo midiendo lo extraído por cada madre. Se utilizaron las escalas STAI para ansiedad, BDI para depresión, y, la escala piloto ALMA para autoeficacia. Estas fueron aplicadas a los 14 días de vida y a las 36 semanas posmenstruales. Se registraron, además, las características biosociales de madres y neonatos. Resultados. Participaron 118 madres. La PLM media a los 14 días fue de 169 ml (desvío estándar –DE– ± 132,4) y de 285 ml (DE ± 266,9) a las 36 semanas, y se asoció significativamente con percepción de autoeficacia en lactancia (p < 0,001), que se mantuvo durante la hospitalización. Existió una tendencia a menor producción en madres con mayores índices de depresión a los 14 días de vida de su hijo, pero no a las 36 semanas. No se encontró asociación entre PLM y ansiedad. No se encontraron asociaciones consistentemente significativas con variables biosociales. Conclusión. La PLM se asoció positivamente con autoeficacia en lactancia; no se encontró asociación con ansiedad y depresión en madres de RNMBPN.
Reducción de la fecundidad y envejecimiento de la población de mujeres chilenas en edad fértil: 1990-2004
(2009) Donoso Siña, Enrique; Carvajal C., Jorge A.; Domínguez, Angélica
Background: Chile is in the advanced stage of demographic transition with a low natural growth and a progressively aging population. Aim: To analyze births by range of maternal age and to establish if population aging is expressed in the women's fertile age range. Material and methods: Trend analysis of births and age-specific birth rates in the period 1990-2004, in the Chilean women population of reproductive age. Raw data were obtained from the Vital Statistics Yearbooks of the National Institute of Statistics. Trends were studied by linear regression and Generalized Estimating Equation (GEE). Results: The general trend of births descended significantly from 1999 to 2004 (r: -0.996; p <0.001). Births significantly decreased in the range of ages from 20 to 34 years. There was an increase in the range of ages from 35 to 44 and from 10 to 14 years. The age-specific birth rate declined in all ranges, with the exception of women aged 10 to 14 years. The number of women increased significantly at all age ranges, except for the 20-24 year-old range where no significant change was observed and the 25-29 year-old range that experienced a significant reduction. Conclusions: In the period from 1990 to 2004, there was a significant reduction of births and age-specific birth rates in Chile. There was also an increased birth rate among women aged 35 to 44 years and an aging of the fertile women population.

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