Estrategia de marketing para pensionado de maternidad del Hospital Base de Linares.

91 p.La reforma de salud pretende lograr que los hospitales públicos logren autogestionarse, para ello cada institución debe aumentar sus ingresos a través de recursos propios. El Hospital Base de Linares pretende responder a dicho requerimiento a través del Pensionado de Maternidad. Por esta razón el objetivo principal de esta memoria es definir una estrategia de marketing para el Pensionado de Maternidad del Hospital Base de Linares. Para ello se realizó un análisis interno con el que se determinaron las Fortalezas y Debilidades además de analizar el macroambiente y el entorno competitivo, con estos últimos análisis se detectaron las Oportunidades y Amenazas que tiene que enfrentar el Pensionado de Maternidad. También se estableció el mercado meta y se dio a conocer el posicionamiento para que finalmente se desarrollara la mezcla de marketing. Para llevar a cabo lo antes mencionado se recopiló información a través de entrevistas personales, revisión de libros, páginas web, entre otros. Además se utilizó una investigación de mercado llamada “Medición de la Calidad del Servicio del Pensionado de Maternidad del Hospital Base de Linares”, la cual fue realizada el segundo semestre del año 2003. La Estrategia de Marketing se enfocó principalmente en el Marketing Externo, para el logro de esto se realizó un cuestionario donde se obtuvo diversa información que fue ocupada para diseñar la estrategia de marketing y fundamentalmente la estrategia promocional. Se concluyó que las personas de Linares se informan mayoritariamente por televisión y que un buen porcentaje de ellos ve el canal local, principalmente en el horario donde se transmite el noticiario de la zona. El segundo medio de información preferido por las personas es la radio, mientras el tercer lugar es ocupado por los periódicos. Además de los medios de comunicación mencionados anteriormente, los lugares escogidos por los encuestados para obtener información con respecto a las formas de pago, donde existe un alto grado de desconocimiento, fueron los médicos o matrona de cabecera, la sección de información del hospital, y los consultorios que en la actualidad no brindan este servicio

Development and internal validation of a multifactorial risk prediction model for gallbladder cancer in a high-incidence country

Since 2006, Chile has been implementing a gallbladder cancer (GBC) prevention program based on prophylactic cholecystectomy for gallstone patients aged 35 to 49 years. The effectiveness of this prevention program has not yet been comprehensively evaluated. We conducted a retrospective study of 473 Chilean GBC patients and 2137 population-based controls to develop and internally validate three GBC risk prediction models. The Baseline Model accounted for gallstones while adjusting for sex and birth year. Enhanced Model I also included the non-genetic risk factors: body mass index, educational level, Mapuche surnames, number of children and family history of GBC. Enhanced Model II further included Mapuche ancestry and the genotype for rs17209837. Multiple Cox regression was applied to assess the predictive performance, quantified by the area under the precision-recall curve (AUC-PRC) and the number of cholecystectomies needed (NCN) to prevent one case of GBC at age 70 years. The AUC-PRC for the Baseline Model (0.44%, 95%CI 0.42-0.46) increased by 0.22 (95%CI 0.15-0.29) when non-genetic factors were included, and by 0.25 (95%CI 0.20-0.30) when incorporating non-genetic and genetic factors. The overall NCN for Chileans with gallstones (115, 95%CI 104-131) decreased to 92 (95%CI 60-128) for Chileans with a higher risk than the median according to Enhanced Model I, and to 80 (95%CI 59-110) according to Enhanced Model II. In conclusion, age, sex and gallstones are strong risk factors for GBC, but consideration of other non-genetic factors and individual genotype data improves risk prediction and may optimize allocation of financial resources and surgical capacity.Fil: Boekstegers, Felix. Ruprecht Karls Universitat Heidelberg; AlemaniaFil: Scherer, Dominique. Ruprecht Karls Universitat Heidelberg; AlemaniaFil: Barahona Ponce, Carol. Ruprecht Karls Universitat Heidelberg; AlemaniaFil: Marcelain, Katherine. Universidad de Chile; ChileFil: Gárate Calderón, Valentina. Universidad de Chile; ChileFil: Waldenberger, Melanie. No especifíca;Fil: Morales, Erik. Universidad Católica de Maule; ChileFil: Rojas, Armando. Universidad Católica de Maule; ChileFil: Munoz, César. Universidad Católica de Maule; ChileFil: Retamales, Javier. Instituto Nacional del Cáncer; ChileFil: de Toro, Gonzalo. Universidad Austral de Chile; ChileFil: Barajas, Olga. Universidad de Chile; ChileFil: Rivera, María Teresa. Hospital del Salvador; ChileFil: Cortés, Analía. Hospital del Salvador; ChileFil: Loader, Denisse. Hospital Padre Hurtado; ChileFil: Saavedra, Javiera. Hospital Padre Hurtado; ChileFil: Gutiérrez, Lorena. Hospital San Juan de Dios; ChileFil: Ortega, Alejandro. Hospital Regional; ChileFil: Bertrán, Maria Enriqueta. Hospital Base de Valdivia; ChileFil: Bartolotti, Leonardo. Hospital Base de Valdivia; ChileFil: Gabler, Fernando. Hospital Clínico San Borja Arriarán; ChileFil: Campos, Mónica. Hospital Clínico San Borja Arriarán; ChileFil: Alvarado, Juan. Hospital Regional de Concepción - Dr. Guillermo Grant Benavente; ChileFil: Moisán, Fabricio. Hospital Regional de Concepción - Dr. Guillermo Grant Benavente; ChileFil: Spencer, Loreto. Hospital Regional de Concepción - Dr. Guillermo Grant Benavente; ChileFil: Nervi, Bruno. No especifíca;Fil: Carvajal Hausdorf, Daniel. Universidad del Desarrollo; ChileFil: Losada, Héctor. Universidad de La Frontera; ChileFil: Almau, Mauricio. Hospital de Rancagua; ChileFil: Fernández, Plinio. Hospital de Rancagua; ChileFil: Olloquequi, Jordi. Universidad de Barcelona; EspañaFil: Fuentes Guajardo, Macarena. Universidad de Tarapacá; ChileFil: Gonzalez-Jose, Rolando. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Centro Nacional Patagónico. Instituto Patagónico de Ciencias Sociales y Humanas; ArgentinaFil: Bortolini, Maria Cátira. Universidade Federal do Rio Grande do Sul; BrasilFil: Acuña Alonzo, Victor. No especifíca;Fil: Gallo, Carla. Universidad Peruana Cayetano Heredia; PerúFil: Ruiz-Linares, Andres. Colegio Universitario de Londres; Reino UnidoFil: Rothhammer, Francisco. Universidad de Tarapacá; ChileFil: Lorenzo Bermejo, Justo. Ruprecht Karls Universitat Heidelberg; Alemani

Mendelian Randomization Analysis of the Relationship Between Native American Ancestry and Gallbladder Cancer Risk

Background A strong association between the proportion of Native American ancestry and the risk of gallbladder cancer (GBC) has been reported in observational studies. Chileans show the highest incidence of GBC worldwide, and the Mapuche are the largest Native American people in Chile. We set out to investigate the causal association between Native American Mapuche ancestry and GBC risk, and the possible mediating effects of gallstone disease and body mass index (BMI) on this association. Methods Markers of Mapuche ancestry were selected based on the informativeness for assignment measure and then used as instrumental variables in two-sample mendelian randomization (MR) analyses and complementary sensitivity analyses. Result We found evidence of a causal effect of Mapuche ancestry on GBC risk (inverse variance-weighted (IVW) risk increase of 0.8% for every 1% increase in Mapuche ancestry proportion, 95% CI 0.4% to 1.2%, p = 6.6×10-5). Mapuche ancestry was also causally linked to gallstone disease (IVW risk increase of 3.6% per 1% increase in Mapuche proportion, 95% CI 3.1% to 4.0%, p = 1.0×10-59), suggesting a mediating effect of gallstones in the relationship between Mapuche ancestry and GBC. In contrast, the proportion of Mapuche ancestry showed a negative causal effect on BMI (IVW estimate -0.006 kg/m2 per 1% increase in Mapuche proportion, 95% CI -0.009 to -0.003, p = 4.4×10-5). Conclusions The results presented here may have significant implications for GBC prevention and are important for future admixture mapping studies. Given that the association between Mapuche ancestry and GBC risk previously noted in observational studies appears to be causal, primary and secondary prevention strategies that take into account the individual proportion of Mapuche ancestry could be particularly efficient

Gallbladder Cancer Risk and Indigenous South American Mapuche Ancestry: Instrumental Variable Analysis Using Ancestry-Informative Markers

A strong association between the proportion of indigenous South American Mapuche ancestry and the risk of gallbladder cancer (GBC) has been reported in observational studies. Chileans show the highest incidence of GBC worldwide, and the Mapuche are the largest indigenous people in Chile. We set out to assess the confounding-free effect of the individual proportion of Mapuche ancestry on GBC risk and to investigate the mediating effects of gallstone disease and body mass index (BMI) on this association. Genetic markers of Mapuche ancestry were selected based on the informativeness for assignment measure, and then used as instrumental variables in two-sample Mendelian randomization analyses and complementary sensitivity analyses. Results suggested a putatively causal effect of Mapuche ancestry on GBC risk (inverse variance-weighted (IVW) risk increase of 0.8% per 1% increase in Mapuche ancestry proportion, 95% CI 0.4% to 1.2%, p = 6.7 × 10−5) and also on gallstone disease (3.6% IVW risk increase, 95% CI 3.1% to 4.0%), pointing to a mediating effect of gallstones on the association between Mapuche ancestry and GBC. In contrast, the proportion of Mapuche ancestry showed a negative effect on BMI (IVW estimate −0.006 kg/m2, 95% CI −0.009 to −0.003). The results presented here may have significant implications for GBC prevention and are important for future admixture mapping studies. Given that the association between the individual proportion of Mapuche ancestry and GBC risk previously noted in observational studies appears to be free of confounding, primary and secondary prevention strategies that consider genetic ancestry could be particularly efficient.Fil: Zollner, Linda. Ruprecht Karls Universitat Heidelberg; Alemania. German Cancer Research Center; AlemaniaFil: Boekstegers, Felix. Ruprecht Karls Universitat Heidelberg; AlemaniaFil: Barahona Ponce, Carol. Ruprecht Karls Universitat Heidelberg; AlemaniaFil: Scherer, Dominique. Ruprecht Karls Universitat Heidelberg; AlemaniaFil: Marcelain, Katherine. Universidad de Chile; ChileFil: Gárate Calderón, Valentina. Ruprecht Karls Universitat Heidelberg; Alemania. Universidad de Chile; ChileFil: Waldenberger, Melanie. German Research Center For Environmental Health; AlemaniaFil: Morales, Erik. Hospital Regional de Talca; Chile. Universidad Católica de Maule; ChileFil: Rojas, Armando. Universidad Católica de Maule; ChileFil: Muñoz, César. Hospital Regional de Talca; Chile. Universidad Católica de Maule; ChileFil: Alvarado, Juan. Hospital Regional de Concepción Dr. Guillermo Grant Benavente; ChileFil: Moisán, Fabricio. Hospital Regional de Concepción Dr. Guillermo Grant Benavente; ChileFil: Spencer, Loreto. Hospital Regional de Concepción Dr. Guillermo Grant Benavente; ChileFil: Nervi, Bruno. Pontificia Universidad Católica de Chile; ChileFil: Carvajal, Daniel. Universidad del Desarrollo; ChileFil: Losada, Héctor. Universidad de La Frontera; ChileFil: Almau, Mauricio. Hospital de Rancagua; ChileFil: Fernández, Plinio. Hospital de Rancagua; ChileFil: Olloquequi, Jordi. Universidad Autónoma de Chile; Chile. Universidad de Barcelona; EspañaFil: Carter, Alice R.. University of Bristol; Reino UnidoFil: Miquel Poblete, Juan Francisco. Pontificia Universidad Católica de Chile; ChileFil: Bustos, Bernabe Ignacio. Northwestern University; Estados UnidosFil: Fuentes Guajardo, Macarena. Universidad de Tarapacá; ChileFil: Gonzalez-Jose, Rolando. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Centro Nacional Patagónico. Instituto Patagónico de Ciencias Sociales y Humanas; ArgentinaFil: Bortolini, Maria Cátira. Universidade Federal do Rio Grande do Sul; BrasilFil: Acuña Alonzo, Victor. National Institute Of Anthropology And History; MéxicoFil: Gallo, Carla. Universidad Peruana Cayetano Heredia; PerúFil: Ruiz-Linares, Andres. Fudan University; China. Anthropologie Bio-Culturelle, Droit, Éthique et Santé; Francia. Colegio Universitario de Londres; Reino UnidoFil: Rothhammer, Francisco. Universidad de Tarapacá; ChileFil: Lorenzo Bermejo, Justo. Ruprecht Karls Universitat Heidelberg; Alemania. Institut de Cancérologie Strasbourg Europe; Franci

Subtypes of Native American ancestry and leading causes of death: Mapuche ancestry-specific associations with gallbladder cancer risk in Chile

<div><p>Latin Americans are highly heterogeneous regarding the type of Native American ancestry. Consideration of specific associations with common diseases may lead to substantial advances in unraveling of disease etiology and disease prevention.</p><p>Here we investigate possible associations between the type of Native American ancestry and leading causes of death. After an aggregate-data study based on genome-wide genotype data from 1805 admixed Chileans and 639,789 deaths, we validate an identified association with gallbladder cancer relying on individual data from 64 gallbladder cancer patients, with and without a family history, and 170 healthy controls. Native American proportions were markedly underestimated when the two main types of Native American ancestry in Chile, originated from the Mapuche and Aymara indigenous peoples, were combined together. Consideration of the type of Native American ancestry was crucial to identify disease associations. Native American ancestry showed no association with gallbladder cancer mortality (P = 0.26). By contrast, each 1% increase in the Mapuche proportion represented a 3.7% increased mortality risk by gallbladder cancer (95%CI 3.1–4.3%, P = 6×10⁻²⁷). Individual-data results and extensive sensitivity analyses confirmed the association between Mapuche ancestry and gallbladder cancer. Increasing Mapuche proportions were also associated with an increased mortality due to asthma and, interestingly, with a decreased mortality by diabetes. The mortality due to skin, bladder, larynx, bronchus and lung cancers increased with increasing Aymara proportions. Described methods should be considered in future studies on human population genetics and human health. Complementary individual-based studies are needed to apportion the genetic and non-genetic components of associations identified relying on aggregate-data.</p></div

Genetic principal component analyses of individuals used in the aggregate-data study to investigate the relationship between the type of Native American ancestry and disease-specific mortality risks (panels A-D), and scatter plots of estimated Native American proportions using different reference individuals as surrogates of Native American ancestry: 9 Mapuche and 9 Aymara reference individuals versus samples from the Americans in the Human Genome Diversity Project, supervised ADMIXTURE analysis (panel E) and unsupervised ADMIXTURE analysis with four ancestral populations (panel F).

<p>Genetic principal component analyses of individuals used in the aggregate-data study to investigate the relationship between the type of Native American ancestry and disease-specific mortality risks (panels A-D), and scatter plots of estimated Native American proportions using different reference individuals as surrogates of Native American ancestry: 9 Mapuche and 9 Aymara reference individuals versus samples from the Americans in the Human Genome Diversity Project, supervised ADMIXTURE analysis (panel E) and unsupervised ADMIXTURE analysis with four ancestral populations (panel F).</p

Maps with average regional African, European, Native American, Aymara and Mapuche proportions, and regional mortality rates due to gallbladder cancer in Chile.

<p>Maps with average regional African, European, Native American, Aymara and Mapuche proportions, and regional mortality rates due to gallbladder cancer in Chile.</p

Genetic principal component analyses of individuals used in the validation study to investigate the relationship between Mapuche proportions and gallbladder cancer risk, using Mapuche and Aymara individuals as surrogates of the two largest indigenous peoples in Chile (panels A-C).

<p>Gallbladder cancer cases are represented by black dots and unaffected subjects by grey dots. Fig 4D represents the pedigrees of the four families included in the validation study (Gallbladder cancer cases genotyped in the study are represented by black dots, unaffected genotyped subjects by grey dots, non-genotyped gallbladder cancer cases by red dots and unaffected non-genotyped subjects by empty circles).</p

Estimated hazard ratios of being diagnosed with gallbladder cancer in the validation study.

<p>Estimated hazard ratios of being diagnosed with gallbladder cancer in the validation study.</p

Venn diagram with results from a stepwise forward model selection to identify the ancestry components showing the most significant associations with disease-specific mortality rates.

<p>Mapuche ancestry (reddish) showed the most significant associations with mortality rates due to 12 ICD10-disease categories and the Aymara component (in blue) was selected for 19 categories.</p