Chilean Public Research Articles

Rehabilitation with removable dentures in adults and older people with partial or total edentulism: Chilean Public Health System Experience, 2017–2019

Statement of problemTooth loss is frequent among the Chilean population, particularly the poor and elderly. The Public's response is mostly via removable dentures (RDs), however there is limited evidence regarding its results. PurposeThe objective of this descriptive ecological study is to monitor and characterize the production of RDs within Chile's Public Health System. Material and methodsPublic records were obtained from the Department of Statistics and Health Information of Chile (DEIS) website. All records regarding RDs activities within the Public Health System for years 2017 to 2019 were retrieved and included in the analysis. ResultsBetween 2017 and 2019, the Public Health sector delivered an average of 342,261 RDs annually, which corresponds to 2.4 RD per 100 individuals. Overall, 70.3 % of beneficiaries were female, 63.2 % were for people between the ages of 20 to 64, and 35.3 % were for people aged 65 or older. Among RDs provided, 57 % were made at the primary level and 43 % at the secondary level of care. The program “More Smiles”, accounted for 52.3 % of primary healthcare RD delivery. At the secondary level, 14.9 % of RDs had metallic framework, while 85.1 % were acrylic. Older persons and males were more likely to receive acrylic RDs than their counterparts. ConclusionsRDs are regularly supplied in Chile's Public Healthcare System, mainly through primary care. The characterization regarding programs, type of RDs, gender and age of the recipients, may guide future hypothesis regarding the adequateness of the response to address tooth loss at a population level. Further investigation into the impact on patient satisfaction and RD quality is recommended to enhance understanding in this domain. Clinical implicationsThe study explores the scale and characteristics of removable prosthetic provision within Chile's Public Health System. This comprehensive overview enables the identification of areas requiring further attention to ensure the delivery of high-quality treatments and the efficient allocation of public resources.

Does Selective Secondary Schools Make a Difference? A Quasi-Experimental Study in Chilean Public Schools

This study utilizes longitudinal data from two 10th-grade student cohorts in Chile to investigate the effects of selective secondary schools. Employing propensity scores and difference-in-difference methods, we find significant and positive short-term effects, ranging from 0.2 to 0.3 SD, with minor variations across subjects and cohorts studied. Likewise, these schools are not a viable alternative for vulnerable students, even though the greatest measured effect is on students with lower socioeconomic status. Our findings suggest that the additional value of selective schools may not be directly linked to standardized test performance but rather related to the interactions among equally talented students.

Carbapenem-resistant hypervirulent ST23 Klebsiella pneumoniae with a highly transmissible dual-carbapenemase plasmid in Chile

BackgroundThe convergence of hypervirulence and carbapenem resistance in the bacterial pathogen Klebsiella pneumoniae represents a critical global health concern. Hypervirulent K. pneumoniae (hvKp) strains, frequently from sequence type 23 (ST23) and having a K1 capsule, have been associated with severe community-acquired invasive infections. Although hvKp were initially restricted to Southeast Asia and primarily antibiotic-sensitive, carbapenem-resistant hvKp infections are reported worldwide. Here, within the carbapenemase production Enterobacterales surveillance system headed by the Chilean Public Health Institute, we describe the isolation in Chile of a high-risk ST23 dual-carbapenemase-producing hvKp strain, which carbapenemase genes are encoded in a single conjugative plasmid.ResultsPhenotypic and molecular tests of this strain revealed an extensive resistance to at least 15 antibiotic classes and the production of KPC-2 and VIM-1 carbapenemases. Unexpectedly, this isolate lacked hypermucoviscosity, challenging this commonly used hvKp identification criteria. Complete genome sequencing and analysis confirmed the K1 capsular type, the KpVP-1 virulence plasmid, and the GIE492 and ICEKp10 genomic islands carrying virulence factors strongly associated with hvKp. Although this isolate belonged to the globally disseminated hvKp clonal group CG23-I, it is unique, as it formed a clade apart from a previously reported Chilean ST23 hvKp isolate and acquired an IncN KPC-2 plasmid highly disseminated in South America (absent in other hvKp genomes), but now including a class-I integron carrying blaVIM−1 and other resistance genes. Notably, this isolate was able to conjugate the double carbapenemase plasmid to an E. coli recipient, conferring resistance to 1st -5th generation cephalosporins (including combinations with beta-lactamase inhibitors), penicillins, monobactams, and carbapenems.ConclusionsWe reported the isolation in Chile of high-risk carbapenem-resistant hvKp carrying a highly transmissible conjugative plasmid encoding KPC-2 and VIM-1 carbapenemases, conferring resistance to most beta-lactams. Furthermore, the lack of hypermucoviscosity argues against this trait as a reliable hvKp marker. These findings highlight the rapid evolution towards multi-drug resistance of hvKp in Chile and globally, as well as the importance of conjugative plasmids and other mobile genetic elements in this convergence. In this regard, genomic approaches provide valuable support to monitor and obtain essential information on these priority pathogens and mobile elements.

Integrating Comprehensive Rehabilitation Care to Multimorbidity Approach: A Challenge for the Chilean Public Health System.

The multimorbidity approach involves promotional and preventive strategies. The demand for rehabilitation services has grown exponentially in recent years, leading to the urgency of rethinking care delivery. In Chile, there are laws, programs, and guidelines that, from their theoretical basis, include a person-centered care focus. But in real practice, multiple barriers trigger important fragmentation of care. In response, a new strategy has been proposed to answer whether comprehensive rehabilitation care based on multimorbidity positively impacts the health system performance, people's functionality, and quality of life, which will be implemented as a pilot study with a national scale-up focus.

Teachers’ Implementation of the Writing Curriculum in Grades 7-8 of Chilean Public Schools: A Multiple Case Study

The Chilean curriculum for writing education includes five paradigms: cultural, macro-linguistic, micro-linguistic, procedural, and communicative. The implementation of such a poly-paradigmatic curriculum can occur in multiple ways. Therefore, we analyzed classroom practices with two aims: (a) to describe how the paradigms are evident across practices, and (b) to analyze the paradigms’ internal alignment within each practice. We conducted classroom observations with five Spanish language teachers with varied orientations toward writing instruction. A content analysis of teachers’ discourse formed the basis for a narrative case-by-case analysis and a cross-case analysis. This process was guided by data collected during a previous survey study and supported by teachers’ interviews. Findings revealed that the cultural, macro- and micro- linguistic paradigms were implemented most often, while the implementation of procedural and communicative paradigms was rare. Additionally, paradigm alignment was visible in two practices but not in other practices. Possible reasons for this lack of integration and potential solutions to resolve this issue are discussed.

EE218 Budget Impact and Cost Minimization Analysis of Phesgo ® (Trastuzumab + Pertuzumab SC) for the Treatment of HER2+ Breast Cancer in the Chilean Public Health System

EE218 Budget Impact and Cost Minimization Analysis of Phesgo ® (Trastuzumab + Pertuzumab SC) for the Treatment of HER2+ Breast Cancer in the Chilean Public Health System

Haploidentical Hematopoietic Stem Cell Transplantation with Post-Transplant Cyclophosphamide in the Chilean National Health System. a Single Center Study

Haploidentical peripheral blood stem cell transplantation with post-transplant cyclophosphamide (Haplo-PTCy) is the most common transplantation modality in low-and-middle-income countries (LMIC). Registry data has shown comparable outcomes when using haploidentical donors versus Matched Unrelated Donors (MUD) in patients with acute leukemias. In the Chilean Public Health System Haplo-PTCy was incorporated in 2016 for adults up to 60 years old. We analyzed all adult patients who received an Haplo-PTCy at Hospital del Salvador, in a prospective registry study between 2016 and 2021. The primary outcome was overall survival (OS). Secondary outcomes were event-free survival (EFS), cumulative incidence of relapse, and incidence of grade II-IV acute graft-versus-host disease (aGVHD) at day +100. Overall survival and EFS were estimated using the Kaplan-Meier method. The cumulative incidence of relapse was calculated using relapse as the primary event and death without relapse as a competing event. Acute GVHD is shown as absolute incidence at day +100. All statistical analyses were performed with R. This study was done in compliance with the Helsinki Declaration and was approved by the Institutional Review Board. Eighty-five Haplo-PTCy were performed in 82 patients (Table 1). Three-second Haplo-PTCy were excluded from this analysis. The median age was 25 years (range, 15-51), and 65% were male. Ninety-four percent of patients had a neoplastic disease (77/82), and the most common diagnosis was acute lymphoblastic leukemia (57%). Forty-seven percent proceeded to transplant in the first complete response. Most of the patients (76%) presented a low hematopoietic cell transplantation (HCT)-specific comorbidity index. Conditioning was mostly myeloablative (96%). The median dose of CD34+ cells infused was 8.1 x 106/kg (range, 2.4-10.0). No patient needed a desensitization regimen. Cytokine release syndrome (CRS) was common (86%) but no grade 3 CRS was observed. Primary graft failure was observed in one patient (1.2%). Poor graft function was observed in 11 patients (13%). Five patients (6.1%) died before engraftment. The incidence of grade II-IV aGVHD at day +100 was 29% (grade IV was not observed). With a median follow-up of 33 months (range 0-84), the estimated 3-year OS and EFS were 68.3% (95% CI 59-79%) and 64.6% (95% CI 55-76%), respectively (Figure 1). In patients with neoplastic disease (n=77), the 3-year cumulative incidence of relapse was 23% (95% CI 15-33%). Haplo-PTCy is feasible in LMIC. This cohort of cases, mostly young patients with neoplastic disease, shows encouraging survival with an acceptable aGVHD and relapse incidence.

‘No, buddy, I will not speak to the press – I am working!’: criminal justice and the interprofessional dynamics of communication production in the Chilean Public Prosecutorial Office

AbstractThis article analyses the interprofessional dynamics of communication production in the criminal justice system. Through 26 in‐depth interviews, we investigate the production of media information on prosecutorial work in Chile, tracking the relationships between internal communication agents, prosecutors, and external legal journalists. Previous scholarship has shown the success of police organizations in defining the content of crime communication based on asymmetrical power relations with the media. By contrast, our study reveals that legal journalists can bypass attempts to control the flow of information from the prosecutorial office and impose extra‐organizational goals. Lawyers regularly dismiss the work of journalists, particularly those working as strategic communication advisors with prosecutors, but the asymmetrical relationship between the criminal justice agency and the media plays in favour of external legal journalists. Our article considers several explanations for this configuration, including interprofessional values, transactional relationships between journalists and prosecutors, and local legal culture.

Impact of the COVID-19 Pandemic on Dermatology Care in the Chilean Public Health Sector

Due to the Coronavirus-19 (COVID-19) pandemic, most resources of the public health system were allocated to the increasing demand from respiratory patients. From this, it is expected that specialty consultations would decrease drastically. Access to dermatology care in the Chilean public health has been historically limited. To evaluate the impact of the pandemic on dermatology care, the total number of dermatological consultations (DCs) to the Chilean public sector in 2020 is analyzed according to sex and age range and compared with the available databases from 2017 to 2019. From this, 120,095 DCs were performed during 2020, with an incidence of 6.3 consultations per 1000 inhabitants. When compared to 2019 (n = 250,649), there was a 52.1% decrease. The regions most affected were located in the central part of Chile, which correlates with the regions most affected by the pandemic. Age and sex distributions remained similar to previous years but lower in amplitude. The month with the lowest number of consultations was April, with a gradual increase observed thereafter until December 2020. Although DCs decreased drastically in the Chilean public sector during 2020, sex and age range proportions were conserved, thus affecting all groups in a similar manner.

Access to justice in prisons or the limitations of prison defense

This article sought to understand the adequacy of criminal defense services within prisons. By analyzing secondary data and interviews, it describes the justiciable problems and legal needs, the lines of action, and the obstacles that the adult prison population encounters. The results show that the experience and needs that arise in prison surpass the institutional capabilities of the chilean Public Defender’s Office. Therefore, a new institutional framework must be created to meet the justice claims of prisoners.

Spine Surgery in the Chilean Public Health System.

Chile is a country with an area of 756,102 km2.[1][1] It spans a distance of 4270 km (2653 miles) of coastline from north to south, which creates problems in delivering sophisticated health care in rural areas. It is the 38th largest country in the world by size.[2][2] It was founded in 1810 as an

EE672 Cost-Effectiveness Evaluation of Human Papilloma Virus Test in Comparison With Cytology From the Chilean Public System Perspective

EE672 Cost-Effectiveness Evaluation of Human Papilloma Virus Test in Comparison With Cytology From the Chilean Public System Perspective

PCR206 Evaluation of a Multimorbidity Patient-Centered Care Model Implemented in the Chilean Public Health System: Users´ Perspective

PCR206 Evaluation of a Multimorbidity Patient-Centered Care Model Implemented in the Chilean Public Health System: Users´ Perspective

Perception of Cognitive Functions and Academic Performance in Chilean Public Schools.

Understanding the perception that students have about their own cognitive processes is a key aspect that allows for a deeper assimilation of the different factors that affect school performance. However, there is limited evidence explaining the link between students’ perception of their own cognitive functions and their academic performance. The objective of this study was to analyze the association between perception of cognitive functions, such as memory, processing speed, attention, execution of complex tasks and nervousness, and academic performance in Chilean schoolchildren from the province of Biobio. A cross-sectional analytic design was conducted. The sample consisted of 590 elementary school students (12 ± 1.3 years old; 48.3% female) from Chilean public schools. The academic performance was measured by means of the accumulated final grades in the language, mathematics, physical education and health subjects, and the grade point average (GPA) of each student. Moreover, a survey to measure the cognitive functions of the participants was applied. The results show that 20.3% of the students perceived themselves as very nervous and 16.8% felt distracted. Differences in marks were observed in all the measured subjects, as well as in GPAs, depending on the perception of cognitive functions. Thus, the students with low to moderate perceptions of their cognitive functions received lower marks than those who reported a high perception. These results were consistent after a multivariate analysis adjusted for a socio-educational variables model. In conclusion, one in five public school students in the Biobío Region of Chile expressed a low perception of their cognitive functions, which is consistent with their weaker school performance. Therefore, it is believed that integrating curricular activity and cognitive work could potentially boost the perception of said functions, and thus reduce the risk of poor academic performance.

Edificios históricos de madera, restaurados con fines públicos en el Sur de Chile. Un análisis crítico y un enfoque hacia el paisaje cultural

The objective of this paper is to update and summarize the arguments behind the Integrated Heritage Rehabilitation (IHR) for Wooden Cities methodology. Building in the Coastal Temperate Rainforest ecoregion relied on native species, and is still characteristic of the towns in southern Chile, including the city of Valdivia. However, the historic town’s urban fabric is vulnerable to natural disasters and neoliberal market practices. Regulations and instruments for architectural restoration hinder IHR since their primary focus lies in social sciences, excluding the fundamental architectonic technical aspects, as well as a broader understanding of the context. Through an analysis of a set of historic buildings restored with public funds, the relationship between social sciences, engineering, architecture, and the theories of public use and landscape is patent. It is evident that there is a need to establish effective practices to extend the service life of buildings through cultural heritage management. Eight key points were identified, that connect history with the material conditions, which today are lacking in the Chilean Public Service. For the restoration processes to be integrated, evaluations must include new dimensions, such as the economic relationship and the material or tangible management, as well as the integration with the surrounding original architectural identity and the ease with which it can be culturally associated. From the harmonization of these eight points within the heritage regulatory framework, an improvement of the integrated rehabilitation of heritage buildings in the southern Chilean towns is expected, with priority given to timber conservation and public contribution.

An Application of Machine Learning in Public Policy: Early Warning Prediction of School Dropout in the Chilean Public Education System

2021AbstractSchool dropout is a serious problem worldwide, and contributes to a great deal of poverty and misery. People who have not finished school obviously suffer the consequences, but these extend to all of society since they become a burden due to lack of education and skills for the workplace. Much like poverty, school dropout is complex and multidimensional. Hence, early warning systems that predict which children are at risk of dropping out of school are of the utmost importance, and furthermore, the interventions to rescue these children must be bespoke, i.e., tailored to the specific situation of each child. Much work has been done using traditional methods such as attendance thresholds and logistic regression. However, school dropout prediction by means of applying machine learning is relatively new. In addition, an application that has worked in one country does not necessarily work in another, since the available data sets are different. Therefore, the following question arises: does machine learning enable a more accurate early warning of school dropout specifically in Chile? In this paper we answer this question, testing and comparing machine learning predictive models with a traditional logistic regression, using public databases from the Chilean Ministry of Education. In addition, we offer some practical recommendations for other researchers and policy makers who endeavour to implement practical working early warning systems for school dropout.

EE17 Budget Impact Analysis of the Incorporation of Tiotropium Bromide Monohydrate-Olodaterol Hydrochloride in Chronic Obstructive Pulmonary Disease in the Chilean Public Health Sector

One in 20 deaths were from Chronic Obstructive Pulmonary Disease (COPD) in 2015. The TONADO 1 and 2 studies demonstrated that Tiotropium-Olodaterol significantly improved lung function and symptoms compared to monocomponents.

EE483 The Economic Impact of Coronavirus Pandemic on Stroke Care: Direct and Indirect Costs Estimations in Chile

EE483 The Economic Impact of Coronavirus Pandemic on Stroke Care: Direct and Indirect Costs Estimations in Chile

Chilean Public Policies and their Impact on Biotechnology Small and Medium Enterprises

It is difficult to find cases of technology-based Small and Medium Enterprises in developing countries, however Chile has some within the biotechnology sector. How has this been possible? As a consequence of the different public policies and structural economic conditions that allowed their emergence, especially in the 1990s. This study describes the historical conditions and how they have been able to create a sector within the Chilean economy. From the analysis of secondary data the emergence of this type of company within the country is described. This analysis shows the link between structural conditions and appropriate public policies, meaning that these companies did not emerge by chance. Understanding their development process is crucial to promote the creation of more such technology-based Small and Medium Enterprises, as they have many positive externalities and are more globally competitive.

Paracetamol as an adjuvant to opioids for cancer pain management

Cancer related pain is one of the most frequent and relevant symptoms in patients with malignant tumors, causing a huge impact in their quality of life. According to the Chilean Public Health System Technical Report of the Cancer Pain Control and Palliative Care Program 2013-2014, 90% of cancer patients admitted to the Program experienced pain, being moderate or intense in 34%. International and local standards recommend the use of strong opioids (morphine, methadone, or fentanyl) associated with adjuvants such as paracetamol as an initial strategy for pain management. This recommendation assumes that the use of combined analgesics could allow the use of lower opioid doses to obtain similar analgesic effect, decreasing the occurrence of opioid side effects. However, this technical report also describes that there is uncertainty about the impact of paracetamol as an adjuvant in patients with cancer pain who are already receiving strong opioids. This review aims to describe the current state of the art regarding the role of paracetamol as a coadjuvant in cancer pain patients.