We develop a design-aware framework that combines penalized prediction and causal inference for finite populations observed through complex survey designs. The framework integrates survey-weighted pseudo-likelihoods, ℓ1-penalized estimation, Neyman-orthogonal moment functions, and a bootstrap procedure that resamples primary sampling units within strata. Methodologically, the contribution is an explicit pipeline that supports design-based inference while separating predictive associations from structurally adjusted effects in high-dimensional, clustered data. We illustrate the framework using data from the Chilean National Health Survey (ENS) 2016–2017 to study the relationship between chronic kidney disease (CKD) and high cardiovascular (CV) risk. In the ENS adult population, the survey-weighted prevalence of CKD was 3.1% (95% CI: 2.4–3.8), and the prevalence of high CV risk was 23.9% (95% CI: 21.5–26.3). High CV risk was markedly more frequent among individuals with CKD than among those without CKD (90.9% versus 21.5%). Predictive and associational analyses combined survey-weighted penalized logistic regression (LASSO) with refitted unpenalized models. In conventional survey-weighted logistic regressions, CKD showed a strong association with high CV risk (odds ratio = 5.66; 95% CI: 2.71–11.82; p<0.001), and effect sizes remained stable after LASSO-based variable selection. To assess causal relevance under confounding and potential endogeneity, we implemented two endogeneity-aware estimators: two-stage residual inclusion (2SRI) and double/debiased machine learning (DML). The DML estimator, defined as the primary causal estimand, reports an orthogonalized estimate of the average treatment effect of CKD on the probability of high CV risk. After adjustment for age and major cardiometabolic comorbidities, the DML estimate was attenuated and statistically non-significant (average treatment effect = −0.094; 95% CI: [−0.409,0.220]). The 2SRI approach yielded unstable estimates with wide confidence intervals, consistent with the limited effective sample size of CKD cases (nCKD≈190 in a sample with n ≈ 6233) and weak identification conditions under low-prevalence settings. Simulation experiments under ENS-like complex sampling suggest that naive predictive associations may overestimate the structural contribution of CKD under confounding, whereas orthogonalized estimators yield more conservative estimates when identification holds. The causal interpretation relies on a conditional mean independence assumption given observed covariates and survey design, while control-function specifications are treated as diagnostic sensitivity analyses due to the absence of credible exclusion-based instruments. Overall, the results demonstrate a fundamental divergence between predictive relevance and causal importance in finite-population settings, underscoring the need for design-aware and endogeneity-robust methods in statistical modeling.

Oral health is an often-overlooked component of healthy ageing, as a sign of cumulative functional decline. This study explored the association between oral functional status and all-cause mortality. This was a secondary analysis of the 2016-2017 Chilean National Health Survey linked to mortality records through December 31, 2022. In total, 223 participants aged ≥ 60 years were included (N = 1,016,557). Minimum dentition (MD) was defined as ≥10 teeth, prosthesis use was self-reported, and frailty was assessed using a modified Fried phenotype. Survey-weighted Cox models estimated associations with all-cause mortality, adjusting for age, sex, area, education, frailty, diabetes, and hypertension. In the survey-weighted Cox model, each category representing MD and/or prosthesis use was associated with lower mortality hazards compared with the reference group (<10 teeth and no prostheses): prostheses only (HR 0.17, 95% CI 0.05-0.61), MD only (HR 0.16, 95% CI 0.04-0.74), and MD with prostheses (HR 0.08, 95% CI 0.01-0.46). Increasing age and rural residence were associated with higher mortality hazards, whereas estimates for sex, education, frailty, diabetes and hypertension were imprecise and generally compatible with no clear association. These findings are hypothesis-generating and support further evaluation of oral functional status as a marker of broader health vulnerability in aged Chileans.

People with substance-use disorders (SUDs) have increased mortality risk, yet Chilean estimates of SUD-based mortality are scarce. This study aimed to quantify all-cause and cause-specific mortality following SUD treatment in Chile compared with the general population and assess variation across key clinical and demographic subgroups. National-level registry-based retrospective data linkage cohort study. Publicly funded SUD psychosocial treatments offered by the Chilean National Drug Agency, linked with official national mortality records from 2010 to 2020. 70064 adults aged 18-64 years (24% women, median age 35 at treatment entry) were followed after their first treatment episode until death or 31 December 2020. Primary outcome was all-cause mortality. Secondary outcomes were cause-specific mortality by the International Classification of Diseases, 10th revision, underlying and external causes. We estimated age-sex-calendar year directly standardized rates (DSR), and standardized mortality ratios (SMR) compared with the expected rate for the (sub)population. We also stratified rates and ratios by sex (men/women), attained age (18-29, 30-44, 45-59, 60+), setting (ambulatory/residential), primary substance (alcohol; illicit: predominantly cocaine paste base, marijuana and cocaine hydrochloride) and treatment compliance (not completed/completed). Additionally, we estimated rates and SMRs for underlying and external causes of mortality. Over a median 4.9-year follow-up (353 826 person-years), 2996 deaths occurred [DSR = 10.6, 95% confidence interval (CI) = 8.6-13.1]. Overall SMR was 3.65 (95% CI = 3.52-3.79). Excess risk was particularly pronounced for women (SMR = 5.57, 95% CI = 5.14-6.03), patients admitted due to alcohol use disorder (SMR = 4.59, 95% CI = 4.33-4.86), in residential care (SMR = 4.91, 95% CI = 4.45-5.42) and treatment noncompletion (SMR = 4.04, 95% CI = 3.85-4.24). Cause-specific mortality revealed elevated external-cause excess risk for SUD patients, including intentional self-harm (SMR = 6.67, 95% CI = 6.05-7.36), unintentional injuries (SMR = 5.37, 95% CI = 4.79-6.02) and assaults (SMR = 4.98, 95% CI = 4.16-5.96). Notable excess risk was also observed for non-external mortality causes: digestive system (SMR = 8.20, 95% CI = 7.62-8.83), symptoms and signs (SMR = 5.18, 95% CI = 4.29-6.26) and respiratory diseases (SMR = 5.18, 95% CI = 4.47-5.99) were greater than expected. In Chile, patients with a history of publicly funded substance-use disorder treatment appear to have an all-cause mortality up to 3.7 times higher than the general population, driven predominantly by digestive and respiratory causes, as well as self-harm, unintentional injuries and assaults.

The improvement of the governance system is an important adaptation factor for medium-sized powers to join the "Belt and Road Initiative" cooperation. The sound governance system, rule system and implementation capacity are highly consistent with the basic concept of win-win cooperation advocated by "Belt and Road Initiative". It will help to reduce institutional costs and various risks and challenges in international cooperation, and improve the efficiency of cooperation. Chile is a typical representative of a medium-sized power with a relatively perfect governance system in Latin America. Chile is an important partner for China to carry out "Belt and Road Initiative" Latin American infrastructure construction cooperation with stable political situation, complete legal system and clear strategic planning. its railway modernization is the main platform for "facility connectivity" between China and Chile. It centrally reflects the special logic and wisdom of the medium-sized powers participating in the cooperation of "Belt and Road Initiative" with complete system. The author takes the largest single contract of Chilean National Railway Company as the case study object, taking the governance mechanism as the starting point, on the basis of medium power theory and embedded autonomy theory, this paper discusses the governance of the project from three aspects: system docking, interest coordination and risk prevention and control. And contact the literature and cases of friendly relations between the two countries, transnational knowledge transfer, medium-power governance, unification of railway standards, bilateral trade, digital Silk Road, industrial linkage development, foreign investment strategy, foreign governance and so on. This paper reveals the inherent law of Belt and Road Initiative cooperation among medium-sized powers with complete system based on multi-dimensional governance system, and summarizes the replicable experience and enlightenment, so as to provide theoretical reference and practical plan for deepening multi-field cooperation between China and similar countries.

Social participation, a principle that has guided health reform processes globally, presents diverse barriers according to the political and social context, obstructing its effective exercise. This study examines the perceptions of various stakeholders regarding the barriers and opportunities for social participation in decision-making processes within Chile's National Cancer Plan and Law framework. A qualitative multiple-case study design (cases: politicians, academics, decision-makers, organisations) was employed. A total of 28 semi-structured online interviews were conducted with stakeholders involved in the planning and implementation of the National Cancer Plan and Law, as well as with its beneficiaries. Thematic analysis was carried out through the analytical framework method, a systematic and flexible approach to analysing qualitative data. Approved by the Scientific Ethics Committee of the Universidad del Desarrollo, Chile. The main perceived barriers were classified into four areas: (a) disarticulation of civil society organisations, (b) lack of validation of organisations in decision-making processes, (c) lack of access to information and (d) lack of tools for the professionalisation of organisations. Opportunities for action are proposed that involve joint actions from all actors in a paradigm shift exercise on social participation in health, and the degree of involvement that all stakeholders should have to achieve more significant equity in participation. The results suggest that persistent barriers to effective participation exist, primarily due to power imbalances and the dominance of biomedical perspectives. The findings emphasize the importance of authorities and decision-makers acknowledging the value of knowledge from civil society to encourage collaborative and sustained work that transcends individual leaders and governments.

Iodine intake in adults: Sociodemographic and dietary determinants from a National Health survey.

Background/Objectives: Hip fractures in older adults are associated with substantial morbidity, functional decline, and high in-hospital mortality. Early identification of patients at increased risk of death may improve clinical decision-making and resource allocation. This study aimed to develop and internally validate supervised machine learning models to predict in-hospital mortality among older adults hospitalized for hip fracture using nationwide administrative data from Chile. Methods: A retrospective cohort study was conducted using anonymized hospital discharge records from the Chilean National Health Fund (FONASA), covering admissions between 1 January 2019 and 31 December 2024, across 72 public hospitals. Demographic, clinical, and care-related variables were included as predictors. Multiple supervised machine learning algorithms were trained and evaluated using stratified train-test partitioning. Model performance was assessed using AUC-ROC, precision, recall, and F1-score. Model interpretability was explored using SHapley Additive exPlanations (SHAP). Results: A total of 40,253 hospitalization episodes were analyzed. The Gradient Boosting model achieved the best overall performance, with an AUC-ROC of 0.885 and a favorable balance between precision and recall. SHAP analysis identified age, comorbidity burden, and surgical treatment as the most influential predictors, revealing nonlinear and clinically meaningful contributions to mortality risk. Conclusions: Supervised machine learning models based on routinely collected administrative data demonstrated strong predictive performance for in-hospital mortality after hip fracture. Interpretable models may support early risk stratification and clinical decision-making at a national healthcare level.

Background: Pneumonia is a leading cause of hospitalization and death among older adults, reflecting both patient vulnerability and the quality of acute care. However, evidence from Latin America remains limited. Objective: to examine the association between frailty level assessed using the HFRS and in-hospital mortality among older adults hospitalized with community-acquired pneumonia (CAP). Methods: We conducted a retrospective cohort study using the Chilean National Health Fund (Fondo Nacional de Salud, FONASA) database, including patients aged ≥ 60 years hospitalized with CAP (ICD-10 codes J12-J18) between 2019 and 2024. Variables analyzed included age, sex, frailty level assessed by the Hospital Frailty Risk Score (HFRS), comorbidity burden (Charlson Comorbidity Index), Diagnosis-Related Group (DRG) severity level, and relative weight. Survival was analyzed using Kaplan-Meier curves and log-rank tests. Multivariable Cox proportional hazards models estimated adjusted hazard ratios (HR) with 95% confidence intervals (CI). Results: The cohort comprised 58,040 patients (51.2% women). Overall, in-hospital mortality was 19.3%. Independent predictors of mortality included advanced age (≥90 years: HR = 2.41; 95% CI: 2.27-2.56), male sex (HR = 1.10; 95% CI: 1.06-1.14), high frailty risk (HR = 1.57; 95% CI: 1.47-1.68), and greater DRG severity (per level: HR = 1.66; 95% CI: 1.58-1.73). The Charlson Comorbidity Index lost significance after adjustment. Conclusions: Frailty emerged as a strong and independent determinant of in-hospital mortality in older adults with CAP. Systematic frailty assessment combined with comorbidity indices could improve risk stratification and guide more personalized, evidence-based clinical management in acute care settings.

This study proposes and evaluates a data-driven framework for short-term System Marginal Price (SMP) forecasting in the Chilean National Electric System (NES), a power system characterized by high penetration of variable renewable generation and persistent transmission congestion. Using publicly available hourly operational data for 2024, multiple machine learning regressors including Linear Regression (base case), Bayesian Ridge, Automatic Relevance Determination, Decision Trees, Random Forests, and Support Vector Regression are implemented under a node-specific modeling strategy. Two alternative approaches for predictor selection are compared: a system-wide methodology that exploits lagged SMP information from all network nodes; and a spatially filtered methodology that restricts SMP inputs to correlated subsystems identified through nodal correlation analysis. Model robustness is explicitly assessed by reserving January and July as out-of-sample test periods, capturing contrasting summer and winter operating conditions. Forecasting performance is analyzed for representative nodes located in the northern, central, and southern zones of the NES, which exhibit markedly different congestion levels and generation mixes. Results indicate that non-linear and ensemble models, particularly Random Forest and Support Vector Regression, provide the most accurate forecasts in well-connected areas, achieving mean absolute errors close to 10 USD/MWh. In contrast, forecast errors increase substantially in highly congested southern zones, reflecting the structural influence of transmission constraints on price formation. While average performance differences between M1 and M2 are modest, a paired Wilcoxon signed-rank test reveals statistically significant improvements with M2 in highly congested zones, where M2 yields lower absolute errors for most models, despite relying on fewer inputs. These findings highlight the importance of congestion-aware feature selection for reliable price forecasting in renewable-intensive systems.

Psychological dispositions and behavioral adaptations are central to understanding adherence in chronic disease. This review examined how these factors influence adherence in adults with non-communicable chronic diseases, analyzing which personality traits and coping strategies shape adherence. A Scopus and Web of Science search (2013-2023) identified 20 studies (n = 82,738), following PRISMA. Risk of bias was assessed with Joanna Briggs Institute (JBI) tools, and certainty with the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Narrative synthesis indicated neuroticism and avoidant coping predicted poorer adherence, whereas conscientiousness, adaptive coping, and coping self-efficacy promoted enhanced adjustment. Openness, extraversion, and agreeableness had modest yet positive effects, and emotion-focused coping yielded context-dependent outcomes. Predominant cross-sectional designs and limited Global South representation underscore the need for tailored, context-sensitive interventions. The review was preregistered in Open Science Framework (OSF) and funded by the Chilean National Agency for Research and Development. Further longitudinal research is needed to clarify mechanisms and improve generalizability.

Environmental tobacco smoke (ETS) remains a significant public health concern in Chile despite the implementation of comprehensive smoke-free policies. This study aimed to identify sociodemographic, behavioral, and biochemical factors associated with daily ETS exposure across different environments among Chilean adults. A cross-sectional analysis was conducted using data from the 2016-2017 Chilean National Health Survey (ENS), a nationally representative survey with a complex multistage sampling design. The analytical sample included 6,233 individuals aged 15 years or older, of whom 5,520 had biochemical measurements; missing data were addressed using multiple imputation. Six outcome variables representing daily hours (0-24) of ETS exposure were analyzed across home, workplace, and other environments on weekdays and weekends. Given the high proportion of zero values (~88.5%) and evidence of overdispersion (dispersion = 6.2), Poisson, negative binomial, and zero-inflated Poisson models were formally compared using likelihood-based criteria, while quasi-Poisson models were used exclusively to assess overdispersion and the robustness of standard errors. Survey-weighted generalized linear models were fitted, and exponentiated coefficients were interpreted as mean ratios (MR). Negative Binomial models provided the best fit (AIC = 6,300 vs. 11,470 for Poisson), with consistent findings across sensitivity analyses. ETS exposure was higher among men, urban residents, and individuals reporting insomnia. Age was inversely associated with exposure (MR ≈ 0.99 per year), indicating lower expected exposure hours among older individuals. Women showed lower exposure compared to men (MR = 0.69; 95% CI: 0.55-0.87), and rural residence was associated with reduced exposure (MR = 0.61; 95% CI: 0.45-0.84). Insomnia was associated with higher exposure (MR = 1.74; 95% CI: 1.10-2.73). Descriptive analyses indicated that exposure was highest in "other environments," particularly during weekends. These findings suggest that ETS exposure in Chile is unevenly distributed and shaped by sociodemographic and behavioral factors. Accounting for complex survey design and distributional characteristics of exposure data improves the validity and interpretability of results. Targeted public health strategies focusing on high-risk groups and environments are needed, while integrating behavioral and contextual determinants into tobacco control policies.

BackgroundLatin America (LA) experiences disparities driven by social determinants of health and low socioeconomic status, which increase the risk of dementia. These adverse factors may contribute to dementia through allostasis, the body's adaptive response to stressors. Chronic stressors can lead to allostatic overload, disrupting physiological systems and increasing the risk of diseases like dementia. While chronic stress is linked to cognitive decline, further research is needed to understand cumulative effects and develop an allostatic index (ALI) specific to the LA population.MethodWe analyzed data from 8,044 participants across four LA cohorts: Chilean National Health Survey (Chile), GERO (Chile), ReDLat, and Costa Rica, including individuals with and without cognitive impairment or dementia. ALI was calculated using metabolic, cardiovascular, immune, neuroendocrine, and anthropometric biomarkers. Specific indices were developed for each cohort, considering cutoff values, percentiles, and risk quartiles. Logistic regression models examined associations between ALI and cognitive status, assessed with the Mini‐Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Clinical Dementia Rating (CDR).ResultHigher ALI was associated with increased risk of cognitive impairment and dementia. In Costa Rica, ALI was significantly associated with cognitive impairment (OR = 1.048; p = 0.021). In the ReDLat cohort, higher ALI correlated with worse clinical cognitive status (OR = 1.068; p = 0.031). In the GERO Chile cohort, ALI showed significant impact (OR = 1.17; p = 0.04). In the CNHS, higher ALI notably increased cognitive impairment risk (OR = 7.15; p = 0.015).ConclusionALI is a relevant marker for identifying cognitive impairment and understanding its relationship with chronic stress. Monitoring biomarkers such as systolic blood pressure and waist‐to‐height ratio can improve the characterization of dementia in LA populations. These findings highlight the importance of addressing chronic stress and its biological impacts in diverse settings.

BackgroundCognitive impairment (CI) is considered a risk factor for premature mortality. However, it has not been extensively studied in Latin American populations (LATAM). We investigated the association between CI and all‐cause mortality in four LATAM cohorts from Chile, Costa Rica, Mexico and Puerto Rico.MethodThis prospective cohort study included up to n = 12,990 participants aged ≥60 years from four studies: the Chilean National Health Survey 2009‐2010 (CNHS n = 1,226), the Costa Rican Study on Longevity and Healthy Aging 2004‐2006 (CRELES n = 1,898), the Mexico City Prospective Study 2015‐2019 (MCPS n = 6,448), and the Puerto Rican Elderly: Health Conditions 2002‐2003 (PREHCO n = 3,418). Data on all‐cause mortality was collected until 2020, 2010, 2022, and 2013, respectively. The Mini‐Mental State Examination (MMSE) assessed cognitive performance (higher scores indicate better performance). A CI case was determined according to the MMSE cut‐off criteria established by each cohort. The Kaplan‐Meier estimator and multivariable Cox proportional hazards models were performed. Results were expressed as HR (95%CI) per cohort and in meta‐analysis.ResultThe mean age across the cohorts ranged from 69 years (IQR 64–76) in CNHS to 73 years (IQR 67–81) in CRELES. The follow‐up period varied between 3.69 years in CRELES and 8.88 years in CNHS. The prevalence of cognitive impairment (CI) ranged from 4.5% in PREHCO to 40.9% in MCPS. The mortality rate ranged from 8.9% in CRELES to 34.7% in CNHS. Subjects with CI had a lower probability of survival than those with normal cognition. The risk of mortality associated with cognitive impairment was 66% (HRCNHS=1.66, p <0.001), 53% (HRMCPS=1.53, p <0.001), and 58% (HRPREHCO=1.58, p = 0.01). For CRELES, no significant association was observed (HR=1.22, p = 0.25). The meta‐analysis across cohorts yielded a pooled risk of all‐cause mortality of 52% (HR=1.52; p <0.001).ConclusionLATAM adults aged ≥60 with CI have a lower survival probability and higher mortality risk. Higher MMSE scores are protective against premature mortality. These results are consistent across cohorts and in meta‐analysis.

Introduction: Youth soccer players face nutritional risks associated with competitive demands and the formative environment. Evidence regarding the role of nutritional counseling attendance in this population remains limited. Objective: To analyze the association between nutritional counseling attendance, food quality, and disordered eating behaviors in youth soccer players from clubs affiliated with the Chilean National Professional Football Association. Methodology: Cross-sectional study involving 581 soccer players aged 14 to 19 years from 24 clubs in Chile’s First Division A and B. The Global Food Quality Index and the risk eating behavior subscale of the E-TONA instrument were applied. Spearman correlations, simple linear regressions, and logistic regressions with 95% confidence intervals were used. Results: Higher frequency of nutritional counseling attendance was significantly associated with better overall food quality (p &lt; 0.001), greater consumption of fruits (p = 0.001), vegetables, lunch and dinner, and lower intake of sweets (p &lt; 0.001) and fried foods (p &lt; 0.001). In addition, lower odds of experiencing binge eating (p = 0.002), constant hunger (p &lt; 0.001), and eating until feeling completely full (p = 0.003) were observed. Differences in food quality were also identified according to competitive division (p = 0.018). Conclusions: Higher frequency of nutritional counseling attendance was associated with better food quality and lower odds of disordered eating behaviors in youth soccer players, reinforcing the importance of nutritional interventions from formative stages.

The inclusion of Psychological Health in the Life's Essential 8 (LE8) may improve its predictive validity and contribute to a more equitable assessment of mortality by better accounting for this crucial component. Therefore, this study aimed i) to assess the longitudinal association between a modified version of Life's Crucial 9 (LC9) score and all-cause mortality in the Chilean population and ii) to examine whether adding psychological health to the original LE8 framework might enhance its predictive ability. We included 3,546 participants aged ≥15 from the Chilean National Health Survey 2016-2017. Mortality was ascertained through linkage with the Chilean Civil Registry and Identification. A modified version of the LC9 score was created and divided into quartiles. The modified version was calculated from nine health and behavioral components, incorporating a Psychological Health variable (composite of depression and social integration). The association between LC9 and all-cause mortality was examined using crude Kaplan-Meier survival curves and Cox proportional hazard models adjusted for sociodemographic and lifestyle factors. Non-linear associations were explored using restricted cubic splines. Predictive performance of LC9 was further compared with LE8 using model fit criteria (AIC, BIC) and discrimination measures (C-statistics, ROC-AUC). Over a median follow-up of 5 years, 169 participants (4.8 %) died from any cause. Survival curves showed lower survival probabilities among individuals in the lowest LC9 quartile than to those in higher quartiles (log-rank <0.001). Compared with participants in Q1, those in Q4 had a 49 % lower risk of all-cause mortality after full adjustment for confounders (HR: 0.51; 95 % CI: 0.31-0.82). When comparing indices, LC9 (C-statistics= 0.854 (95 % CI: 0.842-0.866) provided marginally better model fit than LE8 (C-statistics= 0.851 (95 % CI: 0.839-0.864), but their overall predictive performance for mortality was similar. Higher LC9 scores were associated with lower all-cause mortality. The incorporation of Psychological Health measures may slightly improve the prediction of the models.

Background: Hip fracture is a common geriatric condition associated with disability, institutionalization, and mortality. In-hospital mortality reflects both patient vulnerability and the quality of care, yet evidence from Latin America is scarce. Objective: We aimed to identify factors associated with in-hospital mortality in Chilean older adults with hip fractures. Methods: We conducted a retrospective cohort study using the Chilean National Health Fund (FONASA) database, which included patients aged 60 years or older who were hospitalized with a hip fracture (ICD-10 S72.0–S72.2) between 2019 and 2024. Variables analyzed included age, sex, surgical treatment, number of comorbidities, Diagnosis-Related Group (DRG) severity level, and relative weight. Survival was evaluated with Kaplan–Meier curves and log-rank tests. Multivariable Cox proportional hazards models estimated adjusted hazard ratios (HR) with 95% confidence intervals (CI). Results: The cohort comprised 40,253 patients (76.8% women; mean age 81.9 ± 9.1 years). Overall, in-hospital mortality was 3.5%. Independent predictors of mortality included absence of surgery (HR = 9.56; 95% CI: 8.38–10.90), higher DRG severity level (HR = 3.87; 95% CI: 3.42–4.37), advanced age (HR per year = 1.05; 95% CI: 1.04–1.05), male sex (HR = 1.12; 95% CI: 1.03–1.27), and multimorbidity (≥3 comorbidities; HR = 2.73; 95% CI: 1.98–3.99). Conclusions: Timely surgery and stratification with administrative indicators (DRG) are key to reducing in-hospital mortality. The findings support strengthening orthogeriatric models in Chile.

BackgroundCongenital anomalies affect approximately 6% of global births annually and contribute significantly to infant mortality and long-term disability. Low folate status has been linked to malformations such as neural tube defects (NTDs) and orofacial clefts (OFCs). This work aimed to estimate the national prevalence of these two groups of malformations in Chile, a country subjected to mandatory folic acid fortification of flour. We also analyzed the sex dimorphism of the NTD and OFC and described the main associated comorbidities.MethodsIn this cross-sectional descriptive study, we used data from the Chilean National Registry of Congenital Anomalies (2016–2017) to analyze NTD and OFC prevalence and sex bias.ResultsThe study included 3,376 records, revealing a total of 7.63/10,000 births for NTD patients and 12.01/10,000 for OFC patients. Anencephaly and cleft lip/palate were the most prevalent subtypes in the NTD and OFC. Sex-related differences were noted, with a significantly greater prevalence of cleft lip/palate and cleft lip in males and a tendency toward a greater prevalence of anencephaly in females. Approximately 70% of NTD cases were isolated; associated malformations primarily involved the nervous, musculoskeletal, and facial systems. Isolated OFC accounted for 77% of cases, with musculoskeletal and neurological malformations being the most frequently associated.ConclusionsNTD and OFC prevalence and sex-specific variations are consistent with estimates in countries that apply mandatory folic acid fortification policies. This study provides valuable insights into the epidemiology of NTDs and OFCs in Chile and emphasizes the importance of ongoing surveillance through standardized data collection.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12887-025-05999-6.

Peasant movements are key to thinking and acting creatively in food and socio-ecological transformation processes. Drawing bridges between feminist political ecology and critical ecofeminisms, this article analyzes Chile's National Association of Rural and Indigenous Women (ANAMURI) as key agents of social change. The study follows a qualitative methodology based on an analysis of ANAMURI's working papers, in-depth interviews, and ethnographic observations of the organization's women leaders (data collected in 2021-2023). The article explores how ANAMURI mobilizes political identity categories (women, peasantry) and politicizes key materialities for food production (land, water, seeds, among others) as strategies for food transitions. It also analyzes ANAMURI's approach to popular peasant feminism and care and earthcare ethics at the center of its political work. The relevance of social organization and the political formation of rural women as agents of social change for food transitions is evidenced.

BackgroundSystemic lupus erythematosus (SLE) is a chronic autoimmune disease with diverse clinical manifestations and regional variations in epidemiology. Despite its clinical significance, robust epidemiological data from Latin America, particularly Chile, remain limited. This study aims to provide the first comprehensive epidemiological assessment of SLE in Chile using population-adjusted denominators and rigorous statistical methods.MethodsWe analyzed data from Chile's Specific Health Guarantees Program (GES) from July 2013 to August 2024, covering 95% of the insured population. Population denominators were obtained from Chile's National Institute of Statistics stratified by age and sex. Incidence rates were calculated using annual new case reports from 2014 to 2023, while prevalence and mortality were estimated through 2024. All analyses included 95% confidence intervals using Poisson distribution methods. Rate ratios were calculated using Poisson regression models with population offset terms. Sensitivity analyses modeled different assumptions regarding program discharge mortality proportions.ResultsThe median annual SLE incidence in Chile was 7.1 per 100,000 beneficiaries (IQR 6.3-7.7) using population-adjusted denominators. Prevalence increased from 26.7 per 100,000 in 2013 to 91.3 per 100,000 in 2024. The male-to-female incidence ratio was 1:10.61 (Rate Ratio: 0.093, 95% CI: 0.088-0.098). Mortality analysis using program discharges as a proxy revealed an overall rate of 11.9 per 1000 SLE patients (IQR 7.2-18.8), with significantly higher rates in males compared to females (Rate Ratio: 1.756, 95% CI: 1.546-1.987). Age-stratified analysis demonstrated progressive mortality increases, with patients ≥60 years showing rates of 87.4 per 1000 in males and 49.0 per 1000 in females. Sensitivity analyses modeling different assumptions about discharge mortality (70%-100% fatal) yielded mortality estimates ranging from 8.2 to 11.9 per 1000 SLE patients.ConclusionsThis study provides a comprehensive epidemiological assessment of SLE in Chile using population-adjusted denominators and statistical confidence intervals. Our findings demonstrate SLE incidence rates higher than North American estimates, significant sex disparities in both incidence and mortality, and age-related mortality progression. The sensitivity analysis addresses limitations in mortality estimation through administrative data. These findings contribute essential epidemiological parameters for healthcare planning and underscore the need for enhanced surveillance systems for autoimmune diseases in Latin America.

Artisanal and small-scale gold mining (ASGM) constitutes an essential livelihood strategy for marginalized communities, yet it is also associated with severe environmental and social challenges. Persistent inequality and poverty underpin miners’ dependence on informal practices, where access to safer technologies is limited. Mercury use remains critical in ASGM, often mismanaged in processing, applied in amalgamation, and released into air, water, and soils. An estimated 1000–2000 tonnes are emitted annually despite Minamata Convention commitments. This paper examines how mining governance can foster sustainable transitions in ASGM, focusing on the Chilean National Mining Company (ENAMI) as a case study. ENAMI’s model—combining regulatory oversight, institutional support, and inclusive decision-making—shows how public governance can reduce mercury reliance, mitigate environmental degradation, and enhance social inclusion. Findings highlight the importance of regulation, community participation, capacity-building, and addressing structural inequalities as integral components of sustainability. The study argues that sustainable ASGM requires not only technical innovation but also culturally sensitive institutional reforms capable of overcoming resistance and promoting long-term behavioral change. By situating ASGM within the broader framework of sustainable rural development, this research provides insights for policymakers, practitioners, and scholars seeking to reconcile economic inclusion with environmental stewardship in vulnerable contexts.