Health In Chile Research Articles

Examining Resilience, Subjectivity, and Trauma: The Case of Migrants´ Mental Health in Chile

Examining Resilience, Subjectivity, and Trauma: The Case of Migrants´ Mental Health in Chile

Informal Employment Under the Skin: Informality and Health Inequalities Among Chilean Workers.

Informal employment has been identified as an important social determinant of health. This article addresses the processes through which informal employment affects workers' health in Chile. The study's methodological approach was based on qualitative interviews with 34 formal and informal workers. The findings show how workers perceive informal employment as negatively affecting their mental and physical health through different dimensions of their living and working conditions. Incorporating a gender perspective proves to be integral to the analysis of these processes. The article concludes by discussing how neoliberalism underlies such vulnerability processes and negatively impacts on the population's health.

The social and health protection of migrants in Chile: qualitative analysis of civil society proposals for constitutional change

BackgroundA sustained period of social, economic, and political unrest took place during October of 2019 in Chile. As an institutional solution, the “Agreement for Social Peace and the New Constitution” was signed. In this document, most political parties committed to reestablishing peace and public order in Chile, agreeing on the initiation of a constitutional process. To promote participation of civil society actors, the “Popular Initiative for Norms” was enabled. This was a platform where civilians could submit proposals for constitutional norms to be discussed by the Constitutional Convention. We aimed to analyze proposals related to migrants and migrant health.MethodsWe conducted a qualitative thematic analysis of the proposals. Sixteen of them were related to migrants, and we analyzed their association to health. We also evaluated their link to the Health Goals 2030 set out by the Chilean Ministry of Health and the Global Action Plan 2019–2023 for Promoting the Health of Refugees and Migrants by the World Health Organization.ResultsFour main thematic categories were identified: 1) Humans rights of migrants, refugees, and asylum seekers; 2) Nationality and regularization of migrants and refugees; 3) Political participation and cultural integration of migrants and refugees; and 4) Specific regulations on slavery and human trafficking. These resonated with broader frameworks established in the Health Goals 2030 (Chile) and the Global Action Plan 2019–2023 for Promoting the Health of Refugees and Migrants by the World Health Organization.ConclusionsThe ‘Popular Initiative for Norms’ was a non-binding participatory mechanism. Although the proposals sent through were not guaranteed to be included in the constitutional draft—and despite the final draft being rejected last September 2022—the platform allowed to gain insights into civilian opinions. Our findings showed that there is an incipient yet weak recognition of the rights and situation of migrants in Chile. There was no direct mention of health nor an explicit contemplation of social determinants of health. Despite there being an urgent need to define strategies for migrants’ health in Chile, this study demonstrated that civil awareness and interest are still insufficient.

Inequalities by sex on remaining teeth in adults: A decomposition analysis.

To identify which social determinants of health explain the gap in the remaining teeth between men and women. A secondary analysis of data from the Chilean National Health Survey (CNHS) 2016-2017 was performed on the number of remaining teeth in adults. The explanatory variables were organized into structural and intermediate social determinants of health according to the WHO framework. The contribution of both groups and the contribution of each individual explanatory variable to the remaining teeth gap was estimated using the Blinder-Oaxaca decomposition analysis. The predicted average number of remaining teeth for men was 23.4 and 21.0 for women, thus a mean difference of 2.4 teeth. 49.8% of the inequality between men and women was due to the different distribution (endowments) of the predictors in the model. Among them, structural determinants of health, namely education level (15.8%) and employment status (17.8%), contributed the most. Intermediate determinants had no relevant contribution to explain the gap. Results revealed that the difference in the mean number of remaining teeth between men and women was mainly explained by two structural determinants: education level and employment status. The lack of explanatory power of intermediate determinants and the large explanatory power of structural determinants means that tackling oral health inequity in Chile requires strong political commitment. The role of intersectoral and intersectional public policies to address gender inequalities in oral health in Chile is discussed.

A long but fruitful journey: From clinical psychoanalysis to public mental health in Chile

AbstractThe authors, both professors of psychiatry, trained as psychoanalysts according to the standards of the International Psychoanalytic Association (IPA), recount 30 years of conceptual and empirical research work for the construction of a model of brief and adaptive psychodynamic psychotherapy applicable at the Primary Health Care level. The many milestones of this journey are reviewed, starting with the difficulties and obstacles encountered when pursuing this task within IPA institutions. Once the authors decided to conduct the task outside the analytic institution, they created two training programs for psychodynamic therapists and a research group in psychotherapy, all of which have attained excellence. This effort gave birth to several institutions that are still in operation, such as the Chilean and Latin American chapters of the Society for Psychotherapy Research, the Chilean Congress of Psychotherapy, the PhD Program in Psychotherapy, and finally the Millennium Institute for Research and Personality (MIDAP). In its 8 years of existence, MIDAP has become a national and Latin American reference center for research in Mental Health, aimed at implementing preventive and psychotherapeutic interventions in vulnerable populations at the primary health care and community level. The article ends with a description of the main components and the final process of the construction of the Protocol of Psychotherapeutic Competences for the Treatment of Depression in Primary Health Care level.

Long-term functional ability trajectories and mental health among older people before and after the COVID-19 pandemic onset in Chile

Objectives Despite the advances in understanding the complex association between functional abilities and mental health in old age, studies have overlooked two important aspects. First, traditionally, research has employed cross-sectional designs, measuring limitations at a single time point. Second, most gerontological studies on this field have been conducted before the COVID-19 pandemic onset. This study aims to explore the association between diverse long-term functional ability trajectories across late adulthood and old age, and older people’s mental health in Chile, before and after the COVID-19 pandemic onset. Methods We use data from the population-representative and longitudinal ‘Chilean Social Protection Survey’, sequence analysis to reconstruct functional ability trajectory types from 2004 to 2018, and bivariate and multivariate analyses to measure their association with depressive symptoms in early 2020 (N = 891) and late 2020 (N = 672). We analyzed four age groups defined by their age at baseline (2004): people aged 46–50, 51–55, 56–60, and 61–65. Results Our findings indicate that erratic or equivocal patterns of functional limitations across time (with people transiting back and forth between low and high levels of limitations) show the worst mental health outcomes, both before and after the pandemic onset. Prevalence of people with depression increased after the COVID-19 onset in most groups, being particularly high among those with previous equivocal functional ability trajectories. Conclusions The relationship between functional ability trajectories and mental health calls for a new paradigm, moving away from age as the main policy guide, and highlighting the need to adopt strategies to improve population-level functional status as an efficient policy to address the challenges of population aging.

One hundred years of health in a demographic, epidemiological and public policy context: the transition of childhood morbidity and its challenges

Chile is in an advanced stage of demographic and epidemiological transition. It is in this scenario that the political, economic and health crisis occurred, with the social outbreak in 2019 and then the COVID-19 pandemic. The mortality of children and adolescents dropped significantly, however, changes in lifestyles and demotivation, associated with long confinement and worsening health of parents and caregivers triggered an epidemic of mental health, developmental and nutritional problems. Pediatricians were forced to reinvent themselves, exposing themselves to stress and burnout. The aim of the manuscript is to describe the demographic, epidemiological and public policy context of child health in Chile in the last century, as a backdrop to dimension the immediate impact of the COVID-19 pandemic. The new health challenges for this age group in the medium and long term are discussed. Some theories, conceptualizations, and relevant milestones of the public health system in Chile are presented. The emergence of "post-pandemic morbidity", such as sedentary lifestyle, food insecurity, screen addiction, identity conflicts, violence, mental health disorders and reemergence of morbidity and mortality due to infectious and contagious diseases is discussed. Professionals responsible for the care of children must redouble their efforts to provide comprehensive care, accompanying families in the new challenges, in order to rehabilitate a healthy childhood.

Health in Chile's Recent Constitutional Process: A Qualitative Thematic Analysis of Civil Proposals.

(1) Background: In response to the recent political crisis in Chile, the "Agreement for Social Peace and the New Constitution'' was approved. We aimed to analyze the health-related civil proposals uploaded to the official website for popular participation in the new constitution in Chile. (2) Methods: We carried out a qualitative thematic analysis of 126 health-related valid proposals. Moreover, we analyzed their link to the Health Goals 2030, established by the Ministry of Health of Chile and to the Sustainable Development Goals (SDGs). (3) Results: Sixteen main categories were reached. In all, they were organized into four main areas: (i) the right to health and the establishment of a universal health system; (ii) effective access to selected healthcare services; (iii) improving health outcomes for all and for the relevant subgroups; and (iv) the social determinants of health, health in all the policies, and community health. We found that these four areas were strongly linked to the Health Goals 2030 for Chile and to the SDGs. (4) Conclusions: Despite the fact that the new constitutional proposal was rejected in September 2022, the civil health-related proposals and the areas of health and healthcare were of interest to the citizens as the request showed a strong demand from the population for participation in matters of health, healthcare, and public health.

Improving the Efficiency of a Public Health Service by Designing Its Innovation Management Structure Based on Data Envelopment Analysis

This paper presents a proposal for Chile's health system innovation structure based on a formal service design approach, including management and process architecture definition. Such structure defines how to allocate innovation resources in the health system to increase its efficiency. It uses data envelopment analysis (DEA) to measure hospitals' efficiency, which also determines the variables that explain such efficiency. Thus, the architecture uses the knowledge about hospitals' efficiency and their determinants to define innovation projects and assign financial resources for them. It also assures their implementation to increase the efficiency of the hospitals. DEA measurements show great improvement potential since only six of 40 hospitals had an efficiency value of 1.0. Some of the projects with the best improvement potential were implemented with very good results, summarized in the paper. The main contribution of this work is to formalize and enlarge the scope of the structural design of health services to generate improved results for users at a lower cost.

Parental educational similarity and inequality implications for infant health in Chile: Evidence from administrative records, 1990–2015

This study expands existing scholarship on the relationship between parental educational similarity and infant health using rich administrative data from Chile covering births that occurred between 1990 and 2015. We test the relationship between parental educational similarity ( homogamy ) or dissimilarity ( heterogamy ) and two measures of infant health, namely low birth weight (LBW) and preterm birth (PB). We show that parental educational homogamy is associated with a reduced probability of low birth weight and preterm birth – particularly at the high end of the educational distribution – and the observed association is only partly driven by selection into homogamous couples, as demonstrated by complementary quasi-experimental analyses conducted on a subsample of matched step-siblings from same mothers but different fathers. We further show that couples where women outrank men in educational attainment ( hypogamy ) exhibit worse birth outcomes relative to their homogamous and hypergamous counterparts. Municipality-level analyses merging external information on female labor force participation (FLFP) prior to childbirth reveal that the association between hypogamy and children’s outcomes is increasingly negative as FLFP increases, highlighting a strong work-life balance tension for highly-educated women who are actively engaged in the labor force. Insights from this study contribute to a better understanding of the inequality debate surrounding the intergenerational transmission of advantage and disadvantage – a topical issue in a country that has recently joined the rank of the world’s wealthiest nations yet maintains extreme levels of socioeconomic inequality. • Chile has recently joined the rank of the world’s wealthiest nations, yet it maintains extreme levels of socio-economic inequality and worsening infant health overtime • We explore whether the educational composition of couples – and their changing nature over time – bears any relationship with infant health using rich birth records from Chile • We leverage quasi-experimental methods to assuage endogeneity concerns related to selection into specific couple types • We find that couples where men and women hold the same level of education exhibit better infant health than couples where men and women hold different levels of education • However, couples where women outrank men in educational attainment exhibit worse birth outcomes relative to their homogamous and hypergamous counterparts • The latter finding is exacerbated in contexts characterized by higher female labor force participation

Sexual and gender minority health in Chile: findings from the 2016-2017 Health Survey.

To expose visibility of the health concerns of sexual and gender minority groups in Chile, as well as to provide a platform to advocate for policies that support the health and well-being of sexual and gender minority people in the country. The health conditions and risk factors of participants identified as sexual and gender minority were compared to those identified as cisgender heterosexual using data from the 2016-2017 National Health Survey. Despite reporting higher self-rated health than heterosexual men, gay men had a higher risk of lifetime diagnosis of sexually transmitted infections. Compared to heterosexual women, the prevalence of depression was higher among bisexual women, who were also less likely to have been tested for HIV. Moreover, transgender participants were more likely to report depression and worse self-rated health than cisgender heterosexual participants. Small sample sizes of sexual and gender minority subgroups might have obscured some differences that would have been observable in larger samples. Despite this, we found statistically significant sexual and/or gender identity differences in several health areas, especially mental, sexual, and overall health.

Adulthood Employment Trajectories and Later Life Mental Health before and after the Onset of the COVID-19 Pandemic.

This life course study has two aims. First, to explore how diverse employment trajectories across adulthood are related to older people's mental health in Chile, a country with no research in this field, and second, to analyze these associations before and after the onset of the COVID-19 pandemic. We use data from the nationally-representative and longitudinal 'Chilean Social Protection Survey' sequence analysis to reconstruct employment trajectory types, and bivariate and multivariate analyses to measure their association with depressive symptoms. Our findings indicate that formal labor force patterns in adulthood show the lowest burden of depressive symptomology before and after the onset of the overwhelming COVID-19 pandemic when controlling for traditional risk factors. We emphasize that policymakers in both the labor market and public health domains must consider the relationship between informal employment pathways in adulthood and poorer mental health in old age. Public policies should improve the conditions and quality of jobs during adulthood and promote more formalization in the labor market to address the high uncertainty involving low social protection, which is strongly associated with severe mental health problems in later life.

State of Mental Health Research of Adolescents and Youth in Chile: An Ontological Analysis.

Knowing the state of mental health research in adolescents and youth can be an important tool for decision-making, especially in contexts of limited resources. The aim of this study is to map the scientific research on adolescent and youth mental health in Chile using an ontological framework. We have mapped the population of research articles on mental health of adolescents and youth in Chile in Scopus, Web of Science, and SciELO databases onto the ontology. The PRISMA reporting guidelines were used to screen the 1688 items based on relevance, duplication, and version. The corpus of 346 articles was coded into the ontology through an iterative process among the seven authors. This ontological mapping shows isolated research efforts that have been carried out in Chile to explain the whole state of mental health in adolescents and youth. There is a lack of coordination between the priorities established by the decision-makers and the researchers. Our results coincide with the need to strengthen mental health research in the country, and to prioritizing those topics that contribute to decision-making based on the needs of the population.

Analysis on Integral, Integrated and Coordinated Health, new looks beyond the disciplines of Health in Chile.

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)The IJIC 20th Anniversary Issue was published in 2021.

State of the Art and Future Applications of Digital Health in Chile

State of the Art and Future Applications of Digital Health in Chile

COVID-19 case fatality risk by age and gender in a high testing setting in Latin America: Chile, March\u2013August 2020

BackgroundEarly severity estimates of coronavirus disease 2019 (COVID-19) are critically needed to assess the potential impact of the ongoing pandemic in different demographic groups. Here we estimate the real-time delay-adjusted case fatality rate across nine age groups by gender in Chile, the country with the highest testing rate for COVID-19 in Latin America.MethodsWe used a publicly available real-time daily series of age-stratified COVID-19 cases and deaths reported by the Ministry of Health in Chile from the beginning of the epidemic in March through August 31, 2020. We used a robust likelihood function and a delay distribution to estimate real-time delay-adjusted case-fatality risk and estimate model parameters using a Monte Carlo Markov Chain in a Bayesian framework.ResultsAs of August 31, 2020, our estimates of the time-delay adjusted case fatality rate (CFR) for men and women are 4.16% [95% Credible Interval (CrI): 4.09–4.24%] and 3.26% (95% CrI: 3.19–3.34%), respectively, while the overall estimate is 3.72% (95% CrI: 3.67–3.78%). Seniors aged 80 years and over have an adjusted CFR of 56.82% (95% CrI: 55.25–58.34%) for men and 41.10% (95% CrI: 40.02–42.26%) for women. Results showed a peak in estimated CFR during the June peak of the epidemic. The peak possibly reflects insufficient laboratory capacity, as illustrated by high test positivity rates (33% positive 7-day average nationally in June), which may have resulted in lower reporting rates.ConclusionsSeverity estimates from COVID-19 in Chile suggest that male seniors, especially among those aged ≥ 70 years, are being disproportionately affected by the pandemic, a finding consistent with other regions. The ongoing pandemic is imposing a high death toll in South America, and Chile has one of the highest reported mortality rates globally thus far. These real-time estimates may help inform public health officials' decisions in the region and underscore the need to implement more effective measures to ameliorate fatality.

Effects of an urban regeneration program on related social determinants of health in Chile: A pre-post intervention study.

Urban regeneration programs, such as "Programa Quiero mi Barrio" (PQMB) that is carried out in neighborhoods with greater deprivation across Chile, can improve health and quality of life in socio-economically deprived neighborhoods. The aim of this study was to analyze the effects of this program on the physical, social, and safety environments of neighborhoods intervened between 2011 and 2018, according to gender and socioeconomic position. Four indices and six sub-indices were constructed to measure physical, social, and safety environments of the neighborhoods. We conducted a pre- and post-intervention analysis with 2095 people using linear models adjusted for repeated measurements. After the intervention, participants had an improved perception of physical, social, and safety environments, as well as the use of spaces, particularly among women and people with higher levels of education. Therefore, the PQMB program is a form of public policy that can improve the quality of life and health of people living in underprivileged areas.

Public health leadership in the times of COVID-19: a comparative case study of three countries

PurposeThe purpose is to understand the role of public leadership during the COVID-19 pandemic and advocate for a more active role of public health professionals in helping manage the crisis.Design/methodology/approachThe authors use the framework developed by Boin et al. (2005) on crisis leadership. The authors focus on three of the core tasks – sense-making, decision-making and meaning-making – that are relevant to explain the role of public leaders during the ongoing crisis. The authors draw from the experience of three countries – Chile, France and the United States – to illustrate how these tasks were exercised with concrete examples.FindingsSeveral examples of the way in which public leaders reacted to the crisis are found in the selected countries. Countries show different responses to the way they assessed and reacted to the COVID-19 as a crisis, the decisions taken to prevent infections and mitigate consequences, and the way they communicate information to the population.Practical implicationsA better understanding public leadership as a key for better crisis management, particularly for designing policy responses to public health crises. Public health leaders need to assume a more active role in the crisis management process, which also implies the emergence of a new class of public health leaders and a more prominent role for public health in the public eye.Originality/valueThe use of examples from three different countries, as well as the focus on the core leadership tasks during an ongoing crisis help not only assessing the crisis management but also extracting lessons for the coming months, as well as future public health emergencies. The three authors have a first-hand experience on the evolution of the crisis in their countries and the environment, since they are currently living and working in public health in Chile, France and the United States.

Debate: Mental health, social crisis and the COVID-19 pandemic in Chile.

Mental health in Chile has been significantly challenged by the beginning of a social crisis in October of 2019 and the COVID‐19 pandemic of 2020. Despite widening of shortage of services, both the burgeoning of Telepsychiatry and a Presidential Initiative to integrate mental health to policy making and services provided by all sectors of government have mitigated the effects of this crisis.

Examen oftalmológico durante el control del niño sano en atención primaria: conocimiento y dificultades de los miembros del equipo de salud

IntroductionThe red reflex examination (RRE) and visual acuity testing (VA) is a mandatory part of the examination during the well-child visits (WCV) in primary health care centres of the public system of health in Chile. The eye examination is aimed at the early detection of severe eye diseases in children, such as retinoblastoma, congenital cataracts, and amblyopia. The knowledge and difficulties experienced by health workers in primary care health centres for evaluating the red reflex during WCV in Chile is unknown. Material and methodsA survey was performed in primary community health centres of XXX Santiago de Chile. ResultsThe WCV were mainly performed by physicians (45.2%) and nurses (35.8%). Only 34% of health workers performed the red reflex test, and 42.3% checked VA during the WCV. The main reasons for not doing it include the lack of direct ophthalmoscopes and VA charts (55.2% and 43.9%, respectively) at their centres, and not having the knowledge or skills (29.3% and 22%, respectively) to properly perform these clinical tests. ConclusionIn this series, the eye examination of children attending WCV was unfrequently performed. A better implementation of the health centres and training of the health workers are needed in order to improve the access and quality of the paediatric eye examination in primary health care institutions in Chile.