Health In Chile Research Articles

Dental recommendations in the COVID-19 pandemic: A narrative review

COVID-19 is a world public health problem due to its morbidity and mortality, especially in at-risk groups. The dental environment has a high risk of viral transmission; accordingly, this study aimed to identify recommendations based on the best available evidence for dental care during this pandemic. We performed a search for scientific evidence published since 2002 to March 23th 2020 in electronic databases (MEDLINE/PubMed, EMBASE, Cochrane, and Epistemonikos) and the web pages of the American Dental Association, Centers for Disease Control and Prevention Oral Health, the Ministry of Health in Chile and scientific societies. We included nine published studies. The recommendations were the following: unrestricted use of personal protection elements, use of extraoral radiographic techniques, use of mouth rinses with 1% hydrogen peroxide or 0.2% iodine povidone, a four-hand technique with ongoing aspiration and the use of absorbable sutures. Furthermore, there is a consensus that non-urgent treatments should be postponed during periods of community transmission. Dental practitioners are exposed to a high risk of cross-infection, meaning they must implement recommendations based on the best available evidence to preserve the health of team members and the population they are caring for.

Living in the midst of miasmas: The social issue of Chile between 1880 and 1920

The social issue in Chile stems from an accumulation of social problems resulting from the migratory movements of the countryside-city and mining areas. The cities did not have the hygienic conditions necessary to receive migrants, which caused housing and health problems within the population. To analyze the problems of housing, hygiene, and health in Chile between 1880-1920. We conduct a qualitative, analytical, and interpretive study using primary sources for the categories of analysis around housing, hygiene, and health of the following cities in Chile: Santiago, Valparaíso, Concepción and Chillán. The economic modernization led to the development of public works in the main cities of Chile, which also experienced a demographic phenomenon known as field-city migration, with urban growth never before seen. In the cities, there were problems of housing, hygiene, and health for the popular urban sectors. The State passed laws to regulate the conditions of the conventillos and public spaces to mitigate diseases and vices of the population.

Disability-free life expectancy and life expectancy in good self-rated health in Chile: Gender differences and compression of morbidity between 2009 and 2016.

BackgroundChile has one of the highest life expectancies at 60 years in South America. This study was aimed to determine healthy life expectancies among Chilean older people, according to self-rated health and disability, and to explore gender differences.MethodsData from the National Survey of Health (2009 and 2016) were used to estimate prevalence of less than good self-rated health and disability among people aged 60 years and above. Health expectancies were calculated with the Sullivan method.ResultsIn both years, women expected to live a lower proportion of their life expectancy in good self-rated health (54.5% [95% CI 50.0–58.8] for men and 37.6% [95% CI 34.3–40.8] for women in 2009; 46.1% [95% CI 42.6–49.7] for men and 38.5% [95% CI 35.6–41.4] for women in 2016). Life expectancy in less than good self-rated health increased for men (9.4 years [95% CI 8.4–10.3] in 2009; 11.5 years [95% CI 10.7–12.2]). Women expected to live a lower proportion of their remaining life without disabilities (65.3% [95% CI 61.2–69.4] for men and 44.9% [95% CI 41.9–47.9] for women in 2009; 71.9% [95% CI 68.7–75.0] for men and 61.1% [95% CI 58.5–63.8] for women in 2016). In 2016, disability-free life expectancy increased among women, but they still had a higher life expectancy with mild disability (2.8 years [95% CI 2.3–3.4] for men and 6.0 years [95% CI 5.4–6.7] for women).ConclusionsWomen expected to spend more years in less than good self-rated health and disabled. There was an expansion of life expectancy in less than good SRH among men and a compression of disability in both sexes. The high proportion of years expected to be lived in less than good self-rated health and gender differences in disability-free life expectancy of older adults should be addressed by public health policies in Chile.

Práctica de profesionales de salud brindando intervenciones en apego con perspectiva comunitaria: “Encuentros y desencuentros”

La política pública de salud mental en Chile tiene una orientación comunitaria, sin embargo, esto no parece darse a nivel de las intervenciones en el tema del apego. Desde esta perspectiva la investigación buscó, por medio de metodologías cualitativas, identificar los conceptos teóricos y técnicos que los profesionales de salud articulan en sus trabajos y con los cuales se puedan diseñar y ejecutar intervenciones en el área del apego que estén a favor del establecimiento de alianzas con las comunidades. Concluyendo así que sus prácticas aún presentan una tensión entre modelo custodial y el comunitario, pero que sus experiencias las han llevado a ampliar las miradas a nuevas formas de crianza y problematización de ésta, donde la comunidad es un agente angular de la crianza de los niños y niñas de un territorio.

Extension of working life and implications for occupational health in Chile

Chile has one of the highest effective retirement ages among the countries of the Organisation for Economic Cooperation and Development (OECD). This could be associated with retirement at older ages, as low pensions encourage people to remain active in the workforce.People undergo several changes due to the passage of time, and they have an impact on their health from a biological, psychological and social point of view. However, there is not enough knowledge on how these changes impact and interact with working, employment and health conditions of workers as they get older.This article aims to contribute to the critical debate on the extension of working life and its implications for occupational health. Some reflections in this regard are proposed based on a review of the most recent relevant literature.

Health care reform, adverse selection and health insurance choice

This paper builds and estimates a dynamic choice model to examine the impact on health insurance selection of Chile's GES health care reform. This program provides guarantees in coverage and benefits to several health conditions in the context of a market where public and private health insurers co-exist. Structural differences in premiums, benefits and out-of-pocket medical costs across systems may have caused adverse selection problems. Restrictions on pre-existing conditions in the private system mean that insurance selection could be a dynamic process in which current choices can affect future health insurance selection. In fact, estimation results suggest there is willingness to pay to have access to private insurance to those affected by pre-existing conditions. The GES reform may have also altered health insurance choices, as it seems to have significantly reduced out-of-pocket medical costs to people affected by the covered illnesses. Simulations show an increase in participation in the public system of about 3.8 percentage points due to the reform, which is stronger for younger, healthier and more educated individuals. Therefore, the reform may have eased adverse selection problems in Chile's health care system by drawing low-risk individuals towards the public system.

Can preterm birth be prevented from ascending bacterial infection and its adverse results in the public hospitals of Chile?

Preterm birth (PB) is the main contributor to the perinatal morbidity/mortality. In spite of the knowledge of the risk factors and the introduction of medical interventions intended to prevent PB, its frequency has increased. Ascending bacterial infection (ABI) is the obstetric condition most frequently associated to PB causing an important adverse perinatal outcome in a public hospital in Chile. This review shows the association between PB and ABI, analyzes the physiopathology and immunology of vaginal infections in the susceptible pregnant woman., as well as their application in this group of effective measures demonstrated by evidence, such as routine control, treatment of genitourinary tract infections (GTI), prophylactic or therapeutic cerclage, use of probiotics, use of vaginal progesterone, metabolic control of diabetes mellitus and weight of the obese woman. Treatment GTI together with the use of medical interventions that improve the vaginal immunity in the risk population allow to predict a reduction of PB by ABI and of its immediate consequences, long term sequels and high associated costs, with the consequent benefit of the public health in Chile.

National action plan for the emergence of invasive meningococcal disease in Chile, 2012-2013

Invasive meningococcal disease is challenging for public health, mainly when it manifests with sudden changes in incidence, serogroups and hypervirulent clones that spread in the population, causing great alarm due to its sequelae and often fatal course, a situation that occurred in Chile, starting at week 26 of the year 2012. To face this scenario, an organization of multidisciplinary teams was required, called W-135 Action Plan in Chile, which included sanitary alerts, education, reinforcement of the epidemiological surveillance of suspicious cases, immediate diagnosis through state-of-the-art techniques, blocking of contacts, communication plans, and, from the 42nd week, ON the vaccination campaign was started for children aged from 9-months-old to less than 5 years of age. The vaccination strategy had a great impact on the decrease in incidence (1.3 to 0.1/100,000) and case fatality rate in the vaccinated population (23% to 0%), with a high safety profile, leading to its subsequent inclusion in the national immunization program. The ability to develop molecular, clinical and epidemiological studies allowed us to better understand the situation, supporting public health policy decisions for its control. The W-135 Action Plan implemented by the Ministry of Health in Chile, to manage the outbreak of meningococcal disease by Neisseria meningitidis serogroup W, demonstrated that the coordination of these efforts, through an organized Action Plan, allows the implementation of campaigns at the national level achieving high coverage of risk populations in short periods of time, generating a positive impact on the health of the population.

Evolving child and adolescent mental health and development programs in Chile.

ABSTRACTThis analysis reviews the situation of child and adolescent mental health in Chile, organizational determinants, and the initiatives and interventions implemented to enhance child development despite the country’s inequities. Progressive development of national mental health plans is covered, from the country’s first plan in 2000, to growing the number of mental health professionals and the training they receive, such as MhGAP, to the implementation of “Chile Crece Contigo,” whose preliminary evaluations are starting to show some effectiveness. However, the World Health Organization reports that progress in complying with the United Nations Convention of Children’s Rights is insufficient. A set off legislative initiatives on behalf of children and adolescents have been passed, while others are being discussed in Parliament. There is much to be done in the nation as a whole and within its health system to ensure improved child and adolescent mental health and wellbeing. More research into child and adolescent mental health should be undertaken. Adequate funding and policymaking are also crucial to giving priority to child and adolescent mental health in Chile.

Natural attributes of Chilean honeys modified by the presence of neonicotinoids residues

Honeys in Chile are produced from native and endemic plant species that, due to phenolic compounds, present beneficial biological attributes. However, certain undesirable pollutants can exist in honeys from beehives located near agricultural crops or commercial industries. Neonicotinoids are a widely used pesticide group in farming, despite acute, negative effects to bee health. Indeed, neonicotinoids are associated with colony collapse disorder, one of the main causes for increased death rates in bee populations. Declining bee health in Chile may consequently be related to neonicotinoids exposure. To assess this threat, honey samples collected from different regions in Chile were analyzed to quantify phenolic contents, antioxidant activity, and the presence of four neonicotinoids (i.e., thiamethoxam, thiacloprid, acetamiprid, and imidacloprid). Pesticide-free honey samples were also fortified with three concentrations of the four neonicotinoids to evaluate changes in the chemical properties of honey. Total phenol contents decreased and antioxidant activity increased in relation to the assessed fortification concentrations. Since the agricultural use of neonicotinoids has been related to those negatives damages for bee health, in Chile, beehives should be strategically located to prevent the contamination of honeys with neonicotinoid pesticides.

Out-of-Pocket Expenditures in Health and Medications in Chile: Comparative Analysis Between 1997, 2007, and 2012

Out-of-pocket spent (OPS) of health services are considered inefficient and are a consequence of inequalities in financing and access. The main objective of this study was to compare OPS on health and medicine, including catastrophic expenditure, overall and by quintiles and deciles, for the great Santiago city in the periods 1997, 2007 and 2012. Cross-sectional study based on household budget surveys 1997, 2007 and 2012. OPS on health and medicine for households of the great Santiago was estimated overall and for different quintiles and deciles. In addition, the probability of incurring in catastrophic due to health and drug expenditure were also estimated. OPS showed a progressive increase in the three periods. Drug spending showed a decrease concentrated in the lower deciles and an increase in top deciles of expenditure. Catastrophic drug expenditure decreased progressively. By observing the catastrophic drug spending by deciles were the three richest deciles which showed a large increase between 2007 and 2012. OPS on health remained high between 2007 and 2012, despite presenting slight decreases in some quintiles and deciles. However, drug coverage improved over time. This study demonstrates that improvements are needed in the financial protection mechanisms on health in Chile, especially for poorer quintiles and deciles.

Social Inequality and Mental Health in Chile, Ecuador, and Colombia

The results of a comparative study of social inequality and mental health show that Chile and Colombia, which have enormous social gaps despite their economic growth, are characterized by poor mental health indicators and social discontent, while the better equity indicators in Ecuador are not clearly linked to mental health. The concept of social defeat is suggested as a mediator between social inequality and individual and collective mental health, and participation and empowerment are suggested as ways of improving social well-being. Los resultados de un estudio comparativo de desigualdad social y salud mental muestran que Chile y Colombia, que tienen enormes brechas sociales a pesar de su crecimiento económico, se caracterizan por indicadores de salud mental deficientes y descontento social, mientras que los mejores indicadores de equidad en Ecuador no están claramente vinculados a la salud mental. El concepto de derrota social se sugiere como un mediador entre la desigualdad social y la salud mental individual y colectiva, y la participación y el empoderamiento se sugieren como formas de mejorar el bienestar social.

Orígenes de la Asociación Médica de Chile: una mirada crítica

The origin of the institutionalism of health in Chile and the intense debates which took place within the medical association, constitute the main topic of the text by Carlos Molina. The author offers a critical analysis of contradictions of a profession which began asking itself about the question of the social role of medicine in a time of profound social changes and economic crisis. Physicians, as profesionals and intelectual elites, could not keep themselves away from political struggles, and had to offer answers in front of social crisis. The origin of the vision of the functional aspects of technical-health, which ended with the creation of the SNS (1952) and lasted until 1973, is the result of this intense period of agitation within the different professional associations.

Implementation of Interventions for the Control of Typhoid Fever in Low- and Middle-Income Countries.

.Past research has focused on typhoid fever surveillance with little attention to implementation methods or effectiveness of control interventions. This study purposefully sampled key informants working in public health in Chile, India, Pakistan, Bangladesh, Thailand, Vietnam, South Africa, and Nigeria to 1) scope typhoid-relevant interventions implemented between 1990 and 2015 and 2) explore contextual factors perceived to be associated with their implementation, based on the Consolidated Framework for Implementation Research (CFIR). We used a mixed methods design and collected quantitative data (CFIR questionnaire) and qualitative data (interviews with 34 public health experts). Interview data were analyzed using a deductive qualitative content analysis and summary descriptive statistics are provided for the CFIR data. Despite relatively few typhoid-specific interventions reportedly implemented in these countries, interventions for diarrheal disease control and regulations for food safety and food handlers were common. Most countries implemented agricultural and sewage treatment practices, yet few addressed the control of antibiotic medication. Several contextual factors were perceived to have influenced the implementation of typhoid interventions, either as enablers (e.g., economic development) or barriers (e.g., limited resources and habitual behaviors). Consolidated Framework for Implementation Research factors rated as important in the implementation of typhoid interventions were remarkably consistent across countries. The findings provide a snapshot of typhoid-relevant interventions implemented over 25 years and highlight factors associated with implementation success from the perspective of a sample of key informants. These findings can inform systematic investigations of the implementation of typhoid control interventions and contribute to a better understanding of the direct effects of implementation efforts.

Network integration and care coordination: the case of Chile's health system.

The article analyzes the implementation of integrated healthcare networks (RISS) and the strategies for care coordination by PHC in the Chilean public health system. Semi-structured interviews were conducted with policymakers from the public health system and academics, complemented by documentary analysis and bibliographic review. The country stands out for the institutionalization of care coordination instruments widely recognized, such as referral maps, demand manager physician, electronic records and, mainly, definition of protocols, under the strong leadership of the Ministry of Health and conduction by the Servicios de Salud managers, regional space for the construction of RISS. However, segmentation and fragmentation's degrees within the public subsystem were identified, with the maintenance of free-choice for specialized medical appointment and double waiting lists - one for procedures with explicit access guarantees and another for others cases. The Chilean experience demonstrates the need for a greater role for PHC so it will be able to take on the leadership of RISS. In the country, the network seems to orbit around large and powerful hospitals. Elements of a broader context of the health system also condition advances and impasses in the development of the analyzed strategies.

Inequality of opportunity in health: evidence from Chile.

ABSTRACTOBJECTIVE To assess the possible presence of inequality of opportunities in the health status of Chileans, according to sociodemographic circumstances.METHODS Self-rated health data were used from the Chilean National Health Survey of 2010 to test the hypothesis of strong and weak equality of opportunities in the health status of the Chilean population. These hypotheses were tested using nonparametric techniques and second-order stochastic dominance criteria.RESULTS Robust empirical evidence was obtained, which indicate that the education level of the mother, household socioeconomic status, sex, zone, and region of residence determine opportunities to achieve good health in Chile.CONCLUSIONS Better health status was identified for Chilean adults whenever their mothers had a higher education level, their household income was higher, they were men, or lived in urban areas. The region of residence also affects opportunities to achieve good health in Chile.

Investigación y política en salud mental infanto-juvenil en Chile. Revisión sistemática, 2000-2015

The Health Objectives 2011-2020 recognize the usefulness of health research in the decision-making process through four strategies: formulating priorities, encouraging research, developing the research capabilities of the system and promoting knowledge transfer. To this end, WHO proposes, among others, to make a comprehensive synthesis of the scientific evidence that allows to see the knowledge gaps. Thus, the objective of this paper was to analyze the gap between academic production on child and adolescent mental health in Chile and the governmental agenda in health and mental health, between 2000-2015. The methodology followed the recommendations of the Prisma Declaration and added 160 indexed articles, which examine the Chilean population under the age of 29; descriptive statistics and content analysis were applied. The results show important difficulties in science that make it difficult to prioritize the child and adolescent mental health on the governmental agenda, including the predominance of the risk factors approach and the absence of concrete solutions related to the policy of the country. The conclusions aim to modify the use of scientific knowledge, abandoning the rational and linear conceptions that do not consider the complexity of the political process of construction of the public problems.

Investigación y política en salud mental infanto-juvenil en Chile. Revisión sistemática, 2000-2015

Los Objetivos sanitarios 2011-2020 reconocen la utilidad de la investigación en salud en la toma de decisiones de política pública a través de cuatro estrategias: formular prioridades, incentivar la investigación, desarrollar las capacidades investigativas del sistema y promover la transferencia del conocimiento. Con este propósito, la OMS propone, entre otros, realizar una síntesis amplia de la evidencia científica que permita conocer los vacíos del conocimiento. Así, el objetivo de esta investigación fue analizar la brecha entre la producción académica en salud mental infanto juvenil y la agenda gubernamental en salud y salud mental, entre 2000-2015. La metodología siguió las recomendaciones de la Declaración Prisma y sumó 160 artículos indexados producidos en población chilena menor de 29 años; se aplicó estadística descriptiva y análisis de contenido. Los resultados evidencian dificultades importantes en la ciencia que dificultan la priorización de la salud mental infanto-juvenil en la agenda gubernamental, entre las cuales, se incluye el predominio del enfoque de los factores de riesgo y la ausencia de soluciones concretas vinculadas a la realidad socio-política del país. Las conclusiones apuntan a modificar el uso del conocimiento científico abandonando las concepciones lineales y racionales que no consideran la complejidad del proceso político de construcción de los problemas públicos.

[ign]Complementary/alternative medicine in adolescents with attention deficit hyperactivity disorder and mood disorders

Review the available evidence regarding the use of CAM in adolescents with the attention deficit hyperactivity syndrome (ADHD) and mood disorders. A review of the related literature about this topic on PubMed, focus on the last 10 years and using as a keywords Complementary/Alternative Medicine/Therapies, Attention deficit disorder with hyperactivity, Mood disorders, and Children/Adolescents. The revision was also complemented with other sources of information. Globally there has been a progressive increase in publications in relation to the CAM. However, not all studies follow a good methodology and the majority of the studies in adolescents show inconclusive results. The ADHD studies have shown benefits when using omega 3 fatty acids. Regarding other CAM and ADHD, the evidence does not show any favorable results beyond placebo. Though some of these studies have methodological mistakes or lack of enough studies, making it impossible to have conclusive. In mood disorders, there are several promising therapies, such as: physical exercise, light therapy, St. John’s Wort and some kinds of meditation like Mindfulness. In Chile, there are still no studies in this age group, which makes important the development of a line of research in this area.

Psychiatry and occupational diseases act in Chile: historical and critical review of a complex relationship

The Work Accidents and Occupational Diseases Act exists in Chile since 1968. It uses a single model for the understanding and management of both somatic diseases like silicosis and psychiatric disorders. During the last decade in Chile, the consultation rates due to psychiatric conditions of probable labor origin has rose over 1,000%, a factor that underscored the deficiencies of this model. The aim of this paper is to analyze the consequences of the application of this act in the psychiatric field for almost 50 years after its promulgation. This article contains an historical overview and an epistemological debate based on the authors’ experience dealing with clinical and administrative work both in occupational psychiatry departments and in regulatory entities. The development of occupational mental health in Chile is examined as part of an historical process that initially did not consider the relationship between work and mental suffering as relevant. The application of a single causality model in psychiatry, as well as the effects of building a psychiatric nosology upon legal rather than medical criteria is contested.