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1.

Impacto económico del tabaquismo en los sistemas de salud de América Latina: un estudio en siete países y su extrapolación a nivel regional/ Financial impact of smoking on health systems in Latin America: A study of seven countries and extrapolation to the regional level

Pichon-Riviere, Andrés; Bardach, Ariel; Augustovski, Federico; Alcaraz, Andrea; Reynales-Shigematsu, Luz Myriam; Pinto, Márcia Teixeira; Castillo-Riquelme, Marianela; Torres, Esperanza Peña; Osorio, Diana Isabel; Huayanay, Leandro; Munarriz, César Loza; de Miera-Juárez, Belén Sáenz; Gallegos-Rivero, Verónica; Puente, Catherine De La; Navia-Bueno, María del Pilar; Caporale, Joaquín
| Idioma(s): Español
RESUMEN Objetivo Estimar los costos médicos directos atribuibles al tabaquismo en los sistemas de salud de América Latina. Métodos Se utilizó un modelo de microsimulación para cuantificar el impacto económico en enfermedad cardiovascular y cerebrovascular, enfermedad pulmonar obstructiva crónica (EPOC), neumonía, cáncer de pulmón y otras nueve neoplasias. Se realizó una búsqueda sistemática de datos epidemiológicos y de costos de los eventos. El modelo se calibró y validó para Argentina, Bolivia, Brasil, Chile, Colombia, México y Perú, países que representan el 78% de la población de América Latina; luego se extrapolaron los resultados a nivel regional. Resultados Cada año el tabaquismo es responsable de 33 576 millones de dólares en costos directos para el sistema de salud. Esto equivale a 0,7% del producto interno bruto (PIB) de la región y a 8,3% del presupuesto sanitario. La enfermedad cardiovascular, la EPOC y el cáncer fueron responsables de 30,3%, 26,9% y 23,7% de este gasto, respectivamente. El costo atribuible al tabaquismo varió entre 0,4% (México y Perú) y 0,9% (Chile) del PIB y entre 5,2% (Brasil) y 12,7% (Bolivia) del gasto en salud. En la región, la recaudación impositiva por la venta de cigarrillos apenas cubre 37% del gasto sanitario atribuible al tabaquismo (8,1% en Bolivia y 67,3% en Argentina). Conclusiones El tabaquismo es responsable de una importante proporción del gasto sanitario en América Latina, y la recaudación impositiva por la venta de cigarrillos está lejos de llegar a cubrirlo. La profundización de medidas como el aumento de impuestos al tabaco debería ser seriamente considerada por los países de la región. ABSTRACT Objective Estimate smoking-attributable direct medical costs in Latin American health systems. Methods A microsimulation model was used to quantify financial impact of cardiovascular and cerebrovascular disease, chronic obstructive pulmonary disease (COPD), pneumonia, lung cancer, and nine other neoplasms. A systematic search for epidemiological data and event costs was carried out. The model was calibrated and validated for Argentina, Bolivia, Brazil, Chile, Colombia, Mexico, and Peru, countries that account for 78% of Latin America’s population; the results were then extrapolated to the regional level. Results Every year, smoking is responsible for 33 576 billion dollars in direct costs to health systems. This amounts to 0.7% of the region’s gross domestic product (GDP) and 8.3% of its health budget. Cardiovascular disease, COPD, and cancer were responsible for 30.3%, 26.9%, and 23.7% of these expenditures, respectively. Smoking-attributable costs ranged from 0.4% (Mexico and Peru) to 0.9% (Chile) of GDP and from 5.2% (Brazil) to 12.7% (Bolivia) of health expenditures. In the region, tax revenues from cigarette sales barely cover 37% of smoking-attributable health expenditures (8.1% in Bolivia and 67.3% in Argentina). Conclusions Smoking is responsible for a significant proportion of health spending in Latin America, and tax revenues from cigarette sales are far from covering it. The region’s countries should seriously consider stronger measures, such as an increase in tobacco taxes.
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2.

Hiperuricemia y componentes del síndrome metabólico en niños y adolescentes obesos./ [Hyperuricaemia and metabolic syndrome in obese children and adolescents].

Castillo-Durán, Carlos; Sepúlveda A, Cecilia; Espinoza G, Aníbal; Rebollo G, María Jesús; Le Roy O, Catalina
| Idioma(s): Español
INTRODUCTION: Hyperuricaemia has been suggested as an additional metabolic factor in adult obese patients, but it has not been sufficiently studied in paediatric. OBJECTIVES: To assess the relationship between serum uric acid levels (SUAL) with the level of general and visceral obesity, and other biochemical parameters in children and adolescents of Santiago, Chile. SUBJECTS AND METHOD: A cross sectional study was conducted on 770 children and adolescents (ages: 6-15 y.) from a public school in Santiago, Chile, of whom 227 (29%) were obese (BMI>2 SD, WHO growth standards). Ninety subjects were randomly selected and 77 with no other chronic disease (41 males) accepted to participate. Data was collected on weight, stature, abdominal circumference (AC), visceral adiposity using ultrasound, and other biochemical measurements including fasting glucose, insulin, serum lipids, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and SUAL. RESULTS: The mean SUAL was 0.200±0.065 mmol/L, and was increased in children with hyperinsulinism (adjusted by age: 0.221±0.075 vs. 0.183±0.054 mmol/L; P<.01), with no significant differences according to HOMA. Differences were also found between children with ALT>or<26 U/mL: 0.238±0.070 vs. 0.178±0.054 mmol/L, P<.001. The logistic regression showed the increased SUAL was only associated with increased ALT. No significant differences were found in general or visceral adiposity measurements or fatty liver. CONCLUSIONS: Children and adolescents from Santiago, Chile have higher uric acid serum uric acid levels as well as an association with increased ALT and insulin. It is demonstrated in this study that uric acid should be measured in obese children and adolescents, and in their follow up.
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3.

Iron assimilation and siderophore production by Vibrio ordalii strains isolated from diseased Atlantic salmon Salmo salar in Chile.

Ruiz, Pamela; Balado, Miguel; Toranzo, Alicia E; Poblete-Morales, Matías; Lemos, Manuel L; Avendaño-Herrera, Ruben
| Idioma(s): Inglés
Vibrio ordalii is the causative agent of vibriosis in several cultured salmonid species worldwide. Despite its impact on aquaculture, relatively little information is available about its virulence factors. The present study demonstrates for the first time that V. ordalii possesses different systems of iron acquisition, one involving siderophore synthesis and another one that uses direct binding of heme to use iron. Using 6 strains of V. ordalii from Atlantic salmon Salmo salar and the V. ordalii type strain, we could demonstrate that all strains could grow in presence of the chelating agent 2,2'-dipyridyl and produced siderophores in solid and liquid media. Cross-feeding assays among V. ordalii strains evidenced variability in the siderophores produced. Bioassays and PCR data suggest that V. ordalii could produce a siderophore with a structure similar to piscibactin, although the production of a second siderophore in certain strains cannot be discarded. Furthermore, all strains were able to use hemin and hemoglobin as the only iron sources, although the cell yield was higher when using hemoglobin. A hemin-binding assay indicated the presence of constitutive heme-binding molecules at the cell surface of V. ordalii. Virulence tests using rainbow trout as a model of infection revealed a clear relationship between iron-uptake ability and pathogenicity in V. ordalii.
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4.

Sarampión: la enfermedad, epidemiología, historia y los programas de vacunación en Chile/ Measles: the disease, epidemiology, history and vaccination programs in Chile

Delpiano, Luis; Toro, Jorge; Astroza, Leonor
| Idioma(s): Español
Measles, one of most important inmuno-preventable diseases, remains as a worldwide concern issue with an important morbidity and mortality. Particularly in the America region declared free of measles in 2010 by WHO, they still appear imported cases that origin outbreaks of variable magnitude in susceptible subjects usually none vaccinated which is the current situation in Santiago, the capital city of Chile. In this review we present characteristics of the etiological agent, the disease, epidemiological aspects with national historical focus, impact of immunization programs and outbreaks in Chile, in order to contribute to knowledge and management of this always present public health problem. Sarampión una de las más importantes enfermedades inmuno-prevenibles, se mantiene como foco de preocupación en el mundo, con elevada carga de morbilidad y mortalidad. Particularmente en América, región declarada libre de esta enfermedad en 2010 por la OMS, se siguen identificando casos importados que originan brotes de diferente magnitud en personas susceptibles, habitualmente no vacunados, situación recientemente diagnosticada en Santiago, ciudad capital de Chile. En esta revisión, se presenta características del agente etiológico, de la enfermedad, aspectos epidemiológicos con foco en datos históricos nacionales, el impacto de los programas de vacunación, la ocurrencia de brotes en Chile, para contribuir al conocimiento y enfrentamiento de este siempre presente problema de salud pública.
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5.

Estudio exploratorio del impacto del alfabetismo funcional sobre conductas sanitarias deficientes a nivel poblacional/ An exploratory study of functional literacy on health care behaviors in Chile

Russo, Moisés
| Idioma(s): Español
Background: Health Literacy is the set of skills that constitute the ability to perform reading and numerical tasks to function in the health care environment. People with functional illiteracy are unable to understand written documents and therefore sanitary information. Aim: To explore the effects of functional illiteracy on personal health care behaviors in Chile. Material and Methods: Using the Chilean Social Characterization Survey of 2006, respondents were separated into those that had read a book in the last year and those that had not as a proxy variable for functional literacy. Using econometric models, the impact of this variable on having a Papanicolaou (PAP) smear done and consulting in primary health clinics rather than in emergency services, was explored. Results: The survey is nationally representative, and 76% interviewees declared not having read a book in the last year. Probability of having a PAP smear done during the last three years was higher among women who had read a book with an OR of 1.19 (1.15-1.25). Likewise, the probability of consulting in emergency services rather than in primary health clinics was lower among those who had read a book with an OR of 0.85 (0.80-0.91). Conclusions: This study provides evidence of possible impacts of low functional literacy in health care behaviors in the Chilean population.
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6.

El Sistema de Salud de Chile: una tarea pendiente/ The Chilean Health Care System: The task ahead

Goic G, Alejandro
| Idioma(s): Español
The most important event in Chilean public health in the XXth Century was the creation of the National Health Service (NHS), in 1952. Systematic public policies for the promotion of health, disease prevention, medical care, and rehabilitation were implemented, while a number of more specific programs were introduced, such as those on infant malnutrition, complementary infant feeding, medical control of pregnant women and healthy infants, infant and adult vaccination, and essential sanitation services. In 1981, a parallel private health care system was introduced in the form of medical care financial institutions, which today cover 15% of the population, as contrasted with the public system, which covers about 80%. From 1952 to 2014, public health care policies made possible a remarkable improvement in Chile s health indexes: downward trends in infant mortality rate (from 117.8 to 7.2 x 1,000 live births), maternal mortality (from 276 to 18.5 x 100,000), undernourished children < 5 years old (from 63% to 0.5%); and upward trends in life expectancy at birth (from 50 to 79,8 years), professional hospital care of births (from 35% to 99.8%), access to drinking water (from 52% to 99%), and access to sanitary sewer (from 21% to 98.9%). This went hand in hand with an improvement in economic and social indexes: per capita income at purchasing power parity increased from US$ 3,827 to US$ 20,894 and poverty decreased from 60% to 14.4% of the population. Related indexes such as illiteracy, average schooling, and years of primary school education, were significantly improved as well. Nevertheless, compared with OECD countries, Chile has a relatively low public investment in health (45.7% of total national investment), a deficit in the number of physicians (1.7 x 1,000 inhabitants) and nurses (4.8 x 1,000), in the number of hospital beds (2.1 x 1,000), and in the availability of generic drugs in the market (30%). Chile and the USA are the two OECD countries with the lowest public investment in health. A generalized dissatisfaction with the current Chilean health care model and the need of the vast majority of the population for timely access to acceptable quality medical care are powerful arguments which point to the need for a universal public health care system. The significant increase in public expenditure on health care which such a system would demand requires a sustainable growth of the Chilean economy.
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7.

Indicadores de fragilidad en adultos mayores del sistema público de salud de la ciudad de Antofagasta/ Rates of frailty among older people ascribed to chilean primary care clinics

Tapia P, Catalina; Varela V, Héctor; Valdivia-Rojas, Yenny; Carmona G, Andrés; Jorquera C, Mónica; Iturra M, Verónica
| Idioma(s): Español
Background: Frailty is not universal among older people but increases the risk of dependence. Aim: To assess frailty among older people and its relationship with biological, psychological and social factors. Material and Methods: Seven hundred fifty four older people aged 73 ± 6 years (61% females), attending a public primary care were assessed. Frailty was defined according to Fried criteria that considers inexplicable weight loss, tiredness, muscle weakness and lack of physical activity. Results: Absence of frailty, pre-frailty and frailty was found in 26, 69 and 5% of participants, respectively. Significant differences between frailty groups were observed for age, gender, years of studies, minimental and self-efficacy scores. Among participants defined as being in a pre-frail condition, 59% were non-disabled without risk and 41% non-disabled in risk, according to the functional assessment for older people used in Chilean primary care clinics. Conclusions: Frailty among older people is associated with increasing age, education, cognitive status and self-efficacy.
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8.

Cuantificación económica de los beneficios en salud asociados a la reducción de la contaminación por MP10 en Concepción Metropolitano, Chile/ Health and economic benefits of reducing 10 µm particulate matter (PM10) in Metropolitan Area of Concepción, Chile

Mardones, Cristian; Saavedra, Andrés; Jiménez, Jorge
| Idioma(s): Español
Background: Several international studies show the effects of PM10 pollution on health but specific analyses for many cities in Chile are lacking. Aim: To relate PM10 concentrations to effects with population health and quantify the economic benefits of its reduction in Concepción Metropolitan Area. Material and Methods: Poisson regression and generalized additive models were used to analyze the short-term effects of PM10 on mortality and morbidity, controlling for lags, seasonal, trend and weather variables. The damage function method to determine the economic impact of pollution reduction was used. Results: The selected concentration-response (C-R) coefficients showed that PM10 concentrations had effects on hospital admissions with a two days lag for respiratory diseases in children under 15 years of age and with a one day lag for asthma in patients over 64 years. The effects on premature mortality had a six days lag. The decrease in 1 µg/m³ of PM10 concentration would generate benefits ranging from 1,025.8 to 32,490.9 million of Chilean pesos per year, with a confidence level of 95%, according the estimation based on concentration-response coefficients and their economic cost. Conclusions: Reduction of PM10 would have important health and economic benefits.
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9.

Perfiles de egreso de las carreras de Medicina en Chile/ Professional profiles of graduates from Chilean Faculties of Medicine

Parada, Mario; Romero, María I; Moraga, Fabián
| Idioma(s): Español
Background: The professional profile of health care professionals should incorporate recommendations of international agencies and adapt to the local conditions of each country. Aim: To conduct a qualitative analysis of Medical Graduate Profiles of universities grouped in the Chilean Association of Medicine Faculties (ASOFAMECH), characterizing its Social Focus, Humanist Approach, Social and Communication Skills. Material and Methods: Documentary analysis of profiles published on the respective web pages, using Atlas Ti software, establishing emerging categories and subcategories. These profiles were compared with the recommendations of the Pan-American Health Organization. Results: Data in Social Focus suggests that although community issues are a common element, the work in primary health and health promotion are rarely included. The Humanist Approach is addressed more commonly than the Social Focus, emphasizing humanization of care, ethical and religious values. Although, social and communication skills are scarcely acknowledged, those mentioned are teamwork and leadership role. Conclusions: There is a marked heterogeneity in the information declared and universities have not fully incorporated the recommendations of international organizations.
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10.

Determinantes sociales y conductuales en salud nutricional: evidencia para Chile/ Social and behavioral determinants on nutritional health: evidence for Chile

Caro S, Juan Carlos
| Idioma(s): Español
Due to the nutritional transition in the last decades, the risk factors linked to food nutrition are in the spotlight of public policy and reduction of their prevalence is a key goal in the public health promotion strategies involving food security and nutrition (FSN). Understanding the factors underlying poor nutrition status is a must in order to execute successful policy interventions in the general population. This paper analyses the impact that social and individual behavior variables have on the risk factors linked to poor nutrition (obesity, high levels of cholesterol, glycaemia and sodium) using data from the National Health Survey 2009-2010 using a Seemingly Unrelated Equations (SUR) approach in order to have a consistent estimation outcome. Findings suggest that variables linked to social environment and individual behavior have a significant impact on the food-related health risk factors, taking account for social, demographic, genetic and economic controls. Unsurprisingly, when people underestimate their nutritional status, it conduces to a greater health risk, explaining up to 6 cms of abdominal girth and 3 points of the BMI index. Also, an insecure neighborhood and weak social networks explain part of the health risk. These results are a starting point to discuss the design of public policy regarding health and nutrition in order to promote the food security especially regarding information and education programs, where there is the possibility to strengthen the social support networks. Los factores de riesgo a la salud asociados con la alimentación son un foco clave en las estrategias de promoción de la salud y de seguridad alimentaria y nutricional en Chile (SAN). Este artículo entrega un análisis de los efectos que variables conductuales y sociales tienen sobre los factores de riesgo asociados a una mala nutrición (obesidad, altos niveles de colesterol, glicemia elevada y altos niveles de sodio), en base a la Encuesta Nacional de Salud 2009-2010 utilizando una estimación por regresiones aparentemente no relacionadas (SUR). Los resultados revelan que las variables asociadas a aspectos conductuales y sociales tienen un impacto significativo en los factores de riesgo de salud alimentaria, controlando por variables demográficas, genéticas y socioeconómicas. Destaca el efecto de la subestimación de las personas respecto a su estado nutricional, que puede explicar hasta 6 cm de circunferencia abdominal y 3 puntos en el IMC. Asimismo, las redes de apoyo social y económico a nivel individual juegan un rol fundamental. Los resultados entregados son un insumo relevante para la discusión sobre los mecanismos que la política pública debiese tener a fin de promover la seguridad alimentaria y nutricional, en particular al diseñar programas de educación e información a la población, donde existe la posibilidad de fortalecer las redes de apoyo existentes.
Resultados  1-10 de 1.323