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1.

Implementación de la vacunación contra el virus papiloma humano en Chile: una mirada desde los determinantes sociales de la salud "ingreso" y "género"/ HPV vaccine implementation in Chile: an appraisal from the social determinants of health model

Fernández González, Loreto
| Idioma(s): Español
Cervical cancer is the fourth most common neoplasm in women worldwide and its incidence is associated with profound social inequities. In Chile, it is the second cause of death in women of reproductive age. The Chilean clinical guideline identifies the vaccine against Human Papillomavirus (HPV) as the main preventive measure. Since 2014, the Ministry of Health has implemented free immunization against HPV for girls and female adolescents. This article critically analyzes this public policy from the viewpoint of health equity, using as framework the Social Determinants of Health Model. Specifically, we address the structural determinants of income and gender, which act as material and social barriers for achieving immunization, affecting protection against cervical cancer. These barriers correspond to the high cost of the vaccine, and social attitudes/cultural beliefs towards sexual behavior in Latin America and Chile that affect the acceptability of vaccination. The Social Determinants of Health Model constitutes a useful tool for identifying health inequities and understanding public policy from an equity viewpoint that complements the biomedical and epidemiological understanding of disease. In this topic, the initiative aims to strengthen the idea of health as a human right and health promotion as an essential function of public health policy.
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2.

Modelo participativo para el abordaje de la violencia contra las mujeres en La Araucanía, Chile/ A participatory model for addressing violence against women in La Araucanía, Chile/ Modelo participativo para abordagem da violência contra a mulher em La Araucanía, Chile

Ketterer Romero, Lucy Mirtha; Mayorga Muñoz, Cecilia; Carrasco Henríquez, Marcelo; Soto Higueras, Abel; Tragolaf Ancalaf, Ana; Nitrihual, Luis; del Valle, Carlos
| Idioma(s): Español
La violencia contra la mujer se considera un problema de salud pública que afecta a las mujeres en todo el mundo. Recientemente, el Consejo Directivo de la Organización Panamericana de la Salud declaró sus graves repercusiones sociales y económicas en la Región de las Américas y se comprometió a emprender acciones en los servicios de salud para afrontar el problema. En ese marco, se presentan los pasos de una investigación-acción-participativa (IAP), que se está desarrollando en el territorio wenteche de la región de La Araucanía de Chile, que apuesta por fortalecer los vínculos comunitarios, revalorizar los espacios de diálogo con y entre las personas del territorio, la participación social y la democracia en la generación de conocimientos pertinentes y participativos sobre este problema, y obtener información para diseñar un modelo de intervención que se adecúe a las características locales. Violence against women is considered a public health problem that affects women worldwide. Recently, the Directing Council of the Pan American Health Organization declared its serious socioeconomic impact in the Region of the Americas and committed to undertaking actions in the health services to address this problem. Within that framework, this paper describes the steps of a participatory action research (PAR) approach that is being implemented in the Wenteche Territory of the La Araucanía region of Chile, which aims to strengthen community bonds, rekindle opportunities for dialogue with and among the people of the territory, foster social participation and democracy in the generation of pertinent, participatory knowledge regarding this problem, and obtain information to support design of an intervention model adapted to local characteristics. A violência contra a mulher é um problema de saúde pública que atinge mulheres em todo o mundo. Recentemente, o Conselho Diretor da Organização Pan-Americana da Saúde reconheceu as sérias repercussões socioeconômicas do problema na Região das Américas e se comprometeu a realizar ações nos serviços de saúde para combatê-lo. Como parte deste enquadramento, são apresentadas as etapas de uma pesquisa-ação participativa sendo desenvolvida no território wenteche da região de La Araucanía, no Chile, que visa reforçar os vínculos na comunidade, revalorizar os espaços de diálogo com e entre os habitantes locais, a participação social e a democracia na geração de conhecimento pertinente e participativo sobre esta problemática e obter dados para a elaboração de um modelo de intervenção adequado às características locais.
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3.

Equity in out-of-pocket payment in Chile

Mondaca, Alicia Lorena Núñez; Chi, Chunhuei
| Idioma(s): Inglés
ABSTRACT OBJECTIVE To assess the distribution of financial burden in Chile, with a focus on the burden and progressivity of out-of-pocket payment. METHODS Based on the principle of ability to pay, we explore factors that contribute to inequities in the health system finance and issues about the burden of out-of-pocket payment, as well as the progressivity and redistributive effect of out-of-pocket payment in Chile. Our analysis is based on data from the 2006 National Survey on Satisfaction and Out-of-Pocket Payments. RESULTS Results from this study indicate evidence of inequity, in spite of the progressivity of the healthcare system. Our analysis also identifies relevant policy variables such as education, insurance system, and method of payment that should be taken into consideration in the ongoing debates and research in improving the Chilean system. CONCLUSIONS In order to reduce the detected disparities among income groups, healthcare priorities should target low-income groups. Furthermore, policies should explore changes in the access to education and its impact on equity.
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4.

Boletín de la Cooperación Técnica, enero 2017

Organización Panamericana de la Salud
| Idioma(s): Español
[Introducción], El Dr. Theodor Fiedrich, Representante de la FAO y la Dra. Vivian Pérez, Consultora de OPS/OMS en Cuba, realizaron la presentación conjunta del más reciente informe del Panorama del Estado de la Seguridad Alimentaria y Nutricional de América Latina y el Caribe, que en esta ocasión se centró en analizar el incremento de la obesidad y el sobrepeso en la región y cómo las políticas agrarias pueden contribuir a mejorar la oferta de alimentos para una nutrición saludable. Según su nuevo informe conjunto, el Panorama de la Seguridad Alimentaria y Nutricional en América Latina y el Caribe, cerca del 58 % de los habitantes de la región vive con sobrepeso (360 millones de personas). Salvo en Haití (38,5%), Paraguay (48,5%) y Nicaragua (49,4%) el sobrepeso afecta a más de la mitad de la población de todos los países de la región, siendo Chile (63%), México (64 %) y Bahamas (69%) los que presentan las tasas más elevadas. La obesidad afecta a 140 millones de personas, el 23% de la población regional y las mayores prevalencias se pueden observar todas en países del Caribe: Bahamas (36,2%) Barbados (31,3%), Trinidad y Tobago (31,1%) y Antigua y Barbuda (30,9%). El aumento de la obesidad ha impactado de manera desproporcionada a las mujeres: en más de 20 países de América Latina y el Caribe, la tasa de obesidad femenina es 10 puntos porcentuales mayores que la de los hombres
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5.

Propuesta de un Programa de Vigilancia Ambiental y de Salud para Trabajadores con Exposición a Agentes Químicos en Fundiciones de Cobre en Chile/ ENVIRONMENTAL AND HEALTH SURVEILLANCE PROGRAM PROPOSAL FOR WORKERS EXPOSED TO CHEMICAL AGENTS IN COPPER SMELTERS IN CHILE

Pérez-Montoya, Sergio Alfredo
| Idioma(s): Español
RESUMEN El presente trabajo tiene por objetivo proponer un programa de vigilancia ambiental y de salud para trabajadores expuestos a agentes químicos en fundiciones de cobre. La metodología fue en base a revisión bibliográfica en inglés y en español, búsqueda manual dirigida y criterio de expertos por medio de entrevistas cualitativas no estructuradas. El proceso de búsqueda se dividió en dos etapas, la primera orientada a responder dos preguntas relacionadas al estado del arte de programas preventivos de exposición y, la segunda, relacionada a búsqueda de referencias orientada a la vigilancia ambiental y de la salud en el trabajo. Se seleccionaron artículos científicos, donde se identificaron protocolos, normas, estándares y documentos de diversas organizaciones para la vigilancia ambiental y de la salud, desde los cuales se realizó una nueva búsqueda manual dirigida, sustentada por la directrices señaladas por expertos de las áreas de Higiene y Salud Ocupacional que colaboraron en el diseño del programa. Como resulado, los puntos más importantes fueron la identificación, evaluación y control de los agentes en contacto con los trabajadores como As, Hg, Pb, SO2, SiO2, Cd, Cr, Zn y Cu; propuesta de los niveles de riesgo y exposición en base a la presencia y el contacto de los contaminantes; se determinaron los niveles de acción para la vigilan cia ambiental y de la salud en niveles de 1 a 5; y finalmente los exámenes médicos y su periodicidad. ABSTRACT This work aims to propose an environmental and health surveillance program for workers exposed to chemical agents in copper foundry. The methodology was based on a bibliographical review in English and Spanish, directed manual search and expert judgment through unstructured qualitative interviews. The search process was divided into two stages; the first one aimed answering two questions related to the state of the art of preventive exposure programs, and the second, related to reference search aimed at environmental monitoring and health at work. Scientific articles were selected, where protocols, norms, standards and documents from various organizations for environmental and health surveillance were identified, from which a new manual search was conducted, supported by the guidelines indicated by experts from the areas of Hygiene And Occupational Health that collaborated in the design of the program. As a result, the most important points were the identification, evaluation and control of agents in contact with workers such as As, Hg, Pb, SO2, SiO2, Cd, Cr, Zn and Cu; Proposal of risk and exposure levels based on the presence and contact of pollutants; the levels of action for environmental and health surveillance were determined at levels 1 to 5; And finally the medical examinations and their periodicity.
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6.

Conocimientos y prácticas sobre hidatidosis y triquinosis en usuarios y acompañantes del Hospital Comunitario de Salud Familiar El Carmen, Región del Biobío, Chile./ [Knowledge and practices regarding cystic echinococcosis and trichinellosis in users and companions of users of the Hospital Comunitario de Salud Familiar El Carmen, Biobio Region, Chile].

Lisboa-Navarro, Raúl; González, Jorge; Junod, Tania; Melín-Coloma, Millaray; Landaeta-Aqueveque, Carlos
| Idioma(s): Español
We surveyed users of the Hospital Comunitario de Salud Familiar El Carmen and their companions to analyze knowledge and practices regarding cystic echinococcosis and trichinellosis. Most people recognized risky practices. Previous attendance at talks and working in agricultural-livestock enhanced the knowledge. Age, sex and formal education were not associated with the knowledge. Knowledge was not associated with practices.
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7.

Impact of a school-based intervention on nutritional education and physical activity in primary public schools in Chile (KIND) programme study protocol: cluster randomised controlled trial.

Bustos, Nelly; Olivares, Sonia; Leyton, Bárbara; Cano, Marcelo; Albala, Cecilia
| Idioma(s): Inglés
BACKGROUND: Chile has suffered a fast increase in childhood obesity in the last 10 years. As a result, several school programmes have been implemented, however the effectiveness of these needs to be evaluated to identify and prioritize strategies to curve this trend. METHODS: Cluster randomized controlled trial. Twelve primary public schools chosen at random over three regions of the country will take part in this study. The sample size consisted of a total of 1,655 children. For each region one school will be selected for each of the three nutritional intervention modes and one school will be selected as the control group. The intervention modes consist of the following: Healthy Kiosk and nutritional education (KSEAN); Optimized physical activity (AFSO); Healthy Kiosk and nutritional education (KSEAN) + optimized physical activity (AFSO); Control group. The effectiveness of each intervention will be evaluated by determining the nutritional condition of each child by measuring percentage of body fat, BMI and the z-score of the BMI. This study will also identify the eating behaviours, nutritional knowledge and fitness of each child, along with the effective time of moderate activity during physical education classes. DISCUSSION: A protocol to evaluate the effectiveness of a school based intervention to control and/or reduce the rates of childhood obesity for children between 6 and 10 years of age was developed. The protocol was developed in line with the Declaration of Helsinski, the Nüremberg Code and the University of Chile Guidelines for ethical committees, and was approved by the INTA, Universidad de Chile ethical committee on Wednesday 12 March 2014. There is consensus among researchers and health and education personnel that schools are a favourable environment for actions to prevent and/or control childhood obesity. However a lack of evidence on the effectiveness of interventions to date has led some to question the wisdom of allocating resources to programmes. This is the first study of this kind in Chile and could be an important first step to provide guidance to political authorities in relation to which food and nutrition strategies to prioritize to curve this alarming trend. TRIAL REGISTRATION: ISRCTN32136790 , registered retrospectively on 05 September 2014.
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8.

La reforma de salud chilena a diez años de su implementación./ [Chilean health reform ten years since its implementation].

Urriola, Carlos; Infante, Antonio; Aguilera, Ismael; Ormeño, Héctor
| Idioma(s): Español
Objective:: To analyze the process of design and implementation of AUGE. Materials and methods:: Literature review of pre-reform background, architecture design and implementation process of reform AUGE and complementary interviews to eight informants involved in its development. Results:: The assessment of health equity was a key element in pre-reform, there are four fundamental dimensions in the design, and the implementation has nine phases. Conclusion:: The results show AUGE strengthening public health by investing in equipment for cost-effective treatments, and also through clinical guidelines that standardize and guide the management of health professionals with patients.
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9.

Desempeño hospitalario en un sistema de salud segmentado y desigual: Chile 2001-2010./ [Hospital performance in a segmented and unequal health system: Chile 2001-2010].

Cid, Camilo; Herrera, Cristian A; Prieto, Lorena
| Idioma(s): Español
Objective:: To analyze the differences in health outcomes by hospital characteristics, focusing on ownership: public, private not-for-profit (PNFP) and private for-profit (PFP). Materials and methods:: We used a discharged patient dataset of Chilean hospitals for the period 2001-2010 with a total of 16 205 314 discharges in 20 public, six PNFP and 15 PFP hospitals.We selected a subsample of two medical conditions: myocardial infarction and stroke.We used probit regression analyses with mortality rates as dependent variable, ownership status as the key explanatory variable, and control variables which included patients' health status and socioeconomic level, and hospital characteristics. Results:: Private hospitals showed lower risk of death relative to public hospitals: 1.3% in PNFP, 0.7% in PFP and 3.5% in public hospitals. Conclusions:: The analysis shows the inequities that exist between public hospitals and the private sector.
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10.

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
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.
Resultados  1-10 de 1.406