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1.

Evaluación de Tecnologías Sanitarias (ETESA) una visión global del concepto y de sus alcances/ Health Technology Assessment (HTA). An overview of the concept and its scope

Manterola, Carlos; Otzen, Tamara; Castro, Mayra; Grande, Luis
| Idioma(s): Español
La progresivas preocupación de los países para optimizar el acceso, la eficiencia y la calidad de la salud, han impulsado la utilización más apropiada de las intervenciones en salud. Por ende, el interés tanto de profesionales sanitarios como de tomadores de decisiones en salud, ha sido orientado hacia la medicina basada en la evidencia, la eficacia comparativa y la Evaluación de Tecnologías Sanitarias (ETESA). Aunque los conceptos anteriormente señalados son convergentes en sus características, no son sinónimos. Sin embargo, todos estos, se basan en la orientación sistemática de pruebas y el enfoque en resultados relevantes para el paciente entre otras. Como consecuencia de todo esto, el interés no sólo implica los conceptos de eficacia, efectividad y eficiencia; sino que también en práctica clínica, costes y transparencia. En este artículo se resumen los conceptos de economía de la salud, evaluación económica, tecnología sanitaria (TS) y ETESA. Luego, se comenta el ciclo de vida de una TS, razones para implementar un programa de ETESA; para finalizar con algunos ejemplos de TS emergentes, comentarios respecto de la evidencia científica en la ETESA; y algunos ejemplos de estudios de ETESA en la práctica clínica cotidiana. The progressive concern of countries to optimize access, efficiency and quality of health have led to the most appropriate use of health interventions. Therefore, the interest of both health professionals and health decision makers has been oriented towards evidence-based policy, comparative efficacy and Health Technologies Assessment (HTA). Although the aforementioned concepts are converging in their characteristics, they are not synonymous. However, all these are based on systematic testing orientation and focus on relevant patient outcomes among others. As a consequence of all this, interest does not only imply the concepts of effectiveness, effectiveness and efficiency, but also in clinical practice, costs and transparency.This manuscript summarizes concepts of health economics, economic evaluation, health technology and HTA. Then, the life cycle of a health technology and the reasons for implementing an HTA program are discussed. Concluding with some examples of emerging health technologies, comments on the scientific evidence in HTA, and some examples of HTA studies in daily clinical practice.
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2.

Protección financiera en salud: evolución y comparación del gasto de bolsillo de los hogares chilenos./ [Financial protection for health care expenses provided by public and private systems in Chile].

Gallegos, Eduardo; Muñoz, Alberto
| Idioma(s): Español
BACKGROUND: People need a financial protection system to face the high costs of health care. AIM: To compare the financial protection between households affiliated to the Chilean public health financing system (FONASA) or to a private health financing system (ISAPRE). To describe the evolution of protection at the national level between 2007 and 2012. MATERIAL AND METHODS: As proposed by the World Bank, impact indicators to measure the equity and efficiency of the insurance systems were generated. Namely, average out-of-pocket expenses by insurance and average out-of-pocket spending as a percentage of expenditure. Also, the evolution of out-of-pocket spending by quintiles and Gini Coefficient were measured as measure of equity. To determine these, Family Budget Surveys for 2007 and 2012 were used. RESULTS: Household out-of-pocket spending increased by 14.12%. When expressed as a percentage of total expenditure, it grew from 5.6% to 6.2%. Household Gini coefficient and per capita out-of-pocket spending decreased and the ratio between the highest and lowest quintile out-of-pocket increased at both analysis levels. Pocket expense in absolute values or expressed as a percentage of total expenses was higher among persons insured in private systems than those affiliated to the public financing service. CONCLUSIONS: Out-of-pocket spending increased for all income groups and people insured in the public system had a lower absolute and relative spending than those insured in private systems.
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3.

Exposición a nitratos en agua y su relación con disfunción de la glándula tiroides: revisión sistemática ¿Existen riesgos para la salud de la población?/ [Exposure to nitrates in drinking water and its association with thyroid gland dysfunction].

Donoso M, Rodrigo; Cortés A, Sandra
| Idioma(s): Español
BACKGROUND: Nitrate exposure may be associated with thyroid gland dysfunction. AIM: To review the available evidence about the relationship between nitrates in drinking water and thyroid gland dysfunction. MATERIAL AND METHODS: A wide search was performed using Medline, Cochrane, Lilacs, IBECS and Scielo databases using pertinent keywords, finding a total of 66 related studies. After filtering and in depth reviewing, a total of 12 studies were included in this review. RESULTS: The main results reveal the importance of this ion for human health, finding evidence both in animals and human beings that suggest pathological changes in the gland as its relationship with the occurrence of subclinical hypothyroidism, and potentially cancer of the thyroid gland. In Chile, nitrate is not considered a critical contaminant so its regular measuring and control is not enforced. CONCLUSIONS: In light of the present review we believe that there is evidence to consider nitrate as a critical contaminant whose measurement, registration and correct implementation of valid policies would have a direct benefit for the population of this country. Without this information, it is not possible to quantify the damage to human health, especially in vulnerable groups residing in areas at greatest risk of exposure.
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4.

Adaptación del instrumento WAST para la detección de violencia doméstica en Centros de Salud./ [Cultural adaptation and translation of the Woman Abuse Screening Tool].

Binfa, Lorena; Cancino, Valentina; Ugarte, Isaac; Mella, Maribel; Cavada, Gabriel
| Idioma(s): Español
BACKGROUND: The Woman Abuse Screening Tool (WAST) is a screening tool for domestic violence used in Unites States. AIM: To carry out the cultural adaptation of the WAST instrument for early detection of domestic violence in primary health care. MATERIAL AND METHODS: Qualitative techniques for cultural adaptation were used in stages 1 and 2 and quantitative techniques were used in stage 3. The validity of content was assessed using judge tests carried out with experts in the field. Linguistic adaptation was carried out using a focal group technique to ensure semantic and language comprehension. Finally, the culturally adapted instrument was applied to 16 women who were victims of violence and to 28 women without a history of violence. RESULTS: For cultural adaptation, the judges' test added the item of economic violence to the instrument. According to the focus groups, some words were changed to facilitate understanding by the subjects. According to the scores obtained in women with and without a history of violence, a cut-off point of 15 points was defined to determine a history of domestic violence with a sensitivity of 100% and a specificity of 96%. The Cronbach Alpha of the questionnaire was 91%. CONCLUSIONS: WAST is an effective and easily applied instrument for the early detection of domestic violence.
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6.

Factores asociados a sedentarismo en Chile: evidencia de la Encuesta Nacional de Salud 2009-2010./ [Correlates of sedentary behaviors in Chile: evidence from the National Health Survey 2009-2010].

Martínez, María Adela; Leiva, Ana María; Petermann, Fanny; Garrido, Alex; Díaz, Ximena; Álvarez, Cristian; Salas, Carlos; Cristi, Carlos; Rodríguez, Fernando; Aguilar, Nicolás; Ramírez, Rodrigo; Celis, Carlos
| Idioma(s): Español
BACKGROUND: Sedentary behaviors are one of the major risk factors for cardiovascular diseases. AIM: To identify factors associated with high sedentary behaviors in the Chilean population. MATERIAL AND METHODS: We included 5,040 participants from the Chilean National Health Survey 2009-2010. Physical activity level and sedentary behavior (sitting time) were measured using the Global Physical Activity Questionnaire (GPAQ v2). Highly sedentary behaviors were determined as > 4 hours per day of sitting time. Logistic regression was used to identify correlates of highly sedentary behavior. RESULTS: Forty seven percent of the study population reported spending more than 4 hours per day sitting. The prevalence was higher in women. The main factors associated with high sedentary behavior were: high income levels (Odds ratio (OR):1.91 [95% Confidence intervals (CI:1.61-2.27]); being woman (OR:1.39 [95% CI:1.24-1.56]): having central obesity (OR:1.15 [95% CI:1.02-1.30]), being physically inactive (OR:2.35 [95% CI:2.06-2.68]), and living in an urban area (OR:1.92 [95% CI:1.63-2.26]). Other factors associates with high sedentary behavior were: being smoker, having a television set, computer and private car at their homes. Participants reporting a poor self-reported health and wellbeing and those with diabetes or metabolic syndrome were more likely to be highly sedentary. CONCLUSIONS: The main factors associated with high levels of sedentary behavior are socio-demographic issues, lifestyles and health status.
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7.

Hospitalizations for cancer in international migrants versus local population in Chile.

Oyarte, Marcela; Delgado, Iris; Pedrero, Víctor; Agar, Lorenzo; Cabieses, Báltica
| Idioma(s): Inglés; Español
OBJECTIVE: To compare cancer hospital morbidity among the local population and the immigrant population in Chile. METHODS: This is a prevalence study based on the analysis of hospital discharges of all the health centers of Chile. Cancer hospital discharges were characterized in 2012 according to the migratory status. The crude and specific rates of hospital morbidity for this cause were estimated for the analysis of their association with migratory status using zero-inflated negative binomial regression, adjusted for sociodemographic variables. RESULTS: The neoplasms were the third cause of hospital discharges for immigrants and the seventh one for Chileans. The adjusted rate of cancer hospital discharges was higher for Chileans than immigrants, and the latter had fewer days of hospitalization and greater proportion of surgical interventions. In the group of immigrants, cancer hospital discharges mainly corresponded to patients belonging to the private system (46%), and in the group of Chileans they mainly corresponded to patients in the public system (71.1%). We observed a large difference in the proportion of cancer hospital discharges for patients with no health insurance between the two populations (22.6%: immigrants, 1.0%: Chileans). In both populations, the three most frequent types of cancer were: (i) lymphoid tissue, hematopoietic organs, and related tissues, (ii) digestive organs, and (iii) breast cancer. CONCLUSIONS: Models of differentiated care should be considered for immigrants, with the creation of specific programs of information, coverage, and protection against cancer. More information on this problem must be generated at the local and international level.
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8.

Costs of examinations performed in a hospital laboratory in Chile.

Andrade, Germán Lobos; Palma, Carolina Salas
| Idioma(s): Inglés; Español
OBJECTIVE: To determine the total average costs related to laboratory examinations performed in a hospital laboratory in Chile. METHOD: Retrospective study with data from July 2014 to June 2015. 92 examinations classified in ten groups were selected according to the analysis methodology. The costs were estimated as the sum of direct and indirect laboratory costs and indirect institutional factors. RESULTS: The average values obtained for the costs according to examination group (in USD) were: 1.79 (clinical chemistry), 10.21 (immunoassay techniques), 13.27 (coagulation), 26.06 (high-performance liquid chromatography), 21.2 (immunological), 3.85 (gases and electrolytes), 156.48 (cytogenetic), 1.38 (urine), 4.02 (automated hematological), 4.93 (manual hematological). CONCLUSION: The value, or service fee, returned to public institutions who perform laboratory services does not adequately reflect the true total average production costs of examinations.
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9.

Effects of air pollution on infant and children respiratory mortality in four large Latin-American cities.

Gouveia, Nelson; Junger, Washington Leite
| Idioma(s): Inglés
OBJECTIVES: Air pollution is an important public health concern especially for children who are particularly susceptible. Latin America has a large children population, is highly urbanized and levels of pollution are substantially high, making the potential health impact of air pollution quite large. We evaluated the effect of air pollution on children respiratory mortality in four large urban centers: Mexico City, Santiago, Chile, and Sao Paulo and Rio de Janeiro in Brazil. METHODS: Generalized Additive Models in Poisson regression was used to fit daily time-series of mortality due to respiratory diseases in infants and children, and levels of PM and O . Single lag and constrained polynomial distributed lag models were explored. Analyses were carried out per cause for each age group and each city. Fixed- and random-effects meta-analysis was conducted in order to combine the city-specific results in a single summary estimate. RESULTS: These cities host nearly 43 million people and pollution levels were above the WHO guidelines. For PM the percentage increase in risk of death due to respiratory diseases in infants in a fixed effect model was 0.47% (0.09-0.85). For respiratory deaths in children 1-5 years old, the increase in risk was 0.58% (0.08-1.08) while a higher effect was observed for lower respiratory infections (LRI) in children 1-14 years old [1.38% (0.91-1.85)]. For O , the only summarized estimate statistically significant was for LRI in infants. Analysis by season showed effects of O in the warm season for respiratory diseases in infants, while negative effects were observed for respiratory and LRI deaths in children. DISCUSSION: We provided comparable mortality impact estimates of air pollutants across these cities and age groups. This information is important because many public policies aimed at preventing the adverse effects of pollution on health consider children as the population group that deserves the highest protection.
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10.

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.
Resultados  1-10 de 1.785