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Determinantes sociales de la salud de niños migrantes internacionales en Chile: evidencia cualitativa./ [Social determinants of the health of international migrant children in Chile: qualitative evidence.]

Bernales, Margarita; Cabieses, Báltica; McIntyre, Ana María; Chepo, Macarena; Flaño, Javiera; Obach, Alexandra
| Idioma(s): Español
OBJECTIVE: To explore the social determinants of health (SDH) of international migrant children, from the perceptions of caregivers, health workers and local authorities in eight municipalities in Chile. MATERIALS AND METHODS: A secondary analysis of data was conducted from a qualitative study that took place between 2014 and 2017. The original study involved semi-structured interviews and focus groups. The secondary thematic analysis of data included all emerging issues related to international migrant children and their living conditions, including use of health services. RESULTS: Findings were grouped according to the model of social determinants of health, which allow a reflection on living conditions of international migrant children and their health situation. CONCLUSIONS: This research shows the impact of SDH on international migrant children in Chile, highlighting relevant issues around this group.
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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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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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"Freud para todos": psicoanálisis y cultura de masas en Chile, 1920-1950./ "Freud para todos": psicoanálisis y cultura de masas en Chile, 1920-1950./ "Freud for all:" psychoanalysis and mass culture in Chile, 1920-1950.

Ruperthuz Honorato, Mariano
| Idioma(s): Español; Inglés
This article deals with the circulation and early spread of Freudianism in mass culture in Chilean society at the turn of the twentieth century. It documents the first references to Sigmund Freud in the Chilean media, the announcement of Freudian-style self-help classes, the appearance of psychoanalysts as characters in some fantasy novels, and the open lectures on psychoanalysis given by the first juvenile court judge in Santiago, the lawyer Samuel Gajardo Contreras. It explores the expectations projected onto Freudianism by the Chilean elite, and how Freud's theories contributed to a rethinking of childhood, the family and emotional life in Chile from 1920-1950.
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Trail Making Test: Normative data for the Latin American Spanish-speaking pediatric population.

Arango-Lasprilla, J C; Rivera, D; Ramos-Usuga, D; Vergara-Moragues, E; Montero-López, E; Adana Díaz, L A; Aguayo Arelis, A; García-Guerrero, C E; García de la Cadena, C; Llerena Espezúa, X; Lara, L; Padilla-López, A; Rodriguez-Irizarry, W; Alcazar Tebar, C; Irías Escher, M J; Llibre Guerra, J J; Torales Cabrera, N; Rodríguez-Agudelo, Y; Ferrer-Cascales, R
| Idioma(s): Inglés
OBJECTIVE: To generate normative data for the Trail Making Test (TMT) in Spanish-speaking pediatric populations. METHOD: The sample consisted of 3,337 healthy children from nine countries in Latin America (Chile, Cuba, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Peru, and Puerto Rico) and Spain. Each participant was administered the TMT as part of a larger neuropsychological battery. The TMT-A and TMT-B scores were normed using multiple linear regressions and standard deviations of residual values. Age, age2, sex, and mean level of parental education (MLPE) were included as predictors in the analyses. RESULTS: The final multiple linear regression models showed main effects for age on both scores, such that as children needed less time to complete the test while they become older. TMT-A scores were affected by age2 for all countries except, Cuba, Guatemala, and Puerto. TMT-B scores were affected by age2 for all countries except, Guatemala and Puerto Rico. Models indicated that children whose parent(s) had a MLPE >12 years of education needed less time to complete the test compared to children whose parent(s) had a MLPE ≤12 years for Mexico and Paraguay in TMT-A scores; and Ecuador, Mexico, Paraguay, and Spain for TMT-B scores. Sex affected TMT-A scores for Chile, Cuba, Mexico, and Peru, in that boys needed less time to complete the test than girls. Sex did not affect TMT-B scores. CONCLUSIONS: This is the largest Spanish-speaking pediatric normative study in the world, and it will allow neuropsychologists from these countries to have a more accurate approach to interpret the TMT in pediatric populations.
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Ideal cardiovascular health predicts lower risk of abnormal liver enzymes levels in the Chilean National Health Survey (2009-2010).

García-Hermoso, Antonio; Hackney, Anthony C; Ramírez-Vélez, Robinson
| Idioma(s): Inglés
High levels of gamma glutamyltransferase (gamma-GT) and alanine aminotransferase (ALT), as well as fatty liver index (FLI) has been associated with higher cardiovascular disease risk factors in adults. The aim of this study was to examine the relationship between gamma-GT, ALT, and fatty liver index FLI levels across a gradient number of ideal cardiovascular health metrics in a representative sample of adults from the Chilean National Health Survey 2009-2010. Data from 1,023 men and 1,449 women (≥ 15 years) from the Chilean Health Survey 2009-2010 were analyzed. Ideal cardiovascular health was defined as meeting ideal levels of the following components: four behaviours (smoking, body mass index, physical activity and diet adherence) and three factors (total cholesterol, blood pressure and fasting glucose). Adults were grouped into three categories according to their number of ideal cardiovascular health metrics: ideal (5-7 metrics), intermediate (3-4 metrics), and poor (0-2 metrics). Blood levels of gamma-GT and ALT were measured and the FLI was calculated. A higher number of ideal cardiovascular health index metric was associated with lower gamma-GT, ALT and FLI (p from trend analysis <0.001). Also, adults meeting at least 3-4 metrics were predicted less likely to have prevalence of abnormal levels of gamma-GT and FLI (p<0.001) compared to adults who met only 0-2 metrics. These findings reinforce the usefulness of the ideal cardiovascular health metrics proposed by the American Heart Association as a tool to identify target subjects and promote cardiovascular health in South-American adults.
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Investigation of orthologous pathogen recognition gene-rich regions in solanaceous species.

Di Donato, A; Andolfo, G; Ferrarini, A; Delledonne, M; Ercolano, M R
| Idioma(s): Inglés
Pathogen receptor proteins such as receptor-like protein (RLP), receptor-like kinase (RLK), and nucleotide-binding leucine-rich repeat (NLR) play a leading role in plant immunity activation. The genome architecture of such genes has been extensively investigated in several plant species. However, we still know little about their elaborate reorganization that arose during the plant speciation process. Using recently released pepper and eggplant genome sequences, we were able to identify 1097 pathogen recognition genes (PRGs) in the cultivated pepper Zunla-1 and 775 in the eggplant line Nakate-Shinkuro. The retrieved genes were analysed for their tendency to cluster, using different methods to infer the means of grouping. Orthologous relationships among clustering loci were found, and interesting reshuffling within given loci was observed for each analysed species. The information obtained was integrated into a comparative map to highlight the evolutionary dynamics in which the PRG loci were involved. Diversification of 14 selected PRG-rich regions was also explored using a DNA target-enrichment approach. A large number of gene variants were found as well as rearrangements of sequences encoding single protein domain and changes in chromosome gene order among species. Gene duplication and transposition activity have clearly influenced plant genome R-gene architecture and diversification. Our findings contribute to addressing several biological questions concerning the parallel evolution that occurred between genomes of the family Solanaceae. Moreover, the integration of different methods proved a powerful approach to reconstruct the evolutionary history in plant families and to transfer important biology findings among plant genomes.
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Clinical and molecular aspects of familial hypercholesterolemia in Ibero-American countries.

Santos, Raul D; Bourbon, Mafalda; Alonso, Rodrigo; Cuevas, Ada; Vasques-Cardenas, Norma Alexandra; Pereira, Alexandre C; Merchan, Alonso; Alves, Ana Catarina; Medeiros, Ana Margarida; Jannes, Cinthia E; Krieger, Jose E; Schreier, Laura; Perez de Isla, Leopoldo; Magaña-Torres, Maria Teresa; Stoll, Mario; Mata, Nelva; Dell Oca, Nicolas; Corral, Pablo; Asenjo, Sylvia; Bañares, Virginia G; Reyes, Ximena; Mata, Pedro
| Idioma(s): Inglés
BACKGROUND: There is little information about familial hypercholesterolemia (FH) epidemiology and care in Ibero-American countries. The Ibero-American FH network aims at reducing the gap on diagnosis and treatment of this disease in the region. OBJECTIVE: To describe clinical, molecular, and organizational characteristics of FH diagnosis in Argentina, Brazil, Chile, Colombia, Mexico, Portugal, Spain, and Uruguay. METHODS: Descriptive analysis of country data related to FH cascade screening, molecular diagnosis, clinical practice guidelines, and patient organization presence in Ibero-America. RESULTS: From a conservative estimation of an FH prevalence of 1 of 500 individuals, there should be 1.2 million heterozygous FH individuals in Ibero-America and roughly 27,400 were diagnosed so far. Only Spain, Brazil, Portugal, and Uruguay have active cascade screening programs. The prevalence of cardiovascular disease ranged from 10% to 42% in member countries, and the highest molecular identification rates are seen in Spain, 8.3%, followed by Portugal, 3.8%, and Uruguay with 2.5%. In the 3 countries with more FH patients identified (Spain, Portugal, and Brazil) between 10 and 15 mutations are responsible for 30% to 47% of all FH cases. Spain and Portugal share 5 of the 10 most common mutations (4 in low density lipoprotein receptor [LDLR] and the APOB3527). Spain and Spanish-speaking Latin American countries share 6 of the most common LDLR mutations and the APOB3527. LDL apheresis is available only in Spain and Portugal and not all countries have specific FH diagnostic and treatment guidelines as well as patient organizations. CONCLUSIONS: Ibero-American countries share similar mutations and gaps in FH care.
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Doctors' experience of coordination across care levels and associated factors. A cross-sectional study in public healthcare networks of six Latin American countries.

Vázquez, María-Luisa; Vargas, Ingrid; Garcia-Subirats, Irene; Unger, Jean-Pierre; De Paepe, Pierre; Mogollón-Pérez, Amparo Susana; Samico, Isabella; Eguiguren, Pamela; Cisneros, Angelica-Ivonne; Huerta, Adriana; Muruaga, María-Cecilia; Bertolotto, Fernando
| Idioma(s): Inglés
Improving coordination between primary care (PC) and secondary care (SC) has become a policy priority in recent years for many Latin American public health systems looking to reinforce a healthcare model based on PC. However, despite being a longstanding concern, it has scarcely been analyzed in this region. This paper analyses the level of clinical coordination between PC and SC experienced by doctors and explores influencing factors in public healthcare networks of Argentina, Brazil, Chile, Colombia, Mexico and Uruguay. A cross-sectional study was carried out based on a survey of doctors working in the study networks (348 doctors per country). The COORDENA questionnaire was applied to measure their experiences of clinical management and information coordination, and their related factors. Descriptive analyses were conducted and a multivariate logistic regression model was generated to assess the relationship between general perception of care coordination and associated factors. With some differences between countries, doctors generally reported limited care coordination, mainly in the transfer of information and communication for the follow-up of patients and access to SC for referred patients, especially in the case of PC doctors and, to a lesser degree, inappropriate clinical referrals and disagreement over treatments, in the case of SC doctors. Factors associated with a better general perception of coordination were: being a SC doctor, considering that there is enough time for coordination within consultation hours, job and salary satisfaction, identifying the PC doctor as the coordinator of patient care across levels, knowing the doctors of the other care level and trusting in their clinical skills. These results provide evidence of problems in the implementation of a primary care-based model that require changes in aspects of employment, organization and interaction between doctors, all key factors for coordination.
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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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