Nowcasting methods to improve the performance of respiratory sentinel surveillance: lessons from the COVID-19 pandemic.

Respiratory diseases, including influenza and coronaviruses, pose recurrent global threats. This study delves into the respiratory surveillance systems, focusing on the effectiveness of SARI sentinel surveillance for total and severe cases incidence estimation. Leveraging data from the COVID-19 pandemic in Chile, we examined 2020-2023 data (a 159-week period) comparing census surveillance results of confirmed cases and hospitalizations, with sentinel surveillance. Our analyses revealed a consistent underestimation of total cases and an overestimation of severe cases of sentinel surveillance. To address these limitations, we introduce a nowcasting model, improving the precision and accuracy of incidence estimates. Furthermore, the integration of genomic surveillance data significantly enhances model predictions. While our findings are primarily focused on COVID-19, they have implications for respiratory virus surveillance and early detection of respiratory epidemics. The nowcasting model offers real-time insights into an outbreak for public health decision-making, using the same surveillance data that is routinely collected. This approach enhances preparedness for emerging respiratory diseases by the development of practical solutions with applications in public health.

Cancer Care Access in Chile's Vulnerable Populations During the COVID-19 Pandemic.

Objectives. To examine the COVID-19 pandemic's impact on cancer care access in Chile, analyzing differential effects by insurance type, gender, and age. Methods. We conducted a quasi-experimental study using interrupted time series analysis. We used multiple data sources for a broad evaluation of cancer-related health care utilization from January 2017 to December 2020. We fit negative binomial models by population groups for a range of services and diagnoses. Results. A sharp drop in oncology health care utilization in March was followed by a slow, incomplete recovery over 2020. Cumulative cancer-related services, diagnostic confirmations, and sick leaves were reduced by one third in 2020; the decrease was more pronounced among women and the publicly insured. Early diagnosis was missed in 5132 persons with 4 common cancers. Conclusions. The pandemic stressed the Chilean health system, decreasing access to essential services, with a profound impact on cancer care. Oncology service reductions preceded large-scale lockdowns and supply-side disruptions. Importantly, not all population groups were equally affected, with patterns suggesting that gender and socioeconomic inequalities were exacerbated. (Am J Public Health. 2022;112(S6):S591-S601. https://doi.org/10.2105/AJPH.2021.306587).

[Cancer care access in Chile's vulnerable populations during the COVID-19 pandemicAcesso a tratamento de câncer em populações vulneráveis no Chile durante a pandemia de COVID-19]. / Acceso a la atención del cáncer en los grupos vulnerables de Chile durante la pandemia de COVID-19.

Objectives: To examine the COVID-19 pandemic's impact on cancer care access in Chile, analyzing differential effects by insurance type, gender, and age. Methods: We conducted a quasi-experimental study using interrupted time series analysis. We used multiple data sources for a broad evaluation of cancer-related health care utilization from January 2017 to December 2020. We fit negative binomial models by population groups for a range of services and diagnoses. Results: A sharp drop in oncology health care utilization in March was followed by a slow, incomplete recovery over 2020. Cumulative cancer-related services, diagnostic confirmations, and sick leaves were reduced by one third in 2020; the decrease was more pronounced among women and the publicly insured. Early diagnosis was missed in 5132 persons with 4 common cancers. Conclusions: The pandemic stressed the Chilean health system, decreasing access to essential services, with a profound impact on cancer care. Oncology service reductions preceded large-scale lockdowns and supply-side disruptions. Importantly, not all population groups were equally affected, with patterns suggesting that gender and socioeconomic inequalities were exacerbated.

Objetivos: Examinar o impacto da pandemia de COVID-19 no acesso a tratamento de câncer no Chile, analisando efeitos diferenciais por tipo de cobertura de assistência à saúde, gênero e idade. Métodos: Realizamos um estudo quase-experimental utilizando análise de séries temporais interrompidas. A partir de várias fontes de dados, efetuamos uma avaliação abrangente da utilização de atenção à saúde relacionada ao câncer, de janeiro de 2017 a dezembro de 2020. Ajustamos modelos binomiais negativos por grupos populacionais a vários tipos de serviços e diagnósticos. Resultados: Uma queda acentuada no uso da assistência médica oncológica em março foi seguida por uma recuperação lenta e incompleta ao longo de 2020. Cumulativamente, a utilização de serviços oncológicos, as confirmações de diagnóstico e os afastamentos do trabalho por doença foram reduzidos em um terço em 2020. Essa redução foi mais pronunciada em mulheres e usuários do sistema público de saúde. No total, 5132 pessoas com 4 cânceres comuns não foram diagnosticadas precocemente. Conclusões: A pandemia impôs pressão sobre o sistema de saúde chileno, reduzindo o acesso a serviços essenciais e causando um profundo impacto no tratamento do câncer. As reduções na prestação de serviços de oncologia precederam os lockdowns em larga escala e as interrupções na oferta de suprimentos. É importante ressaltar que nem todos os grupos populacionais foram igualmente afetados e os padrões observados sugerem que as desigualdades de gênero e socioeconômicas foram exacerbadas.

Aging and self-reported health in 114 Latin American cities: gender and socio-economic inequalities.

BACKGROUND: Understanding how urban environments influence people's health, especially as individuals age, can help identify ways to improve health in the rapidly urbanizing and rapidly aging populations. OBJECTIVES: To investigate the association between age and self-reported health (SRH) in adults living in Latin-American cities and whether gender and city-level socioeconomic characteristics modify this association. METHODS: Cross-sectional analyses of 71,541 adults aged 25-97 years, from 114 cities in 6 countries (Argentina, Brazil, Colombia, Chile, El Salvador, and Guatemala), as part of the Salud Urbana en America Latina (SALURBAL) Project. We used individual-level age, gender, education, and self-reported health (SRH) data from harmonized health surveys. As proxies for socioeconomic environment we used a city-level socioeconomic index (SEI) calculated from census data, and gross domestic product (GDP) per-capita. Multilevel Poisson models with a robust variance were used to estimate relative risks (RR), with individuals nested in cities and binary SRH (poor SHR vs. good SRH) as the outcome. We examined effect modification by gender and city-level socioeconomic indicators. RESULTS: Overall, 31.4% of the sample reported poor SRH. After adjusting for individual-level education, men had a lower risk of poor SRH (RR = 0.76; CI 0.73-0.78) compared to women, and gender modified the association between age and poor SRH (p-value of interaction < 0.001). In gender stratified models, the association between older age and poor SRH was more pronounced in men than in women, and in those aged 25-65 than among those 65+ (RR/10 years = 1.38 vs. 1.10 for men, and RR/10 years = 1.29 vs. 1.02 for women). Living in cities with higher SEI or higher GDP per-capita was associated with a lower risk of poor SRH. GDP per-capita modified the association between age (25-65) and SRH in men and women, with SEI the interaction was less clear. CONCLUSIONS: Across cities in Latin America, aging impact on health is significant among middle-aged adults, and among men. In both genders, cities with lower SEI or lower GDP per-capita were associated with poor SRH. More research is needed to better understand gender inequalities and how city socioeconomic environments, represented by different indicators, modify exposures and vulnerabilities associated with aging.

An approach on the migratory processes in the north of Chile based on Y chromosome analysis.

OBJECTIVES: Northern Chile is an area characterized by a complex cultural and demographic trajectory. During the last few centuries, this complex trajectory has become the destination of intra- and intercontinental migratory waves. In this study, we analyzed the Y chromosome to evaluate how migratory and admixture patterns have affected the genetic composition of the populations in northern Chile compared with other populations of the country. METHODS: A total of 311 people from urban (Antofagasta and Calama), rural (Azapa and Camarones), and Native (Aymara and Atacameño) populations from northern Chile were characterized by 26 SNPs and the STR DYS393 of the Y chromosome, along with 69 individuals from Native populations (Mapuche, Pehuenche, and Huilliche) from southern Chile. In addition to characterizing the paternal lineages, multivariate analyses were performed to compare with published data from other Chilean populations. RESULTS: Both the Antofagasta and Calama populations show differences compared with the rest of the Chilean population. On one side, Antofagasta shows a high diversity of non-Amerindian lineages, including the highest value for haplogroup I (12%) for all Chileans populations. Otherwise, Calama has the highest value of any Chilean urban population (31.9%) for Amerindian lineages, including the only Q-M3 sub-lineage detected in the entire sample. Regarding the Native population, Aymara presents the highest percentage of Q-M3 (94.4%). CONCLUSIONS: The Y chromosome haplogroup distribution allowed us to identify recent migratory processes typical of the northern populations studied. These have shaped the demographic and cultural dynamics of local and migrant groups in the territory.

Exploring physical activity in Central Chile during the Early Ceramic Period and Late Intermediate Period (200-1450 CE).

OBJECTIVES: We explore physical activity in early farming societies of Central Chile during the Early Ceramic and Late Intermediate Periods (200-1450 CE), a time of technological changes and intensification of food production. The existence of differences in entheseal changes (EC) between females and males is evaluated in two periods with different subsistence strategies. MATERIAL AND METHODS: EC were recorded with method in the upper and lower limbs of 56 male and female adult individuals from the Early Ceramic Period (ECP) and Late Intermediate Period (LIP). Hierarchical multiple factor analysis and hierarchical clustering on principal components were performed using an exploratory approach. RESULTS: In all the analyzed limbs, the EC scores are higher in males than females, which may be explained by sexual dimorphism. A constant overlap in the variability of the EC among males and females is observed. However, the EC scores show a different pattern of variability when comparing ECP females with LIP females. The results show that the scores increase in the latter. In contrast, when comparing ECP males with LIP males scores decrease in the later period. DISCUSSION: Physical activity in the societies of Central Chile with incipient agriculture did not vary by sex or during the timeframe studied. Nevertheless, the interaction between sex-period and the variability pattern of the EC from one period to another suggests different ways of doing similar physical activities or different emphases for similar biomechanical actions.

Native American mitochondrial lineages in admixed populations from Chile: Detecting recent migrations during post-Columbian times using geographically restricted lineages.

OBJECTIVES: To analyze the mitochondrial diversity in three admixed populations and evaluate the historical migration effect of native southern population movement to Santiago (capital of Chile). The intensity of migration was quantified using three mitochondrial lineages restricted to South-Central native groups. METHODS: D-loop sequences were genotyped in 550 unrelated individuals from San Felipe-Los Andes (n = 108), Santiago (n = 217), and Concepción (n = 225). Sequence processing, alignment, and haplogroup inference were carried out, and different genetic structure analyses were performed for haplogroup frequencies and D-loop sequences. RESULTS: The Native lineages B2i2, C1b13, and D1g were the most frequent haplogroups, especially in Santiago (71.8%). Despite the distance, this city showed a high-genetic affinity with southern populations, including Concepción (~500 km distant) and native groups, rather than with those from San Felipe-Los Andes (<100 km distant). In fact, there was a negative correlation between geographical and genetic distance among these cities (r corr = -0.5593, p value = 0.8387). Network analysis revealed shared haplotypes between Santiago, Concepción, and other southern populations. Finally, we found lineages from Concepción acting as ancestral nodes in the northern clade. CONCLUSIONS: Considering the geographic distances from these cities, the results were not consistent with a model of genetic isolation by geographic distance, revealing the effects of a historical migration process from the south to the capital. We also show evidence of possible north-to-south migration during admixture onset in Concepción and in addition, we were able to identify previously unreported mitochondrial diversity in urban populations that became lost in Native groups post-European contact.

Ancestry and admixture of a southernmost Chilean population: The reflection of a migratory history.

OBJECTIVES: Punta Arenas is a Chilean city situated on ancestral Aönikenk territory. The city was founded by 19th- and 20th-century colonists from Chile (Chiloé) and Europe (Croatia). This work uses uniparental and ancestry-informative markers (AIMs) to explore the effects of historic migratory and admixture patterns on the current genetic composition of Punta Arenas. METHODS: We analyzed mitochondrial DNA (mtDNA), Y-chromosome single-nucleotide polymorphisms (SNPs), and 141 AIMs obtained from 129 DNA samples from male residents with regional ancestry. After characterizing uniparental lineages and ancestry proportions, multivariate analysis was used to explore relationships among the various types of data. RESULTS: Punta Arenas has an admixed population with three main genetic components: European (56.5%), northern Native (11.3%), and south-central Native (28.6%). The Native component is preponderant in the mtDNA (83.76%), while the foreign component predominates in the Y-chromosome (92.25%). Non-Native mtDNA lineages are associated with European genetic ancestry, and Native mtDNA lineages originated mainly in the southern and southernmost regions of Chile. Most non-Native Y-chromosome SNPs originated in Spain, and secondly, in Croatia. CONCLUSIONS: The population of Punta Arenas is mainly of Chilote origin with south-central Native and Spanish ancestral components, as well as some Croatian components. The persistence of local Native lineages is notable, suggesting continuity with the ancestral populations of the region such as the Kawésqar, Aönikenk, Yámana, or Selknam peoples. This study contributes to our knowledge of local history and its links to national and global developments in genetic ancestry.

Acceso a la atención del cáncer en los grupos vulnerables de Chile durante la pandemia de COVID-19 / Cancer care access in Chile's vulnerable populations during the COVID-19 pandemic / Acesso a tratamento de câncer em populações vulneráveis no Chile durante a pandemia de COVID-19

RESUMEN Objetivo. Estudiar la repercusión de la pandemia de COVID-19 en el acceso a la atención del cáncer en Chile, analizando los efectos diferenciales por tipo de seguro, sexo y edad. Métodos. Se llevó a cabo un estudio cuasiexperimental mediante análisis de series temporales interrumpidas. Se recurrió a fuentes de datos múltiples con el fin de lograr una evaluación amplia de la utilización de la atención del cáncer de enero del 2017 a diciembre del 2020. Se ajustaron modelos binomiales negativos en función de los grupos de población para una diversidad de servicios y diagnósticos. Resultados. Tras una disminución considerable de la utilización de la atención oncológica en marzo, se observó una recuperación lenta e incompleta durante el 2020. Los servicios de atención del cáncer, las confirmaciones diagnósticas y las licencias por enfermedad acumulados se redujeron en un tercio en el 2020; la disminución fue más pronunciada en las mujeres y las personas afiliadas al seguro de enfermedad público. No se hizo un diagnóstico temprano en 5132 personas con cuatro tipos frecuentes de cáncer. Conclusiones. La pandemia sobrecargó el sistema de salud chileno y provocó una disminución del acceso a los servicios básicos, con una repercusión profunda en la atención del cáncer. La reducción de los servicios de oncología precedió los confinamientos a gran escala y las interrupciones por parte de los prestadores. Cabe destacar que no todos los grupos de la población se vieron afectados por igual y se observaron pautas que indican un agravamiento de las desigualdades por situación socioeconómica y sexo.

ABSTRACT Objectives. To examine the COVID-19 pandemic's impact on cancer care access in Chile, analyzing differential effects by insurance type, gender, and age. Methods. We conducted a quasi-experimental study using interrupted time series analysis. We used multiple data sources for a broad evaluation of cancer-related health care utilization from January 2017 to December 2020. We fit negative binomial models by population groups for a range of services and diagnoses. Results. A sharp drop in oncology health care utilization in March was followed by a slow, incomplete recovery over 2020. Cumulative cancer-related services, diagnostic confirmations, and sick leaves were reduced by one third in 2020; the decrease was more pronounced among women and the publicly insured. Early diagnosis was missed in 5132 persons with 4 common cancers. Conclusions. The pandemic stressed the Chilean health system, decreasing access to essential services, with a profound impact on cancer care. Oncology service reductions preceded large-scale lockdowns and supply-side disruptions. Importantly, not all population groups were equally affected, with patterns suggesting that gender and socioeconomic inequalities were exacerbated.

RESUMO Objetivos. Examinar o impacto da pandemia de COVID-19 no acesso a tratamento de câncer no Chile, analisando efeitos diferenciais por tipo de cobertura de assistência à saúde, gênero e idade. Métodos. Realizamos um estudo quase-experimental utilizando análise de séries temporais interrompidas. A partir de várias fontes de dados, efetuamos uma avaliação abrangente da utilização de atenção à saúde relacionada ao câncer, de janeiro de 2017 a dezembro de 2020. Ajustamos modelos binomiais negativos por grupos populacionais a vários tipos de serviços e diagnósticos. Resultados. Uma queda acentuada no uso da assistência médica oncológica em março foi seguida por uma recuperação lenta e incompleta ao longo de 2020. Cumulativamente, a utilização de serviços oncológicos, as confirmações de diagnóstico e os afastamentos do trabalho por doença foram reduzidos em um terço em 2020. Essa redução foi mais pronunciada em mulheres e usuários do sistema público de saúde. No total, 5132 pessoas com 4 cânceres comuns não foram diagnosticadas precocemente. Conclusões. A pandemia impôs pressão sobre o sistema de saúde chileno, reduzindo o acesso a serviços essenciais e causando um profundo impacto no tratamento do câncer. As reduções na prestação de serviços de oncologia precederam os lockdowns em larga escala e as interrupções na oferta de suprimentos. É importante ressaltar que nem todos os grupos populacionais foram igualmente afetados e os padrões observados sugerem que as desigualdades de gênero e socioeconômicas foram exacerbadas.

[Design of a real and perceived academic workload measurement instrument for health care undergraduate students]. / Diseño y validación de un instrumento de medición de la carga académica de estudiantes de carreras de la salud.

BACKGROUND: A high academic workload may have adverse consequences among university students. AIM: To design and validate an instrument to measure both real and perceived academic workload for health care students. MATERIAL AND METHODS: The questionnaire was designed based on a bibliographic revision and the conduction of two focus groups conformed by undergraduate students from a Faculty of Medicine. Afterwards, it was submitted to qualitative pre-tests. The final instrument consists of a self-applied questionnaire with both a characterization section (10 questions) and one concerning academic workload by subject and semester (five and two questions, respectively). A national and international panel of 14 experts evaluated the survey content's validity. The analysis was performed according to the Content Validity Ratio and the Content Validity Index. RESULTS: The complete instrument was validated with an 84% consensus between the judges. Each section of the instrument was approved separately with a 77% and a 94% agreement, respectively. After being individually analyzed by the judges, each question was validated. The wording of questions was improved taking the experts comments into consideration. CONCLUSIONS: The proposed instrument constitutes a contribution for the measurement of real and perceived academic workload for students.

Diseño y validación de un instrumento de medición de la carga académica de estudiantes de carreras de la salud / Design of a real and perceived academic workload measurement instrument for health care undergraduate students

Background: A high academic workload may have adverse consequences among university students. Aim: To design and validate an instrument to measure both real and perceived academic workload for health care students. Material and Methods: The questionnaire was designed based on a bibliographic revision and the conduction of two focus groups conformed by undergraduate students from a Faculty of Medicine. Afterwards, it was submitted to qualitative pre-tests. The final instrument consists of a self-applied questionnaire with both a characterization section (10 questions) and one concerning academic workload by subject and semester (five and two questions, respectively). A national and international panel of 14 experts evaluated the survey content's validity. The analysis was performed according to the Content Validity Ratio and the Content Validity Index. Results: The complete instrument was validated with an 84% consensus between the judges. Each section of the instrument was approved separately with a 77% and a 94% agreement, respectively. After being individually analyzed by the judges, each question was validated. The wording of questions was improved taking the experts comments into consideration. Conclusions: The proposed instrument constitutes a contribution for the measurement of real and perceived academic workload for students.