RESUMO
BACKGROUND: The association of cardiovascular diseases with socio-demographic factors has not been fully explored. AIM: To analyze the association of socio-demographic features with the survival time of individuals who died due to cardiovascular diseases. MATERIAL AND METHODS: The death registries published by the Ministry of Health were analyzed. All deaths due to cardiovascular diseases occurred between 2001 and 2013 in people aged over one year were considered. Using a principal component analysis, the age at death was associated with socio-demographic features such as sex, marital status, residence zone, schooling, work status and medical care prior to death. RESULTS: A total of 293,370 cardiovascular deaths were analyzed. The median age at death was 77 years. Not receiving medical care prior to death, was significantly associated with a lower age at the moment of the decease, mainly between 20 and 80 years of age. Among men, being occupationally active (hazard ratio (HR = 1.5 p < 0.01) and being unemployed (HR = 1.1 p < 0.01) were risks factors for early cardiovascular death. Being married, having higher schooling, residing in urban areas and having prior medical care were associated with a higher age at the moment of decease. CONCLUSIONS: Socio-demographic profiles are associated with the age at death due to cardiovascular diseases. The effect of not receiving medical care on the age at death is noteworthy and reflects social inequities in the access to health care.
Assuntos
Doenças Cardiovasculares/mortalidade , Adolescente , Adulto , Distribuição por Idade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Criança , Pré-Escolar , Chile , Feminino , Disparidades em Assistência à Saúde , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Fatores de Risco , Distribuição por Sexo , Fatores Socioeconômicos , Fatores de Tempo , Adulto JovemRESUMO
BACKGROUND: Emergency contraception refers to contraceptive methods that can be used after a sexual intercourse Aim: To analyze the evolution of emergency contraception (EC) consultations on the Chilean public health system, at a communal level, in relation to the legal changes that recently took place, aimed to ease the delivery of the benefit. To analyze its association with socioeconomic, demographic and municipal healthcare system characteristics. MATERIAL AND METHODS: We analyzed data bases of the Ministry of Health to study EC consultation rates on Chilean communes, including consultations on emergency departments and by rape, from 2008 to 2013. We evaluated the association with communal characteristics, obtained from the National Municipal Information System. RESULTS: Both the communal consultation rates and percentage of communes with consultations increased progressively during the period, with an explosive increase between 2009 and 2010. We observed a high dispersion in EC consultations both at a communal and regional level. There was an inverse significant association of the number of consultations with the communal poverty rate. CONCLUSIONS: Our results reveal the impact of legal modifications implemented in Chile since 2009 on the communal EC consultation rates. On other hand, our results reveal that although these modifications were oriented to favor the delivery of this benefit, a high dispersion subsists, associated with populations socioeconomic factors, mainly, the communal poverty level.
Assuntos
Anticoncepção Pós-Coito/estatística & dados numéricos , Atenção à Saúde/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Adolescente , Adulto , Criança , Chile , Anticoncepção Pós-Coito/tendências , Atenção à Saúde/legislação & jurisprudência , Feminino , Humanos , Estudos Longitudinais , Pobreza/estatística & dados numéricos , Estupro/estatística & dados numéricos , Encaminhamento e Consulta/tendências , Estudos Retrospectivos , Fatores Socioeconômicos , Adulto JovemRESUMO
INTRODUCCIÓN Y OBJETIVOS El embarazo adolescente es un problema de salud pública mundial. En Chile no se ha estudiado su asociación a desigualdad y determinantes sociales. Se evaluó la distribución del embarazo adolescente, cuantificó su desigualdad y analizaron los factores socioeconómicos, demográficos y del sistema de salud municipal asociados, por comunas chilenas. Método Se estudió el porcentaje de nacidos vivos de mujeres de 10 a 19 años y la tasa de fertilidad adolescente, por comunas chilenas desde 2008 a 2012. Se midieron los indicadores de desigualdad Gini, Theil, Coeficiente de variación y Razón 90/10. Se evaluó la asociación de la tasa de fertilidad adolescente a características comunales con modelos de datos de panel. Resultados Se observó una disminución en la mediana del embarazo adolescente comunal, con un leve aumento en los indicadores de desigualdad medidos. La fertilidad adolescente se asoció a una mayor dependencia de los recursos municipales a un fondo de redistribución (p<0.01), menor gasto en salud municipal per cápita (p<0.05) y menor tasa de consultas por anticoncepción de emergencia (p<0.05 o p<0.1, dependiendo del modelo). En algunos modelos, se encontró asociación directa a pobreza (p<0.01) y años de vida perdidos (AVPP) (p<0.01), e indirecta a años de escolaridad promedio (p<0.05). Conclusiones Existe una asociación a características socioeconómicas y del sistema de salud municipal que permite proponer una tendencia al alza en la desigualdad en embarazo adolescente, profundizando la desigualdad de oportunidades y la transmisión intergeneracional de la pobreza.
ABSTRACT Introduction and objectives Teen pregnancy is a worldwide public health problem. In Chile, its association to social determinants and inequality has not been well studied. Our objective was to evaluate teen pregnancy distribution, quantify inequality and analyze associated socioeconomic, demographic and municipal health factors, by Chilean communes. Methods We studied the percentage of live births from woman 10 to 19 years old and adolescent fertility rate, from 2008 to 2012, in the 345 communes of Chile. We measured inequality through four indicators: Gini, Theil, Variation coefficient and 90/10 ratio. Using panel data models, we evaluated association of adolescent fertility rate to communes' characteristics. Results We observed a decrease in the communal teen pregnancy median, with a mild raise in inequality indicators. Adolescent fertility was heavily associated to a greater dependence in municipal resources to a redistribution fund (p<0.01), less expense in municipal healthcare per capita (p<0.05) and less emergency contraception consultations rate (p<0.05 or p<0.1, depending on the model built). In some models, we found a direct association to poverty (p<0.01) and years of life lost (YLL) (p<0.01), and indirect to average schooling years (p<0.05). Conclusions Association found to socioeconomic and municipal health characteristics allows proposing that inequality in teen pregnancy by communes in Chile will continue increasing, deepening inequality of opportunity and intergenerational transmission of poverty.
Assuntos
Humanos , Feminino , Criança , Adolescente , Gravidez na Adolescência , Saúde da Mulher , Nascido Vivo , Gravidez na Adolescência/prevenção & controle , Atenção Primária à Saúde , Fatores Socioeconômicos , Chile , Estudos Retrospectivos , Comportamento do Adolescente , Fertilidade , Estudo ObservacionalRESUMO
Background: The association of cardiovascular diseases with socio-demographic factors has not been fully explored. Aim: To analyze the association of socio-demographic features with the survival time of individuals who died due to cardiovascular diseases. Material and Methods: The death registries published by the Ministry of Health were analyzed. All deaths due to cardiovascular diseases occurred between 2001 and 2013 in people aged over one year were considered. Using a principal component analysis, the age at death was associated with socio-demographic features such as sex, marital status, residence zone, schooling, work status and medical care prior to death. Results: A total of 293,370 cardiovascular deaths were analyzed. The median age at death was 77 years. Not receiving medical care prior to death, was significantly associated with a lower age at the moment of the decease, mainly between 20 and 80 years of age. Among men, being occupationally active (hazard ratio (HR = 1.5 p < 0.01) and being unemployed (HR = 1.1 p < 0.01) were risks factors for early cardiovascular death. Being married, having higher schooling, residing in urban areas and having prior medical care were associated with a higher age at the moment of decease. Conclusions: Socio-demographic profiles are associated with the age at death due to cardiovascular diseases. The effect of not receiving medical care on the age at death is noteworthy and reflects social inequities in the access to health care.
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Doenças Cardiovasculares/mortalidade , Fatores Socioeconômicos , Fatores de Tempo , Chile , Análise de Regressão , Fatores de Risco , Causas de Morte , Fatores Etários , Distribuição por Sexo , Distribuição por Idade , Disparidades em Assistência à SaúdeRESUMO
Background: Emergency contraception refers to contraceptive methods that can be used after a sexual intercourse Aim: To analyze the evolution of emergency contraception (EC) consultations on the Chilean public health system, at a communal level, in relation to the legal changes that recently took place, aimed to ease the delivery of the benefit. To analyze its association with socioeconomic, demographic and municipal healthcare system characteristics. Material and Methods: We analyzed data bases of the Ministry of Health to study EC consultation rates on Chilean communes, including consultations on emergency departments and by rape, from 2008 to 2013. We evaluated the association with communal characteristics, obtained from the National Municipal Information System. Results: Both the communal consultation rates and percentage of communes with consultations increased progressively during the period, with an explosive increase between 2009 and 2010. We observed a high dispersion in EC consultations both at a communal and regional level. There was an inverse significant association of the number of consultations with the communal poverty rate. Conclusions: Our results reveal the impact of legal modifications implemented in Chile since 2009 on the communal EC consultation rates. On other hand, our results reveal that although these modifications were oriented to favor the delivery of this benefit, a high dispersion subsists, associated with populations socioeconomic factors, mainly, the communal poverty level.
Assuntos
Humanos , Feminino , Criança , Adolescente , Adulto , Adulto Jovem , Encaminhamento e Consulta/estatística & dados numéricos , Atenção à Saúde/estatística & dados numéricos , Anticoncepção Pós-Coito/estatística & dados numéricos , Pobreza/estatística & dados numéricos , Estupro/estatística & dados numéricos , Encaminhamento e Consulta/tendências , Fatores Socioeconômicos , Chile , Estudos Retrospectivos , Estudos Longitudinais , Atenção à Saúde/legislação & jurisprudência , Anticoncepção Pós-Coito/tendênciasRESUMO
Introducción: las enfermedades musculoesqueléticas tienen elevada prevalencia y alto impacto socio económico sobre el bienestar de la población y la productividad económica de un país. En Chile, este grupo de patologías constituyen la principal causade enfermedades profesionales y con mayores tasas anuales de licencias médicas laborales, aún cuando se considera que estas enfermedades, en la actualidad, estarían siendo subnotificadas. Independiente del origen de la enfermedad, el dolor y la impotencia funcional son los principales síntomas en este grupo de patologías, al conducir el diagnóstico y tratamiento y guiar la indicación de reposo y reintegro laboral. En su fisiopatología interactúanfrecuentemente una serie de riesgos personales y ambientales, entre los que se encuentran factores de riesgo laborales, siendo reconocidas algunas de estas patologías entre el listado deenfermedades profesionales de la Organización Internacional del Trabajo. Sin intención de saldar el debate sobre el origen de este grupo de patologías, sino con el fin de aportar evidencia ala discusión sobre la compleja interacción entre sus factores de riesgo, presentamos una revisión bibliográfica sobre enfermedades osteomusculares observadas con frecuencia en la población. Metodología: Se seleccionaron 11 patologías musculoesqueléticas de diagnóstico frecuente en población económicamente activa y que generan ausentismo laboral: Cervicalgia, Dorsalgia, Epicondilitis, Lumbago Mecánico, Quiste Sinovial, Tendinitis Aquiliana, TendinitisBicipital, Tendinitis del Manguito Rotador, Tendinitis Rotuliana, Tenosinovitis de De Quervain, Síndrome del Túnel Carpiano. Se realizó una revisión de la literatura registrada en las principales bases de datos a nivel internacional y una búsqueda manual de estudios referenciados en los artículos principales...
Introduction: musculoskeletal diseases have highprevalence and socioeconomic impact on populationswellbeing and countries economic productivity. In Chile,this group of pathologies constitute the main cause ofprofessional diseases, with the highest working leaveperiods annual rate, even though it is considered that thisdiseases are being subnotified. Independent of diseaseorigin, pain and functional impotence are main symptomson this group of pathologies, conducting its diagnosis andtreatment, and guiding the indication of rest and return towork. In its pathophysiology several personal and ambientrisks interact, with occupational risk factors in-between,being some of the diseases recognized on the InternationalWork Organizations list of Professional Diseases. Withoutintention of settle the debate about the origin of thisgroup of diseases, but with intention of contribute withevidence to the discussion of the complex interactionbetween its risk factors, we present a bibliographic reviewof musculoskeletal diseases observed with frequency.Methodology: 11 musculoskeletal diseases of frequentdiagnosis on economically active population that produceworking absenteeism were selected: Cervicalgia, Dorsalgia,Epicondylitis, Low back pain, Synovial Cyst, AchillesTendinitis, Bicipital Tendinitis, Rotator Cuff Tendinitis,Patellar Tendinitis, De Quervain Tenosynovitis and CarpalTunnel Syndrome. A literature review registered on maininternational databases was performed, and a manualsearch of studies cited on main articles...
Assuntos
Humanos , Doenças Musculoesqueléticas/epidemiologia , Dor Musculoesquelética/epidemiologia , Saúde Ocupacional , Doenças Musculoesqueléticas/complicações , Dor Musculoesquelética/etiologia , Fatores de RiscoRESUMO
Introducción: El cáncer cobra cada vez más relevancia en elperfil epidemiológico de los países desarrollados o en altas vías dedesarrollo, siendo el dolor el síntoma más frecuente y limitante,especialmente en estadíos avanzados. El dolor neuropático revisteespecial importancia en estos pacientes, debido a las diferenciasy dificultad de su manejo, su severidad y asociación a mayordeterioro en la calidad de vida. En Chile se ha estimado unaprevalencia 8,5% de dolor neuropático en pacientes ingresadosal Programa de Alivio del Dolor y Cuidados Paliativos por cánceravanzado. Este Programa ha sido evaluado exitosamente en elalivio del dolor previo al fallecimiento, sin distinción por tipo dedolor. El presente trabajo evalúa la eficacia de este programa enel alivio del dolor neuropático puro o combinado, y analiza losfactores asociados a su mejoría.Materiales y métodos: Estudio cuantitativo, observacional ylongitudinal sobre la mejoría del dolor, cuantificado según la EscalaVisual Análoga, obtenida entre el ingreso y el fallecimiento de lospacientes atendidos en Programa de Alivio del Dolor y CuidadosPaliativos por cáncer avanzado de Chile, entre los años 1995 a 2009.Se evaluó además, la asociación a variables clínicas y demográficas,mediante análisis de correspondencia y regresión logística, y serealizó un análisis del tiempo de sobrevida en el programa.Resultados: 8,5% (n=306) de los pacientes presentaron dolorneuropático puro o combinado. El 43,1% (n=132) correspondióa dolor somático-neuropático. Las principales localizacionesneoplásicas encontradas fueron: broncopulmonar, mama y cáncercerebral. 75,8% (n=232) vio disminuida su capacidad funcional.La mediana de sobrevida fue de 3 meses desde el ingreso...
Introduction: Every moment cancer takes more relevance on the epidemiologic profile of developed or in high developing countries, being pain the most frequent and limiting symptom, especially on advanced stages. Neuropathic pain is of special importance in this patients, because differences and difficulty on its management, its severity and higher association to a deterioration on life quality. In Chile, a prevalence of 8,5 percent on neuropathic pain has been estimated on patients admitted to the Pain Relief and Palliative Care by Advanced Cancer Program. This program has been evaluated as successful on pain relief before death, without differences by pain type. Our work aims to evaluate this programs efficacy on relief of neuropathic pain (pure or combined), and to analyze factors associated to itsimprovement. Materials and methods: Quantitative, observational and longitudinal study of pain improvement, quantified by the Analog Visual Scale (AVS), obtained at admission and death of patients attended on the Pain Relief and Palliative Care by Advanced Cancer Program of Chile, between years 1995 to 2009. We also evaluated the association to clinical and demographic variables, through a correspondence analysis and logistic regression. We also analyzed survival in time in the program. Results: 8,5 percent (n=306) of patients presented pure or combined neuropathic pain. 43,1 percent (n=132) corresponded to somaticneuropathic pain. Main neoplastic localizations identifies were: bronchopulmonary, breast and brain cancer. 75,8 percent (n=232) had a detriment on its functional capacity...
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Neoplasias/epidemiologia , Neuralgia/epidemiologia , Neuralgia/terapia , Chile/epidemiologia , Estudos Longitudinais , Neoplasias/complicações , Estudos Observacionais como Assunto , Medição da Dor , Cuidados Paliativos , Índice de Gravidade de Doença , Análise de SobrevidaRESUMO
Introducción: se define dolor pélvico como aquél que se presenta en la región abdominal baja o pélvica, que puede ser agudo o crónico, y representa un frecuente motivo de consulta y hospitalización ginecológica. Mientras la valoración del dolor pélvico agudo está orientada a disminuir el riesgo de morbimortalidad a través de su identificación etiológica oportuna, en el caso del dolor pélvico crónico aún existe controversia respecto de su definición y criterios de inclusión etiológicos. Si bien existen amplias variaciones en las estimaciones de prevalencia de dolor pélvico, existe consenso que el dolor pélvico crónico tiene importantes repercusiones, tanto a nivel individual como del sistema de salud. En Chile no existen estudios que hayan cuantificado la prevalencia de dolor pélvico. Se presenta una descripción demográfica y epidemiológica de los egresos hospitalarios por dolor pélvico de causa ginecológica en Chile, desde los años 2001 al 2012, con el fin de aportar cifras iniciales sobre la magnitud de esta problemática de salud de la mujer. Materiales y métodos: Estudio descriptivo del universo de egresos hospitalarios por dolor pélvico en mujeres de 12 años y más, ocurridos en Chile entre los años 2001 y 2012, a partir de las bases de datos nacionales del Ministerio de Salud de Chile. Se seleccionaron los códigos CIE-10, correspondientes a dolor pélvico y perineal, y dolor relacionado con órganos genitales femeninos y con el ciclo menstrual. A partir de las variables disponibles, se realizó un análisis descriptivo sociodemográfico y epidemiológico, realizando inferencia estadística con nivel de significancia de 5%...
Introduction: pelvic pain is defined as the one presenting in lower abdomen or pelvis, which may be acute or chronic, and it represents a frequent reason for gynecologic consultations and hospitalization. While acute pelvic pain valuation is oriented to diminish morbidity and mortality through its opportune etiological identification, in chronic pelvic pain, there is still controversy about its definition and optimal inclusion criteria. While there are wide variations in prevalence estimates of pelvic pain, there is consensus in that chronic pelvic pain has important effects at an individual and health system level. In Chile there are not studies that quantify pelvic pain prevalence. Our work presents a demographic and epidemiological description of hospital discharges by gynecological pelvic pain in Chile, from 2001 to 2012, in order to provide initial figures on the extent of this health issue in women. Materials and methods: Descriptive study of hospital discharges by pelvic pain in women 12 years old and older in Chile between 2001 and 2012, from the national databases of the Chilean Health Ministry. We selected ICD-10 codes corresponding to pelvic and perineal pain, and pain related to female genitalia and the menstrual cycle. With the available variables, we made a sociodemographic and epidemiological analysis, conducting statistical inference with a significance level of 5%...