Infant Mortality in the Metropolitan Region, Chile 2005-2014. / Mortalidad Infantil en las comunas de la Región Metropolitana, periodo 2005-2014.

INTRODUCTION: Infant mortality depends on the economic, social, and cultural level of development of the place of residence. OBJECTIVE: To describe the infant mortality rates (IMR) and the late infant mortality rates (LIMR) of the Metropolitan Region (MR) communes and to evaluate their trend between 2005 and 2014. MATERIAL AND METHOD: Ecological study that describes the rates of the 52 communes of the MR. For the analysis, the IMR and LIMR were elaborated for each year and com mune and were compared using population attributable risk (PAR), attributable risk percent (AR%), and rate ratio (RR). Trends were analyzed through the Prais-Winsten model. A value p < 0.05 was considered a statistically significant trend. RESULTS: The commune 'Independencia' presented the hig hest IMR and LIMR with 12.7 and 4.05 per 1000 live births respectively, 1.75 and 2.05 times more compared with the IMR and LIMR of the MR. The commune 'Las Condes' and 'Vitacura' presented the lowest IMR and LIMR respectively. The IMR trend regarding 2005 increased in Lo Barnechea, Lo Espejo, and Recoleta, and decreased in Las Condes, Macul, Pudahuel and San Bernardo. The LIMR decreased in Peñalolén, Puente Alto, Las Condes, Providencia, San Bernardo, Macul, Pudahuel, Tala- gante, Pedro Aguirre Cerda, and Quilicura, and increased in Peñaflor. CONCLUSION: The regional IMR and LIMR hide the slight increase in rates and the persistence of heterogeneity among communes. This forces us to explore the causes of these inequities through future analytical studies.

[Deaths due to oral cancer in Chile in the period 2002-2012]. / Mortalidad por cáncer oral en Chile, 2002-2012.

BACKGROUND: Oral cancer is the 15th most common cause of cancer death in the world. In Chile, 1% of all cancer deaths are related to oral and pharyngeal cancer. AIM: To determine mortality rates for oral cancer in Chile and its regions between 2002-2012. MATERIAL AND METHODS: Deaths and their causes between the years 2002-2012 were obtained from the Chilean National Statistics Institute. Crude and adjusted rates by age and sex were calculated for the country and its regions. The denominator was Chilean population on June 30, 2012 and the WHO standard population. RESULTS: In the period studied, 1,611 individuals with a mean age of 67.6 years (63% men) died because of oral cancer. The most common location of the tumor was the tongue in 27% of cases and the parotid gland in 16%. The adjusted mortality rate in Chile was 0.85 / 100,000 inhabitants (1.13 and 0.58 in men and women, respectively). The regions with the highest rates were Antofagasta (1.51), Aysén (1.22) and Magallanes (1.17). Deaths among men occurred at younger ages than women. CONCLUSIONS: Mortality rates due to oral cancer in Chile are lower than abroad. The highest rates observed in some regions may be influenced by environmental factors such as arsenic contamination in Antofagasta and the lack of specialists and specialized care centers in Aysén and Magallanes.

Social Inequalities in Mental Health and Self-Perceived Health in the First Wave of COVID-19 Lockdown in Latin America and Spain: Results of an Online Observational Study.

COVID-19 lockdowns greatly affected the mental health of populations and collectives. This study compares the mental health and self-perceived health in five countries of Latin America and Spain, during the first wave of COVID 19 lockdown, according to social axes of inequality. This was a cross-sectional study using an online, self-managed survey in Brazil, Chile, Ecuador, Mexico, Peru, and Spain. Self-perceived health (SPH), anxiety (measured through GAD-7) and depression (measured through PHQ-9) were measured along with lockdown, COVID-19, and social variables. The prevalence of poor SPH, anxiety, and depression was calculated. The analyses were stratified by gender (men = M; women = W) and country. The data from 39,006 people were analyzed (W = 71.9%). There was a higher prevalence of poor SPH and bad mental health in women in all countries studied. Peru had the worst SPH results, while Chile and Ecuador had the worst mental health indicators. Spain had the lowest prevalence of poor SPH and mental health. The prevalence of anxiety and depression decreased as age increased. Unemployment, poor working conditions, inadequate housing, and the highest unpaid workload were associated with worse mental health and poor SPH, especially in women. In future policies, worldwide public measures should consider the great social inequalities in health present between and within countries in order to tackle health emergencies while reducing the health breach between populations.

[Impact of COVID-19 lockdown on self-perceived health in Chile by gender]. / Impacto del confinamiento por la COVID-19 en la salud autopercibida en Chile según género.

OBJECTIVE: To analyse the social factors associated with self-perceived health during the COVID-19 lockdown in the Chilean resident population according to gender perspective. METHOD: Cross-sectional study conducted during the COVID-19 lockdown between May 17 and August 17, 2020 with an online survey. Self-perceived health was analysed in the population aged 18 years or older in relation to social variables. Multivariate logistic regression models were constructed to assess the association between independent variables with self-perceived health, through adjusted odds ratio (aOR). Analyses were stratified by sex (M: men; W: women). RESULTS: 5981 persons were analysed (women: 63.9%). 29.6% of women and 19.2% of men reported poor self-perceived health. In women it worsens with increasing age. Worse self-perceived health was mainly associated with lack of social support (ORa M: 2.05; ORa W: 2.34), concern about living together at home (ORa M: 1.66; ORa W: 1.38), perceived inadequate housing conditions (ORa M: 1.89; ORa W: 2.63), and disagreement with government measures (ORa M: 2.80; ORa W: 1.82). In women, it was also associated with informal work or being inactive in the labour market (ORa: 2.11). In men worse self-perceived health was associated with being self-employed (ORa: 1.65; confidence interval [CI]: 1.11-2.45) and has secondary education (ORa: 2.81; CI: 1.32-5.98). CONCLUSIONS: The social impact of lockdown in self-perceived health is related to gender, age, care work, and socioeconomic conditions, as well as, by disagreement with the measures implemented to manage the pandemic.

Pulmonary tuberculosis infection among workers in the informal public transport sector in Lima, Peru.

BACKGROUND: Because a strong association was observed between pulmonary tuberculosis (TB) and the use of public transport, increasing with duration of journey, a study was carried out to assess infection by Mycobacterium tuberculosis and working conditions among workers in this sector. METHODS: A cross-sectional study was conducted between June and September 2008. A total of 104 workers from two public transport minibus ('combi') cooperatives covering marginal areas of the Ate-Vitarte district in Lima were interviewed. Demographic and occupational details were collected as well as prior family and personal history of TB and BCG vaccination. The tuberculin skin test (TST) was administered to each study subject and an induration of ≥ 10 mm was considered positive. Statistical analysis was based on logistic models, ORs and their 95% CIs. RESULTS: TST results were obtained for 70.2% (n=73), of whom 76.6% (n=56) were positive. Positivity was significantly associated with those who had worked for more than 2 years (crude OR 11.04; 95% CI 3.17 to 38.43) and more than 60 h/week (crude OR 9.8; 95% CI 2.85 to 33.72). These associations remained significant in a multivariate model as well. CONCLUSION: The association observed between years of working and weekly work burden among minibus workers suggests an occupational risk in service jobs in low-income countries with high TB prevalence. Consequently, other types of users are at increased risk for TB infection, with a causal relationship between effect and duration of exposure.

Public transportation and pulmonary tuberculosis, Lima, Peru.

The association between public transportation for commuting and pulmonary tuberculosis (TB) was analyzed in workers in Lima, Peru. Traveling in minibuses was a risk factor for pulmonary TB. Preventive measures need to be taken by health services to prevent spread of this disease.

Caracterización epidemiológica de los nuevos diagnósticos de infección por virus de inmunodeficiencia humana en Chile período 2010-2019

Resumen Introducción: Chile lidera el porcentaje de aumento de nuevas infecciones de VIH en Latinoamérica. Objetivo: Caracterizar los nuevos diagnósticos de infección por VIH/SIDA y describir la evolución de las tasas en las regiones durante el período 2010-2019. Métodos: Diseño ecológico. Se utilizó los casos de infección por VIH/SIDA obtenidos del ISP y las estimaciones de población del INE. Las variables fueron año, sexo, edad, nacionalidad y región. Se describió la muestra en número y porcentajes, se estimó la incidencia y se evaluó la tendencia con el modelo Prais Winsten. Se utilizó Stata V.14 y ArcGis versión 10 en los mapas. Resultados: El 84,3% (38.863/46.125) fueron hombres. La mediana de edad fue 30 y 34 años en hombres y mujeres, respectivamente. La incidencia aumentó hasta el año 2018, y presentó una leve disminución en el 2019. Las tasas aumentaron, en ambos sexos, en todas las edades y regiones. A diferencia de la población nacional, los casos en inmigrantes aumentaron y alcanzaron a 40% en el 2019, evidenciando un franco incremento en adultos jóvenes, con predominio de la nacionalidad venezolana 35,2% y haitiana 22%. La tendencia de las tasas mostró un aumento significativo en hombres y una distribución heterogénea en magnitud en todas las regiones. Conclusiones: Existen cambios en la epidemiología del VIH y especial vulnerabilidad en jóvenes, mujeres, inmigrantes y adultos mayores.

Abstract Background: Chile leads the percentage increase of new HIV infections in Latin America. Aim: To characterize new diagnosis of HIV/AIDS and describe the rates evolution in the regions during the 2010-2019 period. Methods: Ecological design. The HIV/AIDS cases used were obtained from the ISP (Instituto de Salud Pública de Chile) and the population estimates from the INE (Instituto Nacional de Estadísticas). The variables studied were year, sex, age, nationality, and region. The sample was described in numbers and percentages, then, the incidence was estimated and the trend was evaluated with the Prais Winsten model. Stata V.14 and ArcGis version 10 were used for the maps. Results: 84.3% (38,863/46,125) were men. The median for age were 30 and 34 years for men and women, respectively. The incidence increased until 2018 and showed a slight decrease in 2019. The rates increased for both sexes and all ages. Unlike the national population, immigrant's cases increased and reached 40% in 2019, with a frank increase in young adults, with a predominance for Venezuelan (35,2) and Haitian (22%) nationals. According to region, all the samples showed a rate increase with a heterogeneous distribution in statistically significant magnitude in men. Conclusions: There are changes in the epidemiology of HIV and special vulnerability in young people, women, immigrants and the elderly.

Mortalidad Infantil en las comunas de la Región Metropolitana, periodo 2005-2014 / Infant Mortality in the Metropolitan Region, Chile 2005-2014

Resumen: Introducción: La mortalidad infantil depende del nivel de desarrollo económico, social y cultural del área de residencia. Objetivo: Describir las tasas de mortalidad infantil (TMI) y mortalidad infantil tardía (TMIT) de las comunas de la Región Metropolitana (RM) y evaluar su tendencia en el perio do 2005-2014. Material y Método: Estudio ecológico que describe las tasas en las 52 comunas de la Región Metropolitana (RM). Para el análisis se construyó la TMI y TMIT para cada año y comuna y se compararon mediante riesgo atribuible poblacional (RAP), Riesgo atribuible porcentual (RAP%) y razón de tasas (RT). Las tendencias se evaluaron con el modelo Prais-Winsten. Se consideró una tendencia estadísticamente significativa un valor p < 0,05. Resultados: La comuna de Independencia mostró la TMI y TMIT más altas con 12,7 y 4,05 por mil RNV respectivamente; 1,75 y 2,05 veces comparado con la TMI y TMIT de la RM. Las tasas más bajas se observaron en Las Condes (TMI) y en Vitacura (TMIT). La tendencia de la TMI respecto al 2005 aumentó en Lo Barnechea, Lo Espejo y Recoleta y disminuyó en Las Condes, Macul, Pudahuel y San Bernardo. La TMIT disminuyó en Peñalolén, Puente Alto, Las Condes, Providencia, San Bernardo, Macul, Pudahuel, Talagante, Pedro Aguirre Cerda y Quilicura y aumentó en Peñaflor. Conclusión: La TMI y la TMIT regional ocultan el leve incremento de las tasas y la persistencia de la heterogeneidad entre las comunas, lo que obliga a explorar las causas de estas inequidades en estudios analíticos a futuro.

Abstract: Introduction: Infant mortality depends on the economic, social, and cultural level of development of the place of residence. Objective: To describe the infant mortality rates (IMR) and the late infant mortality rates (LIMR) of the Metropolitan Region (MR) communes and to evaluate their trend between 2005 and 2014. Material and Method: Ecological study that describes the rates of the 52 communes of the MR. For the analysis, the IMR and LIMR were elaborated for each year and com mune and were compared using population attributable risk (PAR), attributable risk percent (AR%), and rate ratio (RR). Trends were analyzed through the Prais-Winsten model. A value p < 0.05 was considered a statistically significant trend. Results: The commune 'Independencia' presented the hig hest IMR and LIMR with 12.7 and 4.05 per 1000 live births respectively, 1.75 and 2.05 times more compared with the IMR and LIMR of the MR. The commune 'Las Condes' and 'Vitacura' presented the lowest IMR and LIMR respectively. The IMR trend regarding 2005 increased in Lo Barnechea, Lo Espejo, and Recoleta, and decreased in Las Condes, Macul, Pudahuel and San Bernardo. The LIMR decreased in Peñalolén, Puente Alto, Las Condes, Providencia, San Bernardo, Macul, Pudahuel, Tala- gante, Pedro Aguirre Cerda, and Quilicura, and increased in Peñaflor. Conclusion: The regional IMR and LIMR hide the slight increase in rates and the persistence of heterogeneity among communes. This forces us to explore the causes of these inequities through future analytical studies.

Mortalidad por cáncer oral en Chile, 2002-2012 / Deaths due to oral cancer in Chile in the period 2002-2012

Background: Oral cancer is the 15th most common cause of cancer death in the world. In Chile, 1% of all cancer deaths are related to oral and pharyngeal cancer. Aim: To determine mortality rates for oral cancer in Chile and its regions between 2002-2012. Material and Methods: Deaths and their causes between the years 2002-2012 were obtained from the Chilean National Statistics Institute. Crude and adjusted rates by age and sex were calculated for the country and its regions. The denominator was Chilean population on June 30, 2012 and the WHO standard population. Results: In the period studied, 1,611 individuals with a mean age of 67.6 years (63% men) died because of oral cancer. The most common location of the tumor was the tongue in 27% of cases and the parotid gland in 16%. The adjusted mortality rate in Chile was 0.85 / 100,000 inhabitants (1.13 and 0.58 in men and women, respectively). The regions with the highest rates were Antofagasta (1.51), Aysén (1.22) and Magallanes (1.17). Deaths among men occurred at younger ages than women. Conclusions: Mortality rates due to oral cancer in Chile are lower than abroad. The highest rates observed in some regions may be influenced by environmental factors such as arsenic contamination in Antofagasta and the lack of specialists and specialized care centers in Aysén and Magallanes.

[Salmonella's transmission from turtle to child: public health nursing experience about a new case]. / Transmisión de Salmonella entre tortugas y niños: experiencia de la enfermería de salud pública a propósito de un caso.

Salmonellosis is usually related to food poisoning however other possible causes such as reptile exposure are often unrecognised. The aim of this study is to describe a case of salmonella infection related to pet exposure. After a salmonella infection in an eleven month old baby was reported to our public health agency, an epidemiological investigation took place. Despite all family members had had clinical symptoms suggesting salmonella infection none of the microbiological analysis was positive. At the infant's home they had an exotic pet: a turtle. We found out that Salmonella was present in a sample of water of its aquarium. Both profiles of S. parathyphi B (from the infant and from the aquaria samples) were identical. Exotic pets are not often recognized as Salmonella infection carriers and vehicles in Europe. As described in this study, an inaccurate hygiene after touching turtles or its habitat can lead to spread salmonella infection in humans. When investigating Salmonella infection exposure to exotic pets has to be addressed. People that have or wish to have a turtle or any other reptile should be informed about its risks. Nursing role is most important in the surveillance and study of such cases.

Factors associated with the non-completion of conventional anti-tuberculosis treatment in Peru.

BACKGROUND: The non-adherence to tuberculosis treatment is associated with increased infection, antibiotic resistance, increased costs and death. Our objective was to identify factors associated with lack of completion of conventional treatment for tuberculosis in Peru. PATIENTS AND METHODS: An unmatched case-control study in patients diagnosed with tuberculosis from 2004-2005 who completed treatment until September 2006. The cases were defined as patients who discontinued treatment for ≥30 consecutive days, while the controls were defined as those who completed treatment without interruption. The factors were identified by logistic regression, calculating odds ratios (OR) and 95% confidence intervals (CI). RESULTS: We studied 265 cases and 605 controls. The non-adherence to treatment in our study was associated with the male sex (OR=1.62; CI: 1.07-2.44), having felt discomfort during treatment (OR=1.76; CI: 1.19-2.62), a prior history of non-compliance (OR=7.95; CI: 4.76-13.27) and illegal drug use (OR=3.74; CI: 1.25-11.14). Also, if we consider the interaction of previous non-adherence history and poverty, the risk of non-completion increases (OR=11.24; CI: 4-31.62). Conversely, having been properly informed about the disease (OR=0.25; CI: 0.07-0.94) and being able to access health-care services within office hours (8 am-8 pm) (OR=0.52; CI: 0.31-0.87) were associated with better adherence. CONCLUSIONS: The non-compliance with anti-tuberculosis treatment was associated with non-modifiable factors (male sex, previous non-compliance) and with others whose control would improve compliance (malaise during treatment, illegal drug use and poverty). Likewise, providing access to the health-care system and improving the information given about tuberculosis should be priorities.