Visión respecto a la legislación laboral chilena, desde sujetos en situación de discapacidad con participación política / Vision regarding chilean labor legislation, from subjects in disability situation with political participation

La presente investigación aborda la temática “Discapacidad y legislación laboral chilena”, con el propósito de incorporar en el análisis la visión de sujetos en situación de discapacidad con experiencia organizativa y orientados a la acción política. El objetivo es analizar la visión respecto a la legislación laboral actual chilena desde sujetos en situación de discapacidad que participan activamente en política, pertenecientes al Colectivo Palos de Ciego durante el año 2014. Se utiliza una metodología participativa con enfoque cualitativo, orientada a la emancipación y con perspectiva etnográfica. La recolección de información se realiza a partir de la observación participante, notas de campo y entrevistas en profundidad. El análisis de la información se realiza mediante codificación abierta. Los resultados se estructuran a partir de tres ejes temáticos: visión política de la legislación laboral, limitantes percibidas y propuestas de transformación respecto de la inclusión laboral chilena. La problemática central tiene relación con la lógica dominante bajo la cual el Estado actúa de manera subsidiaria, no reconociendo los Derechos inherentes de los sujetos en situación de discapacidad. Los miembros del Colectivo proponen estrategias de transformación de orden político, con incidencia en aspectos globales y de acción política directa, destacándose la importancia de concientizar a la sociedad respecto a la comprensión de la discapacidad como problema político. Finalmente, se expresa el desafío de ampliar la Terapia Ocupacional al ámbito político, orientando la participación del profesional en los procesos de lucha política de los sujetos en situación de discapacidad.

This research is framed in the thematic “Disability and Chilean labor legislation” with the purpose of incorporating the vision of the subjects in disability situation with experience and political action. The aim of this research is to analyze the political vision regarding the current Chilean labor legislation, from the subjects in disability situation belonging to the group “Palos de ciego” during 2014. A participatory methodology with qualitative focusing is used, oriented to emancipation, with ethnographic perspective. Data gathering is from participant observation, field notes, and in-depth interviews. The analysis of information is done through open coding. Results are structured from three thematic axes: political vision of the labor legislation, limitations and proposals of transformation of the Chilean labor inclusion. The central issue is related to the dominant logic, under which the state acts on a subsidiary basis, not recognizing the inherent rights of the subjects in disability situation. The group proposes strategies of transformation of political order, with incidence in global and specific aspects, standing out the importance of awareness in society regarding compression of disability as a political problem. Finally, is expressed the challenge of enlarge occupational therapy to a political scope, encouraging the professional’s participation in the processes of political struggle of the subjects in situation of disability, as well as political participation thereof.

Treatment of childhood acute lymphoblastic leukemia in central America: a lower-middle income countries experience.

BACKGROUND: Five Asociación de Hemato-Oncología de Centroamérica (AHOPCA) countries have used an adapted BFM-based protocol for childhood acute lymphoblastic leukemia (ALL). PROCEDURE: In the AHOPCA-ALL 2008 protocol, patients were stratified by age, white blood cell count, immunophenotype, central nervous system involvement, day 8 prednisone response, and morphologic bone marrow response to induction therapy. Patients at Standard Risk (SR) received a three-drug induction regimen, a reinduction phase, and maintenance with protracted intrathecal therapy. Those at Intermediate (IR) and High Risk (HR) received, in addition, daunorubicin during induction therapy, a consolidation phase and two or three reinduction phases respectively. RESULTS: From August 2008 through July 2012, 1,313 patients were enrolled: 353 in SR, 548 in IR, 412 in HR. During induction therapy, 3.0% of patients died, 2.7% abandoned treatment, 1.1% had resistant ALL, and 93.2% achieved morphological complete remission (CR). Deaths and abandonment in first CR occurred in 2.7% and in 7.0% of patients, respectively. The relapse rate at a median observation time of 2.1 years was 15.0%. At 3 years, the event-free survival (EFS) and overall survival (OS), with abandonment considered as an event, were 59.4% (SE 1.7) and 68.2% (SE 1.6). Three-year EFS was 68.5% (SE 3.0), 62.1% (SE 2.6), and 47.8% (SE 3.2) for SR, IR, and HR groups. Adolescents had a significantly higher relapse rate (P = 0.001). CONCLUSIONS: This experience shows that common international studies are feasible in lower-middle income countries. Toxic deaths, abandonment of treatment, and relapses remain major obstacles to the successful treatment. Alternative treatment strategies may be beneficial.

Cost-benefit analysis for the use of Haemophilus influenzae type b conjugate vaccine in Santiago, Chile.

Cost-benefit analyses can be integral to the evaluation of interventions in developing countries. The authors compare the potential benefits to the Chilean Ministry of Health, in terms of treatment costs averted, by prevention of Haemophilus influenzae type b (HIB) invasive disease, with the costs of adding HIB conjugate vaccine to the diphtheria-tetanus-pertussis (DTP) immunization routinely administered to infants. In their basecase model, over a 10-year period (1991-2000), vaccination against HIB will prevent 1,229 cases of HIB invasive disease, including 713 cases of meningitis, 107 of whom would suffer severe, long-term sequelae, and between 29 and 116 deaths. Assuming a cost of US$1 for a full three-dose regimen of vaccine, the benefit/cost ratio of 1.66, with a net discounted savings of over $403,225, illustrates that HIB vaccine can be cost-beneficial. Sensitivity analyses which alter each of the variables in the analysis indicate that if the true incidence of HIB disease is twice the published rate, then three doses of vaccine remains cost-beneficial at US#3.

PIP: Health practitioners reviewed the clinical records of all 6-60 month old children who were treated for meningitis caused by Haemophilus influenzae type b (HIB) in 1989-1990 at Roberto del Rio Children's Hospital in Santiago, Chile, to estimate costs for all phases of meningitis treatment (ambulatory visits, hospitalization, and follow-up). They also estimated annual HIB incidence. They determined the cost of adding HIB conjugate vaccine to the DTP vaccine. They assumed a cost of US$1 for a full 3-dose regimen of vaccine. They then conducted a cost benefit analysis of the use of HIB conjugate vaccine to prevent invasive HIB disease in Santiago. The National Health Service had to pay an average of US$1301/case of HIB meningitis and US$887/case of HIB invasive disease other than meningitis, including pre- and post-hospitalization costs and adjustment for frequency of sequelae. Several factors indicated that the estimates were actually underestimates. For example, the researchers did not take into account herd immunity and the fact that sequelae often do not appear until the children are older. The addition of the HIB conjugate vaccine to the immunization program would prevent at least 1229-3111 cases of HIB invasive disease, disabling sequelae, and deaths during a 10-year period. Further, it would save the National Health Service more than US$403,225. The benefit/cost ratio was 1.66. The researchers changed each of the variables in the cost benefit analysis. These sensitivity analyses revealed that if the true incidence of HIB disease were 2 times greater than the based on reported data, the 3 doses of HIB conjugate vaccine would still have a cost benefit of US$3. These results indicated that adding HIB conjugate vaccine would exert a considerable public health and cost benefit. Cost benefit analyses of vaccines would also prove useful to decision-makers in other developing countries.