Accessibility in People with Disabilities in Primary Healthcare Centers: A Dimension of the Quality of Care.

The purpose of this research is to evaluate universal accessibility in primary healthcare (PHC) centers in the Atacama region, Chile, through an analytical cross-sectional study with a quality approach, which uses the external audit model with the application of a dichotomous comparison guideline, evaluating levels of compliance with four dimensions of universal accessibility described in the literature: participation, information, accessibility chain and architectural aspects. This was carried out in 18 PHC, and set as Lower Control Limit (LCL) of 70% to compare levels of compliance, and a hierarchical model and k-mean analysis were applied. Results: Very low compliance averages were obtained, 37.7% participation, 4% information, 44.4% access chain, and 63.9% architectural aspects, indicating a critical situation. Moreover, the cluster comparison allowed to observe that a group of healthcare centers complies more than other groups, which requires more attention. Conclusions: The low level of accessibility for people with disabilities may be associated with various factors that require further monitoring and analysis. However, low levels of accessibility require changing the way of relating to this vulnerable group of the population, and considering including them in the design and reasonable adjustments made in PHC centers. The findings from this research open the possibility for future research that increases understanding of how to reduce barriers in a such wide variety of forms of disability.

Characterization of Communes with Quality Accredited Primary Healthcare Centers in Chile.

The accreditation process of primary healthcare centers in Chile has not had the same progress as in hospitals, which show high levels of compliance. The purpose of this research is to characterize the communes that have accredited family healthcare centers (CESFAMs) through socio-economic, municipal management, clinical management, and population variables by performing a principal components analysis (PCA) with biplot analysis and a grouping of communes through a hierarchical analysis. The biplot analysis and hierarchical analysis yielded the formation of three large groups of communes with accredited CESFAMs, characterized mainly by population size, number of people registered in the municipal health system, socioeconomic indicators, and financial management and clinical management variables. It was found that the communes that have accredited CESFAMs are characterized by dissimilar behavior in relation to the variables analyzed. Through the model used, it was possible to establish at least three groups of communes according to their behavior against these variables. Of these, the variables of a municipal financial nature were not decisive in achieving the accreditation of the CESFAMs of these communes. Therefore, it is possible that there are other variables or factors that could be facilitating the achievement of accreditation processes.

Evolution of infant mortality in Chile and how it has been reflected in scientific publications between 1980 and 2019. / Evolución de la mortalidad infantil en Chile y su reflejo en las publicaciones científicas entre 1980 y 2019.

INTRODUCTION: One of the Millennium Development Goals is to reduce the child mortality rate (CMR), an indicator still present in the Sustainable Development Goals (2015-2030). At the same time, scientific investigations and reports were necessary to assess the behavior of the infant mortality rate (IMR) and the effectiveness of interventions to approach it. OBJECTIVE: To describe IMR behavior in Chile and how it has been reflected in the scientific publications made in the 1980-2019 period. MATERIAL AND METHODS: Implementation of the multivariate adaptive regression spline (MARS) method in relation to IMR between 1980 and 2016, and search for related articles published between 1980 and 2019 in SciELO, Lilacs, PubMed, Cochrane Library, and Embase. The analysis included IMR behavior and its reflection in the publications made in that period. RESULTS: IMR decreased from 28 % to 7.2 % per 1000 live births between 1980 and 2016 (-74 %) and 82 publications were identified in this period. Two types of studies about IMR were reported as of the cutoff point of 1996. In the first period, studies focused on preventable diseases and interventions, while IMR showed a slowing down in its reduction. After the cutoff point, studies focused on non-preventable diseases and factors related to inequalities and inequities. CONCLUSIONS: IMR prevails as a synthetic indicator of health conditions. Changes in its evolution and causes have been reflected in publications, which have shifted their focus and areas of interest in accordance with the changes in this indicator.

Introducción. Los Objetivos de Desarrollo del Milenio incluyen la reducción de la tasa de mortalidad infantil (TMI), indicador que sigue vigente en las metas de los Objetivos de Desarrollo Sostenible (2015-2030). En paralelo, se requirieron investigaciones y reportes científicos para evaluar el comportamiento de la TMI y la efectividad de intervenciones para su abordaje. Objetivo. Describir el comportamiento de la TMI en Chile y su reflejo en las publicaciones científicas durante el período 1980-2019. Material y métodos. Aplicación del método de regresión lineal multivariable adaptiva (MARS, por su sigla en inglés) sobre las TMI entre 1980 y 2016, y búsqueda de artículos relacionados publicados entre 1980 y 2019 en SciELO, Lilacs, PubMed, Cochrane Library y Embase. Se analizó el comportamiento de la TMI y su reflejo en las publicaciones del período. Resultados. Hubo una reducción de la TMI de 28 ‰ a 7,2 ‰ nacidos vivos entre 1980 y 2016 (-74 %) y se identificaron 82 publicaciones en el período. Se registraron dos tipos de estudio sobre la TMI a partir de un punto de corte en 1996. En el primer período, los estudios abordaron patologías evitables e intervenciones, a la par de una reducción de la velocidad de descenso de la TMI. Posteriormente al punto de corte, los estudios se enfocaron en enfermedades no evitables y factores relacionados con inequidades y desigualdades. Conclusiones. La TMI prevalece como indicador sintético de las condiciones de salud. Las modificaciones en su evolución y sus causas se han reflejado en las publicaciones, que han variado sus énfasis y focos de atención según el cambio en este indicador.

Evolución de la mortalidad infantil en Chile y su reflejo en las publicaciones científicas entre 1980 y 2019 / Evolution of infant mortality in Chile and how it has been reflected in scientific publications between 1980 and 2019

Introducción. Los Objetivos de Desarrollo del Milenio incluyen la reducción de la tasa de mortalidad infantil (TMI), indicador que sigue vigente en las metas de los Objetivos de Desarrollo Sostenible (2015-2030). En paralelo, se requirieron investigaciones y reportes científicos para evaluar el comportamiento de la TMI y la efectividad de intervenciones para su abordaje. Objetivo. Describir el comportamiento de la TMI en Chile y su reflejo en las publicaciones científicas durante el período 1980-2019. Material y métodos. Aplicación del método de regresión lineal multivariable adaptiva (MARS, por su sigla en inglés) sobre las TMI entre 1980 y 2016, y búsqueda de artículos relacionados publicados entre 1980 y 2019 en SciELO, Lilacs, PubMed, Cochrane Library y Embase. Se analizó el comportamiento de la TMI y su reflejo en las publicaciones del período. Resultados. Hubo una reducción de la TMI de 28 ‰ a 7,2 ‰ nacidos vivos entre 1980 y 2016 (-74 %) y se identificaron 82 publicaciones en el período. Se registraron dos tipos de estudio sobre la TMI a partir de un punto de corte en 1996 En el primer período, los estudios abordaron patologías evitables e intervenciones, a la par de una reducción de la velocidad de descenso de la TMI. Posteriormente al punto de corte, los estudios se enfocaron en enfermedades no evitables y factores relacionados con inequidades y desigualdades. Conclusiones. La TMI prevalece como indicador sintético de las condiciones de salud. Las modificaciones en su evolución y sus causas se han reflejado en las publicaciones, que han variado sus énfasis y focos de atención según el cambio en este indicador

Introduction. One of the Millennium Development Goals is to reduce the child mortality rate (CMR), an indicator still present in the Sustainable Development Goals (2015-2030). At the same time, scientific investigations and reports were necessary to assess the behavior of the infant mortality rate (IMR) and the effectiveness of interventions to approach it. Objective. To describe IMR behavior in Chile and how it has been reflected in the scientific publications made in the 1980-2019 period. Material and methods. Implementation of the multivariate adaptive regression spline (MARS) method in relation to IMR between 1980 and 2016, and search for related articles published between 1980 and 2019 in SciELO, Lilacs, PubMed, Cochrane Library, and Embase. The analysis included IMR behavior and its reflection in the publications made in that period. Results. IMR decreased from 28 % to 7.2 % per 1000 live births between 1980 and 2016 (-74 %) and 82 publications were identified in this period. Two types of studies about IMR were reported as of the cutoff point of 1996. In the first period, studies focused on preventable diseases and interventions, while IMR showed a slowing down in its reduction. After the cutoff point, studies focused on non-preventable diseases and factors related to inequalities and inequities. Conclusions. IMR prevails as a synthetic indicator of health conditions. Changes in its evolution and causes have been reflected in publications, which have shifted their focus and areas of interest in accordance with the changes in this indicator.