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1.
PLoS One ; 19(5): e0300019, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38768137

RESUMO

This paper estimates efficiency measures for the banking system in Chile for the period 2000-2019. In contrast to previous studies, we use input-distance functions, introduce the nonparametric slack-based model, and choose the intermediate inputs approach in determining inputs and outputs. Our results suggest that the Chilean system has achieved relatively high levels of efficiency, although with no significant variation over the sample period. Ownership (government, foreign and public) and size had a positive impact on efficiency. On average, mergers and acquisitions seem to have targeted highly efficient banks in order to improve the overall efficiency of the controlling institution in the short run. Other sources of efficiency gains could be an increase in bond funding or a reduction in expenses and capital holdings. The latter could be induced by deepening the local derivatives market.


Assuntos
Indústrias , Chile , Humanos , Indústrias/economia , Modelos Econômicos , Conta Bancária , Propriedade
2.
BMJ Open ; 14(5): e085248, 2024 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-38729757

RESUMO

OBJECTIVE: To assess the impact of tobacco control regulations and policy implementation on smoking cessation tendencies in cigarette users born between 1982 and 1991 in Chile. DESIGN: Longitudinal cross-sectional study. SETTING: National level. PARTICIPANTS: Data from the National Survey of Drug Consumption (Service of Prevention and Rehabilitation for Drug and Alcohol Consumption). A pseudo-cohort of smokers born between 1982 and 1991 (N=17 905) was tracked from 2002 to 2016. PRIMARY AND SECONDARY OUTCOMES MEASURES: Primary outcome was the tendency to cease smoking conceptualised as the report of using cigarettes 1 month or more ago relative to using cigarettes in the last 30 days. The main exposure variable was the Tobacco Policy Index-tracking tobacco policy changes over time. Logistic regression, controlling for various factors, was applied. RESULTS: Models suggested a 14% increase in the smoking cessation tendency of individuals using cigarettes 1 month or more ago relative to those using cigarettes in the last 30 days (OR 1.14, CI 95% CI 1.10 to 1.19) for each point increment in the Tobacco Policy index. CONCLUSIONS: Our study contributes to documenting a positive impact of the implementation of interventions considered in the MPOWER strategy in the progression of smoking cessation tendencies in smokers born between 1982 and 1991 in Chile.


Assuntos
Abandono do Hábito de Fumar , Humanos , Chile/epidemiologia , Abandono do Hábito de Fumar/estatística & dados numéricos , Estudos Transversais , Masculino , Estudos Longitudinais , Feminino , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Adolescente , Fumar Cigarros/epidemiologia , Política de Saúde , Modelos Logísticos , Produtos do Tabaco/legislação & jurisprudência , Controle do Tabagismo
3.
Sci Rep ; 14(1): 8817, 2024 04 17.
Artigo em Inglês | MEDLINE | ID: mdl-38627494

RESUMO

This study aimed to assess the use of colorectal cancer (CRC) tests for prevention and early detection, alongside exploring the associated barriers to these tests. A stratified national survey was conducted in Chile, involving 1893 respondents (with a 2.3% error margin and 95% confidence interval). Logistic and multinomial regression analyses were employed to examine variations in test utilization likelihood and barrier. We found that the key determinants for undergoing CRC tests included age, health status, possession of private health insurance, and attainment of postgraduate education. Notably, 18% and 29% of respondents covered by public and private insurance, respectively, cited personal prevention as the primary motivation for test uptake. The principal obstacle identified was lack of knowledge, mentioned by 65% of respondents, while 29% and 19% of the publicly and privately insured respectively highlighted lack of access as a barrier. The results of this study provide valuable insights into factors influencing CRC screening, aiming to inform public health policies for expanding national coverage beyond diagnosis and treatment to encompass preventive measures.


Assuntos
Neoplasias Colorretais , Seguro Saúde , Humanos , Chile/epidemiologia , Detecção Precoce de Câncer , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/prevenção & controle , Cobertura do Seguro
4.
Appetite ; 198: 107354, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38642723

RESUMO

Changes in unprocessed healthy food purchases associated with the implementation of comprehensive food policy remain understudied. This study analyzes whether, following the announcement, modification, and implementation of Chile's Food Labeling and Advertising law targeting highly processed food (occurring in 2012, 2015, and 2016, respectively), households improved their fruit purchase decisions: purchase participation (i.e., buying likelihood) and purchase quantity. Expenditure data from a representative sample of Chilean households were employed, covering two consecutive survey waves conducted in 2011/2012 and 2016/2017. After controlling for socioeconomic factors (e.g., prices and income), results indicate that only purchase participation increased, providing weak support for positive spillover effects of a comprehensive food policy on fruit purchases. Subsample analyses reveal that this increase was driven by college-educated, childless, and low-income households and was stronger for sweeter and more convenient fruits. Considering that households in Chile do not meet health recommendations for daily fruit intake, additional policy efforts targeting healthy, unprocessed food consumption could be considered.


Assuntos
Comportamento do Consumidor , Características da Família , Frutas , Política Nutricional , Humanos , Chile , Feminino , Masculino , Política Nutricional/legislação & jurisprudência , Adulto , Pessoa de Meia-Idade , Fatores Socioeconômicos , Rotulagem de Alimentos/legislação & jurisprudência , Dieta Saudável/economia , Preferências Alimentares/psicologia , Adulto Jovem
5.
Public Health ; 231: 1-6, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38582055

RESUMO

OBJECTIVES: In Chile, colorectal cancer (CRC) is the fourth cause of death by cancer. Few studies have evaluated the role of contextual and individual socio-economic variables associated with premature death by CRC (<70 years). We analyzed the association between socio-economic factors (at individual and contextual levels) and premature death from CRC in Santiago de Chile. STUDY DESIGN: This was a cross-sectional study. METHODS: We analyzed deaths from CRC between 2014 and 2018 using data published by the Ministry of Health. Individual predictors were sex, marital status, and educational level. Contextual variable included the Social Priority Index (SPI) of the commune where the deceased lived. The association was assessed through multilevel logistic regression models. RESULTS: During the period, 4762 deaths occurred (51.7% women); 39.3% were premature. At the individual level, male sex (odds ratio [OR] 1.36; 95% confidence interval [CI] 1.20-1.53) and single marital status (OR 1.45; 95% CI 1.24-1.68) were associated with premature death from CRC. Primary or lower education was a protective factor (OR 0.53; 95% CI 0.47-0.60). At the contextual level, communes with a higher SPI were three times more at risk than those with a lower SPI (OR 3.13; 95% CI 2.15-4.57). CONCLUSIONS: This study showed that individual and contextual socio-economic variables are related to premature death from CRC. Residing in communes with greater socio-economic vulnerability was associated with greater risk. To reduce this gap, it is urgent to design and implement structural policies to reduce social inequities and improve access to health care.


Assuntos
Neoplasias Colorretais , Mortalidade Prematura , Fatores Socioeconômicos , Humanos , Neoplasias Colorretais/mortalidade , Masculino , Feminino , Estudos Transversais , Chile/epidemiologia , Pessoa de Meia-Idade , Idoso , Adulto , Fatores de Risco , Fatores Sexuais
7.
Prev Vet Med ; 226: 106185, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38507889

RESUMO

The global rise in companion animal populations, particularly dogs and cats, is driven by emotional and social benefits for owners, and their population management is becoming critically important to avoid a plethora of adverse effects on themselves, humans, and wildlife. We estimated the size and density of the owned canine and feline population in Chile and evaluated the status of microchipping, registration, sterilization rates, and the proportion of owned animals that roam unsupervised. A cross-sectional household survey in 36 districts was conducted and standard inferential statistics was employed to analyze differences between cats and dogs, sexes within each species, and between rural and urban areas. Additionally, two negative binomial models with mixed effects were developed to predict the number of dogs and cats per households. Two methods were used to compare population size estimates at the country level, multiplying: (1) the estimated mean number of companion animals per household by the estimated number of households at the country level, and (2) the estimated human:dog and human:cat ratios by the total human population. The study involved 6333 respondents, of which 76% (74% urban; 83% rural) owned companion animals (dogs and/or cats). Individuals in rural multi-person households increase the probability of owning dogs and/or cats. Additionally, women exhibit a greater inclination towards cat and dog ownership compared to men, while those over 30 years old demonstrate lower rates of companion animal ownership in contrast to the 18-30 age group for both species. The overall human:dog and human:cat ratios estimated were 2.7:1, and 6.2:1, respectively. The estimated total number of owned dogs and cats in Chile ranged from 9.6 to 10.7 million, depending on the methodological approach, while national median density of companion animals was 12 dogs per km2 (ranging from 0.02 to 7232) and 5 cats per km2 (ranging from 0.01 to 3242). This nationwide study showed one of the highest percentages of households with companion animals in Latin America and relatively low registration and sterilization rates, highlighting the need to strength long-term public policies to control populations of companion animals and promote responsibility in pet ownership.


Assuntos
Doenças do Gato , Doenças do Cão , Masculino , Animais , Humanos , Gatos , Cães , Feminino , Estudos Transversais , Chile/epidemiologia , Doenças do Cão/epidemiologia , Animais Selvagens , Características da Família , Propriedade
8.
Artigo em Inglês | PAHOIRIS | ID: phr-59321

RESUMO

[ABSTRACT]. We estimated trends in the prevalence of obesity and overweight among Chilean primary and secondary students before and after Chile’s 2016 regulations on the marketing and availability of foods high in energy, total sugars, sodium, or saturated fat. We used data from Chile’s Survey of Nutrition, which measured the body mass index (BMI) of students in government-funded schools. Using BMI thresholds defined by the World Health Organization, we calculated the prevalence of overweight and obesity for each year from 2013 to 2019 among students attending pre-kindergarten (age 4 years), kindergarten (age 5 years), first grade (6 years), and ninth grade (14 years). In ninth grade students, overweight and obesity prevalence rose by 2 percentage points over the 3 years after introduction of the 2016 regulations. In pre-kindergarten, kindergarten, and first grade, overweight and obesity fell 1 to 3 percentage points 1 year after the regulations were introduced, but rebounded to previous levels the next year. Chile’s food regulations were not followed by a sustained decline in obesity in primary- and secondary-school students. Future research should examine whether and how children in Chile and other countries maintain high levels of overweight and obesity despite food regulations designed to reduce consumption of obesogenic foods and beverages.


[RESUMEN]. Se estimaron las tendencias en la prevalencia de la obesidad y el sobrepeso en estudiantes chilenos de educación primaria y secundaria, antes y después de las regulaciones introducidas en Chile en el 2016 sobre la comercialización y disponibilidad de productos hipercalóricos, con un alto contenido de azúcares, sodio o grasas saturadas. Se utilizaron datos del Mapa Nutricional de Chile, una encuesta en la que se midió el índice de masa corporal (IMC) de la población estudiantil de las escuelas públicas. Tomando los umbrales de IMC definidos por la Organización Mundial de la Salud, se calculó la prevalencia del sobrepeso y la obesidad para cada año entre el 2013 y el 2019 en estudiantes de jardín de infancia (4 años), preescolar (5 años), primer grado (6 años) y noveno grado (14 años). En los estudiantes de noveno grado, la prevalencia del sobrepeso y la obesidad aumentó en 2 puntos porcentuales durante los 3 años posteriores a la introducción de las regulaciones del 2016. En el caso de los grupos de jardín de infancia, preescolar y primer grado, el sobrepeso y la obesidad disminuyeron entre 1 y 3 puntos porcentuales un año después de la introducción de las regulaciones, pero al año siguiente volvieron a los niveles anteriores. La introducción de las regulaciones alimentarias de Chile no estuvo seguida de una disminución continua de la obesidad en la población estudiantil de primaria y secundaria. En las investigaciones futuras se deberá examinar si la población infantil de Chile y otros países mantiene niveles altos de sobrepeso y obesidad a pesar de las regulaciones alimentarias diseñadas para reducir el consumo de productos y bebidas obesogénicos, así como las características específicas que adopta este problema de salud.


[RESUMO]. Foram estimadas tendências de prevalência da obesidade e do sobrepeso em alunos chilenos do ensino fundamental e médio antes e depois da regulamentação de 2016 da propaganda e disponibilidade de alimentos com alto teor calórico ou ricos em açúcares totais, sódio ou gorduras saturadas no Chile. Foram utilizados dados obtidos da Pesquisa em Nutrição do Chile, que aferiu o índice de massa corporal (IMC) de escolares da rede pública. Com base nos limiares de IMC definidos pela Organização Mundial da Saúde (OMS), calculou-se a prevalência anual de sobrepeso e obesidade em crianças na pré-escola (4 anos), no jardim da infância (5 anos), no primeiro ano (6 anos) e no nono ano (14 anos) em cada ano no período entre 2013 e 2019. Entre os alunos do nono ano, a prevalência de sobrepeso e obesidade aumentou 2 pontos percentuais nos 3 anos que se seguiram à introdução da regulamentação de 2016. Entre os alunos da pré-escola, do jardim de infância e do primeiro ano, ocorreu uma redução de 1 a 3 pontos percentuais na prevalência de sobrepeso e obesidade um ano após a introdução da regulamentação, mas os níveis voltaram a subir no ano seguinte. A regulamentação de alimentos não resultou em um declínio sustentado da obesidade nos alunos do ensino fundamental e médio do Chile. Pesquisas futuras devem ser realizadas para avaliar se, e como, a prevalência de sobrepeso e obesidade nas crianças chilenas e de outros países se mantém alta a despeito da regulamentação de alimentos visando à redução do consumo de alimentos e bebidas obesogênicos.


Assuntos
Política Nutricional , Marketing , Criança , Obesidade , Chile , Política Nutricional , Marketing , Criança , Obesidade , Criança , Obesidade
9.
GM Crops Food ; 15(1): 85-104, 2024 Dec 31.
Artigo em Inglês | MEDLINE | ID: mdl-38506577

RESUMO

We estimate producer and consumer surplus changes due to a possible GM maize import ban in Chile, which produces only non-GM grains for internal use. Without foreign non-GM sources, the ban's effect on domestic maize prices would be so significant as to induce Chile to switch from net exporter to net importer of animal products. Fixed factor owners in farm production would benefit significantly, although non-GM maize imports would moderate gains. Total social welfare measures would decline considerably, requiring large offsetting noneconomic benefits for a ban's political viability. Without non-GM imports, internal maize prices would likely eliminate domestic animal product industries; with possible imports, industries and final consumers would suffer, but much less. Currently, the country is a net importer of grain and a net exporter of pork and poultry, and so most welfare losses on the demand side of the market for maize would be in terms of the economic rents generated by the pork and poultry sectors. International competition would protect final consumers to the extent that animal product imports based on GM feed were permitted.


Assuntos
Animais Domésticos , Zea mays , Animais , Chile , Zea mays/genética , Grão Comestível , Fazendas
10.
Sci Total Environ ; 921: 171054, 2024 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-38378069

RESUMO

Environmental risk assessments strategies that account for the complexity of exposures are needed in order to evaluate the toxic pressure of emerging chemicals, which also provide suggestions for risk mitigation and management, if necessary. Currently, most studies on the co-occurrence and environmental impacts of chemicals of emerging concern (CECs) are conducted in countries of the Global North, leaving massive knowledge gaps in countries of the Global South. In this study, we implement a multi-scenario risk assessment strategy to improve the assessment of both the exposure and hazard components in the chemical risk assessment process. Our strategy incorporates a systematic consideration and weighting of CECs that were not detected, as well as an evaluation of the uncertainties associated with Quantitative Structure-Activity Relationships (QSARs) predictions for chronic ecotoxicity. Furthermore, we present a novel approach to identifying mixture risk drivers. To expand our knowledge beyond well-studied aquatic ecosystems, we applied this multi-scenario strategy to the River Aconcagua basin of Central Chile. The analysis revealed that the concentrations of CECs exceeded acceptable risk thresholds for selected organism groups and the most vulnerable taxonomic groups. Streams flowing through agricultural areas and sites near the river mouth exhibited the highest risks. Notably, the eight risk drivers among the 153 co-occurring chemicals accounted for 66-92 % of the observed risks in the river basin. Six of them are pesticides and pharmaceuticals, chemical classes known for their high biological activity in specific target organisms.


Assuntos
Monitoramento Ambiental , Poluentes Químicos da Água , Poluentes Químicos da Água/análise , Ecossistema , Rios/química , Chile , Medição de Risco
11.
Ambio ; 53(6): 941-950, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38315412

RESUMO

Dogs can negatively affect the wellbeing of people and nature, but if this changes along a socioeconomic gradient, then social inequity might be at fault. Here, we identify environmental injustice at the city scale by modeling differences in the density of urban dog populations according to varying levels of socioeconomic development across municipalities of Chile's capital, Santiago. Our analysis demonstrates a strong relation between dog density and social inequity, specifically because dog density increases along with poverty, but decreases in municipalities with higher municipal income. We offer specific proposals to ameliorate and reverse this inequity. These results expose another aspect of the impacts people and nature are subjected to by dogs, adding a new social lens to address the dog problem worldwide.


Assuntos
Cidades , Chile , Animais , Cães , Fatores Socioeconômicos , Densidade Demográfica , Humanos , População Urbana
12.
BMC Med Educ ; 24(1): 167, 2024 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-38383416

RESUMO

BACKGROUND: Lesbian, gay, bisexual, transgender, intersex, queer, and other sexual and gender identities (LGBTIQ+) individuals face health inequities. Additionally, medical students report a lack of confidence in providing specific health care to LGBTIQ + individuals, and medical schools do not offer the breadth and depth of coverage needed to fully prepare and make them comfortable in caring for these individuals. This study aims to characterize the teaching of curricular content related to LGBTIQ + health issues in medical schools in Chile. METHODS: This was a cross-sectional descriptive mixed-methods study based on a 15-question survey sent to school directors of the 24 medical schools in Chile, conducted between October 2020 and July 2021. The questions included in the study were mostly based on two pre-existing questionnaires covering content, assessment methods, and identification of barriers to teaching this content. RESULTS: The validated questionnaire was answered by 14 of 24 Chilean medical schools, with 11 schools (78.9%) declaring that they included some training in their curriculum. The predominant range of time allocated to LGBTIQ + training in medical programs was between 1 and 5 h. The most addressed topics were HIV (92.85%), sexual orientation (78.57%), and chronic disease risk in LGBTIQ + populations (78.57%). Most schools, accounting for 71.5%, considered the content they delivered to be "moderately insufficient" or "insufficient". Regarding the teaching methodologies, the most used were lectures (92.8%), clinical cases (42.9%), and clinical simulation (28.6%). CONCLUSION: Most surveyed medical schools reported curricular spaces dedicated to teaching health issues of LGBTIQ + individuals, primarily during the pre-internship training period. However, the time allocated is insufficient, and there is little approach to topics beyond the patient's sexual history or sexual orientation. Given the crucial role of medical schools, they must adopt both local and national strategies to enrich training focused on the care of LGBTIQ + patients.


Assuntos
Minorias Sexuais e de Gênero , Pessoas Transgênero , Humanos , Feminino , Masculino , Estudos Transversais , Chile , Faculdades de Medicina , Identidade de Gênero , Comportamento Sexual
14.
PLoS One ; 19(2): e0297807, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38346084

RESUMO

BACKGROUND: Access to medicines is a serious problem globally and in Chile. Despite the creation of coverage policies, part of the population with chronic conditions of high prevalence, still does not have access to the medicines it requires and disease control continues to be low. The objective of the study was to estimate the medication use and effective coverage for diabetes, dyslipidemia and hypertension in Chile, analyzing them according to sociodemographic variables and social determinants of health. METHODS: Cross-sectional analytical study with information from the 2016-2017 National Health Survey (sample = 6,233 people aged 15 years or older, expanded = 14,518,969). Descriptive analyses of medication use and effective coverage for hypertension, diabetes and dyslipidemia were carried out, and multivariate logistic regression models were developed to analyze possible associations with variables of interest. RESULTS: 60% of people with hypertension or diabetes use medications and only 27.7% in dyslipidemia. While 54.2% of those with diabetes have their glycemia controlled, in hypertension and dyslipidemia the effective coverage drops to 33.3% and 6.6%, respectively. There are no differences in use by health system, but there are differences in the control of hypertension and diabetes, favoring beneficiaries of the private subsystem. Effective coverage of dyslipidemia and hypertension also increases in those using medications. The drugs coincide with the established protocols, although beneficiaries of the private sector report greater use of innovative drugs. CONCLUSION: A significant proportion of Chileans with hypertension, diabetes or dyslipidemia still do not use the required medications and do not control their conditions.


Assuntos
Diabetes Mellitus , Dislipidemias , Hipertensão , Cobertura do Seguro , Seguro Saúde , Medicamentos sob Prescrição , Humanos , Chile/epidemiologia , Doença Crônica , Estudos Transversais , Diabetes Mellitus/tratamento farmacológico , Diabetes Mellitus/economia , Diabetes Mellitus/epidemiologia , Dislipidemias/tratamento farmacológico , Dislipidemias/economia , Dislipidemias/epidemiologia , Hipertensão/tratamento farmacológico , Hipertensão/economia , Hipertensão/epidemiologia , Medicamentos sob Prescrição/economia , Medicamentos sob Prescrição/uso terapêutico , Prevalência , População da América do Sul , Cobertura do Seguro/economia , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/economia
15.
Int J Drug Policy ; 124: 104316, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38219676

RESUMO

BACKGROUND AND AIMS: There is ample evidence from high-income countries that fiscal policies such as alcohol taxes can affect the consumption of alcohol by increasing alcohol prices. In the case of Latin American countries, much less is known about how sensitive alcohol demand is to alcohol price changes. This study aims to expand the evidence base on the sensitivity of off-premises pure alcohol demand to price and expenditure increases in five Latin American countries: Argentina, Chile, Costa Rica, Honduras, and Uruguay, which have different socioeconomic profiles and alcohol consumption patterns. DESIGN AND SETTING: Cross-sectional study MEASUREMENTS: The price and expenditure elasticities were estimated using an Almost Ideal Demand System (AIDS). Own price and expenditure elasticities for off-premises pure alcohol were estimated using representative household surveys, which collect data on households' expenses to construct the consumer basket of goods and services used to calculate the consumer price index (CPI) for the country. FINDINGS: Own price elasticities of off-premises pure alcohol for all countries were negative, inelastic, and significant at 1 %. They were -0.418 for Argentina; -0.656 for Chile; and for Costa Rica, Honduras, and Uruguay, they were equal to -0.608, -0.509, and -0.32, respectively. Expenditure elasticities were positive and significant at 1 %, except for Costa Rica, which was significant at 10 %. They were equal to 0.865 in Argentina; 0.943 in Chile; 1.182 in Costa Rica; 0.874 in Honduras; and 0.857 in Uruguay. Elasticities for Costa Rica should be interpreted cautiously, as there is insufficient geographical price variability to identify the demand correctly. CONCLUSIONS: Results were consistent with previous literature for countries from other regions. Governments should expand this study to measure total demand elasticities to improve the design of alcohol tax policies.


Assuntos
Comércio , Impostos , Humanos , Chile , Uruguai , Costa Rica , Honduras , América Latina , Argentina , Estudos Transversais
16.
PLoS One ; 19(1): e0296923, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38271408

RESUMO

Numerous studies from Europe and North America have documented sexual orientation-based health disparities, but due to data limitations, very little is known about the health of sexual minorities (i.e., lesbians, gay men, bisexual individuals, and other non-heterosexual populations) in developing countries. This research note uses newly available nationally representative data from the Chilean Socio-Economic Characterization Survey (CASEN) to explore sexual orientation-based disparities in self-rated health, health insurance coverage, and healthcare utilization in Chile. Our findings indicate that sexual minority respondents report worse self-rated health and greater health care utilization, and that sexual minority men are more likely to have private health insurance relative to heterosexual men. These findings are important in facilitating continued efforts to reduce health disparities in Latin America.


Assuntos
Homossexualidade Feminina , Minorias Sexuais e de Gênero , Humanos , Masculino , Feminino , Chile , Comportamento Sexual , Desigualdades de Saúde
17.
Medwave ; 24(1)2024 Jan 03.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-38170932

RESUMO

Introduction: More than 600 thousand people in Chile live with morbid obesity. Effective, safe, cost-effective therapeutic interventions are critical for healthcare systems and insurance schemes. In 2022, two bundled payment codes for bariatric surgery (gastric bypass and gastric sleeve) were incorporated into the National Health Fund's free-choice modality fee scheme. The objective was to characterize the execution of this payment mechanism program associated with bariatric surgery diagnosis in its first year of implementation.More than six hundred thousand people in Chile are estimated to live with morbid obesity. Effective, safe, cost-effective therapeutic interventions are critical for health systems and insurance schemes. In 2022, FONASA incorporated two Bariatric Surgery codes into the Free Choice Modality: Gastric Bypass and Sleeve Gastrectomy. Our objective was to characterize the execution of the Bariatric Surgery Bundled Payment Program in its first year of implementation. Methods: Descriptive and observational study of the pragmatic approach of the national execution of the payment associated with diagnosis in bariatric surgery. We examined sociodemographic variables (sex, age brackets, and National Health Fund tranches) and characterization of surgeries by code broken down by public or private provider, period of issue, unit cost, co-payment, and medical loans between March and December 2022. Results: We recorded n = 13 118 surgeries (45.81% bypass versus 54.19% sleeve), of which n = 2424 (18.48%) used medical loans. A total of 85.01% (p = 0.01) of the procedures were in women, in people between 35 and 39 years of age (20.15%), and 45.12% in beneficiaries of tranche B. Private providers performed a total of 99.21% of the surgeries. Ten accounted for 50% of the activity (range n = 1200 to 426 surgeries per year; n = 4.8 to 1.7 surgeries per working day). Total program expenditure was $71 626 948 350 CLP, accounting for 5.04% of the total activity of the national Diagnosis Associated Payment Program. Conclusions: The implementation of this bariatric surgery voucher benefited more than 13 thousand people living with obesity, mostly women of productive ages and with purchasing capacity. As an equity strategy, regardless of the access route through the voucher, it will be important to safeguard the activity in the public network.


Introducción: Más de 600 mil personas en Chile viven con obesidad mórbida. La incorporación de intervenciones terapéuticas eficaces, seguras y costo-efectivas es crítica para los sistemas de salud y esquemas de aseguramiento. En el año 2022 se incorporaron al arancel de modalidad de libre elección del Fondo Nacional de Salud dos códigos de pago asociado a diagnóstico para cirugía bariátrica: gástrico y manga gástrica. El objetivo fue caracterizar la ejecución del programa de mecanismo de pago tipo pago asociado a diagnóstico de cirugía bariátrica en su primer año de implementación. Métodos: Estudio descriptivo y observacional de abordaje pragmático de la ejecución nacional del pago asociado a diagnóstico en cirugía bariátrica. Se examinaron variables de caracterización sociodemográfica (sexo, tramos etarios y tramos del Fondo nacional de Salud) y caracterización de cirugías según código desagregadas por prestador público o privado, periodo de emisión, gasto unitario, copago, y préstamos médicos, entre marzo y diciembre de 2022. Resultados: Se registraron n = 13 118 cirugías (45,81% versus 54,19% manga), de las cuales n = 2424 (18,48%) emplearon préstamos médicos. Un 85,01% (p = 0,01) de los procedimientos fueron en mujeres; en personas entre 35 y 39 años (20,15%); y 45,12% en beneficiarios del tramo B. El 99,21% de las cirugías se realizó en prestadores privados. Diez de estos concentraron el 50% de la actividad (rango n = 1200 a 426 cirugías anuales; n = 4,8 a 1,7 cirugías por día hábil). El gasto total del programa fue $71 626 948 350 CLP, explicando un 5,04% de la actividad total del Programa nacional de Pago Asociado a Diagnóstico. Conclusiones: La implementación de este bono para cirugía bariátrica benefició a más de 13 mil personas que viven con obesidad, mayormente mujeres, en edades productivas, y con capacidad de compra. Como estrategia de equidad, independientemente de la vía de acceso mediante el bono, será importante cautelar la actividad en la red pública.


Assuntos
Cirurgia Bariátrica , Derivação Gástrica , Laparoscopia , Obesidade Mórbida , Humanos , Feminino , Masculino , Obesidade Mórbida/diagnóstico , Obesidade Mórbida/cirurgia , Chile , Cirurgia Bariátrica/métodos , Derivação Gástrica/métodos , Gastos em Saúde , Estudos Retrospectivos , Resultado do Tratamento
18.
Mar Pollut Bull ; 199: 116005, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38219292

RESUMO

This study examines the mercury content in the marine matrices water column, surface sediment and benthic invertebrates of Coronel and Coliumo bays, central Chile, under winter and summer conditions. Coronel Bay has been subject to intense industrialization in the last three decades, while Coliumo Bay remains as a fisherman's cove and a popular summer tourism destination. Our results reveal significantly higher mercury concentrations in the three environmental matrices analyzed for Coronel Bay, while Coliumo Bay exhibits levels within the range considered natural. Moreover, the mercury levels in Coronel Bay exceed the optimal criteria for aquatic life, indicating a deterioration in environmental quality of this locality. Industrial development is identified as main factor explaining the differences observed between these two coastal water bodies. This study presents the most updated record of mercury levels in the Southeast Pacific and represents the first comprehensive evaluation of marine environmental matrices in two bays with divergent activities.


Assuntos
Mercúrio , Poluentes Químicos da Água , Mercúrio/análise , Chile , Monitoramento Ambiental/métodos , Poluentes Químicos da Água/análise , Água do Mar , Água , Biota , Baías , Sedimentos Geológicos
19.
J Environ Manage ; 352: 120017, 2024 Feb 14.
Artigo em Inglês | MEDLINE | ID: mdl-38198840

RESUMO

There are various climate policies to decarbonize the energy matrix of a country. In the case of Chile, a carbon tax of 5 USD/tCO2 was initially implemented, and later, a schedule was established for the phase-out of coal-fired thermoelectric plants, all the above in the absence of subsidies for non-conventional renewable energy (NCRE). This study uses a computable general equilibrium (CGE) model and microsimulations to assess the contribution of current climate policies and other more demanding scenarios that accelerate the decarbonization of the Chilean energy matrix, considering economic, environmental, and distributional impacts. Specifically, carbon taxes are simulated with and without complementary climate policies (phase-out of coal-fired power plants and NCRE subsidies). The results show that the scenarios that combine the three climate policies generate a greater decrease in greenhouse gas emissions (40.4% âˆ¼ 57.5%). Besides, the drop in GDP is more pronounced when coal-fired thermoelectric plants phase out (0.3% additional), and NCRE subsidies contribute to moderately reducing emissions. However, NCRE subsidies reduce the negative effect on households' expenditure and income, especially in the poorest quintile. Finally, microsimulations show marginal changes in income distribution and an increase of up to 0.4 percentage points in the poverty rate.


Assuntos
Carbono , Carvão Mineral , Chile , Centrais Elétricas , Energia Renovável , Impostos , Dióxido de Carbono/análise
20.
Int J Epidemiol ; 53(1)2024 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-38224273

RESUMO

BACKGROUND: Socio-economic status (SES) disparities in coronavirus disease 2019 (COVID-19) mortality have been reported but complete information and time trends are scarce. In this study, we analysed the years of life lost (YLL) due to COVID-19 premature mortality during the pandemic in Chile and its evolution according to SES and sex compared with a counterfactual scenario [cerebrovascular accidents (stroke)]. METHOD: We used Chile's national mortality databases from 2020 to 2022. YLL and age-standardized YLL and mortality rates by sex and by epidemic waves were determined. The 346 communes were stratified into SES groups according to their poverty index quintile. Negative binomial regression models were used to test trends. RESULTS: In >2 years of the pandemic, the COVID-19 YLL was 975 937, corresponding to 61 174 deaths. The YLL rate per 100 000 inhabitants was 1027 for males and 594 for females. There was a heterogeneous distribution of YLL rates and the regional level. Communes in the most advantaged SES quintile (Q5) had the highest YLL during the first wave compared with those in the lowest SES quintile (Q1) (P < 0.001) but the opposite was true during the second wave. COVID-19 YLL trends declined and differences between Q1 and Q2 vs Q5 converged from the second to the fourth waves (0.33 and 0.15, Ptrend < 0.001 and Ptrend = 0.024). YLL declined but differences persisted in stroke (-0.002, Ptrend = 0.979). CONCLUSIONS: COVID-19 deaths resulted in a higher impact on premature death in Chile, especially in men, with a heterogeneous geographic distribution along the territory. SES and sex disparities in COVID-19 premature mortality had narrowed by the end of the pandemic.


Assuntos
COVID-19 , Acidente Vascular Cerebral , Masculino , Feminino , Humanos , Mortalidade Prematura , Chile/epidemiologia , Status Econômico , Mortalidade
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