Prevalencia de la soledad en las personas mayores que viven en zonas rurales. Diferencias por grupos étnicos y variables predictivas / Prevalence of loneliness among older people living in rural areas. Differences by ethnic group and predictor variables

ANTECEDENTES: La soledad es uno de los problemas de salud pública más recurrentes en las personas mayores, sin embargo, en Chile se disponen de escasos datos sobre su prevalencia en personas mayores a 60 años que viven en zonas rurales y que pertenecen a pueblos originarios o al tribal afrodescendiente. OBJETIVO: Examinar la prevalencia de la soledad entre personas mayores que viven en zonas rurales por grupo étnico; y analizar las variables sociodemográficas, familiares y de salud que se relaciona con soledad. MATERIAL Y MÉTODOS: Se aplicó la escala de soledad DJGLS-6, APGAR-familiar, cuestionario de 13 problemas de salud más frecuentes en personas mayores chilenas, e índice de Barthel a 1.692 personas mayores que residen en zonas rurales de las regiones de Arica y Parinacota, Tarapacá, Antofagasta, Atacama, Coquimbo, Valparaíso, Los Lagos, Aisén y Magallanes. RESULTADOS: Se observa una alta prevalencia de la soledad (sobre el 55%) en personas de los pueblos: Afrodescendiente, Quechua, Atacameño, Colla, Chango, Huilliche, Kawesqar y no indígenas. Siendo la soledad emocional la más prevalente entre personas mayores indígenas y no indígenas que viven en zonas rurales (≥ 71%). Las variables que se asocian con soledad son: ser mujer, edad, no tener pareja, vivir solo(a), disfuncionalidad familiar y tener problemas de salud. CONCLUSIONES: La soledad en zonas rurales es más alta en las personas mayores y esta situación se complejiza en el cruce de diversidad étnico cultural, es necesario seguir abordando este problema que afecta el bienestar biopsicosocial en la vejez.

BACKGROUND: Loneliness is one of the most recurrent public health problems in older people. However, there is little data available in Chile on its prevalence in people over 60 years of age living in rural areas and belonging to native or Afro-descendant groups. AIM: To examine the prevalence of loneliness among older people living in rural areas by ethnic group and to analyze the socio-demographic, family, and health variables related to loneliness. METHODS: We interviewed 1,692 elderly people living in Chilean rural areas of the regions of Arica and Parinacota, Tarapacá, Antofagasta, Atacama, Coquimbo, Valparaíso, Los Lagos, Aisén and Magallanes. The instruments applied were the DJGLS-6 loneliness scale, Family-APGAR, questionnaire of 13 most frequent health problems in Chilean older people, and Barthel index. RESULTS: We found a high prevalence of loneliness (over 55%) among Afro-descendants, Quechua, Atacameño, Colla, Chango, Huilliche, Kawesqar and non-indigenous people. Emotional loneliness is the most prevalent among indigenous and non-indigenous older people living in rural areas (≥ 71%). Variables associated with loneliness were being female, age, not having a partner, living alone, family dysfunctionality, and having health problems. CONCLUSIONS: Loneliness in rural areas is higher in older people, and this situation becomes more complex at the crossroads of ethnic-cultural diversity; it is necessary to continue to address this problem that affects biopsychosocial well-being in old age.

Analyzing the 2019 Chilean social outbreak: Modelling Latin American economies.

In this work, we propose a quantitative model for the 2019 Chilean protests. We utilize public data for the consumer price index, the gross domestic product, and the employee and per capita income distributions as inputs for a nonlinear diffusion-reaction equation, the solutions to which provide an in-depth analysis of the population dynamics. Specifically, the per capita income distribution stands out as a solution to the extended Fisher-Kolmogorov equation. According to our results, the concavity of employee income distribution is a decisive input parameter and, in contrast to the distributions typically observed for Chile and other countries in Latin America, should ideally be non-negative. Based on the results of our model, we advocate for the implementation of social policies designed to stimulate social mobility by broadening the distribution of higher salaries.

Assessment of bullet holes through the analysis of mushroom-shaped morphology in synthetic fibres: analysis of six cases.

Textiles damage analysis is a very valuable tool in forensic investigations. However, to date, very little research has been carried out to understand the impact of bullet causing damages to clothing. According to the review of the most recent scientific papers, the frictional heating and crushing action of a bullet passing through synthetic fibres cause a unique transformation in their ends called mushroom-shaped morphology. In this study, the textile remains of six individuals executed during the first decade of the Chilean military dictatorship period (1973-1990) were analysed. The purpose was to examine their clothing in order to describe the fibre defects in the bullet holes. The fibres were directly observed using two different models of stereomicroscopy (MZ16A and EZ4D, Leica Microsystem Ltd., Wetzlar, Germany) and through a combination of transmitted, oblique and co-axial illumination (with Leica DFC500 Digital Camera), at × 230 and at a resolution of up to 840 Lp/mm. The mushroom-shaped morphology, along with rupturing of yarns, fibrillation or splitting of fibres, was observed in the bullet holes. Although the mushroom-shaped is a useful pattern for bullet hole identification in synthetic fibres, further research needs to be performed for developing a sounder interpretational framework of this type of forensic evidence.

Inequalities in the Age of Universal Health Coverage: Young Chileans with Diabetes Negotiating for Their Right to Health.

While universal health coverage (UHC) has been praised as a powerful means to reduce inequalities and improve access to health globally, little has been said about how patients experience and understand its implementation locally. In this article, we explore the experiences of young Chileans with type 1 diabetes when seeking care in Santiago, within Chile's UHC program, which sought to improve people's access to health care. We argue that the implementation of UHC, within a structurally fragmented health system, did not lead to the promised equitable health care delivery. Although UHC aimed to equitably provide universal care, locally it materialized in heterogeneous configurations forcing individuals into positions of precarity and generating new inequalities. Furthermore, for the young people in the study, UHC intersected with their health insurance and socioeconomic status, impacting on the health care they could access, consequently making diabetes care and management a difficult challenge.

[Health care effects of cultural beliefs about physicians and perceived discrimination]. / Creencias culturales sobre los médicos y percepción de discriminación: El impacto en la continuidad de la atención.

BACKGROUND: Healthcare inequities may hamper physical and mental health. AIM: To examine perceived discrimination in healthcare services in relation to socio-structural and cultural antecedents as well as their effect on psychological processes and health. MATERIAL AND METHODS: Questionnaires on beliefs about physicians, perceived discrimination, emotions and affective states and avoidance consequences in health were answered by 337 child caregivers (85% women) attending preventive health care appointments at primary health care centers. RESULTS: Negative beliefs about healthcare professionals are directly associated with avoidance behaviors in health and perceived discrimination. The latter perception has no direct effects on avoidance behaviors, but it has an indirect effect through negative emotions associated with discrimination. CONCLUSIONS: There is an association between cultural, psychological and structural factors in health care. These results contribute to understand the phenomenon of discrimination and its negative consequences.

Creencias culturales sobre los médicos y percepción de discriminación: El impacto en la continuidad de la atención / Health care effects of cultural beliefs about physicians and perceived discrimination

Background: Healthcare inequities may hamper physical and mental health. Aim: To examine perceived discrimination in healthcare services in relation to socio-structural and cultural antecedents as well as their effect on psychological processes and health. Material and Methods: Questionnaires on beliefs about physicians, perceived discrimination, emotions and affective states and avoidance consequences in health were answered by 337 child caregivers (85% women) attending preventive health care appointments at primary health care centers. Results: Negative beliefs about healthcare professionals are directly associated with avoidance behaviors in health and perceived discrimination. The latter perception has no direct effects on avoidance behaviors, but it has an indirect effect through negative emotions associated with discrimination. Conclusions: There is an association between cultural, psychological and structural factors in health care. These results contribute to understand the phenomenon of discrimination and its negative consequences.

Physical and psychosocial development of Mapuche and nonindigenous Chilean toddlers: A modest role of ethnicity.

Mapuche represents the largest indigenous group in Chile amounting to nearly 10% of the total population. In a longitudinal cohort of 12,398 children, we analyzed the role of ethnicity in physical and psychosocial development of Mapuche and nonindigenous Chilean toddlers (age 2.5 years), taking into account sociodemographic and caregiver characteristics. As indicated by our univariate analysis, the Mapuche developmental niche was characterized by lower income, lower maternal education, poorer quality of the home environment, longer breastfeeding, and higher parental stress. Physical development showed higher body mass index. Mapuche children showed less externalizing problems. We then analyzed the incremental contribution of ethnicity in a series of hierarchical regressions with the second wave of developmental measurements (age 4.5 years) as outcome variables, showing a significant but modest incremental contribution of ethnicity to the prediction of children's development between 2.5 and 4.5 years of age. Controlling for environmental variables, Mapuche showed less externalizing and internalizing, behavior problems. Socioeconomic status, quality of the home environment, and parenting stress were stronger predictors of socioemotional development than ethnicity per se.

Engaging critical community resilience praxis: A qualitative study with Mapuche communities in Chile facing structural racism and disasters.

Mapuche are the largest indigenous group in Chile and have survived histories of colonialism, socionatural disasters, and more recently, increasing conflicts with the Chilean state. This study aimed to engage critical theories and examine resilience processes from indigenous perspectives while exploring the impact of racism, intersecting adversities, and ongoing decolonial struggles in Mapuche communities. Decolonial qualitative methods, situational analysis, and community-engaged participatory approaches were utilized in application of a critical community resilience praxis (CCRP). First, an interagency collaborative entitled Mapuche Equipo Colaborativo para la Investigación de la Resiliencia (MECIR) was established. MECIR involved partnerships between a Chilean national research center for disasters, a nongovernmental organization of indigenous advocates/researchers, and a Mapuche community health center. MECIR completed semistructured interviews with 10 participants (N = 10) in addition to ethnographic observations. Four themes of resilience emerged: newen, "strength and spiritual life-nature force"; azmapu, "ancestral systems of social organization and tribal law"; nietun, "cultural revitalization"; and marichiweu, "resistance." Findings contribute to reconceptualizations of resilience from Mapuche perspectives while identifying culturally meaningful strategies for promoting racial justice and mental health equity. Results show benefits of CCRP in community psychology research in an international setting.

[Facilitators and barriers to implementation of intercultural health policy in Chile]. / Facilitadores y obstaculizadores de la implementación de la política de salud intercultural en Chile.

Objective To identify elements that either facilitate or hinder implementation of Chile's intercultural health policy. Methods A descriptive study was conducted with the participation of health services users from the Mapuche ethnic group, biomedical health professionals, intercultural facilitators, and key informants in two health facilities serving towns with a high density of Mapuche population. The information was obtained through semi-structured interviews that were analyzed thematically. Results Factors identified as facilitating the implementation of this policy include laws and regulations pertaining to the rights of indigenous peoples, the empowerment of users around their rights, the formation of implementation teams, the presence of professionals of Mapuche origin in health facilities, and the existence of processes for systematization of the work carried out. The asymmetric relationship between the Mapuche people and the state, and between the Mapuche health system and the biomedical model, constitutes a fundamental barrier. Other obstacles include the lack of theoretical and practical clarity around the concept of intercultural health and a lack of resources. Conclusions Despite the facilitators identified and the achievements to date, meaningful progress in implementation of an intercultural health policy is limited by barriers that are hard to change. These include the usual forms of government planning and the hegemony of the biomedical model.

Learning globally to enhance local practice: an international programme in primary care & family health.

PURPOSE: In a global context of growing health inequities, international learning experiences have become a popular strategy for equipping health professionals with skills, knowledge, and competencies required to work with the populations they serve. This study sought to analyse the Chilean Interprofessional Programme in Primary Health Care (CIPPHC), a 5 week international learning experience funded by the Ministry of Health in Chile targeted at Chilean primary care providers and delivered in Toronto by the Department of Family and Community Medicine at the University of Toronto. METHOD: The study focused on three cohorts of students (2010-2012). Anonymous programme evaluations were analysed and semi-structured interviews conducted with programme alumni. Simple descriptive statistics were gathered from the evaluations and the interviews were analysed via thematic content analysis. RESULTS: The majority of participants reported high levels of satisfaction with the training programme, knowledge gain, particularly in the areas of the Canadian model of primary care, and found the materials delivered to be applicable to their local context. CONCLUSIONS: The CIPPHC has proven to be a successful educational initiative and provides valuable lessons for other academic centres in developing international interprofessional training programmes for primary care health care providers.

Tiwanaku influence and social inequality: A bioarchaeological, biogeochemical, and contextual analysis of the Larache cemetery, San Pedro de Atacama, Northern Chile.

OBJECTIVES: To assess the relationship between the Tiwanaku polity and the individuals buried at the Middle Horizon (∼AD500-1000) cemetery of Larache in northern Chile, a site that has been singled out as a potential elite foreign enclave. MATERIALS AND METHODS: We explore this association through the skeletal remains of 48 individuals interred at the cemetery of Larache using bioarchaeological, biogeochemical, and artifactual evidence. Data from cranial modification practices, violent injury, and the mortuary assemblage are used to explore culturally constructed elements of status and identity, radiogenic strontium isotope analyses provide us with a perspective on the geographic origins of these individuals, and stable carbon and nitrogen analyses allow discussion of paleodiet and access to resources. RESULTS: Radiogenic strontium isotope values show the presence of multiple first generation migrants at Larache. Stable carbon and nitrogen isotope data reveal significant differences among individuals. The mortuary context reveals a standard pattern for the oases but also includes a series of unusual burials with abundant gold and few other objects. Interestingly, both local and nonlocal individuals with different head shapes had access to the differentiated burial context; however nonlocal individuals appear to be the only ones with a heavily maize-based diet. CONCLUSIONS: Our evidence shows that Larache served as a burial place for a diverse, yet culturally integrated and potentially elite segment of the Atacameño population, but not a foreign enclave as had been postulated.

Associations between social vulnerability, employment conditions and hazardous alcohol consumption in Chile.

INTRODUCTION AND AIMS: Studies from many different countries have found associations between alcohol use, employment and social context. The aim of this study was to investigate associations between hazardous alcohol consumption (HAC), social vulnerability and employment conditions among Chilean adults. DESIGN AND METHODS: A cross-sectional study, involving analysis of the 2008 National Survey on Drugs in Chile, was conducted on 8316 economically active men and women aged between 18 and 65 years, who completed the alcohol section of the survey. The participants were selected randomly and data collected through face-to-face interviews. Multilevel analysis was used to achieve the study's objectives. The Alcohol Use Disorders Identification Test was used to define HAC. RESULTS: There were no significant associations between HAC and employment status or occupational category when controlling for potential confounders. Using the social services sector as a reference, the adjusted odds ratio (95% confidence interval) of HAC was 2.60 (1.96-3.46) for those who worked in construction, 2.03 (1.43-2.89) in mining, 1.74 in agriculture (1.16-2.63) and in industry (1.26-2.39), 1.73 (1.31-2.28) in trade, 1.67 (1.29-2.16) in other services and 1.42 (1.01-2.00) in transport. There was no association between the socioeconomic status of the participant's neighbourhood and HAC in the fully adjusted model. The perception of neighbourhood security (third quartile of insecurity) was associated with HAC (odds ratio 1.22; 95% confidence interval 1.02-1.46). DISCUSSION AND CONCLUSIONS: HAC was independently associated with the participant's economic sector and perception of neighbourhood security in Chilean adults. It is important to perform in-depth analyses of contextual effects on individual alcohol consumption.

Evaluación de síntomas ansiosos y etnicidad en población escolar de la comuna de San Pedro de Atacama / Assessment of anxiety symptoms and ethnicity in students from the San Pedro de Atacama district

La comuna San Pedro de Atacama (SPA) tiene alta población rural y étnica, grupos vulnerables, según la literatura, a problemas de salud mental. El objetivo de este trabajo es conocer la prevalencia de síntomas ansiosos en escolares e investigar sus diferencias respecto de variables étnicas, de edad y género. Para ello se utilizó la escala de auto reporte de ansiedad para niños y adolescentes (AANA). La muestra quedó constituida por 416 alumnos, de ellos se analizaron 335 escalas, cuya media de edad fue de 10 años. Un 60,3 por ciento obtuvo sobre el punto de corte para sospecha de trastorno de ansiedad. El género femenino tenía mayor sintomatología ansiosa, junto con el grupo etario de 7 a 11 años. No existió diferencias significativas para la variable étnica. Respecto a las subescalas, la distribución etaria de la fobia social fue diferente a lo reportado en la literatura, lo que podría derivar del contexto sociocultural, necesario de investigaren futuros trabajos.

The San Pedro de Atacama (SPA) district has an important number of rural and ethnic population, which according to the literature, is more vulnerable to mental health problems. The aim of this research is to determine the prevalence of anxiety symptoms in school age children and to study its differences in relation to ethnicity, age and gender. The AANA (self report anxiety scale for children and adolescents) was applied in a sample of 416 students, from which 335 questionnaires were analyzed (mean age: 10 years). A 60.3 percent of the students were above the cut point for suspicion of an anxiety disorder. Females had a higher number of symptoms of anxiety, as did the group with ages 7 to 11 years. There were no statistically significant differences for ethnicity. In the subscales, the age distribution for social phobia was found to be different from the one previously reported; this could be explained by the sociocultural context, which remains to be studied in future research.

Socioeconomic status and age at menarche in indigenous and non-indigenous Chilean adolescents.

The objective was to analyze the relationship between socioeconomic status and age at menarche among indigenous and non-indigenous girls in the Araucanía Region of Chile, controlling for nutritional status and mother's age at menarche. A total of 8,624 randomly selected girls from 168 schools were screened, resulting in the selection of 207 indigenous and 200 non-indigenous girls who had recently experienced menarche. Age at menarche was 149.6 ± 10.7 months in the indigenous group and 146.6 ± 10.8 months in the non-indigenous group. Among the non-indigenous, the analysis showed no significant association between age at menarche and socioeconomic status. In the indigenous group, age at menarche among girls with low socioeconomic status was 5.4 months later than among those with higher socioeconomic status. There were no differences in nutritional status according to socioeconomic level. Obesity was associated with earlier menarche. Menarche occurred earlier than in previous generations. An inverse relationship between socioeconomic status and age at menarche was seen in the indigenous group only; low socioeconomic status was associated with delayed menarche, regardless of nutritional status or mother's age at menarche.

Socioeconomic status and age at menarche in indigenous and non-indigenous Chilean adolescents / Nivel socioeconómico y edad de la menarquia en adolescentes chilenas indígenas y no indígenas

The objective was to analyze the relationship between socioeconomic status and age at menarche among indigenous and non-indigenous girls in the Araucanía Region of Chile, controlling for nutritional status and mother's age at menarche. A total of 8,624 randomly selected girls from 168 schools were screened, resulting in the selection of 207 indigenous and 200 non-indigenous girls who had recently experienced menarche. Age at menarche was 149.6±10.7 months in the indigenous group and 146.6±10.8 months in the non-indigenous group. Among the non-indigenous, the analysis showed no significant association between age at menarche and socioeconomic status. In the indigenous group, age at menarche among girls with low socioeconomic status was 5.4 months later than among those with higher socioeconomic status. There were no differences in nutritional status according to socioeconomic level. Obesity was associated with earlier menarche. Menarche occurred earlier than in previous generations. An inverse relationship between socioeconomic status and age at menarche was seen in the indigenous group only; low socioeconomic status was associated with delayed menarche, regardless of nutritional status or mother's age at menarche.

El objetivo fue analizar la relación entre nivel socioeconómico y edad de menarquia en adolescentes indígenas y no indígenas de la Región de la Araucanía, Chile, controlando el efecto del estado nutricional, y la edad de menarquia de las madres. Se estudiaron 8.624 niñas de 168 escuelas elegidas aleatoriamente, seleccionando 207 indígenas y 200 no indígenas que habían tenido recientemente la menarquia. La edad de menarquia ocurrió a los 149,6±10,7 meses en indígenas y a los 146,6±10,8 meses en no indígenas. En el grupo no indígena, hubo una relación significativa entre edad de menarquia y nivel socioeconómico. En el grupo indígena, edad de menarquia del nivel socioeconómico bajo fue de 5,4 meses más tarde que el nivel socioeconómico más alto. No se observaron diferencias de estado nutricional por nivel socioeconómico. La obesidad adelantó la menarquia y la edad de menarquia ocurrió antes que la de sus madres. Existe una relación inversa entre nivel socioeconómico y edad de menarquia sólo en el grupo indígena; en los niveles socioeconómicos más bajos la edad de menarquia se retrasa independiente del estado nutricional y de la edad de menarquia de la madre.

Nasal profile assessment using geometric morphometrics in a sample of chilean population: clinical and forensic implications / Evaluación del perfil nasal mediante morfometría geométrica en unamuestra de población chilena. Implicancias clínicas y forenses

The search of morphological patterns of nasal profile using traditional morphometrics has been the goal of several studies aiming to orient therapeutical planning and forensic techniques such as facial reconstruction. The present study aims to find and describe such patterns with geometric morphometric tools in a sample of Chilean population with geometric morphometric tools. We used the lateral X-rays of 156 individuals (men and women) and 14 landmarks in bone and soft tissues. Procrustes analysis was performed followed by principal component analysis to assess general shape variation, regression of shape components against centroid size to study to allometric effect and discriminant analysis by sex with cross-validation test. Our results show the lack of shape patterns, and that the size, followed by sex, explains within a limited scope the shape changes which suggests the presence of uncontrolled variables and a high effect of inter-individual variation. In general terms bigger profiles, more frequent in men, show a lower Pronasal point, a more prominent nasal dorsum with a thicker layer of soft tissue, and a vertically expanded upper lip. We suggest the reassessment of the importance of individual aesthetic evaluation for clinical purposes, and recommend caution in concluding results based on forensic reconstruction techniques.

La descripción de patrones morfológicos del perfil nasal en la población que orienten la toma de decisiones y evaluación terapéutica, y que aseguren el éxito de técnicas como la reconstrucción facial forense, ha sido el objetivo de numerosos estudios basados en el uso de morfometría tradicional. El objetivo de este trabajo es el estudio del perfil nasal en una muestra de población chilena utilizando herramientas de la morfometría geométrica. Se utilizaron las radiografías de una muestra mixta de 156 individuos adultos y 14 hitos en perfil duro y blando. Se realizó el análisis de Procusto, seguido de análisis de componentesprincipales para el estudio exploratorio de la forma, regresión de los componentes de la forma contra el tamaño de centroide para el estudio del efecto alométrico en la forma del perfil nasal, análisis discriminante para la variable sexo y prueba de validación cruzada. Los resultados muestran que de las variables controladas, el tamaño y luego el sexo serían las que más explican la variabilidad observada, sin embargo el peso general de estas variables es bajo, sugiriendo la presencia de otras variables no controladas, y un gran componente de variación entre los individuos. Morfológicamente, se observa que los perfiles de mayor tamaño, de mayor frecuencia en hombres, presentan un punto nasal más descendido y un dorso nasal más curvo, así como un labio más expandido verticalmente. Desde el punto de vista estético, se sugiere dar importancia a la evaluación individual con fines terapéuticos. En antropología forense, se sugiere la prudencia en las conclusiones basadas en técnicas de reconstrucción debido a la falta de patrones morfológicos que orienten la técnica de manera certera.

Intercultural health practices: towards an equal recognition between indigenous medicine and biomedicine? A case study from Chile.

Over the past few years, intercultural health has become an emerging issue in health policy. Intercultural health is an approach in health that aims at reducing the gap between indigenous and western health systems, on the basis of mutual respect and equal recognition of these knowledge systems. This article questions the applicability of such a concept in the context of Chile. Here, conflicting interests between the Mapuche and the Chilean state are related to aspects of economic development, modernity processes, integration, intercultural relations, and indigenous rights and are deeply reflected also in projects for an intercultural health system. By analysing the experience of the intercultural practice of Makewe Hospital, this article argues that effective and equitable intercultural health practices will not take place unless there will be an integral valorisation of the Mapuche culture from a broader perspective.

Something fishy: Chile's blue revolution, commodity diseases, and the problem of sustainability.

The United Nations describes aquaculture as the fastest-growing method of food production, and some industry boosters have heralded the coming of a sustainable blue revolution. This article interprets the meteoric rise and sudden collapse of Atlantic salmon aquaculture in southern Chile (1980-2010) by integrating concepts from commodity studies and comparative environmental history. I juxtapose salmon aquaculture to twentieth-century export banana production to reveal the similar dynamics that give rise to "commodity diseases"­events caused by the entanglement of biological, social, and political-economic processes that operate on local, regional, and transoceanic geographical scales. Unsurprisingly, the risks and burdens associated with commodity diseases are borne disproportionately by production workers and residents in localities where commodity disease events occur. Chile's blue revolution suggests that evaluating the sustainability of aquaculture in Latin America cannot be divorced from processes of accumulation.

Putting two and two together? Early childhood education, mothers' employment and care service expansion in Chile and Mexico.

In recent years, several middle-income countries, including Chile, Mexico and Uruguay, have increased the availability of early childhood education and care (ECEC) services. These developments have received little scholarly attention so far, resulting in the (surely unintended) impression that Latin American social policy is tied to a familialist track, when in reality national and regional trends are more varied and complex. This article looks at recent efforts to expand ECEC services in Chile and Mexico. In spite of similar concerns over low female labour force participation and child welfare, the approaches of the two countries to service expansion have differed significantly. While the Mexican programme aims to kick-start and subsidize home- and community-based care provision, with a training component for childminders, the Chilean programme emphasizes the expansion of professional ECEC services provided in public institutions. By comparing the two programmes, this article shows that differences in policy design have important implications in terms of the opportunities the programmes are able to create for women and children from low-income families, and in terms of the programmes' impacts on gender and class inequalities. It also ventures some hypotheses about why the two countries may have chosen such different routes.

Putting the market in its place: food security in three Mapuche communities in southern Chile.

This article analyzes the impact of state policies since the 1970s on household food security in several Mapuche communities in the Araucanía region of Chile (Region IX). The author highlights key transformations in the national economy and food system and endeavors to link those to local phenomena, in particular the absorption of the local livelihood strategies and food systems into capitalist markets and the high incidences of food insecurity. The article concludes that a reconceptualization of macroeconomic and indigenous policies are required to rebuild the material and social foundations of rural Mapuche communities that provide the bases from which their inhabitants can reconstruct a mutually beneficial relationship with the broader Chilean society and avert the continued acceleration of tension and violence.