Structural determinants explain caries differences among preschool children in Chile's Metropolitan Region.

OBJECTIVE: To estimate the association between Social Determinants of Health (structural and intermediate) and caries indicators in Chile's Metropolitan Region preschool children. METHODS: A multilevel cross-sectional study of Social Determinants of Health (SDH) and caries in children aged 1 to 6 years in Chile's Metropolitan Region was conducted in 2014-2015, with three levels: district, school and child. Caries were assessed by the dmft-index and the prevalence of untreated caries. The structural determinants analyzed were Community Human Development Index (CHDI), urban/rural location, school type, caregiver's education and family income. Poisson multilevel regression models were fit. RESULTS: The sample size was 2,275 children from 40 schools in 13 districts. While the highest CHDI district had an untreated caries prevalence of 17.1% (12.3-22.7%), in the most disadvantaged district it was 53.9% (95% CI 46.0-61.6%). As family income increased, the probability of untreated caries prevalence decreased (PR = 0.9 95% CI 0.8-1.0). Rural districts had an average dmft-index of 7.3 (95% CI 7.2-7.4), while in urban districts, it was 4.4 (95% CI 4.3-4.5). Higher probabilities of untreated caries prevalence (PR = 3.0 95% CI 2.3-3.9) were observed in rural children. Greater probabilities of untreated caries prevalence (PR = 1.3 95% CI 1.1-1.6) and prevalence of caries experience (PR = 1.3 95% CI 1.1-1.5) were observed in children whose caregivers had a secondary educational level. CONCLUSIONS: A strong association was observed between the social determinants of health, specifically the structural ones, and the caries indicators studied in children of the Metropolitan Region of Chile. There were notable differences in caries between districts according to social advantage. Rurality and caregiver's education were the most consistent predictors.

Gender differences in positive screen for depression and diagnosis among older adults in Chile.

BACKGROUND: Different factors are associated with late life depression and diagnosis, including gender. It has also been reported that depression among older people is underdiagnosed. As a result, the mental health needs of this group are insufficiently met. The aim of this study was to explore gender differences in the factors associated with positive screens for depression and self-reported diagnosis among older adults in Chile. METHODS: Data from 3786 older adults who participated in the Social Protection Survey in 2016 were analysed. PHQ-9 was used to identify screen-positive cases. Self-reported diagnosis of depression was used to determine the proportion of people with a screen-positive result who had received a diagnosis of depression. Logistic regression models were used to determine sociodemographic and health factors associated with depression and underdiagnosis in older men and women. RESULTS: The prevalence of a screen-positive result was 20.91% (5.83% major depressive disorder) among men, and 36.38% (12.43% major depressive disorder) among women. 18.77% of men and 34.11% of women with a positive depression screening had received a diagnosis. More educated men were more likely to receive a diagnosis. Older age was associated with a lower probability of diagnosis among older women. CONCLUSIONS: Our results suggest that depressive disorders are undiagnosed in a high proportion of older adults in Chile. Gender is a relevant factor in the underdiagnosis of depression in this group. Further research is needed to understand the factors involved in these gaps, to improve detection and provide timely support and treatment.

Health literacy and adherence to treatment in different districts in Chile.

The relationship between health literacy and adherence has been described in medical literature, especially for patients with non-communicable diseases (NCDs). However, the relevance that an individual's local context can have has not been considered. This study aimed to examine the association of both concepts at a population level and estimate the correlation between health literacy and adherence to pharmacological treatment in adults from 14 districts in different regions in Chile. A cross-sectional study was carried out in 14 districts from 3 different regions of Chile. Sampling was carried out by volunteers. Three questionnaires were applied: sociodemographic; Morisky-Green-Levine (MMAS-4) and the Short Assessment of Health Literacy for Spanish Adults test (SAHLSA-50). Data were analyzed descriptively, and a Multilevel Poisson Regression model was fitted to evaluate the relationship between health literacy and adherence to pharmacological treatment, considering the districts as fixed intercepts. A total of 1,336 persons were surveyed; 811 self-reported as having at least 1 NCD. A 83.4% had adequate literacy and 37.1% were adherent to pharmacological treatment, regardless of their health literacy. A 3.6% (variance partition coefficient = 0.036) correlation of adherence to treatment was observed in respondents living in the same district. Those with inadequate health literacy had a 12% greater prevalence of being non-adherent (prevalence ratio 1.12; IC 95% 0.87 - 1.47) when adjusting for individual variables. These results could suggest that the individual's local context does not influence the relation of functional health literacy and adherence to pharmacological treatment in populations with basic and intermediate levels of education. We suggest further studies in this matter.

[Diagnostic properties of case definitions of suspected COVID-19 in Chile, 2020Características diagnósticas das definições de caso suspeito de COVID-19 no Chile, 2020]. / Propiedades diagnósticas de las definiciones de caso sospechoso de COVID-19 en Chile, 2020.

OBJECTIVE: Compare the diagnostic properties of five case definitions of suspected COVID-19 that were used or proposed in Chile during the first eight months of the pandemic. METHODS: An analysis was done of the diagnostic properties (sensitivity, specificity, and positive and negative predictive values) of three case definitions of suspected COVID-19 used in Chile between March and October 2020, as well as two alternative proposed definitions. The sample was 2,019 people with known results for the polymerase chain reaction (PCR) test for SARS-CoV-2. Stepwise logistic regression was used to develop criterion 5, optimizing sensitivity and specificity values. Multifactor logistic regression was used to explore the association between demographic variables, symptoms and signs, and PCR positivity. Different positivity scenarios were analyzed and ROC curves were compared. RESULTS: The presence of anosmia (OR = 8.00; CI95%: 5.34-11.99), fever (OR = 2.15; CI95%: 1.28-3.59), and having been in close contact with a person sick with COVID-19 (OR = 2.89; CI95%: 2.16-3.87) were associated with a positive PCR result. According to the analysis of the ROC curve, criterion 5 had the highest capacity for discrimination, although there were no significant differences with the other four criteria. CONCLUSIONS: Criterion 5-based on anosmia, close contact with people with COVID-19, and fever as sufficient unique elements-was the most sensitive in identifying suspected cases of COVID-19, a key aspect in controlling the spread of the pandemic.

OBJETIVO: Comparar as características diagnósticas de cinco critérios das definições de caso suspeito de COVID-19 usados ou propostos no Chile nos oito primeiros meses de pandemia. MÉTODOS: Foram avaliadas as características diagnósticas (sensibilidade, especificidade e valores preditivos positivo e negativo) de três critérios das definições de caso suspeito de COVID-19 usados no Chile entre março e outubro de 2020 e de duas alternativas propostas para definição de caso. A amostra do estudo consistiu 2 019 pessoas com resultados conhecidos no exame de reação em cadeia da polimerase (PCR) para SARS-CoV-2. Para elaborar o critério 5, uma regressão logística com método stepwise foi realizada otimizando os valores de sensibilidade e especificidade. A associação entre variáveis demográficas, sintomas e sinais e resultado positivo no exame de PCR foi testada em um modelo de regressão logística multifatorial. Situações diferentes de resultado positivo foram testadas com uma análise comparativa das curvas ROC. RESULTADOS: Presença de anosmia (OR 8,00; IC95% 5,34­11,99), febre (OR 2,15; IC95% 1,28­3,59) e contato próximo anterior com uma pessoa com COVID-19 (OR 2,89; IC95% 2,16­3,87) foram associados a um resultado positivo no exame de PCR. De acordo com a análise das curvas ROC, o critério 5 demonstrou maior capacidade discriminatória, apesar de não existir diferença significativa com os outros quatro critérios. CONCLUSÃO: O critério 5 ­ presença de anosmia, febre e contato próximo com uma pessoa com COVID-19 como elementos únicos e suficientes ­ demonstrou maior sensibilidade para identificar casos suspeitos de COVID-19, o que é fundamental para controlar a disseminação da pandemia.

[Validation of the short assessment of health literacy for spanish-speaking adults test in Chile]. / Validación del test Short Assessment of Health Literacy for Spanish-speaking Adults en Chile, para medir alfabetización en salud.

BACKGROUND: Health literacy is defined as the degree to which individuals obtain, process and understand basic health information and services. It is necessary to make appropriate decisions about their health. Evidence has shown that the level of health literacy is critical to the prognosis of chronic diseases. The Short Assessment of Health Literacy for Spanish-speaking Adults (SAHLSA-50) is a short and simple health literacy adult assessment. AIM: To determine the validity and reliability indicators of SAHLSA-50 in Chilean adults. MATERIAL AND METHODS: The survey was applied to 84 older adults living in high and low income neighborhoods. RESULTS: The survey had an adequate construct validity and reliability, its Comparative Fit Index was 0.93, its Tucker-Lewis index was 0.927 and its Root Mean Square Error of Approximation was 0.044. “Close fit” was not statistically significant (p = 0.828). Reliability was estimated by K-Richardson, which reported a good outcome (0.9255). Despite the good global indicators obtained, it is necessary to pay attention to some items that would fail to explain the “Health literacy” construct or were beyond the parameters of difficulty and discrimination proposed by the authors of the test. CONCLUSIONS: We propose this test as a useful tool to assess health literacy in the adult population in Chile. Its use and incorporation into local research can be especially recommended in the areas of education and health promotion.

Gender differences in life expectancy free of depressive symptoms in Chile between 2003 and 2016.

The aim of the study was to analyze gender differences in life expectancy free of depressive symptoms among the adult population in Chile between 2003 and 2016. The Sullivan method was used to estimate the total and marginal life expectancy, based on prevalence data from the National Health Survey (2003, 2010 and 2016), and abridged life tables for the Chilean population. There was a compression of morbidity among middle-aged men during the first period and among younger and older women during the last one. Men at all ages could expect to live a higher proportion of their lives without depressive symptoms during the whole period. The gender gap in the proportion of life expectancy free of depressive symptoms reached 10 percent points or more, considering almost all ages and periods. Unemployment and lower education increased the probability of depressive symptoms, and these effects were more marked among women. Public policies should have a gender-sensitive approach to address the gap in depression and the disadvantage experienced by women in life expectancy free of depressive symptoms, considering those dimensions that intersect with gender, such as access to education, employment or income.

[Spatial autocorrelation of breast cancer mortality in the Metropolitan Region, Chile: an ecological study]. / Autocorrelación espacial de mortalidad por cáncer de mama en la Región Metropolitana, Chile: estudio ecológico.

INTRODUCTION: Breast cancer is the most common malignancy in women worldwide and Chile, being the leading cause of female cancer death. A wide variation in mortality has been reported, with geographic clusters of higher risk. OBJECTIVE: To spatially analyze mortality from breast cancer in women in the Metropolitan Region in 2015. METHODS: Ecological study of location. We used death records in 2015 (C50 according to ICD10) and population projections of the Statistics Institute to estimate mortality rates. We calculated crude breast cancer mortality rates and standardized mortality ratios and performed a spatial epidemiological analysis of breast cancer mortality in women, estimating the global and local Moran I index to assess spatial autocorrelation. We present the results in maps according to the 2016 pre-census cartography. RESULTS: There were 622 deaths from breast cancer in the Metropolitan Region in 2015. The mean age was 66 years (SD: 15.5). 92.4% of deaths were registered in urban or central areas. However, the highest mortality rates were observed in peripherical districts. No global spatial autocorrelation was observed in the region (Morans I 0.007 p = 0.134). However, at the local level, four districts differ significantly from their neighbors. CONCLUSIONS: The risk of dying from breast cancer in the Metropolitan Region of Chile is concentrated in women from peripherical communes. Four districts in the region present different risks from their neighboring districts. It is necessary to investigate local realities to prevent deaths from this pathology.

INTRODUCCIÓN: El cáncer de mama es la neoplasia maligna más común en las mujeres en todo el mundo y en Chile, siendo la primera causa de muerte oncológica femenina. Se ha reportado amplia variación en la mortalidad, con focos geográficos de mayor riesgo. OBJETIVO: Analizar espacialmente la mortalidad por cáncer de mama en mujeres de la Región Metropolitana en 2015. MÉTODOS: Estudio ecológico. Se utilizaron los datos de los registros de defunciones del año 2015 (C50 según CIE10), y las proyecciones poblacionales del Instituto Nacional de Estadísticas. Se calcularon tasas de mortalidad por cáncer de mama brutas y razones de mortalidad estandarizadas. Se realizó un análisis epidemiológico espacial estimando el índice I de Moran Global y Local para evaluar autocorrelación espacial. Los resultados se presentan en mapas (cartografía pre-censo 2016). RESULTADOS: Se registraron 622 defunciones por cáncer de mama en la Región Metropolitana en 2015. La edad promedio de las mujeres fallecidas fue de 66 años (desviación estándar: 15,5). El 92,4% de las muertes se registró en zonas centrales o urbanas. Sin embargo, las mayores tasas de mortalidad se observaron en comunas periféricas. No se observó autocorrelación espacial global en la región (I de Moran de 0,007; p = 0,134). A nivel local, cuatro comunas se diferencian de forma significativa de sus vecinas. CONCLUSIONES: El riesgo de morir por cáncer de mama en la Región Metropolitana de Chile se concentra en comunas periféricas. Cuatro comunas de la región presentan riesgos diferentes de sus comunas vecinas, por lo que es necesario explorar factores que explican la desigual distribución de las muertes.

Systematic review of Latin American national oral health surveys in adults.

BACKGROUND: Oral diseases represent a main public health problem worldwide. There is scarce information about oral health indicators in adults in middle-income countries in Latin America and Africa. OBJECTIVES: To identify and describe national health surveys with national representative samples that included oral health assessment for adults in Latin America. METHODS: A systematic review was conducted in scientific and regional bibliographic databases (PubMed, SciELO, Wos and Embase); this was complemented with searchings in grey literature (Google Scholar, Open Grey and government health organization websites), from August 2016 to May 2017 (from 2000 to date). Studies conducted, supervised or funded by Ministries of Health or National Health Institutes were included. Data extracted included country, year, methods, interview and dental examination. Two researchers independently performed search and data extraction. Results were discussed as a group. RESULTS: Only 5 countries in Latin America have developed national health surveys evaluating the dental status in adults, with overall national representative samples during 2000-2015: Brazil, Colombia, Panama, Chile and Uruguay. Main differences were observed in the type of dental indicators selected, measure of dental services access and the professional who performed the dental examination. While some dental surveys were specifically designed as oral health surveys (Brazil, Colombia, Panama and Uruguay) and the examination was performed by dentists, other surveys represent a module within a general health survey (Chile) and the examination was performed by nurses. CONCLUSIONS: There are a small number of Latin American countries that report research about dental status with national representation samples. Most of these studies have been conducted as national oral health surveys, and fieldwork was carried out by dentists. The development of oral health research in this part of the world should be promoted as these surveys provide relevant information to monitor oral health and evaluate the effectiveness of health programmes.

Propiedades diagnósticas de las definiciones de caso sospechoso de COVID-19 en Chile, 2020 / Diagnostic properties of case definitions of suspected COVID-19 in Chile, 2020 / Características diagnósticas das definições de caso suspeito de COVID-19 no Chile, 2020

RESUMEN Objetivo. Comparar las propiedades diagnósticas de cinco definiciones de caso sospechoso de COVID-19 utilizadas o propuestas en Chile durante los primeros ocho meses de la pandemia. Métodos. Se analizaron las propiedades diagnósticas (sensibilidad, especificidad, y valores predictivos positivo y negativo) de tres definiciones de caso sospechoso de COVID-19 utilizadas en Chile entre marzo y octubre del 2020, y dos propuestas de definición alternativas. La muestra fue de 2 019 personas con resultados conocidos a la prueba de la reacción en cadena de la polimerasa (PCR) para SARS-CoV-2. Para elaborar el criterio 5 se aplicó una regresión logística escalonada (stepwise) optimizando los valores de sensibilidad y especificidad. Se exploró la asociación de variables demográficas, síntomas y signos con la positividad a la PCR mediante regresión logística multifactorial. Se analizaron diferentes escenarios de positividad y se compararon las curvas ROC. Resultados. La presencia de anosmia (OR = 8,00; IC95%: 5,34-11,99) y fiebre (OR = 2,15; IC95%: 1,28-3,59) y el haber tenido contacto estrecho previo con una persona enferma de COVID-19 (OR = 2,89; IC95%: 2,16-3,87) se asociaron con un resultado positivo de la PCR. Según el análisis de las curvas ROC, el criterio 5 tuvo la mayor capacidad de discriminación, aunque sin diferencias significativas con los otros cuatro criterios. Conclusiones. El criterio 5 —basado en la anosmia, el contacto estrecho con personas enfermas de COVID-19 y la fiebre como elementos únicos suficientes— tuvo la mayor sensibilidad para identificar los casos sospechosos de COVID-19, aspecto fundamental para controlar la propagación de la pandemia.

ABSTRACT Objective. Compare the diagnostic properties of five case definitions of suspected COVID-19 that were used or proposed in Chile during the first eight months of the pandemic. Methods. An analysis was done of the diagnostic properties (sensitivity, specificity, and positive and negative predictive values) of three case definitions of suspected COVID-19 used in Chile between March and October 2020, as well as two alternative proposed definitions. The sample was 2,019 people with known results for the polymerase chain reaction (PCR) test for SARS-CoV-2. Stepwise logistic regression was used to develop criterion 5, optimizing sensitivity and specificity values. Multifactor logistic regression was used to explore the association between demographic variables, symptoms and signs, and PCR positivity. Different positivity scenarios were analyzed and ROC curves were compared. Results. The presence of anosmia (OR = 8.00; CI95%: 5.34-11.99), fever (OR = 2.15; CI95%: 1.28-3.59), and having been in close contact with a person sick with COVID-19 (OR = 2.89; CI95%: 2.16-3.87) were associated with a positive PCR result. According to the analysis of the ROC curve, criterion 5 had the highest capacity for discrimination, although there were no significant differences with the other four criteria. Conclusions. Criterion 5—based on anosmia, close contact with people with COVID-19, and fever as sufficient unique elements—was the most sensitive in identifying suspected cases of COVID-19, a key aspect in controlling the spread of the pandemic.

RESUMO Objetivo. Comparar as características diagnósticas de cinco critérios das definições de caso suspeito de COVID-19 usados ou propostos no Chile nos oito primeiros meses de pandemia. Métodos. Foram avaliadas as características diagnósticas (sensibilidade, especificidade e valores preditivos positivo e negativo) de três critérios das definições de caso suspeito de COVID-19 usados no Chile entre março e outubro de 2020 e de duas alternativas propostas para definição de caso. A amostra do estudo consistiu 2 019 pessoas com resultados conhecidos no exame de reação em cadeia da polimerase (PCR) para SARS-CoV-2. Para elaborar o critério 5, uma regressão logística com método stepwise foi realizada otimizando os valores de sensibilidade e especificidade. A associação entre variáveis demográficas, sintomas e sinais e resultado positivo no exame de PCR foi testada em um modelo de regressão logística multifatorial. Situações diferentes de resultado positivo foram testadas com uma análise comparativa das curvas ROC. Resultados. Presença de anosmia (OR 8,00; IC95% 5,34-11,99), febre (OR 2,15; IC95% 1,28-3,59) e contato próximo anterior com uma pessoa com COVID-19 (OR 2,89; IC95% 2,16-3,87) foram associados a um resultado positivo no exame de PCR. De acordo com a análise das curvas ROC, o critério 5 demonstrou maior capacidade discriminatória, apesar de não existir diferença significativa com os outros quatro critérios. Conclusão. O critério 5 - presença de anosmia, febre e contato próximo com uma pessoa com COVID-19 como elementos únicos e suficientes - demonstrou maior sensibilidade para identificar casos suspeitos de COVID-19, o que é fundamental para controlar a disseminação da pandemia.

Autocorrelación espacial de mortalidad por cáncer de mama en la Región Metropolitana, Chile: estudio ecológico / Spatial autocorrelation of breast cancer mortality in the Metropolitan Region, Chile: an ecological study

INTRODUCCIÓN El cáncer de mama es la neoplasia maligna más común en las mujeres en todo el mundo y en Chile, siendo la primera causa de muerte oncológica femenina. Se ha reportado amplia variación en la mortalidad, con focos geográficos de mayor riesgo. OBJETIVO Analizar espacialmente la mortalidad por cáncer de mama en mujeres de la Región Metropolitana en 2015. MÉTODOS Estudio ecológico. Se utilizaron los datos de los registros de defunciones del año 2015 (C50 según CIE10), y las proyecciones poblacionales del Instituto Nacional de Estadísticas. Se calcularon tasas de mortalidad por cáncer de mama brutas y razones de mortalidad estandarizadas. Se realizó un análisis epidemiológico espacial estimando el índice I de Moran Global y Local para evaluar autocorrelación espacial. Los resultados se presentan en mapas (cartografía precenso 2016). RESULTADOS Se registraron 622 defunciones por cáncer de mama en la Región Metropolitana en 2015. La edad promedio de las mujeres fallecidas fue de 66 años (desviación estándar: 15,5). El 92,4% de las muertes se registró en zonas centrales o urbanas. Sin embargo, las mayores tasas de mortalidad se observaron en comunas periféricas. No se observó autocorrelación espacial global en la región (I de Moran de 0,007; p = 0,134). A nivel local, cuatro comunas se diferencian de forma significativa de sus vecinas. CONCLUSIONES El riesgo de morir por cáncer de mama en la Región Metropolitana de Chile se concentra en comunas periféricas. Cuatro comunas de la región presentan riesgos diferentes de sus comunas vecinas, por lo que es necesario explorar factores que explican la desigual distribución de las muertes.

INTRODUCTION Breast cancer is the most common malignancy in women worldwide and Chile, being the leading cause of female cancer death. A wide variation in mortality has been reported, with geographic clusters of higher risk. OBJECTIVE To spatially analyze mortality from breast cancer in women in the Metropolitan Region in 2015. METHODS Ecological study of location. We used death records in 2015 (C50 according to ICD10) and population projections of the Statistics Institute to estimate mortality rates. We calculated crude breast cancer mortality rates and standardized mortality ratios and performed a spatial epidemiological analysis of breast cancer mortality in women, estimating the global and local Moran I index to assess spatial autocorrelation. We present the results in maps according to the 2016 pre-census cartography. RESULTS There were 622 deaths from breast cancer in the Metropolitan Region in 2015. The mean age was 66 years (SD: 15.5). 92.4% of deaths were registered in urban or central areas. However, the highest mortality rates were observed in peripherical districts. No global spatial autocorrelation was observed in the region (Moran's I 0.007 p = 0.134). However, at the local level, four districts differ significantly from their neighbors. CONCLUSIONS The risk of dying from breast cancer in the Metropolitan Region of Chile is concentrated in women from peripherical communes. Four districts in the region present different risks from their neighboring districts. It is necessary to investigate local realities to prevent deaths from this pathology.

Validación del test Short Assessment of Health Literacy for Spanish-speaking Adults en Chile, para medir alfabetización en salud / Validation of the short assessment of health literacy for spanish-speaking adults test in Chile

Background: Health literacy is defined as the degree to which individuals obtain, process and understand basic health information and services. It is necessary to make appropriate decisions about their health. Evidence has shown that the level of health literacy is critical to the prognosis of chronic diseases. The Short Assessment of Health Literacy for Spanish-speaking Adults (SAHLSA-50) is a short and simple health literacy adult assessment. Aim: To determine the validity and reliability indicators of SAHLSA-50 in Chilean adults. Material and Methods: The survey was applied to 84 older adults living in high and low income neighborhoods. Results: The survey had an adequate construct validity and reliability, its Comparative Fit Index was 0.93, its Tucker-Lewis index was 0.927 and its Root Mean Square Error of Approximation was 0.044. “Close fit” was not statistically significant (p = 0.828). Reliability was estimated by K-Richardson, which reported a good outcome (0.9255). Despite the good global indicators obtained, it is necessary to pay attention to some items that would fail to explain the “Health literacy” construct or were beyond the parameters of difficulty and discrimination proposed by the authors of the test. Conclusions: We propose this test as a useful tool to assess health literacy in the adult population in Chile. Its use and incorporation into local research can be especially recommended in the areas of education and health promotion.

Calidad de vida relacionada con salud oral en mayores de 14 años en la comunidad San Juan bautista, isla Robinson Crusoe, Chile / Quality of life related to oral health in subjects 14 Years or Older, San Juan Bautista community, Robinson Crusoe Island, Chile

El aislamiento geográfico y condiciones medioambientales hacen a la población de Juan Fernández altamente vulnerable, siendo relevante conocer la calidad de vida relacionada con salud oral. Se realizó un estudio transversal en 137 habitantes mayores de 14 años. Se aplicó OHIP-14 para medir calidad de vida relacionada con salud oral previo consentimiento informado. El análisis estadístico fue realizado STATA 12.0. Un 51,8% es población femenina, con una edad media de 42,26 (DE 16,5). Un 91,97%, percibe que la salud oral afecta su calidad de vida, siendo levemente mayor en mujeres. Las molestias psicológicas son una manifestación en 80,29% de los encuestados. Un 75,91% percibe incomodidad por dolor en su boca, 62,77% manifiesta problemas de incapacidad psicológica. Existe mayor impacto en la calidad de vida relacionada con salud oral a medida que aumenta la edad. Por cada año de vida, el valor del OHIP-14 aumenta 0,07 (IC:95% 0,04­0,1). Los resultados obtenidos sugieren la necesidad de generar políticas públicas que consideren la salud oral desde una perspectiva integral, con énfasis en poblaciones altamente vulnerables considerando la mejora en la calidad de vida como un resultado a esperar

Geographic isolation and environmental conditions make the population of Robinson Crusoe Island, in the Juan Fernández archipielago highly vulnerable. It is therefore relevant to know the quality of life related to oral health (QOLRTO). In this report a cross sectional study in 137 inhabitants over 14 years of age was carried out. OHIP-14 was applied to measure QOLRTO, after informed consent was obtained. Statistical analysis was made in STATA 12.0. The population is 51.8% female, mean age 42.26 (SD 16.5) being similar in both sexes. Of the subjects studied, 91.97% perceived that oral health affects their quality of life, being slightly higher in women. Psychological distress was a manifestation in 80.29% of subjects, while 75.91% perceived discomfort and mouth pain, and 62.77% reported psychological disability issues. There is a greater impact of oral health issues with increasing age. For each year of life, the value of the OHIP-14 increased 0.07 (CI 95%, 0.04 to 0.1). The results suggest that public health policies that include a comprehensive oral health perspective, with emphasis on highly vulnerable populations should be considered

Nivel de conocimiento de salud oral y utilización de ges odontológico en puérperas atendidas en una clínica privada, Santiago, Chile / Oral health level of knowledge and use of dental ges in puerperal patients at a private clinic, Santiago, Chile

El objetivo de este estudio fue conocer el nivel de conocimientos de salud oral y la utilización de GES odontológico en 200 puérperas atendidas en el servicio integral de la mujer de una clínica privada, del sector norte de Santiago de Chile durante el año 2011. Se aplicó un cuestionario auto-administrado compuesto de 24 preguntas relacionadas con el nivel de conocimiento sobre enfermedades orales, prevención, gestación, atención odontológica y desarrollo dentario. El punto de corte para ser considerado como buen nivel de conocimiento fue igual o mayor a 14 puntos y regular entre 7 y 13 puntos. La edad promedio de la muestra estudiada fue de 29,11 años (+5,71) y la mitad refirió tener un solo hijo. El 57 por ciento refiere educación universitaria, un 70,5 por ciento declaró estar trabajando y sólo un tercio de ellas recibió atención dental durante su embarazo. Existe un nivel de conocimientos bueno en un 35 por ciento de las puérperas y regular en un 64 por ciento, siendo los conocimientos sobre prevención en salud oral los mejores evaluados y el de crecimiento y desarrollo dentario los más deficientes. La edad media fue mayor en el grupo con mejor nivel de conocimientos. Al hacer el análisis estadístico según las categorías de la encuesta no se observó diferencias estadísticamente significativas entre el nivel de conocimientos y haber recibido atención dental durante el embarazo (p=0,64). La relación entre el nivel de conocimientos sobre salud oral y paridad (p=0,37), nivel educacional (p=0,35) y ocupación (p=0,39) no fueron estadísticamente significativas. Se analizó también el puntaje en comparación a las diferentes variables mediante regresión lineal múltiple, solo el nivel educacional de la madre (IC95 por ciento= 0,3:1,8; p=0.007) y la paridad (IC95 por ciento= -0,1:1,5; p=0.05) fueron significativos, sin embargo el intervalo de confianza para la paridad no rechaza la hipótesis nula. Las madres con nivel educacional superior o técnico...

The aim of this study was to determine the level of oral health knowledge in 200 postpartum women attending an integral service for women of a private clinic in the northern sector of Santiago de Chile during the year 2011. We used a self-administered questionnaire based on 24 questions related to the level of knowledge of oral diseases, prevention, pregnancy, dental care and dental development. The cutoff score for being considered a good level of knowledge was higher than or equal to 14 points and regular cooperation between 7 and 13 points. The average age of the sample was 29.11 years (+ 5.71) and half reported having one child. 57% refers university education, 70.5% reported to be working and only a third received dental care during pregnancy. Thirty-five percent of puerperal women had a good level of knowledge and 64% had a regular level. The highest score identified was the knowledge on prevention in oral health and the lowest was health growth and development of dental. The mean age was higher in the group with higher level of knowledge. No statistically significant difference was observed between the level of knowledge and having received dental care during pregnancy (p = 0.635). The relation between level of oral health knowledge and parity (p = 0.367), educational level (p = 0.345) and occupation (p = 0.388) was not statistically significant. Using linear regression we analyzed the relation between level of knowledge score and other variables. The level of education of the mother (95% CI = 0.3:1.8, P = 0.007) and parity (95% CI = -0.1: 1.5, p = 0.05) were significant, but the confidence interval for parity does not reject the null hypothesis. Mothers with higher or technical level of education...

Situación de salud oral y calidad de vida de los adultos mayores / Oral health status and quality of life of older adults

Objetivos: Conocer la situación de salud oral y calidad de vida del adulto mayor que asiste a centros de salud pública del área oriente de Santiago de Chile durante los años 2011-2012. Material y métodos: Estudio descriptivo de corte transversal en una muestra probabilística de 380 adultos mayores. Se evaluó historia de caries, estado periodontal y situación protésica. La percepción de calidad de vida se midió con el Geriatric Oral Health Assessment Index (GOHAI). Se establecieron dos categorías: ômala calidad de vidaõ (puntuación ≤ 57) y ôbuena calidad de vidaõV (puntuación >57). El análisis estadístico se hizo en programa STATA 11.0. Resultados: La edad media fue de 71,33 años (D.E. ± 7,26); 66,1% son mujeres; 51,6% casado y 78,9% pensionado. Un 32,4% tiene educación media completa. El COPD fue de 22,16 (IC: 95% 21,72-22,60) mayor en mujeres (p>0,05) y aumenta con la edad (p< 0.05). Un 44% tiene entre 1 y 4 piezas dentarias con lesiones de caries dental. El edentulismo fue de 7,1%. Un 20% presentó sacos periodontales > a 5,5 mm. Un 43% presenta higiene oral regular. Un 59,5% usa prótesis removible en el maxilar superior y 40,3% en el inferior. Un 76,6% percibe como mala su calidad de vida. Conclusión: Los adultos mayores son un grupo de especial interés para la salud pública debido a la mala percepción de su calidad de vida y vulnerabilidad de su salud bucal.

Objectives: The purpose of this study was to determine de the status of oral health and life quality of older adults who attend in public health centers in the area orient of Santiago, Chile during the years 2011-2012. Material and method: A descriptive cross-sectional study in a random sample of 380 older adults. Was evaluated the history of caries, periodontal and prosthetic situation. The perceived life quality was measured with the Geriatric Oral Health Assessment Index (GOHAI). Were established two categories: ôBad quality lifeõ (score ≤ 57) and ôGood life qualityõ (score >57). The statistical analysis was done in STATA 11.0. Results, the average age was 71.33 years (E.D. ±7.26); 66.1% are women; 51.6% are married y 78.9% retired. 32.4% have completed secondary education. The CAOD was 22.16 (CI 95% 21.72 to 22.60) more in women (p> 0.05) and increased with age (p <0.05). The 44% have between 1 and 4 teeth with dental caries. Edentulous was 7.1%. The 20% presented periodontal pockets> 5.5 mm. About 43% have regular oral hygiene. The 59.5% a removable prosthesis used in the maxilla and 40.3% in the mandible. The 76.6% perceived bad quality of life. Conclusion: The elderly are a group of special interest for public health due to poor perception of their life quality and oral health vulnerability.

Descripción de la satisfacción usuaria de pacientes que reciben atención de urgencia dental en cinco establecimientos de atención primaria de salud / Measurement of user satisfaction in patients receiving emergency dental care at five primary health care centers

La satisfacción usuaria es definida como la medida en que los profesionales de salud logran cumplir las necesidades y expectativas del usuario. En distintos países de Latinoamérica, estudios revelan que los niveles de satisfacción usuaria superan el 80 por ciento en el área dental en general. Sin embargo en Chile no se han realizado estudios nacionales en relación al tema. En la región de la Araucanía tampoco existen estudios al respecto. Se planteó conocer el porcentaje de satisfacción usuaria de pacientes que reciben atención de urgencia dental en cinco establecimientos de Atención primaria de la salud de la ciudad de Temuco. Para la recolección de datos se aplicó un formulario estandarizado a 305 pacientes durante el año 2011. Del total de la muestra, un 53,4 por ciento fueron mujeres, un 60,9 por ciento están en el rango etario de 20-60 años. El 54,8 por ciento de los pacientes consultó por dolor. El tratamiento que más se realizó fue exodoncia la exodoncia dental (62,3 por ciento) seguida por la entrega de recetas médicas (22,9 por ciento). Un 52,1 por ciento consideró excesivo el tiempo de espera. Los ítems evaluados positivamente fueron el buen trato del dentista (99 por ciento), el tiempo de examen (83,6 por ciento). Un 64,6 por ciento considera que no hay suficientes dentistas, sin embargo la mayoría de los pacientes opina que se les solucionó el problema (85,3 por ciento), así como un 90,5 por ciento se consideró satisfecho con la atención. Se obtuvo asociación significativa (p<0,05) entre la satisfacción y las variables tiempo de espera, horario de atención, tiempo que duró la atención, información que se entregó o no cuando se recetaron medicamentos, equipamiento del consultorio, cantidad de dentistas y resolución del problema. Los resultados obtenidos plantean una tendencia que sería interesante abordar con una escala de satisfacción usuaria que permita una asociación más exacta con las variables estudiadas...

User satisfaction is defined as the patient's perception of the "degree in which health care professionals satisfy the needs and expectations of the user", or as "the degree of congruity between users' expectations about ideal health care services, and their perception of the health care they actually receive". At present, there are no statistics on health care user satisfaction in the Araucanía Region. Most of the Latin American countries, a number of studies indicate that the level of user satisfaction exceeds 80 percent for dental care services as a whole. In our study, a standard questionnaire was answered by 305 patients. Of these 305 patients, 53.4 percent were females, and 60.9 percent were in the 20-60 year age bracket; 54.8 percent of all patients had approached the health center because of pain. The most-frequently applied treatment was tooth extraction (62.3 percent), followed by prescription of medication (22.9 percent). Regarding user satisfaction, over half the patients (52.1 percent) felt that waiting time was unduly long. As for the aspects which received a positive evaluation, the overwhelming majority (99 percent) felt that they were well-treated by the dentist; 83.6 percent felt that the time taken by the dentist for diagnosis was adequate; they also appreciated the fact that almost all patients (96.9 percent) receiving a medical prescription were informed of the purpose of the medication, and were given instruction on when and how to take it. 64.6 percent of respondents said that there are not enough dentists at the health center but, at the same time, 85.3 percent stated that the dentist had resolved their problem, and 90.5 percent said they were satisfied with the services received, as a whole. Statistically significant results were obtained on the following aspects of user satisfaction: waiting time; opening hours; effective duration of the dental care received; information given to the patient at the time of prescribing medication...

Prevalencia de Lesiones de la Mucosa Oral en el Hospital Hernán Henríquez Aravena de Temuco / Prevalence of Oral Mucosal Lesions at the Hernán Henríquez Aravena Hospital of Temuco

El propósito de este estudio fue determinar la prevalencia de las lesiones de la mucosa oral en el Hospital Hernán Henríquez Aravena de la ciudad de Temuco, Chile. La muestra fue de 300 pacientes mayores de 20 años, examinados en el mismo hospital (intervalo de confianza del 95 por ciento). La prevalencia de las lesiones de la mucosa oral fue de 66 por ciento. Las lesiones más prevalentes fueron; gránulos de Fordyce (30 por ciento), candidiasis atrófica (14,33 por ciento), mácula melanótica (13,67 por ciento), várices orales (7,33 por ciento), pigmentación fisiológica (6 por ciento), nevos (4 por ciento), efélides (3,33 por ciento), úlceras traumáticas (4 por ciento), leucoplasia (3 por ciento) y queilitis angular (2,68 por ciento). Se encontró una relación directa entre el aumento de la edad y la presencia de candidiasis atrófica, úlceras traumáticas y várices, siendo esta asociación estadísticamente significativa. Podemos concluir que existe una alta prevalencia de lesiones de la mucosa oral en la población adulta de la muestra y que la cantidad de estas lesiones se incrementan con la edad (candidiasis atrófica, úlceras traumáticas y várices orales), por lo que es necesario intensificar el diagnóstico precoz y el tratamiento oportuno de ellas.

The purpose of this study was to determine the prevalence of oral mucosal lesions at the Hernan Henríquez Aravena Hospital in the city of Temuco Chile. Method: The sample consisted of 300 patients aged over 20 years, examined in the same hospital (confidence interval 95 percent). Results: The prevalence of oral mucosal lesions was 66 percent. The most prevalent lesions were; Fordyce granules (30 percent), atrophic candidiasis (14.33 percent), oral melanotic macule (13.67 percent), oral mucosal varicosities (7.33 percent), physiological pigmentation (6 percent), nevus (4 percent), ephelis (3.33 percent), traumatic ulcers (4 percent), leukoplakia (3 percent) and angular cheilitis (2.68 percent). A direct ratio was found between increased age and the presence of atrophic candidiasis, traumatic ulcers and oral mucoral varicosities, this association being statistically significant. It may be concluded that there is a high prevalence of oral mucosal lesions in the adult population of the sample and that the quantity of lesions increases with age (atrophic candidiasis, traumatic ulcers and mucosal varicosities), making it necessary to intensify their early diagnosis and timely treatment.

Frecuencia de auto-exámen y nivel de conocimiento de los pacientes en relación a las lesiones de la mucosa oral en Temuco, Chile / Frecuency of self-exam and level knowledge in patients with respect to oral mucosal lesions in Temuco, Chile

El propósito del presente estudio fue cuantificar la frecuencia de auto-inspección y el conocimiento de los pacientes de la Región de la Araucanía, Chile acerca de la normalidad de la mucosa oral. La muestra estuvo constituida de 300 pacientes mayores de 20 años, examinados en el Hospital Hernán Henríquez Aravena de la ciudad de Temuco, Chile (intervalo de confianza del 95 por ciento). Para evaluar la frecuencia de autoinspección y el conocimiento se creó una encuesta con cinco preguntas dicotómicas sobre conocimientos de normalidad de mucosa oral y una pregunta de selección múltiple sobre frecuencia de auto inspección. Del total de la muestra, el 46,6 por ciento de la muestra expresó que no se examina durante el año; el 24,3 por ciento se examinaba entre una y dos veces al año y el 29,0 por ciento se examinaba tres o más veces al año. En un 52,6 por ciento no hubo concordancia entre lo referido por el paciente y la presencia o ausencia efectiva de lesión al ser examinados por el patólogo oral, y en un 47,3 por ciento hubo concordancia (kappa=0,096). Los resultados obtenidos demuestran la necesidad de educar a la población en técnicas de autoexamen y salud oral, para aumentar el diagnóstico temprano de lesiones de la mucosa oral.

The purpose of the present study was to quantify the frequency of self-inspection by patients in the Araucania Region and their knowledge about the normal state of the oral mucosa. The sample consisted of 300 patients aged over 20 years, examined in the Hernán Henríquez Aravena Hospital in the city of Temuco (confidence interval95 percent). To evaluate the frequency of self-inspection and degree of knowledge a questionnaire was prepared with five yes/no questions about knowledge with respect to the normal state of the oral mucosa and one multiple choice question on the frequency of self-inspection. Of the total sample (n=300), 46.6 percent said that they never carried out self-inspection during the year; 24.3 percent carried out self-inspection once or twice per year and 29 percent three or more times. In 52.6 percent there was no concordance between the patient's answers and the actual presence or absence of lesions in examination by an oral pathologist, and in 47.3 percent there was a concordance (kappa=0.096). The results obtained demonstrate the need to educate the population in techniques of oral health and self-examination, to increase early diagnosis of lesions to the oral mucosa.