Tendencia de niños y niñas de 6 años libres de caries en Chile entrelos años 2012 y 2019

RESUMEN: Objetivo: La caries dental es la patología más prevalente en niños*. En Chile se desconoce si el estado de salud bucal ha mejorado al implementar estrategias y programas preventivos dirigidos a la población infantil en la última década. El objetivo fue determinar la prevalencia de niños de 6 años sin experiencia de caries (ceod=0) del país, su distribución territorial y tendencia en el período 2012 a 2019. Materiales y método: Se realizó un estudio ecológico utilizando los registros de atención odontológica de 1.020.920 niños de 6 años en los Servicios de Salud (SS) de Chile. Se analizó la tendencia en el tiempo utilizando un test de tendencia lineal para proporciones. Resultados: La prevalencia de niños de 6 años sin experiencia de caries aumentó 1,2 puntos por año entre 2012 y 2019. La prevalencia en los SS Arica e Iquique y los tres de la Región de Valparaíso supera el 40% y en los cuatro SS de la Región del Biobío y el SS Chiloé es menor al 25%. Conclusiones: La prevalencia de niños de 6 años sin experiencia de caries ha mejorado en la última década y su distribución territorial presenta gran variabilidad, sin embargo, aún sigue siendo baja. *Se usará la palabra "niño" para referirse a "niños y niñas".

ABSTRACT: Objective: Dental caries is the most prevalent disease in children. In Chile, it is unknown whether the oral health status in children population has improved after the implementation of preventive strategies and programs in the last decade. The objective was to determine the prevalence of 6-year-old children with no caries experience (ceod=0) in the country, its territorial distribution and trend in the period 2012 to 2019. Methodology: An ecological study was carried out using the dental care records of 1,020,920 6-year-old children in the Chilean Health Services. The trend over time was analyzed using a linear trend test for proportions. Results: The prevalence of 6-year-old children without caries experience increased 1.2 points per year between 2012 and 2019. The prevalence in the Arica and Iquique Health Services and in the three Health Services in the Valparaíso Region exceeds 40%. In the four Health Services in the Biobío Region and in the Chiloé Health Service it is less than 25%. Conclusions: The prevalence of 6-year-old children without caries experience has improved in the last decade and its territorial distribution presents great variability; however, it still remains low.

Factores demográficos y comorbilidades asociadas a severidad de COVID-19 en un hospital chileno: el rol clave del nivel socioeconómico / Comorbidities and demographic factors associated with severe COVID-19 outcomes in a Chilean hospital

Background: Several risk factors are associated with COVID-19 severity and death, such as advanced age, male sex, and the presence of comorbidities. Aim: To study the effect of these risk factors and socioeconomic variables on the outcome of Chilean patients admitted with COVID-19 to a Chilean public hospital. Material and Methods: Review of medical records of patients admitted to a Chilean public hospital with a positive PCR test for COVID-19, Chile from March to June 2020. The outcome variable was severity (ICU admission or death). The exposure variables were age, sex, socioeconomic level, and comorbidities. A multivariable logistic regression analysis was performed. Results: Of 1,141 confirmed cases, 266 cases had a severe evolution (23.3%), including 147 deaths (fatality 12.9%). Advanced age and low socioeconomic status were the variables most strongly associated with severity. An age of 80 years or over had an odds ratio (OR) = 11.1 [95% confidence intervals (CI) 5.22-23.53]. The OR [95% CI] for a low socioeconomic level was 3.1 [1.1-8.5]. The figure for male sex was 2.13 [1.5-3.0], for chronic kidney disease was 2.65 [1.49-4.73], for obesity was 2.36 [1.65-3.39], and for diabetes 1.78 [1.22-2.61]. No significant association with severity was found for high blood pressure, chronic pulmonary disease, cardiovascular disease, or smoking. Conclusions: Following age, a low socioeconomic level was the factor with the higher association with a poor outcome or severe evolution of COVID-19.

Salud oral integral para adultos de 60 años: un análisis territorial de su cobertura a 12 años de su implementación / Comprehensive oral health for adults 60 years of age: a territorial analysis of its coverage 12 years after its implementation

INTRODUCCIÓN. Las personas mayores en Chile tienen alta carga de morbilidad oral y de déficit funcional que afecta directamente su calidad de vida. El programa universal GES Salud Oral Integral del adulto de 60 años, implementado desde el 2007, permite a las personas de 60 años acceder a tratamiento odontológico integral, aunque a la fecha se tiene pocos antecedentes de sus resultados. El objetivo de este estudio es estimar la cobertura del programa GES 60 para el año 2019 de los beneficiarios FONASA y su variabilidad territorial desagregada por Servicio de Salud (SS), sexo y tipo de prestador (público o compra de servicios). MATERIALES Y MÉTODOS. Se realizó un estudio observacional ecológico, utilizando fuentes de datos secundarios de uso público (DEIS, FONASA). Se estimó la cobertura nacional total y por sexo, estratificada para cada SS. RESULTADOS. La cobertura del programa en el sector público de salud fue de un 22,8% el año 2019. La menor cobertura se observó en el SS Arica (5,3%) y la mayor en el SS Arauco (37,9%). La cobertura nacional fue significativamente mayor (valor p=0,001) en mujeres (27,1%) que en hombres (17,9%). La compra de servicios a proveedores externos totalizó el 12,2% de las altas dentales, siendo esta proporción heterogénea entre SS con relación inversa entre Compra de servicios y Cobertura. DISCUSIÓN. La cobertura para el año evaluado fue baja, siendo insuficiente para poder resolver la alta carga de morbilidad de las personas mayores chilenas. Existe una amplia variabilidad territorial de la cobertura, presentando diferencias por sexo y en la compra de servicios.

INTRODUCTION. Elderly people in Chile have a high burden of oral morbidity and functional deficits that directly affect their quality of life. The universal GES program: "Comprehensive Oral Health for the 60-year-old adult", implemented since 2007, allows 60-year-olds to access comprehensive dental treatment, however there is limited evidence of its results to date.The aim of this study is to estimate the coverage of the program for the year 2019 of the public health insurance FONASA beneficiaries and their territorial variability disaggregated by Health Service (HS), sex and type of provider (public or purchase of services). MATERIALS AND METHODS. An observational ecological study was carried out, using secondary data from public sources (DEIS, FONASA). Total national coverage and by sex was estimated, stratified for each SS. Results. The coverage of the program in the public health sector was 22.8% in 2019. The lowest coverage was observed in Arica HS (5.3%) and the highest in Arauco HS (37.9%). National coverage was significantly higher (p-value = 0.001) in women (27.1%) than in men (17.9%). Purchase of services from external providers totaled 12.2% of the dental discharges, this pro-portion being heterogeneous between SS with an inverse relationship between "Purchase of services" and "Coverage". DISCUSSION. The coverage for the evaluated year was low, being insufficient to be able to solve the high burden of morbidity of Chilean elderly. There is a wide territorial variability of coverage, presenting differences by sex and in the purchase of services.