Risk and Preventive Factors for Depressive Symptoms Among Older Chilean Adults During the SARS-CoV-2 Outbreak: A Longitudinal Study.

OBJECTIVE: To specifically examine the multiple factors related to the increase in depressive symptoms during the COVID-19 outbreak in older adults in Chile. METHOD: A longitudinal study was conducted using a dataset from a nationally representative survey cohort of Chilean older adults followed at three time points during the COVID-19 outbreak. The main outcome was depressive symptoms (Patient Health Questionnaire scale). The independent variables included: age, sex, educational level, geographic area, living alone, self-perceived health, self-reported resilience, loneliness, and social isolation. RESULTS: A total of 424 older adults were included. Female sex (ß = 0.95, 95% CI: 0.22 to 1.68) and loneliness (ß = 1.21, 95% CI: 1.05 to 1.37) were the main risk factors for an increase in depressive symptoms in older adults. In contrast, living outside the metropolitan region (ß=-0.70, 95% CI: -1.39 to -0.02), living in company (ß=-0.34, 95% CI:-1.24 to 0.56), having better self-perceived health (ß=-5.04, 95% CI:-6.33 to -3.75) and greater resilience (ß=-0.30, 95% CI: -0.38 to -0.23) were preventive factors. CONCLUSION: These results provide useful evidence to develop mental health prevention or control strategies for older adults. CLINICAL IMPLICATIONS: The findings highlight the importance of a holistic approach to health care for older adults that integrates strategies to address loneliness, foster resilience, and promote an active social life.

Iron, folic acid, and vitamin D supplementation during pregnancy: Did pregnant Chilean women meet the recommendations during the COVID pandemic?

BACKGROUND: Antenatal micronutrient supplementation has been defined as a priority for Low-and Middle-income Countries (LMICs). However, it is also relevant to assess its performance in middle-high income countries, such as Chile, particularly given the post-pandemic food insecurity context. AIM: To assess the use (frequency and doses) of daily recommended supplementation (iron (15-30 mg), folic acid (FA) (400-800 µg/day), and vitamin (VD) (400 IU)) in a sample of Chilean pregnant women. METHODS: In 1, 507 pregnant women selected from public health care registries of the Southeast area of Santiago-Chile, we collected maternal, supplement use, sociodemographic, and nutritional information at the first (<15 weeks), second (24-28 weeks), and third trimesters (32-36 weeks) of gestation by using a researcher administer online questionnaire. RESULTS: The median (IQR) age of women was 29 (25-33) years. Pre-conceptional supplementation was rare (24%), but it reached >93% in the first trimester; thereafter supplement use decreased to 79% in the second and 84% in the third trimesters, particularly in women with lower income (p<0.05), lower education (p<0.05), and with excess weight (p<0.05). Use of iron supplements in the first trimester was rare (<21%) as well as the use of VD supplements across pregnancy (<31%). Most FA (70%) and iron (80%) supplement users, exceeded the recommended daily dose while ~40% of VD users took less than the recommended dose. CONCLUSIONS: In this sample of Chilean women, timely initiation of FA, iron, and VD supplementation was low and doses were not aligned with the recommendations. Strengthening adherence and quality of micronutrient supplementation programs delivered through public primary care could benefit particularly the most vulnerable women.

Access disparities and underutilization of germline genetic testing in Chilean breast cancer patients.

PURPOSE: Latin American reports on genetic cancer risk assessments are scarce. In Chile, current breast cancer (BC) guidelines do not define strategies for germline genetic testing. Our study sought to quantify the disparities in access to genetic testing in Chilean BC patients, according to international standards and their clinical characteristics to explore improvement strategies. METHODS: Retrospective analysis of invasive BC databases including patients treated in a Public Hospital (PH) and in an Academic Private Center (AC) in Santiago, Chile between 2012 and 2021. RESULTS: Of 5438 BC patients, 3955 had enough data for National Comprehensive Cancer Network (NCCN) categorization. From these, 1911 (48.3%) fulfilled NCCN criteria for germline testing, of whom, 300 were tested for germline mutations and 268 with multigene panels. A total of 65 pathogenic variants were found in this subset. As expected, BRCA1/2 mutations were the most frequent (17.7%). Access to genetic testing was higher in AC versus PH (19.6% vs. 10.3%, p = 0.0001). Other variables associated with germline genetic testing were BC diagnosis after 2018, being 45 years old or younger at diagnosis, BC family history (FH), FH of ovarian cancer, non-metastatic disease, and triple-negative subtype. CONCLUSION: In our cohort, 15% of BC patients who met NCCN criteria for germline testing were effectively tested. This percentage was even lower at the PH. Current recommendations encourage universal genetic testing for BC patients; however, our findings suggest that Chile is far from reaching such a goal and national guidelines in this regard are urgently needed. To our knowledge, this is the first study of its kind in Chile and Latin America.

Suplementación efectiva de vitamina D en pacientes con fractura tibial / Effective vitamin D supplementation in patients with tibial fracture

OBJETIVOS Determinar la prevalencia de déficit de vitamina D, así como evaluar la seguridad y efectividad de un nuevo método de carga con colecalciferol en pacientes adultos con fractura de tibia. MATERIALES Y MÉTODOS Se reclutaron a 56 pacientes consecutivos con edades entre 18 y 65 años con fractura de tibia ingresados en nuestro hospital durante 1 año. Se determinó el nivel de 25-hidroxivitamina D ([25(OH)-D]) al ingreso y tras suplementación con 100.000 UI semanales de colecalciferol, durante 3 o 5 semanas, en casos de insuficiencia ([25(OH)-D] entre 20 ng/mL y 29,9 ng/mL) o deficiencia ([25(OH)-D] < 20 ng/mL), respectivamente. Se determinó la prevalencia de hipovitaminosis D, el porcentaje de normalización de [25(OH)-D], y los efectos adversos. RESULTADOS Se evaluaron 56 pacientes; 98,2% presentó hipovitaminosis D, y 28 (73,7%) y 10 (26,3%) presentaron déficit e insuficiencia, respectivamente. Tras la suplementación, 92,1% alcanzaron niveles [25(OH)-D] normales. Ningún paciente presentó efectos adversos. DISCUSIÓN La prevalencia de deficiencia de vitamina D en nuestra población fue mayor a la reportada en la literatura. Comprobamos que un esquema de suplementación en altas dosis de vitamina D es seguro, y más efectivo que los previamente recomendados. Este esquema de suplementación puede ser implementado en futuros estudios randomizados. CONCLUSIÓN La prevalencia de hipovitaminosis D en pacientes adultos chilenos con fractura de tibia fue alta (98,2%). El esquema de suplementación con vitamina D propuesto fue efectivo y seguro.

OBJETIVOS Determinar la prevalencia de déficit de vitamina D, así como evaluar la seguridad y efectividad de un nuevo método de carga con colecalciferol en pacientes adultos con fractura de tibia. MATERIALES Y MÉTODOS Se reclutaron a 56 pacientes consecutivos con edades entre 18 y 65 años con fractura de tibia ingresados en nuestro hospital durante 1 año. Se determinó el nivel de 25-hidroxivitamina D ([25(OH)-D]) al ingreso y tras suplementación con 100.000 UI semanales de colecalciferol, durante 3 o 5 semanas, en casos de insuficiencia ([25(OH)-D] entre 20 ng/mL y 29,9 ng/mL) o deficiencia ([25(OH)-D] < 20 ng/mL), respectivamente. Se determinó la prevalencia de hipovitaminosis D, el porcentaje de normalización de [25(OH)-D], y los efectos adversos. RESULTADOS Se evaluaron 56 pacientes; 98,2% presentó hipovitaminosis D, y 28 (73,7%) y 10 (26,3%) presentaron déficit e insuficiencia, respectivamente. Tras la suplementación, 92,1% alcanzaron niveles [25(OH)-D] normales. Ningún paciente presentó efectos adversos. DISCUSIÓN La prevalencia de deficiencia de vitamina D en nuestra población fue mayor a la reportada en la literatura. Comprobamos que un esquema de suplementación en altas dosis de vitamina D es seguro, y más efectivo que los previamente recomendados. Este esquema de suplementación puede ser implementado en futuros estudios randomizados. CONCLUSIÓN La prevalencia de hipovitaminosis D en pacientes adultos chilenos con fractura de tibia fue alta (98,2%). El esquema de suplementación con vitamina D propuesto fue efectivo y seguro.

Indigenous Border Migrants and (Im)Mobility Policies in Chile in Times of COVID-19.

The commodification of healthcare and the structural violence towards the migrant population in the Chilean system materialize in a series of structural barriers to accessing healthcare. In the face of this structural vulnerability, cross-border health mobility is one of the primary resources of indigenous border migrants living in the Tarapacá region (Chile). This involves crossing the border of both people (specialists/patients) and objects (such as ritual supplies or biomedicines), which play a crucial role as, in many cases, it is the only way to satisfy their healthcare needs. The security-orientated geopolitics of border closure (Plan Frontera Segura) has been reinforced by immobility policies linked to the COVID-19 pandemic. While doing so leaves people without the fundamental resource of healthcare mobility or obliges them to cross the border via unauthorized crossings, exposing them to criminalization and abuse by different agents of violence (the military, people smugglers, etc.). In this paper, we will offer a description of these processes of (im)mobility, analyzing their conformation both by the current policies of the Chilean State and by the notorious deficiency in indigenous and migrant rights, denouncing the material impact they have on the health/illness/care process of indigenous migrants.

Trends in cannabis or cocaine-related dependence and alcohol/drug treatment in Argentina, Chile, and Uruguay.

BACKGROUND: In the context of changing cannabis and other drug policy and regulation, concerns may arise regarding drug treatment access and use. We assessed cannabis/cocaine-related dependence and treatment in Argentina, Chile, and Uruguay. METHODS: Nationally representative cross-sectional household surveys of people ages 15-64 in Argentina (4 surveys, 2006-2017), Chile (7 surveys, 2006-2018), and Uruguay (4 surveys, 2006-2018) were harmonized. We estimated weighted prevalences of cannabis or cocaine-related (cocaine or cocaine paste) dependence, based on meeting 3+ past-year ICD-10 dependence criteria. We estimated weighted prevalences of past-year alcohol/drug treatment use (Argentina, Chile) or use/seeking (Uruguay) among people with past-year cannabis/cocaine-related dependence. We tested model-based prevalence trends over time and described individual-level treatment correlates by country. RESULTS: Cannabis/cocaine dependence prevalence increased in the region starting in 2010-2011, driven by cannabis dependence. Adjusted cannabis dependence prevalence increased from 0.7% in 2010 to 1.5% in 2017 in Argentina (aPD=0.8, 95% CI= 0.3, 1.2), from 0.8% in 2010 to 2.8% in 2018 in Chile (aPD=2.0, 95% CI= 1.4, 2.6), and from 1.4% in 2011 to 2.4% in 2018 in Uruguay (aPD=0.9, 95% CI= 0.2, 1.6). Cocaine-related dependence increased in Uruguay, decreased in Argentina, and remained stable in Chile. Among people with past-year cannabis/cocaine dependence, average alcohol/drug treatment use prevalence was 15.3% in Argentina and 6.0% in Chile, while treatment use/seeking was 14.7% in Uruguay. Alcohol/drug treatment prevalence was lower among people with cannabis dependence than cocaine-related dependence. Treatment correlates included older ages in all countries and male sex in Argentina only. CONCLUSION: Alcohol/drug treatment use among people with cannabis/cocaine-related dependence remained low, signaling an ongoing treatment gap in the context of growing cannabis dependence prevalence in the region. Additional resources may be needed to increase treatment access and uptake. Future studies should assess contributors of low treatment use, including perceived need, stigma, and service availability.

Neural tube defects prevalence does not increase after modification of the folic acid fortification program in Chile.

BACKGROUND: In 2000, Chile's Ministry of Health mandated fortification of wheat flour with folic acid at a concentration of 2.2 mg/kg to prevent neural tube defects (NTDs), resulting in a 50% reduction in NTD prevalence. Concerns about possible collateral effects of high folic acid intake led, in 2009, to decrease the folic acid fortification to 1.8 mg/kg of flour. Our study evaluated the impact of this modification on the prevalence of NTDs in Santiago. METHODS: This study measured the prevalence of NTDs in live births and stillbirths born in Santiago. We calculated prevalence ratios (PR) and 95% confidence intervals (CI) between pre-folic acid fortification (1999-2000), post-folic acid fortification (2001-2009), and post-modified folic acid fortification (2010-2015) periods for all NTDs and their specific types. We used chi-square tests to analyze proportions, and a Joinpoint regression to visualize prevalence time trends. RESULTS: The NTD prevalence for the period 2001-2015 was 8.9 per 10,000 births, which represents a 48% reduction (PR = 0.52; 95% CI = 0.45-0.61; p < .001) from the pre-folic acid fortification period. During 2010-2015, the NTD prevalence was 9.5/10,000 births, which was higher, but not statistically significantly different from 2001 to 2009 prevalence of 8.6/10,000 (PR = 1.11; 95% CI = 0.96-1.30, p = .17). CONCLUSIONS: Decreasing the concentration of folic acid fortification was not associated with a statistically significant change in the prevalence of NTDs. Mandatory folic acid fortification continues to be a safe and highly effective policy to prevent NTDs. Future studies should evaluate the prevalence of NTDs across Chile and adherence to folic acid fortification mandates.

Polifarmacia en Chile: una investigación descriptiva / Polipharmacy in Chile: a descriptive research

La polifarmacia es un término que, si bien no existe un consenso, se considerará como el uso concomitante de cinco o más medicamentos ya sean recetados o no por un profesional. Con respecto a ésta, se ha visto que se ha acrecentado en los últimos años tanto en Chile como en el mundo. En la presente investigación descriptiva se realizó un análisis de la Encuesta Nacional de Salud de Chile (ENS) 2016-17 y se comparó con los resultados obtenidos en la Encuesta Nacional de Salud 2009-10 y con la Encuesta sobre Salud, Envejecimiento y Jubilación Europea para de esta forma realizar un recuento objetivo sobre el aumento de esta condición en Chile. Al caracterizar a los grupos más afectados, se vio que en Chile la mayor prevalencia se daba en población adulta mayor sobre 65 años, mujeres y personas con escolaridad menor a 8 años cursados. Esto da cuenta del nivel del problema y la necesidad de una visión médica holística para el especial abordaje de la multimorbilidad, pues la polifarmacia trae consigo a su vez riesgos para la salud como lo son el aumento de las reacciones adversas e interacciones medicamentosas, riesgo de hospitalización, mayor deterioro del estado funcional, incremento de alteraciones cognitivas y mayores costos monetarios para el sistema de salud.

Polypharmacy is a term that, although there is no official definition, is understood as the concomitant use of five or more medications, regardless of whether they are prescribed by a professional. Regarding this phenomenon, an increase can be observed in recent years both in Chile and on a global level. This present descriptive research draws on an analysis of the National Health Survey (ENS) from 2016-17 and a comparison with the National Survey of Health from 2009-10 and with Survey of Health, Ageing and Retirement in Europe in order to carry out an objective count on the increase of this phenomenon. When characterizing the most affected groups, this paper shows that in Chile the highest prevalence can be found in the older adult population over 65 years of age, women and people with less than 8 years of schooling. These results reveal the dimension of the issue, and the need for a holistic medical vision to pay particular attention to multiple morbidities since polypharmacy brings with it health risks such as increased adverse reactions and drug interactions, risk of hospitalization, further deterioration of functional status, increase in cognitive alterations and higher monetary costs for the health system

Conducta fumadora en estudiantes de kinesiología y su asociación con actitudes y conocimientos sobre tabaquismo: estudio de corte transversal / Smoking behavior in Chilean physical therapist students and their association with attitudes and knowledge on cigarette smoking: a cross sectional study

INTRODUCCIÓN: El tabaquismo continúa siendo un problema sanitario en población universitaria y profesionales de la salud. Los kinesiólogos participan en la implementación de programas orientados a la prevención y cese del tabaquismo en la comunidad. El objetivo de este estudio fue explorar la prevalencia de tabaquismo y actitudes sobre consumo de tabaco en estudiantes de kinesiología. MÉTODOS: Estudio de corte transversal realizado en estudiantes de Kinesiología de Concepción (Chile), durante los años 2017 y 2018. Se determinó la conducta y actitudes sobre tabaquismo. Mediante regresión logística se determinó la asociación entre la conducta fumadora y las actitudes sobre tabaquismo. Se consideró un valor de p < 0,05 como estadísticamente significativo. RESULTADOS: Se contestaron 554 cuestionarios. El 57,8% de los estudiantes encuestados declaró no haber fumado nunca, 13 % no haber fumado los últimos 6 meses y 29,4% declaró ser fumador actual. Por su parte, el 99,5% expresó algún grado de acuerdo con que fumar es perjudicial para la salud, lo cual se relacionó con la conducta fumadora (p < 0,0002). En relación a actitudes sobre tabaquismo, comparado a los no fumadores, los fumadores actuales presentan mayor probabilidad de mostrar desacuerdo o indiferencia respecto a actitudes positivas sobre tabaquismo. Principalmente en aquellas acciones que restringen su consumo, venta y divulgación (OR ponderado = 2,43; 95%IC 2,02 - 2,92). CONCLUSIONES: La prevalencia de tabaquismo en estudiantes de Kinesiología de Concepción es del 29,2%. Los estudiantes fumadores expresan una menor aprobación relacionada a intervenciones, actitudes y consecuencias del tabaquismo para la salud comparada con los no fumadores.

INTRODUCTION: Notwithstanding control policies, smoking continues to be a health problem in university students and health professionals, who are responsible for implementing programs oriented to prevention and cessation of smoking in the community. The objective of this study was to explore the prevalence of smoking and attitudes about smoking in physical therapy students. METHODS: Cross-sectional study carried out in students of physical therapy from three universities of Concepción city (Chile), during the years 2017 and 2018. Behavior and attitudes about smoking were evaluated. Association between smoking behavior and attitudes about smoking was determined by logistic regression. A p value < 0.05 was considered statistically significant. RESULTS: 554 questionnaires were answered. 57.8% of respondents had never smoked, 13.0% had not smoked in the last 6 months and 29.4% were current smokers. Moreover 99.5% of respondents stated some degree of agreement that smoking is harmful to health, which was related to smoking behavior (p < 0.0002). In relation to attitudes about smoking, compared to non-smokers, current smokers have a greater chance of showing disagreement or indifference regarding positive attitudes about smoking. Mainly in those actions that restrict tobacco consumption, sale and disclosure (weighted OR = 2.43, 95% CI 2.02 - 2.92). CONCLUSIONS: The prevalence of current smoking in physical therapy students from Concepcion city is 29.2%. Smoking students express lower approval related to interventions, attitudes and consequences of smoking for health compared with non-smokers.

Nutritional Status and Serum Levels of Micronutrients in an Elderly Group Who Participate in the Program for Complementary Food in Older People (PACAM) from the Metropolitan Region, Santiago de Chile.

The increase in the Chilean elderly population has promoted public policies to favor an adequate nutrition in later life. This study evaluated the nutritional status, micronutrients intake and serum micronutrients levels of an elderly group beneficiary of the PACAM from the Metropolitan Region, Santiago de Chile. Anthropometric and dietary survey (24 h food recalls) were assessed in 182 elderly individuals (60 and 80 years old). Blood serum collection was used to measure the micronutrient status. The sample was comprised by 12.6%, 46.1%, 28.0% and 13.2% of underweight, normal weight, overweight and obese subjects, respectively. Women presented 11% of underweight, 45% of normal weight and 44% of overweight and obese, while men-18%, 50% and 32%, respectively. Only the 63% of the elderlies consumed PACAM foods, reaching average daily intakes below (50%) the recommended daily serving. Serum deficiencies of 25-hydroxyvitamin D (88%), vitamin B12 (33%) and calcium (36%) were observed, being the highest ones in the PACAM foods women (60-75 years old). Chilean elderlies presented mainly a normal weight; however, an important proportion of overweight/obese subjects was observed. Although PACAM foods consumption significantly increased the micronutrient intake, it was not enough to ensure an adequate serum micronutrient levels in the elderly.

Mortalidad posoperatoria después de un año del evento quirúrgico en una cohorte de pacientes adultos mayores / One-year postoperative mortality in a cohort of older patients

AIM: To determine one-year postoperative mortality in patients older than 65 years at the Hospital Clínico de la Universidad de Chile. MATERIAL AND METHODS: After approval by the ethics committee, a random sample of 235 patients was obtained from 2,832 patients ≥ 65 years who underwent surgery that required general or regional anesthesia. This sample size was calculated to detect a mortality incidence of 10% ± 5%, with a power of 80%, an  error of 0.05, and a loss of 10%. We recorded the demographic variables together with the Charlson Comorbidity Index (CCI) score from the electronic medical records. While the date of mortality was obtained from the Civil Registry. RESULTS: We studied 233 patients with an age of 73.1 ± 6.3 years, 52.4% were women, and a mean CCI score of 4 (2-11) points. In total 65.7% underwent general anesthesia, 34.3% underwent regional anesthesia, and 24% underwent major surgery. Mortality at 30 days was 1.3% and at one year it was 6%. The patients who died were older and had a higher CCI, especially due to a higher incidence of dementia and solid tumors with metastases. CONCLUSIONS: In our study, postoperative mortality at one year was lower than those reported in older adult patients, and deceased patients were older with more comorbidities, especially with solid tumors with metastases and dementia.

OBJETIVO: Determinar la mortalidad al primer año postoperatorio de pacientes mayores de 65 años en el Hospital Clínico de la Universidad de Chile.MATERIALES Y MÉTODOS: Tras la aprobación del comité de ética, se obtuvo una muestra aleatoria de 235 pacientes de un total de 2.832 pacientes ≥ 65 años sometidos a una cirugía que requirió de anestesia general o regional. Este tamaño muestral fue calculado para detectar una incidencia de mortalidad de 10% ± 4%, con un poder de 80%, un error  de 0,05 y una pérdida de 10%. Se registraron los antecedentes demográficos, se calculó el puntaje de Charlson Comorbidity Index (CCI) y se consignó la mortalidad desde el Registro Civil. RESULTADOS: Se estudiaron 233 pacientes con una edad de 73,1 ± 6,3 años, un 52,4% fueron mujeres y una mediana del puntaje CCI de 4 (2-11) puntos. En total 65,7% fue intervenido bajo anestesia general y 34,3% bajo anestesia regional, y 24% fue sometido a una cirugía de alta complejidad. La mortalidad a los 30 días fue de 1,3% y al año fue de 6%. El grupo de pacientes fallecidos se caracterizó por ser más añoso y tener un CCI mayor, especialmente por una mayor incidencia de demencia y tumores con metástasis. CONCLUSIONES: En nuestro estudio se observó una mortalidad postoperatoria al año menor a lo reportado internacionalmente en pacientes adultos mayores. La mortalidad fue mayor en pacientes de mayor edad, con un mayor número de comorbilidades, con tumores sólidos con metástasis y demencia.

El envejecimiento de la población chilena y los desafíos para la salud y el bienestar de las personas mayores / The aging of the chilean population and the challenges for health and wellbeing of older people

El envejecimiento de la población es un fenómeno global. El proceso ha adquirido mayor velocidad en países en desarrollo que la que tuvo en países desarrollados, los que enfrentan el proceso en un contexto de desarrollo socio-económico muy inferior. Chile es el país que ha aumentado más rápidamente la expectativa de vida al nacer (EVN) en la región, constituyéndose en el país con la mayor expectativa de vida de Sudamérica, con 79,5 años. Los logros económicos y socio-sanitarios alcanzados colocan a Chile entre los países de altos ingresos, sin embargo, persisten importantes desigualdades en la distribución del ingreso, lo que impacta negativamente en los indicadores de salud de los adultos mayores. En el estudio Alexandros se observó que, si bien la expectativa de vida es superior en las mujeres que en los hombres, la diferencia corresponde a expectativa de vida con discapacidad. El seguimiento de la cohorte SABE Chile mostró además importantes diferencias en la prevalencia e incidencia de limitación funcional entre los niveles socioeconómicos alto, medio y bajo en desmedro de estos últimos CONCLUSIONES Chile enfrenta un rápido envejecimiento poblacional en un contexto de profunda desigualdad socioeconómica, de género y urbano-rural en los adultos mayores, lo que plantea a la sociedad múltiples desafíos que deben ser enfrentados a la brevedad. La disminución de la brecha entre expectativa de vida total y expectativa de vida saludable, es posible a través de estilos de vida saludable y participación social sumado a un cuidado de la salud integrado y centrado en la persona.

The aging of the population is a global phenomenon. The process has gained greater speed in developing countries than it had in developed countries, which face the process in a much lower socio-economic development context. In the regional context, Chile is the country that has most rapidly increased life expectancy at birth (LEB), becoming the country with the highest life expectancy in South America, which currently reaches 79,5 years. The economic and socio-sanitary achievements of the country place Chile among the high-income countries, however important inequalities persist in the distribution of income, which negatively impacts the health indicators of older adults. In the Alexandros study, it was observed that although LE is higher in women than in men, life expectancy with disabilities is higher in women than in men. The follow-up of the SABE Chile cohort also showed important differences in the prevalence and incidence of functional limitation between high, medium and low socioeconomic levels at the expense of the latter CONCLUSIONS Chile faces rapid population aging in a context of profound socioeconomic, gender and urban-rural inequality in older people, which poses to society multiple challenges that must be addressed shortly. The reduction of the gap between total life expectancy and healthy life expectancy is possible promoting healthy lifestyles and social participation and providing a people centred, integrated health care.

Ethnicity and Health: Experience with an Urban Mapuche Health Program from the Perspective of Key Actors.

This article explores the relationships and tensions between ethnicity and health, describing the perspectives of various social actors on a Mapuche clinic in the context of a national health program. A qualitative methodology was used to carry out this case study of the Mapuche clinic "La Ruka," located in an urban area of the Metropolitan Region of Chile. The study analyzes the narratives of traditional health practitioners (including a machi, lawentuchefe, lonko, and intercultural facilitator), consumers, conventional healthcare professionals, and local health authorities and community leaders who share a physical, political, and symbolic space around the Mapuche health experience. The systemization of experiences method was applied to the data, acquired through nonparticipant observation, individual interviews, and focus groups. The results suggest that this healthcare experience is highly valued by its protagonists. However, there is a tension surrounding cultural diversity programs that recognize non-Western approaches to healing, such as indigenous practices. This study examines the health-related, cultural, and political tensions involved in projecting indigenous traditions into a homogenizing space such as healthcare in a multicultural neoliberalism system.

[Encephalitis lethargica. The epidemic at the dawn of neurology]. / Encefalitis letargica. La epidemia en los albores de la neurologia.

Lethargic encephalitis is a neurological illness that shows a wide range of symptoms and signs, including neurological and psychiatric spectrum. It presented in an epidemic way, following influaenza relapses. The last relapse started at the beginning of 20th century and it was deeply described by Constantin von Economo. The illness described first in Europe and North America, was described in many others countries including Chile. There were beautiful descriptions by Chilean physicians like Lea-Plaza, Tello, Iturra and Cienfuegos. Their works showed the complexity of the illness like European physicians did too. The etiology is still unknown; however growing evidence about autoinmune aetiology is gaining force with the use of actual medical technology. In this work, we show encephalitis lethargica, focusing in clinical picture, the beauty of medical descriptions that physicians did at this date.

TITLE: Encefalitis letargica. La epidemia en los albores de la neurologia.La encefalitis letargica es un cuadro neurologico con una variada gama de manifestaciones clinicas en el ambito neurologico y tambien en el psiquiatrico. El cuadro se ha presentado de manera epidemica en brotes que han seguido a los de la gripe. El ultimo brote acaecido a comienzos del siglo XX lo describio en profundidad Constantin von Economo. La epidemia notificada inicialmente en Europa y luego en Norteamerica se presento tambien en otras latitudes, incluyendo Chile. Asi, las descripciones de Lea-Plaza, Tello, Iturra, Cienfuegos y otros medicos chilenos dieron cuenta del cuadro en Chile con toda la complejidad que tambien tuvo en Europa. El origen sigue siendo un misterio, aunque la evidencia creciente de que fuera autoinmune gana fuerza con los hallazgos de la tecnologia medica actual. En este trabajo presentamos el cuadro, privilegiando la riqueza clinica y la belleza de las descripciones realizada por los medicos de la epoca en que esta enfermedad se presento.

Spiritual Pain Is Associated with Decreased Quality of Life in Advanced Cancer Patients in Palliative Care: An Exploratory Study.

Background: Improving quality of life (QOL) is important in cancer palliative care (PC) patients. "Spiritual pain" (SP) is common in this population, but it is unknown how it affects QOL. Objective: To study the associations between SP and QOL in cancer patients in PC. Design: Cross-sectional. Settings/Subjects: Cancer patients assessed at a PC clinic in Puente Alto, Chile, were enrolled in a longitudinal study to characterize patients' end of life. Inclusion criteria included age ≥18, a primary caregiver, not having delirium, and a Karnofsky performance status (KPS) ≤80. Measurements: After consenting patients completed baseline surveys that included demographics, single-item questions to assess SP (0-10), financial distress, spirituality-related variables and questionnaires to assess QOL (0-100), and physical (Global distress score-physical) and psychological distress (Hospital Anxiety and Depression Scale), baseline data analyses to explore associations between SP and QOL were adjusted for potential confounders. Results: Two hundred and eight patients were enrolled: mean age was 64, 50% were female, and 67% had SP. In univariate analysis, SP was significantly associated with lower QOL (coefficient [95% confidence interval]: -1.88 [-2.93 to -0.84], p < 0.001). Lower QOL was also associated with being younger, lower KPS, higher physical distress, having anxiety or depression, and decreased religiosity and religious coping. In the multivariate analysis, QOL remained independently associated with SP (-1.25 [-2.35; to -0.15], p < 0.026), religious coping (11.74 [1.09 to 22.38], p < 0.031), and physical distress (-0.52 [-0.89 to -0.16], p < 0.005). Conclusions: SP is associated with QOL in cancer patients in PC. SP should be regularly assessed to plan for interventions that could impact QOL. More research is needed.

Nuevas estrategias de prevención y control de cáncer de cuello uterino en Chile / New strategies for the prevention and control of cervical cancer in Chile

Resumen: Objetivos: Discutir el cáncer cervicouterino (CC), el virus del papiloma humano (VPH), el programa de control del CC y proponer alternativas para Chile. Material y métodos: Se analiza el programa nacional del CC 1966-2015 y la guía clínica 2015-2020, la prevalencia de VPH en mujeres y en casos de CC; la infección y serología de VPH; la autotoma; la precisión y rentabilidad del tamizaje con VPH contra el Papanicolaou y las opciones de triaje en VPH AR positivas. Resultados: En Chile mueren 600 mujeres (principalmente de bajos recursos) al año por CC. La cobertura del Papanicolaou es < 70%, sensibilidad muy inferior al test de VPH, por lo que el cambio es rentable. Desde 2015 se vacuna contra VPH a niñas menores de 13 años. Conclusiones: Las condiciones técnicas y económicas existen en Chile para lograr una mejoría sustancial del CC: se sugiere el reemplazo del Papanicolaou por el examen de VPH; tamizaje cada cinco años con opción de autotoma; triaje con base en la tipificación de VPH 16/18 o Papanicolaou.

Abstract: Objective: To discuss cervical cancer (CC), Human Papilloma Virus (HPV), CC control program and propose alternatives for Chile. Materials and methods: We analyzed the national program of CC 1966-2015 and the clinical CC guideline 2015-2020; HPV prevalence in women and in cases of CC; HPV infection and serology; the self-vaginal sample; the accuracy and cost-effectiveness of screening with HPV versus Papanicolaou, and triage options among HPV-AR positives. Results: 600 women die of CC each year in Chile, mainly from low resources. Papanicolaou coverage is <70%; Papanicolaou sensitivity is much lower than HPV test. Change from Papanicolaou to HPV test is cost-effective. Since 2015, girls under 13 have been vaccinated against HPV. Conclusions: There are the technical and economic conditions for a substantial improvement of CC in Chile: replacement of the Papanicolaou by HPV; screening every five years, with the option of self-sampling, and triage based on HPV 16/18 or Papanicolaou typing.

Complementary and alternative medicine in patients with inflammatory bowel disease: A survey performed in a tertiary center in Chile.

OBJECTIVES: The aim of this study was to assess the type and prevalence of complementary and alternative medicine (CAM) use in patients with inflammatory bowel disease (IBD) who are treated at our center. DESIGN: Observational, cross-sectional questionnaire-based study that included patients from the IBD program of our center. SETTING: Tertiary clinical center in Santiago, Chile. MAIN OUTCOME MEASURES: Types of CAM being used by patients with IBD. RESULTS: A total of 200 patients were included, 68% ulcerative colitis, 29% Crohn's disease, and 3% non-classifiable IBD. Overall, 25% of the patients reported current use of CAM, 30% reported using in it the past, and 45% indicated that they had never used it before. The use of CAM was recommended in 20% of the patients by other healthcare professionals and in 10% of the patients by the gastroenterologist. Forty-nine percent of the patients informed the gastroenterologist that they were using CAM. Overall, 86% of the patients did not modify the conventional medical treatment (CMT). None of the patients who were using curcumin, homeopathic medicine, acupuncture or biomagnetism modified the CMT. CONCLUSIONS: The type of CAM being used plays an important role when the patient makes the decision to inform the gastroenterologist. Other healthcare professionals play an important role in providing the advice to start CAM. Gastroenterologists must be aware of the high prevalence of CAM use in IBD patients, actively ask about CAM use and guide the patients who want to use CAM in a responsible and safe manner.

Impacto del Ácido Fólico en la Incidencia de Fisuras Labiopalatinas de la Población Occidente de la Región Metropolitana, Chile / Impact of Folic Acid on the Incidence of Cleft Lip and Palate of the Western Population of the Metropolitan Region, Chile

RESUMEN: La fisura labiopalatina ha tenido una alta frecuencia en la población chilena. A partir del 2000 se inició el programa de fortificación de la harina con ácido fólico a fin de disminuir los defectos del tubo neural. El objetivo de este estudio fue determinar el impacto que presenta la incorporación del ácido fólico en la incidencia de fisuras labiopalatinas de la población del área occidente de la Región Metropolitana. Se recopiló información a partir de las fichas clínicas de la Fundación Gantz seleccionando a los recién nacidos entre 1990 y 2009, correspondientes a las comunas del Servicio de Salud Occidente de la Región Metropolitana. Desde el 2000 hasta el 2004 se observó una disminución importante en las tasas de fisura labiopalatina, con una tasa de 0,88 fisurados por 1000 recién nacidos vivos. Posteriormente se observó un incremento a partir del 2005 hasta el 2009 llegando a una tasa de 1,52 fisurados por 1000 recién nacidos vivos. En conclusión, el efecto protector del ácido fólico se evidencia en la disminución de las tasas de los recién nacidos con fisuras durante los primeros años de su implementación. Sin embargo, posteriormente se observó un aumento de dichas tasas, lo cual podría deberse al incumplimiento de la norma.

ABSTRACT: Cleft lip and palate has had a high frequency in the Chilean population. From the year 2000 a flour fortification program with folic acid was initiated in order to reduce the defects of the neural tube. The objective of this study was to determine the impact of the incorporation of folic acid in the incidence of cleft lip and palate of the population of the western area of the Metropolitan Region. Information was collected from clinical records of the Gantz Foundation, selecting newborns from 1990 to 2009, corresponding to the districts of the western sector of the Metropolitan Region. From 2000 to 2004 there was a significant decrease in cleft lip and palate rates, with a rate of 0.88 cases per 1000 live births. Subsequently, an increase was observed from 2005 to 2009, reaching a rate of 1.52 cases per 1000 live births. In conclusion, the protective effect of folic acid is evidenced in the reduction of the rates of newborns with cleft palate during the first years of its implementation. However, an increase in these rates was subsequently observed, which could be due to noncompliance with the standard.

Adultos con influenza, evolución clínica, costos y grupos relacionados por el diagnóstico, resultados de 4 años. Clínica Dávila. Santiago de Chile / Adults patients with influenza, clinical evolution, cost and diagnosis related groups, four years results. Clinica Dávila, Santiago, Chile

Resumen Introducción: En 2009 la Influenza A H1N1pdm09 provocó en Chile 12.258 casos y 155 muertes. Objetivo: Analizar en adultos egresados de Clínica Dávila con influenza, en 2009, 2010, 2012 y 2014, soporte ventilatorio, costo de hospitalización, Grupos Relacionados por el Diagnóstico (GRD) y letalidad. Material y Método: Estudio descriptivo retrospectivo usando la ficha médica electrónica. Resultados: Egresaron 115.673 adultos, 338 (0,29%) con diagnóstico de Influenza, edad 56,5 ± 22 años, 59% mujeres, letalidad 4%. Hubo 3 grupos, Grupo 1: sin ningún soporte ventilatorio, 295 pacientes, edad 63 ± 20, estadía 6,6 ± 6,9 días, costo promedio de hospitalización $2.885.261, mediana peso GRD 0,41 (p25 = 0,38 y p75 = 0,62), letalidad 1,01% (3 pacientes). Grupo 2: Ventilación mecánica no invasiva (VMNI), 23 casos, edad 77,1 ± 13, letalidad 22% (5 casos), estadía 16,8 ± 12,4, costo $9.245.242, GRD 0,79 (p25 = 0,62 y p75=1,03). Grupo 3: Intubación y ventilación mecánica invasiva (VMI), 20 pacientes, edad 56,4 ± 15, estadía 36,9 ± 41,4, costo $38.681.099, GRD 5,86 (p25 = 5,82 y p75 = 5,86) y letalidad 30% (6 pacientes). Los GRD grupo VMI versus grupo VMNI y ningún soporte fueron diferentes (p < 0,0001 y p < 0,0001 respectivamente). La letalidad por influenza el 2014 fue de 8,5%, mientras que en los años 2012, 2010 y 2009 fue 1,5%, 3% y 2,5% respectivamente. La mediana de edad el año 2009 fue 37,5 años, menor que la de los otros años (p < 0,0001). Conclusiones: En 2009 los pacientes fueron más jóvenes, la necesidad de soporte ventilatorio provocó un peso GRD, estadía, costo y letalidad mayores que aquellos que no lo requirieron.

Introduction: In 2009 Influenza A H1N1pdm09 caused in Chile 12,258 cases and 155 deaths. Objective: To analyze ventilatory support, cost of hospitalization, Diagnosis Related Groups (DRG) and lethality in adults patients with influenza discharged from our institution, during 2009, 2010, 2012 and 2014. Patients and Method: Retrospective descriptive study using electronic medical records. Results: 115,673 adults were discharged, 338 (0.29%) with diagnosis of Influenza, age 56.5 ± 22 yr.o., 59% women, lethality 4%. There were 3 groups, Group 1: without any ventilatory support, 295 patients, age 63 ± 20, stay 6.6 ± 6.9 days, average cost of hospitalization 2,885,261 clp, medium weight DRG 0.41 (p25 = 0.38) andp75 = 0.62), lethality 1.01% (3 patients). Group 2: Non-invasive mechanical ventilation (NIMV), 23 cases, age 77.1 ± 13, lethality 22% (5 cases), stay 16.8 ± 12.4, cost 9,245,242 clp, DRG 0.79 (p25 = 0.62 and p75 = 1.03). Group 3: Intubation and invasive mechanical ventilation (IMV), 20 patients, age 56.4 ± 15, stay 36.9 ± 41.4, cost 38.681.099 clp, DRG 5.86 (p25 = 5.82 and p75 = 5,86) and lethality 30% (6 patients). The DRG group VMI versus group VMNI and no support were different (p < 0.0001 and p < 0.0001 respectively). The lethality for influenza in 2014 was 8.5%, while in 2012, 2010 and 2009 it was 1.5%, 3% and 2.5% respectively. The median age in 2009 was 37.5 yr.o significantly minor, than the other years (p < 0.0001). Conclusions: In 2009 the patients were younger, the need for ventilatory support led to a higher DRG weight, stay, cost and lethality than those who did not require it.

Neural tube defects: Sex ratio changes after fortification with folic acid.

BACKGROUND: Historically, neural tube defects (NTDs) have predominated in female infants but the reasons remain unclear. In South America, the pre- folic acid fortification (FAF) rates of NTDs were around 18/10,000 births for females and 12/10,000 births for males, with an estimated sex ratio (male/female) of 0.67. During the post- FAF period, unpublished routine reports have indicated changes in the sex ratio for these defects while some descriptive reports are controversial. To date and to our knowledge, however, no studies specifically focusing on these changes to test this hypothesis directly have been undertaken. The aim of this study was to analyze changes in the sex ratio of infants with NTDs after FAF in South American countries. MATERIALS AND METHODS: With a descriptive cross-sectional study design, 2,597 infants with isolated NTDs born between 1990 and 2013 in 3 countries participating in the Latin American Collaborative Study of Congenital Malformations (ECLAMC) network were included: (Chile N = 521 and Argentina N = 1,619 [with FAF policies]; Venezuela N = 457 [without FAF policies; used as control]; total births = 2,229,561). The differences-in-differences method and Poisson regressions were used to evaluate the sex ratio shift from female to male before vs. after FAF, and to assess whether these differences were related to the fortification. RESULTS AND CONCLUSIONS: In Chile and Argentina the prevalence of NTDs, particularly anencephaly and cervico-thoracic spina bifida, showed a greater reduction rate in females than in males after FAF, resulting in a change of the sex ratio of infants with NTDs. Some mechanisms possibly involved in this differential reduction are proposed which might be useful to identify the pathogenesis of NTDs as a whole and specifically of those susceptible to the protective effect of folic acid.