Stroke symptoms, risk factors awareness and personal decision making in Chile. A national survey.

BACKGROUND: Knowledge about stroke symptoms, correct decision in front of a stroke case and recognition of stroke risk factors are crucial to fight against stroke burden. We aimed to assess the stroke awareness among a sample of the Chilean population. METHODS: A closed-ended questions structured survey was applied in November 2019 using a computer-assisted telephone interviewing system. Probabilistic sample, random selection and stratification for region was used. Multivariate logistic regression model was used to estimate the association between participants' characteristics and responses. RESULTS: Of 706 participants, only 74.4% (95% CI 70.9-77.5) recognized at least one typical stroke symptom. Most (586, 82.4% 95% CI 75.2-89.7) chose to contact the emergency ambulance or directly go to the emergency department in case of a stroke symptom and recognized at least one risk factor (692, 97.9% CI 96.7-98.8). In multivariable analysis, sociodemographic characteristics associated to a worse recognition of at least one stroke symptom were being men (OR 0.67, 95% CI 0.47-0.96), being 55 years old or older (OR 0.59 95% CI 0.37-0.93) and from the lowest socioeconomic level (SES) (OR 0.33 95% CI 0.16-0.67). Female sex was associated with lower stroke risk factor knowledge (OR 0.64 95% IC 0.47-0.87). Participants who recognized at least one typical stroke symptom and would promptly seek care at an emergency department differed significantly between SES (p=0.001) and age groups (p=0.035). CONCLUSIONS: We found insufficient knowledge about stroke symptoms and best decisions making in the Chilean population. We describe gaps that can be targeted in future stroke awareness campaigns. There is a need to strengthen tailored stroke education particularly for underserved populations.

Validation of Spanish version of 15-item myasthenia gravis quality-of-life questionnaire.

OBJECTIVES: The aim of this study was to achieve the translation and cross-cultural adaptation of the MG-QOL15R questionnaire into Spanish and the analysis of its psychometric properties. MATERIALS AND METHODS: We recruited patients with MG, ≥18 years old, whose mother tongue was Spanish. After the translation and cross-cultural adaptation of the MG-QOL15-R, the following tests were performed: internal consistency using the Cronbach-α coefficient and corrected item-total correlations; reproducibility with a test-retest analysis using intraclass correlation coefficients; and concurrent validity using Spearman's correlation coefficient of the Spanish language MG-QOL15R-S, Myasthenia Gravis Activity of Daily Living (MG-ADL) and Quantitative Myasthenia Gravis (QMG) scores. As an approximation to construct validity, the nonparametric Mann-Whitney U test was performed between MG-QOL15R-S scores according to the Myasthenia Gravis Foundation of America classification. RESULTS: A total of 83 MG patients were enrolled, mean age 48.19 ± 17.25 years; 58 (69.9%) were women. The mean MG-QOL15R-S score was 11.3 ± 7.1. Cronbach-α coefficient was 0.92. Item-total correlation ranged between 0.43 and 0.75. Intraclass correlation coefficient was 0.80. The Spearman correlation coefficient was 0.637 (p-value < .001) for MG-ADL and 0.487 (p-value < .001) for QMG. Mann-Whitney U tests of the mean MG-QOL15R-S scores were significantly different according to the clinical severity (p-value < .001). CONCLUSIONS: The Spanish version of the MG-QOL15R is a valid and reliable instrument and potentially useful for measuring health-related quality of life in Spanish-speaking MG patients.

[Features and contents of master programs in public health in Chile]. / Características y contenido de los programas de Magíster en Salud Pública en Chile.

BACKGROUND: In Chile, public health training grew both in enrollment and in the number of universities offering programs on the subject. AIM: To compare the academic characteristics and the contents of the master's programs in public health offered by Chilean universities. MATERIAL AND METHODS: A search of all master's programs that include the word "public health " in their title was made, excluding those that did not declare current students in 2020. The academic characteristics and content of each program were compiled according to the information declared by each university. The contents were grouped according to the list of core competencies for the public health professional of the Association of Schools of Public Health in the European Region (ASPHER). RESULTS: Eleven programs were included, most of them are carried out in face-to-face modality. The academic load is expressed in Transferable Credit System credits (62-71), credits (87-125) or teaching hours (1252-2048). All programs declare to have a graduation activity, with a heterogeneous academic load. All programs have basic subjects in epidemiology and more than 60% include introductory topics in public health, research methodology, and health services management. No program declares demography or food safety as compulsory subjects. CONCLUSIONS: There is heterogeneity in the academic load and the contents between the programs. It is necessary to establish common criteria in the training of future public health professionals, at least in the compulsory subjects and the minimum academic load.

Performance measures for in-hospital care of acute ischemic stroke in public hospitals in Chile.

BACKGROUND: The aim of this study were to describe acute care of ischemic stroke patients and adherence to performance measures, as well as the outcomes of these events, in a sample of patients treated in public hospitals in Chile. METHODS: We retrospectively reviewed the medical charts of patients with ischemic stroke from a sample of seven public hospitals in the Metropolitan Region of Santiago. We analyzed adherence to the following evidence-based measures: clinical evaluation at admission, use of intravenous thrombolysis, dysphagia screening and prescription of antithrombotic therapy at discharge. As outcome measures we analyzed post-stroke pneumonia and 30-day case-fatality. We used a logistic regression model by each outcome with generalized estimating equations, which accounted for clustering of patients within hospitals and included sex, age (years), clinical status at admission (reduced level of consciousness, speech disturbance, aphasia and hemiplegia), comorbidities, dysphagia screening and neurological evaluation at admission as measures of acute stroke care. RESULTS: We reviewed the charts of 677 patients, of which 52.3% were men. The mean age was 69.8 years in women and 66.3 years in men. Diagnosis of stroke was confirmed by a computed tomography scan within 4.5 hours of symptom onset in only 9.6% of the patients. Intravenous thrombolysis was administered in 1.7%. Dysphagia screening was performed in 12.1% (95% CI 9.7-15.0) and antithrombotic therapy was prescribed in 68.9% (95% CI 64.6-72.9). Pneumonia was diagnosed in 23.6% (95% CI 20.4-27.2). Thirty-day fatality was 8.7% (95% CI 6.7-11.3). The variables independently associated with 30-day case fatality were age (OR 1.08, 95% 1.06-1.10), pneumonia (OR 7.7, 95% 95% CI 4.0-14.7), aphasia (OR 2.4, 95% CI 1.1-5.6), reduced level of consciousness (OR 2.4, 95% CI 1.3-4.4), and speech disturbance (OR 1.4, 95% CI 1.0-1.9). No association was found between 30-day case fatality and dysphagia screening or neurological evaluation at admission. The factors associated with post-stroke pneumonia were female sex (OR 1.6, 95% CI 1.0-2.3), age (OR 1.04 95% CI 1.03-1.05), diagnosis of diabetes (OR 1.8, 95% CI 1.4-2.4), aphasia (OR 2.0, 95% CI 1.5-2.7), hemiplegia (OR 1.6, 95% CI 1.1-2.4), and reduced level of consciousness on admission (OR 3.4, 95% CI 2.1-5.5). No association was found between pneumonia and dysphagia screening or neurological evaluation at admission. CONCLUSIONS: Adherence to evidence-based performance measures was low. Administration of intravenous thrombolysis was particularly low and diagnostic confirmation of ischemic stroke was delayed. The occurrence of post-stroke pneumonia was frequent and should be reduced. To improve acute stroke care in Chile, organizational change in the health service is urgently needed.

[Trend in cervical cancer mortality in Chile: application of joinpoint regression models]. / Tendencia de la mortalidad por cáncer de cuello uterino en Chile: aplicación de modelos de regresión joinpoint.

OBJECTIVE: To identify and model changes in the cervical cancer mortality trend in Chile between 1990 and 2009 in order to contribute to the design of health policies on cervical cancer. METHODS: The study analyzed deaths from cervical cancer in Chile between 1990 and 2009. The cases were identified by the codes ICD-9 180 and ICD-10 C-53. The population at risk was calculated on the basis of projections by the National Statistics Institute of Chile. Mortality was modeled using Poisson regression analysis, including the variables of age in decades starting at age 30 and time interval in calendar periods and the term of interaction between the two variables. A joinpoint regression model, stratified by age group, was used to assess changes in the trend. In both models, the annual percentage of change (APC) was used as a summary measure. RESULTS: During the period studied, the APC in Chile was -4%. Women aged 40 to 49 experienced the greatest reduction in mortality (incidence rate ratio = 0.98; P < 0.05) (reference group: women aged 30 to 39). Those with the least reduction in mortality were women over 80 (APC -1.18%). The joinpoint model identified six significant changes in the time trend for the women studied: the greatest reductions occurred in 1999-2002 and 2003-2009, with APCs of -6.9 and -4%, respectively. CONCLUSIONS: Mortality from cervical cancer exhibited a downward trend during the period studied, and the trend was more pronounced among women in the youngest age group.

Short- and long-term survival after stroke in hospitalized patients in Chile: a nationwide 5-year study.

BACKGROUND: Short- and long-term stroke survival is a key indicator of hospital performance in stroke care. Our aim was to estimate short- and long-term survival rates in discharged patients diagnosed with ischemic stroke in Chile in a 5-year period and identify associated variables. MATERIALS AND METHODS: We included all discharged patients from all hospitals in Chile with main diagnosis of ischemic stroke from 2003 to 2007, which were identified through the National Hospital Discharge Registry. To establish survival, discharges were linked to deaths in the Deaths Registry. Kaplan-Meier survival curves were used to estimate the cumulative 7-day, 30-day, 1-year, and 3-year survival rates. Independent predictors of death (sex, age, geographical regions, and status insurance) were assessed by Cox proportional hazard regression model. RESULTS: A total of 51,130 with first-ever ischemic stroke patients were identified. Overall survival rate decreased from 88.9% (95% confidence interval [CI] 88.6-89.2) 7 days after hospital admission to 81.9% (95% CI 81.6-82.3), 69.9% (95% CI 69.5-70.3), and 61.2% (95% CI 60.7-61.6) after 30-day, 1-year, and 3-year, respectively. The multivariable model showed that the elderly patients (>80 years; hazard ratio [HR] 4.07; 95% CI 3.89-4.26) and hospital admission in the North (HR 1.14; 95% CI 1.09-1.20) and South area (HR 1.06; 95% CI 1.03-1.110) were associated with lower survival after stroke. Patients with private health insurance have a higher probability of survival than patients with public insurance (private insurance, HR .53; 95% CI .49-.56). CONCLUSIONS: Short- and long-term survival after ischemic stroke was heterogeneous by geographic regions and type of health insurance, regardless age and sex were the strongest predictors. This suggests an impact of socioeconomic factors and access to acute management of strokes on survival.

Temporal Trends of Intravenous Thrombolysis Utilization in Acute Ischemic Stroke in a Prospective Cohort From 1998 to 2019: Modeling Based on Joinpoint Regression.

Introduction: The frequency of intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) is lower than it should be in several regions of the world. It is unclear what interventions can produce significant improvements in IVT utilization. We aimed to investigate the temporal trends in IVT in AIS and identify changes in time that could be associated with specific interventions. Methods: We included patients with AIS who were admitted from January 1998 to December 2019 in our institution. To analyze trends in utilization and time points in which they changed, we performed a Joinpoint regression analysis. Interventions were assigned to a specific category according to the Behavior Change Wheel framework intervention function criteria. Results: A total of 3,361 patients with AIS were admitted, among which 538 (16%) received IVT. There were 245 (45.5%) women, and the mean age and median National Institutes of Health Stroke Scale (NIHSS) scores were 68.5 (17.2) years and 8 (interquartile range, 4-15), respectively. Thrombolysis use significantly increased by an average annual 7.6% (95% CI, 5.1-10.2), with one Joinpoint in 2007. The annual percent changes were.45% from 1998 to 2007 and 9.57% from 2007 to 2019, concurring with the stroke code organization, the definition of door-to-needle times as an institutional performance measure quality indicator, and the extension of the therapeutic window. Conclusions: The IVT rates consistently increased due to a continuous process of protocol changes and multiple interventions. The implementation of a complex multidisciplinary intervention such as the stroke code, as well as the definition of a hospital quality control metric, were associated with a significant change in this trend.

[Changes in suicide mortality trends in Chile, 1997-2018]. / Cambios en la tendencia de mortalidad por suicidio en Chile, 1997-2018.

Using information from the mortality database at Chile's Department of Statistics and Health Information (Ministry of Health), an ecological time-series study was conducted to determine changing trends in suicide rates by sex and age group in Chile from 1997 to 2018. Results show that the mortality rate for men in 2018 was 20.1 per 100,000, almost five times higher than the rate for women. Trends in both sexes show a decrease in aver-age annual percent change of -5.4% [CI95% (-12.9; 1.9)] between 2009 and 2013. Over the same period, the average annual percent change for men was -5.8% [CI95% (-12.5; 2.3)], while for women it was -4.0 [CI95% (-5.8; -2.2)] between 2008 and 2018. No changes have been observed in trends for men aged 60 and over, the group with the high-est rates. Although suicide rates declined following the implementation of policies focus-ing on risk factors for suicide, it is necessary to evaluate the implementation of these pol-icies and devise similar actions geared toward populations with greater risk of suicide.

Con base en el registro de defunciones del Departamento de Estadísticas e Información del Ministerio de Salud de Chile, se realizó un estudio ecológico de series de tiempo para determinar cambios en la tendencia de las tasas de mortalidad por suicidio en Chile según sexo y edad, en el periodo 1997-2018. Los resultados muestran que la tasa de mortalidad en hombres para el año 2018 fue de 20,1 por 100.000, siendo casi 5 veces más que la de mujeres. La tendencia en ambos sexos muestra un descenso en el porcentaje de cambio anual del -5,4% [IC95% (-12,9; 1,9)] en el periodo 2009-2013. Los hombres, en el mismo periodo, muestran un porcentaje de cambio anual del -5,8% [IC95% (-12,5; 2,3)], mientras que en las mujeres, para el periodo 2008- 2018, es -4,0% [IC95% (-5,8; -2,2)]. No se observaron cambios en la tendencia en los hombres de 60 o más años, siendo este grupo el que presenta las tasas más altas. Si bien esta disminución se registra con posterioridad a la implementación de políticas enfocadas en factores de riesgo de suicidio, es necesario evaluar sistemáticamente dichas políticas e implementar otras con enfoque en las poblaciones identificadas con mayor riesgo.

Incidence, risk factors, prognosis, and health-related quality of life after stroke in a low-resource community in Chile (ÑANDU): a prospective population-based study.

BACKGROUND: Stroke is a leading cause of disability and death worldwide. The best estimates of local, national, and global burden of stroke are derived from prospective population-based studies. We aimed to investigate the incidence, risk factors, long-term prognosis, care, and quality of life after stroke in the Ñuble region of Chile. METHODS: We did a prospective community-based study with use of multiple overlapping sources of hospitalised, ambulatory, and deceased cases. Standardised diagnostic criteria were used to identify and follow up all cases occurring in the resident population of the Ñuble region, Chile (in a low-income rural-urban population including predominantly people of Indigenous-European heritage), for 1 year. Participants were included if they had a clinical diagnosis of stroke confirmed according to the study criteria. All cases were adjudicated by vascular neurologists. Incidence rates of first-ever stroke were calculated from the population of Ñuble according to the 2017 national census. FINDINGS: From April 1, 2015, to March 31, 2016, we ascertained 1103 stroke cases, of which 890 (80·7%) were first-ever incident cases. The mean age of patients with first-ever stroke was 70·3 years (SD 14·1) and 443 (49·8%) were women. A CT scan was obtained in 801 (90%) of 890 patients (mean time from symptom onset to scan of 13·4 h (SD 29·8). The incidence of first-ever stroke age-adjusted to the world population was 121·7 (95% CI 113·7-130·1) per 100 000. The age-adjusted incidence rates, per 100 000 inhabitants, by main pathological subtypes were as follows: ischaemic stroke (101·5 [95% CI 90·9-113·0]); intracerebral haemorrhage (17·9 [13·5-23·4]), and subarachnoid haemorrhage (4·2 [2·1-7·3]). The 30-day case-fatality rate was 24·6% (21·9-27·6). At 6 months after the stroke, 55·9% (432 of 773) of cases had died or were disabled, which increased to 61·0% (456 of 747) at 12 months. Health-related quality of life in survivors was low at 6 months, improving slightly at 12 months after the stroke. INTERPRETATION: The incidence of stroke in this low-resource population was higher than our previous finding in northern Chile and within the mid-range of most population-based stroke studies. This result was due mainly to a higher incidence of ischaemic stroke, probably associated with increasing age and a high prevalence of cardiometabolic risk factors in the population studied. Our findings suggest that more should be done for the prevention and care of stroke in communities like the Ñuble population. FUNDING: The National Agency for Research and Development and the Technology-Health Research Fund, Clínica Alemana de Santiago, Boehringer Ingelheim, Bristol Meyers Squibb, The Herminda Martin Clinical Hospital of Chillán, Universidad Mayor, and Universidad de Concepción.

Factors associated with the use of nonprescription psychotropic drugs in Chile: A descriptive study using a nationwide drug consumption survey. / Factores asociados al consumo de psicofármacos sin receta en Chile: estudio descriptivo basado en la Encuesta Nacional de Consumo de Drogas en Población General.

BACKGROUND: The consumption of psychotropic drugs without a medical prescription is a growing public health problem worldwide. Misuse or indiscriminate use involves several risks. OBJECTIVE: To determine sociodemographic factors and behaviors associated with the consumption of psychotropic drugs without prescription in Chile. METHODS: This is a descriptive study based on the data of the XI National Study of Drugs in the General Population in Chile, carried out in the population between 12 and 64 years old (n = 19 512) during 2014. Prevalence was estimated, and a multivariate logistic regression model was adjusted. Also, a multiple correspondence analysis was performed. RESULTS: The prevalence of psychotropic drug use was 2.3%. In the studied population, associated risk factors are female sex (odds ratio: 1.4; 95% confidence interval: 1.16 to 1.77); ages between 20-29 (odds ratio: 1.4; 95% confidence interval: 0.98 to 2.26) and 40-49 (odds ratio: 1.8; 95% confidence interval: 1.19 to 2.75); consumption of marijuana (odds ratio: 3.0; 95% confidence interval: 3.32 to 3.97), cocaine or crack (odds ratio: 3.7; 95% confidence interval: 2.45 to 5.70); tobacco (odds ratio: 1.4; 95% confidence interval: 1.17 to 1.78); alcohol (odds ratio: 1.3; 95% confidence interval: 1.11 to 1.73); and poor health perception (odds ratio: 1.8; 95% confidence interval: 1.51 to 2.28). Military personnel used more pain and cough medication; young women between 19 to 25 years old used stimulants; the population between 45 to 64 years had a bad perception of health associated with the use of tranquilizers; and men between 12 and 18 years used illicit drugs. CONCLUSIONS: The prevalence found in the different groups is consistent with data reported in Latin America, showing the relationship between the use of non-prescription psychotropic drugs with sociodemographic factors, risk behaviors, and the identification of consumption profiles.

ANTECEDENTES: El consumo de psicofármacos sin receta médica es un problema creciente de salud pública en todo el mundo, su uso indebido implica una serie de riesgos. OBJETIVO: Determinar factores sociodemográficos y conductas asociadas al consumo de psicofármacos sin receta en Chile. MÉTODOS: Estudio descriptivo a partir de los datos del XI Estudio Nacional de Drogas en Población General en Chile, año 2014, realizado en población entre 12 y 64 años (n = 19 512). Se estimó la prevalencia y se ajustó un modelo multivariado de regresión logística. Además, se realizó análisis de correspondencia múltiple. RESULTADOS: La prevalencia de consumo de psicofármacos fue 2,3%. En población estudiada, los factores asociados son sexo femenino (Odds ratio: 1,4; intervalo de confianza 95%: 1,16 a 1,77), edades entre 20 y 29 (Odds ratio: 1,4; intervalo de confianza 95%: 0,98 a 2,26) y 40 y 49 años (Odds ratio: 1,8; intervalo de confianza 95%: 1,19 a 2,75), consumo de: marihuana (Odds ratio: 3,0; intervalo de confianza 95%: 3,32 a 3,97), cocaína o pasta base (Odds ratio: 3,7; intervalo de confianza 95%: 2,45 a 5,70), tabaco (Odds ratio: 1,4; intervalo de confianza 95%: 1,17 a 1,78), alcohol (Odds ratio: 1,3; intervalo de confianza 95%: 1,11 a 1,73) y mala percepción de salud (Odds ratio: 1,8; intervalo de confianza 95%: 1,51 a 2,28). De los perfiles, se vinculó a población de fuerzas armadas con consumo de analgésicos y antitusivos, a jóvenes de 19 a 25 años con consumo de estimulantes, a población de 45 a 64 años con mala percepción de salud asociada al consumo de tranquilizantes y a hombres de 12 a 18 años con uso de sustancias psicoactivas. CONCLUSIÓN: Las prevalencias halladas concuerdan con datos en Latinoamérica, permitiendo evidenciar la relación que existe entre el consumo de psicofármacos con factores sociodemográficos, conductas de riesgo e identificación de perfiles de consumo.

Discrete-event simulation applied to analysis of waiting lists. Evaluation of a prioritization system for cataract surgery.

OBJECTIVES: To outline the methods used to build a discrete-event simulation model for use in decision-making in the context of waiting list management strategies for cataract surgery by comparing a waiting list prioritization system with the routinely used first-in, first-out (FIFO) discipline. METHODS: The setting was the Spanish health system. The model reproduced the process of cataract, from incidence of need of surgery (meeting indication criteria), through demand, inclusion on a waiting list, and surgery. "Nonexpressed Need" represented the population that, even with need, would not be included on a waiting list. Parameters were estimated from administrative data and research databases. The impact of introducing a prioritization system on the waiting list compared with the FIFO system was assessed. For all patients entering the waiting list, the main outcome variable was waiting time weighted by priority score. A sensitivity analysis with different scenarios of mean waiting time was used to compare the two alternatives. RESULTS: The prioritization system shortened waiting time (weighted by priority score) by 1.55 months (95% CI: 1.47 to 1.62) compared with the FIFO system. This difference was statistically significant for all scenarios (which were defined from a waiting time of 4 months to 24 months under the FIFO system). A tendency to greater time savings in scenarios with longer waiting times was observed. CONCLUSIONS: Discrete-event simulation is useful in decision-making when assessing health services. Introducing a waiting list prioritization system produced greater benefit than allocating surgery by waiting time only. Use of the simulation model would allow the impact of proposed policies to reduce waiting lists or assign resources more efficiently to be tested.

[Temporal trend of hospital discharges due to infectious diseases in Chile, 2004-2014]. / Evolución temporal de los egresos hospitalarios por enfermedades infecciosas en Chile, 2004-2014.

BACKGROUND: Infectious diseases are important causes of burden of illness and mortality. AIM: To describe the temporal trends of hospital discharges due to infectious in Chile from 2004 to 2014. METHODS: Descriptive study. National Hospital Discharge Registry were used. We included all hospital discharges with main diagnosis of infectious diseases including parasitic diseases. Rates were calculated and standardized. The anual percentage change (APC) was estimated by Poisson regression. RESULTS: During a stated period of time in hospitalization of infectious diseases decreased (APC -4%). Women had fewer hospital discharged compared to men. Patients aged between 0 and 9 years and those who aged 80 years and older showed greater rates than other age groups. CONCLUSIONS: Chile has experimented a reduction in hospital discharges due to infectious diseases.

Determining the lifetime density function using a continuous approach.

OBJECTIVE: To apply a continuous hazard function approach to calculate the lifetime density function (LDF) at any age, and to compare the life expectancies derived from the LDF with those obtained with standard life table (SLT) methods. METHODS: Age-specific mortality rates were modeled through a continuous hazard function. To construct the cumulative hazard function, appropriate integration limits were considered as continuous random variables. The LDF at any age was defined on the basis of the elemental relationships with the cumulative hazard function. Life expectancies were calculated for a particular set of mortality data using the SLT approach and the expectancy of the LDF defined. APPLICATIONS AND COMPARISONS: The proposed approach was applied using mortality data from the 2001 census of Catalonia (Spain). A Gompertz function was used to model the observed age-specific mortality rates, which fitted the observed data closely. The LDF and the life expectancy, median and standard deviation of the LDF were derived using mathematical software. All differences, in percentages, between the life expectancies obtained from the two methods were 1.1% or less. CONCLUSIONS: The LDF gives a wider interpretation of life duration, by extending a deterministic value like life expectancy to a fully informative measure like the LDF.

Time-trend and variations in the proportion of second-eye cataract surgery.

BACKGROUND: Despite recommendations for greater use of second-eye cataract surgery and the bilateral progression of the disease, there is a substantial proportion of unmet need for this treatment. Few studies have explored the factors associated with second-eye cataract surgery utilisation. The objective of our study was to estimate the proportion of second-eye cataract surgery, evaluate its time-trend, and explore differences in utilisation by patients' gender, age, and region of residence. METHODS: All senile cataract surgeries performed between 1999 and 2002 in the public health system of Catalonia (Spain) were obtained from the Minimum Data Set. The proportion of second-eye surgery from November 2000 to December 2002 was calculated. The time-trend of this proportion was characterised through linear regression models with the logarithmic transformation of time. RESULTS: The proportion of second-eye surgery was 30.0% and showed an increasing trend from 24.8% (95% Confidence Interval [CI] 21.6; 26.1) in November 2000 to 31.8% (95% CI 31.4; 33.6) in December 2002. This proportion was 1.9% (95% CI 0.9; 2.9) higher in women (p < 0.001) and held constant across time. Male patients aged less than 60 had the lowest proportion (22.6%; 95% CI 22.4; 22.9) and females between 70 and 79 had the highest proportion (27.4%; 95% CI 26.9; 27.9). The time-trend for the proportion of second-eye surgery in those aged over 80 years was greater than for younger ages, showing an increase of 9% at the end of the period for both males and females. Variations between regions decreased over time because regions with the lowest initial proportions of second-eye surgery (approximately 17%) showed a greater increase over the study period. CONCLUSION: We predict greater utilization of second-eye surgery in patients aged 70 to 79 years and in women. A greater increase in the utilisation rates of second-eye surgery is expected in the regions with lower proportions and in older patients. The observed trend suggests that there will be a substantial proportion of unmet need for bilateral surgery.

Mortality trend of gallbladder cancer in Araucanía Region, Chile, 2004-2014. / Tendencia de la mortalidad por cáncer de vesícula en la Región de la Araucanía, Chile, 2004-2014.

BACKGROUND: Chile has the highest mortality rate for gallbladder cancer in the Andean region. The areas most affected by this cancer are found in southern Chile. OBJECTIVE: To describe the mortality rate trends for gallbladder cancer in the Araucanía region between 2004 and 2014. METHODS: Ecological observational descriptive study. The cases were identified by the codes ICD-10: C-23. The population at risk was obtained from the projections of the National Institute of Statistics of Chile. The mortality rate was modeled using the Poisson regression method, including age, time, and interaction between the two variables. The annual percentage change (APC) was used as a summary measure. RESULTS: In 2014, the Araucanía region had a standardized mortality rate of 10.36 per 100,000 inhabitants, while in the country it was 6.13 per 100,000. At the country level, the temporal evolution of mortality due to gallbladder cancer presented an annual percentage change of 9.1% (incidence rate ratio = 0.91 p-value <0.05), while in Araucanía the decrease was 7 % (incidence rate ratio = 0.93 p-value= 0.16), which is not statistically significant. The mortality rate was 2.68 times higher in women than in Araucanía men (p-value <0.05), a result similar to that of the country. At the national level, the trend according to age group shows a decrease for all groups, being the one of greater magnitude in those people from 45 to 54 years with an annual percent change of -5.36%, these results are not observed in the Araucanía. CONCLUSIONS: Mortality from gallbladder cancer shows a decreasing trend in the period studied for the whole country; however, this is not so for the Araucanía region, which maintains a higher mortality rate than that of the country.

INTRODUCCIÓN: Chile presenta la mayor tasa de mortalidad por cáncer de vesícula de la región andina. Las zonas más afectadas por este cáncer se encuentran al sur del país. OBJETIVO: Describir la tendencia de la tasa de mortalidad por cáncer de vesícula en Región de la Araucanía, entre los años 2004 y 2014. MÉTODOS: Estudio descriptivo observacional de tipo ecológico. Se utilizaron las defunciones por cáncer de vesícula ocurridas entre los años 2004 y 2014 en la Región de la Araucanía y en Chile. Los casos se identificaron utilizando el código CIE-10: C-23. La población en riesgo se obtuvo de las proyecciones del Instituto Nacional de Estadística de Chile. La tasa de mortalidad se modelizó a través del método de regresión de Poisson, utilizando como variables explicativas el tiempo, la edad y la interacción entre estas. Se empleó el porcentaje de cambio anual como medida de resumen. RESULTADOS: En el año 2014 la Región de la Araucanía presentó una tasa de mortalidad por cáncer de vesícula estandarizada de 10,36 por 100 000 habitantes, mientras que en el país fue de 6,13 por 100 000. En Chile, la evolución temporal de la mortalidad por cáncer de vesícula presenta una disminución con un porcentaje de cambio anual de 9,1% (razón de tasas de incidencia: 0,91; p <0,05), mientras que en la Araucanía la disminución fue de un 7% (razón de tasas de incidencia 0,93 p =0,16), no siendo estadísticamente significativo. La tasa de mortalidad fue 2,68 veces mayor en mujeres que en hombres de la Araucanía (p <0,05), resultado similar al del país. A nivel nacional, la evolución según grupo etario muestra un descenso para todos los grupos. La disminución de mayor magnitud se produce en aquellas personas de 45 a 54 años, con un porcentaje de cambio anual de -5,36%. Estos resultados no se observan en la Araucanía. CONCLUSIONES: La mortalidad por cáncer de vesícula tiene una tendencia decreciente en el período estudiado para el país. Sin embargo, no arroja resultados significativos para la Región de la Araucanía, manteniéndose la tasa de mortalidad superior a la nacional.

Factors associated with early childhood caries in Chile.

OBJECTIVE: To determine the prevalence of caries and identify the associated factors among children aged 2 and 4 years in southern Chile. METHODS: A cross-sectional study was conducted in a random sample of 2,987 children. Dental examinations were performed in all participating children and a self-administered survey was administered to their primary caregivers. The statistical analysis included a zero inflated negative binomial regression model. RESULTS: The prevalence of caries was 20.3% for 2-year-olds and 52.7% for 4-year-olds. The factors associated with caries included the following: living in the Bio-Bío region, PR 2 year-old: 1.65 (1.10-2.47), PR 4 year-old: 1.44 (1.18-1.75) and having a low socioeconomic position, PR 2 year-old: 5.39 (2.14-13.57), PR 4 year-old: 3.71 (2.68-5.13) or a medium socioeconomic position, PR 2 year-old: 2.79 (1.06-7.33), PR 4 year-old: 2.70 (1.92-3.79). In 4-year-olds, a high frequency of consuming sugary drinks at bedtime (PR: 1.30; 1.06-1.59), not brushing teeth daily (PR: 1.37; 1.18-1.60), and the presence of gingivitis (PR: 1.64; 1.28-2.09) were also associated with caries. CONCLUSIONS: The high prevalence of caries in this young group is concerning. The factors associated with caries identified in this study could help in the design of preventive interventions at early ages.

Características y contenido de los programas de Magíster en Salud Pública en Chile / Features and contents of master programs in public health in Chile

Background: In Chile, public health training grew both in enrollment and in the number of universities offering programs on the subject. Aim: To compare the academic characteristics and the contents of the master's programs in public health offered by Chilean universities. Material and Methods: A search of all master's programs that include the word "public health " in their title was made, excluding those that did not declare current students in 2020. The academic characteristics and content of each program were compiled according to the information declared by each university. The contents were grouped according to the list of core competencies for the public health professional of the Association of Schools of Public Health in the European Region (ASPHER). Results: Eleven programs were included, most of them are carried out in face-to-face modality. The academic load is expressed in Transferable Credit System credits (62-71), credits (87-125) or teaching hours (1252-2048). All programs declare to have a graduation activity, with a heterogeneous academic load. All programs have basic subjects in epidemiology and more than 60% include introductory topics in public health, research methodology, and health services management. No program declares demography or food safety as compulsory subjects. Conclusions: There is heterogeneity in the academic load and the contents between the programs. It is necessary to establish common criteria in the training of future public health professionals, at least in the compulsory subjects and the minimum academic load.

Cambios en la tendencia de mortalidad por suicidio en Chile, 1997-2018 / Changes in suicide mortality trends in Chile, 1997-2018

RESUMEN Con base en el registro de defunciones del Departamento de Estadísticas e Información del Ministerio de Salud de Chile, se realizó un estudio ecológico de series de tiempo para determinar cambios en la tendencia de las tasas de mortalidad por suicidio en Chile según sexo y edad, en el periodo 1997-2018. Los resultados muestran que la tasa de mortalidad en hombres para el año 2018 fue de 20,1 por 100.000, siendo casi 5 veces más que la de mujeres. La tendencia en ambos sexos muestra un descenso en el porcentaje de cambio anual del -5,4% [IC95% (-12,9; 1,9)] en el periodo 2009-2013. Los hombres, en el mismo periodo, muestran un porcentaje de cambio anual del -5,8% [IC95% (-12,5; 2,3)], mientras que en las mujeres, para el periodo 2008- 2018, es -4,0% [IC95% (-5,8; -2,2)]. No se observaron cambios en la tendencia en los hombres de 60 o más años, siendo este grupo el que presenta las tasas más altas. Si bien esta disminución se registra con posterioridad a la implementación de políticas enfocadas en factores de riesgo de suicidio, es necesario evaluar sistemáticamente dichas políticas e implementar otras con enfoque en las poblaciones identificadas con mayor riesgo.

ABSTRACT Using information from the mortality database at Chile's Department of Statistics and Health Information (Ministry of Health), an ecological time-series study was conducted to determine changing trends in suicide rates by sex and age group in Chile from 1997 to 2018. Results show that the mortality rate for men in 2018 was 20.1 per 100,000, almost five times higher than the rate for women. Trends in both sexes show a decrease in aver-age annual percent change of -5.4% [CI95% (-12.9; 1.9)] between 2009 and 2013. Over the same period, the average annual percent change for men was -5.8% [CI95% (-12.5; 2.3)], while for women it was -4.0 [CI95% (-5.8; -2.2)] between 2008 and 2018. No changes have been observed in trends for men aged 60 and over, the group with the high-est rates. Although suicide rates declined following the implementation of policies focus-ing on risk factors for suicide, it is necessary to evaluate the implementation of these pol-icies and devise similar actions geared toward populations with greater risk of suicide.

Minimum intravenous thrombolysis utilization rates in acute ischemic stroke to achieve population effects on disability: A discrete-event simulation model.

BACKGROUND: The only pharmacological treatment with proven cost-effectiveness in reducing acute ischemic stroke (AIS) associated disability is intravenous thrombolysis with recombinant tissue plasminogen activator but it's utilization rate is still low in most of the world. We estimated the minimum thrombolysis utilization rate needed to decrease the prevalence of stroke-related disability at a population level by using a discrete-event simulation model. METHODS: The model included efficacy according to time to treatment up to 4.5h, and four scenarios for the utilization of intravenous thrombolysis in eligible patients with AIS: a) 2%; b) 12% c) 25% and d) 40%. We calculated the prevalence of AIS related disability in each scenario, using population based data. The simulation was performed from 2002 to 2017 using the ARENA software. RESULTS: A 2% utilization rate yielded a prevalence of disability of 359.1 per 100,000. Increasing thrombolysis to 12% avoided 779 disabled patients. If the utilization rate was increased to 25%, 1783 disabled patients would be avoided. The maximum scenario of 40% decreased disability to 335.7 per 100,000, avoiding 17% of AIS-related disability. CONCLUSION: The current utilization rate of intravenous thrombolysis of 2% has minimal population impact. Increasing the rate of utilization to more than 12% is the minimum to have a significant population effect on disability and should be a public policy aim.