Assistive Devices for Older Adults: A Longitudinal Study of Policy Effectiveness, Santiago, Chile, 2014-2016.

INTRODUCTION Population aging is a worldwide phenomenon. It is estimated that by 2050, one of five persons will be aged ≥60 years. In Chile, 15.8% of the population is now aged ≥60 years, and this figure will reach 30.7% by 2050. In 2006, a national program was implemented to provide assistive devices to older adults aged ≥65 years with limited mobility or difficulty performing activities of daily living. To date, there have been no assessments of the program's effectiveness. OBJECTIVE Assess the effectiveness of an assistive devices policy in Chile on improving functional capacity of older adults aged ≥65 years, and beneficiaries' perceptions of the services received, including changes in their quality of life. METHODS This was a before-after longitudinal study. A cohort of 309 persons was recruited, consisting of patients who received care at a public hospital in Santiago, Chile during 2014-2015. They were assessed before delivery of assistive devices, then followed for seven months, with repeated evaluations made in their homes. The following indicators were measured: functional capacity (Tinetti scale and Barthel Index); changes in perceived quality of life related to use of assistive devices; and other sociodemographic, clinical and protocol-compliance variables. A longitudinal analysis of before-after progress was carried out, as well as a description of service delivery and medical followup. RESULTS Sixty-eight percent of those surveyed were women; median age was 74 years, average schooling was 6 years, and 93% had low income (monthly income

¿Sirven las ayudas técnicas a las personas mayores? Percepción desde la Atención Primaria sobre esta Garantía Explícita en Salud, Santiago, Chile / Are technical aids useful for elderly people? The perception of primary health care-based informants about this Explicit Health Guarantee in Santiago, Chile

OBJETIVO: Conocer la percepción de informantes clave pertenecientes a la red de Atención Primaria de Salud en Chile, respecto al proceso de gestión asistencial y el impacto del programa nacional de Garantías Explícitas en Salud (GES) sobre la entrega de ayudas técnicas a personas mayores. MATERIALES Y MÉTODOS: Un estudio cualitativo basado en análisis de casos múltiples, en el cual se realizó entrevistas semi-estructuradas a 8 informantes clave de la red asistencial, fue desarrollado en 2015 en tres comunas de Santiago, Chile. El análisis de la información recogida se realizó mediante análisis de contenido, y se finalizó el muestreo de máxima variación al saturar la información. Se resguardaron los criterios de rigor científico y el protocolo fue aprobado por un Comité de Ética. RESULTADOS: Hay una percepción de cobertura y detección de necesidad como adecuada en pacientes bajo control, aunque desde la perspectiva de los informantes, hay desconocimiento de esta garantía en la población. La necesidad es detectada por cualquier profesional de salud, pero la indicación es exclusivamente médica, lo que genera barreras de acceso. Hay una entrega oportuna; sin embargo, no se realiza seguimiento ni se aprecia como parte de una atención integral. Se percibe que la ayuda técnica es de calidad y la articulación de la red es adecuada, aunque no hay retroalimentación a Atención Primaria de Salud. El impacto lo consideran positivo en pacientes y familiares: mejora la ejecución de actividades diarias y genera mayor autonomía y capacidad de desplazamiento. CONCLUSIONES: Existe una percepción positiva de este programa GES y su impacto en la mejoría en la calidad de vida de vida de los pacientes. Pero, la entrega de ayudas técnicas se encuentra desvinculada de una atención integral, por ende, este programa prioriza sólo la garantía de oportunidad.

OBJECTIVE: To assess the perception of key informants working in Primary Health Care in Chile, regarding the administration and impact of the national Explicit Health Guarantees (GES) program which provides technical aids to vulnerable elderly adults. MATERIAL AND METHODS: A qualitative study, based on multiple case analysis of semi--structured interviews with 8 key informants of the healthcare network, was conducted in 2015 in three municipalities of Santiago, Chile. The collected information was analyzed by means of content analysis, and máximum variation sampling was carried out until the data saturation point was reached. Rigorous scientific criteria were safeguarded, and the study protocol was approved by an Ethics Committee. RESULTS: Patients deemed the program's coverage and detection of needs to be adequate, although informants conveyed that the general population is largely unaware of the program. While any health professional can detect a patient's need for technical aids, only physicians can prescribe the devices, which generates access barriers. Technical aid delivery is timely; however, it is not monitored or considered to form part of a comprehensive care system. Assistive devices are perceived to be high quality, and the delivery network coordination is seen as adequate, although there is no feedback to Primary Health Care. The program's impact is considered positive among patients and family members, as it improves the performance of daily activities and generates greater autonomy and mobility. CONCLUSIONS: This GES program is positively perceived and viewed to improve patients' quality of life. However, the delivery of technical aids is disconnected from an integral care approach, and thus the program only prioritizes the guarantee of opportunity.

Case-Control Study of Risk Factors for Meningococcal Disease in Chile.

An outbreak of meningococcal disease with a case-fatality rate of 30% and caused by predominantly serogroup W of Neisseria meningitidis began in Chile in 2012. This outbreak required a case-control study to assess determinants and risk factors for infection. We identified confirmed cases during January 2012-March 2013 and selected controls by random sampling of the population, matched for age and sex, resulting in 135 case-patients and 618 controls. Sociodemographic variables, habits, and previous illnesses were studied. Analyses yielded adjusted odds ratios as estimators of the probability of disease development. Results indicated that conditions of social vulnerability, such as low income and overcrowding, as well as familial history of this disease and clinical histories, especially chronic diseases and hospitalization for respiratory conditions, increased the probability of illness. Findings should contribute to direction of intersectoral public policies toward a highly vulnerable social group to enable them to improve their living conditions and health.

[Clinical features and prognostic factors of meningococcal disease: a case series study in Chile during the 2012-2013 outbreak]. / Características clínicas y factores pronósticos de la enfermedad meningocóccica: un estudio de serie de casos en Chile durante el brote 2012-2013.

INTRODUCTION: Meningococcal disease (MD) is a major global problem because of its case fatality rate and sequels. Since 2012 cases of serogroup W have increased in Chile, with nonspecific clinical presentation, high case fatality rate and serious consequences. OBJECTIVE: To characterize the evolution and outcome of MD cases between January 2012 and March 2013 in Chile. MATERIAL AND METHODS: Case series considering 149 MD cases of 7 regions. A questionnaire was applied and clinical records were reviewed, including individual, agent, clinical course and healthcare process variables. The analysis allowed to obtain estimates of the OR as likelihood of dying. RESULTS: 51.5% was meningococcemia, the case fatality rate reached 27%, prevailing serogroup W (46.6%). Factors that increased the probability of dying: > age, belonging to indigenous people, having lived a stressful event, having diarrhea, impaired consciousness, cardiovascular symptoms, low oxygen saturation and low Glasgow coma scale score. DISCUSSION: The case fatality rate exceeded normal levels and was higher in serogroup W. Increasing in this serogroup, associated to the increased presence of nonspecific symptoms or rapid progression to septicemia, hit a health system accustomed to more classic meningococcal disease presentation, which could partly explain the observed increased fatality rate.

Características clínicas y factores pronósticos de la enfermedad meningocóccica: un estudio de serie de casos en Chile durante el brote 2012-2013 / Clinical features and prognostic factors of meningococcal disease: a case series study in Chile during the 2012-2013 outbreak

Introduction: Meningococcal disease (MD) is a major global problem because of its case fatality rate and sequels. Since 2012 cases of serogroup W have increased in Chile, with nonspecific clinical presentation, high case fatality rate and serious consequences. Objective: To characterize the evolution and outcome of MD cases between January 2012 and March 2013 in Chile. Material and Methods: Case series considering149 MD cases of 7 regions. A questionnaire was applied and clinical records were reviewed, including individual, agent, clinical course and healthcare process variables. The analysis allowed to obtain estimates of the OR as likelihoodof dying. Results: 51.5% was meningococcemia, the case fatality rate reached 27%, prevailing serogroup W (46.6%). Factors that increased the probability of dying: > age, belonging to indigenous people, having lived a stressful event, having diarrhea, impaired consciousness, cardiovascular symptoms, low oxygen saturation and low Glasgow coma scale score. Discussion: The case fatality rate exceeded normal levels and was higher in serogroup W. Increasing in this serogroup, associated to the increased presence of nonspecific symptoms or rapid progression to septicemia, hit a health system accustomed to more classic meningococcal disease presentation, which could partly explain the observed increased fatality rate.

Introducción: La enfermedad meningocóccica (EM) es un importante problema mundial por su letalidad y secuelas. Desde 2012 aumentaron en Chile los casos por serogrupo W, con presentación clínica inespecífica, elevada letalidad y secuelas graves. Objetivo: Caracterizar la evolución y desenlace de EM en casos desde enero de 2012 a marzo de 2013 en Chile. Material y Método: Serie de 149 casos de EM de siete regiones. Se aplicó un cuestionario y se revisaron registros clínicos, incluyendo variables del individuo, agente, curso clínico y proceso de atención. Los análisis permitieron obtener OR como estimadores de la probabilidad de fallecer. Resultados: El 51,5% se presentó como meningococcemia, la letalidad alcanzó a 27%, predominando el serogrupo W (46,6%). Aumentaron la probabilidad de fallecer: una mayor edad, pertenencia a pueblos originarios, haber vivido evento estresante, presentar diarrea, compromiso de conciencia, síntomas cardiovasculares, baja saturación de oxígeno y bajo puntaje de Glasgow. Discusión: La letalidad superó las frecuencias habituales y fue mayor en el serogrupo W. El aumento de este serogrupo, asociado a la mayor presencia de síntomas inespecíficos o a la rápida progresión a septicemia, impactó en un sistema de salud habituado a cuadros más clásicos de EM, lo que podría explicar en parte, la mayor letalidad observada.

Barreras y facilitadores para el control prenatal en adolescentes: resultados de un estudio cualitativo en Chile / Barriers and facilitators to antenatal care in adolescents: results of a qualitative study in Chile

Objetivo. Analizar barreras y facilitadores de acceso a control prenatal en adolescentes urbanas de 15-19 años en Santiago, Chile. Material y métodos. Estudio cualitativo con 17 madres adolescentes basado en la teoría fundamentada. Se realizaron 11 entrevistas semiestructuradas y un grupo focal. Resultados. La negación y ocultamiento del embarazo es la principal barrera para ingresar a control en el grupo de acceso tardío; no se identificaron facilitadores. Para mantenerse en control, todas las participantes identifican como facilitador contar con una figura de apoyo. La vulnerabilidad familiar y social explica que algunas adolescentes ingresen a control tardíamente. Conclusión. La presencia de facilitadores es determinante para el ingreso oportuno y mantenerse en control, ya que reduce o anula el efecto de las barreras. El sistema de salud debe constituirse en un facilitador que acompañe desde muy temprano a las adolescentes favoreciendo un vínculo de confianza y respeto.

Objective. Analyze barriers and facilitators of access to prenatal care in pregnant urban adolescents between 15-19 years of age in Santiago, Chile. Materials and methods. Qualitative study based on grounded theory with 17 adolescent mothers. Eleven semi-structured interviews and one focus group were conducted. Results. The denial and concealment of pregnancy is the main barrier to start the prenatal care in the "delayed access group". This group does not identify facilitators. For maintenance in antenatal care, all participants identified a support figure as a facilitator. Family and social vulnerabilities explain why some adolescents start the prenatal care late. Conclusion. The presence of facilitators is crucial for both, the timely entry and the maintenance in antenatal care because they reduce or nullify the effect of barriers. The health system must become a facilitator to accompany adolescents and promote a bond of trust and respect.

[Barriers and facilitators to antenatal care in adolescents: results of a qualitative study in Chile]. / Barreras y facilitadores para el control prenatal en adolescentes: resultados de un estudio cualitativo en Chile.

OBJECTIVE: Analyze barriers and facilitators of access to prenatal care in pregnant urban adolescents between 15-19 years of age in Santiago, Chile. MATERIALS AND METHODS: Qualitative study based on grounded theory with 17 adolescent mothers. Eleven semi-structured interviews and one focus group were conducted. RESULT: . The denial and concealment of pregnancy is the main barrier to start the prenatal care in the "delayed access group". This group does not identify facilitators. For maintenance in antenatal care, all participants identified a support figure as a facilitator. Family and social vulnerabilities explain why some adolescents start the prenatal care late. CONCLUSION: The presence of facilitators is crucial for both, the timely entry and the maintenance in antenatal care because they reduce or nullify the effect of barriers. The health system must become a facilitator to accompany adolescents and promote a bond of trust and respect.