Barriers to healthcare access for children with congenital heart disease in eight Latin American countries.

BACKGROUND: Mortality from congenital heart disease has decreased considerably in the last two decades due to improvements in overall health care. However, there are barriers to access to healthcare in Latin America for this population, which could be related to factors such as healthcare system, policies, resources, geographic, cultural, educational, and psychological factors. Understanding the barriers to access to care is of paramount importance for the design and implementation of policies and facilitate the provision of care. AIM: The aim of the study was to investigate the perception of barriers to access to health care on parents/guardians of children with congenital heart disease in selected Latin American countries. METHODS: A descriptive, cross-sectional study, in which parents/guardians or primary caregivers of children with congenital heart disease was recruited to participate and surveyed. Once the informed consent process had been completed, a set of paper-based scales was used to collect data, namely socioeconomic and demographic information, the Barriers to Care for Children with Special Health Care Needs Questionnaire, and the General Health Questionnaire. RESULTS: In total, 286 participants completed the surveys, with an average age of 34.81 years and 73.4% being female. Mean score of overall barriers was 54.45 (minimum score 39, maximum score 195, higher scores show greater perception of barriers). In Mexico, the parents/guardians of children perceived fewer barriers to access (46.69), while Peru is the country where the most barriers were perceived (69.91). Nonpoor participants showed higher overall barrier perception scores (57.34) than poor participants (52.58). The regression analysis demonstrated the overall perception of barriers was positively associated with individual and social factors, such as educational level, contract status, household monthly income, and psychological well-being and with the country of the participants. CONCLUSIONS: Multiple factors are associated with the perception of barriers to accessing health care for children with congenital heart disease, including socioeconomic status, expectations, psychological well-being, and structural factors.

Bringing an end to diabetes stigma and discrimination: an international consensus statement on evidence and recommendations.

People with diabetes often encounter stigma (ie, negative social judgments, stereotypes, prejudice), which can adversely affect emotional, mental, and physical health; self-care, access to optimal health care; and social and professional opportunities. To accelerate an end to diabetes stigma and discrimination, an international multidisciplinary expert panel (n=51 members, from 18 countries) conducted rapid reviews and participated in a three-round Delphi survey process. We achieved consensus on 25 statements of evidence and 24 statements of recommendations. The consensus is that diabetes stigma is driven primarily by blame, perceptions of burden or sickness, invisibility, and fear or disgust. On average, four in five adults with diabetes experience diabetes stigma and one in five experience discrimination (ie, unfair and prejudicial treatment) due to diabetes, such as in health care, education, and employment. Diabetes stigma and discrimination are harmful, unacceptable, unethical, and counterproductive. Collective leadership is needed to proactively challenge, and bring an end to, diabetes stigma and discrimination. Consequently, we achieved unanimous consensus on a pledge to end diabetes stigma and discrimination.

Estrategia multimodal para la prevención de COVID-19, en una faena minera

Introducción: Al inicio de la pandemia de COVID-19, las empresas mineras, debieron implementar sistemas de gestión para prevenir transmisión de SARS-CoV-2. Objetivo: Describir los resultados iniciales de la estrategia multimodal para la prevención de COVID-19, en una faena minera. Materiales y Métodos: Estudio descriptivo, de corte transversal. Se estructuró un sistema de gestión que consideró medidas administrativas, ambientales, tamizaje de riesgos y gestión de casos de riesgo al interior de la empresa. Análisis de datos con estadística descriptiva. Resultados: Las medidas administrativas se tradujeron en que 8.116 (34%) trabajadores de la faena fueron suspendidos de sus labores habituales. El tamizaje de riesgo antes del ingreso a la faena identificó 450 casos sospechosos que fueron derivados a su domicilio. En el procedimiento de gestión de casos 1.073 personas fueron clasificadas en algunos de los grupos de riesgo. Se detectaron 10 casos de trabajadores con RPC positiva, siendo que 50% fue asintomático; en los sintomáticos, los síntomas más frecuentes fueron: tos (60%) y cefalea (40%). Conclusiones: Estos resultados, dan luces sobre la importancia de implementar una estrategia multimodal, adaptada a la realidad local de una empresa de la gran minería, para prevenir la transmisión de SARS-CoV-2.

Background: Mining companies must implement management systems dedicated to health and safety at work to prevent the transmission of SARS-CoV-2 among their workers, however, the literature on this is scarce. Aim: To describe a multimodal strategy for the management of health and safety at work, to address the risk of COVID-19 in large mining. Methods: Descriptive cross-sectional study, carried out in a large mining company. A management system was structured that considered administrative measures, of an environmental nature, risk screening, and management of risk cases within the company. The data analysis was done using descriptive statistics. Results: The administrative measures resulted in 8,116 (34%) workers at the site being suspended from their usual work. Risk screening before entering the site identified 450 suspected cases that were referred to their home. In the case management procedure, 1,073 people were classified in some of the risk groups. 10 cases of workers with PCR were detected in the follow-up period. Environmental measures were not very sensitive. Conclusions: These results shed light on the importance of implementing a multimodal strategy, adapted to the local reality, in preventing the spread of SARS-CoV-2 in the period under study, at the mining site intervened.

Psychometric Properties of the Spanish-language Version of the Interpersonal Mindfulness in Parenting (IM-P) Scale among Mothers of Preschool Children in Chile / Propiedades psicométricas de la versión en español de la Escala de Atención Plena (Mindfulness) Interpersonal en la Parentalidad en madres de preescolares en Chile

Abstract The Interpersonal Mindfulness in Parenting (IM-P) scale is one of the first measures that specifically assesses mindful parenting, a specific application of mindfulness, that has been defined as paying attention to your child and parenting in a particular way, intentionally, in the present moment, and non-judgmentally. Psychometric properties of a Spanish-language version of the IM-P scale were examined in a sample of 111 mothers of preschool-age children living in Santiago, Chile. The original IM-P model with five factors and 31 items showed indicators of goodness of fit within acceptable ranges, however two items presented extremely low factor loadings that suggest a lack of fit to the model. Also, there was a high correlation between two factors which were theoretical and conceptually very related: Compassion for the self and child and Non-judgmental Acceptance of the self and child. Therefore, it was considered appropriate to test a new four-factor model in which these two factors were merged into one, and items loading low in the previous model were eliminated. This new model showed a slightly better fit than the five-factor model. The resultant four-factor version and its subscales showed good internal consistencies. Construct validity of the IM-P scale was investigated by calculating correlations with general mindfulness (Five Facet Mindfulness Questionnaire, FFMQ). As expected, a significant positive correlation was found between the two measures (r=0.73, p<0.01), and among almost all subscales. In general, the results present sound psychometric properties of the Spanish translation of the IM-P in Chilean mothers of preschool children.

Resumen Las propiedades psicométricas de la versión en español de la escala de Atención Plena (Mindfulness) Interpersonal en la Parentalidad (IM-P) fueron examinadas en una muestra de 111 madres de niños y niñas de edad preescolar en Santiago de Chile. La estructura de cinco factores de la escala IM-P original no fue completamente respaldada mediante análisis factorial confirmatorio. Por lo tanto, se testeó una estructura de cuatro factores. Dos de los factores encontrados fueron coherentes con aquellos originalmente hipotetizados. Los otros consistieron en una re-agrupación de items de las subescalas Consciencia Emocional de si misma y del hijo(a), Aceptación sin juicio de si misma y del hijo(a) y Compasión hacia si misma y hacia su hijo(a), en dos factores: uno que da cuenta de compasión y no-juicio de la madre hacia si misma y, el otro que da cuenta de la compasión, no-juicio y consciencia emocional de la madre hacia su hijio. La versión resultante de cuatro factores y sus sub-escalas presentaron buena consistencia interna. Se analizó la validez de constructo mediante cálculo de correlaciones con mindfulness general (Cuestionario de cinco dimensiones de Mindfulness, FFMQ). Como se esperaba, se encontró una correlación positiva significativa entre las dos medidas (r=0.71, p<0.01), y entre la mayor parte de las subescalas. En general, los resultados dan cuenta de buenas propiedades psicométricas de la versión en español de la escala IM-P en madres de niños y niñas preescolares en Chile.

Psychometric properties of the Spanish version of the Type 2 Diabetes Stigma Assessment Scale (DSAS 2) in a Colombian population / Propiedades psicométricas de la versión en español del Type 2 Diabetes Stigma Assessment Scale (DSAS 2) en población colombiana

Introduction: The perception of stigma has been negatively associated with the metabolic control and quality of life in patients with type 2 diabetes. The Diabetes Stigma Assessment Scale 2 (DSAS 2) was designed to specifically measure the stigma associated with this type of diabetes. However, the psychometric properties of its Spanish version have not yet been addressed. Objective: To analyze the validity and reliability of the Spanish version of DSAS 2 in a Colombian population. Materials and methods: In total, 501 patients with type 2 diabetes from Barranquilla answered the Spanish version of DSAS 2, a questionnaire with sociodemographic and clinical indicators, as well as instruments to measure depression, self-efficacy, and stress. We performed a factor analysis (exploratory and confirmatory) to determine the internal structure of the DSAS 2 in Spanish and used the alpha coefficient (α) to evaluate its reliability. Additionally, we analyzed the relationship between the DSAS 2 scores and the other variables under study. Results: The three-factor structure (different treatment / judgment, guilt and shame) showed good fit to the data (RMSEA = 0.081, CFI = 0.959, TLI = 0.95) and good reliability (α = 0.76). Significant correlations of the scores of the DSAS 2 Spanish version were observed with self-efficacy (rs=-0.37, p<0.001), stress (rs =0.24 , p<0.001), and depression (rs=0.1, p=0.021). Besides, the scores showed variations associated with sociodemographic and clinical variables. Conclusions: The Spanish version showed certain differences compared with the original version of the DSAS2 but there was adequate evidence of its validity and reliability to be used in Colombia.

Introducción. El estigma se ha asociado negativamente al control metabólico y la calidad de vida de pacientes con diabetes de tipo 2. El cuestionario Diabetes Stigma Assesment Scale 2 (DSAS 2) fue diseñado para medir específicamente el estigma asociado en personas con este tipo de diabetes. Sin embargo, las propiedades psicométricas de su versión en español aún no han sido analizadas. Objetivo. Analizar la validez y confiabilidad de la versión en español del DSAS 2 en población colombiana. Materiales y métodos. Se solicitó a 501 pacientes con diabetes de tipo 2 en Barranquilla contestar la versión en español del DSAS 2, un cuestionario con indicadores sociodemográficos y clínicos, así como instrumentos de medición de la depresión, la autoeficacia y el estrés. Se hizo un análisis factorial (exploratorio y confirmatorio) para determinar la estructura interna del DSAS 2 en español y se usó el coeficiente alfa (α) para evaluar su confiabilidad. Además, se analizó la relación entre los puntajes del DSAS 2 y las otras variables estudiadas. Resultados. La estructura de tres factores (trato diferente-juicio, culpa y vergüenza) se ajustó adecuadamente a los datos (raíz del error cuadrático medio (RMSEA)=0,081, índice de ajuste comparativo (CIF)=0,959, índice de Tucker-Lewis (TLI)=0,95) y su confiabilidad fue buena (α=0,76). Se observaron correlaciones significativas del puntaje del DSAS 2 en español con la autoeficacia (rs=-0,37; p<0,001), el estrés (rs=0,24; p<0,001) y la presencia de síntomas depresivos (rs=0,1; p=0,021). Además, los puntajes de la escala mostraron variaciones asociadas a variables sociodemográficas y clínicas. Conclusiones. La versión en español presenta ciertas diferencias con la versión original del DSAS2, sin embargo, su validez y confiabilidad son suficientes y adecuadas para su uso en Colombia.

Propiedades psicométricas de la versión en español del Type 2 Diabetes Stigma Assessment Scale (DSAS 2) en población colombiana / Psychometric properties of the Spanish version of the Type 2 Diabetes Stigma Assessment Scale (DSAS 2) in a Colombian population

Introducción. El estigma se ha asociado negativamente al control metabólico y la calidad de vida de pacientes con diabetes de tipo 2. El cuestionario Diabetes Stigma Assesment Scale 2 (DSAS 2) fue diseñado para medir específicamente el estigma asociado en personas con este tipo de diabetes. Sin embargo, las propiedades psicométricas de su versión en español aún no han sido analizadas. Objetivo. Analizar la validez y confiabilidad de la versión en español del DSAS 2 en población colombiana. Materiales y métodos. Se solicitó a 501 pacientes con diabetes de tipo 2 en Barranquilla contestar la versión en español del DSAS 2, un cuestionario con indicadores sociodemográficos y clínicos, así como instrumentos de medición de la depresión, la autoeficacia y el estrés. Se hizo un análisis factorial (exploratorio y confirmatorio) para determinar la estructura interna del DSAS 2 en español y se usó el coeficiente alfa (α) para evaluar su confiabilidad. Además, se analizó la relación entre los puntajes del DSAS 2 y las otras variables estudiadas. Resultados. La estructura de tres factores (trato diferente-juicio, culpa y vergüenza) se ajustó adecuadamente a los datos (raíz del error cuadrático medio (RMSEA)=0,081, índice de ajuste comparativo (CIF)=0,959, índice de Tucker-Lewis (TLI)=0,95) y su confiabilidad fue buena (α=0,76). Se observaron correlaciones significativas del puntaje del DSAS 2 en español con la autoeficacia (rs=-0,37; p<0,001), el estrés (rs=0,24; p<0,001) y la presencia de síntomas depresivos (rs=0,1; p=0,021). Además, los puntajes de la escala mostraron variaciones asociadas a variables sociodemográficas y clínicas. Conclusiones. La versión en español presenta ciertas diferencias con la versión original del DSAS2, sin embargo, su validez y confiabilidad son suficientes y adecuadas para su uso en Colombia.

Introduction: The perception of stigma has been negatively associated with the metabolic control and quality of life in patients with type 2 diabetes. The Diabetes Stigma Assessment Scale 2 (DSAS 2) was designed to specifically measure the stigma associated with this type of diabetes. However, the psychometric properties of its Spanish version have not yet been addressed. Objective: To analyze the validity and reliability of the Spanish version of DSAS 2 in a Colombian population. Materials and methods: In total, 501 patients with type 2 diabetes from Barranquilla answered the Spanish version of DSAS 2, a questionnaire with sociodemographic and clinical indicators, as well as instruments to measure depression, self-efficacy, and stress. We performed a factor analysis (exploratory and confirmatory) to determine the internal structure of the DSAS 2 in Spanish and used the alpha coefficient (α) to evaluate its reliability. Additionally, we analyzed the relationship between the DSAS 2 scores and the other variables under study. Results: The three-factor structure (different treatment / judgment, guilt and shame) showed good fit to the data (RMSEA = 0.081, CFI = 0.959, TLI = 0.95) and good reliability (α = 0.76). Significant correlations of the scores of the DSAS 2 Spanish version were observed with self-efficacy (rs=-0.37, p<0.001), stress (rs =0.24 , p<0.001), and depression (rs=0.1, p=0.021). Besides, the scores showed variations associated with sociodemographic and clinical variables. Conclusions: The Spanish version showed certain differences compared with the original version of the DSAS2 but there was adequate evidence of its validity and reliability to be used in Colombia.

A Cross-Sectional Analysis of the Stigma Surrounding Type 2 Diabetes in Colombia.

Type 2 diabetes is a global epidemic, and many people feel stigmatized for having this disease. The stigma is a relevant barrier to diabetes management. However, evidence in this regard is scarce in Latin America. This study aimed to analyze the level of stigma surrounding type 2 diabetes in the Colombian population and its relationships with sociodemographic, clinical, psychosocial variables and behaviors related to management of the disease (self-management behaviors). This cross-sectional study included 501 Colombian adults with type 2 diabetes. We estimated the relation between stigma and selected variables through linear regression models. Additionally, we analyzed the mediator role of psychosocial variables in the relationship between stigma and self-management behaviors through structural equation models. A total of 16.4% of patients showed concerning levels of stigma. The time elapsed since diagnosis (ß = -0.23) and socioeconomic status (ß = -0.13) were significant predictors of the level of stigma. Stigma was negatively correlated with self-efficacy (ß = -0.36), self-esteem (ß = -0.37), and relationship with health care provider (ß = -0.46), and positively correlated with stress (ß = 0.23). Self-efficacy, self-esteem, and the relationships with health care providers had a mediation role in the relationship between stigma and self-management behaviors. These variables would be part of the mechanisms through which the perception of stigma harms self-management behaviors. The stigma of type 2 diabetes is frequent in the Colombian population and negatively associated with important aspects of disease management.

[Overview of machine learning and its application in the management of emergency services]. / Generalidades del Machine Learning y su aplicación en la gestión sanitaria en Servicios de Urgencia.

The processes associated with health care generate a large amount of information that is difficult to analyze using standard statistical procedures. In this context, disciplines such as Data Science became relevant, mainly through strategies such as Machine Learning (ML). The latter groups a series of tools whose purpose is to develop algorithms to extract information from data, whether for explanation, classification, or prediction. Despite its usefulness as support for clinical decisions, its potential in health care management has been less explored. Also, there are difficulties in understanding these types of studies. This work tries to offer a nontechnical overview of the ML concept and its advantages for health care management. It collects examples of ML applications in emergency department management.

Efectos de una intervención basada en atención plena para reducir el nivel de burnout en enfermeras / Effects of a Mindfulness-based Intervention to Reduce Burnout Levels in Nurses

RESUMEN Introducción: Se ha descrito que los profesionales de enfermería son particularmente proclives a desarrollar burnout, especialmente aquellos que se desempeñan en unidades con una alta demanda física y psicológica. Diversos estudios han mostrado que la técnica de mindfulness o atención plena (MBI) como un recurso útil para la reducción de burnout en profesionales sanitarios, entendiendo este como simplemente parar y estar presente, sin juicios mentales. Este estudio pretende evaluar el impacto inicial de una intervención basada en esta técnica. Métodos: Estudio exploratorio pre- y post- intervención (n=34 enfermeros). Se implementó una intervención para reducir el estrés basada en atención plena (MBSR) de 8 sesiones según lo propuesto por Shapiro y Carlson. Se midió burnout y nivel de Atención Plena. Para evaluar las diferencias en los niveles de Atención Plena y burnout se utilizó prueba t para muestras relacionadas. Finalmente se analizó la correlación entre la asistencia a las sesiones y el cambio en los niveles de burnout y mindfulness de los participantes. Resultados: El nivel de atención plena se incrementó en promedio 12,62 puntos (p<0.001). No se observó diferencia en el nivel global de burnout. Sin embargo, existieron variaciones en el nivel de culpa e indolencia, los cuales disminuyeron significativamente posterior a la intervención. Además se apreció una correlación positiva entre el porcentaje de asistencia y el cambio en el nivel de atención plena de los participantes. Conclusión: Este estudio muestra un efecto beneficioso de una intervención basada en atención plena tanto en el aprendizaje de la técnica como en la reducción de algunas facetas del burnout en profesionales de enfermería.

ABSTRACT Background: Literature describes that nursing professionals are particularly prone to develop burnout, especially those who work in units with a high physical and psychological demand. Several studies have shown the technique of mindfulness (MBI) as a useful resource for the reduction of burnout in healthcare professionals, understood as simply stopping and being present, without mental judgments. The main goal of this study is to assess the impact of an intervention based on this technique. Methods: Exploratory pre-and post-intervention study (n=34 nurses). We implemented an 8-session mindfulness-based stress reduction intervention (MBSR) proposed by Shapiro and Carlson to measure participants' mindfulness and burnout levels. To evaluate the differences in the levels of mindfulness and burnout, we use a paired sample t-test. Finally, we analyze the correlation between session attendance and changes in burnout and mind-fulness levels of participants. Results: There was a significant increase of 12,36 points (p<0.001) in mindfulness level among participants. No differences in the total score of burnout were observed. However, the ratings in guilty and indolence components of burnout scale significantly fell. We found a positive correlation between attendance and the change in mindfulness levels. No effect was observed in burnout levels. Conclusion: This study shows a positive effect of the intervention in mindfulness learning and some facets of burnout (guilty and indolence) among nursing professionals.

El estigma asociado a la diabetes: elementos conceptuales, mecanismos involucrados y desafíos / Diabetes Surrounding Stigma: Conceptual Issues, Mechanisms Involved and Challenges

RESUMEN La diabetes es una epidemia a nivel mundial. Los factores psicosociales han sido reconocidos como un elemento importante en el manejo y control de la enfermedad. El estigma asociado a la diabetes ha emergido recientemente como un nuevo factor psicosocial que afecta negativamente la salud de los pacientes con diabetes. Sin embargo, la evidencia reciente en torno a este fenómeno aún no ha sido sintetizada. Esta revisión narrativa de literatura aborda: (i) elementos conceptuales y epidemiológicos que contribuyen a la comprensión del fenómeno y su magnitud; (ii) los factores psicosociales, conductuales y fisiológicos involucrados en la relación entre el estigma asociado a la diabetes y los resultados en salud en pacientes con la enfermedad; (iii) desafíos y posibles áreas de investigación.

ABSTRACT Diabetes is a worldwide epidemic. Psychosocial factors have been recognized as an essential element in the management and control of this disease. The diabetes surrounding stigma has recently emerged as a new psychosocial factor that negatively affects patient's health. However, the recent evidence regarding this phenomenon has not been summarized. This narrative literature review address: (i) conceptual and epidemiological elements that contribute to understanding this phenomenon and its magnitude; (ii) the psychosocial, behavioral, and physiological factors involved in the relationship between diabetes stigma and health outcomes in patients with the disease; (iii) challenges and possible research areas.

Generalidades del Machine Learning y su aplicación en la gestión sanitaria en Servicios de Urgencia / Overview of machine learning and its application in the management of emergency services

The processes associated with health care generate a large amount of information that is difficult to analyze using standard statistical procedures. In this context, disciplines such as Data Science became relevant, mainly through strategies such as Machine Learning (ML). The latter groups a series of tools whose purpose is to develop algorithms to extract information from data, whether for explanation, classification, or prediction. Despite its usefulness as support for clinical decisions, its potential in health care management has been less explored. Also, there are difficulties in understanding these types of studies. This work tries to offer a nontechnical overview of the ML concept and its advantages for health care management. It collects examples of ML applications in emergency department management.

Development of an instrument to measure the cultural competence of health care workers.

OBJECTIVE: To validate an instrument measuring the cultural competence in health care workers from Chile. METHODS: Using Sue & Sue's theoretical model of cultural competence, we designed a scale, which was assessed by health care workers and experts. Subsequently, the scale was applied to a sample of 483 different health care workers, during 2018 in Santiago de Chile. The analysis included: exploratory and confirmatory factor analysis, estimation of reliability, and analysis of measurement bias. Finally, the level of cultural competence was calculated for every professional who participated in this study. RESULTS: The final scale include 14 items that are grouped into three dimensions concordant with the theoretical model: sensitivity to own prejudices, cultural knowledge, and skills to work in culturally diverse environments. This scale showed good fit in factor models, adequate reliability and lack of evidence of measurement bias. Regarding the performance of health care workers, sensitivity showed a lower level compared with the other dimensions evaluated. CONCLUSION: The scale for measuring the level of cultural competence in health care workers (EMCC-14) is a reliable instrument, with initial support for its validity, which can be used in the Chilean context. Additionally, the results of this study could guide some possible interventions in the health sector to strengthen the level of cultural competence.

Development of an instrument to measure the cultural competence of health care workers / Desarrollo de un instrumento para medir competencia cultural en trabajadores de Salud

ABSTRACT OBJECTIVE To validate an instrument measuring the cultural competence in health care workers from Chile. METHODS Using Sue & Sue's theoretical model of cultural competence, we designed a scale, which was assessed by health care workers and experts. Subsequently, the scale was applied to a sample of 483 different health care workers, during 2018 in Santiago de Chile. The analysis included: exploratory and confirmatory factor analysis, estimation of reliability, and analysis of measurement bias. Finally, the level of cultural competence was calculated for every professional who participated in this study. RESULTS The final scale include 14 items that are grouped into three dimensions concordant with the theoretical model: sensitivity to own prejudices, cultural knowledge, and skills to work in culturally diverse environments. This scale showed good fit in factor models, adequate reliability and lack of evidence of measurement bias. Regarding the performance of health care workers, sensitivity showed a lower level compared with the other dimensions evaluated. CONCLUSION The scale for measuring the level of cultural competence in health care workers (EMCC-14) is a reliable instrument, with initial support for its validity, which can be used in the Chilean context. Additionally, the results of this study could guide some possible interventions in the health sector to strengthen the level of cultural competence.

RESUMEN OBJETIVO Validar un instrumento de medición de competencia cultural en trabajadores de salud de Chile. MÉTODOS Utilizando el modelo teórico de Sue y Sue, se diseñó un instrumento de medición el cual fue evaluado por trabajadores de salud y expertos. Este instrumento se aplicó a una muestra diversa de 483 proveedores de salud, durante 2018 en Santiago de Chile. Se realizó análisis factorial exploratorio, confirmatorio, estimación de confiabilidad y análisis de sesgo de medición. Se estimó el nivel de competencia cultural alcanzado por los profesionales. RESULTADOS El instrumento final contó con 14 ítems los cuales se agruparon en tres dimensiones: sensibilidad a los propios prejuicios, conocimiento cultural y habilidades para trabajar en entornos culturalmente diversos. Esta herramienta mostró buen ajuste en los modelos factoriales, adecuada confiabilidad y ausencia de evidencias de sesgo de medición. Los trabajadores de salud evaluados exhibieron un bajo nivel de sensibilidad a los propios prejuicios en comparación con las otras dimensiones evaluadas. CONCLUSIONE La Escala de Medición de Competencia Cultural en trabajadores de salud (EMCC-14) es una herramienta confiable, con soporte inicial para su validez, que puede usarse en el contexto Chileno. Además, los resultados de este estudio podrían guiar algunas posibles intervenciones en el sector de la salud para fortalecer el nivel de competencia cultural.

Hospitalizations for cancer in international migrants versus local population in Chile.

OBJECTIVE: To compare cancer hospital morbidity among the local population and the immigrant population in Chile. METHODS: This is a prevalence study based on the analysis of hospital discharges of all the health centers of Chile. Cancer hospital discharges were characterized in 2012 according to the migratory status. The crude and specific rates of hospital morbidity for this cause were estimated for the analysis of their association with migratory status using zero-inflated negative binomial regression, adjusted for sociodemographic variables. RESULTS: The neoplasms were the third cause of hospital discharges for immigrants and the seventh one for Chileans. The adjusted rate of cancer hospital discharges was higher for Chileans than immigrants, and the latter had fewer days of hospitalization and greater proportion of surgical interventions. In the group of immigrants, cancer hospital discharges mainly corresponded to patients belonging to the private system (46%), and in the group of Chileans they mainly corresponded to patients in the public system (71.1%). We observed a large difference in the proportion of cancer hospital discharges for patients with no health insurance between the two populations (22.6%: immigrants, 1.0%: Chileans). In both populations, the three most frequent types of cancer were: (i) lymphoid tissue, hematopoietic organs, and related tissues, (ii) digestive organs, and (iii) breast cancer. CONCLUSIONS: Models of differentiated care should be considered for immigrants, with the creation of specific programs of information, coverage, and protection against cancer. More information on this problem must be generated at the local and international level.

Hospitalizations for cancer in international migrants versus local population in Chile / Hospitalizaciones por cáncer en migrantes internacionales y población local en Chile

ABSTRACT OBJECTIVE To compare cancer hospital morbidity among the local population and the immigrant population in Chile. METHODS This is a prevalence study based on the analysis of hospital discharges of all the health centers of Chile. Cancer hospital discharges were characterized in 2012 according to the migratory status. The crude and specific rates of hospital morbidity for this cause were estimated for the analysis of their association with migratory status using zero-inflated negative binomial regression, adjusted for sociodemographic variables. RESULTS The neoplasms were the third cause of hospital discharges for immigrants and the seventh one for Chileans. The adjusted rate of cancer hospital discharges was higher for Chileans than immigrants, and the latter had fewer days of hospitalization and greater proportion of surgical interventions. In the group of immigrants, cancer hospital discharges mainly corresponded to patients belonging to the private system (46%), and in the group of Chileans they mainly corresponded to patients in the public system (71.1%). We observed a large difference in the proportion of cancer hospital discharges for patients with no health insurance between the two populations (22.6%: immigrants, 1.0%: Chileans). In both populations, the three most frequent types of cancer were: (i) lymphoid tissue, hematopoietic organs, and related tissues, (ii) digestive organs, and (iii) breast cancer. CONCLUSIONS Models of differentiated care should be considered for immigrants, with the creation of specific programs of information, coverage, and protection against cancer. More information on this problem must be generated at the local and international level.

RESUMEN OBJETIVO Comparar la morbilidad hospitalaria por cáncer entre población local e inmigrante en Chile. MÉTODOS Estudio de prevalencia basado en el análisis de egresos hospitalarios de todos los centros de Chile. Se caracterizaron los egresos hospitalarios por cáncer en 2012 según condición migratoria. Se estimaran las tasas brutas y específicas de morbilidad hospitalaria por esta causa, para finalmente analizar su asociación con el estatus migratorio mediante una regresión binomial negativa inflada por ceros ajustada por variables sociodemográficas. RESULTADOS Las neoplasias fueron la tercera causa de egresos hospitalarios en inmigrantes y la séptima en chilenos. La tasa ajustada de egresos hospitalarios por cáncer fue mayor en chilenos que en inmigrantes, y estos presentaron menor cantidad de días de hospitalización y mayor proporción de intervenciones quirúrgicas. En el grupo de inmigrantes, los egresos hospitalarios por cáncer corresponderán principalmente a pacientes pertenecientes al sistema privado (46%) y en chilenos a pacientes en el sistema público (71,1%). Se observó una amplia diferencia en la proporción de egresos hospitalarios por cáncer correspondientes a pacientes sin previsión de salud entre ambas poblaciones (22,6%: inmigrantes, 1,0%: chilenos). En ambas poblaciones, los tres cánceres que se presentaron con mayor frecuencia fueron: (i) tejidos linfáticos, órganos hematopoyéticos y tejidos afines, (ii) órganos digestivos y (iii) cáncer de mama. CONCLUSIONES Se deben considerar modelos de atención diferenciada en inmigrantes, creando programas específicos de información, cobertura y protección frente al cáncer. Es necesario generar más información sobre esta problemática a nivel local e internacional.

Brechas de desigualdad en salud en niños migrantes versus locales en Chile / Health inequality gap in inmigrant versus local children in Chile

Resumen Introducción: Los niños y jóvenes migrantes internacionales enfrentan diferentes retos en salud en comparación con la población local, en particular si se enfrentan a ambientes inseguros o a condi ciones sociales adversas. Este estudio busca identificar brechas existentes en resultados de salud de la niñez entre población migrante internacional y chilena. Métodos: Este estudio analiza tres fuentes de información: (i)Nacer en Chile: Datos de consulta antenatal recolectados de los registros electrónicos de las mujeres usuarias del programa Chile Crece Contigo, de todos los centros de salud familiar (CESFAM) de administración municipal de la comuna de Recoleta el año 2012; (ii)Crecer en Chile: Datos de encuesta poblacional "Caracterización Socioeconómica Nacional" CASEN 2013 y (iii)En-fermar en Chile: Datos de todos los egresos hospitalarios de 2012, proporcionada por el departamento de estadística e información en salud (DEIS) del Ministerio de Salud. Resultados: (i) Nacer en Chile: Hay mayor proporción de inmigrantes con riesgo biopsicosocial (62,3% vs 50,1% en chilenas) y con ingreso tardío al programa (63,1% vs 33,4%). Hay menos cesáreas en inmigrantes que en chilenas (24,2% vs 33,6%). (ii) Crecer en Chile: Existe una mayor proporción de niños migrantes fuera del sistema escolar y una mayor proporción en pobreza multidimensional (40% vs 23,2%). (iii) Enfermar en Chile: En migrantes entre 7-14 años es más frecuente egresar hospitalariamente por traumatismos/ otras causas externas (23,6% vs 16,7% en chilenos). Conclusiones: Este estudio entrega nueva evi dencia sobre necesidades urgentes de salud de nuestros niños en Chile. Este es un imperativo ético, legal y moral, independiente de la condición migratoria.

Abstract Introduction: Children and young international migrants face different health challenges compa red with the local population, particularly if they live in insecure environments or adverse social conditions. This study seeks to identify gaps in health outcomes of children between immigrant and local population in Chile. Methods: This study analyses data from three sources: (i) Born in Chile: Electronic records of antenatal visits from all municipal antenatal clinics of Recoleta in 2012; (ii) Growing up in Chile: Population survey "National Socioeconomic Characterization" (CASEN) from 2013 and (iii) Getting sick in Chile: Data of all hospital discharges in 2012, provided by the department of statistics and health information (DEIS) of the Ministry of Health. Results: (I) Born in Chile: Im migrants more frequently have psychosocial risk (62.3% vs 50.1% in Chileans) and enter later into the program (63.1% vs 33.4% enter later than 14 weeks of pregnancy). All birth outcomes were better among immigrants (e.g. caesarean sections rates: 24.2% immigrants vs % Chileans). (ii) Growing up in Chile: A higher proportion of migrant children is outside the school system and lives in multidi mensional poverty (40% immigrants vs 23.2% Chileans). (iii) Getting sick in Chile: Injuries and other external causes were more frequent cause of hospitalisation among migrants (23.6%) than the local population (16.7%) aged between 7 and 14 years. Conclusions: Addressing the needs of the children in Chile, regardless of their immigration status, is an ethical, legal and moral imperative.