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1.
Medwave ; 20(9): e8039, 2020 Oct 05.
Artigo em Espanhol | MEDLINE | ID: mdl-33031358

RESUMO

Introduction: SARS CoV-2 pandemic is pressing hard on the responsiveness of health systems worldwide, notably concerning the massive surge in demand for intensive care hospital beds. Aim: This study proposes a methodology to estimate the saturation moment of hospital intensive care beds (critical care beds) and determine the number of units required to compensate for this saturation. Methods: A total of 22,016 patients with diagnostic confirmation for COVID-19 caused by SARS-CoV-2 were analyzed between March 4 and May 5, 2020, nationwide. Based on information from the Chilean Ministry of Health and ministerial announcements in the media, the overall availability of critical care beds was estimated at 1,900 to 2,000. The Gompertz function was used to estimate the expected number of COVID-19 patients and to assess their exposure to the available supply of intensive care beds in various possible scenarios, taking into account the supply of total critical care beds, the average occupational index, and the demand for COVID-19 patients who would require an intensive care bed. Results: A 100% occupancy of critical care beds could be reached between May 11 and May 27. This condition could be extended for around 48 days, depending on how the expected over-demand is managed. Conclusion: A simple, easily interpretable, and applicable to all levels (nationwide, regionwide, municipalities, and hospitals) model is offered as a contribution to managing the expected demand for the coming weeks and helping reduce the adverse effects of the COVID-19 pandemic.


Assuntos
Infecções por Coronavirus/epidemiologia , Número de Leitos em Hospital/estatística & dados numéricos , Unidades de Terapia Intensiva/provisão & distribução , Modelos Estatísticos , Pneumonia Viral/epidemiologia , Chile/epidemiologia , Humanos , Pandemias
2.
Mar Environ Res ; 161: 105060, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33070932

RESUMO

Environmental variation may alter biological interactions and their ecological consequences. For instance, in marine ecosystems hosts and parasites are subject to environmental variability across latitudinal gradients, and their co-evolutionary dynamics may be the result of the interplay with local physical-chemical variables in seawater. Thus, assessing the environmental conditions required for a host in order to improve their survival is essential to understand the host-parasite interaction and dynamics. In this study, we evaluated the impact of parasitism by Proctoeces humboldti on the body size and reproduction of the intertidal keyhole limpet Fissurella crassa collected from three populations spanning ca. 1500 km along the latitudinal gradient of the Chilean coast. In addition, for the first time, we explore whether the effect of parasitism can be extended to changes in the organic composition and mechanical properties of the host shell. Our results show that parasitism prevalence and intensity, and body size of F. crassa increased in central Chile (ca. 33°S). Unlike body size, which was greater in parasitized limpets than in non-parasitized limpets at the three study sites, reproductive performance followed this trend only in central Chile populations, with no differences between parasitized and non-parasitized limpets collected in the northern Chilean (ca. 23°S), and lower in parasitized than non-parasitized individuals from the south-central Chile (ca. 37°S). The organic composition of F. crassa shells showed significant differences between parasite conditions (e.g. polysaccharides and water decreased in parasitized limpets) and across sites (e.g. proteins levels increase in shell of parasitized limpets from central Chile, but decreased at south-central Chile). However, variability in shell mechanical properties (e.g. toughness and elastic module) do not showed significant differences across sites and parasitism condition. These results suggest the interplay of both parasitism and environmental fluctuations upon the reproductive performance and morphology of the host. In addition, our result highlight that the host may also trade-offs reproduction, growth and shell organic composition to maintain the shell functionality (e.g. protection for mechanical forces and durophagous predators).


Assuntos
Ecossistema , Trematódeos , Animais , Tamanho Corporal , Chile/epidemiologia , Humanos , Moluscos
3.
Child Adolesc Ment Health ; 25(4): 256-257, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33063384

RESUMO

Mental health in Chile has been significantly challenged by the beginning of a social crisis in October of 2019 and the COVID-19 pandemic of 2020. Despite widening of shortage of services, both the burgeoning of Telepsychiatry and a Presidential Initiative to integrate mental health to policy making and services provided by all sectors of government have mitigated the effects of this crisis.


Assuntos
Infecções por Coronavirus/psicologia , Saúde Mental , Pandemias , Pneumonia Viral/psicologia , Adolescente , Serviços de Saúde do Adolescente , Criança , Saúde da Criança , Serviços de Saúde da Criança , Pré-Escolar , Chile/epidemiologia , Planejamento em Saúde , Humanos , Lactente , Serviços de Saúde Mental
4.
MMWR Morb Mortal Wkly Rep ; 69(37): 1305-1309, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32941415

RESUMO

After recognition of widespread community transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), by mid- to late February 2020, indicators of influenza activity began to decline in the Northern Hemisphere. These changes were attributed to both artifactual changes related to declines in routine health seeking for respiratory illness as well as real changes in influenza virus circulation because of widespread implementation of measures to mitigate transmission of SARS-CoV-2. Data from clinical laboratories in the United States indicated a 61% decrease in the number of specimens submitted (from a median of 49,696 per week during September 29, 2019-February 29, 2020, to 19,537 during March 1-May 16, 2020) and a 98% decrease in influenza activity as measured by percentage of submitted specimens testing positive (from a median of 19.34% to 0.33%). Interseasonal (i.e., summer) circulation of influenza in the United States (May 17-August 8, 2020) is currently at historical lows (median = 0.20% tests positive in 2020 versus 2.35% in 2019, 1.04% in 2018, and 2.36% in 2017). Influenza data reported to the World Health Organization's (WHO's) FluNet platform from three Southern Hemisphere countries that serve as robust sentinel sites for influenza from Oceania (Australia), South America (Chile), and Southern Africa (South Africa) showed very low influenza activity during June-August 2020, the months that constitute the typical Southern Hemisphere influenza season. In countries or jurisdictions where extensive community mitigation measures are maintained (e.g., face masks, social distancing, school closures, and teleworking), those locations might have little influenza circulation during the upcoming 2020-21 Northern Hemisphere influenza season. The use of community mitigation measures for the COVID-19 pandemic, plus influenza vaccination, are likely to be effective in reducing the incidence and impact of influenza, and some of these mitigation measures could have a role in preventing influenza in future seasons. However, given the novelty of the COVID-19 pandemic and the uncertainty of continued community mitigation measures, it is important to plan for seasonal influenza circulation in the United States this fall and winter. Influenza vaccination of all persons aged ≥6 months remains the best method for influenza prevention and is especially important this season when SARS-CoV-2 and influenza virus might cocirculate (1).


Assuntos
Infecções por Coronavirus/epidemiologia , Influenza Humana/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Vigilância da População , Austrália/epidemiologia , Chile/epidemiologia , Humanos , África do Sul/epidemiologia , Estados Unidos/epidemiologia
5.
J Med Internet Res ; 22(10): e22146, 2020 10 06.
Artigo em Inglês | MEDLINE | ID: mdl-32903195

RESUMO

BACKGROUND: As the COVID-19 pandemic disrupted medical practice, telemedicine emerged as an alternative to outpatient visits. However, it is not known how patients and physicians responded to an accelerated implementation of this model of medical care. OBJECTIVE: The aim of this study is to report the system-wide accelerated implementation of telemedicine, compare patient satisfaction between telemedicine and in-person visits, and report provider perceptions. METHODS: This study was conducted at the UC Christus Health Network, a large private academic health network in Santiago, Chile. The satisfaction of patients receiving telemedicine care in March and April 2020 was compared to those receiving in-person care during the same period (concurrent control group) as well as in March and April 2019 (retrospective control group). Patient satisfaction with in-person care was measured using the Net Promoter Score (NPS) survey. Patient satisfaction with telemedicine was assessed with an online survey assessing similar domains. Providers rated their satisfaction and responded to open-ended questions assessing challenges, strategies used to address challenges, the diagnostic process, treatment, and the patient-provider relationship. RESULTS: A total of 3962 patients receiving telemedicine, 1187 patients from the concurrent control group, and 1848 patients from the retrospective control group completed the surveys. Satisfaction was very high with both telemedicine and in-person services. Overall, 263 physicians from over 41 specialties responded to the survey. During telemedicine visits, most providers felt their clinical skills were challenged (61.8%). Female providers felt more challenged than male providers (70.7% versus 50.9%, P=.002). Surgeons, obstetricians, and gynecologists felt their clinical skills were challenged the least, compared to providers from nonsurgical specialties (P<.001). Challenges related to the delivery modality, diagnostic process, and patient-provider relationship differed by provider specialty (P=.046, P<.001, and P=.02, respectively). CONCLUSIONS: Telemedicine implemented in response to the COVID-19 pandemic produced high patient and provider satisfaction. Specialty groups perceived the impact of this new mode of clinical practice differently.


Assuntos
Infecções por Coronavirus/epidemiologia , Satisfação do Paciente , Pneumonia Viral/epidemiologia , Telemedicina/métodos , Centros Médicos Acadêmicos , Adolescente , Adulto , Idoso , Betacoronavirus , Criança , Pré-Escolar , Chile/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Satisfação no Emprego , Masculino , Pessoa de Meia-Idade , Pandemias , Pesquisa Qualitativa , Projetos de Pesquisa , Estudos Retrospectivos , Inquéritos e Questionários , Telemedicina/tendências , Adulto Jovem
7.
PLoS One ; 15(9): e0239887, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32991621

RESUMO

BACKGROUND: South America has become the epicenter of coronavirus pandemic. It seems that asymptomatic population may contribute importantly to the spread of the disease. Transmission from asymptomatic pregnant patients' needs to be characterized in larger population cohorts and symptom assessment needs to be standardized. OBJECTIVE: To assess the prevalence of SARS CoV-2 infection in an unselected obstetrical population and to describe their presentation and clinical evolution. METHODS: A cross-sectional study was designed. Medical records of pregnant women admitted at the Obstetrics & Gynecology department of Clínica Dávila for labor & delivery, between April 27th and June 7th, 2020 were reviewed. All patients were screened with RT-PCR for SARS CoV-2 at admission. After delivery, positive cases were inquired by the researchers for clinical symptoms presented before admission and clinical evolution. All neonates born from mothers with confirmed SARS CoV-2 were isolated and tested for SARS CoV-2 infection. RESULTS: A total of 586 patients were tested for SARS CoV-2 during the study period. Outcomes were obtained from 583 patients which were included in the study. Thirty-seven pregnant women had a positive test for SARS CoV-2 at admission. Cumulative prevalence of confirmed SARS CoV-2 infection was 6.35% (37/583) [CI 95%: 4.63-8.65]. From confirmed cases, 43.2% (16/37) were asymptomatic. From symptomatic patients 85.7% (18/21) had mild symptoms and evolved without complications and 14.3% (3/21) presented severe symptoms requiring admission to intensive care unit. Only 5.4% (2/37) of the neonates born to mothers with a positive test at admission had a positive RT-PCR for SARS CoV-2. CONCLUSION: In our study nearly half of pregnant patients with SARS CoV-2 were asymptomatic at the time of delivery. Universal screening, in endemic areas, is necessary for adequate patient isolation, prompt neonatal testing and targeted follow-up.


Assuntos
Infecções por Coronavirus/diagnóstico , Programas de Rastreamento , Pneumonia Viral/diagnóstico , Complicações Infecciosas na Gravidez/diagnóstico , Adulto , Infecções Assintomáticas , Betacoronavirus , Chile/epidemiologia , Técnicas de Laboratório Clínico , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Pandemias , Gravidez , Complicações Infecciosas na Gravidez/virologia , Gestantes , Prevalência , Adulto Jovem
8.
Ann Agric Environ Med ; 27(3): 418-426, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32955225

RESUMO

INTRODUCTION AND OBJECTIVE: Burning coal and firewood generates toxic emissions that are associated with respiratory illness, cardiovascular disease, and even death. The aim of the study is to evaluate the association between county-level prevalence of household coal and firewood use and health outcomes, including total, respiratory, and cardiovascular mortality, as well as total and respiratory hospitalization rates. MATERIAL AND METHODS: The ecological study included data on the use of household coal and firewood in 139 counties obtained from the 2015 Chilean National Socio-economic Characterization Survey. Total, respiratory, and cardiovascular mortality, as well as total and respiratory hospitalization rates, were obtained from the Department of Health Statistics. Poisson models with robust error variance, Pearson linear correlation coefficients, and scatterplots were used to explore associations between household coal and firewood use and morbidity-mortality, stratifying by geographic zone. RESULTS: Total, respiratory, and cardiovascular mortality and total and respiratory hospitalization rates were 5.7 per 1,000, 552 per 100,000, 157 per 100,000, 92.5 per 1000, and 8.8 per 1000 inhabitants, respectively. The median prevalence of coal use for residential cooking, heating, or water heating was 3.64%, while the median prevalence of firewood combustion was 12%. In southern counties, age- and gender-adjusted respiratory mortality increased 2.02 (95% CI: 1.17-3.50), 1.5 (95% CI: 1.11-1.89), and 1.76-fold (95% CI: 1.19-2.60) for each percentage increase in household coal and firewood use for heating, cooking and heating water, respectively. CONCLUSIONS: The prevalence of household coal and firewood used for heating and cooking was positively correlated with respiratory mortality and hospitalization in southern zone counties.


Assuntos
Poluição do Ar em Ambientes Fechados/efeitos adversos , Doenças Cardiovasculares/mortalidade , Carvão Mineral/efeitos adversos , Mortalidade Hospitalar , Hospitalização/estatística & dados numéricos , Doenças Respiratórias/mortalidade , Madeira/efeitos adversos , Doenças Cardiovasculares/induzido quimicamente , Chile/epidemiologia , Culinária , Feminino , Calefação , Humanos , Masculino , Doenças Respiratórias/induzido quimicamente
9.
PLoS One ; 15(9): e0237515, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32898138

RESUMO

BACKGROUND: Regional variations in gastric cancer incidence are not explained by prevalence of Helicobacter pylori, the main cause of the disease, with several areas presenting high H. pylori prevalence but low gastric cancer incidence. The IARC worldwide H. pylori prevalence surveys (ENIGMA) aim at systematically describing age and sex-specific prevalence of H. pylori infection around the world and generating hypotheses to explain regional variations in gastric cancer risk. METHODS: We selected age- and sex-stratified population samples in two areas with different gastric cancer incidence and mortality in Chile: Antofagasta (lower rate) and Valdivia (higher rate). Participants were 1-69 years old and provided interviews and blood for anti-H. pylori antibodies (IgG, VacA, CagA, others) and atrophy biomarkers (pepsinogens). RESULTS: H. pylori seroprevalence (Age-standardized to world population) and antibodies against CagA and VacA were similar in both sites. H. pylori seroprevalence was 20% among children <10 years old, 40% among 10-19 year olds, 60% in the 20-29 year olds and close to or above 80% in those 30+ years. The comparison of the prevalence of known and potential H. pylori cofactors in gastric carcinogenesis between the high and the low risk area showed that consumption of chili products was significantly higher in Valdivia and daily non-green vegetable consumption was more common in Antofagasta. Pepsinogen levels suggestive of gastric atrophy were significantly more common and occurred at earlier ages in Valdivia, the higher risk area. In a multivariate model combining both study sites, age, chili consumption and CagA were the main risk factors for gastric atrophy. CONCLUSIONS: The prevalence of H. pylori infection and its virulence factors was similar in the high and the low risk area, but atrophy was more common and occurred at younger ages in the higher risk area. Dietary factors could partly explain higher rates of atrophy and gastric cancer in Valdivia. IMPACT: The ENIGMA study in Chile contributes to better understanding regional variations in gastric cancer incidence and provides essential information for public health interventions.


Assuntos
Infecções por Helicobacter/complicações , Helicobacter pylori/isolamento & purificação , Neoplasias Gástricas/etiologia , Estômago/patologia , Adolescente , Adulto , Idoso , Atrofia/etiologia , Atrofia/microbiologia , Atrofia/patologia , Criança , Pré-Escolar , Chile/epidemiologia , Feminino , Infecções por Helicobacter/epidemiologia , Infecções por Helicobacter/microbiologia , Infecções por Helicobacter/patologia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Estômago/microbiologia , Neoplasias Gástricas/microbiologia , Neoplasias Gástricas/patologia , Adulto Jovem
10.
Dis Aquat Organ ; 141: 127-138, 2020 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-32969345

RESUMO

Caligus rogercresseyi is the dominant sea louse parasite affecting the salmon and trout industry in southern Chile. This parasite has a wide range of native and endemic fish hosts. The Patagonian blenny Eleginops maclovinus, which is parasitized mostly by the caligid species Lepeophtheirus spp. and C. rogercresseyi, is presumably responsible for the transmission of C. rogercresseyi to salmonids. The aim of this study was to characterize the transmission of parasites between different fish species and parasite cohort development under laboratory conditions. Parasite abundances and intensities were quantified. Transmission of parasites from Patagonian blenny to Atlantic salmon Salmo salar was lower (~9%, mainly corresponding to C. rogercresseyi) than from salmon to Patagonian blenny (14.7-26.9%, where only C. rogercresseyi were observed). This suggests that the transmission of C. rogercresseyi from salmon individuals is higher than the transmission from a native fish. Parasite cohorts developed successfully on both fish species, but apparently under different developmental rates. Water temperature, oxygen, and juvenile abundances were the variables that better explained cohort development success and variation in C. rogercresseyi adult abundances over time.


Assuntos
Copépodes , Doenças dos Peixes , Salmo salar , Salmonidae , Animais , Chile/epidemiologia , Doenças dos Peixes/epidemiologia , Salmão
11.
PLoS One ; 15(9): e0238534, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32881894

RESUMO

INTRODUCTION: Chile experiences a growing prevalence of DM2 in its adult population over time. The country has prioritised the diagnosis and treatment of DM2 through a universal health care package, largely focused on the clinical dimensions of the disease. We analysed the significance of socioeconomic variables in the prevalence of DM2, as well as its related dimensions of presence of complications (diabetic foot and ophthalmologic complications), attendance to health checks and acquisition of recommended lifestyle changes due to this condition. METHODS: Secondary analysis of the national health survey (ENS) 2016-2017 (n = 6,233 respondents). Crude and income-adjusted odds of reporting DM2 was estimated, as well as the relationship between complications due to diabetes and a number of clinical and sociodemographic variables using weighted log-linear multiple regression models. RESULTS: We found a clear social gradient of the prevalence of DM2 by household income quintiles and educational level in the adult population. Income quintile and educational level gradients remained significantly associated with the presence of complications and attendance to health checks. We found no significant association, however; between income quintile and reported lifestyle change. The association between complications due to DM2 and socioeconomic variables, particularly income, remained relevant even after adjusting for all sociodemographic variables. CONCLUSION: This is the first study to analyse the association between DM2 and socioeconomic variables in Chile, useful for monitoring and policy planning. Income was strongly associated with DM2 prevalence and with related clinical variables (complications and attendance to health checks). Age, health care provision and educational level were also relevant factors, but lost significance in the fully adjusted model.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Fatores Socioeconômicos , Adolescente , Adulto , Idoso , Chile/epidemiologia , Estudos Transversais , Feminino , Disparidades nos Níveis de Saúde , Inquéritos Epidemiológicos , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Prevalência , Adulto Jovem
12.
PLoS One ; 15(9): e0238909, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32915902

RESUMO

E. granulosus is a cestode that causes Cystic Echinococcosis (CE), a zoonotic disease with worldwide presence. The immune response generated by the host against the metacestode induces a permissive Th2 response, as opposed to pro-inflammatory Th1 response. In this view, mixed Th2 and regulatory responses allow parasite survival. Overall, larval Echinococcus infections induce strong regulatory responses. Fasciola hepatica, another common helminth parasite, represents a major infection in cattle. Co-infection with different parasite species in the same host, polyparasitism, is a common occurrence involving E. granulosus and F. hepatica in cattle. 'While it is known that infection with F. hepatica also triggers a polarized Th2/Treg immune response, little is reported regarding effects on the systemic immune response of this example of polyparasitism. F. hepatica also triggers immune responses polarized to the Th2/ Treg spectrum. Serum samples from 107 animals were analyzed, and were divided according to their infection status and Echinococcal cysts fertility. Cytokines were measured utilizing a Milliplex Magnetic Bead Panel to detect IFN-γ, IL-1, IL-2, IL-4, IL-6, IL-10, IL-12 and IL-18. Cattle infected only with F. hepatica had the highest concentration of every cytokine analyzed, with both 4.24 and 3.34-fold increases in IL-10 and IL-4, respectively, compared to control animals, followed by E. granulosus and F. hepatica co-infected animals with two-fold increase in IL-10 and IL-4, compared to control animals, suggesting that E. granulosus co-infection dampens the cattle Th2/Treg immune response against F. hepatica. When considering Echinococcal cyst fertility and systemic cytokine concentrations, fertile cysts had higher IFN-γ, IL-6 and IL-18 concentrations, while infertile cysts had higher IL-10 concentrations. These results show that E. granulosus co-infection lowers Th1 and Th2 cytokine serological concentration when compared to F. hepatica infection alone. E. granulosus infections show no difference in IFN-γ, IL-1, IL-2, IL-6 and IL-18 levels compared with control animals, highlighting the immune evasion mechanisms of this cestode.


Assuntos
Doenças dos Bovinos/epidemiologia , Coinfecção/epidemiologia , Citocinas/sangue , Equinococose/veterinária , Echinococcus granulosus/imunologia , Fasciola hepatica/imunologia , Fasciolíase/veterinária , Animais , Bovinos , Doenças dos Bovinos/sangue , Doenças dos Bovinos/imunologia , Doenças dos Bovinos/parasitologia , Chile/epidemiologia , Coinfecção/sangue , Coinfecção/imunologia , Coinfecção/parasitologia , Equinococose/sangue , Equinococose/imunologia , Equinococose/parasitologia , Fasciolíase/sangue , Fasciolíase/imunologia , Fasciolíase/parasitologia , Células Th1/imunologia , Células Th2/imunologia
13.
Rev Chilena Infectol ; 37(3): 237-243, 2020 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-32853314

RESUMO

BACKGROUND: The Chilean Program for the Control and Elimination of Tuberculosis (PROCET) has reduced mortality from this disease by 78% between 2004 and 2013. However, after decades of successful results, starting in 2000 there was a slowdown in the reduction of incidence and since 2014, an increase in it. AIM: To describe the socio-epidemiological evolution of tuberculosis (TB) cases treated at health clinics in the Metropolitan Region (MR) of Chile from 2005 to 2018, stratifying by country of origin. METHODS: Cross-sectional study with ecological components, including analyses of age, sex, TB localization, bacteriological confirmation of diagnosis, co-infection with HIV, incarceration, country of origin, and effectiveness of tuberculosis treatment. RESULTS: A total of 7,507 TB cases were recorded during the study period; 75.1% of cases were pulmonary tuberculosis, and 65.4% were bacteriologically confirmed. Overall, 19.0% of cases involved persons born outside of Chile, with the proportion of cases in foreign-born persons increasing over the past 6 years. Incidence decreased during the first half of the study period but then began to increase after 2012, moving the country away from the threshold of elimination. A total of 74.3% of cases were treated successfully, and 13.4% expired. CONCLUSION: In recent years, TB incidence has increased in the MR of Chile, possibly attributable to growing populations of vulnerable groups such as immigrants. This finding suggests an urgent need to implement and reinforce strategies such as education, an active screening model and more efficient contact tracing to prevent the spread of TB.


Assuntos
Tuberculose , Chile/epidemiologia , Estudos Transversais , Emigrantes e Imigrantes , Humanos , Incidência , Tuberculose/epidemiologia
14.
Rev Chilena Infectol ; 37(3): 244-251, 2020 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-32853315

RESUMO

Campylobacter spp. is considered as the first etiologic agent of diarrhea in developed countries and the second or third in developing countries. The high incidence of Campylobacter gastroenteritis and its possible post-infection sequelae (reactive arthritis, Miller-Fisher syndrome or Guillain-Barré syndrome) give it great importance from the socioeconomic point of view. However, in most developing countries there is no routine microbial diagnosis of this pathogen. In Chile, campylobacteriosis is notifiable since 1983. However, the lack of routine diagnosis by clinical laboratories has made it difficult to know the true prevalence of this pathogen in both intestinal and extra-intestinal infections. In addition, although campylobacteriosis is a zoonotic disease, the diagnosis of this pathogen is not considered within the Chilean Food Sanitary Regulations. All this results in a lack of knowledge about the epidemiology of Campylobacter spp disease in Chile. Therefore, the objective of this review is to analyze the situation of campylobacteriosis in the last two decades in Chile and to determine the challenges that remain to achieve an effective microbial diagnosis and epidemiologic surveillance.


Assuntos
Infecções por Campylobacter , Doenças Transmissíveis , Gastroenterite , Animais , Infecções por Campylobacter/diagnóstico , Infecções por Campylobacter/epidemiologia , Chile/epidemiologia , Diarreia
15.
PLoS One ; 15(8): e0237967, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32857819

RESUMO

BACKGROUND: Globally, tobacco consumption continues to cause a huge burden of preventable diseases. Chile has been leading the tobacco burden ranking in the Latin American region for the last ten years; it has currently a 33. 3% prevalence of current smokers. METHODS: A microsimulation economic model was developed within the framework of a multi-country project in order to estimate the burden attributable to smoking in terms of morbidity, mortality, disability-adjusted life-years (DALYs), and direct costs of care. We also modelled the impact of increasing cigarettes' taxes on this burden. RESULTS: In Chile, 16,472 deaths were attributable to smoking in 2017, which represent around 16% of all deaths. This burden corresponds to 416,445 DALYs per year. The country's health system spends 1.15 trillion pesos annually (in Dec 2017 CLP, approx. U$D 1.8 billion) in health care treatment of illnesses caused by smoking. If the price of tobacco cigarettes was to be raised by 50%, around 13,665 deaths and 360,476 DALYs from smoking-attributable diseases would be averted in 10 years, with subsequent savings on health care costs, and increased tax revenue collection. In Chile, the tobacco tax collection does not fully cover the direct healthcare costs attributed to smoking. CONCLUSION: Despite a reduction observed on smoking prevalence between 2010 (40.6%) and 2017 (33.3%), this study shows that the burden of disease, and the economic toll due to smoking, remain high. As we demonstrate, a rise in the price of cigarettes could lead to a significant reduction of this burden, averting deaths and disability, and reducing healthcare spending.


Assuntos
Fumar/economia , Produtos do Tabaco/economia , Adulto , Idoso , Chile/epidemiologia , Efeitos Psicossociais da Doença , Assistência à Saúde/economia , Política de Saúde , Humanos , Pessoa de Meia-Idade , Modelos Teóricos , Infarto do Miocárdio/economia , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/patologia , Anos de Vida Ajustados por Qualidade de Vida , Fumar/epidemiologia
17.
Rev Med Chil ; 148(3): 393-398, 2020 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-32730385

RESUMO

The catastrophic emergency experienced by many countries with the COVID-19 pandemic emphasized the importance of bioethics for decision-making, both at the public health (equitable and effective policies) and at the clinical level. At the clinical level, the issues are the fulfillment of medical care demand with adequate health care teams, infrastructure, and supplies, and to cover critical care demands that surpass the available resources. Therefore, ethically correct approaches are required for the allocation of life sustaining resources. There are recommendations for the allocating life support during disasters based on multiple considerations, including ethical ones. However, the ethical criteria of existing guidelines are variable. Ethical principles usually considered are saving the greatest number of lives, saving the greatest number of years of life and the principle of the life cycle or the goal to give each individual equal opportunity to live through the various phases of life. However, the centrality of the human being and the search for the common good should be considered. Knowledge of public perspectives and moral benchmarks on these issues is essential. A successful assignment effort will require everyone's trust and cooperation. Decision making should be planned and discussed in advance, since in-depth deliberation will be extremely complex during the disaster. Our goal is to help the health care teams to wisely allocate resources in shortage periods.


Assuntos
Tomada de Decisão Clínica/ética , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Alocação de Recursos para a Atenção à Saúde/ética , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Chile/epidemiologia , Humanos , Guias de Prática Clínica como Assunto
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