Health outcomes, utilization, and equity in Chile: an evolution from 1990 to 2015 and the effects of the last health reform.

OBJECTIVE: Chile is an attractive case study because of the deep political changes that it underwent over a short period of time: from a universal health service (60s), through a neoliberal reform (70s) and onto a series of legislative reforms (80s-90s). This article aims to explore and assess the evolution of health outcomes, equity, and utilization in Chile through the last period of these reforms (1990-2015). STUDY DESIGN: Standardized health equity analysis. METHODS: We conducted a standardized economic analysis on health equity and healthcare utilization using the ADePT software (by the World Bank) and using data from the Chilean National Socio-economic Survey. We evaluated trends of health equity and examined concentration curves of health utilization of healthcare services and health outcomes such as children/elder/pregnant nutritional status, self-reported health, and physical limitations. RESULTS: Health outcomes such as nutritional problems in children and pregnant women were concentrated among the poor, while others such as high-relevance health conditions were similar for poorest and richest households. The concentration indexes for health outcomes suggested that income makes the distribution pro-poor. However, the opposite was true for age, in which the probability of health problems among rich individuals increased with age. The concentration curves for utilization of healthcare services showed that dental visits, laboratory exams, specialty visits, and hospitalizations were concentrated on the richest households, while the use of emergency services and preventive medicine were highly concentrated among poor individuals. CONCLUSIONS: Although a positive trend in the increase of healthcare service use among income groups was observed, a significant impact of the latest health reform was not observed.

Influence of Coastal Submarine Groundwater Discharges on Seagrass Communities in a Subtropical Karstic Environment.

The influence of coastal submarine groundwater discharges (SGD) on the distribution and abundance of seagrass meadows was investigated. In 2012, hydrological variability, nutrient variability in sediments and the biotic characteristics of two seagrass beds, one with SGD present and one without, were studied. Findings showed that SGD inputs were related with one dominant seagrass species. To further understand this, a generalized additive model (GAM) was used to explore the relationship between seagrass biomass and environment conditions (water and sediment variables). Salinity range (21-35.5 PSU) was the most influential variable (85%), explaining why H. wrightii was the sole plant species present at the SGD site. At the site without SGD, GAM could not be performed since environmental variables could not explain a total variance of > 60%. This research shows the relevance of monitoring SGD inputs in coastal karstic areas since they significantly affect biotic characteristics of seagrass beds.

Non-myeloablative stem cell transplantation in patients with relapsed acute lymphoblastic leukemia: results of a multicenter study.

Using non-myeloablative conditioning, allogeneic hematopoietic stem cell transplantation (HSCT) was conducted in 43 ALL patients in a CR2. The median age of the patients was 19 years. Patients received oral busulfan 4 mg/kg/day for 2 days; i.v. cyclophosphamide 350 mg/m(2)/day for 3 days; and i.v. fludarabine 30 mg/m(2)/day for 3 days. Oral cyclosporin A 4 mg/kg was started and methotrexate 5 mg/m(2) was delivered on days 1, 3, 5 and 11. The median CD34+ cell dose received was 5.0 x 10(6)/kg. The medium time to achieve a granulocyte count above 0.5 x 10(9)/l was 14 days. Thirteen patients were alive 30-1050 days after the HSCT. The 3-year overall survival rate was 30%. Ten patients (23%) developed acute GVHD, whereas eight patients (18.6%) developed chronic GVHD. Thirty patients died between days 47 and 1050 after the HSCT, most of them (70%) because of an ALL relapse. One hundred-day mortality was 15%, whereas transplant-related mortality was 21%. These results are inferior to those obtained using the same allografting method in other leukemias, probably as a consequence of poor susceptibility to the graft-versus-leukemia effect of the ALL cells beyond first remission as compared with other hematological malignancies.