Exposure of 4-year to 24-year olds to tobacco imagery on prime-time Chilean television.

INTRODUCTION: The extent of the population's exposure to tobacco imagery across all genres of regular TV programming and the contribution of each of these genres is unknown, except for UK broadcast channels. The objective of this study is to estimate the exposure of young people to tobacco imagery on Chilean prime-time television and the programme source contributing to such exposure. METHODS: Programmes aired during 3 weeks in 2019 from the 15 highest audience channels in Chile were content-analysed for the occurrence of tobacco categorised as actual use, implied use, tobacco paraphernalia, tobacco brand appearances and whether they violated Chilean smoke-free law for each 1 min interval (92 639). The exposure of young people to tobacco content was estimated using media viewership figures. RESULTS: Young people received 29, 11 and 4 million tobacco impressions of any type, explicit use and smoke-free violation, respectively, at a rate of 21.8, 8.0 and 2.1 thousand impressions per hour of TV viewing. The main sources of exposure to tobacco impressions were feature films and animated productions, which were almost entirely non-Chilean. Finally, young people were exposed to tobacco brand impressions primarily through films, effectively circumventing the advertising ban in Chile. DISCUSSION: Television programming is a source of significant youth exposure to tobacco imagery, including branding impressions. To conform to the WHO FCTC, Chile should prohibit tobacco branding in any TV programme and require strong anti-tobacco advertisements prior to any TV programme portraying tobacco.

Compliance with the smoking ban in enclosed, semiopen and open areas of workplaces and public places in Chile.

OBJECTIVE: To assess the national level of compliance with the Chilean comprehensive smoke-free legislation by observing healthcare facilities, education centres, government offices, hospitality venues and private workplaces, by type of area within workplaces and public places: enclosed, semiopen and open. METHODOLOGY: In this cross-sectional observational study, we studied a national representative sample of 3253 venues obtained through a two-stage cluster sampling design. First, 57 municipalities were randomly selected, proportionally to the total number of venues of interest. Second, within each selected municipality, a maximum of 12 venues of each sector was selected systematically from a list of existing sites. We determined the non-compliance level by estimating the percentage of the visited venues where smoking was observed or suspected in banned areas of the premises. RESULTS: Smoking or suspicion thereof was not observed in any enclosed area of any establishment. However, smoking violations were observed in semiopen areas ranging from less than 0.5% of schools and healthcare centres to around 10% of hospitality venues or 23.0% of higher education centres. Smoking violations were also observed in outdoor areas of 6.7% and 1.6% of the health centres and schools, respectively. DISCUSSION: The stark contrast in compliance with the smoking ban between the enclosed areas and the semiopen areas may be a consequence of the complex definition of semiopen areas in the regulations. The study also reflects the need to improve the overall enforcement of the smoke-free law, particularly in universities and hospitality venues.

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.

[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.

Seroprevalence and estimation of the impact of SARS-CoV-2 infection in older adults residing in Long-term Care Facilities in Chile. / Seroprevalencia y estimación del impacto de la infección por SARS-CoV-2 en personas mayores residentes en centros de larga estadía en Chile.

Introduction: Older adults are at a higher risk of severe illness and death from COVID-19. This vulnerability increases in those who live in long-term care facilities due to overcrowding, greater physical dependence, and contact with health workers. Evidence on the impact of the pandemic on these establishments in lowand middle-income countries has been scant. This study aims to determine the seroprevalence of SARS-CoV-2 in older people residing in long-term care facilities and estimate the impact of infection after the first wave of the pandemic. Methods: A cross-sectional design with 2099 residents in three regions of Chile was carried out between September and November 2020. Measurement of antibodies was performed with a rapid test. The impact of SARS-CoV-2 infection was estimated with seropositive residents, those who had a history of positive polymerase chain reaction tests, and those who died from COVID-19. Bivariate analysis with the region, sex, age, history of COVID-19, physical dependence, and serological results were performed. In addition, we performed a correlation analysis between the seroprevalence of the centers by the municipality and the rate of confirmed cases. Results: The seroprevalence of SARS-CoV-2 antibodies in the three regions was 14.7% (95% confidence interval: 13.2 to 16.3%), the infection impact was 46.4%, and the fatality rate was 19.6%. A significant correlation was found between the seroprevalence of older adults residing in long-term care facilities and the cumulative incidence by municipalities. Conclusions: The seroprevalence of older adults residing in long-term care facilities was higher than the general population. The high impact of infection among this population at the end of the first wave of the COVID-19 pandemic is similar to other countries. The centers' environment is directly related to COVID-19 infection. Morbidity and mortality monitoring systems should be implemented promptly to establish prevention and control measures.

Introducción: Las personas mayores tienen más riesgo de enfermar gravemente y fallecer por COVID-19. Esta vulnerabilidad aumenta en quienes viven en establecimientos de larga estadía, debido a hacinamiento, mayor dependencia física y contacto con los trabajadores. La evidencia sobre el impacto de la pandemia de estos establecimientos en países de medianos y bajos ingresos ha sido escasa. El objetivo es determinar la seroprevalencia de la infección por SARS-CoV-2 en personas mayores que residen en establecimientos de larga estadía. Así como estimar el impacto global de la infección después de la primera ola de la pandemia. Métodos: Diseño transversal con 2099 residentes en tres regiones de Chile, realizado entre septiembre y noviembre 2020. Anticuerpos fueron medidos con test rápido contra SARS-CoV-2. Se estimó el impacto de la infección con los residentes seropositivos, los residentes con antecedentes de reacción en cadena de la polimerasa de transcripción inversa positiva, y residentes que murieron por COVID-19. Análisis bivariado entre el resultado serológico y región, sexo, edad, antecedentes de COVID-19 y dependencia física fueron realizados. Además, realizamos un análisis de correlación entre la seroprevalencia de los centros por municipio y la tasa acumulada de casos confirmados. Resultados: La seroprevalencia de anticuerpos en las tres regiones fue 14,7% (intervalo de confianza del 95%: 13,2 a 16,3%). El impacto real de la infección se estimó en 46,4% y la tasa de letalidad en 19,6%. La seroprevalencia de los residentes de los centros por comuna se correlacionó positiva y significativamente con la frecuencia de la enfermedad a nivel comunal. Conclusiones: Seroprevalencia superior a la de la población general, observándose un alto impacto de la infección por COVID-19 al final de la primera ola de la pandemia. El lugar en el que se encuentran los establecimientos está directamente relacionado con la tasa de seroprevalencia en ellos. Sistemas de vigilancia epidemiológica deben aplicarse con prontitud para establecer medidas de prevención y control.

Compliance with the smoking ban in urban public transportation in Chile.

INTRODUCTION: The aim of the study is to assess the national level of compliance with the Chilean smoke-free legislation in the urban public transportation system. METHODS: In this cross-sectional observational study, we studied a national representative sample of 475 vehicles obtained through a two-stage cluster sampling design in 2018. First, 57 municipalities were randomly selected, proportionally to the total number of public transportation vehicles. Second, within each municipality, a convenience sample of up to 4 taxis, 4 buses, and 2 metro coaches was observed. We determined the non-compliance level by systematic direct observation of smoking inside the cabin of the vehicle. We estimated the percentage of the visited vehicles where smoking was observed inside the cabin of the vehicle. RESULTS: The observation of metros, buses and taxis was completed in 24, 52, and 48, of the 57 sampled municipalities, respectively. Smoking was observed inside of about 2% of buses and 7% of taxis. Smoking was not observed in metro carriages. Overall, smoking was observed in almost 3% of the vehicles studied. A 3% noncompliance could expose a significant number of persons in public transportation to secondhand smoke, given that every 100 inhabitants results in about 84 rides a day of almost one hour duration. There are few comparable studies to put in an international context our results. In 2018, the year in which we collected the data, WHO considered that compliance with the law in public transportation was maximum. Our compliance estimate was lower, however WHO used a different methodology and its scope also included the inter-urban mobility, which we did not. CONCLUSIONS: The study highlights the need to improve the enforcement of the smoke-free law in the transportation system in Chile, which presently is almost non-existent.

Seroprevalencia y estimación del impacto de la infección por SARS-CoV-2 en personas mayores residentes en centros de larga estadía en Chile / Seroprevalence and estimation of the impact of SARS-CoV-2 infection in older adults residing in Long-term Care Facilities in Chile

INTRODUCTION: Older adults are at a higher risk of severe illness and death from COVID-19. This vulnerability increases in those who live in long-term care facilities due to overcrowding, greater physical dependence, and contact with health workers. Evidence on the impact of the pandemic on these establishments in lowand middle-income countries has been scant. This study aims to determine the seroprevalence of SARS-CoV-2 in older people residing in long-term care facilities and estimate the impact of infection after the first wave of the pandemic. METHODS: A cross-sectional design with 2099 residents in three regions of Chile was carried out between September and November 2020. Measurement of antibodies was performed with a rapid test. The impact of SARS-CoV-2 infection was estimated with seropositive residents, those who had a history of positive polymerase chain reaction tests, and those who died from COVID-19. Bivariate analysis with the region, sex, age, history of COVID-19, physical dependence, and serological results were performed. In addition, we performed a correlation analysis between the seroprevalence of the centers by the municipality and the rate of confirmed cases. RESULTS: The seroprevalence of SARS-CoV-2 antibodies in the three regions was 14.7% (95% confidence interval: 13.2 to 16.3%), the infection impact was 46.4%, and the fatality rate was 19.6%. A significant correlation was found between the seroprevalence of older adults residing in long-term care facilities and the cumulative incidence by municipalities. CONCLUSIONS: The seroprevalence of older adults residing in long-term care facilities was higher than the general population. The high impact of infection among this population at the end of the first wave of the COVID-19 pandemic is similar to other countries. The centers' environment is directly related to COVID-19 infection. Morbidity and mortality monitoring systems should be implemented promptly to establish prevention and control measures.

INTRODUCCIÓN: Las personas mayores tienen más riesgo de enfermar gravemente y fallecer por COVID-19. Esta vulnerabilidad aumenta en quienes viven en establecimientos de larga estadía, debido a hacinamiento, mayor dependencia física y contacto con los trabajadores. La evidencia sobre el impacto de la pandemia de estos establecimientos en países de medianos y bajos ingresos ha sido escasa. El objetivo es determinar la seroprevalencia de la infección por SARS-CoV-2 en personas mayores que residen en establecimientos de larga estadía. Así como estimar el impacto global de la infección después de la primera ola de la pandemia. MÉTODOS: Diseño transversal con 2099 residentes en tres regiones de Chile, realizado entre septiembre y noviembre 2020. Anticuerpos fueron medidos con test rápido contra SARS-CoV-2. Se estimó el impacto de la infección con los residentes seropositivos, los residentes con antecedentes de reacción en cadena de la polimerasa de transcripción inversa positiva, y residentes que murieron por COVID-19. Análisis bivariado entre el resultado serológico y región, sexo, edad, antecedentes de COVID-19 y dependencia física fueron realizados. Además, realizamos un análisis de correlación entre la seroprevalencia de los centros por municipio y la tasa acumulada de casos confirmados. RESULTADOS: La seroprevalencia de anticuerpos en las tres regiones fue 14,7% (intervalo de confianza del 95%: 13,2 a 16,3%). El impacto real de la infección se estimó en 46,4% y la tasa de letalidad en 19,6%. La seroprevalencia de los residentes de los centros por comuna se correlacionó positiva y significativamente con la frecuencia de la enfermedad a nivel comunal. CONCLUSIONES: Seroprevalencia superior a la de la población general, observándose un alto impacto de la infección por COVID-19 al final de la primera ola de la pandemia. El lugar en el que se encuentran los establecimientos está directamente relacionado con la tasa de seroprevalencia en ellos. Sistemas de vigilancia epidemiológica deben aplicarse con prontitud para establecer medidas de prevención y control.

Respuesta inmunitaria al SARS-CoV-2 y factores asociados previo a la vacunación, en personal de salud de atención primaria en una comuna de Santiago, Chile

Resumen Introducción: La pandemia de COVID-19 surgida en China a fines de 2019, se extendió rápidamente por el mundo, con casi 600 millones de casos y 6,3 millones de fallecidos en la actualidad. Los más afectados fueron los trabajadores de la salud con al menos tres veces más riesgo que la comunidad general de contraer la enfermedad. La mayoría de los estudios sobre seroprevalencia en trabajadores de la salud, se enfocan en establecimientos de atención hospitalaria y no se ha indagado con igual intensidad sobre lo que ocurre en la Atención Primaria de Salud (APS). Objetivos: Determinar prevalencia de SARS-CoV-2 mediante anticuerpos IgG en personal de atención primaria de comuna de La Pintana y explorar sus características clínicas y factores de riesgo, previo a la vacunación en Chile. Metodología: Diseño transversal realizado en noviembre 2020. Se recogieron datos sociodemográficos y clínicos mediante entrevista cara a cara, previa firma de consentimiento. Se determinó IgG específica mediante ELISA que utiliza proteína N y S. Las diferencias entre sujetos positivos y negativos se estudiaron mediante análisis bivariado y para asociaciones encontradas, se desarrollaron modelos multivariados controlando potenciales variables de confusión. El estudio contó con la aprobación del Comité Ético Científico de la Universidad del Desarrollo. Resultados: Participaron 463 funcionarios (51,4%) encontrando prevalencia de 21,8%. Los factores de riesgo fueron edad menor, ser médico y haber sido contacto estrecho de un caso. El 22% fue asintomático. Entre quienes presentan anosmia o ageusia, la probabilidad de IgG+ fue superior a 70%. Los títulos de anticuerpos aumentan significativamente con la gravedad. Conclusiones: La prevalencia en personal de atención primaria encontrada es concordante con la evidencia previa en trabajadores de salud. La menor edad y la profesión de médico se asocian a un mayor riesgo de enfermar.

Abstract Background: The COVID-19 pandemic that emerged in Wuhan, China at the end of 2019, spread rapidly around the world with almost 600 million cases and 6.3 million deaths today. The most affected were health workers with at least three times the risk of contracting the disease than the general community. Most studies on seroprevalence in health workers focus on hospital care establishments and what happens in Primary Health Care (PHC) has not been investigated with the same intensity. Aim: To determine the prevalence of SARS-CoV-2 using IgG antibodies in primary health care personnel in La Pintana commune, risk factors and clinical characteristics, prior to vaccination in Chile. Methods: A cross-sectional design carried out in November 2020. Sociodemographic and clinical data were collected through face-to-face interviews, after providing informed consent. Specific IgG was determined by ELISA using N and S proteins. The differences between positive and negative subjects were studied using bivariate analysis and multivariate models, controlling for potential confounding variables. The study was approved by the Universidad del Desarrollo Scientific Ethics Committee. Results: 463 employees (51.4%) participated, finding a prevalence of 21.8%. The risk factors found were younger age, being a physician and having been in close contact with a case. 22% were asymptomatic. Among those with anosmia/ageusia, the probability of IgG+ was greater than 70%. Antibody titers increase with severity. Conclusions: Prevalence found in primary health care personnel is consistent with previous evidence. Younger age and medical profession are associated with a higher risk of illness.

[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.

¿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.

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.

Diseño y evaluación de proceso de una intervención comunitaria para la detección precoz del primer episodio de psicosis en Chile / Design and evaluation of a community intervention for early detection of the first episode of schizophrenia

Introducción: La esquizofrenia es una enfermedad mental que genera discapacidad, afectando la calidad de vida de la persona y de sus cuidadores. Las investigaciones demuestran que un menor tiempo de psicosis no tratada durante el primer episodio se asocia con un mejor pronóstico. Objetivo: En este trabajo se describe el diseño y evaluación de proceso de una intervención comunitaria para la detección precoz del primer episodio de psicosis, que fue aplicada en tres sectores del país (comunas de Iquique, La Granja y El Bosque) ligados a un servicio de salud mental. Material y método: Para la evaluación se utilizó una metodología cualitativa de tipo etnográfica, basada en entrevistas semi-estructuradas y entrevistas grupales con los diferentes tipos de participantes (profesores, coordinadores, profesionales médicos y no médicos). Resultados: La evaluación de proceso de esta intervención permitió concluir que contribuyó al cumplimiento de los objetivos de la intervención de manera heterogénea; se obtuvo una buena participación de médicos y profesores; la capacitación fue bien evaluada. Conclusiones: Las recomendaciones principales fueron: 1) obtener respaldo político (autoridades sanitarias locales), 2) crear y mantener vínculos cercanos con el equipo investigador, y 3) adecuar la intervención a los valores y/o necesidades de la comunidad.

Introduction: Schizophrenia is a disabling mental illness that affects the quality of life of both the sufferer and their caretakers. Research has shown that quick diagnosis and treatment of the first episode is associated with better prognosis. Objective: In this paper, the design and evaluation of a community intervention for early detection of the first episode of psychosis in three sectors of the country (municipalities of Iquique, La Granja and El Bosque) is described. Materials and Methods: For the evaluation, a qualitative, ethnographic methodology was used, based in semi-structured and group interviews with different categories of participants (teachers, coordinators, medical professionals and non-medical professionals). Results: Evaluation of this intervention shows that the objectives were fulfilled unequally. A high level of participation was obtained from doctors and teachers, and the training was positively evaluated. Conclusions: The main recommendations were, 1) obtain political support (local health authorities), 2) create and manage close relationships within the research team, and 3) modify the intervention to serve the needs and values of each community.

Adaptación y análisis psicométrico de un cuestionario para evaluar riesgos psicosociales en el trabajo en Chile: versión media del CoPsoQ / Adaptation and psychometric analysis of a questionnaire used to evaluate psychosocial risks in the workplace in Chile: CoPsoQ medium

Objetivo: Describir las propiedades psicométricas de un cuestionario para medir riesgos psicosociales en el trabajo, aplicado a una muestra chilena de trabajadores del rubro servicios. Material y Método: se comenzó con un proceso de adaptación semántica, para posteriormente aplicarlo a una nuestra de 1.087 personas (332 varones y 775 mujeres), con promedio de edad de 41,0 +/- 11,9 años. Resultados: Se eliminó 1 de las 73 preguntas del instrumento original. Se encontró buenas correlaciones ítem-test, una composición factorial similar a la original, buenos indicadores de consistencia interna y buenos indicadores de validez convergente (con el GHO-12). los mejores resultados se obtienen para las grandes dimensiones, más que para las subdimensiones específicas. Conclusiones: se trata de un cuestionario útil para la medición de factores de riesgos psicosociales en el trabajo en nuestro medio y se comporta de manera similar al instrumento original. Se recomienda su uso utilizando las grandes dimensiones.

Objective: Describe the psychometric properties of a questionnaire used to measure psychosocial risks at work, applying it to a sample of workers from the service sector in Chile. Materials and methods: We began with a process of semantic adaptation, in order to later apply it to a sample of 1,087 people (332 male and 775 female), with an average age of 41.0 +/- 11.9 years. Results: One of the 73 questions was eliminated from the original instrument. We found good item-test correlation, a factorial composition similar to the original, good indicators of internal consistency and good indicators of convergent validity (GHQ - 12). The best results were obtained for the main dimensions, more than for the specific sub-dimensions. Conclusions: This was shown to be a useful questionnaire for measuring psychosocial risk factors in the workplace in Chile and behaves similarly to the original instrument. Use of the main dimensions is recommended.

Motivo de inicio de actividad sexual en adolescentes desde una perspectiva de género: Cemera 2005 - 2006 / Motive of sexual activity initiation among adolescents from a gender perspective: CEMERA 2005-2006

La imagen del género es la base a través de la cual las y los adolescentes comienzan a adquirir identidad como mujeres y hombres, ya que los lleva a incorporar patrones de conducta esperados y preestablecidos que determinan lo que "deben ser", entregándoles instrumentos de socialización. Es en este contexto que el conocimiento de las características de inicio de actividad sexual, puede constituirse en un aporte para el diseño de estrategias que promuevan el logro de un desarrollo pleno tanto en hombres como en mujeres. Este estudio busca describir y comparar según sexo, características relacionadas al inicio de la actividad sexual coital en adolescentes ingresados a Cemera durante los años 2005 y 2006. Se trata de un diseño transversal, que utilizó datos secundarios. La población en estudio, corresponde a adolescentes eterosexuales entre 10y 19 años, que han iniciado actividad sexual y son consultantes en planificación familiar. Las variables que mostraron diferencias significativas entre hombres y mujeres son: edad, escolaridad, asistencia a servicios religiosos, edad de inicio en el consumo de tabaco, consumo de alcohol, participación social, relación entre padres, supervisión parental, edad de inicio de actividad sexual y conversación sobre sexualidad. No se encontró asociación entre edad de inicio de actividad sexual y las otras variables independientes del estudio, salvo escolaridad. El conocimiento de tendencias en la sexualidad adolescente, instala bases para el desarrollo de estrategias de acercamiento específicas a cada grupo vulnerable, considerando realidades locales, instancias de encuentro con otros y estilos individuales de aproximación a la sexualidad.

Gender image is the basis through which adolescents, both male and female, start the process leading to the acquisition of their identity as women or men, since it leads them to acquire expected and pre-established behavior patterns that will determine what they “must be”, thus providing socialization tools. Therefore, it is in such context that the appraisal of the characteristics of sexual activity initiation may become a significant contribution to the design of strategies promoting the attainment of a full development both in males and females. The present study aims at describing and comparing according to gender, the characteristics related to coital sexual activity initiation among adolescents admitted to Cemera during 2005 and 2006. This cross-sectional study used secondary data. The study population consisted of heterosexual adolescents aged between 10 and 19, who had initiated their sexual activity and attended consultation for family planning. The variables evidencing significant differences between males and females were: age, scholarship, attendance at religious services, age of initiation of smoking, alcohol consumption, social participation, relationship between parents, parental supervision, age of sexual activity initiation and sexuality discussions. There were no associations between the age of sexual activity initiation and other study independent variables, with exception of scholarship. The appraisal of trends in adolescent sexuality sets the basis for the development of rapprochement strategies specific to each vulnerable group, considering local realities, instances for understanding and individual styles of sexuality approach.

Factores biopsicosociales predictores de oximetría alterada en trabajadores de la minería: un estudio exploratorio / Biopsychosocial factors, predictors of altered oximetry in mining workers: an exploratory study

El propósito del estudio fue explorar el perfil bio-psico-social de una muestra de trabajadores mineros con oximetrías alteradas a través de la utilización de árboles de partición recursiva. El diseño fue de tipo transversal y la muestra la constituyeron 136 trabajadores de la minería. Se realizó una entrevista de salud y se aplicó una encuesta psicosocial. Usando análisis exploratorio de datos y árboles de partición recursiva se encontraron combinaciones multidimensionales (perfiles) de predictores de oximetría alterada. Las variables más importantes fueron la edad, la presencia de sobrepeso u obesidad, el sedentarismo, el colesterol elevado, la fatiga y los síntomas de sueño. Se comprobó que si bien algunas variables aisladamente no aparecen asociadas a las oximetrías alteradas algunas combinaciones de ellas sí resultan ser buenas predictoras.

The purpose of this study was to explore the bio-psycho-social profile of a sample of miners with altered oximetry through the use of recursive partition trees. The design was transversal and the sample comprised 136 miners. There was a health interview and a psychosocial survey applied to each of the members of the sample. The data analysis was based on non-parametric descriptive statistics and recursive partition tress. We found various types of combination of factors that predict altered oximetry. The most important variables were age, the presence overweight or obesity, sedentary lifestyle, cholesterol, fatigue and symptoms of sleep deprivation. It was concluded that while some variables by themselves do not appear associated with altered oximetry, their combination may very well be considered good predictors.