Artículos Medicina y Ciencias de la Salud

Permanent URI for this collection

Browse

Recent Submissions

Now showing 1 - 20 of 2485
  • Publication
    Thiophene Stability in Photodynamic Therapy: A Mathematical Model Approach
    (2024) Alcázar, Jackson
    Thiophene-containing photosensitizers are gaining recognition for their role in photodynamic therapy (PDT). However, the inherent reactivity of the thiophene moiety toward singlet oxygen threatens the stability and efficiency of these photosensitizers. This study presents a novel mathematical model capable of predicting the reactivity of thiophene toward singlet oxygen in PDT, using Conceptual Density Functional Theory (CDFT) and genetic programming. The research combines advanced computational methods, including various DFT techniques and symbolic regression, and is validated with experimental data. The findings underscore the capacity of the model to classify photosensitizers based on their photodynamic efficiency and safety, particularly noting that photosensitizers with a constant rate 1000 times lower than that of unmodified thiophene retain their photodynamic performance without substantial singlet oxygen quenching. Additionally, the research offers insights into the impact of electronic effects on thiophene reactivity. Finally, this study significantly advances thiophene-based photosensitizer design, paving the way for therapeutic agents that achieve a desirable balance between efficiency and safety in PDT.
  • Publication
    Reliable and accurate prediction of basic pKa values in nitrogen compounds: the pKa shift in supramolecular systems as a case study
    (2023) Alcázar, Jackson; Misad, Alessandra; Campodónico, Paola
    This article presents a quantitative structure–activity relationship (QSAR) approach for predicting the acid dissociation constant (pKa ) of nitrogenous compounds, including those within supramolecular complexes based on cucurbiturils. The model combines low-cost quantum mechanical calculations with QSAR methodology and linear regressions to achieve accurate predictions for a broad range of nitrogen-containing compounds. The model was developed using a diverse dataset of 130 nitrogenous compounds and exhibits excellent predictive performance, with a high coefficient of determination (R2 ) of 0.9905, low standard error (s) of 0.3066, and high Fisher statistic (F) of 2142. The model outperforms existing methods, such as Chemaxon software and previous studies, in terms of accuracy and its ability to handle heterogeneous datasets. External validation on pharmaceutical ingredients, dyes, and supramolecular complexes based on cucurbiturils confirms the reliability of the model. To enhance usability, a script-like tool has been developed, providing a streamlined process for users to access the model. This study represents a significantadvancement in pKa prediction, offering valuable insights for drug design and supramolecular system optimization.
  • Publication
    Source-based morphometry reveals structural brain pattern abnormalities in 22q11.2 deletion syndrome
    (2024) Repetto, Gabriela; Ge, Ruiyang; Ching, Christopher; Bassett, Anne; Kushan, Leila; Antshe, Kevin; Van Amelsvoort, Therese; Bakker, Geor; Butcher, Nancy; Campbell, Linda; Chow, Eva; Craig, Michael; Crossley, Nicolas; Cunningham, Adam; Daly, Eileen; Doherty, Joanne; Durdle, Courtney; Emanuel, Beverly; Fiksinski, Ania; Forsyth, Jennifer; Fremont, Wanda; Goodrich-Hunsaker, Naomi; Gudbrandsen, Maria; Gur, Raquel; Jalbrzikowski, Maria; Kates, Wendy; Lin, Amy; Linden, David; McCabe, Kathryn; McDonald, Donna; Moss, Hayley; Murphy, Declan; Murphy, Kieran; Owen, Michael; Villalon, Julio; Roalf, David; Ruparel, Kosha; Schmitt, J. Eric; Schuite, Sanne; Angkustsiri, Kathleen
    22q11.2 deletion syndrome (22q11DS) is the most frequently occurring microdeletion in humans. It is associated with a significant impact on brain structure, including prominent reductions in gray matter volume (GMV), and neuropsychiatric manifestations, including cognitive impairment and psychosis. It is unclear whether GMV alterations in 22q11DS occur according to distinct structural patterns. Then, 783 participants (470 with 22q11DS: 51% females, mean age [SD] 18.2 [9.2]; and 313 typically developing [TD] controls: 46% females, mean age 18.0 [8.6]) from 13 datasets were included in the present study. We segmented structural T1-weighted brain MRI scans and extracted GMV images, which were then utilized in a novel source-based morphometry (SBM) pipeline (SS-Detect) to generate structural brain patterns (SBPs) that capture co-varying GMV. We investigated the impact of the 22q11.2 deletion, deletion size, intelligence quotient, and psychosis on the SBPs. Seventeen GMV-SBPs were derived, which provided spatial patterns of GMV covariance associated with a quantitative metric (i.e., loading score) for analysis. Patterns of topographically widespread differences in GMV covariance, including the cerebellum, discriminated individuals with 22q11DS from healthy controls. The spatial extents of the SBPs that revealed disparities between individuals with 22q11DS and controls were consistent with the findings of the univariate voxel-based morphometry analysis. Larger deletion size was associated with significantly lower GMV in frontal and occipital SBPs; however, history of psychosis did not show a strong relationship with these covariance patterns. 22q11DS is associated with distinct structural abnormalities captured by topographical GMV covariance patterns that include the cerebellum. Findings indicate that structural anomalies in 22q11DS manifest in a nonrandom manner and in distinct covarying anatomical patterns, rather than a diffuse global process. These SBP abnormalities converge with previously reported cortical surface area abnormalities, suggesting disturbances of early neurodevelopment as the most likely underlying mechanism.
  • Publication
    Chromatin regulators in the TBX1 network confer risk for conotruncal heart defects in 22q11.2DS
    (2023) Repetto, Gabriela; Zhao, Yingjie; Wang, Yujue; Shi, Lijie; McDonald, Donna; Crowley, Blaine; McGinn, Daniel; Tran, Oanh; Miller, Daniella; Lin, Jhih-Rong; Zacka, Elaine; Johnston, Richard; Chow, Eva; Vorstman, Jacob; Vingerhoets, Claudia; Van Amelsvoort, Therese; Gothelf, Doron; Swillen, Ann; Breckpot, Jeroen; Vermeesch, Joris; Eliez, Stephan; Schneider, Maude; Van den Bree, Marianne; Owen, Michael; Kates, Wendy; Shashi, Vandana; Schoch, Kelly; Bearden, Carrie; Digili, M. Cristina; Unolt, Marta; Putotto, Carolina; Marino, Bruno; Pontillo, Maria; Armando, Marco; Vicar, Stefano; Angkustsiri, Kathleen; Campbell, Linda; Busa, Tiffany; Heine, Damian; Murphy, Kieran; Murphy, Declan
    Congenital heart disease (CHD) affecting the conotruncal region of the heart, occurs in 40-50% of patients with 22q11.2 deletion syndrome (22q11.2DS). This syndrome is a rare disorder with relative genetic homogeneity that can facilitate identification of genetic modifiers. Haploinsufficiency of TBX1, encoding a T-box transcription factor, is one of the main genes responsible for the etiology of the syndrome. We suggest that genetic modifiers of conotruncal defects in patients with 22q11.2DS may be in the TBX1 gene network. To identify genetic modifiers, we analyzed rare, predicted damaging variants in whole genome sequence of 456 cases with conotruncal defects and 537 controls, with 22q11.2DS. We then performed gene set approaches and identified chromatin regulatory genes as modifiers. Chromatin genes with recurrent damaging variants include EP400, KAT6A, KMT2C, KMT2D, NSD1, CHD7 and PHF21A. In total, we identified 37 chromatin regulatory genes, that may increase risk for conotruncal heart defects in 8.5% of 22q11.2DS cases. Many of these genes were identified as risk factors for sporadic CHD in the general population. These genes are co-expressed in cardiac progenitor cells with TBX1, suggesting that they may be in the same genetic network. The genes KAT6A, KMT2C, CHD7 and EZH2, have been previously shown to genetically interact with TBX1 in mouse models. Our findings indicate that disturbance of chromatin regulatory genes impact the TBX1 gene network serving as genetic modifiers of 22q11.2DS and sporadic CHD, suggesting that there are some shared mechanisms involving the TBX1 gene network in the etiology of CHD
  • Publication
    Functional Dizziness as a Spatial Cognitive Dysfunction
    (2024) Breinbauer, Hayo; Stecher, Ximena; Zamorano, Francisco; Billeke, Pablo; Arévalo, Camilo; Villarroel, Karen; Lavin, Claudio; Faúndez, Felipe; Garrido, Rosario; Alarcón, Kevin; Delano, Paul
    (1) Background: Persistent postural-perceptual dizziness (PPPD) is a common chronic dizziness disorder with an unclear pathophysiology. It is hypothesized that PPPD may involve disrupted spatial cognition processes as a core feature. (2) Methods: A cohort of 19 PPPD patients underwent psycho-cognitive testing, including assessments for anxiety, depression, memory, attention, planning, and executive functions, with an emphasis on spatial navigation via a virtual Morris water maze. These patients were compared with 12 healthy controls and 20 individuals with other vestibular disorders but without PPPD. Vestibular function was evaluated using video head impulse testing and vestibular evoked myogenic potentials, while brain magnetic resonance imaging was used to exclude confounding pathology. (3) Results: PPPD patients demonstrated unique impairments in allocentric spatial navigation (as evidenced by the virtual Morris water maze) and in other high-demand visuospatial cognitive tasks that involve executive functions and planning, such as the Towers of London and Trail Making B tests. A factor analysis highlighted spatial navigation and advanced visuospatial functions as being central to PPPD, with a strong correlation to symptom severity. (4) Conclusions: PPPD may broadly impair higher cognitive functions, especially in spatial cognition. We discuss a disruption in the creation of enriched cognitive spatial maps as a possible pathophysiology for PPPD
  • Publication
    Exploring the behavior of Candida antarctica lipase B in aqueous mixtures of an imidazolium ionic liquid and its surfactant analogue
    (2024) Campodónico, Paola; Calderón, Cristian; Alcázar, Jackson; Olivares, Belén; Jaldin, Limberg; Suárez, Cristian
    The performance of Candida antarctica lipase B (CALB) has been evaluated in 1- butyl-3-methylimidazolium tetrafluoroborate (BMIMBF4)/water mixtures in a wide range of molar fractions (χBMIMBF4) with and without 1-dodecyl-3- methylimidazolium tetrafluoroborate (C12-MIMBF4), a surfactant derived from BMIMBF4. The main aim of this work is to evaluate the influence of χBMIMBF4 over micellar aggregates to assess the activity of enzymatic reactions. The investigated reaction corresponds to the hydrolysis of the substrate p-nitrophenyl laureate in each χBMIMBF4. The kinetic study for χBMIMBF4 at around 0.2 proved to be a border point in enzymatic activity. At χBMIMBF4 = 0.1, the lipase activity increases in thepresence of C12-MIMBF4. However, at higher concentrations, BMIMBF4 has a negligible effect over the lipase activity. These results suggest specific interactions between water and BMIMBF4 molecules in relation to CALB. This research highlights the superactivity phenomenon driven by the reaction media and the micelle interface. In this interfacial interaction, BMIMBF4 acts directly on the changes induced on the enzyme upon its interaction with the micellar interface. This study opens a green perspective toward the biocatalysis field.
  • Publication
    Challenges for the prevention of hypertension among international migrants in Latin America: prioritizing the health of migrants in healthcare systems
    (2024) Cabieses, Baltica; Rada, Isabel
    Among the health priorities of international migrants, non-communicable diseases such as hypertension are of major interest due to their increasing prevalence, mainly in low- and middle-income countries. Previous evidence has reported a significant risk of hypertension in international migrants derived from multiple exposures during the migration process and at the destination, such as living conditions, health literacy and access to preventive services. Also, poorer disease control has been found compared to the local population. Considering existing deficiencies in access and use of healthcare services related to hypertension prevention and continuity of care of migrants globally, we aimed to offer a Latin American perspective of the challenges faced by international migrants residing in Latin America in accessing hypertension preventive care from a human rights, equity, and universal primary healthcare approaches. From a health systems perspective, we conducted a scoping review of scientific literature on hypertension prevention and control among international migrants in Latin America and the Caribbean. Based on the findings, we discuss the potential influence of migration and health policies on healthcare systems and individual and structural barriers to healthcare access, including lack of insurance, linguistic barriers, limited intercultural competence, and geographical and financial barriers. From existing evidence related to hypertension, we highlight the particular healthcare needs of migrants and their implications for regional public health goals. This aligns with promoting culturally tailored interventions considering the migration process, lifestyle patterns, structural vulnerabilities, and gender particularities in hypertension prevention, diagnosis, and treatment. We advocate for developing universal, voluntary, and systemic regional screening and disease control initiatives in Latin America for hypertension and other chronic conditions.
  • Publication
    The legal path for priority setting in Chile: a critical analysis to improve health planning and stewardship
    (2024) Cabieses, Baltica; Espinoza, Manuel; Goic, Carolina; Andrade, Alejandro
    Health systems have committed their path to universal health coverage using health planning to accomplish their goals of efficiency, equity and sustainability. Chile, a high-income country with a public-private mix health system, has made significant progress through several successive health policies implemented in the last 20 years which have been consistent with this approach. However, in the last 5 years, the national congress has produced several disease-specific laws, which have been mainly promoted by the civil society. These laws indicate the actions the health authority must perform to tackle the needs of the affected population, which ultimately determine the priorities of the health system. We argue that this legal pattern has become an alternative path to priority-setting, as opposed to health planning. We claim this “legal path” is a mechanism used by civil society in a context where the health authority fails to implement a robust and legitimate prioritization process. Although these laws have brought benefits to patients suffering the corresponding conditions, we highlight this approach does not guarantee improvements in equity, efficiency and health system performance. Instead, we advocate for taking back the control of the priority-setting based on health planning, through a new institutionalization of health technology assessment and quality of care
  • Publication
    The impact of stigma and discrimination-based narratives in the health of migrants in Latin America and the Caribbean: a scoping review
    (2023) Cabieses, Baltica; CARREÑO CALDERON, ALEJANDRA; Rada, Isabel; Belo, Karoline; Rojas, Karol; Araoz, Candelaria; Knipper, Michael
    Stigma and discrimination-based narratives have been associated with adverse health outcomes. Migrants and refugees face multiple barriers to accessing healthcare, influenced by stigma and discrimination-based narratives against them. We conducted a scoping review of scientific and grey literature (n = 61) to discuss available evidence in Latin America and the Caribbean (LAC) concerning communication and narrative speeches related to international migration and its implications for population health, particularly when associated with stigma and discrimination against migrants and refugees. We found that a better understanding how communication and narratives might affect migrants’ experience while transiting or residing in a different country is valuable for public health and health systems performance aims. Our review depicts the multilevel and dynamic effects of stigma and discrimination-based narratives against migrants in Latin America, highlighting the urgent need for transformative and constructive social and healthcare narratives around migration to promote population health in the region.
  • Publication
    Trenzando las antropologías de la salud en Chile: temas, diálogos y desafíos
    (2023) CARREÑO CALDERON, ALEJANDRA; Obach, Alexandra; Leyton, Daniela; Sadler, Michelle
    La formación del campo de la antropología de la salud (o antropología médica) en Chile es paralela al desarrollo de la disciplina en el país. Actualmente observamos la consolidación de distintos temas y el surgimiento de nuevos diálogos y desafíos. El artículo reflexiona sobre el pasado, el presente y el futuro del campo, y propone una caracterización de las distintas etapas de esta subdisciplina basada en una revisión de investigaciones nacionales y de tesis de pregrado y postgrado dedicadas al tema. Se destacan los aportes y las limitaciones de cada período y se reflexiona en torno a los desafíos que la subdisciplina enfrenta actualmente considerando el arribo a un momento histórico de mayor reconocimiento y de implicación en el debate nacional sobre los procesos de salud/enfermedad/atención/cuidado. The development of the field of anthropology of health (or medical anthropology) in Chile has taken similar pathways as local social anthropology. We can currently observe the consolidation of different topics and the development of new dialogues and issues. The article reflects on the field’s past, present, and future directions, putting forward a proposal to describe the different stages of the subdiscipline in Chile based on a review of the local research, as well as under- and post-graduate dissertations and theses. The contributions and limitations of each stage are highlighted, and we reflect on the challenges the subdiscipline currently faces as it gains further recognition and involvement in the national debate on health/disease/attention/care processes.
  • Publication
    Desafíos para el abordaje de la salud de los migrantes en Chile durante la pandemia por Covid-19: una revisión de alcance
    (2023) Cabieses, Baltica; Obach, Alexandra; Blukacz, Alice; Rada, Isabel; CARREÑO CALDERON, ALEJANDRA; Mezones, Edward
    Objetivo.Indagar sobre los principales desafíos reportados en el marco de la emergencia sanitaria de SARS-CoV-2 según la evidencia científica disponible a la fecha en esta materia en Chile. Material y métodos. Revisión de alcance con base en tres búsquedas en Web of Science, PubMed y Google Scholar de publicaciones en inglés y español publicadas entre 2020 y 2023. Resultados. Se identificaron tres áreas clave: desafíos de acceso y uso efectivo del sistema de salud, desafíos más allá del sistema de salud, incluyendo aquellas relaciones con determinantes sociales de la salud, autocuidado e información y, finalmente, desafíos de integración de los enfoques de interculturalidad, género y cooperación internacional. Conclusiones. Se evidencian oportunidades de mejorar el abordaje de la salud de personas migrantes internacionales en Chile a raíz de la pandemia por Covid-19, de cara a futuras crisis sanitarias y para reducir brechas e inequidades que impactan la salud poblacional. Objective. To investigate the main challenges in the context of the SARS-CoV-2 health emergency according to the scientific evidence available to date in this area in Chile. Materials and methods. Scoping review based on three searches in Web of Science, PubMed and Google Scholar of publications in English and Spanish published between 2020 and 2023. Results. Three key areas were identified: the challenges of access and effective use of the health system, the challenges beyond the health system, including those related to social determinants of health, self-care and information, and finally, the challenges of integrating intercultural, gender and international cooperation approaches. Conclusions. There are opportunities to better address the health of international migrants in Chile in the wake of the Covid-19 pandemic, anticipating future health crises and to reduce gaps and inequities that impact population health.
  • Publication
    Condiciones de vida de la población migrante venezolana en situación irregular y percepciones sobre la respuesta sanitaria brindada durante la pandemia de SARS-CoV-2 en Chile
    (2023) Cabieses, Baltica; Larenas, Daniel; Torres, Irene; Cubillos, Andrés; Arroyo, Juan
    El presente estudio tiene como objetivo identificar percepciones sobre la situación de la población migrante venezolana en situación irregular durante la pandemia de COVID-19 en Chile y de las estrategias desarrolladas para responder a sus necesidades de salud. Para esto, se desarrolló un análisis temático de 19 entrevistas semi-estructuradas. Se identificó un círculo vicioso de barreras que dificultan la regularización y el acceso al trabajo. Esto produce necesidades de vivienda y dificultades de acceso a salud. No obstante, se reconocen estrategias de acceso a atención y cobertura, capacitación del personal y difusión de información realizadas en el país. Se requiere desarrollar estrategias locales y regionales para resolver los problemas relacionados a la criminalización de las personas migrantes en situación irregular, las trabas de los procesos de regularización, las necesidades básicas no cubiertas y las dificultades asociadas a la garantía del goce del derecho a la salud. O presente estudo tem como objetivo identificar as percepções sobre a situação da população migrante venezuelana em situação irregular durante a pandemia de COVID-19 no Chile e as estratégias desenvolvidas para responder às suas necessidades de saúde. Para isso, foi desenvolvida uma análise temática de 19 entrevistas semiestruturadas. Com base nisso, identificou-se um círculo vicioso de barreiras que dificultam a regularização e o acesso ao trabalho. Isso produz carências habitacionais e dificuldades de acesso à saúde. No entanto, são reconhecidas as estratégias de acesso à atenção e cobertura, capacitação de pessoal e divulgação de informações realizadas no país. É necessário desenvolver estratégias regionais e locais para resolver os problemas relacionados com a criminalização de migrantes em situação irregular, os obstáculos ao processo de regularização, as necessidades básicas não cobertas e as dificuldades associadas à garantia do gozo do direito à saúde.
  • Publication
    El rol de nuevas organizaciones de la sociedad civil en la promoción de salud sexual en Chile
    (2023) Obach, Alexandra; Sadle, Michelle; Roberts, Antonia; Marín, Matías
    El artículo que da cuenta de los resultados de dos investigaciones cualitativas ejecutadas entre 2020 y 2022, tiene como propósito, desde un enfoque de salud global, salud colectiva y vulnerabilidad estructural, reflexionar en torno al rol que juegan nuevos actores de la sociedad civil en la promoción de la salud sexual, de derechos sexuales y en la prevención y detección del VIH en Chile. Estos actores son organizaciones de la sociedad civil conformadas por jóvenes profesionales de la salud que han construido espacios de información, promoción y atención en salud sexual y reproductiva fuera del sistema formal de salud; y organizaciones lideradas por jóvenes LGBTIQA+ en torno a información en sexualidades en general, y a acceso a prevención y detección del VIH en particular. El artículo contribuye en mostrar la importancia que tienen estos nuevos actores en las trayectorias terapéuticas en materia de salud sexual de jóvenes en Chile, y la relevancia aún mayor que han adquirido desde el inicio de la pandemia de Covid-19 The article which gives an account of the results of two qualitative investigations carried out between 2020 and 2022, has the purpose, from a global health, collective health and structural vulnerability approach, to reflect on the role played by new civil society actors in the promotion of sexual health, sexual rights and in the prevention and detection of HIV in Chile. These actors are civil society organizations led by young health professionals who have built spaces for information, promotion, and care in sexual and reproductive health outside the formal health system; and organizations led by LGBTIQA+ youth around information on sexualities in general, and access to HIV prevention and detection in particular. The article contributes to show the importance that these new civil society actors have in therapeutic trajectories in the field of sexual health of young people in Chile, and the even greater relevance that they have acquired since the beginning of the Covid-19 pandemic.
  • Publication
    Formación Inicial Docente (FID) y educación intercultural: cómo prevenir la violencia hacia la niñez migrante
    (2023) Pavez, Iskra; Poblete, Daniela; Poblete, Rolando; Alfaro, Carmen; Domaica, Anastassia
    A propósito del aumento de la matrícula de niñas y niños de origen extranjero en el sistema educativo chileno, es objetivo de este artículo analizar la relación entre las necesidades de formación docente en el ámbito de la interculturalidad y la violencia hacia la niñez migrante con miras hacia una educación antirracista. Se presentan resultados de un estudio realizado en dos regiones del país: Metropolitana y Valparaíso. A través de una metodología cualitativa, se aplicaron entrevistas semiestructuradas a docentes y profesionales que atienden a población escolar migrante. Se concluye que existen discursos que reconocen las problemáticas de racismo y discriminación que sufre esta población, así como otros relatos que lo niegan o minimizan jerarquizando las nacionalidades del estudiantado migrante. También se constata una imperiosa necesidad de Formación Inicial Docente que se desprenda de una política pública promotora de un currículo actualizado en el que la diversidad cultural sea un valor, a la vez que la categoría de infancia se reconozca como un eje de desigualdad prioritario y la acogida sea vista como un punto de partida. En el actual escenario, surgen variados conflictos de convivencia que requieren ser gestionados desde paradigmas amigables con la infancia migrante y metodologías que reconozcan sus derechos y permitan garantizar una verdadera inclusión en nuestro país. The goal of this article is to analyze the relationship between teacher training needs in the field of interculturality and violence against migrant children with a view to an anti-racist education. Results of a study carried out in two regions of the country are presented: Metropolitan and Valparaíso. Through a qualitative methodology, semi-structured interviews were applied to teachers and professionals who serve the migrant school population. It is concluded that there are discourses that recognize the problems of racism and discrimination suffered by this population, as well as other accounts that deny or minimize it, hierarchizing the nationalities of origin of the migrant student body. There is also an urgent need for teacher training that emerges from a global public policy that promotes an updated curriculum where cultural diversity is a value, while the category of childhood is recognized as a priority axis of inequality and the recognized reception as a transversal practice. In the current scenario, various coexistence conflicts arise that need to be managed from paradigms that are friendly to migrant children and methodologies that recognize their rights and guarantee true inclusion in our country.
  • Publication
    Reflexividad ética de un traspié: niñez y adolescencia migrantes no acompañadas
    (2023) Pavez, Iskra; Geng, Sius; Dufraix, Iciar; Ortiz, Juan; Acuña, Valeria
    El objetivo de este artículo es sistematizar un proceso de reflexividad ética surgido en un proyecto de investigación (Fondecyt) cuyo fin era conocer la situación de la niñez y la adolescencia migrantes no acompañadas en Chile. El proyecto fue aprobado con reparos éticos que hacían difícil poner en práctica métodos participativos. Este «traspié» dio paso a la reflexividad. Mediante una metodología de panel de expertos, creamos un comité de ética autoconvocado (profesionales en derecho y psicología especialistas en infancia) que capacitó al equipo y elaboró recomendaciones y protocolos. En los resultados exponemos algunos dilemas éticos (en torno al consentimiento informado, los derechos de autoría y un balance entre riesgos y beneficios) identificados en las distintas instancias evaluativas, así como los aprendizajes derivados de ello; finalizamos con futuras líneas de investigación.
  • Publication
    “Border closure only increased precariousness”: a qualitative analysis of the efects of restrictive measures during the COVID‑19 pandemic on Venezuelan’s health and human rights in South America
    (2023) Cabieses, Baltica; Rocha, Teresita; Olivari, Carla; Martínez, Alejandra; Knipper, Michael
    Background: In 2010, a political and social crisis pushed thousands of Venezuelans out of their country; today, seven million Venezuelans live abroad. In addition, during the COVID-19 pandemic, border closure increased and affected specific vulnerable migration flows, such as Venezuelans trying to migrate to Chile through the Northern borders. In this context, there is little evidence of migrants' health status and needs, their access to health services, and other basic needs (e.g., housing) from a human rights perspective. Therefore, we qualitatively explored the effects of border closure due to the COVID-19 pandemic on Venezuelan migrants' health and human rights, focusing on access to healthcare in the Northern Chilean border that adjoins Peru and Bolivia. Methods: Following a case-study qualitative design, we conducted an ethnography that included participatory observation of relevant sites (e.g., hospitals, main squares, migrant shelters) in Antofagasta, Iquique, and Arica and 30 in-depth interviews with actors in the health sector (n = 7), experts from the non-governmental sector (n = 16), and governmental actors (n = 7) in three large cities close to the Northern border. Results: We found four main dimensions: (i) border and migration processes, (ii) specific groups and intersectionality, (iii) barriers to healthcare services, and (iv) regional and local responses to the crisis during the COVID-19 pandemic. Programs characterized by the presence of healthcare providers in the field were essential to attend to migrants' health needs at borders. Conclusions: Coordination between actors is crucial to implement regional protocols that respond to current migration phenomena and migrants' health needs. Health policies using a human rights approach are urgently required to respond to migrants' healthcare needs at borders in South America
  • Publication
    Calidad de vida relacionada con la salud en chilenos de comunas vulnerables
    (2023) Cabieses, Baltica; Rada, Isabel; Ortiz, Manuel
    Objetivo La pandemia de COVID-19 y la crisis sociosanitaria resultante tuvieron impacto sobre el bienestar de la población. La calidad de vida relacionada con la salud (CVRS) podría verse afectada, principalmente en condición de vulnerabilidad social. El objetivo fue analizar la CVRS y las propiedades psicométricas del instrumento EQ-5D en población chilena adulta de comunas vulnerables de la Región Metropolitana. Método Estudio transversal realizado durante la cuarentena de abril-junio de 2021. Se seleccionaron 500 adultos residentes en comunas de Chile que completaron por videollamada un cuestionario estructurado incluyendo el instrumento EQ-5D. Se realizaron análisis descriptivos y factoriales confirmatorios del modelo reflectivo tradicional. Resultados La edad promedio fue de 36,36 ± 12,41 años, la mayoría reportaron un nivel educativo secundario y estar empleado. Con respecto al instrumento EQ-5D, se encontró mayor afectación en la dimensión dolor/malestar y ansiedad/depresión. El estado de salud global evaluado con la escala visual análoga fue de 73,0 ± 19,71 puntos. El modelo evaluado presentó un ajuste adecuado: χ2 = 6.992, p = 0.221, CFI = 0.996, TLI = 0.993, RMSEA = 0.028 (IC90%: 0.000-0.073) y SRMR = 0.067. Además, los ítems de la escala resultaron buenos indicadores del constructo de interés. Conclusiones En contexto de pandemia, la población estudiada presentó mayor afectación en las dimensiones dolor/molestia y ansiedad/depresión. El instrumento EQ-5D es una herramienta útil para estimar la CVRS en población chilena en contexto de pandemia. Además, la evidencia psicométrica respalda la unidimensionalidad del constructo y la potencial utilidad de descomponer su análisis. Objective The COVID-19 pandemic and the resulting social and health crisis impacted the well-being of the population. Health-related quality of life (HRQoL) could be affected, mainly in conditions of social vulnerability. The objective was to analyze the HRQoL and the psychometric properties of the EQ-5D instrument in adult Chilean population from vulnerable communes of the Metropolitan Region. Method Cross-sectional study carried out during quarantine period April to June 2021. Five hundred adults residing in Chilean communes were selected and completed a structured questionnaire by video-call, including the EQ-5D instrument. Descriptive analyzes and confirmatory factor analyzes of the traditional reflective model were performed. Results The age of the sample was 36.36 ± 12.41 years, the majority reported having a secondary education level and being employed. Regarding the EQ-5D instrument, the most affected dimensions were pain/discomfort and anxiety/depression. The global health status was 73.0 ± 19.71 points. The model showed an adequate fit: χ2 = 6.992, p = 0.221, CFI = 0.996, TLI = 0.993, RMSEA = 0.028 (90% CI: 0.000–0.073) and SRMR = 0.067. In addition, the items of the scale were good indicators of the construct of interest. Conclusions In a pandemic context, the population was mostly affected by pain/discomfort and anxiety/depression. The EQ-5D instrument is a useful tool to estimate CRSV in the Chilean population in the context of pandemic. In addition, the psychometric evidence supports the dimensionality of the construct and the potential utility of decomposing its analysis.
  • Publication
    The socioeconomic distribution of life expectancy and healthy life expectancy in Chile
    (2023) Cabieses, Baltica; Espinoza, Manuel; Severino, Rodrigo; Balmaceda, Carlos; Abbott, Tomas
    Background: Life expectancy (LE) has usually been used as a metric to monitor population health. In the last few years, metrics such as Quality-Adjusted-Life-Expectancy (QALE) and Health-Adjusted-Life- Expectancy (HALE) have gained popularity in health research, given their capacity to capture health related quality of life, providing a more comprehensive approach to the health concept. We aimed to estimate the distribution of the LE, QALEs and HALEs across Socioeconomic Status in the Chilean population. Methods: Based on life tables constructed using Chiang II´s method, we estimated the LE of the population in Chile by age strata. Probabilities of dying were estimated from mortality data obtained from national registries. Then, life tables were stratified into five socioeconomic quintiles, based on age-adjusted years of education (pre-school, early years to year 1, primary level, secondary level, technical or university). Quality weights (utilities) were estimated for age strata and SES, using the National Health Survey (ENS 2017). Utilities were calculated using the EQ-5D data of the ENS 2017 and the validated value set for Chile. We applied Sullivan´s method to adjust years lived and convert them into QALEs and HALEs. Results: LE at birth for Chile was estimated in 80.4 years, which is consistent with demographic national data. QALE and HALE at birth were 69.8 and 62.4 respectively. Men are expected to live 6.1% less than women. However, this trend is reversed when looking at QALEs and HALEs, indicating the concentration of higher morbidity in women compared to men. The distribution of all these metrics across SES showed a clear gradient in favour of a better-off population-based on education quintiles. The absolute and relative gaps between the lowest and highest quintile were 15.24 years and 1.21 for LE; 18.57 HALYs and 1.38 for HALEs; and 21.92 QALYs and 1.41 for QALEs. More pronounced gradients and higher gaps were observed at younger age intervals. Conclusion: The distribution of LE, QALE and HALEs in Chile shows a clear gradient favouring better-off populations that decreases over people´s lives. Differences in LE favouring women contrast with differences in HALEs and QALEs which favour men, suggesting the need of implementing gender-focused policies to address the case-mix complexity. The magnitude of inequalities is greater than in other high-income countries and can be explained by structural social inequalities and inequalities in access to healthcare.
  • Publication
    "Healthcare should be the same for everyone": perceived inequities in therapeutic trajectories of adult patients with lung cancer in Chile, a qualitative study
    (2023) Cabieses, Baltica; Obach, Alexandra; Campaña, Carla; Vezzani, Francisca
    Background: Globally, it has been reported that different social determinants of health affect health outcomes in lung cancer (LC). Research on the therapeutic trajectories of patients (TTP) is a novel field for identifying barriers and facilitators in health. The objective of this study was to reveal perceived differences in TTP with LC in Chile according to selected social determinants of health (SDH) and the experiences of patients, health professionals, and civil society leaders. Methods: This is a qualitative paradigm, one case-study design. Online semi-structured interviews were conducted with patients with LC, health professionals, and civil society leaders. The strategies for the recruitment process included social networks, civil society organizations, health professionals, and the snowball technique. A thematic analysis was carried out. Results: Selected SDH impact LC's TTP in Chile, particularly concerning health system access, health services, information, and patient navigation experiences. The analysis of the experiences of the participants allowed us to identify barriers related to the selected SDH in three stages of the TTP: initiation, examinations, and diagnosis and treatment. Individuals with limited education, those residing outside the capital, women, and those in the public health system encountered more barriers throughout their TTP. Discussion: Study findings suggest that being a woman with low education, from the public health system, and not from the capital might represent one of the most powerful intersections for experiencing barriers to effective healthcare in LC in Chile. It is necessary to monitor the TTP from an SDH perspective to guarantee the rights of access, opportunity, quality, and financial protection.
  • Publication
    Barreras para la utilización de servicios de Atención Primaria de Salud en personas migrantes internacionales
    (2023) Cabieses, Baltica; Cruz, Consuelo; Macaya, Gustavo; Urzúa, Alfonso
    Objetivo: analizar las barreras que enfrentan las personas migrantes internacionales al utilizar los servicios de Atención Primaria de salud en la comuna de Antofagasta, Chile. Método: diseño de investigación cualitativa bajo un enfoque interpretativo fenomenológico-descriptivo. Se utilizó un muestreo por conveniencia y por bola de nieve hasta la saturación del discurso. La muestra se conformó por 42 personas mayores de 18 años (personal funcionario y personas migrantes). Se realizaron entrevistas individuales y grupales semiestructuradas. Para el análisis de los datos se llevó a cabo un análisis reflexivo temático, con codificación abierta para la posterior construcción de categorías. Como criterios de calidad se utilizó la triangulación, la confirmabilidad y la reflexividad. Resultados: desde el personal funcionario de salud se identificaron dimensiones como la aceptabilidad del otro, el idioma y la alteridad racializadora. Desde las personas migrantes internacionales se destacó el idioma, el trato discriminatorio y las dificultades en el acceso relacionadas con los procedimientos administrativos para afiliarse al seguro público de salud. Además, se identificaron barreras en las interacciones diarias entre los equipos de salud y las personas migrantes, en las cuales las interpretaciones mutuas de las acciones desempeñan un papel importante. Conclusiones: las barreras existentes en la utilización de los servicios de la Atención Primaria de Salud presentan componentes del sistema asociado a políticas y normativas que en las prácticas se relaciona a un segundo componente, el individual, en donde el personal funcionario y las personas migrantes estarían plasmados en las interacciones cotidianas durante el proceso de atención. Objective: to analyse the barriers faced by international migrants when using Primary Care services in the commune of Antofagasta, Chile. Method: a qualitative research design with an interpretative phenomenological-descriptive approach. Convenience andsnowball sampling was used until the saturation point was reached. The sample was formed by 42 >18-year-old persons (civil servants and migrants). Semi-structured individual and group interviews were conducted. Reflexive-thematic analysis was used for data analysis, with open coding for subsequent category building. The quality criteria used were triangulation, confirmability and reflectivity. Results: the dimensions identified by the health civil servants were: acceptability of the other, language, and racialization otherness. The international migrants highlighted language, discriminatory treatment, and difficulties for access associated with administrative procedures to enrol in the public health system. Moreover, barriers were detected in the daily interactions between health services and migrants, where mutual interpretations of actions played a major role. Conclusions: the current barriers for the use of Primary Care services presented system components associated with policies and rules which in practice are associated with a second component, the individual one, which would be reflected in the daily interactions by civil servants and migrants during the process of care.