DSpace Repository :: Browsing by Author "Castillo-Laborde, Carla"

Browsing by Author "Castillo-Laborde, Carla"

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Barriers and Facilitators in Access to Diabetes, Hypertension, and Dyslipidemia Medicines: A Scoping Review
(2022) Castillo-Laborde, Carla; Hirmas Adauy, Macarena; Matute, María Isabel; Jasmen, Anita; Urrejola, Oscar; Molina, Xaviera; Awad, Camila; Frey, Catalina; Pumarino, Sofia; Descalzi, Fernando; Ruiz, Tomás; Plass, Barbara
Objective: Identify barriers and facilitators in access to medicines for diabetes, hypertension, and dyslipidemia, considering patient, health provider, and health system perspectives. Methods: Scoping review based on Joanna Briggs methodology. The search considered PubMed, Cochrane Library, CINAHL, Academic Search Ultimate, Web of Science, SciELO Citation Index, and grey literature. Two researchers conducted screening and eligibility phases. Data were thematically analyzed. Results: The review included 219 documents. Diabetes was the most studied condition; most of the evidence comes from patients and the United States. Affordability and availability of medicines were the most reported dimension and specific barrier respectively, both cross-cutting concerns. Among high- and middle-income countries, identified barriers were cost of medicines, accompaniment by professionals, long distances to facilities, and cultural aspects; cost of transportation emerges in low-income settings. Facilitators reported were financial accessibility, trained health workers, medicines closer to communities, and patients' education. Conclusion: Barriers and facilitators are determined by socioeconomic and cultural conditions, highlighting the role of health systems in regulatory and policy context (assuring financial coverage and free medicines); providers' role bringing medicines closer; and patients' health education and disease management.
Exposure of 4- year to 24- year olds to tobacco imagery on prime- time Chilean television
(2023) Peruga, Armando; Oscar Urrejola; Delgado, Iris; Matute, María Isabel; Castillo-Laborde, Carla; Molina, Xaviera; Hirmas Adauy, Macarena; Olea, Andrea; González, Claudia; Aguilera, Ximena; Sargent, James
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.
Exposure to tobacco impressions during prime-time TV among Chilean minors by sex and socioeconomic status
(2022) Peruga, Armando; Castillo-Laborde, Carla; Matute, María Isabel; Molina, Xaviera; Urrejola, Oscar; Aguilera, Ximena
Introduction: We tested if tobacco impressions were delivered differentially to prime-time TV watching minors by sex and socioeconomic status. Methods: Programs aired during prime-time for three random weeks in 2019 from the 15 highest audience channels in Chile were content-analyzed for the occurrence of tobacco for each one-minute interval of 92639 recorded. Such occurrences were categorized as actual use and whether they violated Chilean smoke-free law or tobacco brand appearances. We estimated the number of persons per hour (p/h) exposed to tobacco impressions for the 4 to 17 years age group by sex and socioeconomic status (SES). Results: Minors spent over a billion p/h watching TV during the observation period. Minors were exposed to tobacco explicit use, branding and smoke-free violation impressions for 9.7 million, 1.2 million, and 1.0 million p/h, respectively. The odds ratios (OR) of exposure to total tobacco impressions were always greater among boys with higher SES compared to boys with low SES. However, they were greater among girls of low SES compared to those of high SES for all types of impressions. The OR of exposure to tobacco branding was higher among girls of any SES compared to boys of any SES. Conclusions: Minors need protection from tobacco imagery on television, particularly girls of low SES. To that end, new legislation should implement all measures to counter depictions of tobacco in entertainment media, as recommended in the WHO FCTC Article 13 guidelines. This should require strong anti-tobacco advertisements before any TV program portraying tobacco targeting minor audiences, particularly girls of low SES. Given that Chile has one of the highest prevalences in the world of current cigarette smoking among young females, the potential contribution of tobacco impressions on TV to smoking differentials across female socioeconomic groups should be further studied.
From instinct to evidence: the role of data in country decision-making in Chile
(Taylor & Francis Online, 2017) Aguilera, Ximena; Espinosa-Marty, Consuelo; Castillo-Laborde, Carla; Gonzalez, Claudia
BACKGROUND: The Chilean health system has undergone profound reforms since 1990, while going through many political upheavals, and faced demographic, health, and economic transformations. The full information requirements to develop an evidence-informed process implied the best possible use of available data, as well as efforts for improving the information systems. OBJECTIVE: To examine, from a historical perspective, the use of data during the health reforms undertaken in Chile since 1990, and to identify the factors that have determined its utilization and improvement. DESIGN: A qualitative methodological approach was followed to review the case study of the Chilean experience with data on decision-making. We use as the primary source our first-hand experience as officials of the Ministry of Health (MOH) and the Ministry of Finance during the reform period considered. Second, a literature review was conducted, using documents from official sources, historical accounts, books, policy reports, and articles about the reform process, looking for the use of data. FINDINGS: The Chilean health care reform process was intensive in utilization and production of information. In this context, the MOH conducted several studies, from the burden of disease, efficacy of interventions, cost-effectiveness, out-of-pocket payments, and fiscal impact to social preferences, among others. Policy and prioritization frameworks developed by international agencies influenced the use of data and the studies' agenda. CONCLUSIONS: Health systems in Latin America have struggled to adapt to changing health needs caused by demographic transition and economic growth. Health reforms in Chile provide lessons of this sustained effort, based on data and scientific grounds, with lights and shadows. Tradition, receptiveness to foreign ideas, and benchmarking with international data determined this approach, facilitated by the political influence of physicians and other technocrats. Besides, internationally comparable statistics are shown to play a significant role in policy debate.
Immunization and SARS-CoV-2 antibody seroprevalence in a country with high vaccination coverage: Lessons from Chile
(2022) Aguilera, Ximena; González, Claudia; Apablaza, Mauricio; Rubilar, Paola; Icaza, Gloria; Ramírez-Santana, Muriel; Pérez, Claudia; Cortés, Lina Jimena; Núñez-Franz, Loreto; Quezada-Gaete, Rubén; Castillo-Laborde, Carla; Correa, Juan; Said, Macarena; Hormazábal, Juan; Vial, Cecilia; Vial, Pablo
Objective: Chile is among the most successful nations worldwide in COVID-19 vaccine rollout. By December 31st, 2021, 84.1% of the population was fully vaccinated, and 56.1% received booster doses using DIFFERENT TYPES OF COVID-19 VACCINES. In this context, we aimed to estimate the anti-SARSCoV-2 antibodies following the infection and vaccination campaign. Study design: Population-based cross-sectional serosurvey based on a representative sample of the cities of Santiago, Coquimbo/La Serena, and Talca used in a previous study. Methods: We selected the participants using a three-stage stratified sampling. They were blood-sampled on-site and answered a questionnaire regarding COVID-19-associated variables and vaccination antecedents using Wantai SARS-CoV-2 Ab ELISA to determine seroprevalence. This research followed the generic protocol of World Health Organization Unity studies. Results: We recruited 2,198 individuals aged 7-93 between October 5th and November 25th, 2021. In our sample, 2,132 individuals received COVID-19 vaccinations (97%); 67 (3.1%) received one dose; 2,065 (93.9%) received the complete scheme; and 936 received the booster jab (42.6%). Antibody seroprevalence reached 97.3%, ranging from 40.9% among those not vaccinated to 99.8% in those with booster doses (OR=674.6, 154.8-2938.5). SARS-CoV-2 antibodies were associated with vaccination, previous COVID-19 diagnosis, age group, and city of residence. In contrast, we found no significant differences in the type of vaccine used, education, nationality, or type of health insurance. Conclusion: We found a seroprevalence close to 100% in the population aged seven years and older, primarily due to the successful vaccination program, which has a strong emphasis on universal access.
Monitoring and Evaluating Progress towards Universal Health Coverage in Chile
(Public Library of Medicine Science, 2014) Aguilera, Ximena; Castillo-Laborde, Carla; Nájera, Manuel; Delgado, Iris; Ibañez, Ciro
This paper is a country case study for the Universal Health Coverage Collection, organized by WHO. It illustrates progress towards UHC and its monitoring and evaluation in Chile.
Rare diseases in Chile: challenges and recommendations in universal health coverage context
(BioMed Central, 2019) Encina Silva, Gonzalo; Castillo-Laborde, Carla; Lecaros, Juan Alberto; Dubois-Camacho, Karen; Calderón, Juan; Aguilera, Ximena; Klein, Andrés; Repetto, Gabriela
Rare diseases (RDs) are a large number of diverse conditions with low individual prevalence, but collectively may affect up to 3.5-5.9% of the population. They have psychosocial and economic impact on patients and societies, and are a significant problem for healthcare systems, especially for countries with limited resources. In Chile, financial protection exists for 20 known RDs through different programs that cover diagnosis and treatments. Although beneficial for a number of conditions, most RD patients are left without a proper legal structure that guarantees a financial coverage, and in a vulnerable situation. In this review, we present and analyze the main challenges of the Chilean healthcare system and legislation on RDs, and other ambits of the RD ecosystem, including patient advocacy groups and research. Finally, we propose a set of policy recommendations that includes creating a patient registry, eliciting social preferences on health and financial coverage, improving access to clinical genetic services and therapies, promoting research on RDs and establishing a Latin-American cooperation network, all aimed at promoting equitable quality healthcare access for people living with RDs
SARS-CoV-2 Neutralizing Antibodies in Chile after a Vaccination Campaign with Five Different Schemes
(2022) Aguilera, Ximena; Hormazábal, Juan; Vial, Cecilia; Cortés, Lina Jimena; González, Claudia; Rubilar, Paola; Apablaza, Mauricio; Ramírez-Santana, Muriel; Icaza, Gloria; Núñez-Franz, Loreto; Castillo-Laborde, Carla; Ramírez-Riffo, Carolina; Pérez, Claudia; Quezada-Gate, Rubén; Said, Macarena; Vial, Pablo
Using levels of neutralizing antibodies (nAbs), we evaluate the successful Chilean SARS-CoV-2 vaccine campaign, which combines different vaccine technologies and heterologous boosters. From a population-based study performed in November 2021, we randomly selected 120 seropositive individuals, organized into six groups of positive samples (20 subjects each) according to natural infection history and the five most frequent vaccination schemes. We conclude that the booster dose, regardless of vaccine technology or natural infection, and mRNA vaccines significantly improve nAbs response.
Under five and infant mortality in Chile (1990- 2016): Trends, disparities, and causes of death
(2020) Aguilera, Ximena; Delgado, Iris; Icaza, Gloria; Apablaza, Mauricio; Villanueva, Loreto; Castillo-Laborde, Carla; Publicado
Background Child health has been a health policy priority for more than a century in Chile. Since 2000, new health and intersectoral interventions have been implemented. However, no recent analyses have explored child mortality and equity in Chile, an indispensable input to guide policies towards the achievement of the Sustainable Development Goals, specially, in the context of a deeply unequal country such as many other Latin American countries. Thus, the objectives of this study are to analyze the variations in the risk and the causes of death among Chilean children aged <5 years, to identify the determinants, and to measure inequality of infant mortality from 1990 to 2016. Materials and methods An observational study was conducted to analyze the Chilean children's mortality from 1990 to 2016 using under five deaths and live births data from the Vital Statistics System. To describe the variation in the risk of death, a time series analysis was performed for each of the under five mortality rate components. A comparative cause of death analysis was developed for Neonatal and 1–59 months’ age groups. The determinants of infant mortality were studied with a descriptive analysis of yearly rates according to mother’s and child factors and bivariate logistic regression models at the individual level. Finally, simple and complex measures of inequality at individual level were estimated considering three-year periods. Results Regarding under 5 mortality: (i) Child survival has improved substantially in the last three decades, with a rapid decline in under five mortality rate between 1990 and 2001, followed by a slower reduction; (ii) early neonatal mortality has become the main component of the under five mortality rate (50.6%); (iii) congenital abnormalities have positioned as the leading cause of death; (iv) an important increase in live births below 1,000 grs. Regarding infant mortality: (i) birth weight and gestational age are the two most relevant risk factors in the neonatal period, while social variables are more significant for post-neonatal mortality and, (ii) the inequality according to mother’s education has shown a steady decline, with persistent inequalities in post-neonatal period. Conclusions The Chilean experience illustrates child health achievements and challenges in a country that transitioned from middle-to high-income in recent decades. Although inequity is one of the main challenges for the country, the health sector by granting universal access was able to reduce disparities. However, closing the gap in post-neonatal mortality is still challenging. To overcome stagnation in neonatal mortality, new and specific strategies must address current priorities, emphasizing the access of vulnerable groups.

Browsing by Author "Castillo-Laborde, Carla"

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