Browsing by Author "Delgado, Iris"
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Publication A non-randomized multicentre trial of human immune plasma for treatment of hantavirus cardiopulmonary syndrome caused by Andes virus(International Medical Press, 2015) Vial, Pablo; Valdivieso, Francisca; Calvo, Mario; Rioseco, María; Riquelme, Raúl; Araneda, Andrés; Tomicic, Vinko; Graf, Jerónimo; Paredes, Laura; Fiorenzano, Matías; Bidart, Teresa; Cuiza, Analía; Marco, Claudia; Hjelle, Brian; Ye, Chunyan; Hanfelt-Goade, Daniel; Vial, Cecilia; Rivera, Juan; Mertz, Gregory; Hantavirus Study Group in Chile; Delgado, IrisBACKGROUND: In Chile, Andes virus (ANDV) is the sole aetiological agent of hantavirus cardiopulmonary syndrome (HCPS) with mean annual incidence of 55 cases, 32% case fatality rate (CFR) and no specific treatment. Neutralizing antibody (NAb) titres at hospital admission correlate inversely with HCPS severity. We designed an open trial to explore safety and efficacy and evaluate pharmacokinetics of immune plasma as a treatment strategy for this disease. METHODS: We performed plasmapheresis on donors at least 6 months after HCPS and measured NAb titres through a focus-reduction neutralization test. Subjects admitted to 10 study sites with suspected/confirmed HCPS were eligible for treatment with immune plasma by intravenous infusion at an ANDV NAb dose of 5,000 U/kg. HCPS was confirmed through immunoglobulin M serology or reverse transcriptase-PCR. The main outcome was mortality within 30 days. RESULTS: From 2008-2012, we enrolled and treated 32 cases and confirmed HCPS in 29. CFR of hantavirus plasma-treated cases was 4/29 (14%); CFR of non-treated cases in the same period in Chile was 63/199 (32%; P=0.049, OR=0.35, CI=0.12, 0.99); CFR of non-treated cases at the same study sites between 2005-2012 was 18/66 (27%; (P=0.15, OR=0.43, CI=0.14, 1.34) and CFR in a previous methylprednisolone treatment study was 20/60 (33%; P=0.052, OR=0.32, CI=0.10, 1.00). We detected no serious adverse events associated to plasma infusion. Plasma NAb titres reached in recipients were variable and viral load remained stable. CONCLUSIONS: Human ANDV immune plasma infusion appears safe for HCPS. We observed a decrease in CFR in treated cases with borderline significance that will require further studies for confirmation.Item Achieving effective universal health coverage with equity: evidence from Chile(Oxford University Press, 2014) Frenz, Patricia; Delgado, Iris; Kaufman, Jay; Harper, SamChile's 'health guarantees' approach to providing universal and equitable coverage for quality healthcare in a dual public-private health system has generated global interest. The programme, called AUGE, defines legally enforceable rights to explicit healthcare benefits for priority health conditions, which incrementally covered 56 problems representing 75% of the disease burden between 2005 and 2009. It was accompanied by other health reform measures to increase public financing and public sector planning to secure the guarantees nationwide, as well as the state's stewardship role. We analysed data from household surveys conducted before and after the AUGE reform to estimate changes in levels of unmet health need, defined as the lack of a healthcare visit for a health problem occurring in the last 30 days, by age, sex, income, education, health insurance, residence and ethnicity; fitting logistic regression models and using predictive margins. The overall prevalence of unmet health need was much lower in 2009 (17.6%, 95% CI: 16.5%, 18.6%) than in 2000 (30.0%, 95% CI: 28.3%, 31.7%). Differences by income and education extremes and rural-urban residence disappeared. In 2009, people who had been in treatment for a condition covered by AUGE in the past year had a lower adjusted prevalence of unmet need for their recent problem (11.7%, 95% CI: 10.5%, 13.2%) than who had not (21.0%, 95% CI: 19.6%, 22.4%). Despite limitations including cross-sectional and self-reported data, our findings suggest that the Chilean health system has become more equitable and responsive to need. While these changes cannot be directly attributed to AUGE, they were coincident with the AUGE reforms. However, healthcare equity concerns are still present, relating to quality of care, health system barriers and differential access for health conditions that are not covered by AUGE.Item Análisis de una experiencia de consultoría ético clínica en cuidado intensivo(2010) Beca, Juan Pablo; Delgado, Iris; Solar, Sebastián; KOPPMANN A, ALEJANDRO; CHÁVEZ, PAMELASon muy pocos los pacientes que se presentan a los comités de ética, y las consultas éticas individuales son una respuesta a esta situación. En la unidad de cuidados intensivos (UCI) de Clínica Alemana, Santiago de Chile, se organizó un sistema de consulta de ética coordinado con el comité de ética. Objetivo: Informar una evaluación de este sistema de consulta ética. Material y métodos: Análisis de los primeros 50 casos analizados en el sistema de consulta. Análisis de las respuestas de los médicos de cuidados intensivos a un cuestionario sobre los principales problemas éticos a los que se enfrentan en su trabajo. Resultados:El sistema de consulta es requerido principalmente por el personal de la UCI y reporta al comité de ética. El 54% de los pacientes consultados tenían más de 80 años. Los principales diagnósticos fueron problemas neurológicos, oncológicos o cardiopulmonares. Los problemas éticos identifcados fueron limitación del tratamiento (62%), proporcionalidad o futilidad (42%), necesidad de una muerte pacífica (36%), falta de decisiones anticipadas (28%), desacuerdo entre médicos y familiares del paciente (24 %), subrogación indefinida (14%) y abuso de recursos públicos (14%). Veintiséis de los 31 médicos de la UCI respondieron el cuestionario, utilizando una escala de 1 (mínimo) a 7 (máximo). Descubrieron que la consulta es útil para la toma de decisiones (6,3), útil para mejorar la percepción ética (6,0), de apoyo para el personal (6,5), buena para los pacientes (6,3), de apoyo para las familias (6,7),Conclusiones: Como complemento al trabajo del comité de ética, la consulta es una alternativa válida para el asesoramiento ético y un apoyo para los médicos y familiares de los pacientes. Su implementación depende de las particularidades de cada institución de salud.Publication Assessing Pulmonary Epithelial Damage in Hantavirus Cardiopulmonary Syndrome: Challenging the Predominant Role of Vascular Endothelium through sRAGE as a Potential Biomarker(2023) Meza, Gabriela; López, René; Vial Cox, María Cecilia; Cortes, Lina; Retamal, Mauricio A.; Delgado, IrisHantavirus cardiopulmonary syndrome (HCPS) is a severe respiratory illness primarily associated with microvascular endothelial changes, particularly in the lungs. However, the role of the pulmonary epithelium in HCPS pathogenesis remains unclear. This study explores the potential of soluble Receptors for Advanced Glycation End-products (sRAGE) as a biomarker for assessing pulmonary epithelial damage in severe HCPS, challenging the prevailing view that endothelial dysfunction is the sole driver of this syndrome. We conducted a cross-sectional study on critically ill HCPS patients, categorizing them into mild HCPS, severe HCPS, and negative control groups. Plasma sRAGE levels were measured, revealing significant differences between the severe HCPS group and controls. Our findings suggest that sRAGE holds promise as an indicator of pulmonary epithelial injury in HCPS and may aid in tracking disease progression and guiding therapeutic strategies. This study brings clarity on the importance of investigating the pulmonary epithelium's role in HCPS pathogenesis, offering potential avenues for enhanced diagnostic precision and support in this critical public health concern.Item Assistive Devices for Older Adults: A Longitudinal Study of Policy Effectiveness, Santiago, Chile, 2014–2016(2019) Hirmas, Macarena; Olea, Andrea; Matute, Isabel; Delgado, Iris; Aguilera, Ximena; Poffald, Lucy; González, Claudia; Nájera, Manuel; Gómez, María Inés; Gallardo, Ligia; Abusleme, María Teresa; Leppe, Jaime; Mery, Hernán; Recabarren, Eladio; Massad, Cristián; Bustamante, HernánINTRODUCTION Population aging is a worldwide phenomenon. It is estimated that by 2050, one of five persons will be aged ≥60 years. In Chile, 15.8% of the population is now aged ≥60 years, and this figure will reach 30.7% by 2050. In 2006, a national program was implemented to provide assistive devices to older adults aged ≥65 years with limited mobility or difficulty performing activities of daily living. To date, there have been no assessments of the program's effectiveness. OBJECTIVE Assess the effectiveness of an assistive devices policy in Chile on improving functional capacity of older adults aged ≥65 years, and beneficiaries' perceptions of the services received, including changes in their quality of life. METHODS This was a before-after longitudinal study. A cohort of 309 persons was recruited, consisting of patients who received care at a public hospital in Santiago, Chile during 2014-2015. They were assessed before delivery of assistive devices, then followed for seven months, with repeated evaluations made in their homes. The following indicators were measured: functional capacity (Tinetti scale and Barthel Index); changes in perceived quality of life related to use of assistive devices; and other sociodemographic, clinical and protocol-compliance variables. A longitudinal analysis of before-after progress was carried out, as well as a description of service delivery and medical followup. RESULTS Sixty-eight percent of those surveyed were women; median age was 74 years, average schooling was 6 years, and 93% had low income (monthly incomeItem Características clínicas y factores pronósticos de la enfermedad meningocóccica: un estudio de serie de casos en Chile durante el brote 2012-2013(Sociedad Chilena de Infectología, 2015) Matute, Isabel; Olea, Andrea; López, Darío; Loayza, Sergio; Nájera, Manuel; González, Claudia; Poffald, Lucy; Hirmas, Macarena; Delgado, Iris; Pedroni, Elena; Alfaro, Tania; Gormaz, Ana María; Sanhueza, Gabriel; Vial, Pablo; Dabanch, Jeannette; Gallegos, Doris; Aguilera, XimenaIntroduction: 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.Item Case fatality rate and associated factors in patients with 22q11 microdeletion syndrome: a retrospective cohort study(BMJ Publishing Group, 2014) Repetto, Gabriela; Guzmán, Maria Luisa; Delgado, Iris; Loyola, Hugo; Palomares, Mirta; Lay-Son, Guillermo; Vial, Cecilia; Benavides, Felipe; Espinoza, Karena; Alvarez, PatriciaOBJECTIVE: Chromosome 22q11.2 deletion is the most commonly occurring known microdeletion syndrome. Deaths related to the syndrome have been reported, but the magnitude of death has not been quantified. This study evaluated the deletion's impact on survival and its clinical manifestations in a large cohort of Chilean patients. DESIGN: Demographic and clinical data of individuals with 22q11 deletions diagnosed between 1998 and 2013 were collected from medical records and death certificates. Case fatality rate was calculated and compared with national vital statistics. OR with 95% CI analysis was used to assess the association between clinical manifestations and death. SETTING: Genetic services in tertiary care centres in Chile, following patients with 22q11.2 deletion. OUTCOMES: Fatality rate and associated factors. RESULTS: 59 of 419 patients (14.1%) died during the study period at a median of 3.4 months (range 0 to 32 years of age). Factors associated with death included congenital heart disease (OR 5.27; 95% CI 2.06 to 13.99; p<0.0001), hypocalcaemia (OR 4.27; 95% CI 1.67 to 11.15; p<0.002) and airway malacia (OR 13.37; 95% CI 1.19 to 110.51; p<0.002). Patients with deletions and defects such as tetralogy of Fallot with or without pulmonary atraesia, truncus arteriosus or ventricular septal defect, had a 2.6-fold to 4.6-fold higher death rate compared with nationwide reports for the same types of defects. CONCLUSIONS: In this cohort, we observed a death rate of 14.1%, implying that one in seven patients with 22q11 deletion died during the study period. Significant associations with cardiac defects, hypocalcaemia and airway malacia were observed. Furthermore, the death risk in patients with 22q11 deletion and cardiac defects exceeded the global figures observed in Chile for infants with structurally similar but apparently isolated anomalies. These observations indicate a need to identify patients who may require specific perioperative management to improve survival.Item Case−Control Study of Risk Factors for Meningococcal Disease in Chile(Centers for Disease Control and Prevention, 2017) Olea, Andrea; Matute, Isabel; Gonzalez, Claudia; Delgado, Iris; Poffald, Lucy; Pedroni, Elena; Alfaro, Tania; Hirmas, Macarena; Nájera, Manuel; Gormaz, Ana; Lopez, Dario; Sergio, Loayza; Ferreccio, Catterina; Gallegos, Doris; Fuentes, Rodrigo; Vial, Pablo; Aguilera, XimenaAn 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.Item Comparison of Muscular Power Between Dominant and Nondominant Legs in Healthy Young Adults Associated With Single-Leg-Dominant Sports(2017) Vaisman, Alex; Guiloff, Rodrigo; Rojas, Juan; Delgado, Iris; Figueroa, David; Calvo, RafaelBackground: Achieving a symmetrical power performance (difference <15%) between lower limbs is generally recommended during sports rehabilitation. However, athletes in single-leg-dominant sports, such as professional soccer players, could develop significant asymmetry between their dominant and nondominant legs, such that symmetry does not act as a viable comparison. Purpose: To (1) compare maximal muscular power between the dominant and nondominant legs in healthy young adults, (2) evaluate the effect of a single-leg-dominant sport activity performed at the professional level, and (3) propose a parameter of normality for maximal power difference in the lower limbs of this young adult population. Study Design: Controlled laboratory study. Methods: A total of 78 healthy, male, young adults were divided into 2 groups according to sport activity level. Group 1 consisted of 51 nonathletes (mean ± SD age, 20.8 ± 1.5 ears; weight, 71.9 ± 10.5 kg) who participated in less than 8 hours a week of recreational physical activity with nonspecific training; group 2 consisted of 27 single-leg-dominant professional soccer players (age, 18.4 ± 0.6 years; weight, 70.1 ± 7.5 kg) who specifically trained and competed at their particular activity 8 hours or more a week. For assessment of maximal leg power, both groups completed the single-leg squat jump test. Dominance was determined when participants completed 2 of 3 specific tests with the same extremity. Statistical analysis included the Student t test. Results: No statistical difference was found for maximal power between dominant and nondominant legs for nonathletes (t ¼ –1.01, P ¼ .316) or single-leg-dominant professional soccer players (t ¼ –1.10, P ¼ .281). A majority (95%) of participants studied showed a power difference of less than 15% between their lower extremities. Conclusion: Among young healthy adults, symmetrical power performance is expected between lower extremities independent of the existence of dominance and difference in sport activity level. A less than 15% difference in power seems to be a proper parameter to define symmetrical power performance assessed by vertical single-leg jump tests.Item Compliance with the smoking ban in enclosed, semiopen and open areas of workplaces and public places in Chile(2020) Peruga, Armando; Molina, Xaviera; Delgado, Iris; Matute, Isabel; Olea, Andrea; Hirmas, Macarena; González, Claudia; Aguilera, XimenaObjective 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.Item Continuous EPO receptor activator therapy of anemia in children under peritoneal dialysis(2011) Cano, Francisco; Alarcón, Claudia; Azocar, Marta; Lizama, Carolina; Lillo, Ana María; Delucchi, Ángela; González, Mariluz; Arellano, Patricia; Delgado, Iris; Droguett, María TeresaThe short half-life of erythropoietin (rHuEPO) leads to repeated fluctuations in hemoglobin levels and the need for frequent administration. Continuous erythropoietin receptor activator (CERA) therapy has been approved for once or twice a month in adult dialysis patients. To evaluate the efficacy and safety of CERA therapy in the management of anemia in pediatric peritoneal dialysis (PD) stable PD children under twice-a-week EPO were converted to a subcutaneous CERA, scheduled every 2 weeks. The follow-up was 6 months. The primary efficacy parameter was hemoglobin > 11 g/dL. The exclusion criteria were ferritin < 100 ng/ml and Hb saturation < 20%. Sixteen children, aged 9.75 +/- 3.6 years, including 11 boys, participated in the study. Mean Hb level at month 0 was 10.8 +/- 1.9 g/dL. A decrease in hemoglobin to 10.38 +/- 1 g/dL at month 2 was observed. The CERA dose was increased from 0.86 +/- 0.33 to 1.67 +/- 0.4 mu g/kg at month 3. The target Hb level was reached by the 3rd month. The Hb level and CERA dose were 12.2 +/- 1.2 and 1.6 +/- 0.67 mu g/kg respectively at the end of the study. No adverse events were observed during the protocol. CERA is an effective and safe therapy for maintaining hemoglobin levels when administered twice, up to once a month, in PD children. Doses required to reach target Hb were higher than published experiences in adult populations.Item Correlación clínica – imagenológica – artroscópica en el diagnóstico de las lesiones meniscales(2011) Figueroa, PD; Vaisman, B A; Calvo, R R; Mococain, M P; Delgado, IrisObjetivo: Evaluar la relación que existe entre la localización e intensidad del dolor en la interlínea articular referida por el paciente y objetivada al examen físico, con el tipo y localización de la lesión meniscal encontrada en el estudio imagenológico y en la artroscopía de rodilla. Método: Estudio prospectivo, observacional, longitudinal en 34 pacientes consecutivos con diagnóstico clínico y artroscópico de rotura meniscal sintomática. Se registró la ubicación del dolor, se realizó una resonancia magnética (RM) y finalmente todos los pacientes fueron evaluados mediante una artroscopía de rodilla. Resultados: Encontramos una excelente correlación entre la expresión clínica del dolor y los hallazgos artroscópicos (p ‹ 0.001), así como también entre la clínica y la RM (p ‹ 0.001). Conclusión: El correlacionar la expresión clínica de la patología meniscal con la lesión anatómica tal podría ser de ayuda al momento de indicar la cirugía, ya que al identificar ciertos tipos de roturas meniscales clínicamente, potencialmente podría incidir en el momento más adecuado para realizar la intervención. Al respecto, nuestro estudio demuestra que no hay una relación significativa entre la magnitud del dolor y la lateralidad de la lesión, así como tampoco entre la magnitud del dolor y el tipo de lesión diagnosticado en la artroscopía, lo que indica que no se podría seleccionar a los pacien longites según la anatomía de la lesión sólo utilizando el examen físicoItem Detección y abordaje fonoaudiológico de fallas en el implante coclear de usuarios pediátricos de la Región Metropolitana(Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, 2020) Concha, Macarena; Rodríguez, Javiera; Delgado, IrisIntroducción: EnChile la hipoacusia alcanza un 8,74% de las deficiencias que causan discapacidad. El Implante Coclear(IC)es un dispositivo de ayuda auditiva que permiten mejorar el rendimiento auditivo y calidad de vida, sin embargo, su instalación no está exenta de complicaciones. Objetivo: Analizar los aspectos relacionados con la frecuencia, detección y abordaje del rehabilitador al encontrarse con una falla en el funcionamiento del dispositivo coclear en niños de 1 a 7 años de la Región Metropolitana. Metodología:Elestudio es de tipo cuantitativo,observacionalytransversal. La población de estudio son rehabilitadores especialistas en audiología que trabajen con pacientes de 1 a 7 años con IC, de instituciones tanto públicas como privadas dentro de la Región Metropolitana.Se utilizó un cuestionario creado por las investigadoras, aplicado a 15 rehabilitadores. Resultado: La tasa de fallas de IC en el último año es de 12,5%. El componente que mayormente tiende a fallar es el cable con un 51,7%,siendo de manifestación abrupta en la mayoría de los casos. El 62.5% de los casos son los padres quienes detectan esta falla donde el 40% menciona observar cambios en la conducta de sus hijos.En cuanto al abordaje, un 46,7% de los rehabilitadores utiliza el “Test de Ling” paracorroborar una falla, y el 86,7% menciona derivar al audiólogo tratante luego de verificar la falla. Discusión: La frecuencia de fallas detectada a través de los rehabilitadores de laRM es mayor a la documentada internacionalmente. Conclusión: Dado el gran uso del IC es necesario generar evidencia para conocer y documentar fallas en este dispositivo para definir programas de intervención que apunten a disminuir la prevalencia de fallas del IC y al abordaje para el rehabilitador y cuidador.Item Did socioeconomic inequality in self-reported health in Chile fall after the equity-based healthcare reform of 2005? a concentration index decomposition analysis(PLoS, 2015) Cabieses, Báltica; Cookson, Richard; Espinoza, Manuel; Santorelli, Gillian; Delgado, IrisOBJECTIVE: Chile, a South American country recently defined as a high-income nation, carried out a major healthcare system reform from 2005 onwards that aimed at reducing socioeconomic inequality in health. This study aimed to estimate income-related inequality in self-reported health status (SRHS) in 2000 and 2013, before and after the reform, for the entire adult Chilean population. METHODS: Using data on equivalized household income and adult SRHS from the 2000 and 2013 CASEN surveys (independent samples of 101 046 and 172 330 adult participants, respectively) we estimated Erreygers concentration indices (CIs) for above average SRHS for both years. We also decomposed the contribution of both "legitimate" standardizing variables (age and sex) and "illegitimate" variables (income, education, occupation, ethnicity, urban/rural, marital status, number of people living in the household, and healthcare entitlement). RESULTS: There was a significant concentration of above average SRHS favoring richer people in Chile in both years, which was less pronounced in 2013 than 2000 (Erreygers corrected CI 0.165 [Standard Error, SE 0.007] in 2000 and 0.047 [SE 0.008] in 2013). To help interpret the magnitude of this decline, adults in the richest fifth of households were 33% more likely than those in the poorest fifth to report above-average health in 2000, falling to 11% in 2013. In 2013, the contribution of illegitimate factors to income-related inequality in SRHS remained higher than the contribution of legitimate factors. CONCLUSIONS: Income-related inequality in SRHS in Chile has fallen after the equity-based healthcare reform. Further research is needed to ascertain how far this fall in health inequality can be attributed to the 2005 healthcare reform as opposed to economic growth and other determinants of health that changed during the period.Item Enfermería escolar como protagonista de la política pública de salud en educación(Universidad del Desarrollo. Facultad de Gobierno, 2021-08) Moreno Pérez, Danilo Andrés; Silva Burgos, Luis; Delgado, IrisEl presente estudio tiene por objetivo analizar los elementos que determinan la inclusión de los profesionales de Enfermería en los establecimientos de educación escolar, así como también conocer las experiencias de Enfermeras y de distintos actores que se relacionan con la Enfermería escolar lo que finalmente permitirá identificar los factores que favorecen e impiden su inclusión en los establecimientos de educación escolar. Se trata de un estudio cualitativo, con un diseño de tipo fenomenológico en donde a través de un muestreo no probabilístico, intencionado y variado se realizaron 13 entrevistas en profundidad, enfocados en distintos actores de interés en área de la salud, educación y política, junto a lo anterior se utilizó una encuesta online como método complementario de recolección de datos dirigido a profesionales de enfermería escolar pertenecientes a la Sociedad Chilena de Enfermería Escolar con el objetivo de caracterizar a esta comunidad. Los hallazgos revelan que la enfermería escolar posee competencias que les permiten encargarse de una comunidad de forma positiva e integral durante todo su ciclo vital y lograr además incluir a sus familias y su entorno, sin embargo, los factores que impiden la incorporación de los profesionales a los establecimientos se encuentran supeditados al rol del Estado.Item Estructura y funcionamiento del sistema de salud chileno. Serie de Salud Poblacional N°2(Universidad del Desarrollo, 2019) Aguilera, Ximena; Castillo, Carla; Covarrubias, Trinidad; Delgado, Iris; Fuentes, Rodrigo; Gómez, María Inés; González, Claudia; Hirmas, Macarena; Matute, Isabel; Olea, Andrea; Quiroga, Anita; Urrejola, Oscar; Soto, Marco; Aguilera, Ximena; Castillo, Carla; Covarrubias, Trinidad; Delgado, Iris; Fuentes, Rodrigo; Gómez, María Inés; González, Claudia; Hirmas, Macarena; Matute, Isabel; Olea, Andrea; Quiroga, Anita; Urrejola, Oscar; Soto, MarcoCon este documento ponemos a su disposición la segunda publicación de la serie Salud Poblacional del Centro de Epidemiología y Políticas de Salud, dedicada en esta oportunidad a entregar una visión global sobre la estructura, organización y funcionamiento del sistema de salud chileno, como una herramienta que permita a los estudiantes comprender su estructura, funciones y complejas interrelaciones.Item Estudio Descriptivo. Comportamiento del ausentismo laboral, por causa médica, en los trabajadores protegidos por el seguro social de Chile, en el periodo 2018-2019(Universidad del Desarrollo. Facultad de Gobierno, 2021-09) Cáceres Ruíz, Carolina Paz; Delgado, Iris; Rojas Jara, ArmandoLa presente investigación aborda la problemática del ausentismo laboral en Chile por causa médica, fenómeno que según la Organización Mundial de la Salud, (OMS) citado por Llanos (2016, p. 7) lo define como “La falta de asistencia de los empleados a sus puestos de trabajo por causa directa o indirectamente evitables, tales como: Enfermedad, cualquiera que sea su duración y carácter común, profesional, accidente laboral, no incluidas las visitas médicas, así como las ausencias injustificadas durante toda o parte de la jornada laboral, y los permisos circunstanciales dentro del horario laboral “. Sobre el particular, la definición de Ausentismo laboral de la OMS, contempla los elementos “causa evitable”, es por ello que la investigación de las causas, es fundamental para prevenir y potenciar programas de salud y de seguridad, en torno a la mantención de la salud de la población laboral. Por una parte, el ausentismo laboral es un indicador del estado de salud de la población laboral de un país, cuantificable a través del número de licencias médicas otorgadas a los cotizantes del seguro de salud y un indicador económico del gasto del sistema de salud, por concepto de Subsidio de Incapacidad Laboral (SIL). Al respecto, la Superintendencia de Seguridad Social (SUSESO), informó que en el año 2019 se otorgaron más de 6 millones de licencias médicas correspondientes a 77.603.153 días de ausentismo laboral, lo que significó en 2019 para el sistema de salud público y privado el pago de MM$1.544.620 por concepto de SIL.(SUSESO,2019a) Por otra parte, el ausentismo laboral, también es un parámetro que permite identificar la capacidad de desarrollo de un país y que permite comparar a los países en este ámbito. En dicho contexto, Chile es país miembro de La Organización para la Cooperación y Desarrollo Económicos (OCDE), organización que lleva a cabo evaluaciones entre pares y desarrolla estándares y reglas de cooperación internacional. En 2012, la OCDE señala a Chile como el país con mayor ausentismo laboral por enfermedad en sus funcionarios públicos, muy superior al resto de sus países integrantes, con un ausentismo promedio anual de 15,7 días por trabajador, siendo el estándar OCDE, 11 días. (OCDE, 2012) Si bien existen elementos que permiten de forma indirecta observar el ausentismo laboral en Chile, el presente estudio tiene como objetivo profundizar las estadísticas antes mencionada y presentar indicadores de ausentismo laboral con resultados que permitan determinar el comportamiento y la caracterización de la población laboral con derecho a licencia médica, entre 2018-2019, en sus distintos grupos etarios, actividades económicas y distribución territorial. En términos generales, la presente investigación corresponde a un estudio descriptivo con paradigma positivista a través de un diseño cuantitativo. La población de estudio es todo trabajador (a) que se encuentre cubierto por el sistema de previsión social de Chile y que hubiere presentado una licencia médica en los años 2018 o 2019. La información utilizada para el análisis estadístico son las bases de datos de los sistemas informáticos de la Superintendencia de Seguridad Social, específicamente los que contienen las licencias médicas electrónicas de origen común y las licencias u órdenes de reposo laborales. Excluyendo las licencias maternales y las relativas a enfermedad grave del niño menor de un año.Item Evaluación comparativa entre MELD y Child-Pugh como escalas pronósticas de sobrevida en pacientes con cirrosis hepática en Chile(Sociedad Medica de Santiago, 2017) Sanhueza, Edgar; Contreras, Jorge; Zapata, Rodrigo; Sanhueza, Matías; Elgueta, Fabián; López, Constanza; Jerez, Sigrid; Jerez, Verónica; Delgado, IrisBackground: Currently, most liver units use the Child-Pugh (CP) or the Model for End-Stage Liver Disease (MELD) scores to establish survival prognosis among patients with liver cirrhosis. Which classification is superior, is not well defined. Aim: To compare CP and MELD classification scores to predict survival among adult patients with liver cirrhosis in Chile. Material and Methods: Follow-up of 137 consecutive adult patients with liver cirrhosis aged 59 ± 12 years (55% women). The diagnosis was reached by clinical, laboratory and image studies at three different centers of Santiago. Patients were staged with CP and MELD classification scores at baseline and followed over a period of 12 months. The predictive capacity of the scores for survival was analyzed using a multivariate statistical analysis (Kaplan-Meier curves). Results: The most common etiology was alcohol (37.9%). The actuarial survival rate was 79.6% at 12 months of follow-up. When comparing groups with areas under curve of receiver operating characteristic curves (AUROC), there was no statistically significant difference in survival between less severe and advanced disease, assessed with both survival scales. The AUROC for MELD and CP were 0.80 and 0.81, respectively. Conclusions: This clinical study did not find a statistically significant difference between the two classifications for the prediction of 12 months survival in patients with cirrhosis.Item Evaluation of the effectiveness and equity of the maternity protection reform in Chile from 2000 to 2015(2019) Delgado, Iris; Cabieses, Báltica; Apablaza, Mauricio; Castillo, Carla; Aguilera, Ximena; Matute, Isabel; Najera, Manuel; Pericás, Juan M.; Benach, JoanIntroduction According to the International Labor Organization, Maternity Protection (MP) policies try to harmonize child care and women’s paid work, without affecting family health and economic security. Chile Law 20.545 (2011) increased benefits for economically active women and reduced requirements for accessing these benefits. The goals of the reform included: 1) to increase MP coverage; and 2) to reduce inequities in access to the benefits. Method This study uses two data sources. First, using individual data routinely collected from 2000 to 2015, yearly MP coverage access over time was calculated. Second, using national representative household surveys collected before and after the Law (2009 and 2013), coverage and a set of measures of inequality were estimated. To compare changes over time, we used non-experimental, before-after intervention design for independent samples. For each variable, we estimated comparative proportions at 95% confidence interval before and after the intervention. Additionally, we included multivariate and propensity score analysis. Results Between 2000 and 2015, MP coverage grew from 24.4% to 44.8%. Using comparable 2009 and 2013 survey data, we observed the same trend, with 31.6% of estimated MP coverage in 2009, escalating to 39.5% in 2013. We conclude that: 1) after the reform, there was an increase in MP coverage; and, 2) there was no significant reduction of inequities in the distribution of MP benefits. Discussion/Conclusion Few scientific evaluations of MP reforms have been conducted worldwide; even fewer including an equity analysis. This study provides an empirically-based evaluation of MP reform from both a population-level and an equity-focused perspective. We conclude that this reform needs to be complemented with other policies to ensure maternity protection in terms of access and equity in a country with deep socioeconomic stratification.Item Evolución de las licencias por enfermedad grave del niño(a) menor de un año 2004-2008: certezas e interrogantes(Sociedad Medica de Santiago, 2012) Delgado, Iris; Hirmas, Macarena; Prieto, FlorenciaBackground: The increase in expenses of the health care system caused by sick leaves, especially those granted to mothers with children of less than one year of age with severe diseases, is a topic of concern. Aim: To describe the rates of sick leaves granted to mothers with children of less than one year of age with severe diseases from 2004 to 2008. Material and Methods: Analysis of databases containing information about sick leaves coming from Chilean public and private health care subsystems. Leaves granted to mothers with sick children of less than one year were specifically analyzed in terms of days off work and the amount of monetary benefits. Results: A sustained increase, ranging from 20 to 120% in the number of sick leaves motivated by diseases of children of less than one year, was observed. Thirty four percent of maternity leaves concentrate immediately after finishing the legal period (24 weeks after birth) and almost 60% of them occured within the first 6 months after birth. The most frequent diagnoses that motivated the higher number of leaves were gas-troesophageal reflux and bronchitis. Conclusions: There is probably a bad use of the benefit in a percentage of leaves. The benefit is also regressive since it favors mostly mothers of a better socioeconomic condition. The law that will extend the postnatal maternity leave will solve in part these problems.