Browsing by Author "Hirmas, Macarena"
Now showing 1 - 14 of 14
Results Per Page
Sort Options
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 Barreras y facilitadores para el control prenatal en adolescentes: resultados de un estudio cualitativo en Chile(Instituto Nacional de Salud Pública de Mexico, 2013) Poffald, Lucy; Hirmas, Macarena; Aguilera, Ximena; Vega, Jeanette; González, María; Sanhueza, GabrielOBJECTIVE: Analyze barriers and facilitators of access to prenatal care in pregnant urban adolescents between 15-19 years of age in Santiago, Chile. MATERIALS AND METHODS: Qualitative study based on grounded theory with 17 adolescent mothers. Eleven semi-structured interviews and one focus group were conducted. RESULT: . The denial and concealment of pregnancy is the main barrier to start the prenatal care in the "delayed access group". This group does not identify facilitators. For maintenance in antenatal care, all participants identified a support figure as a facilitator. Family and social vulnerabilities explain why some adolescents start the prenatal care late. CONCLUSION: The presence of facilitators is crucial for both, the timely entry and the maintenance in antenatal care because they reduce or nullify the effect of barriers. The health system must become a facilitator to accompany adolescents and promote a bond of trust and respect.Item 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−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 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 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 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.Item Health insurance scheme performance and effects on health and health inequalities in Chile(Medical Education Cooperation with Cuba, 2017) Castillo, Carla; Aguilera, Ximena; Hirmas, Macarena; Matute, Isabel; Delgado, Iris; Nájera, Manuel; Olea, Andrea; González, ClaudiaINTRODUCTION Health systems are one determinant of health; their role is to facilitate timely and equitable access to quality services. The way in which a health system is organized can profoundly affect achievement of its objectives. The main feature of the Chilean health system is the coexistence of a public health insurance program (based on a social insurance model) with several market-based private health insurance companies. This hybrid structure provides an interesting framework for analyzing and evaluating the system’s effects on health inequalities. OBJECTIVE Assess Chilean public and private health insurance schemes’ performance and its effects on health inequalities. METHODS Public health insurance was compared with private insurance using indicators from 2013 (or the closest year) in the following domains: inputs, outputs (provider visits, discharges), outcomes (coverage) and impact (on health, quality of life, finances and patient satisfaction) as well as demographic and social determinant indicators. A conceptual framework for measuring health system performance was used. Data were obtained from administrative records and population-based surveys. RESULTS The publicly insured population had greater health care needs, was older (aging index 83.4 vs. 36.5) and poorer (17.2% vs. 1.5% below the poverty line) than the population covered by private insurers. The public insurer received average monthly funding of US$50.94 per beneficiary and spent US$51.43, while private insurers on average collected US$94.79 monthly per beneficiary, and spent US$69.63 on health services (excluding medical leave benefits). Private health insurance beneficiaries were more likely than their publicly insured counterparts to access specialized medical services (18.3% vs. 9.3%) and dentists (11.2% vs. 5.9%), have laboratory tests (18.1% vs. 4.8%), and undergo surgery (7.8% vs. 5.9%). Risk factor and disease prevalence was lower among private insurance beneficiaries for 16 of 18 tracer conditions, although age-adjusted differences were not significant. Finally, incidence of catastrophic spending was slightly lower among private insurance beneficiaries (3.7% vs. 4.2%), and a greater proportion of them were satisfied or very satisfied with the health system (37% vs. 17%). CONCLUSIONS The relative youth and better financial status of beneficiaries of private insurers is compatible with selection for lower risk. While private plans offer greater financial protection and receive higher user satisfaction ratings than the public plan, differences in financing between the two types of insurance affect availability and utilization of services. This constitutes a structural problem for the Chilean health system. There is an urgent need to move toward an integrated health system, in which incentives are aligned with social insurance objectives.Publication Immune response against SARS-CoV-2 of primary healthcare personnel in a commune of Santiago, Chile: follow-up at 6 months(2022) Matute, Isabel; Hirmas, Macarena; González, Claudia; Iruretagoyena, Mirentxu; Munita, José; Pedroni, Elena; Gómez, María; Córtez, L.; Hormazábal, J.; Olea, AndreaBackground The COVID-19 pandemic that emerged in Wuhan, China at the end of 2019, spread rapidly around the world with almost 600 million cases and 6.3 million deaths today. The most affected were health workers with at least three times the risk of contracting the disease than the general community. Most studies on seroprevalence in health workers focus on hospital care establishments and what happens in Primary Health Care (PHC) has not been investigated with the same intensity. Objectives to determine the prevalence and know the variation of antibody titers for SARS-CoV-2 in serial samples of primary healthcare personnel from the commune of La Pintana. Method an analytical observational study with a cross-sectional and a longitudinal component, carried out from November 2020 to June 2021. The first component consisted of an IgG antibody seroprevalence study performed at baseline (time 0) in volunteer of a universe of 900 workers. The longitudinal component considered the monitoring of IgG antibodies in those who presented a positive result at baseline and the analysis of neutralizing antibodies in a random sub-sample of 50% of them. Additionally, sociodemographic and clinical information was collected via a questionnaire. Univariate, bivariate, and longitudinal analyses were performed to evaluate differences in antibodies. The study was approved by the Universidad del Desarrollo’s Scientific Ethics Committee. Results 463 primary healthcare workers participated, mostly women and with a median of 38 years; doctors and nurses represented 9.5% each and 14.7% had a history of COVID-19. The seroprevalence at baseline was 22.3% and was associated with younger age, being a doctor and having been in close contact of a case. IgG titers increased with the vaccine, but decreased over time. At the 6-month follow-up, 76% had neutralizing antibodies. Those belonging to indigenous peoples had higher IgG levels and higher rates of neutralizing antibodies. Conclusion Healthcare workers were highly affected by COVID-19, and the medical profession and younger age were factors associated with increased risk. Antibodies decrease over time, highlighting the importance of follow-up studies, as well as the importance of vaccination boosters in healthcare workers, especially those in PHC.Item La ruta del medicamento en Chile(2022) Castillo, Carla; Aguilera, Ximena; Matute, Isabel; Aguilera, Ximena; Awad, Camila; Castillo, Carla; González Wiedmaier, Claudia; Hirmas, Macarena; Matute, Isabel; Olea, AndreaRuta del medicamento en Chile: principales actores, instituciones y procesos relacionados con el acceso a medicamentos. El presente documento se propone abordar el acceso a los medicamentos desde una mirada de los procesos, instituciones y actores relacionados, describiendo y analizando el camino que recorren, desde que se producen o importan, hasta su consumo por parte de la población.Item Modelling cost-effectiveness of syphilis detection strategies in prisoners: exploratory exercise in a Chilean male prison(2021) Castillo, Carla; Gajardo, Pedro; Nájera, Manuel; Matute, Isabel; Hirmas, Macarena; Aguirre, Pablo; Ramírez, Héctor; Ramírez, Daniel; Aguilera, XimenaSyphilis, together with other sexually transmitted infections, remains a global public health problem that is far from controlled. People deprived of liberty are a vulnerable population. Control activities in prisons rely mostly on passive case detection, despite the existence of affordable alternatives that would allow switching to active case-finding strategies. Our objective was to develop a mathematical modelling framework for cost-effectiveness evaluation, from a health system perspective, of different approaches using rapid tests for the detection of syphilis in inmates' populations and to explore the results based on a Chilean male prison population.Publication Respuesta inmunitaria al SARS-CoV-2 y factores asociados previo a la vacunación, en personal de salud de atención primaria en una comuna de Santiago, Chile(2022) Olea, Andrea; Matute, Isabel; Hirmas, Macarena; González, Claudia; Iruretagoyena, Mirentxu; Munita, José; Pedroni, Elena; Gómez, María; Nájera, ManuelIntroducción: La pandemia de COVID-19 surgida en China a fines de 2019, se extendió rápidamente por el mundo, con casi 600 millones de casos y 6,3 millones de fallecidos en la actualidad. Los más afectados fueron los trabajadores de la salud con al menos tres veces más riesgo que la comunidad general de contraer la enfermedad. La mayoría de los estudios sobre seroprevalencia en trabajadores de la salud, se enfocan en establecimientos de atención hospitalaria y no se ha indagado con igual intensidad sobre lo que ocurre en la Atención Primaria de Salud (APS). Objetivos: Determinar prevalencia de SARS-CoV-2 mediante anticuerpos IgG en personal de atención primaria de comuna de La Pintana y explorar sus características clínicas y factores de riesgo, previo a la vacunación en Chile. Metodología: Diseño transversal realizado en noviembre 2020. Se recogieron datos sociodemográficos y clínicos mediante entrevista cara a cara, previa firma de consentimiento. Se determinó IgG específica mediante ELISA que utiliza proteína N y S. Las diferencias entre sujetos positivos y negativos se estudiaron mediante análisis bivariado y para asociaciones encontradas, se desarrollaron modelos multivariados controlando potenciales variables de confusión. El estudio contó con la aprobación del Comité Ético Científico de la Universidad del Desarrollo. Resultados: Participaron 463 funcionarios (51,4%) encontrando prevalencia de 21,8%. Los factores de riesgo fueron edad menor, ser médico y haber sido contacto estrecho de un caso. El 22% fue asintomático. Entre quienes presentan anosmia o ageusia, la probabilidad de IgG+ fue superior a 70%. Los títulos de anticuerpos aumentan significativamente con la gravedad. Conclusiones: La prevalencia en personal de atención primaria encontrada es concordante con la evidencia previa en trabajadores de salud. La menor edad y la profesión de médico se asocian a un mayor riesgo de enfermar.Item ¿Sirven las ayudas técnicas a las personas mayores? Percepción desde la Atención Primaria sobre esta Garantía Explícita en Salud, Santiago, Chile(Esc. Salud Pública, Universidad de Chile, 2019) Hirmas, Macarena; Pofald, Lucy; Olea, Andrea; Ximena, Aguilera; Matute, Isabel; González, Claudia; Delgado, Iris; Nájera, Manuel; Gómez, María Inés; Gallardo, Ligia; Bustamante, Hernán; Di Silvestre, María CristinaObjetivo: Conocer la percepción de informantes clave pertenecientes a la red de Atención Primaria de Salud en Chile, respecto al proceso de gestión asistencial y el impacto del programa nacional de Garantías Explícitas en Salud (GES) sobre la entrega de ayudas técnicas a personas mayores. Materiales y métodos: Un estudio cualitativo basado en análisis de casos múltiples, en el cual se realizó entrevistas semi-estructuradas a 8 informantes clave de la red asistencial, fue desarrollado en 2015 en tres comunas de Santiago, Chile. El análisis de la información recogida se realizó mediante análisis de contenido, y se finalizó el muestreo de máxima variación al saturar la información. Se resguardaron los criterios de rigor científico y el protocolo fue aprobado por un Comité de Ética. Resultados: Hay una percepción de cobertura y detección de necesidad como adecuada en pacientes bajo control, aunque desde la perspectiva de los informantes, hay desconocimiento de esta garantía en la población. La necesidad es detectada por cualquier profesional de salud, pero la indicación es exclusivamente médica, lo que genera barreras de acceso. Hay una entrega oportuna; sin embargo, no se realiza seguimiento ni se aprecia como parte de una atención integral. Se percibe que la ayuda técnica es de calidad y la articulación de la red es adecuada, aunque no hay retroalimentación a Atención Primaria de Salud. El impacto lo consideran positivo en pacientes y familiares: mejora la ejecución de actividades diarias y genera mayor autonomía y capacidad de desplazamiento. Conclusiones: Existe una percepción positiva de este programa GES y su impacto en la mejoría en la calidad de vida de vida de los pacientes. Pero, la entrega de ayudas técnicas se encuentra desvinculada de una atención integral, por ende, este programa prioriza sólo la garantía de oportunidad.Item Tuberculosis in prisoners and their contacts in Chile: estimating incidence and latent infection(International Journal of Tuberculosis and Lung Disease, 2016) Aguilera, Ximena; González, C; Nájera, Manuel; Hirmas, Macarena; Delgado, Iris; Olea, Andrea; Lezaeta, L; Montaña, A; González, P; Homazábal, JC; Fernández, J; García, C; Herrera, TSETTING: Contact investigation of tuberculosis (TB) patients in Chilean prisons. OBJECTIVE: 1) To estimate TB incidence and the prevalence of latent tuberculous infection (LTBI) among prisoners and their contacts; and 2) to determine factors associated with disease transmission. DESIGN: Cross-sectional study conducted in 46 prisons (51% of the total prison population) to assess the prevalence of and risk factors for LTBI among contacts of prisoners newly diagnosed with pulmonary TB. We used in vitro interferon-gamma release assays to establish LTBI and a questionnaire to address risk factors. RESULTS: During the 1-year follow-up, we studied 418 contacts of 33 active TB cases. We found high TB incidence (123.9 per 100,000 prisoners) and high LTBI prevalence (29.4%) among contacts. LTBI rates are significantly higher in prison inmates than in non-prisoners (33.2% vs. 15.6%). Male sex, illicit drugs, malnutrition, corticosteroid use, low educational level and sharing a cell with a case increase the risk of LTBI. Multivariate analyses showed that corticosteroid use, duration of incarceration and overcrowding are the most relevant determinants for LTBI among all contacts. CONCLUSIONS: Our results confirm that incarceration increases the risk of tuberculous infection and TB disease, and that it was associated not only with origin from vulnerable groups, but also with the prison environment. Reinforcing TB control is essential to prevent TB transmission in prisons.