Browsing by Author "Poffald, Lucy"
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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.