Browsing by Author "Rada, Isabel"
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Item A comparative analysis of health status of international migrants and local population in Chile: a population-based, cross-sectional analysis from a social determinants of health perspective(2022) Oyarte, Marcela; Cabieses, Báltica; Rada, IsabelBackground: During recent decades intraregional migration has increased in Latin America. Chile became one of the main receiving countries and hosted diverse international migrant groups. Evidence have suggested a healthy migrant effect (HME) on health status, but it remains scarce, controversial and needs to be updated. This study performed a comprehensive analysis verifying the existence of HME and its association with social determinants of health (SDH). Methods: We analyzed data from the Chilean National Socioeconomic Characterization Survey (CASEN, version 2017). Unadjusted prevalence of health status indicators such as negative self-perceived health, chronic morbidity, disability, and activity limitations were described in both international migrants and local population. Adjusted associations between these outcomes and sets of demographics, socioeconomic, access to healthcare, psychosocial and migration-related SDH were tested using multivariate logistic regression in each population. The HME for each health outcome was also tested using multivariate logistic regression and sequentially adjusting for each set of SDH (ref = Chilean). Results: International migrants had lower unadjusted prevalence of all health indicators compared to Chileans. That is, unadjusted analysis revealed an apparent HME in all health outcomes. Age, unemployment, and health care system affiliation were associated with health outcomes in both populations. Psychosocial determinants were both risk and protective for the analysed health outcomes. After adjustment for each set of SDH, the immigrant health advantage was only significant for chronic morbidity. Being migrant was associated with 39% lower odds of having chronic diseases compared to locals (OR: 0.61; 95% CI: 0.44-0.84; P = 0.0003). For all other outcomes, HME disappeared after adjusting by SDH, particularly unemployment, type of health system and psychosocial factors. Conclusions: Testing the HME in Chile revealed an advantage for chronic morbidities that remained significant after adjustment for SDH. This analysis shed light on health disparities between international migrants and local population in the Latin American region, with special relevance of unemployment, type of health system and psychosocial SDH. It also informed about differential exposures faced during migration process that could dissolve the HME over time. Evidence from this analytical approach is useful for informing health planning and intersectoral solutions from a SDH perspective.Item Alternativas de estrategias para una respuesta ética dirigida a personas migrantes internacionales en residencias sanitarias durante emergencias sanitarias. Policy Brief(Instituto de Ciencias e Innovaión en Medicina, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo;Organización Mundial de la Salud, 2021) Cabieses, Báltica; Obach, Alexandra; Blukacz, Alice; Carreño Calderón, Alejandra; Larenas, Daniel; Rada, Isabel; Mompoint, EmanuelEl Programa de Estudios Sociales en Salud (PROESSA) del Instituto de Ciencias e Innovación Médica (ICIM), Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, con el patrocinio de la Organización Mundial de la Salud (OMS), presenta este documento, realizado en base a los resultados obtenidos en el Proyecto Migrantes internacionales en residencias sanitarias en Chile durante la pandemia COVID-19: Hacia una respuesta ética en emergencias sanitarias. Este Policy Brief, estructura cuatro alternativas de estrategia a implementar, explicitando para cada una sus beneficios, potenciales perjuicios, factores de incertidumbre, aspectos clave para su implementación y la visión de actores interesados. Tiene como propósito facilitar un proceso de toma de decisiones basadas en evidencia en torno al cuidado ético de migrantes internacionales en centros de cuarentena, siendo un insumo para tomadores de decisiones, organizaciones internacionales, organizaciones no gubernamentales y organizaciones de la sociedad civil interesadas en temáticas relacionadas a la salud de migrantes internacionales.Item Alternativas de estrategias Sanitarias con perspectiva intercultural dirigidas a comunidades de migrantes internacionales vulnerables en Chile en contexto de pandemia. Policy brief(Instituto de Ciencias e Innovaión en Medicina, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo; Agencia Nacional de Investigación, 2021) Cabieses, Báltica; Obach, Alexandra; Blukacz, Alice; Vicuña, José Tomás; Carreño Calderón, Alejandra; Stefoni, Carolina; Pérez, Claudia; Avaria, Andrea; Urrutia, Carla; Oyarte, Marcela; Rada, Isabel; Schneider, StephenEl Programa de Estudios Sociales en Salud (PROESSA) del Instituto de Ciencias e Innovación Médica (ICIM), Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, con el patrocinio de la Agencia Nacional de Investigación y Desarrollo (ANID), presenta el Policy Brief Alternativas de estrategias sanitarias interculturales dirigidas a comunidades de migrantes internacionales vulnerables en Chile en contexto de pandemia. Este se encuentra enmarcado en el Proyecto Vulnerabilidades y recursos de comunidades migrantes internacionales en Chile para enfrentar la pandemia SARS-CoV-2: Construyendo estrategias diferenciadas desde la interculturalidad, financiado por la Dirección de Investigación y Desarrollo (DID) de la Universidad del Desarrollo y alojado en los proyectos ANID COVID-19 (código COVID0873). En base a los resultados del proyecto de investigación, el presente Policy Brief estructura cinco alternativas de estrategia a implementar, explicitando para cada una sus beneficios, potenciales perjuicios, factores de incertidumbre, aspectos clave para su implementación y la visión de actores interesados. A través de esto, el presente Policy Brief tiene como propósito contribuir al proceso de toma de decisiones basadas en evidencia para abordar la vulnerabilidad psicosocial y socioeconómica de migrantes internacionales en contexto de pandemia. Este Policy Brief se presenta como un apoyo para la toma de decisiones de diseñadoras de políticas públicas, organizaciones internacionales, organizaciones no gubernamentales y organizaciones de la sociedad civil que trabajan en temáticas de vulnerabilidad social, migración internacional y salud.Publication Calidad de vida relacionada con la salud en chilenos de comunas vulnerables(2023) Cabieses, Báltica; Rada, Isabel; Ortiz, ManuelObjetivo 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 Challenges for the prevention of hypertension among international migrants in Latin America: prioritizing the health of migrants in healthcare systems(2024) Cabieses, Báltica; Rada, IsabelAmong 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 Desafíos para el abordaje de la salud de los migrantes en Chile durante la pandemia por Covid-19: una revisión de alcance(2023) Cabieses, Báltica; Obach, Alexandra; Blukacz, Alice; Rada, Isabel; CARREÑO CALDERON, ALEJANDRA; Mezones, EdwardObjetivo.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.Item ¿Existe efecto de migrante sano en salud cardiovascular? Revisión narrativa de literatura científica(2021) Cabieses, Báltica; Rada, IsabelLa migración internacional es un proceso complejo que impacta la salud poblacional, siendo considerado un determinante social de la salud (DSS). Se ha expuesto una posible ventaja en salud en migrantes con respecto a nativos, llamada efecto de migrante sano (EMS). Actualmente su evidencia es controversial en salud cardiovascular. Se realizó una búsqueda en Web of Science y PubMed con términos referentes a migración, factores de riesgo enfermedades cardiovasculares y DSS. La búsqueda arrojó 2933 registros , se seleccionaron 90 publicaciones: 46 reportan evidencia del EMS (a favor, en contra, mixta o neutros) y 44 describen DSS asociados. El EMS parece aplicar selectivamente en condiciones específicas y subgrupos según origen y destino analizados. La evidencia de los DSS asociados favorece la comprensión de estas diferencias. Por lo tanto es necesario un enfoque de análisis amplio que integre las diversas exposiciones del proceso migratorio que podrían afectar la salud cardiovascular.Publication Genetics of spontaneous cervical and coronary artery dissections(2023) Munoz Venturelli, Paula; Rada, Isabel; Calderón, Juan; Martínez, GonzaloObjectives: Spontaneous cervical artery dissections (SCeAD) and coronary artery dissections (SCoAD) are major causes of neurovascular and cardiovascular morbidity in young adults. Although multiple aspects of their etiology are still unknown, most consensuses are focused on the presence of constitutional genetic aspects and environmental triggers. Since recent evidence of genetic contribution points to a possible overlap between these conditions, we aimed to describe current information on SCeAD and SCoAD genetics and their potential shared pathological aspects. Materials and methods: A narrative review is presented. Publications in English and Spanish were queried using database search. The articles were evaluated by one team member in terms of inclusion criteria. After collecting, the articles were categorized based on scientific content. Results: Given that patients with SCeAD and SCoAD rarely present connective tissue disorders, other genetic loci are probably responsible for the increased susceptibility in some individuals. The common variant rs9349379 at PHACTR1 gene is associated with predisposition to pathologies of the arterial wall, likely mediated by variations in Endothelin-1 (ET-1) levels. The risk of arterial dissection may be increased for those who carry the rs9349379(A) allele, associated with lower expression levels of ET-1; however, the local effect of this vasomotor imbalance remains unclear. Sex differences seen in SCeAD and SCoAD support a role for sex hormones that could modulate risk, tilting the delicate balance and forcing vasodilator actions to prevail over vasoconstriction due to a reduction in ET-1 expression. Conclusions: New evidence points to a common gene variation that could explain dissection in both the cervical and coronary vasculatures. To further confirm the risk conferred by the rs9349379 variant, genome wide association studies are warranted, hopefully in larger and ethnically diverse populations.Item Memoria Programa de Estudios Sociales en Salud: PROESSA/CESGI. 2015-2022(Universidad del Desarrollo. Facultad de Medicina, Clínica Alemana-ICIM. Programa de Estudios Sociales en Salud, 2022) Cabieses, Báltica; Obach, Alexandra; Bernales, Margarita; Pérez, Claudia; Markkula, Niina; Attalah, Celeste; Pedrero, Víctor; McIntyre, Ana María; Oyarte, Marcela; Chandía, Sabrita; Flaño, Javiera; Chepo, Macarena; Covarrubias, Trinidad; Astorga, Sofía; Ajraz, Nassim; Gálvez, Piedad; Carreño, Alejandra; Larenas, Daniel; Darrigrandi, Florencia; Agurto, Herleyn; Correa, Eliana; Moena, Olaya; Molina, Xaviera; Bussenius, Pascale; Sepúlveda, Camila; Urrutia, Carla; Blucakz, Alice; Silva, Claudia; Jaramillo, Karina; Rada, Isabel; Rodriguez, Cecilia; Alvarez, María Inés; Oliva, Alejandra; Vezzani, Francisca; Madrid, Paula; Roberts, Antonia; Campaña, CarlaPrograma interdisciplinario de investigación con foco en diversos procesos sociales que impactan en la salud poblacional en Chile y la región. Parte del Instituto de Ciencias e Innovaciones Médicas, ICIM, de la Facultad de Medicina Clínica Alemana, Universidad del Desarrollo.Item Promoting the Participation of “Hard-to-Reach” Migrant Populations in Qualitative Public Health Research during the COVID-19 Pandemic in Chile(2023) Blukacz, Alice; Cabieses, Báltica; Obach, Alexandra; Carreño, Alejandra; Álvarez, María; Madrid, Paula; Rada, IsabelThe COVID-19 pandemic has further deepened socioeconomic and health inequities worldwide, especially among populations experiencing social vulnerability, such as international migrants. Sustained lockdowns and social distancing have raised challenges to conducting public health research with hard-to-reach populations. This study aims at exploring strategies to recruit “hard-to-reach” international migrants for qualitative public health research during the pandemic in Chile, based on the authors’ experience. A retrospective qualitative evaluation process was carried out on the recruitment processes of three qualitative research projects focused on international migrants in Chile. All projects were implemented during the COVID-19 pandemic, demanding complementary and flexible strategies: (i) social media; (ii) snowball sampling; (iii) referrals from social workers and pro-migrant and migrant-led organizations; (iv) vaccination centers and healthcare centers; and (v) community-based recruitment. The strategies are qualitatively evaluated around seven emerging qualitative categories: (i) feasibility during lockdown periods; (ii) speed of recruitment; (iii) geographical coverage; (iv) sample diversity; (v) proportion of successful interviews; (vi) ethical considerations; and (vii) cost. Engaging hard-to-reach international migrants in public health research during the pandemic required constantly adapting recruitment strategies. Furthermore, relying on strategies that were not only Internet-based promoted the participation of populations with limited access to the Internet and low-digital literacy.Item Salud y efectos sociales en personas migrantes internacionales en tiempo de pandemia en Chile(Universidad del Desarrollo. Facultad de Medicina. ICIM;, 2022) Cabieses, Báltica; Obach, Alexandra; Rada, Isabel; Bacigalupo, Juan; Vezzani, Francisca; Wolleter, DanielaPublication The impact of stigma and discrimination-based narratives in the health of migrants in Latin America and the Caribbean: a scoping review(2023) Cabieses, Báltica; CARREÑO CALDERON, ALEJANDRA; Rada, Isabel; Belo, Karoline; Rojas, Karol; Araoz, Candelaria; Knipper, MichaelStigma 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 Unequal Access and Use of Health Care Services among Settled Immigrants, Recent Immigrants, and Locals: A Comparative Analysis of a Nationally Representative Survey in Chile(2022) Oyarte, Marcela; Cabieses, Báltica; Rada, Isabel; Blukacz, Alice; Espinoza, Manuel; Mezones-Holguin, EdwardGlobally, and particularly in the Latin American region, international migration continues to grow. Access and use of health care services by migrants vary according to their country of origin and residence time. We aimed to compare the access and use of health care services between international migrants (including settled migrants from Peru, Argentina, Bolivia, Ecuador; Emerging migrants from Venezuela, Dominican Republic, Colombia, Haiti; and migrants from other countries) and the Chilean population. After performing a secondary data analysis of population-based nationally representative surveys (CASEN 2011–2017), access and use patterns (insurance, complementary insurance, non-consultation, and non-treatment coverage) were described and compared among settled immigrants, recent emerging immigrants, others, and locals. Immigrants had a significantly higher uninsured population compared to locals. Specifically, in CASEN 2017, 19.27% of emerging (95% CI: 15.3–24.1%), 11.79% of settled (95% CI: 10.1–13.7%), and 2.25% of locals (95% CI: 2.1–2.4%) were uninsured. After 2013, settled and recent emerging migrants showed higher percentages of non-consultation. Collaborative and interculturally relevant strategies from human rights and equity perspectives are needed. Initiatives with a particular focus on recent immigrants can contribute to reducing the existing disparities in health care access and use with locals due to lack of insurance and treatment coverageItem Vulnerabilidades y recursos de comunidades migrantes internacionales en Chile para enfrentar la pandemia SARS-CoV-2: Construyendo estrategias diferenciadas desde la interculturalidad. Informe de resultados generales y recomendaciones para la política sanitaria.(Agencia Nacional de Investigación y Desarrollo; Instituto de Ciencias e Innovaión en Medicina, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, 2021) Cabieses, Báltica; Obach, Alexandra; Blukacz, Alice; Vicuña, José Tomás; Carreño Calderón, Alejandra; Stefoni, Carolina; Pérez, Claudia; Avaria, Andrea; Oyarte, Marcela; Rada, Isabel; Schneider, StephenEste informe pretende entregar los resultados obtenidos del estudio realizado para determinar las vulnerabilidades psicosociales y socioeconómicas que presenta la población migrante internacional que reside en Santiago de Chile, así como los recursos y capitales sociales que debiera de considerar la política pública sanitaria de modo de que sus estrategias y medidas sean efectivas y pertinentes