Browsing by Author "Zitko, Pedro"
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Item Aging and health policies in chile: New Agendas for research(2017) Thumala, Daniela; Kennedy, Brian K; Calvo, Esteban; Gonzalez-Billault, Chriastian; Zitko, Pedro; Lillo, Patricia; Villagra, Roque; Ibáñez, Agustín; Assar, Rodrigo; Andrade, Maricarmen; Slachevsky, AndreaPopulation aging is among the most important global transformations. Compared to European and North American countries, Chile is among the countries with the fastest growth of life expectancy at birth during recent decades. The aging of Chile's population is related to the improvement of living conditions, but also entails risks that tend to be associated with a rapid economic growth accompanied by large income inequalities and a chronic deficit of basic social benefits. The rapid demographic transition towards an aged population has unfolded in a context of poor development of public policies to tackle the opportunities and needs associated with an aging society. This article provides a brief overview of current Chilean public policy on aging, with a focus on healthy aging as defined by World Health Organization. The discussion addresses core challenges to successfully achieve healthy aging in Chile.Item ¿Cómo se ha medido la posición social en investigación en salud? Una revisión de la literatura internacional(2011) Cabieses, Báltica; Zitko, Pedro; Pinedo, Rafael; Espinoza, Manuel; Albor, ChristoLa posición social (PS) es una variable multidimensional ampliamente utilizada en la investigación en salud. No hay una sola forma óptima de estimarla, sino que en cada caso su medición varía de acuerdo con la pregunta de investigación, la teoría considerada de base, la población de interés, el evento de interés y, en algunos casos, la información disponible. Esta revisión de literatura desarrolla los siguientes aspectos relacionados a la medición de la PS a partir de fuentes electrónicas científicas internacionales disponibles: i) identifica el rol de la PS en el contexto de la investigación epidemiológica social, ii) describe los principales indicadores y enfoques metodológicos utilizados para medir la PS en investigación en salud y iii) analiza las dificultades particulares de medir la PS en poblaciones específicas como grupos étnicos, mujeres, niños, ancianos y contextos rurales versus urbanos. La revisión permite finalmente describir algunas de las implicancias de la medición de PS en países de América Latina.Item Determinants of access to health care for depression in 49 countries: A multilevel analysis(2018) Araya, Ricardo; Zitko, Pedro; Markkula, Niina; Rai, Dheeraj; Jones, KelvynBackground: The relative importance of individual and country-level factors influencing access to diagnosis and treatment for depression across the world is fairly unknown. Methods: We analysed cross-national data from the WHO World Health Surveys. Depression diagnosis and access to health care were ascertained using a structured interview. Logistic Bayesian Multilevel analyses were performed to establish individual and country level factors associated with: (1) receiving a diagnosis and (2) accessing treatment for depression if a diagnosis was ascertained. Results: The sample included 7870 individuals from 49 countries who met ICD-10 criteria for depressive episode in the past 12 months. A third (32%) of these individuals had ever been diagnosed with depression in their lifetime. Among those diagnosed with depression, 66% reported to have ever received treatment for depression. Although individual factors were more important determinants of access to treatment for depression, countrylevel factors explained 27.6% of the variance in access to diagnosis and 24.1% in access to treatment. Access to treatment for depression improved with increasing country income. Female gender, better education, the presence of physical co-morbidity, more material assets, and living in urban areas were individual level determinants of better access. Limitations: Data on other contextual factors was not available. Unmet need was likely underestimated, since only lifetime treatment data was available. Conclusion: This study highlights major inequalities in access to a diagnosis and treatment of depression. Unlike the prevalence of depression, where contextual factors have shown to have less importance, a significant proportion of the variance in access to depression care was explained by country-level income.Item Evaluación del primer “Entrenamiento en Metodología de Investigación Clínica en Chile”(2011) Espinoza, Manuel; Cabieses, Báltica; Pedreros, Cesar; Zitko, PedroThis paper describes the evaluation of the first training on clinical research methodology in Chile (EMIC-Chile) 12 months after its completion. An online survey was conducted for students and the Delphi method was used for the teaching team. Among the students, the majority reported that the program had contributed to their professional development and that they had shared some of the knowledge acquired with colleagues in their workplace. Forty-one percent submitted a project to obtain research funding through a competitive grants process once they had completed the course. Among the teachers, the areas of greatest interest were the communication strategy, teaching methods, the characteristics of the teaching team, and potential strategies for making the EMIC-Chile permanent in the future. This experience could contribute to future research training initiatives for health professionals. Recognized challenges are the involvement of nonmedical professions in clinical research, the complexities associated with the distance learning methodology, and the continued presence of initiatives of this importance at the national and regional level.Item GERO Cohort Protocol, Chile, 2017-2022: Community-based Cohort of Functional Decline in Subjective Cognitive Complaint elderly(2020) Slachevsky, Andrea; Zitko, Pedro; Martínez-Pernía, David; Forno, Gonzalo; Court, Felipe A; Lillo, Patricia; Villagra, Roque; Duran-Aniotz, Claudia; Parrao, Teresa; Assar, Rodrigo; Orellana, Paulina; Toledo, Carolina; Rivera, Rodrigo; Ibañez, Agustín; Parra, Mario A; Christian González-Billault, Christian; Amieva, Helena; Thumala, DanielaBackground: With the global population aging and life expectancy increasing, dementia has turned a priority in the health care system. In Chile, dementia is one of the most important causes of disability in the elderly and the most rapidly growing cause of death in the last 20 years. Cognitive complaint is considered a predictor for cognitive and functional decline, incident mild cognitive impairment, and incident dementia. The GERO cohort is the Chilean core clinical project of the Geroscience Center for Brain Health and Metabolism (GERO). The objective of the GERO cohort is to analyze the rate of functional decline and progression to clinical dementia and their associated risk factors in a community-dwelling elderly with subjective cognitive complaint, through a population-based study. We also aim to undertake clinical research on brain ageing and dementia disorders, to create data and biobanks with the appropriate infrastructure to conduct other studies and facilitate to the national and international scientific community access to the data and samples for research. Methods: The GERO cohort aims the recruitment of 300 elderly subjects (> 70 years) from Santiago (Chile), following them up for at least 3 years. Eligible people are adults not diagnosed with dementia with subjective cognitive complaint, which are reported either by the participant, a proxy or both. Participants are identified through a household census. The protocol for evaluation is based on a multidimensional approach including socio-demographic, biomedical, psychosocial, neuropsychological, neuropsychiatric and motor assessments. Neuroimaging, blood and stool samples are also obtained. This multidimensional evaluation is carried out in a baseline and 2 follow-ups assessments, at 18 and 36 months. In addition, in months 6, 12, 24, and 30, a telephone interview is performed in order to keep contact with the participants and to assess general well-being. Discussion: Our work will allow us to determine multidimensional risks factors associated with functional decline and conversion to dementia in elderly with subjective cognitive complain. The aim of our GERO group is to establish the capacity to foster cutting edge and multidisciplinary research on aging in Chile including basic and clinical research.Publication Population attributable fraction of modifiable risk factors for dementia in Chile(2022) Vergara, Rodrigo; Zitko, Pedro; Slachevsky, Andrea; San Martin, Consuelo; Delgado, CarolinaIntroduction: Projected dementia incidence in Latin America and the Caribbean for the next decades is overwhelming. Access to local data, stratified by sex, is imperative for planning precise dementia-prevention strategies. Methods: We analyzed the individual and overall weighted population attributable fraction (PAF) of nine modifiable risk factors for dementia, in dementia-free subjects ≥45-years-old, using the 2016-2017 Chilean National Health Survey. Results: The overall weighted PAF for modifiable risk factors was 45.8% (42.2% to 49.3%). Variables with the highest PAF were lower education, high blood pressure, hearing loss, and obesity. Women showed a greater overall weighted PAF: 50.7% (45.3% to -56.1%), compared to men: 40.2% (35.4% to 45.0%), driven by a higher PAF for physical inactivity and depression in women. Discussion: The PAF for modifiable risk factors for dementia in Chile is higher than in previous world reports, due to a greater prevalence of cardiovascular risk factors. Women have a higher potential for dementia prevention. Highlights: The proportion of dementia associated to modifiable risk factors in Chile is 45.8%.The main modifiable risk factors are high blood pressure, obesity, and hearing loss.Women had a greater prevalence of physical inactivity and depression than men.Chile had a greater prevalence of metabolic risk factors than other world regions.Item Priority setting for mental health research in Chile(BioMed Central, 2017) Zitko, Pedro; Borghero, Francesca; Zavala, Cynthia; Markkula, Niina; Santelices, Emilio; Libuy, Nicolás; Pemjean, AlfredoBackground: Scientifc knowledge is a fundamental tool for making informed health policy decisions, but the link between health research and public policy decision-making is often missing. This study aims to identify and prioritize a national set of research gaps in mental health. Methods: A multi-approach method to identify gaps in knowledge was developed, including (1) document analysis and identifcation of possible research questions, (2) interviews to Ministry of Health key informants, (3) focus groups with diferent stakeholders, and (4) a web consultation addressed to academics. The identifed gaps were translated to a standardized format of research questions. Criteria for prioritization were extracted from interviews and focus groups. Then, a team of various professionals applied them for scoring each question research. Findings: Fifty-four people participated in the knowledge gaps identifcation process through an online consultation (n = 23) and focus groups (n = 18). Prioritization criteria identifed were: extent of the knowledge gap, size of the objective population, potential beneft, vulnerability, urgency and applicability. 155 research questions were prioritized, of which 44% were related to evaluation of systems and/or health programs, and 26% to evaluation of interventions, including questions related to cost-efectiveness. 30% of the research questions came from the online consultation, and 36% from key informants. Users groups contributed with 10% of total research questions. Conclusion: A fnal priority setting for mental health research was reached, making available for authorities and research agencies a list of 155 research questions ordered by relevance. The experience documented here could serve to other countries interested in developing a similar process.Item Socioeconomic determinants of disability in Chile(2011) Zitko, Pedro; Cabieses, BálticaBackground: Disability is a worldwide public health priority. A shift from a biomedical perspective of dysfunction to a broader social understanding of disability has been proposed. Among many different social factors described in the past, socioeconomic position remains as a key multidimensional determinant of health. The study goal was to analyze the relationship between disability and different domains of socioeconomic position in Chile. Methods: Cross-sectional analysis of an anonymized population-based survey conducted in Chile in 2006. Any disability (dichotomous variable) and 6 different types of disability were analyzed on the bases of their relationship with income quintiles, occupational status, educational level, and material living standards (quality of the housing, overcrowding rate and sanitary conditions). Confounding and interaction effects were explored using R statistical program. Results: Income, education, occupation, and material measures of socioeconomic position, along with some sociodemographic characteristics of the population, were independently associated with the chance of being disabled in Chile. Interestingly, classic measures of socioeconomic position (income, education, and occupation) were consistently associated with any disability in Chile, whereas material living conditions were partially confounded by these classic measures. In addition to this, each type of disability showed a particular pattern of related social determinants, which also varied by age group. Conclusions: This study contributed to the understanding of disability in Chile and how different domains of socioeconomic position might be associated with this prevalent condition. Disability remains a complex multidimensional public health problem in Chile that requires the inclusion of a wide range of risk factors, of which socioeconomic position is particularly relevant. (C) 2011 Elsevier Inc. All rights reserved.Item The Impact of Universal Health Care Programmes on Improving ‘Realized Access’ to Care for Depression in Chile(2018) Araya, Ricardo; Zitko, Pedro; Markkula, NiinaUniversal health care programmes have the potential to reduce treatment gaps. We explored the potential impact of an equityoriented universal health care programme on access to care for depression, hypertension and diabetes using data from two nationally representative health surveys in Chile. The likelihood a depressed individual had accessed health care appears to have increased significantly after the programme was introduced whereas those for hypertension and diabetes remained unchanged. Depressed women seem to have benefited mostly from the programme. Universal health care programmes for depression could substantially increase coverage and reduce inequities in access to health care in middle-income countries