Person: Cabieses, Báltica
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Publication Quemaduras: ¿por qué prestarles especial atención a los adolescentes en América Latina y El Caribe desde un enfoque de prevención primaria en salud?(2023) Blukacz, Alice; Cabieses, Báltica; Obach, Alexandra; Fuentes, Rodrigo; Carmina, Domic; Peredes, Carola; Saavedra, Rolando; Rojas, JorgeLa evidencia existente en materia de quemaduras en población menor de edad a nivel global se ha enfocado principalmente en niños y niñas menores de 10 años, dejando atrás al grupo etario definido como "adolescente" por la Organización Mundial de la Salud. Sin embargo, la etapa de la adolescencia presenta características propias que la diferencian de los rangos etarios menores con respecto a las quemaduras. Estas diferencias son relevantes desde una perspectiva de prevención primaria, la cual se centra en evitar la enfermedad o lesión. En este contexto, el presente artículo reflexiona en torno a los motivos por los cuales es necesario prestarles especial atención a las y los adolescentes en el marco de la prevención primaria de las quemaduras, con relevancia para Latinoamérica y El Caribe. Primero, los escenarios de quemaduras en adolescentes muchas veces se vinculan con la participación en actividades de riesgo por presión, deseabilidad social o baja percepción de los riesgos asociados. Segundo, es importante recalcar que los adolescentes pueden experimentar vulnerabilidad social, la cual los puede exponer al riesgo de sufrir una quemadura intencional o no. Tercero, el riesgo de quemaduras en adolescentes se puede asociar con la salud mental y escenarios de autolesión. Se requiere indagar en estos aspectos, tanto a través de estudios cuantitativos epidemiológicos como de estudios cualitativos, para poder diseñar e implementar estrategias de prevención primarias relevantes para este grupo de población en la región.Publication Exploring the characteristics of cancer-centred civil society organisations in Chile: A qualitative study(2025) Roberts, Antonia; Vezzani, Francisca; Cabieses, Báltica; Obach, Alexandra; Campaña, Carla; Espinoza, ManuelBackground: In Chile, civil society organisations in health have been historically active in population health and specifically in cancer; they have had an important role in addressing patients' and families' necessities. Although they occupy a central role, there is no clarity about who they are, how they are organised, the goals that guide their performance and how they materialize social participation in health. Based on that, this study aimed to explore the characteristics of civil society organisations that work in cancer in Chile and to identify the networks they build with other actors to achieve their goals. Materials and methods: Qualitative case study using semi-structured online interviews with organisation representatives, politicians, decision-makers and academics related to cancer in Chile. Content analysis was performed, admitting emerging categories from the participants' narratives. Results: Three main profiles of organisations were identified: (i) Long-established organisations focused on influencing public policy and decision-making in cancer, (ii) Growing organisations focused on informing and supporting families and patients, (iii) Newly established organisations focused on patient well-being, such as sports activities. Relationships between groups and other actors involve perceived benefits like the growth of the organisations and funding for activities. However, perceived barriers and inequities are also identified, mainly lack of financial resources, competition between organisations and insufficient information. Discussion: The objectives of civil society organisations in cancer are diverse and reflect multiple ways of practising social participation in health. Tensions generate unequal participation and missed opportunities to promote public health in cancer in Chile. The study highlights the importance of recognising cancer social organisations as essential actors in public health. It is crucial to involve them in formulating and implementing comprehensive responses to maximise the opportunities for progress in this field.Publication Barriers and facilitators to access sexual and reproductive health services among young migrants in Tarapacá, Chile: a qualitative study(2024) Obach, Alexandra; Blukacz, Alice; Sadler, Michelle; Carreño Calderón, Alejandra; Cabieses, Báltica; Carolina DíazBackground: Chile has become a destination country for immigrants from Latin America, including youth. Guaranteeing access and use of sexual and reproductive health services for young migrants is crucial because of their overlapping experiences of transitioning to a new country and to adulthood. However, the existing evidence shows barriers to accessing sexual and reproductive healthcare among young migrant populations. In this context, the main objective of this article is to identify the barriers and facilitators that young migrants experience to access sexual and reproductive healthcare in the Tarapacá region of Chile. Methods: A qualitative study was conducted in the Tarapacá region of Chile. Semi-structured interviews with 25 young migrants from Venezuela, Colombia, and Ecuador, as well as 10 health workers, were carried out. The interviews were transcribed and thematically analysed. The study was approved by the Ethics Committee of the Universidad del Desarrollo (#2019-22). Results: Young migrants face barriers linked to structural shortcomings within the healthcare system, which may be similar to those faced by the local population. Barriers are also derived from reductionist sexual and reproductive health approaches, which prioritise the prevention of pregnancy, sexually transmitted infections, and HIV, with a predominantly heteronormative focus. The prevailing narratives from the health system are those of risk and lack of control and self-care among young people, and they are exacerbated in the case of migrants. Young migrants, especially from the Caribbean, are stereotyped as over-sexualised and liberal in comparison to the local population and believed to be engaging in riskier sexual behaviours that should be kept under check. This may translate into experiences of discrimination and mistreatment when receiving care. Facilitators include good-quality information and community-level interventions. Conclusions: This study shows a limited approach to the sexual and reproductive health of young migrants in Chile, severely hampering their reproductive and sexual rights. Policies and initiatives must work towards removing structural barriers, changing narratives, and empowering young migrants regarding their sexual and reproductive health.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 Barriers to access to insulin pumps in Chile: A qualitative study of a high-cost technology(2025) Cabieses, Báltica; Obach, Alexandra; Madrid, Paula; Paredes, DanielaObjective: To investigate the barriers to accessing advanced insulin delivery system from the experiences of patients with type 1 diabetes (T1DM), family members, and treatment teams. Methods: A qualitative study, taking a comprehensive approach, investigated a person’s experience with T1DM and receiving insulin pump treatment, emphasizing the barriers to accessing it. A case study was conducted, considering a diverse range of individuals, including young patients, adult patients, family members or care givers, and health professionals. Twenty-nine semi-structured individual interviews provided a rich and varied perspective on the issue. Results: According to study participants, the main barriers to access to insulin pump treatment for T1DM patients in Chile were the following: (i) Geographic barriers, (ii) Socioeconomic barriers, (iii) Administrative barriers, and (iv) Barriers from health teams. Participants also identified emerging barriers related to the insulin pump’s adaptation process. Conclusions: Despite the barriers and bottlenecks identified, an effort to fill short gaps in access to insulin pump treatment by the Chilean health system is recognized. To keep improving in equitative access to high-cost treatments in T1DM and other chronic conditions, it is imperative to consider the active and meaningful participation of patients and their families in health decision-making. This can lead to more patient-centric and effective healthcare policies and practices.Publication International migration, food insecurity, and mental health: A scoping review protocol(2024) Blukacz, Alice; Cabieses, Báltica; Huerta, Catalina; Lake, Amelia A.; Smith, Jo; Giles, Emma L.; Deane, FayeINTRODUCTION Food insecurity is a global priority that has been found to negatively impact mental health, increasing the risk of mental disorders and severe mental illness. International migrants may face food insecurity throughout their migratory cycle due to a range of risk factors, such as poor transit conditions, precarious employment, financial pressure, discrimination, and lack of availability and access to culturally relevant food, among others. Although there are multiple reviews on migration, food insecurity, and health in general, no scoping review has been conducted on food insecurity among international migrants focusing on mental health. OBJECTIVE To investigate the available evidence on food insecurity and mental health among international migrants. METHODS A search of scientific literature in English, Spanish, French, Italian, and Portuguese published since 2013 will be performed in the Web of Science, PubMed, Medline, APA PsycArticles, Cinahl, and ASSIA databases, including grey literature available in Google Scholar. Two authors will independently review titles, abstracts, and full texts before extracting data from publications complying with the eligibility criteria. Extracted data will be descriptively mapped according to emerging thematic categories. EXPECTED RESULTS The review will contribute to identifying what is known about international migration, food insecurity, and mental health, gaps in the literature, opportunities for specific research subtopics, and how food insecurity and mental health can be linked in the existing literature.Publication Borders and liminality in the right to health of migrants in transit: The case of Colchane in Chile and Necoclí in Colombia(2024) Jaramillo Contreras, Andrea Carolina; Cabieses, Báltica; Knipper, Michael; Rocha Jiménez, TeresitaThe absence of the right to health of migrants in transit has evolved into a significant global health concern, particularly in the border regions thus, this study aims to improve knowledge in this area by exploring the effects of the spatio-temporal liminal characteristics at borders in the achievement of the right to health of migrants in transit moving across two of the most transited and dangerous borders in Latin America: Colchane (Chile-Bolivia) and the Dari´en Gap (Colombia-Panamá). Through a qualitative descriptive multi-case study, we implemented 50 semi-structured interviews (n = 30 in Chile and n = 20 in the Dari´en/Necoclí) involving national, regional, and local stakeholders. The findings highlight that the fulfilment of the right to health of migrants in transit is hindered by liminal dynamics at the borders. These dynamics include closure of borders, (in)securities, uncer tainty and waiting, lack of economic resources, lack of protection to all, liminal politics, and humanitarian in terventions. These findings surface how the borders’ liminality exacerbates the segregation of migrants in transit by placing them in a temporospatial limbo that undermines their right to health. Our study concludes that not just the politics but also the everyday practices, relationships and social infrastructure at borders impedes the enjoyment of the right to health of distressed migrants in transit. The short-term humanitarian response; illicit dynamics at borders; migratory regulations; and border and cross-border political structures are some of the most significant determinants of health at these borderlands.Publication Socioeconomic and spatial distribution of depressive symptoms and access to treatment in Peru: A repeated nationwide cross-sectional study from 2014 to 2021(2025) Villarreal-Zegarra, David; Al-kassab-Córdova, Ali; Otazú-Alfaro, Sharlyn; Cabieses, BálticaBackground: Globally, evidence indicates that poverty and geographical setting influence the prevalence of depressive symptoms and access to treatment. Therefore, this study aimed to evaluate the socioeconomic and spatial distribution of depressive symptoms and treatment in Peru. Methods: We conducted an observational study based on the analysis of secondary data derived from the Peruvian Demographic and Health Surveys for 2014–2021. Using the Patient Health Questionnaire-9 on depressive symptoms, we estimated the Erreygers concentration index (ECI) to identify socioeconomic inequality in depressive symptoms and access to treatment. Spatial analyses were conducted using Global Moran’s I, Kriging interpolation, hotspot analysis (Getis-Ord-Gi*), and the Bernoulli-based Kulldorff spatial analysis. Results: The surveys included a total of 113,392 participants. Depressive symptoms exhibited only negative ECI values throughout the 2014–2021 period (pro-poor distribution), whereas access to treatment only displayed positive ECI values (pro-rich distribution). We identified two and four significant clusters in the southeastern areas of Peru in 2014 and 2021, respectively. Conclusions: Depressive symptoms were concentrated among the poorest, whereas access to treatment was remarkably concentrated among the wealthiest groups. A clustered spatial pattern was observed, and similar high-risk areas were identified. Social policies that address unequal socioeconomic and spatial distribution in depressive symptoms and treatment are required.Publication “Border closure only increased precariousness”: a qualitative analysis of the efects of restrictive measures during the COVID‑19 pandemic on Venezuelan’s health and human rights in South America(2023) Cabieses, Báltica; Rocha, Teresita; Olivari, Carla; Martínez, Alejandra; Knipper, MichaelBackground: In 2010, a political and social crisis pushed thousands of Venezuelans out of their country; today, seven million Venezuelans live abroad. In addition, during the COVID-19 pandemic, border closure increased and affected specific vulnerable migration flows, such as Venezuelans trying to migrate to Chile through the Northern borders. In this context, there is little evidence of migrants' health status and needs, their access to health services, and other basic needs (e.g., housing) from a human rights perspective. Therefore, we qualitatively explored the effects of border closure due to the COVID-19 pandemic on Venezuelan migrants' health and human rights, focusing on access to healthcare in the Northern Chilean border that adjoins Peru and Bolivia. Methods: Following a case-study qualitative design, we conducted an ethnography that included participatory observation of relevant sites (e.g., hospitals, main squares, migrant shelters) in Antofagasta, Iquique, and Arica and 30 in-depth interviews with actors in the health sector (n = 7), experts from the non-governmental sector (n = 16), and governmental actors (n = 7) in three large cities close to the Northern border. Results: We found four main dimensions: (i) border and migration processes, (ii) specific groups and intersectionality, (iii) barriers to healthcare services, and (iv) regional and local responses to the crisis during the COVID-19 pandemic. Programs characterized by the presence of healthcare providers in the field were essential to attend to migrants' health needs at borders. Conclusions: Coordination between actors is crucial to implement regional protocols that respond to current migration phenomena and migrants' health needs. Health policies using a human rights approach are urgently required to respond to migrants' healthcare needs at borders in South AmericaPublication The social and health protection of migrants in Chile: qualitative analysis of civil society proposals for constitutional change(2023) Cabieses, Báltica; Obach, Alexandra; Blukacz, Alice; Esnouf, Sophie; Mezones, Edward; Espinoza, Manuel; DeJong, JocelynBackground: A sustained period of social, economic, and political unrest took place during October of 2019 in Chile. As an institutional solution, the "Agreement for Social Peace and the New Constitution" was signed. In this document, most political parties committed to reestablishing peace and public order in Chile, agreeing on the initiation of a constitutional process. To promote participation of civil society actors, the "Popular Initiative for Norms" was enabled. This was a platform where civilians could submit proposals for constitutional norms to be discussed by the Constitutional Convention. We aimed to analyze proposals related to migrants and migrant health. Methods: We conducted a qualitative thematic analysis of the proposals. Sixteen of them were related to migrants, and we analyzed their association to health. We also evaluated their link to the Health Goals 2030 set out by the Chilean Ministry of Health and the Global Action Plan 2019-2023 for Promoting the Health of Refugees and Migrants by the World Health Organization. Results: Four main thematic categories were identified: 1) Humans rights of migrants, refugees, and asylum seekers; 2) Nationality and regularization of migrants and refugees; 3) Political participation and cultural integration of migrants and refugees; and 4) Specific regulations on slavery and human trafficking. These resonated with broader frameworks established in the Health Goals 2030 (Chile) and the Global Action Plan 2019-2023 for Promoting the Health of Refugees and Migrants by the World Health Organization. Conclusions: The 'Popular Initiative for Norms' was a non-binding participatory mechanism. Although the proposals sent through were not guaranteed to be included in the constitutional draft-and despite the final draft being rejected last September 2022-the platform allowed to gain insights into civilian opinions. Our findings showed that there is an incipient yet weak recognition of the rights and situation of migrants in Chile. There was no direct mention of health nor an explicit contemplation of social determinants of health. Despite there being an urgent need to define strategies for migrants' health in Chile, this study demonstrated that civil awareness and interest are still insufficient.