Person: Obach, Alexandra
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Obach
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Alexandra
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Alexandra Obach
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Publication 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.Publication “¿Cómo podría hablar yo de esto?”: Juventudes mapuches, sexualidades y VIH en la Región de la Araucanía, Chile(2024) Obach, Alexandra; Carreño Calderón, Alejandra; Alarcón, Ana María; Panguinao, LuisPublication 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 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 Trenzando las antropologías de la salud en Chile: temas, diálogos y desafíos(2023) Carreño Calderón, Alejandra; Obach, Alexandra; Leyton, Daniela; Sadler, MichelleLa formación del campo de la antropología de la salud (o antropología médica) en Chile es paralela al desarrollo de la disciplina en el país. Actualmente observamos la consolidación de distintos temas y el surgimiento de nuevos diálogos y desafíos. El artículo reflexiona sobre el pasado, el presente y el futuro del campo, y propone una caracterización de las distintas etapas de esta subdisciplina basada en una revisión de investigaciones nacionales y de tesis de pregrado y postgrado dedicadas al tema. Se destacan los aportes y las limitaciones de cada período y se reflexiona en torno a los desafíos que la subdisciplina enfrenta actualmente considerando el arribo a un momento histórico de mayor reconocimiento y de implicación en el debate nacional sobre los procesos de salud/enfermedad/atención/cuidado. The development of the field of anthropology of health (or medical anthropology) in Chile has taken similar pathways as local social anthropology. We can currently observe the consolidation of different topics and the development of new dialogues and issues. The article reflects on the field’s past, present, and future directions, putting forward a proposal to describe the different stages of the subdiscipline in Chile based on a review of the local research, as well as under- and post-graduate dissertations and theses. The contributions and limitations of each stage are highlighted, and we reflect on the challenges the subdiscipline currently faces as it gains further recognition and involvement in the national debate on health/disease/attention/care processes.Publication Breast cancer diagnosis and staging in Chile: A nonrandomized survey-based study to assess frequency and delays(2024) Campaña, Carla; Oyarte, Marcela; Cabieses, Báltica; Obach, AlexandraIntroduction: Breast cancer progression involves physiological mechanisms such as metastasis. Delays in diagnosis and treatment increase the risk of mortality and are associated with barriers to healthcare access. In Chile, breast cancer is highly prevalent, and early diagnosis has improved, although disparities in the disease evolution persist. This study characterized diagnostic and staging tests, waiting times, and sociodemographic profiles to identify delays and inequities in care. Methods: Survey study. Using a non-probabilistic sample, a questionnaire was applied in an encrypted platform with prior informed consent. The instrument collected data on requested tests, associated times, staging, and sociodemographic characteristics. These variables were analyzed using descriptive statistics, tests of association, confidence intervals, and comparison tests using bootstrapping. Results: A sample of 263 persons was obtained. The most requested tests were biopsy (99.62%) and blood tests (80.23%). The median number of tests requested was six (Q1:4, Q3:8), with a mean of 5.87 (standard deviation: 2.24). No significant differences were observed in the percentage of persons from whom the total number of examinations were requested according to the studied variables. The day-hour-result intervals ranged from 1 to 365 days. The median day-hour-result of the biopsy was 15 days (Q1:10, Q3:30). People between 40 and 49 years old, non-residents of the capital city, belonging to income quintile I, with high school education, from the public health system, with late-stage diagnosis had higher median day-hour-result in biopsy. There was no significant difference in the number of requested tests according to staging (I and II, or III and IV). Conclusions: Biopsy in Chile is the test of choice for diagnostic confirmation in breast cancer. Other tests are requested regardless of the diagnosis stage, contrary to the recommendations of clinical guidelines. Cancer prognosis is crucial, especially in countries with greater inequalities.Publication Recommendations for Implementing the INTERACT3 CareBundle for Intracerebral Hemorrhagein Latin America: Results of a Delphi Method(2024) Allende, María Ignacia; Munoz Venturelli, Paula; González, Francisca; Bascur, Francisca; Craig S., Anderson; Ouyang, Menglu; Cabieses, Báltica; Obach, Alexandra; Cano-Nigenda, Vanessa; Arauz, Antonio; LATAM INTERACT3 Consensus Statement PanelIntroduction: The third Intensive Care Bundle with Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT3) showed that the implementation of a care bundle improves outcomes after acute intracerebral hemorrhage (ICH). We aimed to establish consensus-based recommendations for the broader integration of the care bundle across Latin American countries (LAC). Methods: A 3-phase Delphi study allowed a panel of 32 healthcare workers from 14 LAC to sequentially rank statements relevant to 7 domains (training, resources/infrastructure, patient education, blood pressure, temperature, glycemic control, and anticoagulation reversal). The pre-defined consensus threshold was 75%. Results: A total of 43 statements reached consensus by the third round, with 12 new statements emerging through rounds. The highest-ranked statements in each domain emphasized critical aspects, but successful implementation requires appropriate resourcing. Key priorities were continuous training of all healthcare workers in ICH management, establishing protocols aligned with available resources, and collaborative interdisciplinary care supported by institutional networks. Statements related to anticoagulation reversal had the highest priority. Conclusions: Consensus statements are provided to facilitate integration of the INTERACT3 care bundle to reduce disparities in ICH outcomes in LAC.Publication Therapeutic trajectories of families with rare diseases in Chile from the perspectives of patients, carers, and healthcare workers: a qualitative study(2025) Cabieses, Báltica; Obach, Alexandra; Roberts, Antonia; Repetto, GabrielaBackground Rare diseases are conditions that have a low prevalence in the population and a high disease burden and are often chronic and progressive. International evidence concerning the experience of people and families living with rare diseases is scarce, leading to late and erroneous diagnoses, as well as non-specific treatments. This study explored the therapeutic trajectories of people and families living with rare diseases within Chile’s public and private healthcare systems from the perspective of patients, caregivers, and medical teams, including the initial symptoms, first consultation, testing, diagnosis, treatment, and follow-up. Methods A qualitative exploratory study was conducted through multiple case studies. Sixty participants were interviewed in person and/or virtually: patients (n = 16), caregivers (n = 22), healthcare workers (n = 20), and two patient organisation leaders. The material was analysed using thematic analysis. The project was approved by the Scientific Ethics Committee of Facultad de Medicina Clínica Alemana, Universidad del Desarrollo. Results After similar initial symptoms and first consultation, three main types of trajectories were identified: (i) the path taken by those who reach a diagnosis for a disease that has specific treatment available; (ii) the journey of those who reach a diagnosis for their health condition, but their disease does not have a specific treatment available; and (iii) the trajectory of those who have not reached a diagnosis and receive symptomatic treatments for symptoms. Conclusions The therapeutic trajectories of patients with rare symptoms are similar in terms of initial symptoms and first consultation. However, their paths diverge at the diagnostic stage, with diverse experiences related to these journeys, largely based on having a diagnosis and whether there is a specific treatment. Rare conditions in Chile requires further attention and urgent action that considers those who live with them and their families.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 El rol de nuevas organizaciones de la sociedad civil en la promoción de salud sexual en Chile(2023) Obach, Alexandra; Sadle, Michelle; Roberts, Antonia; Marín, MatíasEl artículo que da cuenta de los resultados de dos investigaciones cualitativas ejecutadas entre 2020 y 2022, tiene como propósito, desde un enfoque de salud global, salud colectiva y vulnerabilidad estructural, reflexionar en torno al rol que juegan nuevos actores de la sociedad civil en la promoción de la salud sexual, de derechos sexuales y en la prevención y detección del VIH en Chile. Estos actores son organizaciones de la sociedad civil conformadas por jóvenes profesionales de la salud que han construido espacios de información, promoción y atención en salud sexual y reproductiva fuera del sistema formal de salud; y organizaciones lideradas por jóvenes LGBTIQA+ en torno a información en sexualidades en general, y a acceso a prevención y detección del VIH en particular. El artículo contribuye en mostrar la importancia que tienen estos nuevos actores en las trayectorias terapéuticas en materia de salud sexual de jóvenes en Chile, y la relevancia aún mayor que han adquirido desde el inicio de la pandemia de Covid-19 The article which gives an account of the results of two qualitative investigations carried out between 2020 and 2022, has the purpose, from a global health, collective health and structural vulnerability approach, to reflect on the role played by new civil society actors in the promotion of sexual health, sexual rights and in the prevention and detection of HIV in Chile. These actors are civil society organizations led by young health professionals who have built spaces for information, promotion, and care in sexual and reproductive health outside the formal health system; and organizations led by LGBTIQA+ youth around information on sexualities in general, and access to HIV prevention and detection in particular. The article contributes to show the importance that these new civil society actors have in therapeutic trajectories in the field of sexual health of young people in Chile, and the even greater relevance that they have acquired since the beginning of the Covid-19 pandemic.
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