Artículos Medicina y Ciencias de la Salud

Permanent URI for this collection

http://repositorio.udd.cl/handle/11447/27

Browse

Now showing 1 - 20 of 2916

SKI regulates rRNA transcription and pericentromeric heterochromatin to ensure centromere integrity and genome stability
(2025) Pola, Víctor; Carrero, David; Sagredo, Eduardo; Inostroza, Víctor; Cappelli, Claudio; Rivas, Solange; Bitrán, Mirita; Zambrano, Evelyn; Gonzalez, Evelin; Morales, Fernanda; Manterola, Marcia; Montecino, Martín; Armisen, Ricardo; Marcelain, Katherine
Accurate chromosome segregation and ribosomal gene expression silencing are essential for maintaining genome integrity, and disruptions in these processes are key for oncogenesis and cancer progression. Here, we demonstrate a novel role for the transcriptional co-repressor SKI in regulating rDNA and pericentromeric heterochromatin (PCH) silencing in human cells. We found that SKI localizes to the rDNA promoter on acrocentric chromosomes and is crucial for maintaining H3K9 trimethylation (H3K9me3) and repressing 45S rRNA gene expression. SKI is also associated with BSR and HSATII satellites within PCH, where is necessary for H3K9 methylation and recruitment of SUV39H1 and HP1α, key players for heterochromatin silencing and centromere function. Consequently, SKI deficiency disrupted centromere integrity and resulted in aberrant chromosome segregation, micronuclei formation, and chromosome instability. The identification of SKI as a key participant in the epigenetic-mediated silencing of pericentromeric and ribosomal DNA provides a fundamental insight, paving the way for new research into the intricate relationship between transcriptional regulation and genome instability during cancer progression, and opening novel opportunities for therapeutic intervention.
Adherence to the EAT-Lancet Diet Among Urban and Rural Latin American Adolescents: Associations with Micronutrient Intake and Ultra-Processed Food Consumption
(2025) Vargas, Rulamán; Monge, Rafael; Rodríguez, Sonia; Araneda, Jacqueline; Teixeira, Leandro; Cedie, Gustavo; Gaitán, Diego; Pizarro, Tito; Pinheiro Fernandes, Anna Christina; Rovirosa, Alicia; Sánchez, Tania; Zapata, María
Background/Objectives: Adolescents in Latin America are experiencing rising rates of overweight/obesity and non-communicable diseases, while public health nutrition efforts targeting this group remain limited. This study explores adherence to the EAT-Lancet diet and its relationship with micronutrient adequacy and ultra-processed food (UPF) consumption. Methods: Cross-sectional data from national nutrition surveys of 19,601 adolescents across six Latin American countries were analyzed. Data on sociodemographics, anthropometrics, and dietary habits were collected using standardized questionnaires and 24 h dietary recalls or food records. Nutrient intake was estimated via statistical modeling, and nutrient adequacy ratios were based on age- and sex-specific requirements. UPF intake was classified using the NOVA system, and adherence to the EAT-Lancet diet was assessed with the Planetary Health Diet Index. Results: Overall adherence to the EAT-Lancet diet was low (mean score: 28.3%). Rural adolescents had higher adherence than urban adolescents, and those aged 10–13 and 17–19 showed better adherence compared to adolescents aged 14–16. Adolescents from lower socioeconomic backgrounds adhered more than those from higher socioeconomic backgrounds. Adherence varied from 20.2% in Argentina to 30.2% in Brazil and Chile. Higher adherence was associated with lower UPF intake. Among urban adolescents, greater adherence was linked to a higher risk of inadequate riboflavin, niacin, and cobalamin intake, a trend not observed in rural adolescents. Conclusions: Adherence to the EAT-Lancet diet is low among Latin American adolescents, particularly in urban areas. Public health efforts should prioritize reducing UPF consumption, improving access to nutrient-dense, culturally appropriate foods, and supporting fortified staple foods.
Advances in lung cancer basic and translational research in 2025 - Overview and perspectives focusing on non-small cell lung cancer
(2025) Mascaux, Celine; Sen, Triparna; Sanchez, Montse; Ortiz, Sandra; Bossé, Yohan; Dammeijer, Floris; Cavic, Milena; Barr, Martin; Arulananda, Surein; Armisen, Ricardo; Berge, Alice; Bianchi, Fabrizio; Carbone, David; Cerciello, Ferdinando; Lockwood, William; Mitsudomi, Tetsuya; Ohara, Shuta; Politi, Katerina; Qin, Sida; Roisman, Laila; Samstein, Robert; Skoulidis, Ferdinandos; Tan, Aaron; Thomas, Anish; Zhang, Jianjun; Wynes, Murry; John, Thomas; Sound, Ming; IASLC Basic and Translational Science Committee
Basic and translational research in lung cancer is a rapidly evolving field with transformational impact in early detection, diagnosis, therapeutic development and personalization of care. Recent advances have greatly increased our understanding in the molecular genomics, proteomics, pathogenesis and cellular biology of this deadly malignancy. The International Association for the Study of Lung Cancer (IASLC) recently formed a Basic and Translational Science (BaTS) Committee to further enhance the scientific leadership of IASLC in thoracic cancer research. This review by members of the committee highlights the breadth of current research in NSCLC, with a focus on molecular risk factors and processes in tumorigenesis, heterogeneity, phenotypic plasticity, metabolic reprograming, immunobiology, the immune microenvironment and microbiome. This review also identifies future research areas that may lead to further improvement in survival outcomes and curative therapies especially for patients with advanced NSCLC.
Molecular Interplay Between Non-Coding RNAs and Connexins and Its Possible Role in Cancer
(2025) Perez Moreno, Pablo; Muñoz, Juan; Retamal, Mauricio A.
Non-coding RNAs (ncRNAs) are sequences that do not encode for proteins and play key roles in different cellular processes, including cell proliferation and differentiation. On the other hand, connexins (Cxs) are transmembrane proteins that principally allow intercellular communication. In pathological conditions such as cancer, there is a deregulation in the expression and/or function of ncRNAs and Cxs, which in turn leads to an enhancement in the aggressive phenotype, such as a greater proliferative and invasive capacity. This suggests a plausible interplay between ncRNAs and Cxs. Based on that, this review aims to summarize the current knowledge regarding this relationship and to analyze how it may influence the development of aggressive traits in cancer cells and the clinicopathological features of cancer patients. Finally, we discuss the potential of ncRNAs and Cxs as promising clinical biomarkers for cancer diagnosis, prognosis, and therapeutic targeting. Keywords: cancer; connexins; non-coding RNAs.
Top ten research priorities in global burns care: findings from the James Lind Alliance Global Burns Research Priority Setting Partnership
(2025) Sarah Richards, Hollie; Staruch, Robert; Kinsella, Suzannah; Savovic, Jelena; Qureshi, Riaz; Elliott, Daisy; Rooshenas, Leila; King, Anni; Acton, Amy; Bayuo, Jonathan; Booth, Simon; Chamania, Shobha; Chieu, Le Quoc; Coates, Charlotte; Collins, Declan; Deguire, Lise; Dheansa, Baljit; Dudley-Southern, Roy; Easton, Ian; Edgar, Dale; Evans, Janine; Falder, Sian; González Silva, Emilio; Holley, Alex; Holley, Catrina; Icaza, Ivette; Jowett, Claire; Leaver, Jane; Lee, Alice; Martin, Niall; Meirte, Jill; Nh Lam, Nguyen; Pugh, Catrin; Shah, Mamta; Stiles, Krissie; Vehmeijer, Marielle; Ahmed, Tanveer; Allorto, Nikki; Ali Cinar, Murat; Allen Dingle, Lewis
Predator-Prey Model for Simulating the Genetic Carcinogenicity of Aggressive Toxicant-Related Cancer
(2025) Fernández, Mauricio; Armisen, Ricardo; Fernández Arancibia, Mario
The mechanism of how toxicant exposure leads to aggressive tumors remains unresolved. A genetic-based hypothesis predicts that under stress, the transcription of growth-related genes will be inhibited by the activation of mitogenic pathways, redirecting energy toward stress response and increasing survival. This hypothesis fails to explain why epidemiological data suggest that growth and stress response are activated, as patients exposed to toxicants exhibit more aggressive growth than nonexposed individuals. This co-occurrence requires increased energy availability to prevent the activation of mitogenic pathways, as seen in the Warburg effect. We hypothesize that if pollutant effects cease, it might drive aggressive cancer, as excess energy that is no longer used for stress response can fuel rapid growth. We model this allocation between growth and stress response as a trophic competition using the Lotka-Volterra equations and using as input RNA-Seq data from growth- and stress-related genes obtained from cancer cells exposed to copper, cadmium, and carboplatin. Our findings suggest that the energy allocation to growth and its rate of allocation is higher in exposed than nonexposed tumors and results in overgrowth in unexposed cells. This study helps to understand how certain scenarios, such as partial or total cessation of exposure, in toxicant-related cancer can drive cancer aggressiveness.
“¿Cómo podría hablar yo de esto?”: Juventudes mapuches, sexualidades y VIH en la Región de la Araucanía, Chile
(2024) Obach, Alexandra; CARREÑO CALDERON, ALEJANDRA; Alarcón, Ana María; Panguinao, Luis
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, Gabriela
Background 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.
Infectious diseases prevention and vaccination in migrants in Latin America: The challenges of transit through the treacherous Darien gap, Panama
(2025) Rodriguez-Morales, Alfonso J.; Puerta-Arias, María Camila; Husni, Rola; Montenegro-Idrogo, Juan J.; Escalera-Antezana, Juan Pablo; Alvarado-Arnez, Lucia E.; Bonilla-Aldana, D. Katterine; Camacho-Moreno, German; Mendoza, Henry; Rodriguez-Sabogal, Ivan Arturo; Millán-Oñate, Jose; Lopardo, Gustavo; Arce, Octavio A.; Cimerman, Sergio; Socorro Souza Chaves, Tânia do; Orduna, Tomas; Lloveras, Susana; Cabrera, Maritza; Thormann, Monica; Özsürekçi, Yasemin; Pérez-Sánchez, Clevy; Sandoval, Nancy; Lysien Zambrano, Lysien; Alvarez-Moreno, Carlos A.; Chacon-Cruz, Enrique; Villamil-Gomez, Wilmer E.; Arteaga-Livias, Kovy; Savio-Larriera, Eduardo; Cardona-Ospina, Jaime A.; Risquez, Alejandro; Forero-Peña, David A.; Contreras, Krisell; Sah, Ranjit; León-Figueroa, Darwin A.; Acosta-España, Jaime David; Sierra, Leandro; López-Delgado, Darío Sebastián; Solarte-Portilla, Marco A.; Escobedo, Angel A.; Haque, Shafiul; Amer, Fatma A.; Leblebicioglu, Hakan; Ulloa-Gutierrez, Rolando; Galan-Rodas, Eden; Matsee, Wasin; Fernandez, Marisa Liliana; Echazarreta, Sofia; Cabieses, Báltica
Human migration is a dynamic, multifaceted and complex phenomenon shaped by economic, political, social, climatic and environmental factors [1–4]. Migration refers to the relocation of individuals from their habitual residence to a new location, while travel involves journeying between destinations for various purposes [5]. In recent years, migration trends have been shaped by globalisation, technological advancements, climate change, armed conflicts, social and economic disparities and political and religious persecution. Migration poses challenges for individual nations and represents a crucial humanitarian and global health issue requiring coordinated international efforts and long-term planning [6–8].
Intersectionality, racism, and mental health of migrants arriving at borders in Latin America: a qualitative study based on in-depth interviews with key informants of the cases of Ecuador and Chile
(2025) Rocha-Jiménez, Teresita; Torres, Irene; Cabieses, Báltica; López-Cevallos, Daniel F.; Mercado-Órdenes, Mercedes
Background Migration is a social determinant of health, as human mobility is associated with the health outcomes of those who move. Social sciences research on migration and health needs to transition from an individual approach to models that reveal how place, processes of racialization, and structural elements impact immigrant health. We aim to describe, from the key informant's perspective in depth, the case of intersectionality, racism, and gender and related perceived effects on Venezuelan migrants' mental health at two relevant Latin American borders. Methods The present study is a multisite observational cross-sectional qualitative project on two selected borders, the northern borders of Chile (Antofagasta, Iquique, Arica) and Ecuador (Tulcán, Nueva Loja). In-depth semi-structured interviews with key informants were collected in (n = 30) Chile from May to December 2022 and in Ecuador (n = 30) from October to December 2022. 22 participants were men, and 38 were women, and in-depth interviews were analysed using an inductive thematic approach. Findings We found structural axes (i.e., socioeconomic, migration status, gender) of power that intersect in migrants' and refugees’ conditions and experiences in their access to health and mental health care. Interpretation We proposed the notions of intersectionality and racism to deliberately connect complex and dynamic concepts relevant to migrant and refugee health research, such as the racism faced by historically racialized populations based on their phenotypes, social class, and/or nationality and socioeconomic and gender inequalities.
Barriers to access to insulin pumps in Chile: A qualitative study of a high-cost technology
(2025) Cabieses, Báltica; Obach, Alexandra; Madrid, Paula; Paredes, Daniela
Objective: 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.
Perceived barriers to reaching equity in effective access to diagnosis and treatment for women with breast cancer in Chile
(2025) Campaña, Carla; Cabieses, Báltica; Obach, Alexandra; Vezzani, Francisca
Globally, it has been reported inequities in breast cancer effective access to health care. The objective of this study was to explore perceived inequities in access to effective diagnosis and treatment in women with breast cancer according to Tanahashi model and social determinants of health model. An exploratory case study, under a qualitative paradigm, was conducted. Theoretical sampling guided the selection of diverse participant profiles, comprising breast cancer patients, healthcare professionals and a civil society leader. The strategies for the recruitment process included social networks, civil society organizations, health professionals, and the snowball technique. Online semi-structured interviews were conducted. Interviews were transcribed, anonymized, and coded using ATLAS.Ti for deductive thematic analysis. Barriers to effective healthcare access were identified in all components of Tanahashi model. Accessibility and acceptability were the components with most perceived barriers. From the determinants of health model, a woman from the public health system, with low income, under 30 or over 40, and residing in a different region from the metropolitan region faces more barriers to access to an effective healthcare. The main barriers were for the high centralisation of healthcare in Chile, not integrated health system network, misinformation to the patient, and non-humanized healthcare. The results of this study offer a comprehensive exploration of perceived barriers to effective breast cancer diagnosis and treatment in Chile, using a qualitative approach incorporating diverse perspectives. Findings underscore significant systemic challenges across Tanahashi’s model components, impacting the overall care experience. The study reveals structural inequities hindering healthcare access, reflecting global patterns in fragmented health systems.
Education as a social determinant of the health of international migrants and locals in Chile between 2013 and 2022
(2025) Blukacz, Alice; Oyarte, Marcela; Cabieses, Báltica; Díaz, Janepsy
Background: Education is a recognised social determinant of health and interacts with other determinants including employment and income. International migration may disrupt these interactions. Education in Chile reflects wider socioeconomic inequalities and in the last decade, it has welcomed an increasing number of migrants. Objective: To analyse education as a social determinant of health among international migrants and locals between 2013 and 2022. Methods: Observational cross-sectional study based on five versions of the CASEN survey. Education, employment, and income were analysed in relation to healthcare needs for both populations and logistic regression models were estimated for each year. For 2022, the interactions between education and employment were explored in relation to healthcare needs. Results: International migrants showed a higher education level and employment rate than Chileans, and a smaller proportion reported healthcare needs. After adjusting for demographic and socioeconomic factors, locals aged 19–25 and 26–59 were more likely to report healthcare needs compared to international migrants across multiple years. The effects of education, employment, and income on healthcare needs among locals and international migrants showed fluctuating ORs without marked trends. In 2022, significant differences in healthcare needs were observed among migrants and locals based on interactions between education and employment, with non-overlapping confidence intervals particularly among unemployed, less-educated youth, middle-aged migrants with incomplete basic education, and older individuals. Conclusions: This study provides an overview of education as a social determinant of health among international migrants and locals for the last decade and call for targeted in-depth analyses on the topic.
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, Báltica
Background: 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.
La construcción de “vulnerabilidad” y “agencia” en niñas y adolescentes no acompañadas: percepción de las y los actores intervinientes en Chile
(2024) Ortiz-López, Juan Eduardo; Poblete-Godoy, Daniela; Acuña Ramirez, Valeria; Dufraix Tapia, Iciar; Salinas Pérez, Sius-Geng; Pavez-Soto, Iskra; Alfaro Contreras, Carmen
El artículo examina las percepciones de autoridades, profesionales y activistas sobre las expe-riencias de niñas y adolescentes no acompañadas en Chile, enfocándose en cómo adultos in-tervinientes construyen los conceptos de vulnerabilidad y agencia. A través de una metodolo-gía cualitativa que utiliza las entrevistas semiestructuradas, el estudio evidencia que las niñas yadolescentes enfrentan una extrema vulnerabilidad en situaciones como la gestación, la explo-tación sexual y otras formas de agresión. A pesar de estas dificultades, también se identificanestrategias de agencia durante su trayecto, donde a menudo viajan acompañadas por adultosen relaciones de poder desiguales. Las entrevistas subrayan la urgencia de priorizar la atencióna adolescentes gestantes en las fronteras, mejorar la coordinación intersectorial para ofrecer unapoyo integral y replantear las políticas públicas y programas desde una perspectiva de género.
Diagnóstico y etapificación de cáncer de mama en Chile: estudio por encuesta no probabilística de III a IV frecuencia y tiempos
(2024) Campaña, Carla; Oyarte, Marcela; Cabieses, Báltica; Obach, Alexandra
INTRODUCCIÓN La progresión del cáncer de mama involucra mecanismos fisiológicos como metástasis. Los retrasos en diagnóstico y tratamiento aumentan el riesgo de mortalidad y se asocian a barreras de acceso a la salud. En Chile, el cáncer de mama es altamente prevalente y su diagnóstico temprano ha mejorado, aunque persisten disparidades en el proceso de enfermedad. Este estudio caracterizó exámenes de diagnóstico y etapificación, tiempos de espera y perfiles sociodemográficos para identificar demoras e inequidades en la atención. MÉTODOS Estudio de encuesta. Utilizando una muestra no probabilística, se aplicó un cuestionario en plataforma encriptada previo consentimiento informado. En el instrumento se recogieron datos de exámenes solicitados, tiempos asociados, etapificación y características sociodemográficas. Estas variables fueron analizadas utilizando estadística descriptiva, test de asociación, intervalos de confianza y test de comparación utilizando bootstrapping. RESULTADOS Se logró una muestra de 263 personas. Los exámenes más solicitados fueron biopsia (99,62%) y exámenes de sangre (80,23%). La mediana de exámenes solicitados fue de 6 (Q1:4, Q3:8), con media 5,87 (desviación estándar: 2,24). No se observaron diferencias significativas en el porcentaje de personas a quienes se solicitó la totalidad de exámenes según variables estudiadas. Los intervalos día-hora-resultado oscilaron entre 1 y 365 días. La mediana día-hora-resultado de la biopsia fue de 15 días (Q1:10, Q3:30). Las personas entre 40 y 49 años, no residentes de la capital, pertenecientes al quintil I de ingreso, con educación media, del sistema público de salud, con diagnóstico en etapa tardía presentaron mayores medianas de día-hora-resultado en biopsia. No hubo diferencia significativa en la cantidad de exámenes solicitados según etapificación (I a II y III a IV). CONCLUSIONES La biopsia en Chile es el examen de elección para la confirmación diagnóstica en cáncer de mama. Otros exámenes son solicitados independientemente de la etapa del diagnóstico, existiendo una discordancia con las recomendaciones de la guía clínica. El pronóstico del cáncer es crucial, especialmente en países con mayores inequidades.
Determinants of COVID-19 and non-COVID-19 vaccine confidence in low- and middle-income countries: A systematic review of qualitative evidence and thematic synthesis
(2025) Blukacz, Alice; Obach, Alexandra; Vásquez, Paola; Campaña, Carla; Huerta, Catalina; Bernal, Yanara; Cabieses, Báltica
Background: The COVID-19 pandemic has shown the immediate risk for global and public health posed by vaccination inequities worldwide. The regions most affected are low- and middle-income countries (LMICs). In addition to systemic challenges, vaccine hesitancy driven by low vaccine confidence has been identified as a threat to vaccine uptake. The aim of this systematic review of qualitative literature is to explore the determinants of COVID-19 and non-COVID-19 vaccine confidence in LMICs. Methods: A systematic review was conducted following the PRISMA and ENTREQ guidelines. The electronic databases Cinahl, Embase, Pubmed, Scopus and Web of Science were searched for qualitative studies focusing on the topic of interest in LMICs published between 2013 and 2023. The quality of the studies was assessed using the Joanna Briggs Institute’s Checklist for Qualitative Research. A thematic synthesis was conducted. The study was registered on the Open Science Framework platform. Findings: 66 studies were included in the review. Three main determinants of vaccine confidence were identified: (1) General perceptions of the safety and efficacy of vaccines; (2) Information and experience; (3) Trust in healthcare providers, institutions, and systems. General perceptions of vaccine safety and efficacy were similar between COVID-19 and non-COVID-19 vaccines, and doubts regarding vaccine safety were neither new nor exclusive to the COVID-19 vaccine, indicating a persisting challenge. Furthermore, low vaccine confidence was partly determined by broader dynamics of mistrust towards Western countries and institutions, which was reflected for both vaccine groups. While conspiracy theories have been persisting determinants of low confidence, low COVID-19 vaccine confidence was partly determined by what was perceived as a lack of specific information. Conclusion: Persistent challenges to vaccine confidence were identified, rooted in colonial legacies and global health inequities, as well as limited intercultural approaches to building trust with regards to vaccines.
Unravelling the potential relationship between the climate crisis and the health of migrant children in LAC: perceptions from migrant parents and healthcare professionals in Chile
(2024) CARREÑO CALDERON, ALEJANDRA; Blukacz, Alice; Cabieses, Báltica
Introduction Latin America and the Caribbean (LAC) is one of the regions most affected by the climate crisis, which is connected to international migration through a complex nexus. During the last years, migratory flows on the continent have increasingly included children and adolescents who are migrating through non-authorised crossing points. The existing literature shows how inequities negatively affect migrant children and the role that healthcare systems can play to mitigate them. Objective Based on a qualitative study, the paper aims to analyse the role of the climate crisis on the healthcare needs of migrant children from LAC who are currently living in Chile, from the point of view of parents from five main countries of immigration in Chile and healthcare professionals. Method An exploratory study was conducted in Arica, Antofagasta and Santiago. In-depth interviews with 20 migrant parents and 20 healthcare professionals were carried out. The interviews were transcribed verbatim and a thematic analysis was performed. Results Three findings emerged from this study: (1) food insecurity affects LAC migrant children in their country of origin and during their migratory trajectories to Chile, (2) natural disasters and environmental degradation in the countries of origin are not the only drivers of migration for LAC families but also prevent returns, even when they remain undocumented and (3) LAC migrant children are exposed to urban pollution and contaminants in informal settlements due to difficulties in accessing formal housing, among others. Conclusions The climate crisis must be integrated into the study of migrant health in LAC, considering the current context of multiple political, health and economic crises in the region. Healthcare professionals and communities play a central role in creating interventions to build sustainable and resilient universal healthcare systems.
Nutrición, niñez y migración: Desafío para su abordaje desde un enfoque de interculturalidad en salud
(2024) CARREÑO CALDERON, ALEJANDRA; Cabieses, Báltica; Blukacz, Alice
Introducción La presencia de niños y niñas migrantes en Chile ha crecido numéricamente, especialmente de aquellos provenientes de América Latina y el Caribe. Hoy se calcula que en Chile un 10,4% de los niños entre 0-14 años son migrantes (CASEN 2020). Desde la determinación social de la salud, la bibliografía indica que la presencia de niñez migrante implica diversos desafíos en temas como inequidades en la afiliación a servicios, el acceso a programas de prevención y promoción de salud, así como mayor exposición a pobreza multidimensional y condiciones de vida desfavorables para su bienestar integral. Sin embargo, una de las dimensiones menos exploradas de estas inequidades se refiere a los temas nutricionales que a nivel internacional han sido identificados como prioritarios tanto por los efectos que la transición alimentaria tiene sobre los niños migrantes, como el registro de desnutrición en niños provenientes de países a alto riesgo de inseguridad alimentaria. Objetivos La propuesta pretende indagar en las percepciones de padres, madres y tutores migrantes así como de personal de atención primaria, sobre las necesidades nutricionales que enfrentan los niños durante su trayectoria migratoria (en país de origen, tránsito y destino) y los desafíos que enfrenta el sistema de salud para abordar las temáticas nutricionales desde un enfoque de interculturalidad Método Enmarcado en un proyecto cualitativo-etnográfico mayor se desarrollaron 10 entrevistas en profundidad a padres, madres y tutores de niños, niñas y adolescentes que pasaron por paso no habilitado en Chile entre los años 2019-2023, a 10 miembros de equipos de atención primaria encargados de atención directa a población migrantes, a 5 informantes clave, encargados de programas sociales y de salud dedicados a infancia y adolescencia y a 5 miembros de ONG’s dedicados al abordaje de temas migratorios, logrando un N=30. Las entrevistas fueron transcritas y se realizó análisis temático a través de la codificación de las mismas. Resultados principales Si bien en Chile existen desde hace años esfuerzos importantes para el abordaje de la desnutrición por exceso durante la infancia y adolescencia, los hallazgos demuestran: 1) el resurgimiento de temas de desnutrición por déficit, especialmente en niños que se encuentran en situación migratoria irregular y en madres migrantes que viven gestaciones en condiciones de vulnerabilidad social; 2) las dificultades que encuentran los equipos de salud para abordar temáticas nutricionales desde un enfoque de interculturalidad, especialmente en temas como la introducción de alimentación sólida en lactantes y la adecuación de recomendaciones alimentarias y 3) la necesidad de profundizar sobre los efectos de la transición alimentaria en niños, niñas y adolescentes migrantes considerando el mayor acceso en Chile a alimentación ultraprocesada, el mayor consumo de carbohidratos como el pan y la adecuación de las dietas a ritmos laborales que reducen los tiempos para el acceso y preparación de alimentos considerados saludables. Conclusiones Se presentan resultados sobre la situación nutricional de niños, niñas y adolescentes migrantes en Chile. Se destaca el resurgimiento de la desnutrición por déficit como problemática que afecta a población infanto-juvenil, las posibles consecuencias de la transición alimentaria debido al mayor acceso a alimentos ultraprocesados y la necesidad de incorporar el enfoque intercultural en los programas de atención dedicados a la nutrición de niños y niñas.
“Hasta que me embaracé no conocí matrona”: salud sexual y reproductiva de jóvenes mujeres mapuche, Chile
(2024) CARREÑO CALDERON, ALEJANDRA; Obach, Alexandra; Correa Matus, M. Eliana
Este estudio pretende explorar la prevención y promoción de salud sexual y reproductiva en jóvenes mapuche de entre 18 y 24 años, indagando en las relaciones que establecen con el sistema de salud biomédico y en los desafíos para la inclusión de la interculturalidad en las prestaciones dirigidas a esta población. Se trata de una investigación cualitativa de estudio de caso. Se aplicaron 32 entrevistas en profundidad a jóvenes mapuche de sectores rurales y urbanos de la región de la Araucanía, Chile. Se identifica la persistencia un abordaje sanitario que carece de herramientas interculturales y de enfoque de derechos sexuales y reproductivos. Las jóvenes reportan falta de acceso a educación sexual tanto por la distancia que establecen con los servicios biomédicos de atención primaria como por las dificultades de hablar de sexualidad con los adultos de sus comunidades. Se concluye que persisten inequidades en el derecho a la salud sexual y reproductiva de jóvenes indígenas, especialmente en mujeres. Es necesario incorporar el enfoque intercultural y de derechos en la formulación de políticas públicas para esta población. Tales intervenciones requieren ser diseñadas e implementadas involucrando tanto a a población joven como a los agentes de salud de sus comunidades de origen.

Browse

Recent Submissions