Examinando por Autor "Nazar, Gabriela"

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    A Technological Framework to Support Asthma Patient Adherence Using Pictograms
    (Multidisciplinary Digital Publishing Institute (MDPI), 2024-08) Figueroa, Rosa; Taramasco, Carla; Lagos, María Elena; Martínez, Felipe; Rimassa, Carla; Godoy, Julio; Pino, Esteban; Navarrete, Jean; Pinto, Jose; Nazar, Gabriela; Pérez, Cristhian; Herrera, Daniel
    Background: Low comprehension and adherence to medical treatment among the elderly directly and negatively affect their health. Many elderly patients forget medical instructions immediately after their appointments, misunderstand them, or fail to recall them altogether. Some identified causes include the short time slots allocated for appointments in the public health system in Chile, the complex terminology used by healthcare professionals, and the stress experienced by patients during appointments. One approach to improving patients’ adherence to medical treatment is to combine written and oral instructions with graphical elements such as pictograms. However, several challenges arise due to the ambiguity of natural language and the need for pictograms to accurately represent various medication combinations, doses, and frequencies. Objective: This study introduces SIMAP (System for Integrating Medical Instructions with Pictograms), a technological framework aimed at enhancing adherence among asthma patients through the delivery of pictograms via a computational system. SIMAP utilizes a collaborative and user-centered methodology, involving health professionals and patients in the construction and validation of its components. Methods: The technological framework presented in this study is composed of three parts. The first two are medical indications and pictograms related to the treatment of the disease. Both components were developed through a comprehensive and iterative methodology that incorporates both qualitative and quantitative approaches. This methodology includes the utilization of focus groups, interviews, paper and online surveys, as well as expert validation, ensuring a robust and thorough development. The core of SIMAP is the technological component that leveraged artificial intelligence methods for natural language processing to analyze, tokenize, and associate words and their context to a set of one or more pictograms, addressing issues such as the ambiguity in the text, the cultural factor that involves many ways of expressing the same indication, and typographical errors in the indications. Results: Firstly, we successfully validated 18 clinical indications along with their respective pictograms. Some of the pictograms were redesigned based on the validation results. However, in the final validation, the comprehension percentages of the pictograms exceeded 70%. Furthermore, we developed a software called SIMAP, which translates medical indications into previously validated pictograms. Our proposed software, SIMAP, achieves a correct mapping rate of 96.69%. Conclusions: SIMAP demonstrates great potential as a technological component for supplementing medical instructions with pictograms when tested in a laboratory setting. The use of artificial intelligence for natural language processing can successfully map medical instructions, both structured and unstructured, into pictograms. This integration of textual instructions and pictograms holds promise for enhancing the comprehension and adherence of elderly patients to their medical indications, thereby improving their long-term health.
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    Association between a lifestyle score and all-cause mortality: a prospective analysis of the Chilean National Health Survey 2009–2010
    (Cambridge University Press CODEN, 2024-12-06) Petermann-Rocha, Fanny; Diaz-Toro, Felipe; Troncoso-Pantoja, Claudia; Martínez-Sanguinetti, María Adela; Leiva-Ordoñez, Ana María; Nazar, Gabriela; Concha-Cisternas, Yeny; Martínez, Ximena Díaz; Lanuza, Fabian; Carrasco-Marín, Fernanda; Martorell, Miquel; Ramírez-Alarcón, Karina; Labrana, Ana María; Parra-Soto, Solange; Villagran, Marcelo; Lasserre-Laso, Nicole; Cigarroa, Igor; Mardones, Lorena; Vásquez-Gómez, Jaime; Celis-Morales, Carlos A.
    Objective: To investigate the association between a lifestyle score and all-cause mortality in the Chilean population. Design: Prospective study. Settings: The score was based on seven modifiable behaviours: salt intake, fruit and vegetable intake, alcohol consumption, sleep duration, smoking, physical activity and sedentary behaviours. 1-point was assigned for each healthy recommendation. Points were summed to create an unweighted score from 0 (less healthy) to 7 (healthiest). According to their score, participants were then classified into: less healthy (0–2 points), moderately healthy (3–4 points) and the healthiest (5–7 points). Associations between the categories of lifestyle score and all-cause mortality were investigated using Cox proportional hazard models adjusted for confounders. Nonlinear associations were also investigated. Participants: 2706 participants from the Chilean National Health Survey 2009–2010. Results: After a median follow-up of 10·9 years, 286 (10·6 %) participants died. In the maximally adjusted model, and compared with the healthiest participants, those less healthy had 2·55 (95 % CI 1·75, 3·71) times higher mortality risk due to any cause. Similar trends were identified for the moderately healthy group. Moreover, there was a significant trend towards increasing the mortality risk when increasing unhealthy behaviours (hazard ratio model 3: 1·61 (95 % CI 1·34, 1·94)). There was no evidence of nonlinearity between the lifestyle score and all-cause mortality. Conclusion: Individuals in the less healthy lifestyle category had higher mortality risk than the healthiest group. Therefore, public health strategies should be implemented to promote adherence to a healthy lifestyle across the Chilean population.
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    Association between oral health and cognitive decline in older Chileans
    (2023-01) Nazar, Gabriela; Díaz-Toro, Felipe; Roa, Pablo; Petermann-Rocha, Fanny; Troncoso-Pantoja, Claudia; Leiva-Ordóñez, Ana María; Cigarroa, Igor; Celis-Morales, Carlos
    Objective: To identify the association between oral health and suspected cognitive impairment in older adults in Chile. Method: Cross-sectional study including 1826 people ≥60 years who participated in the National Health Survey of Chile, 2016-2017. Oral health was evaluated by the number of teeth, presence of caries, use of dental prostheses, self-reported oral health, and pain and/or discomfort in the oral cavity. Cognitive impairment was assessed using the Mini-Mental State Examination (MMSE). The association was evaluated by logistic and linear regression, adjusted for sociodemographic and lifestyle variables. Results: Compared with people without suspicion of cognitive impairment, people with suspected impairment had five fewer teeth (13.4 vs. 8.5 teeth), a much higher difference in women than in men, and a higher frequency of oral pain. Edentulism and fewer teeth were associated with a higher likelihood of suspected cognitive impairment, associations that were not maintained in adjusted models. Oral pain was associated with a higher likelihood of suspected impairment even in the most adjusted model (odds ratio: 1.99; 95% confidence interval [95%CI]: 1.09-3.63). In linear models, an increase of 2% (95%CI: 0.01-0.05) in the MMSE score was observed for each additional tooth. Conclusions: Poor oral health, particularly tooth loss and the presence of pain, was associated with cognitive impairment in older adults in Chile.
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    Frailty Index as a Predictor of Mortality in Middle-Aged and Older People: A Prospective Analysis of Chilean Adults
    (MDPI, 2023-01) Diaz-Toro, Felipe; Nazar, Gabriela; Troncoso, Claudia; Concha-Cisternas, Yeny; Leiva-Ordoñez, Ana Maria; Martinez-Sanguinetti, Maria Adela; Parra-Soto, Solange; Lasserre-Laso, Nicole; Cigarroa, Igor; Mardones, Lorena; Vásquez-Gómez, Jaime; Petermann-Rocha, Fanny; Diaz-Martinez, Ximena; Celis-Morales, Carlos
    We aimed to investigate the association between frailty status and all-cause mortality in middle-aged and older people. We included 2661 individuals aged ≥ 35 from the Chilean National Health Survey 2009–2010. Mortality was determined through linkage with the Chilean Civil Registry and Identification. A 36-item frailty index (FI) was used to assess the frailty status. Associations between frailty status and all-cause mortality were assessed using Kaplan–Meier and Cox proportional hazard models adjusted for sociodemographic and lifestyle factors. A non-linear association was investigated using penalized cubic splines fitted in the Cox models. During an 8.9 median follow-up (interquartile range of 8.6–9.0), 308 individuals died (11.5%). Lower survival rates were observed in frail individuals compared to pre-frail and robust people (log-rank < 0.001). Compared with robust individuals, frail people had a higher mortality risk (HR: 2.35 [95% CI: 1.57 to 3.51]). Frail middle-aged individuals had a higher risk of dying independently of major risk factors. © 2023 by the authors.
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    Latent class analyses of multimorbidity and all-cause mortality: A prospective study in Chilean adults
    (Public Library of Science, 2023-01) Nazar, Gabriela; Díaz-Toro, Felipe; Concha-Cisternas, Yeny; Leiva-Ordoñez, Ana María; Troncoso-Pantoja, Claudia; Celis-Morales, Carlos; Petermann-Rocha, Fanny
    Multimorbidity patterns can lead to differential risks for all-cause mortality. Within the Chilean context, research on morbidity and mortality predominantly emphasizes individual diseases or combinations thereof, rather than specific disease clusters. This study aimed to identify multimorbidity patterns, along with their associations with mortality, within a representative sample of the Chilean population. 3,701 participants aged ≥18 from the Chilean National Health Survey 2009–2010 were included in this prospective study. Multimorbidity patterns were identified from 16 chronic conditions and then classified using latent class analyses. All-cause mortality data were extracted from the Chilean Civil Registry. The association of classes with all-cause mortality was carried out using Cox proportional regression models, adjusting by sociodemographic and lifestyle variables. Three classes were identified: a) Class 1, the healthiest (72.1%); b) Class 2, the depression/cardiovascular disease/ cancer class (17.5%); and c) Class 3, hypertension/chronic kidney disease class (10.4%). Classes 2 and 3 showed higher mortality risk than the healthiest class. After adjusting, Class 2 showed 45% higher mortality risk, and Class 3 98% higher mortality risk, compared with the healthiest class. Hypertension appeared to be a critical underlying factor of all-cause morbidity. Particular combinations of chronic diseases have a higher excess risk of mortality than others.
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    PERCEPCIÓN DE MUJERES CONSULTANTES DE ATENCIÓN PRIMARIA SOBRE EL ABANDONO DEL TRATAMIENTO DE DEPRESIÓN
    (Universidad de Concepción, 2012) Neira, María Elena; Cova, Felix; Nazar, Gabriela; Parra, Lorena; Ortiz, Nestor
    El tratamiento oportuno de los trastornos depresivos es considerado una prioridad sanitaria. Un obstáculo en el logro de este propósito es la baja adherencia o el abandono del tratamiento que realizan algunos consultantes. El objetivo de esta investigación fue comprender la percepción de personas que desertaron de su tratamiento en atención primaria respecto de los factores que motivaron ese abandono. Investigación de orientación cualitativa. Las participantes fueron mujeres entre 18 y 65 años, diagnosticadas de depresión, que ingresaron y abandonaron el Programa Nacional de Diagnóstico y Tratamiento de Depresión en el primer semestre del año 2008 y año 2009 en dos centros de salud familiar de la Octava Región, Chile. Se realizaron 15 entrevistas en profundidad semiestructuradas. las que fueron codifcadas y analizadas a través del método de comparación constante. Las principales razones de abandono del tratamiento se concentraron en la existencia de obstáculos en el acceso o continuidad de la atención y en aspectos relacionados con una percepción negativa del tratamiento recibido, especialmente del farmacológico, pero también del psicológico. Se observó en las consultantes que su implicación en el tratamiento era baja debido a desconocimiento del diagnóstico recibido o una discordancia entre el tratamiento recibido respecto a sus expectativas y creencias. Estos resultados indican que los profesionales de la enfermería podrían tener un rol clave en favorecer la permanencia de los consultantes en el tratamiento al poner una mayor consideración de las expectativas, creencias y necesidades de los propios consultantes.
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    Prevalence of pre-sarcopenic obesity in Chilean older people. Results of the National Health Survey 2016-2017
    (Asociacion Espanola de Dietistas-Nutricionistas, 2023) Concha-Cisternasa, Yeny; Diaz, Felipe; Castro-Pinero, Jose; Lanuza, Fabian; Laserre, Nicole; Leiva-Ordohez, Ana Maria; Cigarroa, Igor; Nazar, Gabriela; Parra-Soto, Solange; Celis-Morales, Carlos; Petermann-Rocha, Fanny
    Introduction: There are no studies in Chile that quantify the prevalence of pre-sarcopenic obesity. Therefore, this study aimed to determine the prevalence of pre-sarcopenic obesity in Chilean older adults.Methodology: 240 people >60 years from the Chilean National Health Survey 2016-2017 were included. Pre-sarcopenia was estimated with the handgrip test and obesity was defined using waist circumference. As a sensitivity analysis, obesity was classified in a subsample of 129 people using body mass index (BMI). Based on the obesity and muscle strength criteria, the participants were categorized as: normal; obesity/ normal; normal/ pre-sarcopenia and obesity/pre-sarcopenia. Results: 22.6% of the population presented obesity/pre-sarcopenia using waist circumference as a diagnostic parameter. The prevalence of pre-sarcopenic obesity was higher in women (22.9%), in older people (33.0%), with urban residence (22.8%), and lower educational levels (37.3%). By incorporating the BMI as an obesity criterion, a decrease in the prevalence of pre-sarcopenic obesity (12.2%) and a higher percentage of women with this phenotype were identified. Conclusions: The prevalence of pre-sarcopenic obesity was identified in 22.6% of the older Chilean population included. Considering the role of obesity and sarcopenia in the development of non-communicable diseases, its identification and early detection could allow the creation of interventions that favours the survival and health of the elderly. © 2023 Asociacion Espanola de Dietistas-Nutricionistas. All rights reserved.