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Non-communicable diseases mortality rate and prevalence of high BMI by income and income inequality across countries: Associations and methodological considerations, an ecological analysis
(European Publishing, 2024-03) Thomas-Lange, Jeffrey; Urra-Miguieles, Diego
Introduction: Today, non-communicable diseases (NCDs) represent the highest morbidity and mortality burden worldwide, with high body mass index (BMI) as one of the main risk factors. NCDs mortality rate and prevalence of high BMI have a clear relationship with wealth but not with other economic indicators such as income inequality. There are well-known theories in dispute – social integration and neomaterial – trying to reveal this relationship. Methods: In this ecological study, utilizing open datasets from World Bank (WB) and Global Health Observatory, we explore the associations between countries’ economic indicators (income and income inequality) and relevant health outcomes (NCDs mortality rate and prevalence of high BMI) using bivariate correlations. To investigate the impact of inequality on health among similar-wealth nations, countries were grouped by the WB’s income classification method. Results: Multiple correlation analyses were conducted, revealing significant associations between the health variables and economic indicators, but more robust with income than inequality. Specifically, high BMI was positively correlated with income (r=0.46, p<0.05) and negatively correlated with inequality (r= -0.17, p<0.05). NCDs mortality rate showed a negative correlation with income (r= -0.54, p<0.05) and a positive correlation with inequality (r=0.20, p<0.05). At the income level groups, most associations were no longer observable, remaining a few in the higher income groups without a clear pattern. Conclusions: Globally, while income inequality may be related to worse health outcomes, this association is significant only once poverty has been largely overcome, compatible with both theories in dispute. Whether these associations observed at a general level are maintained at the grouped level will depend on the health outcomes studied, the construction of the wealth indicator, and the methodological limitations of country-income grouped analysis. These characteristics, typical of ecological studies on health inequity, could explain the literature’s mixed results in this regard.
Efficiency and productivity of the Chilean public health system between 2010 and 2019
(Medwave Estudios Ltda, 2023) Lenz-Alcayaga, Rony; Páez-Pizarro, Luciano
Introduction In view of the strong increase in health expenditure, it is necessary to investigate whether proportional increases in healthcare production for the beneficiaries of the National Health Fund have corresponded to this increase. Methods In this observational, descriptive, and retrospective longitudinal research, we estimate the technical efficiency of the National Health Services System through the average cost of production and average labor productivity in the period from 2010 to 2019. Results During the studied decade, production has increased by approximately 6% annually; the number of workers increased (mostly physicians) by 61%; spending on salaries increased by 106% in real terms; spending on consumer goods and services has increased by 25% in real terms; the efficiency of spending has decreased by 21%, and productivity is the least dynamic element of the system with an average annual growth rate of 0.6%. After subtracting the diagnostic tests component, this scenario worsens. Conclusions The results show that higher health expenditure has not been matched by commensurate increases in output, translating into a fall in the efficiency of healthcare expenditure and meager increases or falls in productivity, depending on how the output is measured. This means that the public sector's growth strategy depends mainly on increases in the number of workers. This low productivity is a serious constraint to improving healthcare access for National Health Fund beneficiaries and contributes to increasing waiting lists. Special attention should be paid to average production costs and average labor productivity in a scenario of less dynamic growth in public health spending and health system reform. © 2023, Medwave Estudios Ltda. All rights reserved.
Changes in sitting time, screen exposure and physical activity during covid-19 lockdown in south american adults: A cross-sectional study
(MDPI, 2021-05-02) Sadarangani, Kabir P.; De Roia, Gabriela F.; Lobo, Pablo; Chavez, Robinson; Meyer, Jacob; Cristi-Montero, Carlos; Martinez-Gomez, David; Ferrari, Gerson; Schuch, Felipe B.; Gil-Salmerón, Alejandro; Solmi, Marco; Veronese, Nicola
The worldwide prevalence of insufficient physical activity (PA) and prolonged sedentary behavior (SB) were high before the coronavirus (COVID-19) pandemic. Measures that were taken by governments (such as home confinement) to control the spread of COVID-19 may have affected levels of PA and SB. This cross-sectional study among South American adults during the first months of COVID-19 aims to (i) compare sitting time (ST), screen exposure, moderate PA (MPA), vigorous PA (VPA), and moderate-to-vigorous PA (MVPA) before and during lockdown to sociodemographic correlates and (ii) to assess the impact of lockdown on combinations of groups reporting meeting/not-meeting PA recommendations and engaging/not-engaging excessive ST (≥7 h/day). Bivariate associations, effect sizes, and multivariable linear regressions were used. Adults from Argentina (n = 575) and Chile (n = 730) completed an online survey with questions regarding demographics, lifestyle factors, and chronic diseases. Mean reductions of 42.7 and 22.0 min./day were shown in MPA and VPA, respectively; while increases of 212.4 and 164.3 min./day were observed in screen and ST, respectively. Those who met PA recommendations and spent <7 h/day of ST experienced greatest changes, reporting greater than 3 h/day higher ST and more than 1.5 h/day lower MVPA. Findings from the present study suggest that efforts to promote PA to South American adults during and after COVID-19 restrictions are needed. © 2021 by the authors. Licensee MDPI, Basel, Switzerland.
Exchanging screen for non-screen sitting time or physical activity might attenuate depression and anxiety: A cross-sectional isotemporal analysis during early pandemics in South America
(Elsevier Ltd, 2023-06) Sadarangani, Kabir P.; Barreto Schuch, Felipe; De Roia, Gabriela; Martínez-Gomez, David; Chávez, Róbinson; Lobo, Pablo; Cristi-Montero, Carlos; Werneck, André O.; Alzahrani, Hosam; Ferrari, Gerson; Ibanez, Agustin; Silva, Danilo R.; Von Oetinger, Astrid; Matias, Thiago S.; Grabovac, Igor; Meyer, Jacob
Objectives: To examine the theoretical substitutions of screen exposure, non-screen sitting time, moderate and vigorous physical activity with depressive and anxiety symptoms in South American adults during the COVID 19 pandemic. Design: A cross-sectional study during the first months of the COVID-19 pandemic with data from 1981 adults from Chile, Argentina, and Brazil. Methods: Depressive and anxiety symptoms were assessed using the Beck Depression and Anxiety Inventories. Participants also reported physical activity, sitting time, screen exposure, sociodemographic, and tobacco use data. Isotemporal substitution models were created using multivariable linear regression methods. Results: Vigorous physical activity, moderate physical activity, and screen exposure were independently associated with depression and anxiety symptoms. In adjusted isotemporal substitution models, replacing 10 min/day of either screen exposure or non-screen sitting time with any intensity of physical activity was associated with lower levels of depressive symptoms. Improvements in anxiety symptoms were found when reallocating either screen exposure or non-screen sitting time to moderate physical activity. Furthermore, replacing 10 min/day of screen exposure with non-screen sitting time was beneficially associated with anxiety (B = −0.033; 95 % CI = −0.059, −0.006) and de pression (B = −0.026; 95 % CI = −0.050, −0.002). Conclusions: Replacement of screen exposure with any intensity of physical activity or non-screen sitting time could improve mental health symptoms. Strategies aiming to reduce depressive and anxiety symptoms highlight physical activity promotion. However, future interventions should explore specific sedentary behaviors as some will relate positively while others negatively. © 2023 The Authors. Published by Elsevier Ltd on behalf of Sports Medicine Australia. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Health-related quality of life in women aged 20-64 years with urinary incontinence
(Institute for Ionics, 2023-07) Ramírez, Julieta Aránguiz; Tirado, Pedro Olivares; Samur, Carlos Sandaña; Gamboa, Carolina Vidal; Oliveres, Xavier Castells
Introduction and hypothesis: Urinary incontinence (UI) in women is a frequent and invisible clinical situation that affects several aspects in the lives of patients. The aim of this study is to assess the impact of urinary incontinence on different dimensions of quality of life. Methods: Cross-sectional observational study. The sample brings together 381 women living in the Metropolitan Region of Chile, who answered a survey between June 2020 and June 2021, with questions about the sociodemographic situation, obstetric history and the EQ5D-3L questionnaire Chilean version and urinary incontinence variables. For the analysis of association between variables were used a correlation coefficient and logistic regressions. Results: The mean age of the sample was 39.9 (SD: 12.6) years, with 68.5% of multiparous women and 42.5% had a history of vaginal delivery. Fifty percent of the respondents belong to a medium-high socioeconomic level according to the health insurance proxy. The analysis adjusted for age, health insurance and obstetrics variables showed that women with a frequency of moderate/severe urine loss had a 72% greater probability of suffering from moderate/severe pain/discomfort compared to women with nothing/little urine loss. In turn, the self-perception of affectation of urine loss was significantly associated with problems in the dimensions of mobility, anxiety/depression and health status. Conclusions: This research contributes with evidence that makes visible the affectation on physical and psychological dimensions in women with urinary incontinence, allowing decision-makers to prioritize resources and design health programs that include clinical management. © 2022, The International Urogynecological Association.
Temporal trends and factors associated with preterm birth in Chile, 1992-2018
(Universidad Nacional de Lanos, 2023) Toro-Huerta, Carol; Vidal, Carolina; Araya-Castillo, Luis
An analytical study based on Chilean birth records obtained from the Department of Statistics and Health Information (DEIS) was conducted. This study aimed to evaluate temporal trends in preterm births by maternal age in Chile from 1990 to 2018. Results show that the preterm birth rate in 1992 was 5.0% and increased to 7.2% in 2018. The average annual percent change (AAPC) was 1.44. Age groups at the extremes (19 and under and 35 and over) presented the highest rates of preterm birth, both at the beginning and at the end of the study period. The latter group showed a smaller decrease at the beginning (1992 to 1995), with an annual percentage change (APC) of -3.00. The probability of preterm birth in both groups was higher compared to the 20-34 year old group. Although Chile boasts some of the best maternal and child health indicators in the region, repercussions associated with the current postponement of maternity – including preterm birth – must be monitored. © This work is under Creative Commons license Attribution 4.0 International (CC BY 4.0). Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use. No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
Procrastination in University Students: A Proposal of a Theoretical Model
(MDPI, 2023-02) Araya-Castillo, Luis; Burgos, Mildred; González, Patricia; Rivera, Yuracid; Barrientos, Nicolás; Yáñez Jara, Víctor; Ganga-Contreras, Francisco; Sáez, Walter
Procrastination is a phenomenon that affects university students and consists of not finishing a task or finishing it late, which has a direct impact on their academic performance. This is relevant because, in a context of high competition, higher education institutions and their decision-makers need to be aware of the factors that influence university students’ procrastination in order to implement actions that favor student attraction and retention. Based on the above, this research aims to propose a theoretical model of procrastination in university students, based on the literature review and content validation assessment through a semi-structured questionnaire. The proposed model is made up of nine dimensions: Psychological, Physiological, Social, Academic, Leisure, Time Management, Resources, Labor, and Environmental. Dimensions were obtained based on adequate levels of content validity provided by the literature and the questionnaire. In the future, the research proposes to study the way in which these dimensions are present in procrastination and design a scale that allows for their measurement. © 2023 by the authors.
Decentralization Can Improve Equity, but Can It Be Sustained?
(Taylor and Francis Ltd., 2022-06) Bossert, T.; Lenz, R.; Guerrero, R.; Miranda, R.; Soto Rojas, V.; Maldonado Vargas, N.
A major theoretical issue about health system reform involving decentralization has been whether it promotes equity of health system funding. An article by the principal author and others in 2003 showed that, under certain conditions and policies, decentralization improved the equity of allocation of financial resources to different income levels of municipalities in Colombia and Chile. Another recurring issue has been whether reforms can be sustained over time. In a follow-up study in 2015, we found that the equity of national allocations was sustained even though the allocation rules for intergovernmental transfers and insurance funding sources had changed, as long as per capita allocation rules were retained. Nevertheless, the wealthier municipalities in Chile were able to increase their own source funding contributing to a larger gap between wealthy and poor municipalities, suggesting that in order to assure continued equity some compensation for these funds be included in intergovernmental transfer rules or that local source funding be restricted by national policy. These reforms may be more likely to be sustained if they become embedded in existing financial systems and if they receive support of status quo constituencies.
Attitudes toward Health Systems Financing in Chile
(SAGE Publications Inc., 2021-05) González, Pablo A.; Gutiérrez, , Laura L; Oyanedel, Juan Carlos,; Sánchez-Rodríguez, Héctor
This article presents an exploratory model to classify public attitudes towards health systems financing and organization. It comprises 5 factors (pay-as-you-use, solidarity, willingness to contribute, mixed financing, and public provision) measured by 17 indicators, selected through Exploratory Structural Equation Modeling (ESEM) applied to a sample of Chilean adults. Based on this model, cluster analysis proposed 2 groups: “Taxes-public” and “Insurance-choice,” representing 47% and 53% of interviewees, respectively. The results show differences between groups concerning the evaluation of both health care providers and insurers. The second cluster tends to evaluate them more harshly, showing less willingness to contribute further, less solidarity, more agreement with the current financing arrangement in terms of the mixture and its insurance (as opposed to purchasing of service based on health problems), and more support for choice of provider. These results highlight the need to consider people’s attitudes in the public discussion of health systems financing. © The Author(s) 2021.
Características epidemiológicas de los fallecidos durante el terremoto y maremoto de Chile 2010
(Sociedad Médica de Santiago, 2012-06) Lastra T., Jorge; Guzmán C., Guillermo; Conejeros R., Consuelo; Suárez V., Guillermo; Chávez F., Orlando
Background: On February 27, 2010 a powerful earthquake followed by a tsunami stroke Chile. The study of mortality during this emergency can provide important public health information. Aim: To describe the main characteristics of people who died during the earthquake and the following three months. Material and Methods: Cross sectional analysis of death records databases obtained from Department of Health Statistics and Information of the Ministry of Health and the Coroner office. Results: Until May 25,2010, 505 corpses were completely identified. Seventy two of these corresponded to people aged 80 years or more. The higher age adjusted death rates per 100,000 inhabitants were observed among subjects aged more than 80 years and those aged 70 to 79 years (22.6 and 7.7 respectively). The higher rates of deaths were observed in regions where the earthquake had a higher intensity and coastal regions affected by the tsunami. The causes of death were trauma in 75% of cases and drowning in 25%. There was no association between the Mercalli scale of earthquake intensity and rates of death. Among deceased subjects, there was a concentration of unemployed, under educated and low socioeconomic status subjects. Conclusions: After the earthquake, the higher rates of deaths occurred among older people and in the region of the epicenter of the earthquake. Most deaths were due to trauma.
Conocimiento y Evaluación Acerca de las Mutuales de Seguridad en Chile
(Fundación Científica y Tecnológica. Asociación Chilena de Seguridad, 2014) Oyanedel, Juan Carlos; Sánchez, Héctor; Inostroza, Manuel; Mella, Camila; Vargas, Salvador
RESUMEN: Este artículo presenta el nivel de conocimiento y evaluación de las mutuales de seguridad, aseguradoras privadas de accidentes laborales y enfermedades profesionales en Chile. Se aplicó una encuesta telefónica a 300 trabajadores dependientes residentes en hogares ubicados en las zonas urbanas de Santiago de Chile. Los hogares fueron seleccionados de forma aleatoria sobre la base de un listado público de teléfonos de hogares. Los resultados muestran que la mayor parte de los encuestados sabe en qué consisten estas instituciones, pero aproximadamente un tercio afirma no tener conocimiento del sistema. Las evaluaciones más altas respecto a la información recibida de las mutuales están en el área de beneficios no relacionados al trabajo (por ejemplo, descuentos en establecimientos educacionales y tiendas) y a las coberturas en salud en caso de accidente. Para aquellos usuarios que han sufrido un accidente laboral, las valoraciones más altas están en el área de atención médica y rehabilitación, mientras las más bajas se encuentran en las prestaciones asociadas a traslado hacia los centros asistenciales, así como de los procedimientos administrativos asociados al tratamiento del accidente. Se concluye que resulta necesario promover el conocimiento de las actividades de las mutuales y mejorar las estrategias de promoción de actividades de prevención de accidentes ocupacionales con el objeto de hacer más eficiente su rol público. De igual manera, la información recolectada permite identificar los procedimientos de apoyo al tratamiento de accidentes como una de las áreas de mejora en el marco de la atención de salud ocupacional.
¿Salud Pública o Privada? Los factores más importantes al evaluar el sistema de salud en Chile
(2015) Aravena L., Pedro; Inostroza P, Manuel
Background: There is a great degree of dissatisfaction with the Chilean health care system. Aim: To investigate which are the most relevant perceived factors when the health care system is evaluated. Material and Methods: Analysis of a survey about the Chilean health care system carried out during 2011, 2012 and 2013, involving 2,801 respondents. Results: The response capacity of emergency systems was the main factor considered for the evaluation of public and private health care systems. Respondents who were affiliated to private insurance systems also took into consideration the quality of medical infrastructure. Conclusions: There are different factors considered when public or private health care systems are evaluated. Key words: Delivery of health care; Public Health; Public Opinion; Chile.
Epidemiología de las consultas respiratorias de adultos en Santiago de Chile desde 2003 a 2008
(2015) Olmos, Claudio; Mancilla, Pedro; Martínez, Luis; Astudillo, Pedro
Background: Respiratory diseases are the third cause of death, and the second cause of hospitalization among people aged 65 years or more in Chile. Aim: To analyze the distribution of consultations due to respiratory diseases among adults living in Metropolitan Santiago. Material and Methods: A daily registry of all consultations of patients older than 15 years old in seven public primary care centers, was carried out between January 2003 and December 2008. Consultations were classified as having non-respiratory or respiratory causes. The latter were broke down in upper or lower respiratory diseases, pneumonia, chronic obstructive pulmonary disease (COPD) and asthma. Results: A total of 1,170,941 consultations were registered and 19% were due to respiratory diseases. Of these, 46% were due to upper respiratory diseases, 31% due to lower respiratory diseases, 8% due to COPD, 6% due to pneumonia, 5% due to asthma and 4% due to other respiratory causes. Pneumonia and COPD were more frequent among consultants older than 65 years. Conclusions: Consultations due to respiratory diseases are approximately one fifth of all primary care consultations. Older people often have more chronic and severe diseases. Key words: Adult; Epidemiology; Morbidity; Respiratory tract diseases.
Malas noticias para el Plan AUGE
(2013) Inostroza P., Manuel
En el reciente discurso del 21 de mayo, el Presidente Piñera ha ratificado su compromiso con subir a 80 los problemas de salud de los chilenos, que están cubiertos en las Garantías Explícitas de Salud (GES), mejor conocidas como AUGE, a partir de Julio de este año 2013. Sin embargo, lo que parece ser una muy buena noticia para el común de nuestros ciudadanos e inclusive para los médicos y profesionales de la salud de nuestro país, en realidad es más bien una pésima señal y muestra cómo los dos últimos gobiernos, independientemente de su color político, en realidad están matando el AUGE o GES, poniendo en jaque a una de las más exitosas políticas públicas de los últimos 23 años en nuestro país.

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