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PubMed1982

Epidemiology of gastric cancer in Chile. III. Diagnostic practices in Santiago, 1976-8.

The purpose of this paper is to estimate the validity of current diagnostic procedures used in Santiago, Chile, in identifying gastric cancer (GC) patients among people with gastric complaints, many of whom suffer possible premalignant conditions. Review of diagnoses on 2296 patients seen at the University Hospital during 1976 and 1977 revealed 103 confirmed cases of adenocarcinoma. This review permitted us to estimate the validity of clinical/radiological and endoscopic methods versus diagnosis made from pathological specimens. A code of diagnostic categories was generated for application in eight hospitals participating in a subsequent case-control study of GC. A high prevalence of chronic atrophic gastritic (CAG) and chronic gastric ulcer (CGU) was found, both conditions together accounting for 50% of diagnoses on 845 clinic controls during the study period 1977-8. The value of gastroscopy and biopsy to separate out GC from other gastric conditions, the importance of studying the epidemiology of premalignant conditions in Chile, and differences between GC in Chile and the United States are discussed.

Biopsy↗
PubMed1998

The introduction of routine Haemophilus influenzae type b conjugate vaccine in Chile: a framework for evaluating new vaccines in newly industrializing countries.

OBJECTIVE: To determine the burden of Haemophilus influenzae type b (Hib) disease, the safety and immunogenicity of Hib conjugate vaccine, the practicality of combining Hib conjugate and diphtheria-tetanus-pertussis vaccines and the effectiveness of routine vaccination. STUDY DESIGNS: A series of studies were carried out involving infants and children in Santiago, Chile. The study designs included retrospective surveillance, cost-benefit analysis, randomized placebo-controlled trials of safety and immunogenicity and a Phase IV postlicensure evaluation of vaccine effectiveness. RESULTS: The studies included in this stepwise process showed that Hib invasive disease was a significant public health problem with a substantial economic burden; that combining Hib conjugate and diphtheria-tetanus-pertussis vaccines was practical, safe and elicited a strong immunologic response; and that the combined formulation afforded a high level of protection against invasive Hib disease (90% effectiveness). CONCLUSIONS: In July, 1996, Chile became only the third newly industrializing country to introduce routine Hib conjugate vaccination. New vaccines, such as Hib conjugates, will be more expensive than existing ones. The stepwise process used in Chile may serve as an example for the evaluation of new vaccines in nonindustrialized countries.

Child, Preschool↗
PubMed2006

Malignant melanoma in Chile: an unusual distribution of primary sites in men from low socioeconomic strata.

BACKGROUND: Mortality from malignant melanoma (MM) has increased in Chile in the past decade. The location of MM lesions on the body has been correlated with prognosis and survival. AIM: To review body site and gender relationships with histopathologically confirmed primary MM in Chile. METHODS: Records of 575 cases presenting to 5 state hospitals from 1992 to 2001 were analysed. RESULTS: There were 360 women and 215 men. Women showed a significantly higher number of MM on the legs, cheeks and arms, and in the genital area, whereas men showed a significantly higher number on the ears, backs of the hands, soles and feet. Men had a predilection for MM with a poor prognosis. CONCLUSION: The different body site distribution of primary MM in men and women may be explained by a different pattern of sun exposure. Ethnic and genetic factors may also be involved. The predominant location of MM in women in Chile is similar to white populations, whereas the location in men is similar to that observed in black and Asian populations. These observations may be relevant to the high mortality of MM in Chilean men.

Chile↗
PubMed2004

Folic acid fortification of wheat flour: Chile.

Neural tube defects (open spina bifida, anencephaly, and encephalocele) represent the first congenital malformations to be preventable through public health measures such as supplementation and/or food fortification with folic acid. In Chile, starting in January 2000, the Chilean Ministry of Health legislated to add folic acid to wheat flour (2.2 mg/kg) to reduce the risk of NTDs. This policy resulted in an estimated mean additional supply of 427 microg/d in significant increases in serum folate and red cell folate of 3.8 and 2.4-fold, respectively, in women of fertile age, one year after fortification. The impact on the rate of NTDs is presently being studied in all births, both live births and still births, with birth weight >500 g in the city of Santiago. Preliminary results show a reduction of 40% in the rates on NTDs from the pre-fortification period (1999-2000) to post-fortification period (2001-June 2002). Fortification of wheat flour with folic acid in Chile is effective in preventing NTDs in Chile.

Bread↗
PubMedDate not supplied

Alcohol and hemorrhagic stroke in Santiago, Chile. A case-control study.

BACKGROUND AND PURPOSE: Hemorrhagic stroke (HS) is a major cause of disability and death worldwide. There is a dearth of information on HS from geographically defined populations in Latin America. In this study we assessed the importance of alcohol consumption as a risk factor for HS in Chile. METHODS: Case-control study in Santiago, Chile, of 140 consecutive patients with CT-confirmed HS, matched by sex and age with 140 hospital controls. Alcohol consumption was measured in grams (ethanol) per week, using a questionnaire administered to the patients or caregivers or both. We defined four categories of alcohol consumption: nondrinkers (0.0 g/week), light (0.1-115 g/week), moderate (116-402.5 g/week) and heavy drinkers (>402.5 g/week). Other variables measured included diabetes mellitus (DM), cigarette smoking, arterial hypertension, liver disease and chronic use of nonsteroidal anti-inflammatory drugs (NSAID). Statistical analysis was performed with STATA 6.0 software. RESULTS: A total of 280 subjects with a mean age of 65.5 years were studied over a 3-year period, 122 men (43.5%) and 158 women (56.5%). Alcohol intake was 394.1 g/week among cases and 174.5 g/week in controls (p=0.01). The following odds ratios (OR) with 95% confidence intervals (CI) were found: hypertension 4.89 (2.86-10.3) and chronic use of NSAID 3.44 (2.15-12.9). Using conditional logistic regression analysis high alcohol intake was found to have a statistically significant OR of 4.47 (CI 1.14-17.2). CONCLUSIONS: In Chile, a high alcohol intake (>402.5 g/week) increased more than 4 times the risk of HS and remained a significant risk factor for HS after controlling for hypertension, cigarette smoking, liver disease, blood cholesterol levels, and chronic use of NSAID. The risk was higher in younger patients (<65 years of age).

Adult↗
PubMed2006

Seasonal variation in suicidal deaths in Chile: its relationship to latitude.

BACKGROUND: Studies in the northern and southern hemispheres consistently identified seasonal influences on monthly and semester suicide distribution. The variations of sunlight exposure in zones of increasing latitude has been suggested as one of the most plausible explanations for this phenomenon. Some recent studies in the northern hemisphere could not find seasonal asymmetries of suicides. The current study examines the monthly, seasonal and semester distribution of suicidal deaths in Chile and the influence of seasons in zones of low latitude as compared with regions of high or very high latitude, trying to determine if a seasonal pattern still exists in a country of the southern hemisphere. METHODS: Monthly, seasonal and semester suicidal data over the period 1995-1999 were examined for the whole sample and for gender-specific subgroups in Chile. Four different latitudinal zones were analyzed separately, in order to investigate the effect of the photoperiod on suicide distribution. Results were analyzed by chi(2) tests for multinomials, as an overall measure of deviation. RESULTS: We found a significant unimodal springtime peak for both genders in the global territory. Among the 4,710 male and 829 female suicides reported in this period there were no gender differences in the seasonal pattern of suicidal deaths. When divided into four different latitudinal zones, the regions with low latitude (north of the country) showed no significant differences, while central and southern zones (higher latitude) show a significant springtime pattern. In the extreme south of the country, no significant differences were found, probably due to the very small number of cases. CONCLUSION: The study confirms the existence of a unimodal springtime peak of suicides in Chile, but not in the zone of low latitude. Results support the notion that the seasonal impact on suicidal distribution is a function of photoperiod.

Analysis of Variance↗
PubMed2004

Use of mental health services in Chile.

OBJECTIVE: S: To address the growing burden of mental illness in Latin America, a better understanding of mental health service use and barriers to care is needed. Although many Latin American countries have nationalized health care systems that could potentially improve access to care, significant barriers to care remain. The authors report the results of a study examining mental health service utilization in the general population of Chile. METHODS: The data were drawn from the Chile Psychiatric Prevalence Study, a national household survey of 2,987 persons aged 15 years and older conducted in 1992-1999. As part of the survey, psychiatric diagnoses were obtained by using the Composite International Diagnostic Interview, and respondents were asked about their use of general and mental health care services in the past six months and about their experience of barriers to treatment. RESULTS: More than 44 percent of respondents reported use of any health care services in the past six months, and 20 percent reported use of mental health services. Of the respondents who met criteria for a psychiatric disorder, a large proportion (62 percent) did not receive mental health care. Increasing severity of the psychiatric disorder correlated with increasing frequency of overall help seeking, but only a small proportion of the respondents with a psychiatric disorder sought specialized mental health services. Regional disparities and inequities in access to care were found. In addition, indirect barriers to mental health care, such as stigma and misconceptions about the course of psychiatric disorders, were important deterrents to service utilization, particularly among persons with lower socioeconomic status. CONCLUSIONS: To reduce the burden of mental illness in Chile, additional efforts are needed to address both the direct and the indirect barriers to mental health care, including regional inequities in access to care.

Adolescent↗
PubMed2006

Goat paratuberculosis in Chile: first isolation and confirmation of Mycobacterium avium subspecies paratuberculosis infection in a dairy goat.

In October 2004, 41 goats > 2 years old from a Saanen dairy goat herd located in Purranque County, 10th Region, Chile, were sampled and tested for paratuberculosis. While collecting samples it was observed that several goats were thin and emaciated. One goat was sufficiently debilitated to warrant humane euthanasia. This animal was brought to the Veterinary School at the Universidad Austral de Chile for necropsy. The goat selected for necropsy was a 12-year-old doe. The animal showed classical clinical signs of caprine paratuberculosis: emaciation despite willingness to eat, dry and rough hair coat, and no evidence of diarrhea. Gross pathology and histopathology of the necropsied goat were consistent with paucibacillary paratuberculosis. Bacteriology, serology, and PCR confirmed the diagnosis. This is the first published report of goat paratuberculosis in Chile confirming a case of caprine paucibacillary paratuberculosis.

Animals↗
PubMed2005

Chile's national nutritional supplementation program for older people: lessons learned.

Demographic changes in developing countries have resulted in rapid increases in the size of the older population. As a result, health-care budgets face increasing costs associated with the declining health and function of older people. Some governments have responded to this situation by designing innovative programs aimed at older people. One such program, implemented by the government of Chile, distributes an instant food mix fortified with vitamins and minerals to all persons over 70 years old who are registered by the national health service. The national health service covers approximately 90% of the older population. The program specifically targets nutritional vulnerability and micronutrient deficiency, which are common among poor older people in Chile. We present here the findings of a one-year investigation into all aspects of Chile's program for the elderly. The research included in-depth interviews with policy makers and program implementers, focus group discussions with user groups, analysis of the micronutrient content of the nutritional supplement, and telephone interviews of a random sample of older people. The results demonstrate that there can be a considerable degree of self-targeting within national programs; programs need to be sufficiently flexible to permit periodic protocol change; user groups must be consulted both before and during program implementation; and the design of an effective program evaluation must be in place before program implementation. It is hoped that these results will be useful to policy makers and implementers planning programs aimed at improving the health and function of older people.

Aged↗
PubMed2001

[Phage typing of Salmonella enteritidis isolated from clinical, food, and poultry samples in Chile].

Since 1994 an extensive epidemic of infections with Salmonella enteritidis (S. enteritidis) has affected Chile. In order to understand the diversity of infective sources, the possible origin of the epidemic, and the epidemiological relationships between clinical, food, and poultry isolates, we carried out phage typing of three groups of samples: 1) 310 S. enteritidis clinical samples collected between 1975 and 1996, 2) 47 food isolates obtained during S. enteritidis outbreaks, and 3) 27 strains isolated in surveillance studies of poultry-raising establishments. With the clinical samples, a total of 13 phage types were identified, 2 isolates could not be typed, and 1 was considered atypical. The phage types that were identified most frequently were 1 (56.8%) and 4 (31.3%), trailed by type 8 (4.8%) and type 28 (1.9%). Over time and in different regions of the country there were major changes in the distribution of the phage types. In the first years of collection the only phage types registered were 8 and 28, which disappeared around 1980 and then began reappearing sporadically in 1996. With the gradual S. enteritidis expansion that started in 1988, in the central and southern areas of the country phage type 4 began to appear; that type had not been found before in Chile. In 1991 in the northern area of the country phage type 1 began to predominate; it was another type that had not been reported before in Chile. In the food isolates the only phage types identified were 1 and 4, which were also the most common in the poultry isolates. Phage typing of S. enteritidis has proved to be useful in guiding the epidemiological analysis of the infections caused by this pathogen.

Animals↗
PubMed2004

[Preliminary evaluation of Chile's First Citizen Consensus Conference].

This piece provides an initial assessment of the First Citizen Consensus Conference, an event held in the city of Santiago, Chile, from 22-24 November 2003, on the subject of "The Management of My Medical Record." This conference was the first citizen consensus conference that has been held in Chile as well as the first such conference in Latin America. Consensus conferences were devised by the Danish Board of Technology in 1987 as a way to assess science and technology issues through discussions between experts and a panel of lay persons. At the end of a consensus conference, the lay persons express their opinions and recommendations in a consensus report that is directed at policymakers, decision-makers, and the public in general. The objective of a consensus conference is to bridge the gaps that routinely exist among the general public, experts, and elected officials. So far, the Danish Board of Technology has organized more than 20 of these conferences, using a methodology that has become established as a model. Taking into account the changes that have occurred in the relationship between science and society at large, the Pan American Health Organization has decided to support the holding of consensus conferences in Latin America and the Caribbean. The First Citizen Consensus Conference adapted the Danish methodology to conditions in Chile, and this piece assesses the modifications that were made. In addition, some 6 to 12 months after the conference, there will be an external evaluation of the outcomes and impact of the conference, especially in the communications media, public debate, decision-making, and perceptions of the persons who were involved. Despite the criticisms made in this piece and some shortcomings that are pointed out, the First Citizen Consensus Conference achieved all of its objectives and will serve as an excellent model for similar conferences in other countries of the Americas.

Chile↗
PubMedDate not supplied

[Service use patterns among adults with mental health problems in Chile].

OBJECTIVE: To describe the patterns in the use of general health services and specialized health services among adults with mental health problems in Chile, as well as those persons' level of satisfaction with the services. The overall objective was to optimize the use of the limited resources available for mental health care in the countries of the Americas, especially Chile. METHODS: The diagnoses and the patterns of use of mental health services were obtained from the Chilean Study of Psychiatric Prevalence (Estudio Chileno de Prevalencia Psiquiátrica). That representative research on the adult population of Chile was based on a stratified random sample of 2,987 people 15 years old and older, done over the period of 1992 to 1999. The psychiatric diagnoses were obtained using the Composite International Diagnostic Interview (CIDI). The interviewees were also asked about their use of general health care services and of mental health services in the preceding six months, as well as any barriers to accessing the services. RESULTS: More than 44% of the interviewees had had contact with some type of health service during the six months prior to the study, but only 5.6% received specialized care. Those who presented with a diagnosis of obsessive-compulsive disorder or of panic disorder consulted more frequently, but not in specialized centers. Consumption of substances such as alcohol and drugs as well as antisocial personality disorder were associated with a low level of consultation. When asked about sources of assistance for mental health problems, the majority of the interviewees mentioned only the formal health care system. More than 75% of the interviewees said that they were satisfied or very satisfied with the care that they had received. CONCLUSIONS: Our results confirm the existence of a wide gap between the need for care and the treatment that is actually received. The informal and folkloric alternative resources (priests, family members, healers, herbalists, etc.) were used less frequently than is generally believed to be true. The indirect barriers of access to services--linked to a lack of knowledge and to stigma--were more frequent than were the direct barriers. A sizable number of people who did not have a positive diagnosis on the CIDI utilized mental health services.

Adolescent↗
PubMed1979

Nutrition and national development: the case of Chile.

This study is an historical analysis of food consumption and nutrition in Chile emphasizing the influence of political and economic factors on nutritional standards. It attempts to document and explain the persistence of malnutrition as a widespread social problem in Chile even as the country achieved a relatively advanced state of economic development and boasted an unusually progressive record of social legislation. The major findings of the study were: (a) Chile's pattern of development, social reform efforts notwithstanding, consistently discriminated against low-income groups, and (b) this discrimination perpetuated low standards of nutrition and low levels of food consumption among the country's poor and undermined the effectiveness of specific measures to alleviate malnutrition.

Agriculture↗
PubMed2004

[Recent changes in prostate cancer mortality in Chile. Trends analysis from 1955 to 2001].

BACKGROUND: By the year 2000, prostate cancer became the second leading cause of cancer death in Chilean men of all ages and is the leading cause of cancer deaths in men of eighty years of age or older. AIM: To analyze the trends in mortality rates from prostate cancer in Chile in a fifty years series, estimating the rate of increase of such rates and their changes in time. MATERIAL AND METHODS: A trend analysis for age standardized mortality rates was performed, using join point regression analysis, which allows estimation of the annual percent change of rates and to find significant changes in such trend. RESULTS: Age standardized mortality rates in Chile reached their peak value in 1996, becoming apparently stable from then on. Crude rates have had a steady increase during the whole period. The trends analysis identified three different periods in the growth of the age standardized rates: a first one of slot increase in rates between 1955 and 1981 (0.9% annual increase), a second one of more aggressive growth starting in 1981 (2.6% annual increase), and a third period starting in 1996, in which rates slowly decline at an annual rate of 1%. CONCLUSIONS: The tendency of prostate cancer seen in Chile resembles that of industrialized countries, with an increase in its age standardized death rates that suffers a downturn by the end of the past decade. Besides early detection techniques, a substantial part of the reduction in mortality from prostate cancer could be explained by therapeutic improvements.

Age Distribution↗
PubMed2004

[Contemporary practice of the coronary angioplasty in Chile. Final report of the Chilean National Coronary Angioplasty Registry (RENAC) 2001-2002].

BACKGROUND: Coronary angioplasty was introduced in Chile in 1982, but only after the introduction of stents it became commonplace. However the results of this procedure at the national level remain largely unknown. AIM: To assess the results and characteristics of coronary angioplasty and develop a national registry in Chile (RENAC). PATIENTS AND METHODS: All centers performing angioplasty were invited to contribute prospectively with the clinical, angiographic, procedural characteristics and results of all consecutive coronary angioplasty procedures attempted between June 2001 and October 2002. RESULTS: In 10 centers, 1768 lesions were treated in 1484 procedures (22.98% in women). Mean age was 60.8 +/- 11.3 years old. Diabetes was found in 21.8%, hypertension in 60.2%, dyslipidemia in 52.0%, active smoking in 40.0%, renal failure in 6.2%. Myocardial infarction was recent in 28.4% and acute in 19.7%. Forty eight percent of patients had unstable angina and 15.5% had stable angina. Fifty three percent of patients had single vessel disease and 71%, normal left ventricular eyection fraction. One vessel was treated in 90.6% of patients and 81.7% of lesions were treated with stents, 17.9% only with baloon and in 0.4% with atherectomy. Angiographic success was obtained in 95.2%. Clinical success was obtained in 92.2%, and 95.1% In patients without acute myocardial infarction. Overall inhospital death was 2.2%. In patients without myocardial infarction, the figure was 1.1%. CONCLUSIONS: Coronary angioplasty in Chile is performed mostly for the treatment of acute coronary syndromes. Stents are the most frequently used devices. The high success, low mortality and complications observed are comparable to North American registries.

Adult↗
PubMed2004

[Work absenteeism in Chile according to the type of work place].

BACKGROUND: The issue of medically justified work absenteeism has a great relevance in Chile at the present moment. AIM: To analyze sick leaves among people working in hospitals, mines, automotive industry and universities. MATERIAL AND METHODS: Analysis of 14 thesis and research papers about absenteeism in Chile. The incapacity rate (number of days with sick leave per worker per year, the frequency rate (number of sick leaves per year per worker) and the severity rate (mean duration of sick leaves) were calculated. The diseases causing the highest rates of absenteeism were also recorded. RESULTS: The mean age of the studied populations was 36 years old and the most common diseases causing absenteeism were respiratory, rheumatologic and trauma. Hospital workers had the highest incapacity rate with 14.3 days of sick leave per worker per year, followed by mining industry with 12 days, automotive industry with 7.1 days and universities with 6 days. CONCLUSIONS: In Chile, respiratory diseases are the main cause of sick leaves and hospital workers have the highest incapacity rate.

Absenteeism↗
PubMed2006

[The growing challenge of the editorial process in Revista Médica de Chile].

During the recent 6 years, a growing number of manuscripts have been submitted annually to Revista Médica de Chile. In 2005 this number was 60% greater than in the year 2000. This determined an increased workload in the editorial handling of manuscripts and in the number of external peer reviewers, who were over 400 participants during 2004, each one reviewing from one to five manuscripts in that year. An increasing use of the electronic mail helps to communicate editors with reviewers and authors. However, there is yet no availability of a software in Spanish to handle all communications in the editorial process in this language. The number of pages per issue has been increased and authors have been requested to limit the extension of their manuscripts, in order to allow more accepted manuscripts to appear in a shorter period of time. At the present, an average of 8.9 months separates the date of submission to the date of publication, in those manuscripts that were accepted in revised version after external peer review. The increasing number of submissions and the fact that this journal ranks high among Chilean journals, in the number of visits to full-text articles in the web page www.scielo.cl, testify that in spite of the aforementioned limitations Revista Médica de Chile is well considered among authors and readers in Chile and other Spanish-speaking countries.

Bibliometrics↗
PubMed2006

[Hepatitis C in Chile: burden of the disease].

Hepatitis C virus-associated chronic hepatitis is one of the most important causes of liver-related mortality and morbidity worldwide. This review analysis the available clinical and epidemiological information about this disease in Chile and compares it with data available from Latin America and other countries. Chronic hepatitis C seroprevalence in the general Chilean population is 1.15% by ELISA III and 0.85% by recombinant immunoblot assay (RIBA). Mortality due to cirrhosis (all causes) in Chile is one of the highest in the world. We show indirect evidence that chronic hepatitis C may account for a significant proportion of these deaths. The disease is the most common cause for liver transplantation in adults. Based on the available information, we conclude that chronic hepatitis C is an important cause of disease and mortality in Chile.

Adult↗