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PubMed2003

Symptom control and palliative care in Chile.

As in other developed and developing countries, the most common chronic disorders affecting the Chilean population are cardiovascular disease, cancer, cirrhosis, diabetes, chronic obstructive pulmo- nary disease and external injuries. Availability of oncology services is not extensive and there are no academic programs to adequately train practitioners in either palliative medicine or comprehensive palliative care for allied health professionals including nurses, psychologists and chaplains. Major efforts have been made to incorporate palliative care as an important health care focus in the last decade and in the development of effective policies for opioid availability. Chile now meets 84% of the 17 criteria outlined by the World Health Organization and the International Narcotics Control Board for opioid availability. Postgraduate medical education in symptom control, clinical use of opioids and end-of-life care remains relatively poor as judged by the results of a questionnaire administered to 158 resident physicians at the Pontificia Universidad Católica de Chile. Improvements in symptom control and the development of palliative care in Chile will depend on the effective assessment of symptom control effectiveness and improved education and training of health professionals in clinical pharmacology, symptom control, clinical ethics, and end-of-life care.

Analgesics, Opioid↗
PubMed2004

Prevalence of antibodies to hantavirus among family and health care worker contacts of persons with hantavirus cardiopulmonary syndrome: lack of evidence for nosocomial transmission of Andes virus to health care workers in Chile.

Nosocomial transmission of Andes virus has been documented in Argentina, but has not yet been proven in Chile. We studied 215 contacts (106 family member contacts and 109 health care worker contacts) of 20 index cases of hantavirus cardiopulmonary syndrome (HCPS) in Chile. The seroprevalence of IgG antibodies against Andes virus was 1.9% (95% confidence interval [CI] = 0.34-6.3%) among the family members and 0.0% (95% CI = 0-3.2%) among the health care workers. Our data suggest that there is no evidence for nosocomial transmission of Andes virus in region IX of Chile.

Adult↗
PubMed2004

[Mortality caused by acute myocardial infarction in Chile in the period 1990--2001].

BACKGROUND: Acute myocardial infarction is the first cause of death among adults in Chile. It caused 5,650 deaths during 2001. AIM: To analyze the evolution and mortality of Acute Myocardial Infarction in Chile between 1990 and 2001. MATERIAL AND METHODS: Analysts of data on mortality caused by Acute Myocardial Infarction in Chile, obtained from the databases of the Ministry of Health. The adjusted morality rates and disability adjusted life years (DALY) were calculated for the period. RESULTS: In the study period, adjusted mortarlity decreased from 86 to 67.6 deaths/100,000 inhabitants. The DALYs ratio between men and women increased from 2.7 to 2.9. The mean death age for men and women was 69.9 and 76.5 years respectively (p <0.001). Forty five percent of women and 51% of men died at home, 78% of women and 66% of men received medical attention. CONCLUSIONS: Although there was a reduction in mortality caused by acute myocardial infarction in the study period, there are still gender differences in the age of death, and access to medical care.

Adolescent↗
PubMedDate not supplied

Incidence and prevalence of hepatitis C virus infection in Chile.

UNLABELLED: Chronic hepatitis C is a major cause of liver-related morbidity and mortality. Epidemiological data regarding this infection in developing countries is scanty. METHODS: Prevalence of hepatitis C (HCV) infection was investigated in a random sample of Chilean general adult population older than 20 years of age. Additionally, frequency of HCV infection was assessed in group of native Chilean Amerindians (Mapuche Indians) living in an isolated locality of the Southern Chile. Incidence of HCV infection was estimated using serum samples separated by 7 years (1993-2000). RESULTS: Among 959 subjects, prevalence of anti-HCV antibodies was 1.15% (95% CI 0.48-1.82%) and 0.83% when only RIBA-confirmed cases were considered. Among these subjects, 62.5% had detectable HCV RNA in serum and 40% of them had a history of blood transfusion. Age distribution of cases showed a steadily increasing prevalence with age. Estimated incidence of new HCV infections was 15 per 100,000 subjects per year in the period 1993-2000. No cases were detected among the 145 Mapuche subjects studied. CONCLUSIONS: HCV infection is a prevalent disease in the Hispanic population of Chile with a low incidence in the last decade, whereas it was not detected in an isolated Mapuche Indian community. Age distribution of prevalence suggests that the peak of infection in Chile occurred 30 to 50 years ago.

Adult↗
PubMed2006

Arsenic exposure and its impact on health in Chile.

The problem of arsenic in Chile was reviewed. In Chile, the population is exposed to arsenic naturally via drinking-water and by air pollution resulted from mining activities. The sources of arsenic were identified to estimate the exposure of population to arsenic through air, water, and food. Health effects, particularly early effects, observed in children and adults, such as vascular diseases (premature cardiac infarct), respiratory illnesses (bronchiectasis), and skin lesions have been described. Chronic effects, such as lung and bladder cancers, were reported 20 years after peak exposure and persisted 27 years after mitigation measures for removing arsenic from drinking surface water were initiated. Although the effects of arsenic are similar in different ethnic and cultural groups (e.g. Japanese, Chinese, Indian, Bangladeshi, American, and Taiwanese), variations could be explained by age at exposure, the dose received, smoking, and nutrition. Since health effects were observed at arsenic levels of 50 microg/L in drinking-water, it is advised that Chile follows the World Health Organization's recommendation of 10 microg/L. The Chilean experience in removal of arsenic suggests that it is feasible to reach this level using the conventional coagulation process.

Arsenic↗
PubMed1991

[Smoking and health in Chile].

Findings from a literature review on the smoking problem in Chile are presented. According to prevalence studies, nearly 40% of the general adult population in Chile smokes. The proportion of smokers is smaller among women than among men. Between 1971 and 1984 the proportion of smokers rose from 36% to 41%, with an especially marked increase in women (from 26% to 39%). Calculation of the relative risk of mortality in smokers indicates that smoking accounts for 11% of all deaths in the country. Moreover, 11% of the infant mortality in Chile is attributable to the lower neonatal weight of children of women who smoke. The presence of smokers in homes is responsible for a 30% higher rate of acute respiratory infections. Women smokers have twice as many spontaneous abortions as nonsmokers and enter menopause an average of five years earlier. Hoarseness is 17 times more frequent and excess facial hair is seven times more frequent among women who smoke compared with those who do not. The habit tends to start during adolescence. The rising smoking rate among Chilean women is inversely related to level of schooling and directly related to economic capacity. Smoking during pregnancy is influenced by level of concern for the effects of tobacco and educational actions encountered during this period. The role of physicians and other members of the health team is crucial in this regard. Reference is made to organized antismoking measures, including bans on smoking, restrictions on advertising, warnings about its harmful effects, and various educational efforts. The main components of the Ministry of Health's smoking control program are reviewed.

Adolescent↗
PubMed1991

[Epidemic of cholera in Chile; 1991].

In January 1991 a severe epidemic of cholera started in Peru, a country located north of Chile. The first case in Chile was confirmed in april and so far 41 cases and 2 deaths have been reported. The epidemic is caused by Vibrio cholerae 01, El Tor biotype, Inaba serotype. Most cases occurred in Santiago, 2/3 of them in men and all above 15 years of age. An unknown number of asymptomatic infected people arriving in Santiago are the likely agents for the epidemic. Contamination of sewage and use of infected water to irrigate vegetable fields is involved in the transmission of the disease. The situation is linked to the inexistence of sewage treatment plants. In comparison to Peru, with near 200,000 patients and over 1000 deaths, the epidemic in Chile has been small as a consequence of intensive health education efforts. Personal hygiene, abstinence from eating raw vegetables and fish, destruction of presumed infected crops, and prohibition of vegetable transportation to other areas have been the cornerstone of the preventive strategies. Early treatment of severely dehydrated patients has determined a low fatality rate. At present, the epidemic is virtually controlled with 1 or 2 cases a week. However, the sanitary problems related to sewage treatment and the existence of cholera in other South American countries poses a serious problem for the future.

Adolescent↗
PubMed1990

[Overview of research in Chile by several epistemolometric indicators].

Scientific productivity in Chile was studied examining a data bank constructed with the publications indexed by the Institute for Scientific Information during 1987 and 1988. The bank excludes meeting abstracts and contains the full title of the published paper, the list of authors, addresses, field, and the nature of collaboration between two or more institutions. The articles were classified in different fields and tabulated according to the institution from which they originated. Although biology remains to be the more productive subject (26.5%) followed by medical sciences (23.9%) and chemistry (12.3%), articles in mathematics and physics continued their increase as in previous years. Using the scientometric indicators published by Braun et al., the impact of the research originated in Chile in biology, physics and mathematics was compared to that attained in Argentina, Brazil, Mexico and Venezuela. The role of the chilean National Research Fund and the output of the financed research projects were also analyzed. The successful results obtained during the first years in which the National Research Fund has been involved in the support of the scientific activity in Chile, confirms the need to strengthen its budget, according to the goals stated in the National Plan for Science and Technology for Development.

Chile↗
PubMed1989

[The Revista Médica de Chile, 100 years ago].

This issue of the journal contains information related to the "Protomedicato", an institution established in Spain in 1477 and incorporated to its colonies. Its functions included the granting of medical licenses, supervision of public hygiene and legal faculties. It was established in Chile in 1738. The dean of the Medical School, University of Chile became "protomedico" en 1843. The institution was abolished in Chile in 1879.

Chile↗
PubMed1994

[The presence of midwives in health in Chile].

This is a lecture given by Dr Luis Tisné, Emeritus Professor of the University of Chile, during the commemorative ceremony of the Obstetrics School creation 160th anniversary. The school was founded in 1834 by Dr Lorenzo Sazie, first dean of the Faculty of Medicine. Drs Alcibiades Vicencio and Victor Manuel Gazitúa promoted the development of study programs and the school's university recognition (1896). Midwives perform 94% of obstetric preventive recognition in Chile (health control of pregnancy and puerperium, family planning and preventive gynecology). Certain designed health plans in Chile such as voluntary control of fecundity, correction of weight alterations in pregnant women, prenatal control, health education and complementary alimentation allowed a reduction of birth rates to 21.6%, infantile mortality to 14.3% and low weight newborns to 5.6% (one of the lowest in the world), to give professional attention to 99% of deliveries and to increase life expectancy at birth to 72 years. In 1965, 306 pregnant women died due to induced abortions, figure that dropped to 28 in 1992. Obstetrical mortality fell to 0.35 per 1.000 alive newborns and induced abortions to 0.13%.

Chile↗
PubMed1994

[New medical schools in Chile].

In Chile there are six established medical schools at public (Chile, Valparaiso and Temuco) or private (Catholic, Concepción and Austral) universities created between 1833 and 1971. Since 1990, three new medical schools (two private) were created and a fourth is projected, concerning the chilean medical corps. We present three position articles on the subject written by Dean Pedro Rosso, from the Catholic University, Dr Pedro Castillo, Chief of Human Resources of the Ministry of Health and Dean Alejandro Goic from the University of Chile. Dean Rosso emphasizes the need to have assessment procedures that guarantee quality standards in the new medical schools. Dr Castillo attracts attention on preserving the compromise with the society, inherent to chilean medicine. Dean Goic analyzes systematically the reasons to prevent the proliferation of medical schools in the country, maintaining an equilibrium between freedom of teaching and public faith protection.

Chile↗
PubMed1994

[Establishing new medical schools in Chile].

In Chile there are six established medical schools at public (Chile. Valparaiso and Temuco) or private (Catholic. Concepción and Austral) universities created between 1833 and 1971. Since 1990, three new medical schools (two private) were created and a fourth is projected, concerning the chilean medical corps. We present three position articles on the subject written by Dean Pedro Rosso, from the Catholic University, Dr Pedro Castillo, Chief of Human Resources of the Ministry of Health and Dean Alejandro Goic from the University of Chile. Dean Rosso emphasizes the need to have assessment procedures that guarantee quality standards in the new medical schools. Dr Castillo attracts attention on preserving the compromise with the society, inherent to chilean medicine. Dean Goic analyzes systematically the reasons to prevent the proliferation of medical schools in the country, maintaining an equilibrium between freedom of teaching and public faith protection.

Chile↗
PubMed1995

[Geographical distribution of physicians in Chile].

In 1994, Chile had 15,451 active physicians (less than 70 years old) for a population of 14,027,344 with a ratio of 1 physician per 908 inhabitants, a satisfactory figure compared to other countries of similar socio-economical development. Ratios of 1:880 and 1:843 are projected for 1999 and 2004 respectively. The annual rate of physician's population growth (2.2%), that is superior to the general population's growth rate (1.6%), will increase to about 2.5% per annum in 2001 as a consequence of the creation of three new medical schools. However, the distribution of physicians along the country is unsatisfactory. While the capital (Metropolitan Region) has a ratio of 1 physician per 629 inhabitants, the figure for the Region of Maule is 1:2,113. Only two of ten regions, excepting the capital, have a ratio lower than 1:1,000. Sixty percent of physicians live in Santiago while only 40% of the general population does so, illustrating their high concentration. Median ratio in Chile, that better reflects the reality than the mean, is 1:1,280. The heterogeneous distribution of physicians in Chile is a sign of social inequity that must be corrected. In a free society a better physician distribution is achieved with economical and professional incentives given by health institutions.

Chile↗
PubMed1995

[Epidemiological profile of liver cirrhosis in Chile 1970-1992].

BACKGROUND: Liver cirrhosis is an important public health problem in Chile. AIM: To review the main epidemiological features of liver cirrhosis in Chile in the last 22 years. METHODS: Review of yearbooks of mortality and causes of death of the Ministry of Health and Instituto Nacional de Estadísticas, review of hospital discharges and review of international statistics published by the World Health Organization. RESULTS: The mortality rate of liver cirrhosis in 1992 was 17.9/100,000 inhabitants and represented 3.3% of all deaths. The risk of cirrhosis is higher among men and in people over 64 years of age. In the last decade, death rates of young adults (15-44 years old) and children decreased dramatically. Hospital discharge rates for cirrhosis have decreased from 46.7 in 1970 to 40.4 in 1992. The men/women ratio in 1991 was 2.1/1 for hospital discharges and 2.8/1 for mortality. Mortality was higher in large urban areas (Santiago, Valparaíso and Concepción). A correlation of +0.17 was found between death rates for cirrhosis and wine production per capita. CONCLUSIONS: Cirrhosis continues to be a highly prevalent disease in Chile.

Adolescent↗
PubMed1996

Ideology drives health care reforms in Chile.

The health care system of Chile evolved from rather unique historical circumstances to become one of the most progressive in Latin America, offering universal access to all citizens. Since the advent of the Pinochet regime in 1973, Chile has implemented Thatcherite/Reaganite reforms resulting in the privatization of much of the health care system. In the process, state support for health care has been sharply curtailed with deleterious effects on health services. As Chile emerges from the shadow of the Pinochet dictatorship, it faces numerous challenges as it struggles to rebuild its health care system. Other developing nations considering free-market reforms may wish to consider the high costs of the Chilean experiment.

Aged↗
PubMed1996

[Lyme disease in Chile. Prevalence study in selected groups].

BACKGROUND: The prevalence of Lyme disease in Chile is unknown. AIM: To study the existence and epidemiology of Lyme disease in Chile. PATIENTS AND METHODS: One hundred eighteen patients with signs or symptoms suggestive of Lyme disease were studied. Antibodies against Borrelia burgdorferi were measured using ELISA and indirect immunofluorescence screening tests. Positive cases were confirmed with ELISA using a purified antigen and Western Blot analysis. Human biological samples and ticks were cultured in BSK-H medium. RESULTS: Five patients, three with dermatological manifestations and two with facial palsy and other neurological symptoms, had antibodies against Borrelia, measured by ELISA and indirect immunofluorescence. However the presence of IgM antibodies by ELISA using purified antigen, was confirmed in only one case. All sera and cerebrospinal fluids were negative on Western Blot Analysis. No plasma, skin, CSF or thick culture yielded Borrelia CONCLUSIONS: We could not confirm the existence of Lyme disease in Chile. Positive screening with negative confirmatory test suggests false positive non-specific reactivity or that local Borrelia are antigenically different compared to North American strains.

Adolescent↗
PubMed1996

[Organizational structure of internal medicine in Chile].

Internal Medicine, as a comprehensive discipline, has become increasingly dismembered during the last decades due to several reasons, some of which are the growing complexities of its practice, its obstinate confinement to hospital-based practice, its generation of and subsequent disfunction from general internal medicine and the medical subspecialities. In Chile internal medicine is currently organized in three levels of patient care, each of anarchical and distortioned proportions. These levels do not constitute a fluent network of progressive patient care but rather an heterogeneous combination of ironclad compartments in search of their own autonomy. A few of the many problems and challenges that internal medicine faces in Chile are: (a) in primary care medicine, problem-solving abilities must be improved and programmed care must be privileged over free choice. Specialist in general medicine must be assigned to primary care and multiprofessional teams must be strengthened; (b) Secondary care is underdeveloped due to the waning prestige of internal medicine and waxing attractiveness of its subspecialities. Programmed formation of specialist in internal medicine has been so far rigorous and demanding, but excessive in number in relation to available post. This leads trained internist to practice as subspecialist, without having the adequate conditions for such a practice. To avoid this situation, the scope of internal medicine emergency wards, integral medicine clinics, and medical student teaching should be handed over to it; (c) Tertiary care is a task of subspecialist. It is not known how many subspecialist are required, or how many physicians are currently practicing as a subspecialist. Most of the currently practicing subspecialist are self-qualified or have received quick training through short rotations by not always well-qualified centers. Many are only former internal medicine residents. In this setting, it is not possible to devise a prospective plan of subespecialty training. To make internal medicine in Chile efficient and timely, its is necessary to restore and restructure a rational patient care network that will do away with the current red tape and waiting list as well as to allow the insertion of well-trained specialist in the corresponding levels of patient care.

Chile↗
PubMedDate not supplied

Complex segregation analysis of facial clefting in Chile.

Nonsyndromic cleft lip with or without cleft palate (CL/P) has an incidence of 1.5 per 1,000 live births in Chile, with 1.7 per 1,000 in males and 1.3 per 1,000 in females, which is nearly the same as the level found in Asian populations. The high rate of occurrence of CL/P in Chile is probably due to the presence of Amerindian genes in Chilean populations. Using the computer program PAP, a complex segregation analysis of CL/P was conducted for 67 multigeneration pedigrees from Chile, each ascertained from one affected proband. These pedigrees yielded 162 affected individuals and over 898 family members who were included in the analysis. The most parsimonious model of transmission indicated the presence of an autosomal dominant gene with reduced (20-25%) penetrance.

Chile↗