Paula Bedregal G

Equidad de género en el acceso a la atención de salud en Chile

Background: In the last two decades, Chile has experienced advances in economical development and global health indicators. However, gender inequities persist in particular related to access to health services and financing of health insurance. Aim: To examine gender inequities in the access to health care in Chile. Material and methods: An analysis of data obtained from a serial national survey applied to assess social policies (CASEN) carried out by the Ministry of Planning. During the survey 45,379 and 48,107 dwellings were interviewed in 1994 and in 1998, respectively. Results: Women use health services 1.5 times more often, their salaries are 30% lower in all socioeconomic strata. Besides, in the private health sector, women pay higher insurance premiums than men. Men of less than two years of age have 2.5 times more preventive consultations than girls. This difference, although of lesser magnitude, is also observed in people over 60 years. Women of high income quintiles and users of private health insurance have a better access to preventive consultations but not to specialized care. Conclusions: An improvement in equitable access of women to health care and financing is recommended. Also, monitoring systems to survey these indicators for women should improve their efficiency (Rev Med Chile 2003; 131: 669-678)

Relación entre bronquiolitis aguda con factores climáticos y contaminación ambiental

Background: Annually, acute bronchiolitis (AB) occurrence peaks during winter and is probably associated with air pollution. Aim: To relate the number of ambulatory consultations, emergency and hospital admission due to AB with climatic factors and air pollution. Patients and methods: Patients of less than 1 year old with AB that consulted to outpatient clinics, the emergency room or were admitted to the Pediatrics ward of the Catholic University Hospital, were enrolled. Information about respiratory syncytial virus (RSV) was obtained from the Catholic University Medical Investigation Center. Indices of air pollution such as particulate matters of less than 10 microns/m 3 (PM 10), of less than 2.5 microns/m3 (PM 2.5), CO, SO 3 and O 3 were obtained from the Metropolitan Environmental Service. Temperature, humidity and precipitations were obtained from the Chilean Meteorological Service. Results: Ninety nine consultations in out patient clinics and 442 in emergency rooms were collected (55% male, mean age 4.8 months). One hundred fifty two were admitted (34.4%). Thirty percent of children consulting in emergency rooms were younger than 3 months and 43% of them were hospitalized. The RSV study was made in 307 patients and 52% were positive. There was a higher rate of hospital admissions among RSV positive than RSV negative patients (52.5 and 22% respectively, p<0.001). No association between environmental variables or air pollution and the number of consultations was observed. Young age and smoking inside the household were the main risk factors for hospital admission due to acute bronchiolitis. Conclusions: Environmental variables did not influence the number of cases of acute brochiolitis. Young age and exposure to tobacco smoke were risk factors for hospital admission (Rev Med Chile 2003; 131: 1117-22). (Key Words: Air pollutants, environmental; Bronchiolitis; Tobacco smoke pollution)

Costo-efectividad de la promoción de la salud en Chile: Experiencia del programa «¡Mírame!»

Background : «iMirame!» program was launched in Chile in 1993, to promote a healthy life style at school age. Aim: To evaluate cost-effectiveness of this program. Material and methods: Fifth and sixth grade school children, from 5 selected municipalities of the Metropolitan Region were studied. The design was a quasi-experiment with an intervention (IP, 1,435 children) and reference population (RP, 1,246 children). Tobacco (T-C) and alcohol (OH-C) consumption were the indicators. A baseline survey was done in 1993 and repeated in 1996 in both groups. The criterion of Net Change was applied to assess effectiveness. For cost evaluation, an institutional perspective was considered. Direct municipal administration and «iMirame!» program costs were analyzed and incremental costs were calculated, using reference municipalities as controls. A univariate sensitivity analysis was done based on the beneficial discount rate and cost discount rate. Cost effectiveness coefficient was calculated. Results: The incremental cost per each boy and girl prevented from OH-C was US

Aproximación al estado de salud mental del profesorado en 12 escuelas de Puente Alto, Santiago Chile

112 (103.6-114.3) and US

Características de niños y adolescentes atendidos en un consultorio psiquiátrico del sistema privado de salud en Chile

132 (129.9-133.3) respectively. The figures for each boy and girl prevented from T-C was US

La admisión a Medicina vía Bachillerato en Ciencias: experiencia de 5 años

154 (142.7-157.4) and US

Necesidades de salud desde la perspectiva de los usuarios

130 (122.5-135.2) respectively. The program caused an additional cost per child, for the city hall of US

El movimiento de la medicina basada en evidencia de la medicina basada en la evidencia: Alcances conceptuales y teóricos

11.7 in two years. Conclusions: It is possible to apply health promotion interventions in schools with a good cost effectiveness in the short run (Rev Med Chile 2004; 132: 361-70).

Asignación de recursos en salud en Chile: Consideraciones éticas en la toma de decisión

Mental health of teachers is a primary concern, considering the important deficiencies in the Chilean educational system. Aim: To explore mental health in teachers from local primary schools. Material and methods: The 12 question version of the Goldberg health questionnaire (a self administered instrument) was applied to 139 teachers working in basic schools in a suburban community. Results: One hundred twenty teachers (99 females) answered the questionnaire. A possible emotional problem was detected in 28.6%. The life prevalence of mental health problems was 32%. Relationships with children were the best perceived and relationships with superiors were the worst perceived. A higher social valuation of teachers and better salaries were the two variables associated with a better satisfaction with work. The number of working hours were directly related to mental health problems. Multivariate analysis showed that age was independent and negatively correlated with Goldberg score and that general satisfaction with work was directly related to the quality of relationships with superiors. Conclusions: Age and number of working hours were two risk factors for mental problems identified in this sample. A better social valuation of teachers work, better salaries and a good relationship with children and superiors should improve labor satisfaction (Rev Med Chile 2003; 131: 159-67)

Mortalidad por anomalías congénitas en Chile (1969-1997)

Background: There is a 7% up to 32% prevalence of psychiatric problems in the pediatric population. Aim: To study the epidemiological features of children and adolescents attended in a psychiatric outpatient clinic. Material and methods: All admissions to a psychiatric outpatient clinic, of people aged 18 years old or less, during 1998, were reviewed. The causes of consultation and the diagnoses were classified according to diagnostic manuals (ICPC-WONCA and DSM-IV respectively), by three experienced psychiatrists. Results: The files of 376 patients were reviewed (200 males, mean age of females 12 years old, mean age of males 10.5 years old). Seventy three percent consulted spontaneously. The main causes of consultation were anxiety disorders and adolescence problems (28%). The main diagnoses were attention deficit disorder and disruptive behavior, adaptative problems, mood and anxiety disorders. There were gender differences in the diagnoses. Women attended a mean of 6.3 sessions and men attended a mean of 4 sessions. Fifty nine percent abandoned treatment. Conclusions: There is a limited access to mental health care. The low compliance with treatments must be studied and improved (Rev Med Chile 2002; 130: 205-303)