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“Healthcare should be the same for everyone”: perceived inequities in therapeutic trajectories of adult patients with lung cancer in Chile, a qualitative study
(2023)
CAMPAÑA, CARLA
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CABIESES VALDES, BALTICA BEATRIZ
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OBACH KING, ALEXANDRA ALICE
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Francisca Vezzani
<jats:sec><jats:title>Background</jats:title><jats:p>Globally, it has been reported that different social determinants of health affect health outcomes in lung cancer (LC). Research on the therapeutic trajectories of patients (TTP) is a novel field for identifying barriers and facilitators in health. The objective of this study was to reveal perceived differences in TTP with LC in Chile according to selected social determinants of health (SDH) and the experiences of patients, health professionals, and civil society leaders.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>This is a qualitative paradigm, one case-study design. Online semi-structured interviews were conducted with patients with LC, health professionals, and civil society leaders. The strategies for the recruitment process included social networks, civil society organizations, health professionals, and the snowball technique. A thematic analysis was carried out.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Selected SDH impact LC's TTP in Chile, particularly concerning health system access, health services, information, and patient navigation experiences. The analysis of the experiences of the participants allowed us to identify barriers related to the selected SDH in three stages of the TTP: initiation, examinations, and diagnosis and treatment. Individuals with limited education, those residing outside the capital, women, and those in the public health system encountered more barriers throughout their TTP.</jats:p></jats:sec><jats:sec><jats:title>Discussion</jats:title><jats:p>Study findings suggest that being a woman with low education, from the public health system, and not from the capital might represent one of the most powerful intersections for experiencing barriers to effective healthcare in LC in Chile. It is necessary to monitor the TTP from an SDH perspective to guarantee the rights of access, opportunity, quality, and financial protection.</jats:p></jats:sec>
Scopus© Citations 4 1
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Las instituciones de formación de profesionales de la salud en Chile. ¿Pueden ser organizaciones data driven?
(2022)
Jorge Contreras
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Claudia Pérez
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Vivian Aedo
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Katherine Leyton
Scopus© Citations 1 1
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Comorbidities in Chilean patients with psoriasis: a Global Healthcare Study on Psoriasis
(2022)
Fernando Valenzuela
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Claudia De La Cruz
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Cristóbal Lecaros
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Javier Fernández
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Gonzalo Hevia
<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>Psoriasis is a chronic inflammatory skin disease associated with several important medical comorbidities. There are scant data available on the comorbidities of patients with psoriasis in South America.</jats:p> </jats:sec> <jats:sec> <jats:title>Aim</jats:title> <jats:p>To examine the comorbidity profile of adult patients with psoriasis in Chile and its association with severity of psoriasis.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>This was a multicentre, cross-sectional study involving 16 hospitals and clinics in Chile, which used a 48-item questionnaire to study clinician- and patient-reported outcomes and comorbidities. Inferential analyses were performed by psoriasis severity, using Fisher exact test, Student t-test and multivariable logistic regression.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>In total, 598 adult patients with psoriasis were included (51.1% male; mean age 49.2 ± 15.1 years); 48.5% mild and 51.4% moderate to severe; Psoriasis Area and Severity Index 11.6 ± 11.5; body surface area 14.7 ± 18.2%. Plaque psoriasis was the most common phenotype (90.2%), followed by guttate (13.4%). Psoriatic arthritis occurred in 27.3% of patients. Comorbidities were reported in 60.2% of all patients with psoriasis. Frequent concomitant diseases were obesity (25.3%), hypertension (24.3%), Type 2 diabetes mellitus (T2DM) (18.7%), dyslipidaemia (17.4%), metabolic syndrome (16.7%) and depression (14.4%). After adjustment, significant associations were found between moderate to severe psoriasis and obesity, T2DM and nonalcoholic fatty liver disease (NAFLD) compared with mild psoriasis.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>We report a large study of comorbidities, including depression, dyslipidaemia, T2DM and NAFLD, in people with psoriasis in Chile. The prevalence of comorbidities with psoriasis in Chile appears similar to that found in Western countries, and emphasizes the importance of assessing patients with psoriasis for risk factors for and presence of, comorbid disease in a multidisciplinary setting.</jats:p> </jats:sec>
Scopus© Citations 4 1
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Experiences and well-being of healthcare professionals working in the field of ultrasound in obstetrics and gynaecology as the SARS-CoV-2 pandemic were evolving: a cross-sectional survey study
(2022)
Tom Bourne
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Christopher Kyriacou
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Harsha Shah
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Jolien Ceusters
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Jessica Preisler
<jats:sec><jats:title>Objective</jats:title><jats:p>Assess experience of healthcare professionals (HCPs) working with ultrasound in obstetrics and gynaecology during the evolving SARS-CoV-2 pandemic, given the new and unprecedented challenges involving viral exposure, personal protective equipment (PPE) and well-being.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Prospective cross-sectional survey study.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>Online international survey. Single-best, open box and Hospital Anxiety and Depression Scale (HADS) questions.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>The survey was sent to 35 509 HCPs in 124 countries and was open from 7 to 21 May 2020. 2237/3237 (69.1%) HCPs from 115 countries who consented to participate completed the survey. 1058 (47.3%) completed the HADS.</jats:p></jats:sec><jats:sec><jats:title>Primary outcome measures</jats:title><jats:p>Overall prevalence of SARS-CoV-2, depression and anxiety among HCPs in relation to country and PPE availability.</jats:p></jats:sec><jats:sec><jats:title>Analyses</jats:title><jats:p>Univariate analyses were used to investigate associations without generating erroneous causal conclusions.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Confirmed/suspected SARS-CoV-2 prevalence was 13.0%. PPE provision concerns were raised by 74.1% of participants; highest among trainees/resident physicians (83.9%) and among HCPs in Spain (89.7%). Most participants worked in self-perceived high-risk areas with SARS-CoV-2 (67.5%–87.0%), with proportionately more trainees interacting with suspected/confirmed infected patients (57.1% vs 24.2%–40.6%) and sonographers seeing more patients who did not wear a mask (33.3% vs 13.9%–7.9%). The most frequent PPE combination used was gloves and a surgical mask (22.3%). UK and US respondents reported spending less time self-isolating (8.8 days) and lower satisfaction with their national pandemic response (37.0%–43.0%). 19.8% and 8.8% of respondents met the criteria for moderate to severe anxiety and depression, respectively.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Reported prevalence of SARS-CoV-2 in HCPs is consistent with literature findings. Most respondents used gloves and a surgical mask, with a greater SARS-CoV-2 prevalence compared with those using ‘full’ PPE. HCPs with the least agency (trainees and sonographers) were not only more likely to see high-risk patients but also less likely to be protected. A fifth of respondents reported moderate to severe anxiety.</jats:p></jats:sec>
11Scopus© Citations 2
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Clinical ethics support services in paediatric practice: protocol for a mixed studies systematic review on structures, interventions and outcomes
(2022)
Mariana Dittborn
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Bernardita Portales
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Joe Brierley
<jats:sec><jats:title>Introduction</jats:title><jats:p>Clinical ethics support services (CESS) have been developing worldwide with growing interest in evaluating their quality. Paediatric-specific CESSs (p-CESS) have received little attention, and evidence from adult services might not be generalisable. Evidence on service models and practices is crucial to inform further research and debate on quality evaluation and minimum standards for p-CESSs. We aim to systematically identify, appraise and synthesise evidence for p-CESS structures, processes and outcomes.</jats:p></jats:sec><jats:sec><jats:title>Methods and analysis</jats:title><jats:p>We will conduct a mixed-studies systematic review including peer-reviewed empirical studies published in English or Spanish language providing data on the evaluation and/or impact on any aspect of p-CESS. We will search seven electronic databases: MEDLINE, Philosopher’s Index, EMBASE, PsycINFO, LILACS, Web of Science and CINHAL, without filters applied. Search terms will be related to “clinical ethics support” AND “paediatrics” AND “structure/process/outcome”. Reference and citation list of included studies will be handsearched. A 10% random sample of retrieved titles/abstracts and all full texts will be independently dual-screened. We will conduct narrative and thematic synthesis for quantitative and qualitative data, respectively, following sequential explanatory synthesis guided by Donabedian’s framework of structure, process and outcomes. Quality will be assessed using the Mixed-Methods Appraisal Tool (2018). The review will be reported using the adapted Preferred Reporting Items for Systematic Reviews and Meta-Analyses for reporting systematic reviews of qualitative and quantitative evidence template. Stakeholders will be involved twice in the review process; prior to data extraction and synthesis and after preliminary results.</jats:p></jats:sec><jats:sec><jats:title>Ethics and dissemination</jats:title><jats:p>As a systematic review of published data, no ethical approval is necessary. Results will be published in a relevant academic peer-reviewed journal.</jats:p></jats:sec><jats:sec><jats:title>PROSPERO registration number</jats:title><jats:p>CRD42021280978.</jats:p></jats:sec>
9
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Stroke care and collaborative academic research in Latin America
(2022)
MUÑOZ VENTURELLI, PAULA ANDREA
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RECULE GONZALEZ, FRANCISCA
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Francisca Urrutia
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MAZZON AGURTO, ENRICO
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NAVIA GONZALEZ, VICTOR HUGO
<jats:p>Objective. A narrative overview of regional academic research collaborations to address the increasing burden and gaps in care for patients at risk of, and who suffer from, stroke in Latin America (LA). Materials and methods. A summary of experiences and knowledge of the local situation is presented. No systematic literature review was performed. Results. The rapidly increasing burden of stroke poses immense challenges in LA, where prevention and management strategies are highly uneven and inadequate. Clinical research is increasing through various academic consortia and networks formed to overcome structural, funding and skill barriers. However, strengthening the ability to generate, analyze and interpret randomized evidence is central to further develop effective therapies and healthcare systems in LA. Conclusions. Regional networks foster the conduct of multicenter studies –particularly randomized controlled trials–, even in resource-poor regions. They also contribute to the external validity of international studies and strengthen systems of care, clinical skills, critical thinking, and international knowledge exchange.</jats:p>
10 1Scopus© Citations 5
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Healthcare and social needs of international migrants during the COVID-19 pandemic in Latin America: analysis of the Chilean case
(2022)
Alice Blukacz
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CABIESES VALDES, BALTICA BEATRIZ
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Edward Mezones-Holguín
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José Manuel Cardona Arias
<jats:p> International migrants are a particularly vulnerable group in the context of the coronavirus disease 2019 (COVID-19) pandemic. Immigrants in Chile tend to experience multidimensional poverty and layers of social vulnerability. Our analysis aims to describe the perceived social and health-related needs of international migrants during the COVID-19 pandemic in Chile in terms of migration as a social determinant of health and layered social vulnerability. We carried out a qualitative analysis of responses to an open-ended question focused on the social and health-related needs linked to the pandemic included in an online questionnaire disseminated during April 2020 aimed at international migrants residing in Chile. The information gathered was thematically analysed. We included 1690 participants. They expressed needs related to health and others linked to the overall socio-economic and political response, employment, material conditions and psychosocial aspects. They also reported needs related to ‘being a migrant’. Additionally, some participants described situations of vulnerability. We analysed their needs and situations of vulnerability identified around the following emerging frames: (a) work and living conditions, (b) regularisation traps and perceived lack of support and (c) and physical and mental health needs. International migrants in Chile report experiencing interrelated layers of social vulnerability during the COVID-19 pandemic, where ‘being a migrant’ exacerbates physical and mental health risks. The issues revealed are immediate and direct public health challenges, as well as different aspects of social vulnerability linked to migratory status, employment and barriers to accessing healthcare that should be addressed through comprehensive policies and measures. </jats:p>
Scopus© Citations 17 1
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Meanings and Practices in Intercultural Health for International Migrants
(2022)
Consuelo Cruz-Riveros
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Alfonso Urzúa
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Gustavo Macaya-Aguirre
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CABIESES VALDES, BALTICA BEATRIZ
<jats:p>In this article, meanings and practices in intercultural health for international migrants in health establishments are described from the perspective of health personnel in the city of Antofagasta in northern Chile. Methodology: The methodology was qualitative with a phenomenological descriptive design, through which discourses from health personnel in the public primary and secondary care system were explored (n = 23). Next, meanings and practices in intercultural health for international migrants in health establishments are described from the perspective of health personnel in the northern Chilean city of Antofagasta. Results: The participants presented trees of thematic categories. There were three thematic categories overall: (1) The meaning of interculturality included features of understanding of the concept, with respect for culture being the transversal axis in all discourses. (2) Practices in health care, where voluntariness, references, and the adequacy or non-technicality of the language are fundamental axes. (3) Training in the intercultural approach, where there is often self-knowledge and lack of supply in the health system. Conclusions: The findings show essential elements to consider in the care of international migrants, including the training and awareness of staff about the intercultural approach through strategies following the local reality in which each health establishment exists.</jats:p>
19Scopus© Citations 6
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Effects of Occupational Therapy Program Based on Active Meditation on Hair Cortisol Levels in Undergraduate Healthcare Students
(2022)
Alejandra Espinosa
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Rodolfo Morrison
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Diego Gonzalez
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Juan Jamardo
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Federico Fortuna
<jats:p>Context. Meditation incorporation helps to fight against disorders such as depression, stress, and anxiety. Specifically, few studies have studied Osho’s Active Meditation on young people, but observed evidence using passive meditation shows that it could improve stress well-management, emotional control, and other mental unhealthy conditions. Goal. The present study pointed to evaluate the results of an occupational therapy program centered on active meditation on hair cortisol concentration in a sample of undergraduate healthcare students. Methods. Undergraduate students from the University of Chile’s health careers were divided at random into control (<jats:inline-formula> <math xmlns="http://www.w3.org/1998/Math/MathML" id="M1"> <mi>n</mi> <mo>=</mo> <mn>7</mn> </math> </jats:inline-formula>) and treated groups (<jats:inline-formula> <math xmlns="http://www.w3.org/1998/Math/MathML" id="M2"> <mi>n</mi> <mo>=</mo> <mn>15</mn> </math> </jats:inline-formula>). The treated group participated in an active meditation program once a week for three months. This treatment included different techniques such as Chakra Sounds, Nataraj, Mandala, Kundalini, Devavani, Gourishankar, and Nadabrahma. Hair samples were taken before and after the treatment period to measure cortisol. Results. The control group increased cortisol level <jats:inline-formula> <math xmlns="http://www.w3.org/1998/Math/MathML" id="M3"> <mn>168.9</mn> <mo>±</mo> <mn>76.8</mn> </math> </jats:inline-formula> pg/mg compared with initial levels. The treated group shows a decrease of initial cortisol values in <jats:inline-formula> <math xmlns="http://www.w3.org/1998/Math/MathML" id="M4"> <mn>28.5</mn> <mo>±</mo> <mn>12.8</mn> </math> </jats:inline-formula> pg/mg after meditation protocol application. Conclusions. Blending active meditation in students’ daily routine through occupational therapy intervention might prevent undergraduate students’ stress in healthcare careers.</jats:p>
8Scopus© Citations 3
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Teleconsulta médica. Análisis y recomendaciones del Departamento de Ética del Colegio Médico de Chile
(2021)
Mauricio R. Besio
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Anamaría Arriagada
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Lionel Bernier-Villarroel
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Gladys Bórquez-Estefó
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Constanza Micolich
13Scopus© Citations 2

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