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Author: search.filters.author.Manuel EspinozaStart date: 2020

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    Global health education programs: Are we embedding contemporary global health needs into the curriculum of master’s programs?
    (Frontiers Media SA, 2026-01-09)
    Samraj Singh Bhullar
    ;
    Antonia Roberts
    ;
    CABIESES VALDES, BALTICA BEATRIZ  
    ;
    Edward Mezones-Holguín
    ;
    Ali Al-kassab-Cordova
    <jats:sec> <jats:title>Introduction</jats:title> <jats:p>Global health education (GHE) is expected to prepare professionals to address complex, interlinked global challenges. However, current GHE structures often reflect persistent power asymmetries between the Global North and South, limiting the development of a truly global and equitable health workforce. This review examines how global health master’s programs are distributed geographically and to what extent their thematic focus and core curricular content reflect current global health priorities, particularly those related to equity and social justice.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>A mapping review of 86 graduate-level GHE programs worldwide was conducted to examine their geographic distribution, thematic focus, and curricular content. Programs were categorized by region and analyzed for thematic emphasis and pedagogical approaches, based on publicly available information on modules and learning activities.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>The review found that 84% of GHE programs are offered by institutions in the Global North. Programs in the Global South are fewer but tend to emphasize environmental health, governance, and community engagement, often incorporating experiential learning. Across all regions, key topics such as health systems, global health challenges, sustainability, law, ethics, and human rights are unevenly integrated. This variability risks producing graduates with inconsistent competencies to address global health priorities. The dominance of Global North institutions in GHE reflects broader structural inequities in global health. While emerging North–South and South–South collaborations and field-based learning suggest a shift toward more reciprocal models, many programs lack clearly defined aims and accountability frameworks.</jats:p> </jats:sec> <jats:sec> <jats:title>Discussion</jats:title> <jats:p>To advance GHE, curricula must embed equity, interdisciplinarity, and regional relevance. Explicit learning outcomes should include power analysis and partnership-building, co-designed and co-delivered with institutions and communities from both the Global North and South. Such reforms are essential to cultivate a workforce capable of addressing global health challenges with contextual sensitivity and systemic insight.</jats:p> </jats:sec>
      2
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    Differential Effects of a Telemonitoring Platform in the Development of Chemotherapy-Associated Toxicity: A Randomized Trial Protocol
    (2024)
    Felipe Martínez
    ;
    Carla Taramasco
    ;
    Manuel Espinoza
    ;
    ACEVEDO ROMO, JOHANNA PATRICIA  
    ;
    Carolina Goic
    <jats:p>Chemotherapy requires careful monitoring, but traditional follow-up approaches face significant challenges that were highlighted by the COVID-19 pandemic. Hence, exploration into telemonitoring as an alternative emerged. The objective is to assess the impact of a telemonitoring platform that provides clinical data to physicians overseeing solid tumor patients, aiming to enhance the care experience. The methodology outlines a parallel-group randomized clinical trial involving recently diagnosed patients with solid carcinomas preparing for curative intent chemotherapy. Eligible adult patients diagnosed with specific carcinoma types and proficient in Spanish, possessing smartphones, will be invited to participate. They will be randomized using concealed allocation sequences into two groups: one utilizing a specialized smartphone application called Contigo for monitoring chemotherapy toxicity symptoms and accessing educational content, while the other receives standard care. Primary outcome assessment involves patient experience during chemotherapy using a standardized questionnaire. Secondary outcomes include evaluating severe chemotherapy-associated toxicity, assessing quality of life, and determining user satisfaction with the application. The research will adhere to intention-to-treat principles. This study has been registered at ClinicalTrials.gov (NCT06077123).</jats:p>
      4Scopus© Citations 2
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    Effects on Quality of Life of a Telemonitoring Platform amongst Patients with Cancer (EQUALITE): A Randomized Trial Protocol
    (2024)
    Felipe Martínez
    ;
    Carla Taramasco
    ;
    Manuel Espinoza
    ;
    ACEVEDO ROMO, JOHANNA PATRICIA  
    ;
    Carolina Goic
    <jats:p>Cancer, a pervasive global health challenge, necessitates chemotherapy or radiotherapy treatments for many prevalent forms. However, traditional follow-up approaches encounter limitations, exacerbated by the recent COVID-19 pandemic. Consequently, telemonitoring has emerged as a promising solution, although its clinical implementation lacks comprehensive evidence. This report depicts the methodology of a randomized trial which aims to investigate whether leveraging a smartphone app called Contigo for disease monitoring enhances self-reported quality of life among patients with various solid cancers compared to standard care. Secondary objectives encompass evaluating the app’s impact on depressive symptoms and assessing adherence to in-person appointments. Randomization will be performed independently using an allocation sequence that will be kept concealed from clinical investigators. Contigo offers two primary functions: monitoring cancer patients’ progress and providing educational content to assist patients in managing common clinical situations related to their disease. The study will assess outcomes such as quality of life changes and depressive symptom development using validated scales, and adherence to in-person appointments. Specific scales include the EuroQol Group’s EQ-5D questionnaire and the Patient Health Questionnaire (PHQ-9). We hypothesize that the use of Contigo will assist and empower patients receiving cancer treatment, which will translate to better quality of life scores and a reduced incidence of depressive symptoms. All analyses will be undertaken with the intention-to-treat principle by a statistician unaware of treatment allocation. This trial is registered in ClinicalTrials under the registration number NCT06086990.</jats:p>
    Scopus© Citations 2  2
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      4
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    Unequal Access and Use of Health Care Services among Settled Immigrants, Recent Immigrants, and Locals: A Comparative Analysis of a Nationally Representative Survey in Chile
    (2022)
    Marcela Oyarte
    ;
    CABIESES VALDES, BALTICA BEATRIZ  
    ;
    Isabel Rada
    ;
    Alice Blukacz
    ;
    Manuel Espinoza
    <jats:p>Globally, and particularly in the Latin American region, international migration continues to grow. Access and use of health care services by migrants vary according to their country of origin and residence time. We aimed to compare the access and use of health care services between international migrants (including settled migrants from Peru, Argentina, Bolivia, Ecuador; Emerging migrants from Venezuela, Dominican Republic, Colombia, Haiti; and migrants from other countries) and the Chilean population. After performing a secondary data analysis of population-based nationally representative surveys (CASEN 2011–2017), access and use patterns (insurance, complementary insurance, non-consultation, and non-treatment coverage) were described and compared among settled immigrants, recent emerging immigrants, others, and locals. Immigrants had a significantly higher uninsured population compared to locals. Specifically, in CASEN 2017, 19.27% of emerging (95% CI: 15.3–24.1%), 11.79% of settled (95% CI: 10.1–13.7%), and 2.25% of locals (95% CI: 2.1–2.4%) were uninsured. After 2013, settled and recent emerging migrants showed higher percentages of non-consultation. Collaborative and interculturally relevant strategies from human rights and equity perspectives are needed. Initiatives with a particular focus on recent immigrants can contribute to reducing the existing disparities in health care access and use with locals due to lack of insurance and treatment coverage.</jats:p>
      9Scopus© Citations 10
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    Percepción de discriminación en inmigrantes comparados a nacidos en Chile y su relación con acceso a servicios y resultados de salud
    (2022)
    Marcela Oyarte
    ;
    CABIESES VALDES, BALTICA BEATRIZ  
    ;
    Manuel Espinoza
    ;
    María Teresa Valenzuela
    ;
    DELGADO BECERRA, OROZIMBA IRIS  
    <jats:p>OBJETIVOS: Comparar la autopercepción de discriminación entre inmigrantes y locales en Chile y analizar la relación entre inmigración y discriminación percibida e inmigración, discriminación y resultados de salud, ajustando por características sociodemográficas y capital social. MÉTODOS: Estudio transversal, utilizando encuesta poblacional (CASEN2017). Se seleccionaron 2.409 inmigrantes (representativos de N = 291.270) y 67.857 locales (representativos de N = 5.438.036) mayores de 18 años encuestados. Se estimaron modelos de regresión logística, considerando la muestra compleja, con discriminación, salud autoevaluada, tratamiento médico, pertenencia al sistema de salud, seguros complementarios de salud, consulta médica y problemas al consultar como variables dependientes, inmigración y discriminación como variables de exposición principal, y capital social y variables sociodemográficas como covariables de los modelos. RESULTADOS: Inmigrantes tuvieron mayor posibilidad de percibir discriminación en general comparado con locales (OR = 2,31; IC95%:1,9–2,9). Sin embargo, esto no ocurre para todos los motivos específicos de discriminación; color de piel y apariencia física fueron las causas de discriminación más frecuentes en inmigrantes. La interacción entre inmigración y discriminación se relacionó significativamente con peores resultados de salud autoevaluada y tratamiento por patologías, en desfavor de los inmigrantes discriminados. Tanto en locales como en inmigrantes la discriminación no se asoció con resultados de acceso a atención en salud, excepto problemas durante la consulta en locales (OR = 1,61; IC95% 1,4–1,8). CONCLUSIONES: En Chile, las experiencias de discriminación se entrelazan con otras formas de rechazo y exclusión social, por lo cual es urgente concientizar a la población para prevenir estas prácticas discriminatorias, sobre todo en la atención en salud y lugares de uso cotidiano. Abordar la discriminación es indispensable para lograr impactar en variables intermedias y resultados de salud. La extensión de los resultados a toda la población inmigrante podría ser de amplia utilidad para profundizar la problemática y mejorar las estimaciones realizadas.</jats:p>
    Scopus© Citations 11  13
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    Health-related quality of life by household income in Chile: a concentration index decomposition analysis
    (2022)
    Rodrigo Severino
    ;
    Manuel Espinoza
    ;
    CABIESES VALDES, BALTICA BEATRIZ  
    <jats:title>Abstract</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p>Health inequities have a profound impact on all dimensions of people’s lives, with invariably worse results among the most disadvantaged, transforming them into a more fragile and vulnerable population. These unfair inequalities also affect dimensions focused on subjectivity, such as health-related quality of life (HRQoL), which has been positioned, in recent decades, as an important outcome in health decision-making. The main objective of this study is to estimate socioeconomic inequality in HRQoL of Chilean by household income. </jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>Secondary analysis of the National Health Survey (ENS 2016–2017, Chile). This survey includes a nationally representative, stratified, and multistage household sample of people aged 15 and above. Socioeconomic inequality in HRQoL (EQ5D) is estimated by the concentration index (CI) ranked by household income. Decomposition analysis is conducted to examine potential explanatory sociodemographic factors. </jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>The CI for household income inequality in HRQoL was -0.063. The lower the household income, the worse the HRQoL reported by in Chile. The decomposition analysis revealed that socioeconomic position contributes 75,7% to inequality in the quality of life, followed by educational level (21.8%), female gender (17.3%), and type of Health Insurance (15%), age (-19.7%) and residence (-10.8%). Less than 1% corresponds to the unexplained residual component.</jats:p> </jats:sec><jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Our findings suggest the existence of a disproportionate concentration of worse HRQoL in the most disadvantaged socioeconomic groups in Chile. This inequality is largely, yet not completely, associated with household income. Other significant factors associated with this inequality are education, gender, and healthcare insurance. These results suggest the need of strengthening efforts to reducing socioeconomic gaps in health outcomes in Chile, as a means to achieve social justice and equity in health and healthcare.</jats:p> </jats:sec>
      3Scopus© Citations 7
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    Scopus© Citations 4  2