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    Evaluating a Memory Clinic Using the RE-AIM Model. The Experience of the “Memory and Neuropsychiatry Clinic” in Hospital Del Salvador, Chile
    (2021)
    Tomas Leon
    ;
    Loreto Castro
    ;
    Franco Mascayano
    ;
    Brian Lawlor
    ;
    SLACHEVSKY CHONCHOL, ANDREA MARÍA  
    <jats:p>The development of healthcare services for dementia is key to improving access to care and post-diagnostic support for people living with dementia. Memory Units have emerged as a new healthcare service composed of multidisciplinary teams with the goal of improving diagnosis and/or management of dementia patients. The main objective of this study was to describe and evaluate the Reach and Effectiveness of a Memory Unit in a public hospital in Chile, using the RE-AIM model, a multi-component model that allows for the evaluation of the implementation of ongoing healthcare programs. Regarding “R” (Reach): from March 2018 up to June 2019, a total of 510 patients were referred and assessed. Most patients came from primary care (51.9%) and from outpatient services at the Hospital Salvador (39.2%), particularly from the Neurology (63.3%) and Psychiatry (16.0%) departments. We estimated that our Memory Unit assessed 5.39% of all of the dementia patients living in the area of referral. With respect to “E” (Effectiveness): 419 patients are still being followed up at the Memory Unit. Ninety-one patients (18%) were discharged. Of these, 55 (66%) were referred to primary healthcare, 28 (31%) to other outpatient services, 9 (10%) to a specialized mental healthcare center, and 9 (10%) to a daycare center. Due to the short period of time that the Memory Unit has been operating, no other RE-AIM dimensions could be evaluated at this juncture. To our knowledge, this is the first implementation study of a Memory Unit in Latin America, and the first using the RE-AIM model. Although cultural differences worldwide might play a role in the lack of international guidelines, the publication of the experience of the first year of this unit in Chile could inform new countries about this process. Ongoing challenges include continuing to collect data to complement the RE-AIM evaluation and developing a protocol that can be adopted elsewhere in Chile and Latin America. Further studies are needed to assess the benefits of a Memory Unit in comparison to regular care and to develop a model that assures continuity and coordination of care for people with dementia.</jats:p>
    Scopus© Citations 8  2
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    Isolation of Ciprofloxacin and Ceftazidime-Resistant Enterobacterales From Vegetables and River Water Is Strongly Associated With the Season and the Sample Type
    (2021)
    Constanza Díaz-Gavidia
    ;
    Carla Barría
    ;
    RIVAS JIMENEZ, LINA MARIA  
    ;
    Patricia García
    ;
    Francisca P. Alvarez
    <jats:p>The dissemination of antibiotic-resistant bacteria (ARB) from water used for crop irrigation to vegetables is poorly studied. During a year, five farmer markets in a city in Central Chile were visited, and 478 vegetable samples (parsleys, corianders, celeries, lettuces, chards, and beets) were collected. Simultaneously, 32 water samples were collected from two rivers which are used to irrigate the vegetables produced in the area. Resistant Enterobacterales were isolated and identified. Colistin resistance gene <jats:italic>mcr-1</jats:italic> and extended spectrum β-lactamases (ESBL) were molecularly detected. The association of environmental factors was evaluated, with the outcomes being the presence of Enterobacterales resistant to four antibiotic families and the presence of multidrug resistance (MDR) phenotypes. Parsley, coriander, and celery showed the highest prevalence of resistant Enterobacterales (41.9% for ciprofloxacin and 18.5% for ceftazidime). A total of 155 isolates were obtained, including <jats:italic>Escherichia coli</jats:italic> (<jats:italic>n</jats:italic>=109), <jats:italic>Citrobacter</jats:italic> sp. (<jats:italic>n</jats:italic>=20), <jats:italic>Enterobacter cloacae</jats:italic> complex (<jats:italic>n</jats:italic>=8), <jats:italic>Klebsiella pneumoniae</jats:italic> (<jats:italic>n</jats:italic>=8), and <jats:italic>Klebsiella aerogenes</jats:italic> (<jats:italic>n</jats:italic>=1). Resistance to ampicillin (63.2%) and ciprofloxacin (74.2%) was most frequently found; 34.5% of the isolates showed resistance to third-generation cephalosporins, and the MDR phenotype represented 51.6% of the isolates. In two <jats:italic>E. coli</jats:italic> isolates (1.29%), the gene <jats:italic>mcr-1</jats:italic> was found and ESBL genes were found in 23/62 isolates (37%), with <jats:italic>bla</jats:italic><jats:sub>CTX-M</jats:sub> being the most frequently found in 20 isolates (32%). Resistant Enterobacterales isolated during the rainy season were less likely to be MDR as compared to the dry season. Understanding environmental associations represent the first step toward an improved understanding of the public health impact of ARB in vegetables and water.</jats:p>
      1Scopus© Citations 28
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    Breaking the breach in Latin America: A pilot study of mechanical thrombectomy in the public healthcare system in Chile
    (2020)
    Rodrigo Rivera
    ;
    Cristian Amudio
    ;
    Enzo Brunetti
    ;
    Pascual Catalan
    ;
    Juan Gabriel Sordo
    <jats:sec><jats:title>Background</jats:title><jats:p> Mechanical Thrombectomy (MT) is the standard of care for treatment of large vessel occlusion stroke. Until the beginning of 2020 MT was not funded nor widely implemented at the public healthcare level in Chile. </jats:p></jats:sec><jats:sec><jats:title>Objective</jats:title><jats:p> To describe the results of a pilot program created to provide access to public MT in Santiago - Chile. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> Analysis from a prospectively collected database of MT cases performed between September 2017 and September 2019 in one center. A stroke network was developed with a single MT capable stroke center and five primary stroke centers. The primary efficacy endpoint was the rate of functional independence (mRS 0-2) at 90 days. Successful reperfusion was defined as 2 b-3 according to the thrombolysis in cerebral infarction scale. Safety outcomes include the rates of symptomatic intracranial hemorrhage and 90-day mortality. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> A total of 100 patients were treated over the study period. Their mean age was 62.8 ± 11.8 years and median baseline National Institute of Health Stroke Scale (NIHSS) measurement was 17. Seventy-seven percent of the patients received intra venous thrombolysis. Successful reperfusion was achieved in 95% of the cases. NIHSS at 24 hours showed a median drop of 7 points from baseline (p &lt; 0.00001) and 50% of the follow-up patients were functionally independent at 90 days. Symptomatic Intracerebral hemorrhage occurred in 5% of the patients and 90-day all case mortality was 11%. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> We demonstrated the feasibility of a publicly funded MT program in Chile, with similar results as other international randomized control trials. </jats:p></jats:sec>
    Scopus© Citations 10  4
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    Pharmacogenetics in Psychiatry: Perceived Value and Opinions in a Chilean Sample of Practitioners
    (2021)
    UNDURRAGA FOURCADE, JUAN PABLO  
    ;
    Ignacio Bórquez-Infante
    ;
    Nicolás A. Crossley
    ;
    Miguel L. Prieto
    ;
    REPETTO LISBOA, MARIA GABRIELA  
    <jats:p>Use of pharmacogenetics (PGx) testing to guide clinical decisions is growing in developed countries. Published guidelines for gene–drug pair analysis are available for prescriptions in psychiatry, but information on their utilization, barriers, and health outcomes in Latin America is limited. As a result, this work aimed at exploring current use, opinions, and perceived obstacles on PGx testing among psychiatrists in Chile, via an online, anonymous survey. Among 123 respondents (5.9% of registered psychiatrists in the country), 16.3% reported ever requesting a PGx test. The vast majority (95%) of tests were ordered by clinicians practicing in the Metropolitan Region of Santiago. Having more than 20 years in practice was positively associated with prior use of PGx (p 0.02, OR 3.74 (1.19–11.80)), while working in the public health system was negatively associated (OR 0.30 (0.10–0.83)). Perceived barriers to local implementation included insufficient evidence of clinical utility, limited clinicians’ knowledge on PGx and on test availability, and health systems’ issues, such as costs and reimbursement. Despite the recognition of these barriers, 80% of respondents asserted that it is likely that they will incorporate PGx tests in their practice in the next five years. Given these results, we propose next steps to facilitate implementation such as further research in health outcomes and clinical utility of known and novel clinically actionable variants, growth in local sequencing capabilities, education of clinicians, incorporation of clinical decision support tools, and economic evaluations, all in local context.</jats:p>
      1Scopus© Citations 10
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    Lifestyle Habits and Health Indicators in Migrants and Native Schoolchildren in Chile
    (2021)
    Mónica Suárez-Reyes
    ;
    Daiana Quintiliano-Scarpelli
    ;
    PINHEIRO FERNANDES, ANNA CHRISTINA  
    ;
    Cristian Cofré-Bolados
    ;
    Tito Pizarro
    <jats:p>In Chile, the migrant population has increased in the last years. Migrants adopt behaviors of this new culture, which can have an effect on their health. Contradictory results regarding differences between migrant and native children have been reported. The aim of this study was to explore the associations between nationality with health indicator and lifestyle habits among schoolchildren in Chile. A cross-sectional and observational study with a non-probabilistic sample was conducted in 1033 children (86.4% Chilean and 13.6% migrant) from second to fourth grade of seven public schools from low-income municipalities from the Metropolitan Region, Chile. Anthropometric measurements (weight, height, waist circumference, triceps and subscapular folds), handgrip strength, and standing long jump measurements, physical activity, self-esteem and food guidelines accomplishments were determined. Migrant children presented lower body mass index (BMI), Z-BMI, body fat% and waist circumference values; and higher handgrip strength, standing long jump, and more satisfactory compliance with food guidelines than natives (p &lt; 0.05). No significant difference for physical activity and self-esteem was observed. In the adjusted models, migrants presented lower odds for overweight/obesity, risk of abdominal obesity, low handgrip strength and unsatisfactory food guidelines accomplishment in all models (p &lt; 0.05). The nutritional and muscular fitness of migrant children was better than that of the Chilean ones.</jats:p>
      1Scopus© Citations 8  1
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    Epidemiology of Parkinson’s Disease in Chile
    (2021)
    VIAL UNDURRAGA, FELIPE AGUSTIN  
    ;
    DELGADO BECERRA, OROZIMBA IRIS  
    ;
    Francisca Canal
    ;
    IDIAQUEZ RIOS, JUAN FRANCISCO  
    ;
    Pedro Chana-Cuevas
    <jats:p>&lt;b&gt;&lt;i&gt;Introduction:&lt;/i&gt;&lt;/b&gt; Parkinson’s disease (PD) is one of the most common neurodegenerative disorders. There is no epidemiological description of PD in Chile and not many descriptions in Latin America. This study aims to describe the incidence and prevalence of PD in Chile. &lt;b&gt;&lt;i&gt;Methods:&lt;/i&gt;&lt;/b&gt; The study group was the population on the public health system in Chile between 2010 and 2018 that were registered in the GES system as having PD. Crude and standardized prevalence and incidence were calculated with a 95% confidence interval. &lt;b&gt;&lt;i&gt;Results:&lt;/i&gt;&lt;/b&gt; 33,345 patients were found in the register as confirmed cases with PD. The crude incidence in 2018 was 23.7/100,000; the crude prevalence in 2018 was 160.7/100,000. The male-to-female ratio was 1.03. &lt;b&gt;&lt;i&gt;Conclusion:&lt;/i&gt;&lt;/b&gt; The prevalence and incidence observed in the Chilean population are consistent with studies from other countries. </jats:p>
    Scopus© Citations 8  114
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    A Chilean Experience of Telestroke in a COVID-19 Pandemic Year
    (2022)
    Carlos Delfino
    ;
    MAZZON AGURTO, ENRICO  
    ;
    Felipe Jurado Díaz
    ;
    MUÑOZ VENTURELLI, PAULA ANDREA  
    ;
    BRUNSER, ALEJANDRO  
    <jats:p>&lt;b&gt;&lt;i&gt;Background and Purpose:&lt;/i&gt;&lt;/b&gt; Telemedicine for stroke patients’ care (telestroke [TS]) has grown notably in recent decades and may offer advantages during health crisis. Hospital admissions related to stroke have decreased globally during the COVID-19 pandemic, but scarce information is available regarding the effect of COVID-19 in TS. Using a population-based TS registry, we investigated the impact of the first year of the COVID-19 pandemic throughout our TS network in Santiago, Chile. &lt;b&gt;&lt;i&gt;Methods:&lt;/i&gt;&lt;/b&gt; Stroke codes evaluated after the onset of COVID-19 restrictions in Chile (defined as March 15, 2020) were compared with those evaluated in 2019. We analyzed differences between number of stroke codes, thrombolysis rate, stroke severity, and time from the stroke onset to hospital admission. &lt;b&gt;&lt;i&gt;Results:&lt;/i&gt;&lt;/b&gt; We observed that the number of stroke codes and the number of patients undergoing reperfusion therapy did not change significantly (&lt;i&gt;p&lt;/i&gt; = 0.669 and 0.415, respectively). No differences were found with respect to the median time from the stroke onset to admission (&lt;i&gt;p&lt;/i&gt; = 0.581) or in National Institutes of Health Stroke Scale (NIHSS) scores (&lt;i&gt;p&lt;/i&gt; = 0.055). The decision-making-to-needle time was significantly shorter in the COVID-19 period (median 5 min [IQR 3–8], &lt;i&gt;p&lt;/i&gt; &amp;#x3c; 0.016), but no significant changes were found at the other times. &lt;b&gt;&lt;i&gt;Conclusions:&lt;/i&gt;&lt;/b&gt; This study demonstrates the potential of adapting TS to extreme situations such as the COVID-19 pandemic, as well as the importance of establishing networks that facilitate patient access to quality treatments. </jats:p>
    Scopus© Citations 7  1
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    Los inicios de la enseñanza de pediatría en Chile y la fundación de hospitales de niños
    (2023)
    Luisa Schonhaut Berman
    ;
    Pablo Chavez Zuñiga
    ;
    Nelson Vargas Catalán
    <jats:p>El objetivo del presente manuscrito es revisar antecedentes históricos previos a la creación de la Sociedad Chilena de Pediatría (SOCHIPE) en el año 1922, con el propósito de reflexionar sobre su impacto en la profesionalización de la pediatría nacional, especialmente en la salud y sobrevida de los niños. Se revisaron documentos de la Junta de Beneficencia, libros y estudios especializados de la época. Hasta principios del siglo XX, el país ostentaba una de las tasas de mortalidad infantil más elevadas del mundo, y contaba con precarias instalaciones para enfrentarlas. En aquellos años, el único establecimiento cerrado para la atención de infantes era la Casa de Huérfanos, que estaba al cuidado de religiosas con apoyo de médicos; es ahí donde se desarrollaron los primeros cursos teórico-prácticos de la especialidad. Presionados por la alta mortalidad infantil y las mortíferas epidemias, la Junta de Beneficencia vio la urgencia de mejorar las condiciones higiénicas y crear instalaciones para el cuidado de los niños. El manuscrito aborda el surgimiento de espacios encargados del resguardo de la salud de los menores de cinco años, desde la creación de la cátedra de pediatría y del primer hospital de niños, el Hospital Roberto del Río, lo que marcó el inicio de las políticas de salud pública infantiles.</jats:p>
      4Scopus© Citations 3
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    Promoting the Participation of “Hard-to-Reach” Migrant Populations in Qualitative Public Health Research during the COVID-19 Pandemic in Chile
    (2023)
    Alice Blukacz
    ;
    CABIESES VALDES, BALTICA BEATRIZ  
    ;
    OBACH KING, ALEXANDRA ALICE  
    ;
    María Inés Álvarez
    ;
    Paula Madrid
    <jats:p>The COVID-19 pandemic has further deepened socioeconomic and health inequities worldwide, especially among populations experiencing social vulnerability, such as international migrants. Sustained lockdowns and social distancing have raised challenges to conducting public health research with hard-to-reach populations. This study aims at exploring strategies to recruit “hard-to-reach” international migrants for qualitative public health research during the pandemic in Chile, based on the authors’ experience. A retrospective qualitative evaluation process was carried out on the recruitment processes of three qualitative research projects focused on international migrants in Chile. All projects were implemented during the COVID-19 pandemic, demanding complementary and flexible strategies: (i) social media; (ii) snowball sampling; (iii) referrals from social workers and pro-migrant and migrant-led organizations; (iv) vaccination centers and healthcare centers; and (v) community-based recruitment. The strategies are qualitatively evaluated around seven emerging qualitative categories: (i) feasibility during lockdown periods; (ii) speed of recruitment; (iii) geographical coverage; (iv) sample diversity; (v) proportion of successful interviews; (vi) ethical considerations; and (vii) cost. Engaging hard-to-reach international migrants in public health research during the pandemic required constantly adapting recruitment strategies. Furthermore, relying on strategies that were not only Internet-based promoted the participation of populations with limited access to the Internet and low-digital literacy.</jats:p>
    Scopus© Citations 10  1