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This study aimed to characterize 5 approaches that have been developed in research on patients and health coverage, which reveal information from the perspective of patients: (1) access to healthcare, (2) therapeutic trajectories, (3) social participation in decision making on health coverage, (4) tacit knowledge, and (5) communities of practice.This is a narrative literature review, based on searches performed in PubMed/MEDLINE and Web of Science, between August and December 2021. A total of 45 scientific articles were selected for analysis, which were complemented by a gray literature search that provided 6 additional manuscripts.Improving access to health services requires an understanding of the meaning of the concept of access from the users themselves. The patient trajectory approach contributes by emphasizing that the focus of analysis must adopt the patient's perspective, given that it provides valuable information for the decision making on health coverage. In addition, the role that social participation has in the process to grant trust and legitimacy is described. Tacit knowledge makes explicit the importance of revealing it as a source of information that adds value to the decision-making process. Finally, communities of practice are described as spaces where new ways of experiencing the disease originate, as well as ways of relating to the health system and its actors.The article raises the relevance that various social actors know these approaches, as well as strategies to integrate them into the assessment processes in terms of health coverage.

To identify the associated factors and assess the inequalities of full vaccination coverage (FVC) among Peruvian infants aged 12-23 months during the COVID-19 pandemic in a nationally representative sample.We carried out a population-based cross-sectional study based on a secondary data analysis using the 2021 Peruvian Demographic Health Survey (DHS) in infants aged 12 to 23 months. The sampling design was probabilistic, multistage, stratified, and independent at both departmental and area of residence levels. FVC was defined according to the WHO definition. We performed generalized linear models (GLM) Poisson family log link function to estimate crude (aPR) and adjusted prevalence ratios (aPR). Also, for inequality assessment, we calculated the concentration curve (CC), concentration index (CI), and Erreygers normalized concentration index (ECI).We included 4,189 infants in our analysis. Nationwide, the prevalence of FVC was 66.19% (95% CI: 64.33-68). Being younger, having a mother with no education or primary education, belonging to a large family, having no access to mass media, having had six or fewer ANC visits, and having a mother whose age was under 20 at first delivery were inversely associated with FVC. Meanwhile, living in the Highlands or on the rest of the coast, and living in rural areas were directly associated with FVC. We found a pro-rich inequality in FVC based on wealth-ranked households (CI: 0.0066; ECI: 0.0175).FVC has dropped among Peruvian infants aged between 12 and 23 months. There were several factors associated with FVC. It was more concentrated among the better-off infants, although in low magnitude.

Chile se ha vuelto un país receptor de población migrante internacional en los últimos años, con creciente influjo en el tiempo. Dentro de los desafíos de la migración internacional se encuentra el acceso equitativo y oportuno de migrantes internacionales al sistema de salud, reportándose diversas barreras para el acceso a la atención de salud. Dentro de las barreras se identifica el encuentro intercultural en salud y la atención de salud con pertinencia cultural a las necesidades de la población migrante. En este ensayo se desarrolla una reflexión sobre los aspectos culturales propios del espacio de atención de salud, considerando el lugar, actores que participan de la interacción y tiempo en que ocurre la atención. Se desarrolla un marco conceptual previo para sentar bases para la reflexión, basados en los conceptos de cultura, interculturalidad en salud e interaccionismo simbólico como propuesta de acercamiento a este fenómeno. Para la realización de este artículo se lleva a cabo una revisión bibliográfica en bases de datos científicos (Pubmed, Scielo y Google Scholar) y literatura gris nacional e internacional, con el objetivo de reflexionar sobre lo cultural en el encuentro de atención de salud entre población migrante internacional y los profesionales de salud que los atienden.

Objetivo Conocer, en contexto de la pandemia por SARS-CoV-2, las vulnerabilidades psicosociales y socioeconómicas de la población migrante internacional en Chile y los recursos y capitales sociales reportados desde la propia comunidad. Métodos Estudio cualitativo descriptivo. Se realizaron 40 entrevistas semiestructuradas a migrantes (N=30) e informantes claves (N=10), ejecutadas virtualmente durante el 2020. El material fue analizado mediante análisis temático. El proyecto fue aprobado por el Comitè de Ètica Científico de la Facultad de Medicina de la Universidad del Desarrollo. Resultados Como principales vulnerabilidades enfrentadas por parte de personas migrantes en pandemia se identifican: hacinamiento, precariedad laboral y necesidades económicas, uso del transporte público, desinformación y creencias en torno al COVID-19, discriminación, falta de redes de apoyo, y estatus migratorio. Como recursos se reconocen: contar con redes de apoyo, posibilidad de teletrabajo o salir a trabajar, acceso a información y a la red asistencial y municipal, apoyo gubernamental y de la sociedad civil. Adicionalmente, se reportan experiencias de diagnóstico de COVID-19, identificando dificultades en acceso a PCR y adaptaciones familiares y laborales como cambios en los hábitos de vida dentro y fuera del hogar. Discusión El estudio entrega información relevante e inédita para la construcción de políticas en salud para migrantes internacionales con foco en crisis sanitarias. Se destaca la necesidad de fortalecer adecuaciones interculturales en las estrategias de prevención del contagio y de promoción de la salud y aumentar la disponibilidad de respuesta en el acceso a salud en el marco de la pandemia, mitigando así la vulnerabilidad social en migrantes y potenciando sus recursos de afrontamiento.

Los desafíos de la migración a la salud pública en Iberoamérica en tiempos de la COVID-19 muestra la importancia de establecer estrategias que se enfoquen en los problemas que enfrentan los migrantes para acudir a los servicios de salud en otros países y para afrontar situaciones de precariedad. Además, evidencia la debilidad de aquellos Estados que no logran implementar estrategias que garanticen el cumplimiento de los derechos básicos de los migrantes, analiza cómo ellos vivieron la pandemia de la COVID-19 y muestra posibles soluciones políticas que podrían mejorar su bienestar y su salud. A través de un enfoque interseccional, este libro evidencia una problemática creciente de exclusión social en el sector de la salud, el cual debe dar una respuesta apropiada a sus poblaciones y, al mismo tiempo, enfrentar una nueva realidad migratoria.

Background Globally, it has been reported that different social determinants of health -structural, sociodemographic, economic, living conditions and cultural factors- may affect opportunities to adhere to prevention measures against SARS-CoV-2. The objective of this study was to explore the perceptions around barriers and facilitators for adherence to COVID-19 prevention measures among the adult population residing in three large cities in Chile from a social determinants of health perspective. Methods Qualitative paradigm, multiple case-study design. Online semi-structured interviews were conducted with men and women aged 18 and over from different socioeconomic groups residing in three large cities. For participant recruitment and selection, purposive contacts were made based on community and social media networks, followed by snowball sampling. Saturation was reached at 61 participants, after which a thematic analysis was carried out with the support of AtlasTi software. The Ethics Committee of the Universidad del Desarrollo in Chile approved this study. Results The main perceived barriers to adherence to COVID-19 preventive measures are linked to structural social determinants of health such as income, occupation, gender, access to basic supplies, and housing. Perceived facilitators are the fear of contagion and the incorporation of measures into daily habits. The social communication of preventive measures by health authorities is perceived as punitive, affecting adherence once the fear of contagion decreased in the country. It is also perceived that the recommended preventive measures are disconnected from communities’ cultural practices and people´s identity, as well as affected by gender inequities and socioeconomic conditions that stakeholders in the country do not sufficiently address. Conclusion Study findings suggest that adherence to preventive measures, such as social distancing, mask use, and hand washing, could be promoted through their incorporation into the daily life habits of people and communities. These measures should consider the structural social determinants that generate multiple barriers to adherence, like poverty, occupational risks, and overcrowding. Socio-cultural dimensions of health and everyday risks need further understanding among the different communities in the country, allowing for differences in viewpoints and practices based on gender, age, place, and social identity.

Background 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. Methods 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. Results 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. Conclusions 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.

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.

El presente articulo analiza la coexistencia y relacion entre dos enfoques que ha mantenido el Estado hacia la poblacion migrante en Chile durante la actual pandemia por COVID-19. El primero esta asociado a la perspectiva universalista de derechos humanos, que ha guiado los avances en el acceso a la salud de la poblacion migrante. El segundo, en cambio, es de caracter excluyente y se desprende de una vision securitista con foco en el control de la migracion irregular. En una primera lectura ambos enfoques pueden parecer opuestos, pero lo cierto es que se vienen aplicando simultaneamente, aunque con variaciones de intensidad de acuerdo a los distintos contextos politicos. A partir de trabajos previos realizados por las investigadoras analizaremos como ambos enfoques han impactado a la poblacion venezolana en el pais. Nos centraremos en el caso venezolano puesto que hoy dia representa el 30% de la poblacion extranjera y porque ha sido uno de los focos de las medidas implementadas por el gobierno en el ultimo ano. Palabras claves: migracion venezolana; pandemia; COVID19; derechos humanos; salud. Abstract This article analyzes the coexistence and relationship between two approaches that the State has maintained towards the migrant population in Chile during the current COVID-19 pandemic. The first one arises from the universal Human Rights approach that has guided the advances in the access to the health system for the migrant population. The second one, arises from an exclusionary approach developed by the national security perspective, with a strong focus on the control of irregular migration. At a first glance, both approaches may seem opposite, but the truth is that they have been applied simultaneously, although with variations in intensity according to the political context. Based on previous work carried out by the researchers, we will analyze how both approaches have impacted the Venezuelan population in the country. We will focus on the Venezuelan case since today it represents 30% of the foreign population and because it has been one of the focuses of the measures implemented by the government in the last year. Keywords: Venezuelan migration; pandemic; COVID 19; human rights; health. Resumo O presente artigo analisa a coexistencia e a relacao entre dois enfoques que o Estado manteve em relacao a populacao migrante no Chile durante a atual pandemia de COVID-19. O primeiro esta associado a perspectiva universalista dos direitos humanos, a qual tem norteado os avancos no acesso a saude da populacao migrante. A segunda, por sua vez, e de carater excludente e decorre de uma visao securitista com o foco no controle da migracao irregular. Em uma primeira leitura, ambos os enfoques podem parecer opostos, mas a verdade e que tem sido aplicados simultaneamente, embora com variacoes de intensidade de acordo com os diferentes contextos politicos. Com base em trabalhos anteriores realizados pelas pesquisadoras, analisaremos como ambas os enfoques tem impactado a populacao venezuelana no pais. Vamos nos concentrar no caso venezuelano posto que hoje representa 30% da populacao estrangeira e porque tem sido um dos focos das medidas implementadas pelo governo no ano passado. Palavras-chave: Migracao venezuelana; pandemia; COVID19; direitos humanos; saude.

El aumento de las solicitudes de asilo en Chile ha sido acompañado con cambios en la ley de refugiados. Hoy en día constatamos que estos cambios se están utilizando para perpetuar el proceso de espera de una respuesta definitiva, que se puede extender por un periodo superior a los dos años. Este antecedente, sumado a las múltiples irregularidades que han llevado a hablar de una crisis del sistema humanitario en Chile, nos ponen frente a la necesidad de indagar las formas en que los procesos burocráticos se instauran como formas de interacción entre Estado-migrantes, que impactan sobre la salud de las personas que se encuentran en esta condición. En particular, a partir de una investigación cualitativa, nos centraremos en lo que Auyero describe como “institucionalización de la espera” en personas en situación de refugio y las consecuencias que ésta tiene sobre el acceso a salud, entre otros derechos. Considerando que la salud es uno de los aspectos más críticos en estos grupos, la presentación analizará las formas en las que el Estado chileno está generando condiciones que restringen el derecho a la salud a través de un sistema burocrático que los suspende en un estado de precariedad e invisibilidad permanente.

In parallel to the COVID-19 pandemic, Chile has experienced a significant influx of international migrants, many of whom are Venezuelan women who have entered the country through unauthorized crossing points. In this context, gender and migration intersect as the social determinants of health, leading to their experiencing a range of adverse events. This poses important challenges in terms of short- and long-term health outcomes, the social determinants of health, and access to healthcare. This study aims at describing Venezuelan women’s perceptions of their health needs as they migrate to Chile via an unauthorized crossing point, with a focus on adverse events throughout the migration cycle, self-reported health needs, and responses. A qualitative case study was carried out with 22 participants in the Antofagasta region of Chile, including Venezuelan migrant women, healthcare professionals, and social workers from the public healthcare system, stakeholders from non-governmental and international organizations, and local government officials. The semi-structured, individual interviews were analyzed thematically. The results show that Venezuelan women face a range of adverse events throughout the migration cycle. The perceived health needs that are reported are sometimes linked to these adverse events or existed prior to migration and were exacerbated throughout the migratory cycle. Addressing these physical and mental health needs is essential for short- and long-term individual and public health; however, despite substantial efforts to ameliorate the situation, persisting gaps in access to care are reported.

This study aimed to estimate the expected cost of hypoglycemia in Diabetes Mellitus type-2 patients receiving hypoglycemic treatment in Chile and to explore the effect of the potential reduction of hypoglycemia over the total cost incurred by its public health system.A cost analysis was carried out based on a state transition mathematical model. The model used microsimulation with data from the National Health Survey 2016-2017 in Chile. Costs included follow-up, in-hospital and ambulatory care. Separate analysis was conducted for patients treated with insulin, or sulfonylurea.The annual expected total cost of hypoglycemia estimated for the Chilean public system was USD 288,922,523 (USD 273 per patient). The subgroup treated with insulin reached USD 353 per patient whereas the sulfonylurea subgroup was USD 217 per patient. The analysis revealed that for every 1% reduction of the incidence rate of severe hypoglycemia the cost is reduced 0.79% in total, 0.59% for the insulin subgroup, and 0.95% for the sulfonylurea subgroup.The cost of hypoglycemia represents a high proportion of the public health budget in Chile, being similar to those resources allocated to provide coverage of diabetic treatments through its universal health benefit plan.DM2: type 2 diabetes mellitus; RR: relative risk; ENS: national health survey in Chile.

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. METHODS: 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. RESULTS: 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.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.

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.

Reseña del libro de Richard Hornton.

International migrants have been recognized as a population at risk in the context of the COVID-19 pandemic. Worldwide, various strategies have been deployed for the protection of this population, such as the establishment of reception and quarantine or isolation centers. This article reports the results of a study that explored the experiences of international migrants in nursing homes in Chile created to ensure a safe quarantine during the COVID-19 pandemic, from an approach of ethical conditions for care. A qualitative study was carried out in 2020-2021. Thirty individual semi-structured online interviews were conducted in the cities of Arica, Iquique, Antofagasta and Santiago with international migrants with experience of using nursing homes; health teams of nursing homes; managers of nursing homes; local authorities; and national experts. Thematic analysis of the information was carried out. The study concludes that for international migrants, although the experience in nursing homes has meant significant health support, it is essential that the care provided, in addition to the requirement that it be framed in an approach of rights and respect for the dignity of each person, incorporate the perspective of interculturality in its work, that is, ensuring the right to culturally relevant health services, respectful of the culture of individuals, minorities, peoples and communities.Migrantes internacionales han sido reconocidos como población de riesgo en el contexto de la pandemia de COVID-19. A nivel mundial se han desplegado diversas estrategias para la protección de esta población, como la habilitación de centros de recepción y cuarentena o aislamiento. El artículo da cuenta de los resultados de un estudio que exploró las experiencias de migrantes internacionales en residencias sanitarias dispuestas en Chile para la realización de cuarentenas seguras en el marco de la pandemia COVID-19, desde un enfoque de condiciones éticas para el cuidado. Se realizó un estudio cualitativo entre los años 2020-2021. Se efectuaron 30 entrevistas individuales semi-estructuradas en línea en las ciudades de Arica, Iquique, Antofagasta y Santiago a migrantes internacionales con experiencia de uso de residencias sanitarias; equipos de salud de residencias sanitarias; mánagers de dichos recintos; autoridades locales; y expertos nacionales. Se realizó análisis temático de la información. El estudio concluye que para migrantes internacionales, si bien la experiencia en residencias sanitarias ha significado un apoyo sanitario significativo, es imprescindible que el cuidado proporcionado, además de la exigencia que se enmarque en un enfoque de derechos y de respeto a la dignidad de cada persona, incorpore la perspectiva de la interculturalidad en su quehacer, es decir, asegurando el derecho a servicios de salud culturalmente pertinentes, respetuosos de la cultura de las personas, las minorías, los pueblos y las comunidades.Migrantes internacionais foram reconhecidos como uma população de risco no contexto da pandemia de COVID-19. Em todo o mundo, várias estratégias têm sido implantadas para a proteção dessa população, como o estabelecimento de centros de acolhimento e quarentena ou isolamento. Este artigo relata os resultados de um estudo que explorou as experiências de migrantes internacionais em residências de saúde organizadas no Chile para quarentena segura no âmbito da pandemia de COVID-19, a partir de uma abordagem de condições éticas para o atendimento. Foi realizado um estudo qualitativo entre os anos de 2020-2021. Foram realizadas 30 entrevistas individuais semiestruturadas online nas cidades de Arica, Iquique, Antofagasta e Santiago com migrantes internacionais com experiência de uso de residências de saúde; equipes de saúde das residências de saúde; gestores dos referidos locais; autoridades locais; e especialistas nacionais. Foi realizada análise temática das informações. O estudo conclui que para os migrantes internacionais, embora a experiência em residências de saúde tenha significado significativo apoio à saúde, é imprescindível que os cuidados prestados, além da exigência de que sejam enquadrados em uma abordagem de direitos e respeito à dignidade de cada pessoa, incorporar a perspectiva da interculturalidade em seu trabalho, ou seja, garantir o direito a serviços de saúde culturalmente relevantes, que respeitem a cultura dos indivíduos, minorias, povos e comunidades.

Background During recent decades intraregional migration has increased in Latin America. Chile became one of the main receiving countries and hosted diverse international migrant groups. Evidence have suggested a healthy migrant effect (HME) on health status, but it remains scarce, controversial and needs to be updated. This study performed a comprehensive analysis verifying the existence of HME and its association with social determinants of health (SDH). Methods We analyzed data from the Chilean National Socioeconomic Characterization Survey (CASEN, version 2017). Unadjusted prevalence of health status indicators such as negative self-perceived health, chronic morbidity, disability, and activity limitations were described in both international migrants and local population. Adjusted associations between these outcomes and sets of demographics, socioeconomic, access to healthcare, psychosocial and migration-related SDH were tested using multivariate logistic regression in each population. The HME for each health outcome was also tested using multivariate logistic regression and sequentially adjusting for each set of SDH (ref = Chilean). Results International migrants had lower unadjusted prevalence of all health indicators compared to Chileans. That is, unadjusted analysis revealed an apparent HME in all health outcomes. Age, unemployment, and health care system affiliation were associated with health outcomes in both populations. Psychosocial determinants were both risk and protective for the analysed health outcomes. After adjustment for each set of SDH, the immigrant health advantage was only significant for chronic morbidity. Being migrant was associated with 39% lower odds of having chronic diseases compared to locals (OR: 0.61; 95% CI: 0.44–0.84; P = 0.0003). For all other outcomes, HME disappeared after adjusting by SDH, particularly unemployment, type of health system and psychosocial factors. Conclusions Testing the HME in Chile revealed an advantage for chronic morbidities that remained significant after adjustment for SDH. This analysis shed light on health disparities between international migrants and local population in the Latin American region, with special relevance of unemployment, type of health system and psychosocial SDH. It also informed about differential exposures faced during migration process that could dissolve the HME over time. Evidence from this analytical approach is useful for informing health planning and intersectoral solutions from a SDH perspective.

Migrantes internacionales han sido reconocidos como población de riesgo en el contexto de la pandemia de COVID-19. A nivel mundial se han desplegado diversas estrategias para la protección de esta población, como la habilitación de centros de recepción y cuarentena o aislamiento. El artículo da cuenta de los resultados de un estudio que exploró las experiencias de migrantes internacionales en residencias sanitarias dispuestas en Chile para la realización de cuarentenas seguras en el marco de la pandemia COVID-19, desde un enfoque de condiciones éticas para el cuidado. Se realizó un estudio cualitativo entre los años 2020-2021. Se efectuaron 30 entrevistas individuales semi-estructuradas en línea en las ciudades de Arica, Iquique, Antofagasta y Santiago a migrantes internacionales con experiencia de uso de residencias sanitarias; equipos de salud de residencias sanitarias; mánagers de dichos recintos; autoridades locales; y expertos nacionales. Se realizó análisis temático de la información. El estudio concluye que para migrantes internacionales, si bien la experiencia en residencias sanitarias ha significado un apoyo sanitario significativo, es imprescindible que el cuidado proporcionado, además de la exigencia que se enmarque en un enfoque de derechos y de respeto a la dignidad de cada persona, incorpore la perspectiva de la interculturalidad en su quehacer, es decir, asegurando el derecho a servicios de salud culturalmente pertinentes, respetuosos de la cultura de las personas, las minorías, los pueblos y las comunidades.

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.

Objetivo. Indagar la percepción de distintos actores clave en torno al rol de facilitadores interculturales en la atención de salud a personas migrantes haitianas en las comunas de Quilicura y Santiago de Chile. Materiales y métodos. Estudio cualitativo de tipo exploratorio y descriptivo, con diseño de estudio de caso, en centros de salud familiar y hospitales de dos comunas de la Región Metropolitana de Chile. Se utilizó la técnica de entrevistas semiestructuradas a actores claves (autoridades sanitarias, trabajadores de salud, facilitadores interculturales y migrantes internacionales), con transcripción verbatim y análisis temático de contenidos (n=18). Resultados. La percepción del rol de los facilitadores interculturales para la atención de salud de migrantes internacionales está relacionada con funciones en traducción, interpretación, educación del sistema sanitario en Chile, mediación intercultural y labores administrativas. Además, colabora en actividades educativas para migrantes que requieren apoyo con el abordaje de diferencias culturales. Esta visión es compartida por diversos actores clave considerados para el estudio y concordante con la política de salud vigente. Conclusión. Los facilitadores interculturales realizan un aporte al encuentro intercultural en salud en Chile y son testigos de cómo nuestras instituciones se enfrentan a realidades diversas en materia lingüística como sociocultural. Reconocer la importancia del facilitador intercultural en la atención sanitaria con pertinencia intercultural hacia población migrante internacional es un avance social y del sistema de salud chileno, que puede ser replicado a países que enfrentan desafíos similares y no desean ignorar la creciente diversidad social y cultural en región de América Latina y el Caribe, como consecuencia de dinámicas transformaciones de procesos de migración internacional.

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.

Background To assess the validity and reliability of the set of scales (general professional activity, health services management, and working conditions) on the different areas of job satisfaction in Peruvian physicians based on the data from the National Survey of Satisfaction of Users in Health (ENSUSALUD). Method We carried out a psychometric study based on the secondary data analysis of Questionnaire 2 of ENSUSALUD-2016. Participants were selected from a two-stage stratified national probability representative sampling by political region. Validity was assessed by exploratory and confirmatory factor analyses, and measurement invariance analysis. We assessed the reliability using internal consistency coefficients (alpha and omega). The set of scales were composed of items related to three different areas of job satisfaction: 1) satisfaction with general professional activity, 2) satisfaction with the health services management, and 3) satisfaction with the working conditions of the health center. Results We included 2137 participants in the analysis. The general professional activity scale with six items (Comparative Fit Index, CFI = 0.946; Root Mean Square Error of Approximation, RMSEA = 0.071; Standardized Root Mean Square Residual, SRMR = 0.035), the health services management scale with eight items (CFI) = 0.972; RMSEA = 0.081; SRMR = 0.028), showed good measurement properties for the one-dimensional model. The working conditions scale with eight items for individual conditions and three items for infrastructural conditions (CFI = 0.914; RMSEA = 0.080; SRMR = 0.055) presented adequate measurement properties with a two-dimensional model. The invariance analysis showed that comparisons between sex, age, civil status, medical speciality, working in other institutions, work-related illness, chronic disease, and time working in the healthcare center. All scales had adequate internal consistency (ω and α between 0.70 and 0.90). Conclusions The set of scales has a solid factorial structure and measurement invariance, making it possible for group comparison. The study achieved stability in the scores as they showed adequate internal consistency coefficients. Based on our findings, these instruments are suitable for measuring job satisfaction among outpatient physicians throughout Peru, as our data is representative of the country level.

Aim To evaluate disparities in the frequency of scientific activity between medical doctors and nurses in Peru. Methods We carried out a secondary data analysis of the National Health Services Users’ Satisfaction Survey (ENSUSALUD), 2016. This nationally representative survey evaluates doctors and nurses working in clinical settings. We defined scientific activity as i) having published an original article (journal indexed in Web of Science, Scopus or Medline); and ii) having authored an abstract in a national or international conference. We estimated crude and adjusted disparities prevalence ratios (aDPR) and 95% confidence intervals (95%CI). Results We included 2025 doctors and 2877 nurses in the analysis; 71% of doctors doctor were male, and 93% of nurses were female (p Conclusions There are important disparities in scientific activity between doctors and nurses working in clinical settings in Peru. Disparities are more significant for article publication than for authoring in conference abstracts. We suggest public policies that promote research dissemination between health professionals, with emphasis on nurses.

Asylum and refuge in Chile h¬ave received limited attention in policymaking and academia, and there is scarce evidence on their mental health needs and outcomes. Studies on mental healthcare access for international migrants suggest systemic barriers linked to costs and coverage, administrative issues, and adequacy of services. Today, we see that asylum and refuge is an emerging topic in Chile, which opens up the challenges around the mental health of refugees and asylum seekers. This topic is gaining visibility due to increased asylum claims over the past ten years, making it an urgent topic at a policy level. An exploratory qualitative study was conducted in 2018 on the health and social needs of asylum seekers and refugees from Latin America in Chile. This study indicated a general lack of knowledge on the mental health needs of refugees and asylum seekers and Chile and a lack of training in mental health professionals to address specific needs. Consequently, the health needs of these people remain largely unaddressed in terms of the number of available services and the relevance and pertinence of the services delivered. As Chile is positioning itself as a receiving country of refugees and asylum seekers in Latin America and the Caribbean, there is an opportunity to "do better" and adequately address the mental health of these marginalized populations.Las temáticas de asilo y refugio han recibido escasa atención por parte de los decidores públicos y de la academia, existiendo poca evidencia respecto a las necesidades de salud mental, índices y acceso a atención de salud de refugiados y solicitantes de asilo. La literatura en temas de acceso a salud mental de migrantes internacionales en general sugiere la existencia de múltiples barreras vinculadas a costos y cobertura, temas administrativos y de adecuación de servicios. Los desafíos en términos de salud mental de estas poblaciones aumentan en la medida en que es un problema emergente en el país, que ha ganado visibilidad debido al importante incremento de las solicitudes de refugio en los últimos diez años. Un estudio cualitativo exploratorio fue conducido durante el año 2018 sobre las necesidades sociales y de salud de refugiados y solicitantes de refugio de origen latinoamericano presentes en Chile. Los resultados indican que existe falta de disponibilidad y de competencias por parte de los profesionales de salud mental para abordar las necesidades de esta población. En consecuencia, la salud mental de esta población está quedando desatendida tanto en términos cuantitativos debido a la falta de disponibilidad de servicios, cuanto en términos cualitativos por falta de adecuación y aceptabilidad de los servicios ofrecidos. Debido a que Chile se está posicionando como país de acogida de migrantes en la región Latinoamérica y Caribe, incluyendo a refugiados, es necesario acoger la oportunidad de hacer “mejor las cosas” respecto a la salud mental de poblaciones particularmente emarginadas, como son solicitantes de asilo y refugiados.

We evaluated the relationship between job satisfaction, burnout syndrome, and depressive symptoms among Peruvian physicians using the job demand–control framework. We carried out a secondary data analysis of the National Survey of Satisfaction of Users in Health 2016 in Peru. The first part was based on the association among the variables based on the job demand–control framework. The second part focused on estimating the acceptability of the proposed model based on the study variables through the structural equation modeling technique. A total of 2,100 physicians were included, and the prevalence of depressive symptoms was 3.3%. Physicians who had a work-related illness were more than twice as likely to have depressive symptoms (PR=2.23) compared with those who did not. The first predictive model based on the variables, depressive symptoms, burnout syndrome, and job satisfaction had a low goodness-of-fit index. Therefore, for a second evaluation, models with correlated errors were considered, and optimal goodness-of-fit indices were found (CFI=0.974; RMSEA=0.060). Our study identified a stable model to explain the relationship between job satisfaction, burnout, and depressive symptoms among physicians. The results are consistent with the job demand–control framework and can be applied to decision making in occupational contexts in Peru.

Se propuso conocer la vulnerabilidad sanitaria y necesidades de salud de personas inmigrantes en Chile, a través de un estudio cualitativo exploratorio. Los hallazgos indican que su vulnerabilidad estaría dada por su condición irregular, trabajo precario y bajos ingresos, cuando lo tienen. Las afecciones de salud son morbilidad común, de salud mental y reproductiva. La aculturación y actitud positiva hacia el autocuidado serían factores protectores. Importante barrera de acceso es la situación ilegal de algunos inmigrantes; y el desconocimiento del sistema sanitario chileno. Se sugiere socializar políticas sanitarias para migrantes y expandir estrategias dirigidas para su atención de salud.

The following study aims to describe the perception of international migrants who use the primary level of care by health personnel and to explore how this perception can affect the care process in the commune of Antofagasta, north of Chile. Methodology: The methodology was qualitative using a phenomenological descriptive design, through which the discourses of the health personnel of three primary health care centers (n = 14) were explored. Results: The participants presented two thematic categories. The first one related to experiences during delivery of care to migrants and included perceptions and beliefs, factors associated with using services, and reasons for consultation. The second category related to stereotypes towards migrants, including prejudices, beliefs about their lives and reasons for migration. Conclusions: The therapeutic relationship with migrants in primary care depends on the health care personnel’s acceptability of this population, hence, allowing the delivery of care based on respect for their culture and rights.

Objectives Out-of-pocket spent (OPS) of health services are considered inefficient and are a consequence of inequalities in financing and access. The main objective of this study was to compare OPS on health and medicine, including catastrophic expenditure, overall and by quintiles and deciles, for the great Santiago city in the periods 1997, 2007 and 2012. Methods Cross-sectional study based on household budget surveys 1997, 2007 and 2012. OPS on health and medicine for households of the great Santiago was estimated overall and for different quintiles and deciles. In addition, the probability of incurring in catastrophic due to health and drug expenditure were also estimated. Results OPS showed a progressive increase in the three periods. Drug spending showed a decrease concentrated in the lower deciles and an increase in top deciles of expenditure. Catastrophic drug expenditure decreased progressively. By observing the catastrophic drug spending by deciles were the three richest deciles which showed a large increase between 2007 and 2012. Conclusions OPS on health remained high between 2007 and 2012, despite presenting slight decreases in some quintiles and deciles. However, drug coverage improved over time. This study demonstrates that improvements are needed in the financial protection mechanisms on health in Chile, especially for poorer quintiles and deciles.

Esta obra, que nos acerca a experiencias de personas migrantes internacionales y reflexiona sobre políticas e intervenciones en salud, aborda la migración internacional y la salud desde la mirada del sistema de salud, políticas de salud, acceso, uso del sistema y de la figura de facilitadores/mediadores interculturales en salud. Luego, refiere a resultados y experiencias de salud en diversas etapas del ciclo vital, recogiendo evidencia original para Chile, y cierra con abordajes específicos territoriales, de salud mental y de enfermedades infecciosas.

Introducción: La migración internacional es un determinante social de la salud, que puede influenciar los resultados de salud de un individuo y comunidad. La humanidad completa, incluyendo migrantes internacionales, ha enfrentado la pandemia del coronavirus SARS-CoV-2 y su enfermedad respiratoria COVID-19. El propósito de este estudio fue conocer qué factores se asocian a que la población migrante internacional que reside en Chile se sienta preparada para enfrentar la pandemia de COVID-19. Material y métodos: Estudio cuantitativo transversal. Encuesta online de auto-aplicación en español y creole, que fue diseñada y piloteada con personas expertas y por migrantes internacionales. Fue difundida a diversos colectivos migrantes internacionales por medio de redes de organizaciones migrantes y pro migrantes, así como la red asistencial de salud pública de Chile en todo el territorio nacional. Se alcanzó un tamaño de muestra efectivo para análisis de 1690 participantes. Se analizó la asociación entre sentirse preparado para enfrentar la pandemia COVID-19 (sí/no) según país de origen, sexo, nivel de educación, tiempo de permanencia en Chile, sistema de salud, angustia o depresión por el COVID-19, confinamiento y evaluación de la información entregada por el gobierno de COVID-19. Resultados: El 61% de los participantes reportan no sentirse preparados para la pandemia. Sentirse preparado se asoció positivamente a sexo masculino (OR=1,8), haber hecho cuarentena (OR=1,7), y evaluar como buena/muy buena la información que se ha entregado (OR=3.8). Comparado con colombianos (referencia), venezolanos tienden a sentirse menos preparados (OR=0,6), también aquellos que se han sentido angustiados o deprimidos (OR=0,5). Discusión: Recibir información de buena calidad sobre la pandemia y el estado anímico son factores importantes asociados a sentirse preparado para enfrentar el COVID-19 en migrantes internacionales en Chile. Ambas dimensiones son potencialmente modificables para incidir en una mejor atención en salud a migrantes en tiempos de crisis sanitarias.

Background Adolescent sexual and reproductive health services in Chile have been primarily provided through health centers. Although some school-based initiatives have been implemented, to date, these have not been assessed. This study aims to identify strengths and challenges of the affectivity and sexuality component of the school-based 3A Program, a health program which seeks to prevent risk behaviors and promote healthy lifestyle habits within public schools (addressing health topics which in Spanish begin with the letter ‘A’, hence ‘3A’), implemented in the municipality of Lo Prado, city of Santiago. Methods We carried out a qualitative study with a descriptive-interpretative approach in three schools. We conducted in-depth interviews with students, teachers, health professionals, and school principals (N = 44); and focus groups with students (N = 3), teachers and health personnel (N = 3). The interviews were analyzed using thematic analysis. Results Participants highlight the integrative approach to health and to sexual and reproductive health promoted in the 3A Program, which is enhanced by the collaboration of interdisciplinary health teams. Permanent and expedited student access to sexual and reproductive health care is achieved, and affectional bonds are developed between students and the Program’s health staff. The Program assists female participants to imagine and form identities that are not inherently tied to motherhood. It also assists boys and LGBTQ+ adolescents in feeling included as relevant actors in sexual and reproductive health and decision making. The delivery of contraception in schools is highly valued. The most significant challenge identified is ensuring effective and ongoing collaboration between health staff and teachers. Conclusion Participants value the effectivity and sexuality component of the 3A Program as an initiative to improve adolescents’ access to sexual and reproductive health care. Our findings suggest that this Program could be replicated throughout the region and the country to improve the quality and accessibility of health services for adolescents.

Introduction: Antimicrobial drug resistance (AMR) is considered a serious threat to public health worldwide. The relation between AMR and human mobility, particularly international migration, has drawn attention from the scientific community in recent years. However, several aspects about this relation remain unclear. Therefore, we aimed at expanding and updating previous systematic review studies, with a novel focus on the AMR prevalence in migrants compared to the local population of the host country, to examine external validity of previous findings.Methods: We searched in Ovid MEDLINE all types of observational studies, without language or year of publication restrictions. We aimed at exploring differences in countries´ bacterial drug resistance rates based on immigration rates. All types of AMR were included, except for those related to HIV/AIDS and Tuberculosis. The comparator group of interest was the local population of the host country. The study protocol is registered with PROSPERO, number CRD42018114436. Results: After screening of 322 articles, 15 papers were selected for data extraction, including 1930 migrants. Compared to the local population, higher rates of methicillin-resistant Staphylococcus aureus, Panton-Valentine leucocidin positive strains, multidrug-resistant Gram-negative bacteria, vancomycin-resistant Enterococcus, and having at least one multidrug-resistant organism were found in migrants in 12 of the 15 papers. Rates of AMR did not differ significantly in two studies and only one of them reported a lower burden of AMR in migrants.Conclusions: Higher prevalence of AMR in migrants were presented in the majority of the included articles, addressing the emerge of the circulation of resistant strains within this group. More detailed descriptions, including time span and route taken by migrants to arrive to country of destination and length of stay by the time of inclusion are essential to gain a deeper understanding of the relation in between AMR and migration. Countries with high migration rates outside Europe should be encouraged to implement strategies for screening of both local population and migrants in countries.

Preventing vertical transmission of HIV is a challenge for all countries worldwide. The permanent construction of global societies with a variable degree of international migrant population has made it more complex. Health policies, programs, and actions for preventing vertical transmission of HIV in pregnant migrants demand an intercultural perspective, where social, cultural, and gender dimen sions associated with the infection are addressed. Understanding the local reality regarding the pre vention of vertical transmission in the international migrant population in Chile is essential to carry out concrete actions that favor the prevention of mother-to-child transmission of HIV. This article presents some essential concepts related to this topic. It also presents international and national in formation on risks of vertical transmission in pregnant migrants, the importance of the national plan for preventing vertical transmission of HIV in our country, and some ongoing efforts to adapt such plan to the reality of social and cultural diversity that pregnant migrants currently present in Chile, as a useful public health instrument with an intercultural perspective.

Background In Chile, despite its steady decrease overall, adolescent pregnancy is concentrated in the most vulnerable population. Efforts in intersectoral collaboration between health and education to address the problem are being developed, but they have not been assessed. Objective To describe intersectoral strategies between health and education to address adolescent sexual and reproductive health, prevent adolescent pregnancy, and to explore adolescents’ and health professionals’ perceptions regarding those strategies. Design A qualitative ethnographic study was carried out in five municipalities in the Metropolitan Region of Chile. A sample of five key informants, 23 health professionals and 50 adolescents participated in a total of 38 semi‐structured interviews and five discussion groups. Results Two intersectoral strategies to respond to adolescents’ sexual and reproductive health needs were identified: (a) the “in‐and‐out” strategy, where health professionals provide health care mostly in health centres and carry out specific actions in schools and (b) the school‐based strategy in which health professionals carry out continuous actions in schools as part of the curriculum. The second is perceived as responding better to adolescents’ needs in sexual and reproductive health issues and in preventing adolescent pregnancy. Discussion The school‐based strategy, with the constant presence of health professionals and lack of bureaucratic procedures, facilitates adolescents to access sexual and reproductive health care. This strategy enables sexual and reproductive health to be understood as an integral dimension of adolescents’ lives, and it reinforces a holistic idea of health in which it is approached as a whole.

Study Objective The Chilean legislation forbids induced abortion, so little is known of the young women who have abortions and what determinants are associated with this practice. In this study we examined the association between adolescents and young women who have had induced abortions and socioeconomic status and compared them with counterparts who reported not having a history of abortion. Design, Setting, Participants, and Main Outcome Measures Drawing on the 2015 Chilean National Youth Survey, a population-based sample of general community youth aged 15-29 years, we conducted a study on 2439 sexually active females. Bivariate and multiple logistic regression was used to examine the relationship between participants who had induced abortions and participants that had not according to socioeconomic status (low, middle, high), while controlling for demographic, sexual behavior, and cultural covariates. Results 5.15% (n = 129) of participants declared having induced an abortion in the past. Participants with high socioeconomic status had 4.89 (95% confidence interval, 1.44-16.51) higher odds of induced abortion compared with participants with low socioeconomic status. Those with middle socioeconomic status had 1.8 (95% confidence interval, 1.02-3.24) higher odds of induced abortion compared with those with low socioeconomic status. Urban or rural residence, indigenous identification, age of sexual debut, contraceptive use at the time of sexual debut, adolescent pregnancy, and religious and political identification did not correlate with induced abortion rates. Conclusion In Chile, where induced abortion is legally restricted, a social gradient was found in the chance of having had an induced abortion according to socioeconomic status; adolescent and young women with higher socioeconomic advantage reported more induced abortions compared with those with low socioeconomic status.

Resumen Introducción: Los niños y jóvenes migrantes internacionales enfrentan diferentes retos en salud en comparación con la población local, en particular si se enfrentan a ambientes inseguros o a condi ciones sociales adversas. Este estudio busca identificar brechas existentes en resultados de salud de la niñez entre población migrante internacional y chilena. Métodos: Este estudio analiza tres fuentes de información: (i)Nacer en Chile: Datos de consulta antenatal recolectados de los registros electrónicos de las mujeres usuarias del programa Chile Crece Contigo, de todos los centros de salud familiar (CESFAM) de administración municipal de la comuna de Recoleta el año 2012; (ii)Crecer en Chile: Datos de encuesta poblacional "Caracterización Socioeconómica Nacional" CASEN 2013 y (iii)En-fermar en Chile: Datos de todos los egresos hospitalarios de 2012, proporcionada por el departamento de estadística e información en salud (DEIS) del Ministerio de Salud. Resultados: (i) Nacer en Chile: Hay mayor proporción de inmigrantes con riesgo biopsicosocial (62,3% vs 50,1% en chilenas) y con ingreso tardío al programa (63,1% vs 33,4%). Hay menos cesáreas en inmigrantes que en chilenas (24,2% vs 33,6%). (ii) Crecer en Chile: Existe una mayor proporción de niños migrantes fuera del sistema escolar y una mayor proporción en pobreza multidimensional (40% vs 23,2%). (iii) Enfermar en Chile: En migrantes entre 7-14 años es más frecuente egresar hospitalariamente por traumatismos/ otras causas externas (23,6% vs 16,7% en chilenos). Conclusiones: Este estudio entrega nueva evi dencia sobre necesidades urgentes de salud de nuestros niños en Chile. Este es un imperativo ético, legal y moral, independiente de la condición migratoria.

Actualmente en Chile la migración a aumentado considerablemente, y presenta un desafío para la atención en salud de las nuevas poblaciones. Este artículo es una columna de opinión que discute sobre los aportes teórico prácticos de la enfermería transcultural, para la atención de salud culturalmente pertinente a la población migrante en Chile, lo que corresponde a un gran desafío. Se discute sobre la necesidad de su aplicación en la formación de enfermeras (os), como herramienta para lograr brindar una atención de salud sensible a las necesidades de las diversas poblaciones.

Introducción: Los migrantes internacionales presentan menos acceso y uso de los servicios de salud mental, tanto en Chile como en el mundo. Esto se puede explicar a partir de las múltiples barreras a las que se enfrentan en su atención en salud. El objetivo de este estudio fue describir la percepción que tienen diversos actores respecto del acceso y uso de los servicios de salud mental por parte de los inmigrantes. Metodología: Se realizó un análisis secundario de los datos cualitativos del estudio Fondecyt 11130042, el cual levantó información en ocho comunas de Chile, con un total de 256 participantes. Utilizando la metodología cualitativa de Estudio de Caso, se realizó un análisis temático de las entrevistas y grupos focales.Resultados: Tantos los inmigrantes, como los trabajadores de la salud y autoridades en salud reportan menor acceso y uso de los servicios de salud mental por parte de los inmigrantes, lo que presenta consecuencias en esta población. Se plantean barreras individuales y del sistema de salud que afectan el acceso a las atenciones en salud mental. Los participantes dan cuenta de iniciativas que mejoran las atenciones a la población migrante. Discusión: El acceso a salud como derecho humano presenta desafíos para los países por integrar a los migrantes internacionales al sistema de salud, especialmente al considerar el menor acceso y uso que tienen de los servicios de salud mental. En Chile los migrantes se encuentran con barreras importantes, barreras de un sistema de salud que restringe el acceso a los inmigrantes en situación irregular. Se hace necesario contar con intervenciones con enfoque de derechos humanos e interculturalidad, que mejoren el acceso a salud mental para los inmigrantes.

Los desplazamientos geográficos son parte inherente de la existencia humana. Hoy en día, en un mundo globalizado ycomplejo,el movimiento de personastiene profundasy duraderasimplicanciasen lassociedades desde donde estas personas parten y en las sociedades a las cuales estas personas llegan. La migración internacional, es decir, el desplazamiento de individuos de un país a otro con intención de asentamiento, se genera como consecuencia de procesos de estratificación internacional del trabajo, distribución desigual de la pobreza entre países, guerra y conflicto, cambio climático y diversos desastres naturales, entre otros.

The population of international migrants in an irregular situation (IMIS) often finds itself in a condition of particular vulnerability that has an impact on its health. Additionally to this, these migrants face multiple barriers that hinder or even impede their access to health services. This review aims at identifying and describing initiatives that address access to health services in the IMIS population. To this end, a narrative review was conducted in PubMed, Embase, Health Systems Evidence, Cochrane, LILACS, and Scielo, between July and August of 2017. Seven hundred and eighty-seven (787) articles were found, of which 26 have been included, accounting for 31 initiatives. Most of these initiatives are located in North America (61%), South-East Asia (10%), and Northern Europe (10%). They refer mostly to primary (48%) and tertiary (52%) services; urgency/emergency services (39%); provide administrative (65%) and financial accessibility (45%); and respond to needs at the "destination" stage of the migration process (97%). It can be concluded that there are several initiatives that deal with the problems faced by the IMIS population in terms of access to healthcare services. However, no initiatives were found aimed at rehabilitation and sexual health; contact and quality, gender perspective, and cultural competence in health.La población migrante internacional en situación irregular (MISI) suele encontrarse en una condición de particular vulnerabilidad que impacta en su salud, y sumado a esto, enfrenta múltiples barreras que dificultan e incluso impiden su acceso a los servicios de salud. La presente revisión tiene por objetivo identificar y describir iniciativas que abordan el acceso a los servicios de salud en población MISI. Para ello, se realizó una revisión narrativa en PubMed, Embase, Health Systems Evidence, Cochrane, LILACS y Scielo entre julio y agosto de 2017. Se encontraron 787 artículos, de los cuales se incluyeron 26, los que dieron cuenta de 31 iniciativas. La mayoría de estas iniciativas se sitúan en América Septentrional (61%), Asia Sudoriental (10%) y Europa Septentrional (10%); se refieren mayoritariamente a servicios de nivel primario (48%) y terciario (52%), servicios de urgencia/emergencia (39%), brindan accesibilidad administrativa (65%) y financiera (45%), y responden a necesidades en la etapa de «destino» del proceso migratorio (97%). Se puede concluir que existen diversas iniciativas que abordan la problemática del acceso a los servicios de salud de la población MISI. No obstante, no se hallaron iniciativas dirigidas a la rehabilitación y salud sexual; contacto y calidad; perspectiva de género y competencia cultural en salud.

Background Since 2010 there has been a growing population of refugees and asylum seekers in Latin America. This study sought to investigate the perceived experiences and healthcare needs of refugees and asylum seekers of Latin American origin in Chile in order to identify main barriers to healthcare and provide guidance on allied challenges for the public healthcare system. Methods Descriptive qualitative case study with semi-structured interviews applied to refugees and asylum seekers (n = 8), healthcare workers (n = 4), and members of Non-Governmental Organizations and religious foundations focused on working with refugees and asylum seekers in Chile (n = 2). Results Although Chilean law guarantees access to all levels of healthcare for the international migrant population, the specific healthcare needs of refugees and asylum seekers were not adequately covered. Primary care and mental healthcare were the most required types of service for participants, yet they appeared to be the most difficult to access. Difficulties in social integration -including access to healthcare, housing, and education- upon arrival and lengthy waiting times for legal status of refugees also presented great barriers to effective healthcare provision and wellbeing. Healthcare workers and members of organizations indicated the need for more information about refugee and asylum-seeking populations, their rights and conditions, as well as more effective and tailored healthcare interventions for them, especially for emergency mental healthcare situations. Conclusions All participants perceived that there was disinformation among institutional actors regarding the healthcare needs of refugees and asylum seekers in Chile. They also perceived that there were barriers to access to primary care and mental healthcare, which might lead to overuse of emergency services. This study highlights a sense of urgency to protect the social and healthcare needs of refugees and asylum seekers in Latin America.

La prevención de la transmisión vertical de VIH es un desafío para todos los países del mundo. Esto se ve complejizado por la construcción permanente de sociedades globales, con grado variable de población migrante internacional. Las políticas, programas y acciones sanitarias para la prevención de transmisión vertical de VIH en gestantes migrantes demandan una perspectiva intercultural, en donde se aborden todas las dimensiones sociales, culturales y de género asociadas a la infección. El entender la realidad local en cuanto a la prevención de transmisión vertical de VIH en población migrante internacional en Chile es esencial para llevar acciones concretas que favorezcan la prevención de transmisión madre-hijo de VIH. En este artículo se presentan algunos conceptos esenciales relacionados a esta temática. También se expone información internacional y nacional sobre riesgos de transmisión vertical de VIH en migrantes gestantes, la importancia del plan nacional de prevención de transmisión vertical de VIH en nuestro país, y algunos esfuerzos que se están realizando para adaptar dicho plan a la realidad de diversidad social y cultural que migrantes gestantes presentan hoy en Chile, como un valioso insumo de salud pública con perspectiva intercultural.

Los niños, niñas y adolescentes (NNA) representan a un cuarto de la población chilena, sobre la cual en términos de protección el país se ha enfocado en la promoción de igualdad de oportunidad de derechos en base a convenciones internacionales. Sin embargo, aún los NNA siguen muriendo por causas prevenibles y modificables, además de experimentar importantes grados de vulnerabilidad, situación que repercute en complejos efectos emocionales y cognitivos a lo largo de su ciclo vital. Según la evidencia internacional el bienestar de los NNA va directamente relacionado con los índices de desigualdad social, valorando el bienestar como un componente esencial y transversal a los derechos de los NNA del país. En Chile, el bienestar subjetivo se define como las percepciones de los NNA respecto de sus condiciones vitales -tanto en el aspecto económico, como social, cultural, de salud y logros personales. Este concepto se ha estudiado a través de diferentes instrumentos los cuales podrían ser de gran utilidad para promover el componente psicosocial y calidad de vida de los NNA en las estrategias y políticas nacionales en esta población. En esta revision se propone integrar de manera explícita en las políticas públicas de la infancia y adolescencia el concepto de bienestar subjetivo, con el fin de entregar oportunidades justas, positivas y sistemáticas para el máximo desarrollo de los NNA en su ciclo vital, validando empíricamente las condiciones necesarias del buen vivir basado en un enfoque moderno de derechos humanos al cual el país se ha comprometido.

IntroductionAccording to the International Labor Organization, Maternity Protection (MP) policies try to harmonize child care and women's paid work, without affecting family health and economic security. Chile Law 20.545 (2011) increased benefits for economically active women and reduced requirements for accessing these benefits. The goals of the reform included: 1) to increase MP coverage; and 2) to reduce inequities in access to the benefits.MethodThis study uses two data sources. First, using individual data routinely collected from 2000 to 2015, yearly MP coverage access over time was calculated. Second, using national representative household surveys collected before and after the Law (2009 and 2013), coverage and a set of measures of inequality were estimated. To compare changes over time, we used non-experimental, before-after intervention design for independent samples. For each variable, we estimated comparative proportions at 95% confidence interval before and after the intervention. Additionally, we included multivariate and propensity score analysis.ResultsBetween 2000 and 2015, MP coverage grew from 24.4% to 44.8%. Using comparable 2009 and 2013 survey data, we observed the same trend, with 31.6% of estimated MP coverage in 2009, escalating to 39.5% in 2013. We conclude that: 1) after the reform, there was an increase in MP coverage; and, 2) there was no significant reduction of inequities in the distribution of MP benefits.Discussion/conclusionFew scientific evaluations of MP reforms have been conducted worldwide; even fewer including an equity analysis. This study provides an empirically-based evaluation of MP reform from both a population-level and an equity-focused perspective. We conclude that this reform needs to be complemented with other policies to ensure maternity protection in terms of access and equity in a country with deep socioeconomic stratification.