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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.

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.

International migration is a social determinant of health. The past decade has seen a large exodus of Venezuelans within Latin America, including Chile. In the past months, the world has been facing the SARS-CoV-2 coronavirus pandemic and its respiratory disease COVID-19.To explore what factors are associated with feeling prepared to face the COVID-19 pandemic among the Venezuelan population residing in Chile.Cross-sectional quantitative study with an opinion poll design. An online self-reported survey in Spanish and Creole was designed and piloted with experts and international migrants. It was disseminated to various international migrant groups through networks of migrant and pro-migrant organizations and the Chilean public health care network across the national territory. An effective sample size for analysis of 1690 participants was reached, of which 1008 (60%) were from Venezuela and included in this analysis. Feeling prepared to face the COVID-19 pandemic (yes/no) among Venezuelan migrants was described, as well as relevant variables like sex, level of education, length of stay, healthcare provision, anxiety or depression due to COVID-19, confinement, and evaluation of the quality of the information provided by the COVID-19 government.65% of the Venezuelan participants reported not feeling prepared for the pandemic. Compared to Venezuelan migrants who feel prepared to face the COVID-19 pandemic, migrants who reported not feeling prepared were in a higher proportion female, with secondary education level, had arrived in Chile in the past year, do not have a job but want to work, and belong to the public healthcare provision.Receiving good quality information on the pandemic and mental health symptoms are important factors associated with feeling prepared to face COVID-19 in Venezuelan migrants in Chile, suggesting that increased attention towards the physical and mental health of Venezuelan migrants in Chile and the region is needed.La migración internacional es un determinante social de la salud que puede influir en los resultados de salud de un individuo y su comunidad. La última década ha experimentado un gran éxodo desde Venezuela a otros países de la región, incluido Chile. En los últimos meses, el mundo se ha enfrentado a la pandemia de coronavirus del SARS-CoV-2 y su enfermedad respiratoria COVID-19.Explorar qué factores están asociados con sentirse preparado para enfrentar la pandemia de COVID-19 entre la población venezolana que reside en Chile.Estudio cuantitativo transversal, siguiendo el diseño de una encuesta de opinión. Encuesta auto-aplicada en línea en español y Creol haitiano, que fue diseñada y puesta a prueba con expertos y migrantes internacionales. Se difundió a varios grupos internacionales de migrantes a través de redes de organizaciones de migrantes y pro-migrantes, así como a través de la red chilena de atención de salud pública en todo el territorio nacional. Tamaño de muestra de 1690 participantes, de los cuales 1008 (60%) eran de Venezuela y se incluyeron en este análisis descriptivo. Se analizó en forma descriptiva la variable principal sentirse preparado para enfrentar la pandemia de COVID-19 (sí/no) así como las variables sexo, nivel educacional, tiempo de estadía en Chile, tipo de previsión de salud, ansiedad o depresión debido a COVID-19, cumplimiento de confinamiento y evaluación de calidad de la información sobre COVID-19 que se ha recibido de autoridades y equipos de salud.65% de los participantes venezolanos informaron no sentirse preparados para la pandemia. En comparación con los migrantes venezolanos que se sienten preparados para enfrentar la pandemia de COVID-19, los migrantes venezolanos que reportaron no sentirse preparados eran en mayor proporción mujeres, con nivel de educación secundaria, habían llegado a Chile en el último año, no tienen trabajo pero quieren trabajar, y pertenecer a la prestación sanitaria pública.Recibir información de buena calidad sobre la pandemia y la salud mental son factores importantes asociados con sentirse preparado para enfrentar COVID-19 en migrantes venezolanos en Chile, lo cual sugiere que se necesita más atención en la salud física y mental de los migrantes venezolanos en Chile y en la región.

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.

Background: A sex-related switch in the prevalence of asthma from childhood (male predominance) to adulthood (female predominance) has been described, but for allergic rhinitis this remains unclear. We aimed to examine sex- and age-group-specific differences in allergic rhinitis prevalence by systematically evaluating studies from across the globe. Methods: A systematic search of MEDLINE and Embase for population-based cross-sectional studies was performed regardless of the language of publication. The search was restricted to the present millennium (2000 to June 2014). Study quality was defined by the sampling method, response rate, sample size, and data collection method. To assess sex differences in the prevalence of self- or parent-reported symptoms of rhinitis, calculated pooled estimates of the male-female ratio (MFR) were obtained using random-effects model meta-analyses due to heterogeneity. A meta-regression analysis was also performed. Results: Out of 6,539 publications identified, 67 cross-sectional population-based studies (291,726 males and 301,781 females) were included in our meta-analysis. In children (Conclusions: The male predominance of rhinitis prevalence in childhood changed towards a female predominance in adolescence across the globe, except in Asia. Longitudinal studies are needed to confirm these cross-sectional data and examine possible determinants and underlying mechanisms.

Equity has been recognized as one of the driving principles of many health systems in the world. In Latin America, Chile has led the explicit inclusion of equity in their health policies, which is reflected in its recent health reform. On the other hand, Chile faces the challenge of defining and implementing a policy for health technology assessment (HTA), which should be consistent with the equity principles that underlie the Chilean national health system. This paper reviews the equity concept emphasizing the relevance of socioeconomic inequalities. Furthermore, it examines how international HTA agencies have explicitly included this element in the evaluation and decision processes. It presents the English case, which highlights the elements of procedural justice rather than adopting a normative position regarding equity. Finally, it examines the methods that have been developed aiming to make explicit consideration of equity in HTA. It concludes that the methodological development to incorporate equity elements with empirical basis is recent and limited. The consideration of equity is, in most of the cases, left to the instances of deliberative participation.

Health research is considered an essential element for the improvement of population health and it has been recommended that a share of the national health budget should be allocated to develop this field. Chile has undertaken efforts in the last decades in order to improve the governmental structure created to promote the development of health research, which has increased human resources and funding opportunities. On the other hand, the sustained economic growth of Chile in the last decades suggests that the health expenditure will maintain its increasing trend in the following years. This additional funding could be used to improve coverage of current activities performed in the health system, but also to address the incorporation of new strategies. More recently, health technology assessment (HTA) has been proposed as a process to support decisions about allocation of resources based on scientific evidence. This paper examines the relationship between the development of health research and the HTA process. First, it presents a brief diagnosis of the situation of health research in Chile. Second, it reviews the conceptual basis and the methods that account for the relationship between a HTA process and the development of health research. In particular, it emphasizes the relevance of identifying information gaps where funding additional research can be considered a good use of public resources. Finally, it discusses the challenges and possible courses of action that Chile could take in order to guarantee the continuous improvement of an articulated structure for health research and HTA.

Adolescent men’s health is a global concern. Most reports and consensus focus on individuals’ health risk behaviours—eg, tobacco consumption, binge drinking, and drug consumption, among others. In addition to this approach, we need to incorporate a sociocultural dimension into adolescent men’s health. Evidence suggests that adolescence is a complex stage in life, in which social interactions are important drivers of behavioural decisions. Adolescents, particularly men, usually report good health status and do not feel the need to use healthcare services, which frequently have a focus on illness. Moreover, for epidemiological reasons, healthcare services have often had an understandable focus on women and c hildren. Adolescent men, particularly those with low socio economic status, are therefore vulnerable both socially and in terms of health. These three social determinants—health-care system, sex, and socioeconomic status—have severe eff ects in the life course, including premature death, morbidity, and poor quality of life. A sociocultural approach would be useful in developing a more comprehensive understanding of adolescent men’s health risk behaviours. First, this approach is crucial in informing the action of health-care workers, because adolescents tend to underuse the system. Second, public health practitioners can engage with broader social determinants of adolescent men’s health. Third, societies can recognise the multiple social constructions of adolescence, thus limiting the oversimplification of this life stage. These ideas are now becoming evident worldwide. For example, a Mexican adolescent man threatened by a criminal organisation has a completely diff erent life course from that of a Syrian adolescent who is trying to enter illegally into Italy. And both life courses are different from that of a wealthy European adolescent who has strong social protection and various life opportunities. Sociocultural differences are also relevant within societies. A nation with high income inequality inevitably creates a rigid social structure, with adolescents experiencing poor life contexts and opportunities. Growing up in violent communities, including war and domestic violence (all associated with inequality), also aff ect adolescent men’s behaviours. We advocate for the urgent need to include a sociocultural approach to adolescent men’s health. Existing approaches that focus on the individual could be strengthened by the incorporation of this perspective for improved and long-lasting health eff ects.

The learning process is sensitive to the demands from the learning task and the specific subject of study. This study provides a characterization of the motivational and cognitive learning strategies used by students in their first year of an undergraduate Civil Engineering degree course at a prestigious Chilean university. The module considered for this study was “Introduction to Calculus”, the first course in Mathematics that these students took at the beginning of their career. A sample of 339 students (73% of the total students enrolled) attended the last lecture and consented to participate in this study lecture (no student rejected to participate). They answered the Motivated Strategies Learning Questionnaire (MSLQ). The MSLQ asked the students about the motivational and cognitive learning strategies that they applied in the selected module. Mean scores for motivational and cognitive items were categorized into low, medium or high values. Students reported high motivational strategies, particularly regarding their value of the task and their control of learning beliefs. These were ranked as “high” level. As for the cognitive learning strategies, they were also high but slightly lower than the motivational dimensions of the learning experience. Hence, they were ranked in an upper-middle range, excelling in metacognitive self-regulation and effort regulation. Moreover, motivational and cognitive strategies were interrelated components affecting the learning outcomes. This study explored self-reported motivational and cognitive learning strategies applied by first-year undergraduate students of a Civil Engineering degree course in one of the largest universities in Chile. Our findings suggest that both motivational and cognitive components of the learning process are relevant and interact with each other. These results contribute to a better understanding of the learning process of Engineering students in an early curricular stage. Hence, they provide relevant knowledge that could be applied in teaching and learning practices in higher education.

Background Disability is a worldwide public health priority. A shift from a biomedical perspective of dysfunction to a broader social understanding of disability has been proposed. Among many different social factors described in the past, socioeconomic position remains as a key multidimensional determinant of health. The study goal was to analyze the relationship between disability and different domains of socioeconomic position in Chile. Methods Cross-sectional analysis of an anonymized population-based survey conducted in Chile in 2006. Any disability (dichotomous variable) and 6 different types of disability were analyzed on the bases of their relationship with income quintiles, occupational status, educational level, and material living standards (quality of the housing, overcrowding rate and sanitary conditions). Confounding and interaction effects were explored using R statistical program. Results Income, education, occupation, and material measures of socioeconomic position, along with some sociodemographic characteristics of the population, were independently associated with the chance of being disabled in Chile. Interestingly, classic measures of socioeconomic position (income, education, and occupation) were consistently associated with any disability in Chile, whereas material living conditions were partially confounded by these classic measures. In addition to this, each type of disability showed a particular pattern of related social determinants, which also varied by age group. Conclusions This study contributed to the understanding of disability in Chile and how different domains of socioeconomic position might be associated with this prevalent condition. Disability remains a complex multidimensional public health problem in Chile that requires the inclusion of a wide range of risk factors, of which socioeconomic position is particularly relevant.

Recently, the translational research model (TR) has been established as a key feature in health worldwide. The objectives of this review are: (1) to define the TR and describe its complex nature; (2) to identify the components of the TR; (3) to link the TR to the decision-making process in health policies; (4) to recognize frequent obstacles and challenges of the association between the TR and the decision-making process in health policies. A systematic literature review was conducted in scientific databases and selected grey literature was done including TR and health policy as key words. We found 60 papers. Results show that the concept of TR and its theoretical formulation has evolved over time and has only recently incorporated the complexity that exists in the transference of scientific knowledge to health. International literature shows different applications of the TR in both research and clinical practice. The application of the TR to public health and health policy decision making is relatively new but necessary and could become a priority for health policies in the countries.

Background: In Chile, members of the civil society and government achieved the passing of the HIV/AIDS Law (19.779). The level of knowledge of the law held by healthcare workers in Chile is not well known. Aim: To analyze the effect of an intervention on knowledge of the existence of the law and its application in clinical practice amongprimary healthcare workers in southeastern Santiago. Material and Methods: Healthcare workers of primary care centers were invited to participate in the study. One group received an educational intervention lasting a total of 16 hours, about AIDS physiopathology, sexually transmitted diseases, communication with patients and current legislation. A control group did not receive the educational intervention. Both groups answered a self-administered questionnaire about the HIV/AIDS law at baseline and three months after the intervention. Results: The intervention was carried out in 262 workers and 293 participated as controls. The initial evaluation revealed that only 16.3% (n = 89) had heard of the law, without any significant difference between intervention and control groups. The knowledge about the law improved by 65% in the intervention group and did not change in controls. At the end of the education period, the intervention and control groups improved their global knowledge by 29 and 3%, respectively (p < 0.05). Conclusions: The educational intervention was effective in improving knowledge of the HIV/AIDS Law among Chilean healthcare workers.

Sr Editor: En salud es frecuente que se utilicen variables que no se observan directamente, como, por ejemplo, la calidad de vida, la satisfaccion usuaria, o la competencia cultural. Estas variables son conocidas como latentes y muchas veces son tratadas de la misma manera que aquellas que son observadas directamente, como el sexo o la estatura. Sin embargo, presentan diferencias considerables, tanto en su definicion, como en las tecnicas utilizadas para estudiar sus relaciones o hacer inferencias a partir de ellas. Las variables latentes son entidades aleatorias no observadas, que no presentan una unidad de medida especifica y, por lo tanto, cualquier estimacion esta sujeta a un error asociado (1). Por ejemplo, la competencia cultural en profesionales de la salud es una variable latente. En caso de contar con un instrumento valido de medicion de esta variable, la asignacion de cualquier valor tendria –ineludiblemente- un margen de error asociado y su unidad de medida podria variar entre estudios, porque no hay consenso en su parametro de comparacion. Por ello, surge la interrogante de como acceder adecuadamente a variables latentes en investigacion en salud. La respuesta esta en la utilizacion de un grupo de variables o indicadores que puedan ser obtenidos directamente y que, a su vez, esten asociados teoricamente a la variable latente de interes, como, por ejemplo, las preguntas de un cuestionario o los items de una encuesta. Asi puede modelarse la probabilidad de tener cierto nivel del rasgo latente dado las respuestas a un set de preguntas o indicadores observados (1). Leer mas...

Sr. Editor: La investigacion en salud conlleva una responsabilidad que es lograr un impacto en la salud de las personas, a nivel individual o poblacional. Tal como senalan Ogilvie et al (1), no esta en disputa la idea de que la investigacion basica y aplicada necesita ser transferida a otros escenarios relevantes. No obstante, existen dos preguntas criticas: ?Que investigacion en salud requiere ser transferida? y ?Como debe realizarse esa transferencia para que resulte efectiva en la practica? La reflexion en torno a estas dos preguntas nos lleva a nuevas interrogantes: ?Cuales son los desafios en salud de acuerdo al perfil epidemiologico actual? ?Cuales son los problemas en salud que debieramos atender en investigacion? ?Como avanzar desde los modelos de investigacion clasicos a modelos que realmente impacten a las comunidades? Leer mas....

To the Editor: Migration is defined as the process of moving from one place to another(1). It has a rather obvious beginning, but the ending is not necessarily clear(2). The United Nations defines an international migrant as a person who stays outside their usual country of residence for at least one year(3). Attempts to define migration have been complex and diverse, involving a wide range of contexts, reasons and types of immigrant, from healthy migrants in search of better opportunities, to political refugees escaping civil wars in their countries of origin. Migration affects the entire world and represents one of the major opportunities for economic, social and cultural integration, and is also a crucial social determinant of health. As Wickramage and Siriwardhana recently stated(4),this phenomenon is rapidly reshaping the world. For instance, labour migrants are increasingly flowing among low-income and middle-income nations in Asia, Africa, and the Middle East(4). The same pattern is found in Latin American countries, where intra-regional migration has deepened socioeconomic inequality over the last decades(5). Leer mas...

Chile is facing one of its major intellectual revolutions in the last century: organised high school, college and university students have led the most salient educational reform since the one that took place during the dictatorship period. This phenomenon is a pacific revolution based on the power of sound, evidence-based, clear and robust ideas. The purpose of this short essay is to reflect some ideas on the conceptualisation of a shared decision making (SDM) process and how they could be transferred to the current students’ educational revolution in Chile. It provides a reflection on how SDM might concretely contribute to this educational reform and on what future steps could be taken to truly achieves a “participatory” democracy in Chile. According to the authors, this debate illustrates the extent to which the level of participation must rely not on particular individuals but on the establishment of a partnership between parties.

Objetivos. Indagar en las percepciones de los trabajadores de salud primaria (TSP) sobre los desafíos de atención de salud para población migrante. Materiales y métodos. Se realizó un estudio cualitativo de caso múltiple en ocho comunas de Chile, mediante la técnica de bola de nieve se reclutó a 101 TSP y autoridades locales. Se realizaron entrevistas semiestructuradas y grupos focales, logrando saturación de información. Resultados. Los hallazgos fueron agrupados en dos grandes ejes temáticos: 1. Dificultades técnicas y administrativas, y 2. Percepción de barreras culturales. De acuerdo a los TSP, pese a que se han establecido normativas y se han generado estrategias de atención en salud para población migrante, estas, en su mayoría, no son estables ni conocidas por todos los TSP. Tampoco son fáciles de implementar en las diversas realidades investigadas. La ausencia de registros sobre el número de migrantes que accederán al sistema sanitario, dificulta el diseño de intervenciones específicas. Adicionalmente, la atención en salud presenta complicaciones, y los TSP no necesariamente poseen herramientas que les permitan brindar una atención que sea culturalmente sensible a las necesidades de la comunidad migrante. Conclusiones. Los hallazgos ponen en discusión los nuevos desafíos en salud que enfrenta Chile frente a la creciente población migrante. Las necesidades percibidas por TSP son: estabilidad y claridad en las normativas vigentes en relación a acceso y prestación de servicios, capacitación en normativas y la manera concreta en la que estas deben operar, y sensibilización en competencia cultural. Objectives. To investigate the perceptions of primary health workers (PHW) about the challenges of health care for migrants. Materials and methods. A qualitative multicase study was conducted in eight communes of Chile, using the snowball technique, where 101 PHW and local authorities were recruited. Semi-structured interviews and focal groups were conducted, achieving information saturation. Results. The findings were grouped into two major thematic axes: 1. Technical and administrative difficulties, and 2. Perception of cultural barriers. According to the PHW, although regulations have been established and health care strategies have been generated for the migrant population, these are mostly not stable or known to all PHW. They are also not easy to implement in the various realities investigated. The absence of records on the number of migrants accessing the health system makes it difficult to design specific interventions. Additionally, health care has complications, and the PHW do not necessarily have tools that allow them to provide a care that is culturally sensitive to the needs of the migrant community. Conclusions. The findings put into question the new challenges in health that Chile is facing in the face of the growing migrant population. The needs perceived by PHW are: stability and clarity in the regulations in force in relation to access and provision of services, training in regulations and the concrete way in which they should operate, and sensitization in cultural competence.

Global public health (GPH) continues to be a challenging field. It focuses on health-related issues that transcend national boundaries and thus requires global cooperation for implementing solutions to public health problems. Information and communication technologies (ICTs) have the potential to contribute to GPH by improving the quality of healthcare services. The purpose of this commentary article is to discuss the nature and characteristics of the existing link between ICTs and GPH. The key underlying questions discussed in this article are (a) whether ICTs can truly reduce the burden of current GPH problems and (b) how to effectively achieve it. We selected three widely recognized GPH challenges: diarrheal disease among children under 5 years old, malaria, and type 2 diabetes mellitus. These are considered to be examples of salient global issues that, despite the availability of cost-effective preventive and therapeutic interventions, still remain a major burden of morbidity and mortality worldwide. We conclude that there is a growing global interest in ICT-related solutions in GPH. We recommend the development of more transparent frameworks, more theory-informed solutions, and clearer translational links between ICTs and GPH matters. Ten further specific recommendations are also discussed in this article.

Normal 0 21 false false false /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Tabla normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} Antecedentes: Estudios reportan un mejor estado de salud de los inmigrantes en comparacion con la poblacion local (efecto del "migrante sano"), independientemente de su posicion socioeconomica (PSE). Esto se conoce como la paradoja latina. Este estudio testeo la paradoja latina dentro de America Latina en Chile. Metodos: analisis secundario de datos de la encuesta CASEN 2006. Tres resultados de salud se incluyeron: discapacidad, enfermedad/accidente, cancer/enfermedad cronica (variables dicotomicas). Datos demograficos (edad, sexo, estado civil, zona urbana / rural, grupo etnico), PSE (nivel educativo, situacion laboral y el ingreso familiar per capita), y condiciones materiales (hacinamiento, saneamiento, calidad de la vivienda). Modelos de regresion ponderados crudos y ajustados fueron analizados en STATA 11.0. Resultados: 1% de la poblacion de Chile eran inmigrantes, principalmente de otros paises de America Latina. Un efecto de "inmigrante sano" aparecio dentro de la poblacion inmigrante total: este grupo tenia una prevalencia cruda significativamente menor que la poblacion chilena en todos los indicadores de salud. Sin embargo, este efecto de migrante sano pierde su significacion al ajustar por PSE. Ademas, la salud de los inmigrantes con mas tiempo de residencia mostro tasas similares de salud a la de origen chileno. Conclusion: la paradoja latina no se observo en Chile. La proteccion de los inmigrantes de baja PSE podria tener grandes efectos positivos en su salud.

Sr. Editor: El acceso a medicamentos de alto costo, en especial aquellos para el tratamiento de enfermedades raras y algunas enfermedades no incluidas en el AUGE, se ha posicionado como un tema de alta importancia en la agenda de las politicas de salud. Como consecuencia de este debate se ha planteado la necesidad de crear un fondo especial de medicamentos, el cual empezaria a funcionar en el ano 2014. Resta preguntarse si el uso de este dinero representa un adecuado uso de los recursos publicos de salud. El adecuado uso de los recursos en una nueva intervencion de salud implica que las nuevas tecnologias financiadas deben ser costo-efectivas, es decir, que los beneficios que se obtienen por el gasto incurrido son al menos de la misma magnitud que si esos recursos fuesen destinados a hacer mas de lo que el sistema hace actualmente. En definitiva, es una comparacion entre unidades de beneficios (netos) entre pacientes con distintos problemas de salud, pacientes que a la luz de la autoridad sanitaria debiesen tener igual prioridad por el acceso a los limitados recursos publicos. Existe una amplia gama de tratamientos que han sido demostrados no costo-efectivos para sistemas de salud que gastan mucho mas que el chileno y son al menos tan eficientes como el nuestro. Por lo tanto, es muy posible que gran parte de las intervenciones que este nuevo fondo de medicamentos financie no sean costo-efectivas, lo que quiere decir que se obtendria mas salud en la poblacion si es que esos recursos fuesen destinados a otras actividades del sector salud. leer mas

EMIC-Chile ("Entrenamiento en Metodologías para la Investigación Clínica en Chile") es un proyecto académico desarrollado durante el año 2008 en Chile para entrenar a profesionales de la salud y disciplinas afines en metodología de investigación clínica, con el objetivo de aumentar la calidad de los proyectos de investigación con fines concursables en nuestro país. El propósito de este artículo es dar a conocer el programa y sus fundamentos teóricos de enseñanza-aprendizaje, que estuvieron en la base de la estructura, metodología, evaluación y sistematización del conocimiento entregado. Para ello, primero se describe el programa, la metodología, la evaluación y el seguimiento. Posteriormente se detallan los aspectos psicoeducativos considerados, con especial énfasis en el aprendizaje social y la educación de adultos. Finalmente, se discute en torno a las posibles consideraciones de este programa para futuras intervenciones educativas en investigación en salud en Chile. Se espera que esta experiencia y sus fundamentos educativos sirvan de motor para futuras iniciativas en el área, a favor de la investigación en salud en Chile.