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Introducción: El colectivo venezolano residente en Chile ha aumentado no solamente en cantidad, sino también en la vulnerabilidad en que migran, por ello se vuelve relevante comprender cómo han llevado adelante las una de las medidas de cuidado ante la propagación de COVID-19 más promulgadas a nivel mundial: la realización cuarentena. Objetivo: Analizar qué elementos dificultan la realización de cuarentena en la población venezolana residente en Chile, al ser el confinamiento una de las medidas más promulgadas para proteger a la población ante la propagación de COVID-19. Metodología: Lo anterior se aborda por medio de un estudio cuantitativo observacional de corte transversal desde una encuesta online sobre COVID-19 a extranjeros en Chile, realizada en abril (2020), por medio de una estrategia de muestreo en “bola de nieve” (n=1.690 migrantes). Este análisis secundario se focaliza en participantes venezolanos (N=1.006), por medio de análisis descriptivo, bivariado y de regresión multivariada, con ajuste de Raking para disminuir el sesgo de auto-selección. Resultados: Las chances de no poder realizar cuarentena son mayor en quienes cuentan con trabajo ([OR=5,35, 95%IC [3,16-9,02]), en relación a los que no; en quienes no poseen previsión de salud ([OR=4,02, 95%IC [1,57-10,32]) y en los que tienen previsión pública (Fonasa) ([OR=3,92, 95%IC [1,84-8,35]), en relación a las personas con previsión privada; en hombres ([OR=2,23, 95%IC [1,50-3,32]) que en mujeres; y en los que tienen nivel educacional menor a nivel superior ([OR=1,74, 95%IC [11,50-3,32]). Conclusión: La asociación encontrada entre no cumplir cuarentena con condiciones laborales y tipo de previsión de salud expone la relevancia de la vulnerabilidad socioeconómica en las oportunidades de llevar adelante medidas de cuidado de salud pública en población migrante venezolana en Chile, como es el seguimiento de confinamiento durante una pandemia como la de COVID-19. Esto es importante para la planificación sanitaria en futuras crisis socio-sanitarias.

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.

Background The association between international migration and mental health is conditioned to several factors, and discrimination may play a significant role. Currently, Peru is one of the principal Venezuelan migrant-receiving countries in Latin America. There are around one million Venezuelan refugees and migrants in the country. This study evaluates the association between self-perceived discrimination and mental health problems in Venezuelan population living in Peru. Method We analyzed data from the Venezuelan Population Residing in Peru Survey 2018, a nationally representative urban sample aimed at collecting information on several dimensions of Venezuelan population wellbeing. We applied logistic regression models to assess the association between self-perceived discrimination and mental health problems. Moreover, we applied the propensity score matching method as a robustness check of our results. Results Of 9487 Venezuelans surveyed, 6806 included complete information. From this sample, 6.3% reported mental health problems related to fear, anger, anxiety, or stress. Logistic regression models showed that Venezuelans who perceived being discriminated against had 2.4 higher odds of presenting mental health problems than their non-discriminated counterparts. Moreover, propensity score matching models showed that Venezuelans who perceived being discriminated against increased by 3.5 percentage points their probability of presenting mental health problems compared to their non-discriminated counterparts. Conclusions There is evidence that self-perceived discrimination is associated with mental health deterioration in Venezuelan migrants living in Peru. Our findings are relevant in the current geopolitical context and could be useful in the decision making processes in international health.

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.

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.

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.

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.

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.

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.

Objetivo. Identificar el conocimiento, acceso y uso del sistema de salud por parte de adolescentes migrantes, y las barreras para el acceso y uso del sistema de salud en dicha población en Chile. Métodos. Estudio exploratorio observacional, de corte transversal, aplicado en jornada participativa con adolescentes migrantes (N=30) de tres comunas de la ciudad de Santiago, Chile. Estudio multimétodos. Se aplicó una encuesta basal sobre el proceso migratorio y las experiencias en el sistema de salud, con análisis descriptivo de datos. Desde lo cualitativo, se realizaron grupos de discusión (n=5) y talleres participativos (n=2) con adolescentes migrantes. Resultados. El 60% de adolescentes afirmó desconocer si está inscrito en el sistema de salud, y la mitad no lo ha utilizado. Se identificó que el tiempo de residencia es un factor relevante para el uso efectivo de algunas prestaciones de salud. Se reconocieron barreras administrativas para acceder al sistema de salud, como situación migratoria, percepción de obligatoriedad de compañía de adultos, y experiencias de discriminación en la atención. Se identificaron necesidades específicas en salud sexual y reproductiva, como acceso a preservativos, y salud mental en relación a la atención de especialistas. Como facilitadores del acceso y uso se destacaron las experiencias de buen trato, y la presencia del sector salud en las escuelas. Conclusiones. Se identificó desconocimiento del sistema de salud, y diversas barreras de acceso y uso de este por parte de adolescentes migrantes. En base a los resultados se proponen recomendaciones generales para el país y la región referidas a la promoción de la salud de este grupo.

RESUMEN El presente artículo analiza las necesidades de atención de salud mental de refugiados y solicitantes de asilo de origen latinoamericano en Chile, por medio de un estudio cualitativo descriptivo, realizado en 2018, desde la voz de las personas solicitantes de refugio y asilo (n=8), profesionales de salud que los atienden (n=4), y miembros de organismos e instituciones dedicados en la temática (n=2). Los hallazgos evidencian que las obligaciones asumidas por Chile, a través de la adhesión a tratados internacionales, no han logrado garantizar el ejercicio del derecho a la salud mental, entendida como parte del derecho universal de acceso a la salud. En lo particular, el artículo documenta la presencia tanto de barreras de acceso a la salud mental en migrantes solicitantes de refugio y asilo, como de factores de estrés posmigratorios que pueden acentuar el riesgo de estos grupos a sufrir trastornos emotivos. También se reporta la insuficiente instalación de capacidades de atención en los equipos de salud mental para abordar las consecuencias psíquicas de los episodios de violencia y persecución que están a la base de la migración forzada. Finalmente, el artículo discute la necesidad de estrechar la vinculación entre la salud mental -como derecho humano fundamental- y el derecho a la protección internacional. ABSTRACT This article analyzes the results of a descriptive, qualitative study carried out in 2018 on the mental healthcare needs of Latin American refugees and asylum seekers in Chile, through the perspectives of refugees and asylum applicants (n=8), healthcare professionals responsible for delivery of care (n=4), and members of civil society organisations involved in this area (n=2). Our findings indicate that despite Chile’s commitment to international treaties in this regard, little has been achieved in safeguarding the right to access to mental health care, understood as part of the universal right to health care access. This article documents barriers to mental health care access for migrants applying for asylum and refugee status. Post-migration stress factors may also increase the risk of emotional disorders within this group of people. Mental healthcare providers and teams are often not equipped with the tools to deal with the psychological consequences arising from the situations of violence and persecution associated with forced migration. Our study discusses the need to strengthen the link between mental health care - as a fundamental human right - and the right to international protection.

Mental health in a context of international migration is a particularly pressing issue, as migration is recognised as a social determinant of physical and mental health. As Chile is increasingly becoming a receiving country of South-South migration, immigrants face mental health inequities, with regards to outcomes and access to care. In order to identify and synthetize mental healthcare inequities faced by international migrants with regards to locals in Chile, a narrative review of the literature on national mental healthcare policies in Chile and a narrative review of the literature on migrants’ mental healthcare in Chile were conducted, with a focus on describing mental health outcomes, policy environment and persisting gaps and barriers for both topics. The existing literature on mental healthcare in Chile, both for the general population and for international migrants, following the social determinant of health framework and categorised in terms of i) Inequities in mental health outcomes; ii) Description of the mental health policy environment and iii) Identification of the main barriers to access mental healthcare. Despite incremental policy efforts to improve the reach of mental healthcare in Chile, persisting inequities are identified for both locals and international migrants: lack of funding and low prioritisation, exacerbation of social vulnerability in the context of a mixed health insurance system, and inadequacy of mental healthcare services. International migrants may experience specific layers of vulnerability linked to migration as a social determinant of health, nested in a system that exacerbates social vulnerability. Based on the findings, the article discusses how mental health is a privilege for migrant populations as well as locals experiencing layers of social vulnerability in the Chilean context. International migrants’ access to comprehensive and culturally relevant mental healthcare in Chile and other countries is an urgent need in order to contribute to reducing social vulnerability and fostering mechanisms of social inclusion. International migration, social determinants of mental health, mental health inequities, social vulnerability, review.

Background Migrants who have been forced to leave their home, such as refugees, asylum seekers, and internally displaced persons (IDP), are likely to experience stressors which may lead to mental health problems. The efficacy of interventions for mental health promotion, prevention, and treatment may differ in this population. Objectives With this overview of systematic reviews, we will map the characteristics and methodological quality of existing systematic reviews and registered systematic review protocols on the promotion of mental health and prevention and treatment of common mental disorders among refugees, asylum seekers, and IDPs. The findings from this overview will be used to prioritise and inform future Cochrane reviews on the mental health of involuntary migrants. Methods We searched Ovid MEDLINE (1945 onwards), Ovid Embase (1974 onwards), Ovid PsycINFO, ProQuest PTSDpubs, Web of Science Core Collection, Cochrane Database of Systematic Reviews, NIHR Journals Library, CRD databases (archived), DoPHER, Epistemonikos, Health Evidence, 3ie International Initiative for Impact Evaluation, and PROSPERO, to identify systematic reviews of mental health interventions for involuntary migrants. We did not apply any restrictions on date, language, or publication status to the searches. We included systematic reviews or protocols for systematic reviews of interventions aimed at refugees, asylum seekers, and internally displaced persons. Interventions must have been aimed at mental health promotion (for example, classroom‐based well‐being interventions for children), prevention of mental health problems (for example, trauma‐focussed Cognitive Behavioural Therapy to prevent post‐traumatic stress disorder), or treatment of common mental disorders and symptoms (for example, narrative exposure therapy to treat symptoms of trauma). After screening abstracts and full‐text manuscripts in duplicate, we extracted data on the characteristics of the reviews, the interventions examined in reviews, and the number of primary studies included in each review. Methodological quality of the included systematic reviews was assessed using AMSTAR 2. Main results The overview includes 23 systematic reviews and 15 registered systematic review protocols. Of the 23 published systematic reviews, meta‐analyses were conducted in eight reviews. It was more common for the search strategy or inclusion criteria of the reviews to state that studies involving refugees were eligible for inclusion (23/23), than for asylum seekers (14/23) or IDPs (7/23) to be explicitly mentioned. In most reviews, study eligiblity was either not restricted by participant age (9/23), or restricted to adults (10/23). Reviews commonly reported on studies of diagnosis or symptoms of post‐traumatic stress disorder or trauma (11/23) and were less likely to report on depression or anxiety (6/23). In 15 reviews the intervention of interest was focused on/ specific to psychological therapy. Across all 23 reviews, the interventions most commonly identified from primary studies were general Cognitive Behavioural Therapy, Narrative Exposure Therapy, and a range of different integrative and interpersonal therapies. Even though many reviews included studies of participants without a diagnosis of a mental health problem, they often assessed mental health treatments and did not usually distinguish between promotion, prevention, and treatment in the review aims. Together the 23 systematic reviews included 336 references, of which 175 were unique primary studies. Limitations to the methodological quality of reviews most commonly related to reporting of selection criteria (21/23), absence of a protocol (19/23), reporting of study design (20/23), search strategy (22/23), and funding sources of primary studies (19/23). Authors' conclusions Gaps exist in the evidence on mental health interventions for refugees, asylum seekers, and internally displaced persons. Most reviews do not specify that internally displaced persons are included in the selection criteria, even though they make up the majority of involuntary migrants worldwide. Reviews specific to mental health promotion and prevention of common mental disorders are missing, and there is more evidence available for adults or mixed populations than for children. The literature is focused on post‐traumatic stress disorder and trauma‐related symptoms, with less attention for depression and anxiety disorders. Better quality systematic reviews and better report of review design and methods would help those who may use these reviews to inform implementation of mental health interventions., Plain language summary An overview of systematic reviews on mental health interventions for involuntary migrants Refugees, asylum seekers, and internally displaced persons are involuntary migrants, who have often experienced distress when forced to leave their home, on the journey, and in the process of settling in a host country or new environment. Mental health promotion, prevention, and treatments for mental health problems such as depression, anxiety, and post‐traumatic stress disorder may work differently in these groups of people than for the general population. This overview of systematic reviews summarises the characteristics of reviews available on this topic, to help us determine which research questions are the most important to address in future Cochrane reviews. We searched for systematic reviews and protocols of systematic reviews on mental health promotion, prevention, and treatment of mental health problems for refugees, asylum seekers, and internally displaced persons. Mental health promotion may, for example, involve a classroom‐based well‐being intervention for children. An example of prevention is trauma‐focused therapy to prevent post‐traumatic stress disorder. Treatment may, for example, include psychological therapy for depression. We found 23 systematic reviews and 15 protocols of reviews in progress. Together the 23 published systematic reviews included 336 references, 175 of which were unique studies. Reviews more commonly included refugees and asylum seekers than internally displaced persons, and were more frequently focused on adults than children. There was more attention on the treatment of post‐traumatic stress disorder than there was for mental health promotion or prevention, or for the treatment of depression or anxiety. Studies of Cognitive Behavioural Therapy, Narrative Exposure Therapy, and integrative and interpersonal therapies were most likely to be included in reviews. The quality of reviews was limited by a range of issues, many of which related to poor reporting of the review methodology. The evidence available from systematic reviews may not match the need for evidence‐based interventions for the mental health of involuntary migrants. Review authors should consider relevant groups such as internally displaced persons, children, and people with depression or anxiety, and relevant interventions such as those for mental health promotion or prevention, and treatments other than psychological therapy.

IntroductionChile experiences a growing prevalence of DM2 in its adult population over time. The country has prioritised the diagnosis and treatment of DM2 through a universal health care package, largely focused on the clinical dimensions of the disease. We analysed the significance of socioeconomic variables in the prevalence of DM2, as well as its related dimensions of presence of complications (diabetic foot and ophthalmologic complications), attendance to health checks and acquisition of recommended lifestyle changes due to this condition.MethodsSecondary analysis of the national health survey (ENS) 2016-2017 (n = 6,233 respondents). Crude and income-adjusted odds of reporting DM2 was estimated, as well as the relationship between complications due to diabetes and a number of clinical and sociodemographic variables using weighted log-linear multiple regression models.ResultsWe found a clear social gradient of the prevalence of DM2 by household income quintiles and educational level in the adult population. Income quintile and educational level gradients remained significantly associated with the presence of complications and attendance to health checks. We found no significant association, however; between income quintile and reported lifestyle change. The association between complications due to DM2 and socioeconomic variables, particularly income, remained relevant even after adjusting for all sociodemographic variables.ConclusionThis is the first study to analyse the association between DM2 and socioeconomic variables in Chile, useful for monitoring and policy planning. Income was strongly associated with DM2 prevalence and with related clinical variables (complications and attendance to health checks). Age, health care provision and educational level were also relevant factors, but lost significance in the fully adjusted model.

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.

Background Immigrant population have exponentialy grown in the past thirty years in Chile, concentrating in the northern and central areas of the country. Iquique is one of the densest cities in the country in terms of international migrants, reaching around 10% of total population. In this city, healthcare network is divided into 4 primary care centres and one hospital. No study; however, has analysed where socioeconomically deprived immigrants are located in the city and how they access healthcare services compared to the local population. This study aimed at analysing the spatial location of international migrants in socioeconomic deprivation in the city of Iquique and how they access public healthcare, as well as compare it to the locals. Methods Secondary data analysis of 2012 census data in Chile. We built a multiple index of deprivation for immigrants and locals separately, with the following dimensions at the census track level (n=1,879): (i) educational level (none/primary/secondary/higher), (ii) any disability (yes/no), (iii) housing (overcrowded, collective, rented), (v) crime (theft/burglary) (iv) environment (traffic accidents). Dimensions of the index were normalized and equally weighted. We compared the multiple index of deprivation between immigrants and the local population. We also measured access to primary healthcare services, as the nearest distance from the centroid of census tract to the corresponding health service through a GIS platform. Results Socioeconomically deprived immigrants concentrate in the same areas that as the local population, that is in the north and centre boroughs of the city. These deprived areas do not only concentrate higher deprived population, but also concentrate higher crime rates and fewer healthcare services than other areas of the city. Nevertheless, the spatial access to primary healthcare services is similar across the four primary healthcare services, averaging 1 kilometer of distance. Conclusion The spatial characterization of socioeconomically deprived population and their distance to healthcare services is useful for policy design and evaluation. We found that both immigrant and local population in socioeconomic deprivation tend to concentrate in similar poorer sectors of the city. The multidimensional index of deprivation was measured for the first time in Chile and became highly informative. More studies are required to understand how socioeconomic deprivation might impact on accessing healthcare among immigrant population in Chile and other countries.