Overcoming Barriers in the Management of Hypertension: The Experience of the Cardiovascular Health Program in Chilean Primary Health Care Centers

Objective. To assess the blood pressure control and cardiovascular risk factors (CVRFs) in a population of hypertensive patients with access to care under a government-financed program, the Cardiovascular Health Program (CHP). Design. A cross-sectional and multicenter study. Setting. 52 primary care centers, metropolitan area of Santiago, Chile. Participants. 1,194 patients were selected by a systematic random sampling from a universe of 316,654 hypertensive patients. Key Measurements. Demographic information, blood pressure (BP) measurements, and CVRF were extracted from medical records of patients followed for a 12-month period. Results. 59.7% of patients reached target BP <140/90 mmHg. More women were captured in the sampling (2.1 : 1), achieving better BP control than men. Diabetic patients (26.4%) had worse BP control than nondiabetics. Antihypertensive medications were used in 91.5%, with multidrug therapy more frequent in patients with higher BP and more difficult control. Conclusions. The success in improving the BP control to values <140/90 mmHg from 45.3% to 59.7% underscores the contribution of this program in the Chilean primary care cardiovascular preventive strategies. However, fewer hypertensive men than women were captured by this program, and it is of concern the underperforming of BP control observed in diabetics

Women's Education Level, Maternal Health Facilities, Abortion Legislation and Maternal Deaths: A Natural Experiment in Chile from 1957 to 2007

The aim of this study was to assess the main factors related to maternal mortality reduction in large time series available in Chile in context of the United Nations' Millennium Development Goals (MDGs).Time series of maternal mortality ratio (MMR) from official data (National Institute of Statistics, 1957-2007) along with parallel time series of education years, income per capita, fertility rate (TFR), birth order, clean water, sanitary sewer, and delivery by skilled attendants were analysed using autoregressive models (ARIMA). Historical changes on the mortality trend including the effect of different educational and maternal health policies implemented in 1965, and legislation that prohibited abortion in 1989 were assessed utilizing segmented regression techniques.During the 50-year study period, the MMR decreased from 293.7 to 18.2/100,000 live births, a decrease of 93.8%. Women's education level modulated the effects of TFR, birth order, delivery by skilled attendants, clean water, and sanitary sewer access. In the fully adjusted model, for every additional year of maternal education there was a corresponding decrease in the MMR of 29.3/100,000 live births. A rapid phase of decline between 1965 and 1981 (-13.29/100,000 live births each year) and a slow phase between 1981 and 2007 (-1.59/100,000 live births each year) were identified. After abortion was prohibited, the MMR decreased from 41.3 to 12.7 per 100,000 live births (-69.2%). The slope of the MMR did not appear to be altered by the change in abortion law.Increasing education level appears to favourably impact the downward trend in the MMR, modulating other key factors such as access and utilization of maternal health facilities, changes in women's reproductive behaviour and improvements of the sanitary system. Consequently, different MDGs can act synergistically to improve maternal health. The reduction in the MMR is not related to the legal status of abortion

Overcoming Barriers in the Management of Hypertension: The Experience of the Cardiovascular Health Program in Chilean Primary Health Care Centers

Objective. To assess the blood pressure control and cardiovascular risk factors (CVRFs) in a population of hypertensive patients with access to care under a government-financed program, the Cardiovascular Health Program (CHP). Design. A cross-sectional and multicenter study. Setting. 52 primary care centers, metropolitan area of Santiago, Chile. Participants. 1,194 patients were selected by a systematic random sampling from a universe of 316,654 hypertensive patients. Key Measurements. Demographic information, blood pressure (BP) measurements, and CVRF were extracted from medical records of patients followed for a 12-month period. Results. 59.7% of patients reached target BP &lt; 140/90 mmHg. More women were captured in the sampling (2.1 : 1), achieving better BP control than men. Diabetic patients (26.4%) had worse BP control than nondiabetics. Antihypertensive medications were used in 91.5%, with multidrug therapy more frequent in patients with higher BP and more difficult control. Conclusions. The success in improving the BP control to values &lt;140/90 mmHg from 45.3% to 59.7% underscores the contribution of this program in the Chilean primary care cardiovascular preventive strategies. However, fewer hypertensive men than women were captured by this program, and it is of concern the underperforming of BP control observed in diabetics

Overestimation of abortion in Colombia and other Latin American countries Sobrestimación del aborto inducido en Colombia y otros países latinoamericanos

Recently, the Guttmacher Institute estimated a number of 400,400 clandestine abortions for Colombia. Because of the strong implications that such brief could have in different areas of interest, a full revision of the methodology of estimation was performed. The methodology used by the Guttmacher Institute was as follows: first, the authors estimated the losses from spontaneous and induced abortions from the opinion of 289 subjects who work in an equal number of Colombian health institutions through the opinion survey entitled "Health Facilities Survey". Subsequently, an expansive multiplier (x3, x4, x5, etc.) was applied to the numbers obtained by this survey that also emerges from a subjective opinion of another 102 respondents of the "Health Professional Survey" selected by convenience. There is no objective data based on real vital events, the whole estimate is based on imagining/ numbers underlying mere opinions. Even as public opinion survey, the sampling technique introduced se

Segmented regression models assessing different join points in the time series of the maternal mortality ratio from 1957 to 2007 in Chile.

<p>Segmented regression models assessing different join points in the time series of the maternal mortality ratio from 1957 to 2007 in Chile.</p

Slopes of different segments observed in the trend of the maternal mortality ratio between 1957 and 2007.

<p>The slopes for the periods 1981 to 2003 and 1989 to 2003 were parallel and no statistical difference was detected in β-coefficients.</p

Trend for abortion mortality ratio (AMR), Chile 1957–2007.

<p>The highest AMR was observed in 1961, with 95.1 per 100,000 live births decreasing to 0.83 per 100,000 live births in 2007. This represented an accumulated reduction of 99.1%. The best estimated curve for the total trend over time was exponential with a goodness-of-fit of 93.5% (secondary chart). In 1989, the year of abortion prohibition, AMR was 10.78 per 100,000 live births. The accumulated decrease for the period between 1989 and 2007 was −9.95 per 100,000 live births (a reduction of 92.3% from 1989).</p

Trend for maternal mortality ratio, Chile 1957–2007.

<p>The secondary graphic shows the best adjustment of total trend for Maternal Mortality Ratio (MMR) over time.</p

Pathway modelling using autoregressive integrated moving average (ARIMA) models for assessing the different predictors of the maternal mortality ratio in a time series from 1957 to 2007 in Chile.

<p>β is the regression coefficient or the estimate of the average change in the maternal mortality ratio per 100,000 live births per unit of change in the independent variable. GDI (Gross Domestic Income) refers to the Gross Domestic Product per 1,000 US dollars. The pathway modelling approach is as follows: Model 1 adjusted for the initial slope in 1957; Model 2 is Model 1 adjusted for the average number of schooling years; Model 3 is Model 2 additionally adjusted for the join point and the slope for the segment from 1965; and Model 4 is Model 3 adjusted for the join point and the slope for the segment from 1981.</p

Parallel time series of the co-variables assessed in the study on maternal mortality in Chile from 1957 to 2007.

†<p>Average of schooling years for women in economically active age.</p