Recommendations of the Chilean association for digestive endoscopy for the management of gastric pre-malignant lesions

Indexación: Web of Science; Scielo.An expert panel analyzed the available evidence and reached a consensus to release 24 recommendations for primary and secondary prevention of gastric cancer (CG) in symptomatic patients, with indication for upper GI endoscopy. The main recommendations include (1) Search for and eradicate H. pylori infection in all cases. (2) Systematic gastric biopsies (Sydney protocol) in all patients over 40 years of age or first grade relatives of patient with CG, to detect gastric atrophy, intestinal metaplasia or dysplasia. (3) Incorporate the OLGA system (Operative Link on Gastritis Assessment) to the pathological report, to categorize the individual risk of CG. (4) Schedule endoscopic follow-up according to the estimated risk of CG, namely annual for OLGA III- IV, every 3 years for OLGA I- II or persistent H. pylori infection, every 5 years for CG relatives without other risk factors and no follow-up for OLGA 0, H. pylori (-). (4) Establish basic human and material resources for endoscopic follow-up programs, including some essential administrative processes, and (5) Suggest the early CG/total CG diagnosis ratio of each institution and the proportion of systematic recording of endoscopic images, as quality indicators. These measures are applicable using currently available resources, they can complement any future screening programs for asymptomatic population and may contribute to improve the prognosis of CG in high-risk populations.http://ref.scielo.org/f2gm5

Lower incidence of myocardial infarction after smoke-free legislation enforcement in Chile

Objective To evaluate the impact of a complete smoking ban in enclosed spaces on the incidence of acute myocardial infarction in Chile. Methods The population-based study involved residents of urban areas, where 80% of the Chilean population live, aged 20 years or older who had a myocardial infarction. Monthly myocardial infarction incidence and mortality rates at health-care facilities between January 2011 and December 2014 were derived from admission and mortality databases. Regression discontinuity methods were used to estimate the near-immediate impact on disease incidence of enforcing smoke-free legislation in March 2013. The same analysis was performed for ischaemic stroke, degenerative disc disease and colon cancer. Data on the concentration of fine respirable particulates were included in an additional analysis of myocardial infarction incidence in the Santiago metropolitan area. Results The enforcement of smoke-free legislation was associated with an abrupt, near-immediate decline of 0.639 cases of myocardial infarction per 100 000 adults per month (95% confidence interval, CI: 0.242 to 1.036; relative decline: 7.8%). Similar declines were observed in men and women and in people aged over and under 70 years. However, enforcement of the legislation was not associated with a significant change in the rate of ischaemic stroke, degenerative disc disease or colon cancer. The abrupt decline in myocardial infarction incidence was also observed when data on fine respirable particulates were included in an analysis for Santiago. Conclusion The enforcement of extensive smoke-free legislation in Chile was associated with an abrupt, near-immediate decline in the incidence of myocardial infarction

La frontera chileno-peruana: Estados, localidades y políticas migratorias (1883-2019)

El artículo analiza, en base a la revisión de la literatura existente y con perspectiva histórica, la construcción de la frontera chileno-peruana a partir de la relación entre las movilidades constantes de personas por las localidades cercanas a la frontera y las políticas y legislación migratoria chilena. Recorreremos la construcción de la frontera a lo largo de cinco periodos históricos: i) 1883-1929, posterior a la Guerra del Pacífico; ii) 1929-1950, con el relativo absentismo estatal chileno en la frontera norte; iii) 1950-1973, con el ciclo chileno de la industrialización fronteriza; iv) 1973-1990, cuando Chile y Perú aplicaron criterios militares, estratégicos y geopolíticos en su relación con estas fronteras; y v) 1990-2019, con la recuperación de la democracia y la consolidación del modelo neoliberal

Incidence and hospital mortality due to heart failure. Are there any differences by sex?

Background: Gender may influence the incidence, severity and hospital mortality due to heart failure (HF). Aim: To evaluate the influence of sex on the proportion of patients hospitalized due to heart failure, its incidence and hospital mortality. Methods: Analysis of the hospital discharge database of the Chilean Ministry of Health during 2014. All hospital admissions for HF were considered according to ICD-10 codes, including the discharge diagnosis of congestive HF (7500), left ventricular HF (1501) and non-specified HF (1509). Incidence rates, proportion of discharges due to HF and hospital mortality were calculated according to age and sex. Results: During 2014, there were 1,306,431 discharges from Chilean hospitals. Of these, 125,484 were for cardiovascular disease and 10% of these corresponded to HF (12,825). The incidence rate was slightly higher in men than in women (0.71 and 0.70 per 1,000 admissions respectively). Among patients aged 80 years or more, the prevalence of admissions for HF was higher in women (19.1 and 15.9% respectively, p < 0.01). Hospital mortality was also higher in women (9.7 and 8.6% respectively, p = 0.03). The factors associated with a higher hospital mortality were an age over 80 years (Odds Ratio (OR) 2.11; 95% confidence intervals (CI): 1.87-2.40; p < 0.01), a length of stay over seven days (OR 1.13; 95%CI: 1.01-1.29; p = 0.04), being admitted to high complexity facilities (OR 1.29; 95%CI: 1.12-1.50; p = 0.01) and being insured by the public national health fund (OR 1.94; 95%CI: 1.54-2.43; p < 0.01). Conclusions: The incidence of hospital admissions due to HF is similar in men and women. There is high hospital mortality, especially in women

Recreating Border Circuits: The Experience of Paraguayan Women in Three Commercial Niches on the Paraná Tri-Border-Area

El presente trabajo deriva de un estudio de caso etnográfico que analiza las experiencias de inserción laboral de 30 mujeres paraguayas en la Triple-frontera del Paraná (entre Argentina, Brasil y Paraguay). Mostraremos porqué el comercio significa una salida laboral central para las entrevistadas, permitiéndoles estrategias de conciliación de las sobrecargas productivas y reproductivas. Finalizamos con reflexiones analíticas que abordan las estrategias y nuevos circuitos comerciales desarrollados por las mujeres en esta zona fronteriza.The present work derives from an ethnographic case study that analyzes the experiences of labor insertion of 30 Paraguayan women in the Paraná Tri-Border-Area (between Argentina, Brazil, and Paraguay). We will show how trade is a central labor niche for the interviewees, which allows them to develop strategies to reconcile their productive and reproductive overloads. We end with analytical reflections that address the strategies and new commercial circuits developed by women in this border area.Fil: Lube Guizardi, Menara. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de San Martín. Instituto de Altos Estudios Sociales; ArgentinaFil: Nazal, Esteban. Universidad Alberto Hurtado; ChileFil: Magalhaes, Lina. Universidade Federal de Santa Catarina; BrasilFil: Stefoni, Carolina. Universidad Mayor de Chile; Chil

(Trans-)Generational Expectations: Access to Formal Education and Labor Insertion of Paraguayan Women on the Paraná Tri-Border

Based on an ethnographic case study, we describe the family experiences and the access to formal education of 30 Paraguayan women to show how these factors influence their labor insertion at the Paraná Tri-Border Area. We will start by reviewing the theoretical debates about gender inequality in labor insertion in border territories. Then, we will explain the study’s methodology and the profile of the interviewees. The analysis consists in describing the relationship between the rural origins of these women and gender inequalities; we will establish how these inequalities are related to low access to formal education and the precariousness of their insertion into the job market. In addition, we will show how these circumstances imply a contradiction in their work experience on the border, between the abuses suffered and the autonomy gained; and we will analyze the expectations of transgenerational transformation that our protagonists project in their children.Fil: Lube Guizardi, Menara. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de San Martin. Instituto de Altos Estudios Sociales. Centro de Estudios En Antropología; Argentina. Universidad de Tarapaca.; ChileFil: Stefoni, Carolina. Universidad de Tarapaca.; Chile. Universidad Alberto Hurtado. Facultad de Ciencias Sociales. Departamento de Sociología; ChileFil: Magalhães, Lina. Universidade Estadual de Santa Catarina; Brasil. Universidad Arturo Prat (unap);Fil: Nazal, Esteban. Universidad Alberto Hurtado. Facultad de Ciencias Sociales; Chil

Association between socioeconomic status and survival after a first episode of myocardial infarction

Background: A low socioeconomic status is associated with higher overall mortality rates. Aim: To assess the effect of socioeconomic inequalities on survival of patients hospitalized with a first myocardial infarction. Material and Methods: Analysis of hospital discharge and mortality databases of the Ministry of Health. Patients aged over 15 years discharged between 2002 and 2011 with a first myocardial infarction (code I-21, ICD-10) were identified. Their survival was verified with the mortality registry. Survival from 0 to 28 and from 29 to 365 days was analyzed. Socioeconomic status was determined using the type of health insurance, stratified as public insurance (low and medium status) and private insurance (high status). Prais-Winsten trend (P-W) and Cox survival analyses were done. Results: We analyzed 59,557 patients (69% males). Sixty three percent were of low socioeconomic status, 19% medium and 18% high. Between 2002 and 2011 the increase in survival was higher among patients of low socioeconomic status, mainly in women (P-W coefficients 0.58:0.31-0.86 in men and 1.12:0.84-1.41 in women for 0-28 days survival and 0.24:0.09-0.39 in men and 0.48:0.37-0.60 in women for 29-365 days survival, respectively). However, age and year of hospitalization adjusted analysis showed a higher mortality risk among patients of low socioeconomic status at 0-28 days ( HR 1.67:1.53-1.83 for men and 1.49:1.34-1.66 for women) and at 29-365 days (HR 2.30: 1.75-2.71 for men and 1.90:1.56-1.85 for women). Conclusions: Survival after a myocardial infarction improved in the last decade especially in patients of low socioeconomic status. However, subjects of this stratum continue to have a higher mortality.Fondo concursable para el apoyo a la investigación, Insituto de Salud Poblacional - Escuela de Salud Pública, Facultad de Medicina, Universidad de Chile

Influence of childhood socioeconomic disadvantage in the incidence of cardiovascular disease in adults in Chile

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