Assessment of universal health coverage for adults aged 50 years or older with chronic illness in six middle-income countries

Objective To assess universal health coverage for adults aged 50 years or older with chronic illness in China, Ghana, India, Mexico;the Russian Federation and South Africa. Methods We obtained data on 16 631 participants aged 50 years or older who had at least one diagnosed chronic condition from the World Health Organization Study on Global Ageing and Adult Health. Access to basic chronic care and financial hardship were assessed and the influence of health insurance and rural or urban residence was determined by logistic regression analysis. Findings The weighted proportion of participants with access to basic chronic care ranged from 20.6% in Mexico to 47.6% in South Africa. Access rates were unequally distributed and disadvantaged poor people, except in South Africa where primary health care is free to all. Rural residence did not affect access. The proportion with catastrophic out-of-pocket expenditure for the last outpatient visit ranged from 14.5% in China to 54.8% in Ghana. Financial hardship was more common among the poor in most countries but affected all income groups. Health insurance generally increased access to care but gave insufficient protection against financial hardship. Conclusion No country provided access to basic chronic care for more than half of the participants with chronic illness. The poor were less likely to receive care and more likely to face financial hardship in most countries. However, inequity of access was not fully determined by the level of economic development or insurance coverage. Future health reforms should aim to improve service quality and increase democratic oversight of health care

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

Artículo de publicación ISISin acceso a texto complet

Mediation of the effect of childhood socioeconomic position by educational attainment on adult chronic disease in Chile

Objectives We estimated the roles of childhood socioeconomic position (ChSEP) and education attainment on chronic diseases in Chilean adults, mediated through structural determinants and health behaviors, to identify potential pro-equity interventions. Methods We analyzed Chile’s longitudinal Social Protection Surveys, a national sample of 14,788 adults with follow- up to 2009. Controlled direct effects (CDE) and natural effects (NDE and NIE) of ChSEP and education on number of chronic diseases were estimated with negative binomial models. Results CDE of low ChSEP with education fixed at 12 years showed a 12% increase with 4% indirect effects. CDEs at favorable levels of BMI, smoking, alcohol use, and physical activity were similar. CDE estimates for education adjusted for ChSEP were larger with negligible mediation. CDEs for women were generally larger. Conclusions Low ChSEP exerts a primarily direct effect on later chronic disease, modestly mediated by education. Education attainment showed larger direct effects with minimal mediation by behaviors. Strengthening current– early child development and education policies, particularly gender aspects, may reduce social inequalities and key pathways for reducing chronic disease inequalities in Chile.Chile’s National Fund for Health Research and Development (Fondo Nacional de Investigacio´n y Desarrollo en Salud, FONIS. Grant no. SA13|20138

Comparison of health examination survey methods in Brazil, Chile, Colombia, Mexico, England, Scotland, and the United States

Comparability of population surveys across countries is key to appraising trends in population health. Achieving this requires deep understanding of the methods used in these surveys to examine the extent to which the measurements are comparable. In this study, we obtained detailed protocols of 8 nationally representative surveys from 2007-2013 from Brazil, Chile, Colombia, Mexico, the United Kingdom (England and Scotland), and the United States-countries that that differ in economic and inequity indicators. Data were collected on sampling frame, sample selection procedures, recruitment, data collection methods, content of interview and examination modules, and measurement protocols. We also assessed their adherence to the World Health Organization's "STEPwise Approach to Surveillance" framework for population health surveys. The surveys, which included half a million participants, were highly comparable on sampling methodology, survey questions, and anthropometric measurements. Heterogeneity was found for physical activity questionnaires and biological samples collection. The common age range included by the surveys was adults aged 18-64 years. The methods used in these surveys were similar enough to enable comparative analyses of the data across the 7 countries. This comparability is crucial in assessing and comparing national and subgroup population health, and to assisting the transfer of research and policy knowledge across countries.Santander Research Catalyst Grant from UCL NHS Digital to work on the Health Survey for England National Institute on Aging consortium of UK government departments National Council on Science and Technology of Mexico (CONACYT) 217523 Research Office at the Universidad de los Andes Colciencias Chilean Ministry of Health University College London - Santande

Políticas públicas

Amputación de extremidades superiores: caracterización epidemiológicaAnálisis comparado de las políticas de promoción de la salud entre Chile y CataluñaAnálisis de los Avisa para la toma de decisiones en políticas de saludAntecedentes de colelitiasis en pacientes que presentaron colecistitis aguda. ¿Se puede prevenir la urgencia?Asociación entre alcoholemia y traumatismos en Copiapó, 2009Automedicación en la población asistente al Cesfam de Puerto NatalesAutotoma vaginal para detección de VPH para la prevención de cáncer cervicouterino, ChileCalidad de atención programa Auge- cáncer cervicouterino: la perspectiva de los profesionalesCaracterización de los casos de traumatismo encéfalo craneano en la comuna de Til-TilConocimiento de conductores universitarios sobre la alcoholemia permitida para conducir y su equivalencia en bebidas alcohólicasDescripción de la consulta dermatológica pediátrica en el Hospital Roberto del Río (2007-2008)Elementos para un abordaje metodológico de la salud intercultural en la Región Metropolitana de SantiagoEstudio descriptivo de consultas Sapu Cesfam Angachilla, visión tras dos años de registro clínico-electrónicoEstudio descriptivo de ingresos a Conin Valdivia, una revisión de 10 años (1998-2008)Estudio descriptivo de pacientes hospitalizados por absceso y celulitis peritonsilar en el hospital de PurranqueEvaluación de la aceptabilidad y consumo de alimentos del Pacam inscritos en el Cesfam Dr. V.M.FEvaluación de la interacción de medicinas alternativas o complementarias (MAC) en dos centros APSExposición a humo de tabaco ambiental. Signos y síntomas respiratorios bajos: estudio de prevalenciaFactores relacionados con la rotación laboral de médicos en consultorios del Gran SantiagoFibrosis quística como patología GES: una mirada críticaHipersensibilidad dentinaria: comparación de diferentes alternativas terapéuticasImpacto del GES en cáncer mamario: seguimiento a 5 años en un hospital del SSMSImplementación de la política nacional de medicamentos: percepción del profesional químico farmacéuticoLa implementación de políticas públicas cambió mortalidad de los pacientes gran quemado en Chile¿La infertilidad debería ser considerada un problema de salud pública en el Perú?Modelo de monitoreo de una política de protección a la infanciaMortalidad materna en el Hospital Dr. Alfredo van Grieken Coro, Estado Falcón, Venezuela 2005-2009Objetivos de desarrollo del milenio. Modelación de la mortalidad infantil Nicaragua - Costa Rica 1978-2008Percepción de riesgo y beneficio respecto del cigarrillo y su relación con el tabaquismo adolescentePolíticas públicas y salud intercultural: la experiencia de la organización indígena Taiñ adkimnPrevalencia de atipias celulares del cuello uterino en mujeres entre 18 y 24 añosProceso de ser histerectomizada: relatos de experiencias de mujeres en un hospital público de SantiagoProceso de ser histerectomizada: relatos de experiencias de mujeres en un hospital público de SantiagoPrograma Auge y cáncer cervicouterino: calidad de atención percibida por las usuarias del programaResolución quirúrgica por patología adenoamigdalina: ¿Es la población mapuche un grupo de riesgo?Resultados de alcoholemias tanatológicas del Servicio Médico Legal de Copiapó 1999-2009Resultados de la evaluación de los objetivos sanitarios de la década 2000-2010Una mirada a los servicios de salud para adolescentes en Puente Alt