Preferred providers, health insurance and primary health care in Chile

PhDReforms in the early 1980s created Chile's mixed system of health care provision and finance. Since then Chileans have had to choose between a statesubsidised public health insurance system or the private health plans offered by several insurance companies. In the public system, users may be restricted to the public facility network, with no choice of doctor or medical centre, or they may opt for a free choice mode (preferred providers), which lets them choose both doctor and place of attention. Private insurance providers offer a wide variety of health plans, giving the customer a reasonable range of care options. Although this public-private mix has now been operating for more than 20 years, there has been no empirical study of the factors determining the choice of the preferred providers' mode by public beneficiaries. Likewise, few studies have looked at the determinants in the choice between public and private insurance, and the relationship between the latter choice and the use of health services. The first two empirical chapters of this thesis look at the determinants of these sources of choice, using different econometric tools: the choice of preferred providers is examined using a logit model; the analysis into the choice between public and private insurance uses a probit model; and the impact of holding private insurance as a factor in determining use of health services is estimated through a two-stage tobit model. A further significant aspect of the reforms of the '80s was the process of decentralisation for primary health care provision. Since then a substantial part of preventive health care and promotion occurs locally, and among these services children's health checks are an important policy objective. To encourage attendance parents are given free food supplements if they keep to the timetable for their child's check-ups. However these free food handouts partially account for attendance at the check-ups. Thus the final empirical chapter of the thesis uses a probabilistic model to look at the monetary and non-monetary factors that lead parents to request health checks for their children

OZONE-INDUCED LUNG INJURY AND INFLAMMATION ARE MODULATED BY CIRCULATING STRESS HORMONES

Air pollution has been associated with a wide-range of health effects. Pulmonary effects of acute ozone inhalation have been widely characterized in humans and animals. These include decrements in lung function, neutrophilic inflammation, and increased epithelial permeability. Ozone has also been shown to induce cardiovascular, neurological, metabolic and immune effects. It is believed that the “spillover” of bioactive lung-derived molecules to the circulation is responsible for extra-pulmonary effects of ozone. Our lab has recently shown that ozone, in addition to pulmonary effects, induces widespread systemic metabolic and immune effects in rats and humans. Importantly, these systemic changes are associated with increased circulating stress hormones, such as corticosterone and epinephrine, which are known to be involved in the “fight-or-flight” response. In our intervention study, we noted that extra-pulmonary but also pulmonary effects of ozone were dramatically reduced in adrenalectomized rats, indicating that circulating stress hormones contributed to all ozone effects. Since neuroendocrine stress response targets two essential survival processes, metabolic and immune, in this project we characterized in detail how pulmonary immune response and injury are influenced by the enhanced release of circulating stress hormones after ozone inhalation. In the first study, we demonstrated that the circulating stress hormones act at a transcriptional level to change gene expression after ozone exposure since global pulmonary gene changes induced by ozone exposure were attenuated in adrenalectomized rats. These ozone-induced expression changes depicted similarity to those predicted by glucocorticoid and adrenergic receptor activation, suggesting the contribution of stress hormones in mediating transcriptional effects. In our second round of studies, we demonstrated that by blocking endogenous stress hormone signaling adrenergic and glucocorticoid receptor antagonists, ozone-induced lung injury and inflammation were reduced in a receptor-specific manner (i.e. β adrenergic blocker inhibited lung neutrophilia while glucocorticoid receptor blocker caused lymphopenia). These results validated the role of stress hormones as bona fide circulating mediators acting directly on the lungs, and provided insights on the role of corticosterone versus epinephrine as individual modulators of ozone effects. In the third study, we combined surgical and pharmacological approaches, and demonstrated that the ozone-injury and inflammation phenotypes can be restored in adrenalectomized rats by providing exogenous glucocorticoid and β-adrenergic receptor agonists. These findings demonstrated unequivocally that stress hormones are the key systemic mediators of ozone-induced lung injury and innate immune effects. Thus, we show that circulating stress hormones, released from adrenal glands in response to ozone exposure, through their effects on β-adrenergic and glucocorticoid receptors, mediate most known pulmonary injury and innate immune effects. Our studies highlight the role of neuroendocrine stress response as a potential key regulator of air pollution health effects. Any perturbations in this neuroendocrine pathway and/or β-adrenergic and glucocorticoid receptor signaling through disease processes or the use of adrenergic or steroidal therapies, are likely to play a central role in susceptibility to air pollution health effects.Doctor of Philosoph

The interpretation of statistical graphs given in the press: advancing towards citizen training

Background: statistical graphs in communication media validates that which communicates, considering that every media has editorial orientation, and is central to the development of citizen capacity for the critical interpretation of graph information. So it is necessary to understand the processes of interpreting graphs in communication media to improve statistical learning. Objective: systematise elements that concur to the action of critical interpretation of the statistical graphs used in communication media. Design: from the socioepistemology and two studies, we focus on the analysis of textualities of the interpretations of graphs published in the press. We characterise operational, perceptual, and experiential elements that concur to the construction of meanings regarding the graphic phenomenon. Setting and participants: this research was done with two groups: students from the 11th grade of schooling in Chile, who carry out an interpreting activity; and university statistics professors from Peru and Chile, who answered a semi-structured interview. Data analysis: through the content analysis of textualities, units of meaning are identified from open encodings, grouped according to operational, perceptual or experiential aspects. Results: the act of interpreting graphs constitutes a space of epistemic activity that allows us to know the graph. In particular, the use of qualitative and perceptual comparisons that make the interpretation permeable to tendentious modifications of graphic elements is evident. Conclusions: it is necessary to incorporate press graphs into didactic designs, with a socio-critical discussion regarding the use of graphs in communication, to strengthen citizenship

Desarrollo de un Modelo del Agente Personal del Proyecto Paleta

59 p.El German Institute for Economic Research en conjunto con la Universidad de Talca están trabajando en PALETA, iniciativa que esta dentro del proyecto IRAIA, dirigido al desarrollo de una red de agentes que apoye los procesos automáticos de ordenamiento de conceptos, cuya finalidad es apoyar a los usuarios de Internet en la búsqueda de información, proporcionando rutas de navegación, que ayuden a recuperar aquellos documentos que satisfacen de mejor forma sus necesidades. Este proyecto considera el diseño del modelo de decisión de los agentes que interactuaran en esta red, que será usado al momento de entregar recomendaciones a los usuarios para realizar de mejor forma una búsqueda. La finalidad es diseñar uno de los agentes de esta red, específicamente el Agente Personal el cual interactúa con el usuario o cliente

External Validation of a Predictive Model for Acute Pancreatitis Risk in Patients With Severe Hypertriglyceridemia

Objective: We previously developed a predictive model to assess the risk of developing acute pancreatitis (AP) in patients with severe hypertriglyceridemia (HTG). In this study, we aimed to externally validate this model. Methods: The validation cohort included cross-sectional data between 2013 and 2017. Adult patients (≥18 years old) with triglyceride levels ≥1,000 mg/dL were identified. Based on our previous 4-factor predictive model (age, triglyceride [TG], excessive alcohol use, and gallstone disease), we estimated the probability of developing AP. Model performance was assessed using area under receiver operating characteristic curve (AUROC). Results: In comparison to the original cohort, patients in the validation cohort had more prevalent acute pancreatitis (16.2% versus 9.2%; P<.001) and gallstone disease (7.5% versus 2.1%; P<.001). Other characteristics were comparable and not statistically significant. The AUROCs were almost identical: 0.8337 versus 0.8336 in the validation and the original cohorts, respectively. In univariable analyses, the highest increase in odds of AP was associated with HTG, followed by gallstones, excessive alcohol use, and younger age. Conclusion: This study externally validates the 4-factor predictive model to estimate the risk of AP in adult patients with severe HTG (TG ≥1,000 mg/dL). Younger age was confirmed to place patients at high risk of AP. The clinical risk categories suggested in this study may be useful to guide treatment options

Systemic metabolic derangement, pulmonary effects, and insulin insufficiency following subchronic ozone exposure in rats

Acute ozone exposure induces a classical stress response with elevated circulating stress hormones along with changes in glucose, protein and lipid metabolism in rats, with similar alterations in ozone-exposed humans. These stress-mediated changes over time have been linked to insulin resistance. We hypothesized that acute ozone-induced stress response and metabolic impairment would persist during subchronic episodic exposure and induce peripheral insulin resistance. Male Wistar Kyoto rats were exposed to air or 0.25 ppm or 1.00 ppm ozone, 5 h/day, 3 consecutive days/week (wk) for 13 wks. Pulmonary, metabolic, insulin signaling and stress endpoints were determined immediately after 13 wk or following a 1 wk recovery period (13 wk + 1 wk recovery). We show that episodic ozone exposure is associated with persistent pulmonary injury and inflammation, fasting hyperglycemia, glucose intolerance, as well as, elevated circulating adrenaline and cholesterol when measured at 13 wk, however, these responses were largely reversible following a 1 wk recovery. Moreover, the increases noted acutely after ozone exposure in non-esterified fatty acids and branched chain amino acid levels were not apparent following a subchronic exposure. Neither peripheral or tissue specific insulin resistance nor increased hepatic gluconeogenesis were present after subchronic ozone exposure. Instead, long-term ozone exposure lowered circulating insulin and severely impaired glucose-stimulated beta-cell insulin secretion. Thus, our findings in young-adult rats provide potential insights into epidemiological studies that show a positive association between ozone exposures and type 1 diabetes. Ozone-induced beta-cell dysfunction may secondarily contribute to other tissue-specific metabolic alterations following chronic exposure due to impaired regulation of glucose, lipid, and protein metabolism

Acompañamiento psicosocial y jurídico a las mujeres víctimas de violencia sexual en el conflicto armado de los barrios Irotama, Ciudad Equidad, Divino Niño II y Ondas del Caribe de la ciudad de Santa Marta D. T. C. H. - Colombia

La violencia generalizada y el conflicto armado en Colombia ha ocasionado violaciones a los derechos humanos y al derecho internacional humanitaria de la población civil, trayendo ondas consecuencias, desencadenadas en fenómenos sociales tales como el desplazamiento forzado, la exclusión social e impunidad, dada la incapacidad del Estado para juzgar la multitud de crímenes cometidos. Las causas del conflicto armado colombiano se conjugan en una amalgama de factores, entre los que cabe destacar la debilidad del Estado, la inequitativa distribución y posesión de la tierra, la existencia de marcadas diferencias económicas, la polarización. Todo conflicto armado supone la existencia de violencia. Las organizaciones de mujeres, activistas, fundaciones, ONG, entre otras, han documentado diferentes formas de violencia sexual ejercida contra la mujer. Con la violencia sexual, no sólo se agrede el cuerpo de la mujer sino que se lastiman sus pensamientos, sentimientos y sus creencias de sí mismas y su estar en el mundo, se deterioran las estructuras familiares a las que pertenecen y como resultado, se destruye el tejido social. No calles, mujer producto de ello se vieron en la necesidad de engañar a sus hijos con tal de no decirles la verdad, mientras que otras rechazaron a sus hijos producto de esa violación o en una fatal imposición, obligadas a abortar. Prohibiendo los actos o amenazas de violencia dirigido a aterrorizar a dicha población. Pese a lo previsto en las normas, los actores del conflicto lejos de cumplirlas, han generalizado la violencia, cuyas magnitudes en cifras de víctimas, desplazados y desaparecidos, ha desbordado la capacidad del Estado para afrontar la problemática social que atraviesa el nuestro país. La dinámica del conflicto, y así lo han evidenciado varios estudios, muestran que la violencia sexual se utiliza como una forma de intimidación, castigo, represalia o de presión para obtener información, es decir, que persigue un objetivo, y por lo tanto se convierte en un mecanismo de la guerra

Sistema de Control de Acceso basado en Hardware y Software Libre para la Detección de potenciales infectados de COVID-19

The pandemic generated by the SARS-COVD-19 virus has affected humanity. Thus, at the global, regional and local levels, different measures have been adopted for its detection, containment and elimination. Consequently, different campaigns, strategies and solutions have been generated, based on different technological developments, ranging from the use of artificial intelligence to electronic components. Likewise, many technological solutions have been based on the early detection of symptoms generated by possible infection by COVID-19; therefore, they have responded by creating tools and platforms that allow users to have real-time information on their body temperature. Therefore, this work presents a full-scale functional prototype, based on free hardware and software platforms, which allows users to know their body temperature in real time, and allowed to determine that, although there are proprietary solutions in the market, it is possible to propose new technologies that with aspects of innovation allow low-income organizations to access low-cost emerging technologies that enhance their processes and services. Second, it was found that one of the most common effects for detecting possible COVID-19 infection is fever.&nbsp;La pandemia generada por el virus SARS-COVD-19 ha afectado a la humanidad. Así, a nivel global, regional, y local, se han adoptado diferentes medidas para su detección, contención, y eliminación. En consecuencia, se han generado diferentes campañas, estrategias y soluciones, basadas en diferentes desarrollos tecnológicos, que van desde el uso de la inteligencia artificial hasta componentes electrónicos. Así mismo, muchas soluciones tecnológicas se han basado en la detección temprana de síntomas generados por posible contagio por COVID-19; por lo tanto, han dado respuestas creando herramientas y plataformas que permitan a los usuarios tener información en tiempo real de su temperatura corporal. Por lo anterior, este trabajo presenta un prototipo funcional a escala real, que basado en plataformas de hardware y software libre permite a los usuarios conocer su temperatura corporal en tiempo real, y permitió determinar que, aunque existan soluciones privativas en el mercado, es posible proponer nuevas tecnologías que con aspectos de innovación permitan a organizaciones de bajos recursos acceder a tecnologías emergentes a bajo costo que potencien sus procesos y servicios. En segundo lugar, se encontró que uno de los efectos más comunes para detectar posibles contagios de COVID-19, es la fiebre.&nbsp

Coartação não corrigida da aorta em paciente grávida

Aortic coarctation accounts for 4% to 6% of congenital heart defects, ranking seventh in the list of all congenital heart diseases. It is characterized by a discrete narrowing, usually in the descending portion of the aortic arch and distal to the left subclavian artery. Pregnant patients with aortic coarctation present a higher risk of complications: rupture or dissection of the aorta, aneurysms in the polygon of Willis and endocarditis. Therefore, defining correct and preventive treatment during pregnancy as well as the way of delivery is important. We present the clinical case of a patient with a history of uncorrected aortic coarctation and diagnosis of pree- clampsia, highlighting the process of care, diagnostic approach and integrated handling during hospitalization. A literature review and critical analysis of the case are also presented. It can be concluded that uncorrected aortic coarctation generates multiple  complications;  the  importance  of  preconception  consultation  is  highlighted  and, in the absence of contraindications, carry out adequate multidisciplinary control by maternal-fetal medicine, car- diology and haemodynamics.La coartación aórtica constituye entre el 4% y 6% de los defectos cardíacos congénitos y ocupa el séptimo lugar en la lista de todas las cardiopatías congénitas. Se caracteriza por un estrechamiento discreto, generalmente en la porción descendente del arco aórtico y distal a la arteria subclavia izquierda. Las pacientes embarazadas con coarta- ción aórtica presentan mayor riesgo de complicaciones: ruptura o disección de la aorta, aneurismas en el polígono de Willis y endocarditis. Es importante definir el tratamiento oportuno y preventivo durante el embarazo, así como la vía del parto. Se presenta el caso clínico de una paciente con antecedente de coartación aórtica no corregida y diagnóstico de preeclampsia, resaltando el proceso de atención, enfoque diagnóstico y manejo integral durante la hospitalización. Se expone además una revisión de la literatura y un análisis crítico del caso. Se concluye que la coartación aórtica sin tratamiento genera múltiples complicaciones; se destaca la importancia de la consulta preconcepcional para evaluar los riesgos del embarazo y llevar un adecuado control multidisciplinario por medicina materno fetal, cardio- logía y hemodinamia.A coarctação da aorta representa entre 4% e 6% das cardiopatias congênitas e ocupa o sétimo lugar na lista de todas as cardiopatias congênitas. Caracteriza-se por estreitamento discreto, geralmente na porção descendente do arco aórtico e distal à artéria subclávia esquerda. Pacientes grávidas com coarctação da aorta apresentam risco aumentado de complicações: ruptura ou dissecção da aorta, aneurismas no círculo de Willis e endocardite. É impor- tante definir o tratamento oportuno e preventivo durante a gravidez, bem como a via de parto. Apresenta-se o caso clínico de uma paciente com história de coarctação de aorta não corrigida e diagnóstico de pré-eclâmpsia, destacando o processo de cuidado, abordagem diagnóstica e atenção integral durante a internação. Uma revisão da literatura e uma análise crítica do caso também são apresentados. Conclui-se que a coarctação da aorta sem tratamento gera múltiplas complicações por tanto é ressaltada a importância da consulta preconcepcio- nal para avaliar os riscos da gravidez e realizar controle multidisciplinar pela medicina materno-fetal, cardiologia e hemodinâmica

Global Air Quality and COVID-19 Pandemic : Do We Breathe Cleaner Air?

The global spread of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has challenged most countries worldwide. It was quickly recognized that reduced activities (lockdowns) during the Coronavirus Disease of 2019 (COVID-19) pandemic produced major changes in air quality. Our objective was to assess the impacts of COVID-19 lockdowns on groundlevel PM2.5, NO2, and O-3 concentrations on a global scale. We obtained data from 34 countries, 141 cities, and 458 air monitoring stations on 5 continents (few data from Africa). On a global average basis, a 34.0% reduction in NO2 concentration and a 15.0% reduction in PM2.5 were estimated during the strict lockdown period (until April 30, 2020). Global average O-3 concentration increased by 86.0% during this same period. Individual country and continent-wise comparisons have been made between lockdown and business-as-usual periods. Universally, NO2 was the pollutant most affected by the COVID-19 pandemic. These effects were likely because its emissions were from sources that were typically restricted (i.e., surface traffic and non-essential industries) by the lockdowns and its short lifetime in the atmosphere. Our results indicate that lockdown measures and resulting reduced emissions reduced exposure to most harmful pollutants and could provide global-scale health benefits. However, the increased O-3 may have substantially reduced those benefits and more detailed health assessments are required to accurately quantify the health gains. At the same, these restrictions were obtained at substantial economic costs and with other health issues (depression, suicide, spousal abuse, drug overdoses, etc.). Thus, any similar reductions in air pollution would need to be obtained without these extensive economic and other consequences produced by the imposed activity reductions.Peer reviewe