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

Consenso salud materna para Chile en el nuevo milenio

Contexto: Chile presenta una tendencia secular hacia una sostenida mejoría en los principales indicadores materno-infantiles. Su situación constituye una experiencia positiva a nivel de la región de Latino-América y el Caribe. Sin embargo, esta tendencia se ha estancado en los últimos diez años lo que produce una situación inestable y preocupante desde el punto de vista de la salud pública materna. Esto motiva una reunión de expertos a nivel nacional e internacional para proponer estrategias para el alto nivel político orientadas a alcanzar los Objetivos 4 y 5 del Milenio. Conclusión: Este documento de consenso sobre mortalidad materna, sugiere un enfrentamiento en dos ejes: primero, enfrentar la nueva realidad epidemiológica desde la etapa pre-concepcional, esto incluye considerar la alta prevalencia de obesidad, hipertensión arterial, diabetes, hiperlipidemias e hipotiroidismo en la población, y por otro lado reforzar la seguridad de la asistencia del embarazo, parto y puerperio en los lugares más alejados y más vulnerables del país. Es necesario focalizar las intervenciones en los grupos de mayor riesgo vital (edades extremas de la vida fértil y portadoras de enfermedades médico-quirúrgicas severas, que se reflejan en el aumento proporcional de las causas indirectas de muerte materna), reforzar las actividades de auditorías de mortalidad/near miss, así como controlar el aumento alarmante de la tasa de partos por cesáreas

Influence of psychosocial factors on adherence to antihypertensive drug therapy. Results from a Cardiovascular Health Program cohort followed in the Metropolitan Region of Santiago, Chile Influencia de factores psicosociales en la adherencia al tratamient

© 2014, Sociedad Medica de Santiago. All rights reserved.Background: Inadequate blood pressure control in hypertensive patients remains a persistent health problem in Chile and worldwide. Poor adherence to antihypertensive drug therapy is one of the frequently cited factors. Objectives: To determine the influence of psychosocial factors in the adherence to drug therapy in hypertensive patients followed through a Cardiovascular Health Program (CHP) that provides free access to primary care centers located in the Metropolitan Region of Santiago, Chile. Methods: Cross sectional study. A randomized sample of 513 hypertensive patients (30 to 68 years) was obtained from a universe of 1.484 patients. Adherence to treatment was determined by the Morisky-Green-Levine test. Demographic, socioeconomic and average values of blood pressure were recorded. Validated questionnaires were utilized to assess the patient-physician relationship, awareness of being hypertensive, patient perception of socia

Impact of emerging virus pandemics on cause-specific maternal mortality time series: a population-based natural experiment using national vital statistics, Argentina 1980-2017

Abstract: Abstract Background Emerging pandemic viruses may have multiple deleterious effects on maternal health. This study examines the effects of a pandemic influenza virus on cause-specific maternal mortality time series, using Argentinian vital statistics. Methods We conducted a population-based natural experiment from national vital records of maternal deaths between 1980 and 2017. Joinpoint regression models were used to model time series of the maternal mortality ratio (MMR). The sensitivity of the registry to detect the effects of the pandemic H1N1 2009 influenza virus on cause-specific MMR was analysed using a panel of parallel interrupted time series (ITS). Findings Over this 38-year study, the MMR decreased by 58¢6% (69¢5 to 28¢8 deaths/100,000 live births), transitioning from direct obstetric causes (67¢0 to 21¢1/100,000 live births; 68¢4% decrease) to indirect causes (2¢6 to 7¢7/ 100,000 live births; 196¢2% increase). The regression analysis showed an average reduction of -2¢2%/year (95% CI: -2¢9 to -1¢4) with 2 join points in the total trend (1998 and 2009). Parallel ITS analyses revealed the pandemic H1N1 virus had an increasing effect on mortality from the respiratory system- and sepsis-related complications (level change 4¢7 and 1¢6/100,000 live births respectively), reversing after the outbreak. No effect was found on MMR from hypertensive disorders, haemorrhage, abortive outcomes, other direct obstetric causes, and indirect non-respiratory comorbidities. Interpretation The Argentinian maternal death registry appears sensitive to detect different effects of emerging infectious epidemics on maternal health. In a population-based natural experiment, pandemic H1N1 virus impacted maternal mortality almost exclusively from the respiratory system- and sepsis-related complications.Supplementary material associated with this article can be found, in the online version, at doi:10.1016/j.lana.2021.100116Resumen: Antecedentes: Los virus pandémicos emergentes pueden tener múltiples efectos nocivos sobre la salud materna. Este estudio examina los efectos de un virus de influenza pandémica mediante series de tiempo ininterrumpidas de mortalidad materna por causas específicas, utilizando estadísticas vitales argentinas. Métodos: Realizamos un experimento natural con base poblacional a partir de registros vitales nacionales de muertes maternas entre 1980 y 2017. Se utilizaron modelos de regresión con punto de unión para modelar series de tiempo de la razón de mortalidad materna (RMM). La sensibilidad del registro para detectar los efectos del virus de la influenza pandémica A H1N1 2009 sobre las causas específicas de la RMM se analizó mediante un panel de series de tiempo interrumpidas (STI). Hallazgos: Durante este estudio de 38 años, la RMM disminuyó en un 58·6% (69·5 a 28·8 muertes/100.000 nacidos vivos), pasando de causas obstétricas directas (67·0 a 21·1/100.000 nacidos vivos; 68·4% de disminución) a causas indirectas (2·6 a 7·7/100.000 nacidos vivos; 196·2% de aumento). El análisis de regresión mostró una reducción promedio de -2·2%/año (IC 95%: -2·9 a -1·4) con 2 puntos de inflexión en la tendencia total (1998 y 2009). Los análisis de STI revelaron que el virus pandémico A H1N1 tuvo un efecto creciente sobre la mortalidad por complicaciones del sistema respiratorio y relacionadas con la sepsis (cambio de nivel 4·7 y 1·6/100.000 nacidos vivos, respectivamente), revirtiéndose después del brote. No se encontró ningún efecto sobre la RMM por trastornos hipertensivos, hemorragia, desenlace abortivo, otras causas obstétricas directas y comorbilidades indirectas no respiratorias. Interpretación: El registro de defunciones maternas de Argentina parece sensible para detectar diferentes efectos de las epidemias infecciosas emergentes sobre la salud materna. En el experimento natural poblacional, el virus pandémico A H1N1 afectó la mortalidad materna casi exclusivamente por complicaciones relacionadas con el sistema respiratorio y la sepsis

Table S11

Maternal mortality ratio with abortive outcome (MMRAO) by place of residence in 32 Mexican states exhibiting a more (m) or less (l) permissive abortion legislation, 2002-2011