The magnitude of the cost of chronic pain has been a matter of concern in many countries worldwide. The high prevalence, the cost it implies for the health system, productivity, and absenteeism need to be addressed urgently. Studies have... more
The magnitude of the cost of chronic pain has been a matter of concern in many countries worldwide. The high prevalence, the cost it implies for the health system, productivity, and absenteeism need to be addressed urgently. Studies have begun describing this problem in Chile, but there is still a debt in highlighting its importance and urgency on contributing to chronic pain financial coverage. This study objective is to estimate the expected cost of chronic pain and its related musculoskeletal diseases in the Chilean adult population. We conducted a mathematical decision model exercise, Markov Model, to estimate costs and consequences. Patients were classified into severe, moderate, and mild pain groups, restricted to five diseases: knee osteoarthritis, hip osteoarthritis, lower back pain, shoulder pain, and fibromyalgia. Data analysis considered a set of transition probabilities to estimate the total cost, sick leave payment, and productivity losses. Results show that the total a...
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BACKGROUND A few instruments that identify and valuate health states are based on the International Classification of Functioning, Disability and Health States of the World Health Organization. One of them is the Health State Description... more
BACKGROUND A few instruments that identify and valuate health states are based on the International Classification of Functioning, Disability and Health States of the World Health Organization. One of them is the Health State Description (HSD) questionnaire first used in the World Health Survey (WHS) initiative (HSD-WHS), whose psychometric properties have not been evaluated in Chile. Additionally, the use of latent variables for the valuation process of health states has been scarcely investigated in the context of population health metrics. We aim to evaluate the psychometric properties and factorial structure of the HSD-WHS for Chile and describe a latent variable method for valuating health states associated with diseases. METHODS We used data from the second Chilean National Health population-based survey from 2009 to 2010 (N = 5293). We explored the factorial structure of the HSD-WHS through exploratory and confirmatory factor analyses, the reliability, and the discriminant validity of the latent variable of disability. Disability weights for diseases were calculated using a linear regression model. RESULTS We found an adequate goodness of fit for a second-order model with 9 factors corresponding to disability domains (Tucker-Lewis index = 0.99, comparative fit index = 0.99, root mean square error of approximation = 0.060), and good reliability estimates (standardized α = 0.91). The rescaled (between 0 and 100) latent variable of disability showed significant difference according to the explored variables. We estimated disability weights for the following: (1) depressive episode, 13.6 (12.1-15.2), (2) hypertension, 1.6 (0.0-3.3), and (3) diabetes, 5.0 (2.5-7.4). CONCLUSIONS This study supports the use of the HSD-WHS questionnaire in the Chilean population and a latent variable approach for valuating health states associated with diseases.
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Additional file 1. Table S1 presents the number of people that participated in the data collection process, Table S2 Prioritization criteria and rankings, Table S3 Complete list of prioritized research questions.
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Background Musculoskeletal disorders are a leading cause of disability adjusted life years (DALY) in the world. We aim to describe the prevalence and to compare the DALYs and loss of health state utilities (LHSU) attributable to common... more
Background Musculoskeletal disorders are a leading cause of disability adjusted life years (DALY) in the world. We aim to describe the prevalence and to compare the DALYs and loss of health state utilities (LHSU) attributable to common musculoskeletal disorders in Chile. Methods We used data from the Chilean National Health Survey carried out in 2016–2017. Six musculoskeletal disorders were detected through the COPCOPRD questionnaire: chronic musculoskeletal pain, chronic low back pain, chronic shoulder pain, osteoarthritis of hip and knee, and fibromyalgia. We calculated the DALY for each disorder for 18 sex and age strata, and LHSU following an individual and population level approaches. We also calculated the fraction of LHSU attributable to pain. Results Chronic musculoskeletal pain disorder affects a fifth of the adult population, with a significant difference between sexes. Among specific musculoskeletal disorders highlights chronic low back pain with the highest prevalence. M...
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OBJECTIVES To estimate the burden of disease through 4 complementary procedures to years lived with disability (YLDs) using the concept of attributable fraction and including analysis of subdomains of disability. METHODS We explored the... more
OBJECTIVES To estimate the burden of disease through 4 complementary procedures to years lived with disability (YLDs) using the concept of attributable fraction and including analysis of subdomains of disability. METHODS We explored the burden on disability for 7 common musculoskeletal disorders (CMD) using the 2009 to 2010 Chilean National Health Survey, which included the Community Oriented Programme for the Control of Rheumatic Disease Core Questionnaire to identify cases with CMD, and an 8-domain questionnaire for health state descriptions. We calculated the proportion of disability attributable to pain in the general population and people with CMD. We also estimated the burden of CMD expressed as YLD and as the proportion of the disability in the general population attributable to people with CMD, with a particular focus in the pain domain of disability. Second order of uncertainty around point estimations was also characterized. RESULTS Pain domain of disability accounted for 23.4% of the total disability in the general population, and between 20% (fibromyalgia) to 27.1% (osteoarthritis of the hip) in people with some of the selected CMD. People with chronic musculoskeletal pain accounted for 21.2% of total disability from general population, which generated 1.2 million of YLD (6679 YLD/100 000 inhabitants). Chronic low back pain and osteoarthritis of the knee were in the top position of specific CMDs, explaining the highest national burden. CONCLUSION Pain is an essential component of disability in people with CMD and also in the general population. The approach used can be easily applied to other health conditions and other domains of disability.
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BackgroundWith the global population aging and life expectancy increasing, dementia has turned a priority in the health care system. In Chile, dementia is one of the most important causes of disability in the elderly and the most rapidly... more
BackgroundWith the global population aging and life expectancy increasing, dementia has turned a priority in the health care system. In Chile, dementia is one of the most important causes of disability in the elderly and the most rapidly growing cause of death in the last 20 years. Cognitive complaint is considered a predictor for cognitive and functional decline, incident mild cognitive impairment, and incident dementia. The GERO cohort is the Chilean core clinical project of the Geroscience Center for Brain Health and Metabolism (GERO). The objective of the GERO cohort is to analyze the rate of functional decline and progression to clinical dementia and their associated risk factors in a community-dwelling elderly with subjective cognitive complaint, through a population-based study. We also aim to undertake clinical research on brain ageing and dementia disorders, to create data and biobanks with the appropriate infrastructure to conduct other studies and facilitate to the nation...
Research Interests: Gerontology, Dementia, Medicine, Population, Cohort, and 3 moreClinical Sciences, Rc, and Cognitive Decline
IntroductionSchool-based interventions to prevent obesity have shown heterogeneous results. Recent school-based trials with “negative” have cast doubt on their effectiveness. In the Juntos Santiago trial, we used an innovative,... more
IntroductionSchool-based interventions to prevent obesity have shown heterogeneous results. Recent school-based trials with “negative” have cast doubt on their effectiveness. In the Juntos Santiago trial, we used an innovative, theory-based gamification strategy to increase motivation and participation in healthy behavioural changes. This is the first trial, to our knowledge, to use gamification to prevent childhood obesity.ObjectiveTo examine the effectiveness of a multicomponent gamification strategy to prevent obesity in 5th and 6th-grade schoolchildren in Santiago de Chile.Materials and methodsSchool-based, parallel cluster-randomized controlled trial. 81 schools in two municipalities in Santiago, Chile, with more than 40 students in 5th and 6th grade altogether were eligible. Schools were randomized and sequentially invited to participate. The multicomponent intervention was a gamification strategy with four components: (i) healthy challenges (snacks, steps and healthy activiti...
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Research Interests: Psychology and Humanities
There is a need for recent, nationally representative data on the prevalence of mental disorders in Latin America. We aim to assess the prevalence of depression in Chile and possible changes over time. In the Chilean National Health... more
There is a need for recent, nationally representative data on the prevalence of mental disorders in Latin America. We aim to assess the prevalence of depression in Chile and possible changes over time. In the Chilean National Health Surveys in 2003 (n = 5469) and 2010 (n = 7212), two nationally representative cross-sectional population surveys, the Composite International Diagnostic Interview, Short Form (CIDI-SF) was applied to establish diagnosis of major depressive episode (MDE) using DSM-IV criteria. Sociodemographic correlates of MDE and time trends were analyzed. The prevalence of MDE was 20.5% (95% CI 18.3-22.7) in 2003 and 18.4% (95% CI 16.5-20.2) in 2010. In 2003, women and persons residing in urban areas had increased risk of depression, whereas in 2010 the risk factors were female sex, younger age and lower education. There were up to 15-fold differences in prevalence between regions. No significant changes in prevalence occurred over the observation period. 21.2% (95% CI...
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The public health system has restricted economic resources. Because of that, it is necessary to know how the resources are being used and if they are properly distributed. Several works have applied classical approaches based in Data... more
The public health system has restricted economic resources. Because of that, it is necessary to know how the resources are being used and if they are properly distributed. Several works have applied classical approaches based in Data Envelopment Analysis (DEA) and Stochastic Frontier Analysis (SFA) for this purpose. However, if we have hospitals with different casemix, this is not the best approach. In order to avoid biases in the comparisons, other works have recommended the use of hospital production data corrected by the weights from Diagnosis Related Groups (DRGs), to adjust the casemix of hospitals. However, not all countries have this tool fully implemented, which limits the efficiency evaluation. This paper proposes a new approach for evaluating the efficiency of hospitals. It uses a graph-based clustering algorithm to find groups of hospitals that have similar production profiles. Then, DEA is used to evaluate the technical efficiency of each group. The proposed approach is ...
Research Interests: Information Systems, Computer Science, Algorithms, Health Informatics, Chile, and 15 moreData Envelopment Analysis, Medicine, Production economics, Humans, Stochastic Frontier Analysis, Medical systems, Health Care Rationing, Public health systems and services research, Dental Care, Statistical models, Organizational Efficiency, Public Art Hospitals, Renal Dialysis, Homogeneous, and Patient discharge
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Research Interests: Demography, Poverty, Health Inequalities, Chile, Adolescent, and 15 moreMedicine, Income inequality, Crisis, Humans, Child, Inequality, Female, Male, Poisson regression, Income, Communication and media Studies, Educational Status, Cross sectional Study, Cross Sectional Studies, and Family Characteristics
This paper describes the evaluation of the first training on clinical research methodology in Chile (EMIC-Chile) 12 months after its completion. An online survey was conducted for students and the Delphi method was used for the teaching... more
This paper describes the evaluation of the first training on clinical research methodology in Chile (EMIC-Chile) 12 months after its completion. An online survey was conducted for students and the Delphi method was used for the teaching team. Among the students, the majority reported that the program had contributed to their professional development and that they had shared some of the knowledge acquired with colleagues in their workplace. Forty-one percent submitted a project to obtain research funding through a competitive grants process once they had completed the course. Among the teachers, the areas of greatest interest were the communication strategy, teaching methods, the characteristics of the teaching team, and potential strategies for making the EMIC-Chile permanent in the future. This experience could contribute to future research training initiatives for health professionals. Recognized challenges are the involvement of nonmedical professions in clinical research, the co...