30 años de estudio sobre ausentismo laboral en Chile: una perspectiva por tipos de empresas / Work absenteeism in Chile according to the type of work place

BACKGROUND: The issue of medically justified work absenteeism has a great relevance in Chile at the present moment. AIM: To analyze sick leaves among people working in hospitals, mines, automotive industry and universities. MATERIAL AND METHODS: Analysis of 14 thesis and research papers about absenteeism in Chile. The incapacity rate (number of days with sick leave per worker per year, the frequency rate (number of sick leaves per year per worker) and the severity rate (mean duration of sick leaves) were calculated. The diseases causing the highest rates of absenteeism were also recorded. RESULTS: The mean age of the studied populations was 36 years old and the most common diseases causing absenteeism were respiratory, rheumatologic and trauma. Hospital workers had the highest incapacity rate with 14.3 days of sick leave per worker per year, followed by mining industry with 12 days, automotive industry with 7.1 days and universities with 6 days. CONCLUSIONS: In Chile, respiratory diseases are the main cause of sick leaves and hospital workers have the highest incapacity rate.

[Cancer mortality in Chile: epidemiological considerations]. / Mortalidad por cáncer en Chile: consideraciones epidemiológicas.

Malignancies are the second most important cause of mortality in Chile, accounting for 21.8% of total deaths. In comparison with other causes, cancer mortality shows an upward trend with increasing mortality rates from 99 to 118 per 100.000 population in the period 1980-1998. The most important cancer locations are stomach, lung and prostate among men and gallbladder, stomach, breast and uterine cervix in women. According to present risks, the mean probability for a Chilean to die from cancer is 3.0% for stomach, 2.3% for prostate, 2.0% for lung, 1.7% for gallbladder, 1.6% for breast and 1.2% for uterine cervix cancer. Recent trends of cancer crude death rates are a matter of concern. During the period 1990-1998 a significant decrease of death rates was only noticed for uterine cervix cancers. On the other hand, important increases were observed for prostate, lung, gallbladder, colon and kidney cancers. If death rates are adjusted by age, an increased risk, not due to the population aging process, is noticed for prostate and to less extent for kidney, colon, skin and myeloma. The adjusted rates show a downward trend for uterine cervix, stomach, breast and esophagus cancer. Increasing cancer mortality is associated with diagnostic and therapeutic delays. Possible actions in screening programs are discussed.

[Adult mortality in Chile]. / Mortalidad del adulto en Chile.

BACKGROUND: The study of mortality of human groups is important to judge the health conditions of population. AIM: To study the main mortality features among Chilean adults. MATERIAL AND METHODS: Information about mortality in Chile from the Instituto nacional de Estadísticas and The World Health Organization, was analyzed. Data was expressed mainly as rates. RESULTS: Annual mortality risk among Chileans is 812 per 100,000 inhabitants and is low compared to the rest of Latin America. In the last 30 years it has decreased systematically at a rate of 1% per year in both genders. The risk of mortality caused by cerebrovascular disease, coronary heart disease, hepatic cirrhosis, gastric cancer and tuberculosis has decreased. On the other hand, the risk of mortality caused by diabetes, hypertension and lung, gallbladder, prostate and colorectal cancer has increased. Mortality varies from 604 per 100,000 in Atacama to 934 per 100,000 in Valparaiso. The most factor that influences this variation is population aging. Mean survival at the start of adulthood is 54 years in men and 61 years in women. At 60 years, the expectancy is 19 and 24 years respectively. Mean age of death in Chile was 71.5 years in 1998. Seventy six percent of deaths occurs in the elderly and 33%, in people of 80 years or more. CONCLUSIONS: Chile is one of the four Latin American countries with lower mortality risk. In the last 30 years, the main causes of deaths among adults, with exception of pneumonia, have decreased. Therefore health care of the adult is in the correct track (Rev Méd Chile 2000; 128: 1144-49).

[Characteristics and management of morbidity in seven Chilean cities]. / Características y manejo de la morbilidad en siete ciudades chilenas.

BACKGROUND: Health population inquiries give information about morbidity as perceived by people, the quality of medical care and the costs of diseases. AIM: To inform the results on morbidity and medical care surveys performed in the Chilean cities of Antofagasta, La Serena, Concepción, Temuco, Llay Llay, Tiltil y Lampa-Batuco. MATERIAL AND METHODS: A random sample of 951 dwellings with 4.192 people was selected and studied three times, in 1995 and 1996. All health events (acute and chronic disease episodes, accidents, health examinations, dental care) and the main features of medical care were registered in the interviews which covered a 2-week period each time. RESULTS: Health events were registered in 30.1% people. When extrapolating fortnight findings to a one year period, each person had 2.37 annual episodes of acute diseases, 0.94 health examinations and 0.69 dental attentions. The prevalence of chronic diseases was 13.2%. The frequency of health events was higher among women and in elders. Hospital stays and deaths were less frequent in higher income levels. Most acute diseases were respiratory illnesses, followed by communicable diseases. The most important chronic diseases detected were hypertension, diabetes mellitus, bronchial asthma and heart diseases. Medical care was provided in 66% of acute and 34% of chronic diseases. CONCLUSIONS: When comparing these results with previous surveys, an increase in the frequency of acute and chronic diseases is found.

[Medical care in 7 Chilean cities]. / Atención médica en siete ciudades Chilenas.

BACKGROUND: In countries with an intermediate development level such as Chile, health care is the main factor that improves the health status of the community. AIM: To inform the results of morbidity and medical care surveys performed in the Chilean cities of Antofagasta, La Serena, Concepción, Temuco, Llay Llay, Tiltil y Lampa-Batuco. MATERIAL AND METHODS: A random sample of 951 dwellings with 4,192 people was selected and studied three times, in 1995 and 1996. All health events (acute and chronic disease episodes, accidents, health examinations, dental care) and the main features of medical care were registered in the interviews which covered a 2-week period each time. RESULTS: Half of sick people received medical care and the rest was managed with self care techniques. Sixty nine percent of subjects with acute diseases received medical care, compared to 32% of those with chronic diseases. The National Health Fund (FONASA) financed most of these medical attentions, half of these were done in private centers and the rest in public premises. Private centers took care of 71% of acute patients, 48% of chronic patients and 27% of health controls. The proportion of private care in different cities paralleled the income of their populations. An estimation of 3.5 medical attentions per capita per year in these cities can be reached. Health care was considered very good by 33% of patients, as good by 55%, as regular by 9% and as deficient by 3%. Quality of care of private centers was perceived as better than that of public centers. Eighty five percent of sick people that did not seek medical care, did so due to the mildness of their ailments. People had to afford a mean of US$ 30 per episode of acute disease, US$ 32 per episode of chronic disease and US$ 56 per each dental attention. CONCLUSIONS: Two thirds of patients with acute diseases and one third of patients with chronic diseases received medical care during the study period.

[Smoking in Santiago, 1993-94]. / Tabaquismo en Santiago, 1993-94.

The aim of this work was to study smoking habits, alcohol and drug use and living standards in a random sample of 1000 dwellings and 4700 people of Santiago through periodic surveys during 1993 and 1994. Forty nine percent of dwellings had at least one inhabitant that was a daily smoker and 73% had at least one occasional smoker. Thirty seven percent of subjects older than 15 years were smokers (40% of men and 35% of women), 27% were presumably addicted to tobacco and 16% former smokers. Alcohol abuse had a prevalence of 2.3%. The highest prevalence of smoking was noticed in low socioeconomical strata. Smoking was not related to educational level or emotional disturbances. Frequency of alcohol abuse or marihuana use was 8.8 times higher in former smokers and 25 times higher in actual smokers, compared to people that never smoked. Comparing these results with previous population surveys, the prevalence of smoking increased in the period 1971-1986 from 47 to 51% in men and from 26 to 43% in women. On the other hand, during the period 1986-1994 the prevalence decreased from 51 to 40% in men and from 43 to 35% in women.

[Medical care in Santiago, 1993]. / Atención médica en Santiago, 1993.

Results of morbidity and medical care surveys performed in Santiago in 1993-94 are presented in this paper. The study has been done in an aleatory population sample of 4,700 people coming from 1,000 dwellings. Main results are as following: The Health National Fund (FONASA) is the most important financing medical care's agency in Santiago (49% out of total population). A majority of medical services are given in private offices or clinics. Medical care systems show significant differences among the studied city districts. A significant direct correlation between people's income and private practice is noticed. One half of acute diseases had medical care and the other half used self care practices; the proportion of medical care is 29% in the case of chronic disease patients. National Health Service eligible people show a significant higher morbidity rate and medical consultation rate than other groups. Lack of medical care mainly depends on low severity of illness episodes or lack of symptoms in chronic disease conditions. In 12% out of total cases, lack of medical care was due to problems in the medical care systems. The quality of care was judged "good or excellent" by 82% of the people, "fair" by 9%, and "bad or deficient" by the remaining 8%. Personal expenditures due to health care are high, one third depending on medical care and two thirds on dental care. In the case of medical care the reasons for expenditures are linked to chronic diseases (60%), acute diseases (28%), injuries and health examinations (15%). Main activities causing personal disbursements are the purchase of drugs (44%), medical visits (30%), laboratory tests (13%) and hospital charges (7%).(ABSTRACT TRUNCATED AT 250 WORDS)

[Characteristics and management of morbidity in Santiago 1993]. / Caracteristicas y manejo de la morbilidad en Santiago 1993.

Results of morbidity and medical care surveys of the Santiago's population are presented in this paper. A random sample of 1,000 dwellings with 4,700 people was selected and studied 3 times, in 1993 and 1994. All health events (acute and chronic morbidity, health examinations, dental care) and main features of medical care were registered in the interviews which covered a 2-week period each time. The population sample had similar characteristics than the results of the last Population and Dwellings Chilean Census. Health events were registered with high frequency: 56% of the families had one or more members with chronic disease; 51% with acute diseases; 46% with emotional troubles; 24% had dental care; 17% health examination and 6% different types of injuries. Frequency of medical care during the fortnight period was 5.6% out of total population of acute diseases; 1.0% of injuries; 4.9% for chronic diseases, 3.9% of health examinations and 5.6% of dental care. Frequency of diseases was significantly higher among women (50%) than in men (33%) and in poor people than in higher socioeconomic levels. Most of the acute disease were respiratory illnesses followed by communicable diseases, skin troubles and rheumatologic disorders. The most important detected chronic diseases were blood hypertension, diabetes mellitus, bronchial asthma and alcoholic addiction.(ABSTRACT TRUNCATED AT 250 WORDS)

[Breast neoplasm: health care and life quality in premature mortality]. / Cáncer de mama: atención de salud y nivel de vida en la mortalidad prematura.

Eight epidemiological indicators and eleven variables pertaining to the chilean population are analyzed regarding their possible relation to cancer of the breast. The observed and expected mortality rates are discussed. Multiple regression models are employed to evaluate their effect on health. The rate is 2.9 per 100,000 women in the age 30-34 years age group and 46.7 por 100,000 women in the 60-64 years age group. A one year increase in age elevates risk of cancer by 1.4 average. There is a great variation among the different regions of the country particularly in the younger age.

[Liver cirrhosis in Chile: epidemiologic considerations]. / Cirrosis hepática en Chile: consideraciones epidemiológicas.

Liver cirrhosis is an important public health problem in Chile, accounting for 5% of all deaths, proportion that has increased 24 fold in the last 60 years. Chile has the highest death rate for cirrhosis in America and the second highest in the world, after Hungary. The risk of death and hospitalization for cirrhosis has increased significantly between 1950 and 1970, stabilizing thereafter in values near to 50 hospitalizations and 30 deaths/year per 100,000 inhabitants. The risk for cirrhosis is higher among men and increases with age. Among people between 35 and 60 years of age, cirrhosis is the first or second cause of death and the third among those aged 60 to 69 years. The age of patients hospitalized for cirrhosis has increased from 42.7 years in 1950 to 55.5 in 1990. Among women, cirrhosis appears at older ages than in men. Mortality rates vary in the different regions of the country and range from 55 in Concepcion and Talcahuano to 8 per 100,000 inhabitants in Coquimbo. The certainty of Chilean information on cirrhosis and the evidences associating cirrhosis to alcohol consumption are discussed, being prominent the significant association between annual death rates for cirrhosis and wine production.

[Impact of health care in the reduction of the mortality of cervix neoplasms in the health services]. / Impacto de la atención de salud en la reducción de la mortalidad por cáncer del cuello uterino en los servicios de salud.

The importance of health care in the mortality caused by cervical uterine cancer in the age group 30 to 64 years is evaluated in the different health centers, excluding the effect of the quality or level of live in those areas. A model of multiple regression predicts the expected mortality rate according to the economic level of the population served by the health center. The different between the observed and predicted rates (the residual rate) is attributed to health care. Another multiple regression model with health variables checks the direct association between the magnitude of the residual rate and medical gynecological consultations; this variable is related significantly and positively to the number of consultations (patient visits) for general morbidity; specialities and with the numbers of midwives. The higher mortality rate associated with higher morbidity rate reflects defects in programs of early diagnosis and identified five deficitiary services. As the activities realized by midwives (such as prenatal check ups and gynecological consultation) are important and the lack of an inverse relation with the mortality rates shown, it is suggested that the resignation of activities and functions to strengthen secondary prevention of cervical uterine cancer be reviewed and modified.

[Hospitalization in Chile: a critical analysis]. / Hospitalizaciones en Chile: análisis crítico.

Main features of hospital stay in Chile are analyzed with special regard to incidence, geographic, sex and age variations, main causes and trends observed in the last decades. The annual admission rate in 1989 was 107 per 1000, twice the overall Latin American rate. Wide variations are observed among geographical areas, with relatively low use of hospital beds in the capital city of Santiago. Hospital needs differ for men and women and according to age, being greater for infants, older people and women of childbearing age. Near two thirds of the needs are related to pregnancy. Admissions for traumatic, digestive, respiratory, urinary and gynecological problems are also frequent. Accidents are the main cause for hospital admission among males, while tumor is foremost among women. During the last 30 years the hospitalization rate has remained stable while the case fatality rate has decreased. Different factors influencing the frequency and features of hospital stay are discussed.

[Chilean hospitals: availability and productivity of the public and private sectors]. / Los hospitales chilenos: dotación y productividad de los sectores público y privado.

Hospital bed availability, trends in number of beds, productivity and administrative aspects in the public and private hospital sectors are analyzed. At present, there are 3.3 beds per 1000 population in Chile. This represents a decrease from previous figures, in spite of increasing demands derived from population aging and greater birth assistance needs. Overall productivity of the hospital system is reflected in 31 annual admissions per bed, an average hospital stay of 8 days and a 75% occupancy rate. The National Health Service System is responsible for 76% of admissions. However, it takes care of more than 90% of bed needs for tuberculosis patients and more than 80% for hospital birth assistance, complications of pregnancy, perinatal disease, communicable diseases, respiratory illnesses, miscarriages and skin diseases. The private sector takes care of more than 40% of rheumatic and musculo skeletal diseases and more than one third of mental health problems. The National Health Service, compared to the private sector, exhibits a greater occupancy rate with an average stay only one day longer. Complexities of hospital administration, new world trends and the relation to external economic resources are discussed.

[Smoking and health in Chile]. / Tabaquismo y salud en Chile.

Findings from a literature review on the smoking problem in Chile are presented. According to prevalence studies, nearly 40% of the general adult population in Chile smokes. The proportion of smokers is smaller among women than among men. Between 1971 and 1984 the proportion of smokers rose from 36% to 41%, with an especially marked increase in women (from 26% to 39%). Calculation of the relative risk of mortality in smokers indicates that smoking accounts for 11% of all deaths in the country. Moreover, 11% of the infant mortality in Chile is attributable to the lower neonatal weight of children of women who smoke. The presence of smokers in homes is responsible for a 30% higher rate of acute respiratory infections. Women smokers have twice as many spontaneous abortions as nonsmokers and enter menopause an average of five years earlier. Hoarseness is 17 times more frequent and excess facial hair is seven times more frequent among women who smoke compared with those who do not. The habit tends to start during adolescence. The rising smoking rate among Chilean women is inversely related to level of schooling and directly related to economic capacity. Smoking during pregnancy is influenced by level of concern for the effects of tobacco and educational actions encountered during this period. The role of physicians and other members of the health team is crucial in this regard. Reference is made to organized antismoking measures, including bans on smoking, restrictions on advertising, warnings about its harmful effects, and various educational efforts. The main components of the Ministry of Health's smoking control program are reviewed.

Health damage caused by the smoking habit in Chile.

The authors review available literature on tobacco use in Chile, devoting particular attention to smoking prevalences, smoking-related health problems, risk factors that tend to encourage smoking, and appropriate control measures. Overall, the available data indicate that roughly 40% of Chile's adult population smokes, that smoking among women is on the rise, that some 11% of both infant and general mortality can be linked to tobacco use, that smoking during pregnancy poses serious health risks, and that the attitudes of physicians and other health workers can have a crucial impact upon the smoking behavior of their patients.

[Health in Chile: reflections for the future]. / La salud en Chile: reflexiones para el futuro.

The health situation in Chile is analyzed. The influence of geographic, ethnic, racial, demographic, socio-economic and cultural factors is considered. Strategies for prevention depend on the epidemiologic status of communities. The quality and availability of health care services is considered to be the main factor influencing health maintenance in Chile. The present health coverage situation which provides for health insurance to 15% of the population using 37% of the resources is clearly inappropriate. The separation of hospitals and outpatient facilities is recognized as an unfavourable situation. A worrying increment in the incidence of tuberculosis and a stagnation in the improvement of maternal child health indexes since 1983 have been observed. Priorities for health development and modifications in health care and prevention systems are discussed.

[Intrahepatic cholestasis in pregnancy and perinatal risk]. / La colestasia intrahepática del embarazo y el riesgo perinatal.

The main purpose of this study was to analyze the accuracy of severity criteria applied in cholestatic jaundice in pregnancy related to health problems in the newborn. The sample, 209 cases, is formed by the total of hospital patients discharges from the Pathologic Pregnancy Unit. Severe cholestatic jaundice (59.3% of cases) presented early itching and impeding premature delivery as the most frequent severity criteria. We found that the greater number of severity criteria, the worse prognosis for the newborn, as shown by birth weight under 2,500 g and Apgar at the minute of 7 or less. Both differences were statistically significant (p = 0.0001; p = 0.0348). No maternal or perinatal deaths were found. Our conclusions are: 1. Severity criteria used in cholestatic jaundice of pregnancy are valied and 2. Clinical management of cases is appropriate, since the major risk reported (perinatal mortality) was absent and maternal and perinatal morbidity were less than those reported in previous studies.

[Medical care in 12 Chilean cities]. / Atención médica en doce ciudades Chilenas.

Frequency of diseases and accidents and the main aspects of medical care were studied in 12 larger Chilean cities, excluding the metropolitan area of Santiago. A survey of 4,737 individuals was performed in a random sample of homes and medical problems observed during a 2 week period were analyzed. A mean of 4.17 disease episodes per person-year was registered, 47% of them receiving medical care. This rate was higher for acute conditions (69%) than for chronic diseases (32%). The sum of consults for disease and health controls gave a total assistance of 3.42 per person-year. 70% of visits took place in outpatient hospital clinics and 30% in private practice facilities. Two thirds of the visits were done in National Health Service's outpatient clinics. The quality of medical care was rated by patients as good or very good in 81% of cases, fair in 13% and deficient in 6%. Main reasons given by patients for not seeking medical care (31% in acute episodes and 68% in chronic patients) were the short course of disease in acute conditions or a feeling that control was not needed in chronic diseases. Problems linked to the medical care system, including financial reasons, explained lack of care in 28% of cases. The medical care situation in these 12 larger cities is similar to that observed in Santiago, using the same type of survey.