[Frequency of smoking among hospitalized patients]. / Consumo de tabaco en pacientes hospitalizados en Clínica Alemana de Santiago de Chile.

BACKGROUND: Smoking is one of the most relevant public health problems worldwide and one of the main causes of preventable premature death. In-hospital treatment and subsequent follow-up are effective in terms of cessation. AIM: To determine the frequency of smoking habits among patients hospitalized at a private clinic in Santiago. MATERIAL AND METHODS: Hospitalized patients were invited to answer a structured and adapted questionnaire on smoking habits. RESULTS: The survey was answered by 294 patients (56% women). Twenty three percent of respondents were smokers. Among smokers, 50% indicated a consumption from 1 to 5 cigarettes per day, 19% smoked during the first hour after waking, and 43% lived with another smoker in their home. Eighty three percent thought about quitting and made unsuccessful attempts to quit using different strategies. CONCLUSIONS: The percentage of smokers in this group of patients is lower than that reported in the national health survey. The high proportion of respondent that are attempted to quit and failed, justifies the availability of structured quitting programs at the hospital and follow-up strategies after discharge.

Consumo de tabaco en pacientes hospitalizados en Clínica Alemana de Santiago de Chile / Frequency of smoking among hospitalized patients

Background: Smoking is one of the most relevant public health problems worldwide and one of the main causes of preventable premature death. In-hospital treatment and subsequent follow-up are effective in terms of cessation. Aim: To determine the frequency of smoking habits among patients hospitalized at a private clinic in Santiago. Material and Methods: Hospitalized patients were invited to answer a structured and adapted questionnaire on smoking habits. Results: The survey was answered by 294 patients (56% women). Twenty three percent of respondents were smokers. Among smokers, 50% indicated a consumption from 1 to 5 cigarettes per day, 19% smoked during the first hour after waking, and 43% lived with another smoker in their home. Eighty three percent thought about quitting and made unsuccessful attempts to quit using different strategies. Conclusions: The percentage of smokers in this group of patients is lower than that reported in the national health survey. The high proportion of respondent that are attempted to quit and failed, justifies the availability of structured quitting programs at the hospital and follow-up strategies after discharge.

Exposure of 4-year to 24-year olds to tobacco imagery on prime-time Chilean television.

INTRODUCTION: The extent of the population's exposure to tobacco imagery across all genres of regular TV programming and the contribution of each of these genres is unknown, except for UK broadcast channels. The objective of this study is to estimate the exposure of young people to tobacco imagery on Chilean prime-time television and the programme source contributing to such exposure. METHODS: Programmes aired during 3 weeks in 2019 from the 15 highest audience channels in Chile were content-analysed for the occurrence of tobacco categorised as actual use, implied use, tobacco paraphernalia, tobacco brand appearances and whether they violated Chilean smoke-free law for each 1 min interval (92 639). The exposure of young people to tobacco content was estimated using media viewership figures. RESULTS: Young people received 29, 11 and 4 million tobacco impressions of any type, explicit use and smoke-free violation, respectively, at a rate of 21.8, 8.0 and 2.1 thousand impressions per hour of TV viewing. The main sources of exposure to tobacco impressions were feature films and animated productions, which were almost entirely non-Chilean. Finally, young people were exposed to tobacco brand impressions primarily through films, effectively circumventing the advertising ban in Chile. DISCUSSION: Television programming is a source of significant youth exposure to tobacco imagery, including branding impressions. To conform to the WHO FCTC, Chile should prohibit tobacco branding in any TV programme and require strong anti-tobacco advertisements prior to any TV programme portraying tobacco.

Exposure to tobacco impressions during prime-time TV among Chilean minors by sex and socioeconomic status.

INTRODUCTION: We tested if tobacco impressions were delivered differentially to prime-time TV watching minors by sex and socioeconomic status. METHODS: Programs aired during prime-time for three random weeks in 2019 from the 15 highest audience channels in Chile were content-analyzed for the occurrence of tobacco for each one-minute interval of 92639 recorded. Such occurrences were categorized as actual use and whether they violated Chilean smoke-free law or tobacco brand appearances. We estimated the number of persons per hour (p/h) exposed to tobacco impressions for the 4 to 17 years age group by sex and socioeconomic status (SES). RESULTS: Minors spent over a billion p/h watching TV during the observation period. Minors were exposed to tobacco explicit use, branding and smoke-free violation impressions for 9.7 million, 1.2 million, and 1.0 million p/h, respectively. The odds ratios (OR) of exposure to total tobacco impressions were always greater among boys with higher SES compared to boys with low SES. However, they were greater among girls of low SES compared to those of high SES for all types of impressions. The OR of exposure to tobacco branding was higher among girls of any SES compared to boys of any SES. CONCLUSIONS: Minors need protection from tobacco imagery on television, particularly girls of low SES. To that end, new legislation should implement all measures to counter depictions of tobacco in entertainment media, as recommended in the WHO FCTC Article 13 guidelines. This should require strong anti-tobacco advertisements before any TV program portraying tobacco targeting minor audiences, particularly girls of low SES. Given that Chile has one of the highest prevalences in the world of current cigarette smoking among young females, the potential contribution of tobacco impressions on TV to smoking differentials across female socioeconomic groups should be further studied.

Barriers and Facilitators in Access to Diabetes, Hypertension, and Dyslipidemia Medicines: A Scoping Review.

Objective: Identify barriers and facilitators in access to medicines for diabetes, hypertension, and dyslipidemia, considering patient, health provider, and health system perspectives. Methods: Scoping review based on Joanna Briggs methodology. The search considered PubMed, Cochrane Library, CINAHL, Academic Search Ultimate, Web of Science, SciELO Citation Index, and grey literature. Two researchers conducted screening and eligibility phases. Data were thematically analyzed. Results: The review included 219 documents. Diabetes was the most studied condition; most of the evidence comes from patients and the United States. Affordability and availability of medicines were the most reported dimension and specific barrier respectively, both cross-cutting concerns. Among high- and middle-income countries, identified barriers were cost of medicines, accompaniment by professionals, long distances to facilities, and cultural aspects; cost of transportation emerges in low-income settings. Facilitators reported were financial accessibility, trained health workers, medicines closer to communities, and patients' education. Conclusion: Barriers and facilitators are determined by socioeconomic and cultural conditions, highlighting the role of health systems in regulatory and policy context (assuring financial coverage and free medicines); providers' role bringing medicines closer; and patients' health education and disease management.

Instrumentos para medir la capacidad funcional intrínseca y la fragilidad de personas mayores en la Atención Primaria en Chile / Instruments to assess functional capacity and the presence of frailty in older people

BACKGROUND: The evaluation of functional capacity and the presence of frailty is an essential prognostic indicator in older people. Aim: To explore the instruments used to characterize the intrinsic functional capacity (CFI) and frailty in elderly people cared at Primary Health Care Centers (PHC) in Chile. MATERIAL AND METHODS: A narrative review of national and international scientific literature was carried out, including observational studies published in Pubmed (since 2015) and Scielo (since 2010) about tools to assess CFI or frailty. Studies in English or Spanish carried out in Chilean beneficiaries of PHC aged 60 years and over, were included. Results: After the first search, 110 articles were selected in Pubmed and 86 in Scielo. According to the relevance of the title and abstract, 36 articles were preliminarily screened, of which 25 were selected for full reading, 12 of which were finally included in this review. In Chile, the main instrument used to assess CFI is the Functional Examination of the Elderly (EFAM). There are few national studies to assess frailty and the instruments used are mainly based on the Fried criteria and the FTI (Frailty Tilburg Indicator). The reviewed studies suggest improving the coverage and reconsidering the predictive capacity of the measurements used for the assessment of CFI and frailty in older people, suggesting the incorporation of handgrip strength as a predictor of frailty. CONCLUSIONS: The main instruments to assess CFI and frailty in older people cared in PHC in Chile are the EFAM, and the Fried and FTI criteria, respectively.

[Instruments to assess functional capacity and the presence of frailty in older people]. / Instrumentos para medir la capacidad funcional intrínseca y la fragilidad de personas mayores en la Atención Primaria en Chile.

BACKGROUND: The evaluation of functional capacity and the presence of frailty is an essential prognostic indicator in older people. AIM: To explore the instruments used to characterize the intrinsic functional capacity (CFI) and frailty in elderly people cared at Primary Health Care Centers (PHC) in Chile. MATERIAL AND METHODS: A narrative review of national and international scientific literature was carried out, including observational studies published in Pubmed (since 2015) and Scielo (since 2010) about tools to assess CFI or frailty. Studies in English or Spanish carried out in Chilean beneficiaries of PHC aged 60 years and over, were included. RESULTS: After the first search, 110 articles were selected in Pubmed and 86 in Scielo. According to the relevance of the title and abstract, 36 articles were preliminarily screened, of which 25 were selected for full reading, 12 of which were finally included in this review. In Chile, the main instrument used to assess CFI is the Functional Examination of the Elderly (EFAM). There are few national studies to assess frailty and the instruments used are mainly based on the Fried criteria and the FTI (Frailty Tilburg Indicator). The reviewed studies suggest improving the coverage and reconsidering the predictive capacity of the measurements used for the assessment of CFI and frailty in older people, suggesting the incorporation of handgrip strength as a predictor of frailty. CONCLUSIONS: The main instruments to assess CFI and frailty in older people cared in PHC in Chile are the EFAM, and the Fried and FTI criteria, respectively.

Night entertainment venues comply poorly with the smoke-free law in Chile / Los locales de entretenimiento nocturno cumplen mal la Ley de ambientes libres de humo en Chile

The initial high level of compliance with the Chilean comprehensive national smoke-free law in 2013 is fading, particularly in the hospitality sector. This paper draws attention to how using a simple and low-cost surveillance inquiry may help focus on the use of scarce inspection resources to improve compliance with the law in the hospitality sector. We conducted a cross-sectional assessment of second-hand smoke exposure in night entertainment venues in Santiago, Chile, by measuring particulate matter of less than 2.5 µm (PM2.5). Smoking where prohibited by law was observed in 36% of the venues visited. Venues where smoking was spotted at the time of the observation had a median PM2.5 concentration 13 times higher than background concentration on the street. The study shows that a targeted approach for inspection to find pockets of venues with suboptimal compliance is feasible and affordable. (AU)

El alto nivel inicial de cumplimiento de la Ley integral chilena de ambientes libres de humo de 2013 se está desvaneciendo, particularmente en el sector de la restauración. Este documento muestra cómo una encuesta de vigilancia simple y económica puede ayudar a mejorar el uso de recursos de inspección escasos para mejorar el cumplimiento de la ley en dicho sector. Se realizó una evaluación transversal de la exposición al humo de tabaco ajeno en locales de entretenimiento nocturno en Santiago, Chile, midiendo el nivel de partículas menores de 2,5 µm (PM2.5). En el 36% de los locales visitados se fumaba donde lo prohíbe la ley. Los locales en los que se fumaba tenían una concentración mediana de PM2.5 13 veces mayor que la concentración en la calle. El estudio muestra que una vigilancia enfocada en la inspección de lugares con cumplimiento subóptimo es factible y asequible. (AU)

Compliance with the smoking ban in enclosed, semiopen and open areas of workplaces and public places in Chile.

OBJECTIVE: To assess the national level of compliance with the Chilean comprehensive smoke-free legislation by observing healthcare facilities, education centres, government offices, hospitality venues and private workplaces, by type of area within workplaces and public places: enclosed, semiopen and open. METHODOLOGY: In this cross-sectional observational study, we studied a national representative sample of 3253 venues obtained through a two-stage cluster sampling design. First, 57 municipalities were randomly selected, proportionally to the total number of venues of interest. Second, within each selected municipality, a maximum of 12 venues of each sector was selected systematically from a list of existing sites. We determined the non-compliance level by estimating the percentage of the visited venues where smoking was observed or suspected in banned areas of the premises. RESULTS: Smoking or suspicion thereof was not observed in any enclosed area of any establishment. However, smoking violations were observed in semiopen areas ranging from less than 0.5% of schools and healthcare centres to around 10% of hospitality venues or 23.0% of higher education centres. Smoking violations were also observed in outdoor areas of 6.7% and 1.6% of the health centres and schools, respectively. DISCUSSION: The stark contrast in compliance with the smoking ban between the enclosed areas and the semiopen areas may be a consequence of the complex definition of semiopen areas in the regulations. The study also reflects the need to improve the overall enforcement of the smoke-free law, particularly in universities and hospitality venues.

Night entertainment venues comply poorly with the smoke-free law in Chile.

The initial high level of compliance with the Chilean comprehensive national smoke-free law in 2013 is fading, particularly in the hospitality sector. This paper draws attention to how using a simple and low-cost surveillance inquiry may help focus on the use of scarce inspection resources to improve compliance with the law in the hospitality sector. We conducted a cross-sectional assessment of second-hand smoke exposure in night entertainment venues in Santiago, Chile, by measuring particulate matter of less than 2.5µm (PM2.5). Smoking where prohibited by law was observed in 36% of the venues visited. Venues where smoking was spotted at the time of the observation had a median PM2.5 concentration 13 times higher than background concentration on the street. The study shows that a targeted approach for inspection to find pockets of venues with suboptimal compliance is feasible and affordable.

Compliance with the smoking ban in urban public transportation in Chile.

INTRODUCTION: The aim of the study is to assess the national level of compliance with the Chilean smoke-free legislation in the urban public transportation system. METHODS: In this cross-sectional observational study, we studied a national representative sample of 475 vehicles obtained through a two-stage cluster sampling design in 2018. First, 57 municipalities were randomly selected, proportionally to the total number of public transportation vehicles. Second, within each municipality, a convenience sample of up to 4 taxis, 4 buses, and 2 metro coaches was observed. We determined the non-compliance level by systematic direct observation of smoking inside the cabin of the vehicle. We estimated the percentage of the visited vehicles where smoking was observed inside the cabin of the vehicle. RESULTS: The observation of metros, buses and taxis was completed in 24, 52, and 48, of the 57 sampled municipalities, respectively. Smoking was observed inside of about 2% of buses and 7% of taxis. Smoking was not observed in metro carriages. Overall, smoking was observed in almost 3% of the vehicles studied. A 3% noncompliance could expose a significant number of persons in public transportation to secondhand smoke, given that every 100 inhabitants results in about 84 rides a day of almost one hour duration. There are few comparable studies to put in an international context our results. In 2018, the year in which we collected the data, WHO considered that compliance with the law in public transportation was maximum. Our compliance estimate was lower, however WHO used a different methodology and its scope also included the inter-urban mobility, which we did not. CONCLUSIONS: The study highlights the need to improve the enforcement of the smoke-free law in the transportation system in Chile, which presently is almost non-existent.

[The opportunity to incorporate subjective well-being in the protection of children and adolescents in Chile]. / La oportunidad de incorporar el bienestar subjetivo en la protección de la infancia y adolescencia en Chile.

Children and adolescents (CA) represent a quarter of the Chilean population, on which the country, regarding protection, has focused on the promotion of equal rights opportunities based on different international conventions. However, CA continue to die from preventable and modifiable causes in addition to experiencing severe degrees of vulnerability, a situation that has an impact on com plex emotional and cognitive effects through their life cycle. According to international evidence, the welfare of CA is directly related to social inequality indices, valuing well-being as an essential and transversal component of the rights of CA in the country. In Chile, subjective well-being is defined as the perceptions of CA regarding their living conditions, both economic, social, cultural, and health aspects and personal achievements. This concept has been studied through different instruments which could be very useful to promote the psychosocial component and quality of life of CA in na tional strategies and policies in this population. This review proposes to explicitly integrate into the public policies of CA the concept of subjective well-being in order to provide fair, positive and sys tematic opportunities for the maximum development of CA in their life cycle, empirically validating the necessary conditions for good living based on a modern human rights approach that the country has committed to.

La oportunidad de incorporar el bienestar subjetivo en la protección de la infancia y adolescencia en Chile / The opportunity to incorporate subjective well-being in the protection of children and adolescents in Chile

Resumen: Los niños, niñas y adolescentes (NNA) representan a un cuarto de la población chilena, sobre la cual en términos de protección el país se ha enfocado en la promoción de igualdad de oportunidad de derechos en base a convenciones internacionales. Sin embargo, aún los NNA siguen muriendo por causas prevenibles y modificables, además de experimentar importantes grados de vulnerabilidad, situación que repercute en complejos efectos emocionales y cognitivos a lo largo de su ciclo vital. Según la evidencia internacional el bienestar de los NNA va directamente relacionado con los índi ces de desigualdad social, valorando el bienestar como un componente esencial y transversal a los derechos de los NNA del país. En Chile, el bienestar subjetivo se define como las percepciones de los NNA respecto de sus condiciones vitales -tanto en el aspecto económico, como social, cultural, de salud y logros personales. Este concepto se ha estudiado a través de diferentes instrumentos los cuales podrían ser de gran utilidad para promover el componente psicosocial y calidad de vida de los NNA en las estrategias y políticas nacionales en esta población. En esta revision se propone integrar de ma nera explícita en las políticas públicas de la infancia y adolescencia el concepto de bienestar subjetivo, con el fin de entregar oportunidades justas, positivas y sistemáticas para el máximo desarrollo de los NNA en su ciclo vital, validando empíricamente las condiciones necesarias del buen vivir basado en un enfoque moderno de derechos humanos al cual el país se ha comprometido.

Abstract: Children and adolescents (CA) represent a quarter of the Chilean population, on which the country, regarding protection, has focused on the promotion of equal rights opportunities based on different international conventions. However, CA continue to die from preventable and modifiable causes in addition to experiencing severe degrees of vulnerability, a situation that has an impact on com plex emotional and cognitive effects through their life cycle. According to international evidence, the welfare of CA is directly related to social inequality indices, valuing well-being as an essential and transversal component of the rights of CA in the country. In Chile, subjective well-being is defined as the perceptions of CA regarding their living conditions, both economic, social, cultural, and health aspects and personal achievements. This concept has been studied through different instruments which could be very useful to promote the psychosocial component and quality of life of CA in na tional strategies and policies in this population. This review proposes to explicitly integrate into the public policies of CA the concept of subjective well-being in order to provide fair, positive and sys tematic opportunities for the maximum development of CA in their life cycle, empirically validating the necessary conditions for good living based on a modern human rights approach that the country has committed to.