Browsing by Author "Leniz Martelli, Javiera"

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    Association between demographic, clinical characteristics and severe complications by SARS-CoV-2 infection in a community-based healthcare network in Chile
    (2024) Leniz Martelli, Javiera; Hernández Jaña, Sam Steven; Soto Durán, Mauricio Javier; Soto, Mauricio; Arenas, Eduardo; Margozzini Maira, Paula Andrea; Suárez, Francisco; Capurro, Daniel; Rojas Villar, María Paulina; Bambs Sandoval, Claudia Elena
    Background Most of the evidence on risk factors for COVID-19 complications comes from North America or Europe with very little research from Latin-America. We aimed to evaluate the association between sociodemographic, clinical factors and the risk of COVID-19 complications among adults in Chile, the fifth Latin-American country with more COVID-19 reported cases since de beginning of the Pandemic. Methods A retrospective population-based cohort study using data from electronic health records from a large Primary Care Network, linked to national hospital, immunization, Covid-19 PCR surveillance, mortality and birth records. We included people 18+ years old enrolled in the Primary Care Network between 1st January 2020 and 31st December 2021. Using Multivariate Cox proportional hazard models, we evaluate the association between sociodemographic, clinical characteristics with three COVID-19 complications: (1) a hospital admission, (2) an ICU admission, and (3) death due to a COVID-19 infection that occurred between the 1st January 2020 and the 31st December 2021. Results 44,674 people were included. The mean age was 44.30 (sd 17.31), 55.6% were female, 15.9% had a type of healthcare insurance for people from the lowest category of income, 11.6% and 9.4% had a record of hypertension or diabetes mellitus diagnosis. Among the 44,674 people, 455 (1.02%) had a hospital admission due to a COVID-19 infection and 216(0.48%) of them also had an ICU admission. Among the 44,674 people,148(0.33%) died due to COVID-19 infection. Older age and male sex were consistently associated with a higher risk of the three COVID-19 complications. Hypertension and diabetes were associated with a higher risk of a hospital admission and death, but not with an ICU admissions due to COVID-19 infection. Having two or more COVID-19 vaccine doses compared with no doses was associated with a lower risk of any hospital admission (HR 0.81; 95% CI 0.77–0.84), an ICU admission (HR 0.60; 95% CI 0.57–0.63) and death (HR 0.50; 95% CI 0.46–0.54). Pregnant or puerperal women were more likely to be admitted to hospital (HR 2.89; 95% CI 1.41–5.89) or ICU (HR 3.04; 95% CI 1.01–9.14). Conclusions Sociodemographic and clinical factors associated with COVID-19 complications such as age, sex and pre-existing conditions were comparable to those reported in similar studies from higher-income countries, and can be used to predict severity in COVID-19 patients.
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    Association between ethnicity and emergency department visits in the last three months of life in England: a retrospective population-based study using electronic health records
    (2024) Davies, Joanna M.; Leniz Martelli, Javiera; Chua, Kia-Chong; Williamson, Lesley E.; Bajwah, Sabrina; Bolton, Thomas; Bone, Anna E.; Hocaoglu, Mevhibe; Verne, Julia; Fraser, Lorna K; Barclay, Stephen; Murtagh, Fliss E. M.; Higginson, Irene J.; Sleeman, Katherine E.
    Introduction Emergency department (ED) visits are distressing yet common in the last months of life and many could be avoided. The association between ethnicity and ED visits in the last months of life has rarely been studied in detail and the intersection with area-based deprivation and other risk factors is not known. Methods Population-based, retrospective cohort study, using electronic health records for adults who died from all causes in 2019 and 2020 in England. Results Of 566 930 deaths in 2020, 356 700 (62.9%) had at least one ED visit in the last 3 months of life. Most ethnic minority groups had more ED visits than white British people and differences were larger for visits out-of-hours. After adjusting for social and clinical factors, compared with white British people, the out-of-hours visit rate for people with Bangladeshi, Pakistani and Indian ethnicities was 17% (95% CI 6% to 28%), 19% (95% CI 12% to 27%) and 14% (95% CI 6% to 22%) higher for women, and 16% (95% CI 9% to 23%), 13% (95% CI 8% to 19%) and 6% (95% CI 0% to 12%) higher for men. The rate of visits was lower in 2020 than in 2019, but differences between ethnic groups were similar. For white British people, there is a clear social gradient—those who live in more deprived areas have a higher rate of ED visits—but this is not seen for most other ethnic groups. Conclusion People with Bangladeshi, Indian and Pakistani ethnicities have higher rates of ED visits in the last 3 months of life that are not fully explained by other social and clinical factors. This difference is driven by visits out-of-hours, which may indicate a need for better support. Future work should try to understand why some ethnic minority groups use ED more and how this relates to differences in needs, preferences and experiences.
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    Detección precoz del cáncer cervicouterino en Chile : tiempo para el cambio
    (2014) Leniz Martelli, Javiera; Van De Wyngard, V.; Lagos Lucero, Sonia Marcela; Barriga Cosmelli, María Isabel; Puschel Illanes, Klaus; Ferreccio Readi, Catterina
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    Early detection of cervical cancer in Chile: time for change
    (SOC MEDICA SANTIAGO, 2014) Leniz Martelli, Javiera; Van De Wyngard, Vanessa; Lagos, Marcela; Isabel Barriga, Maria; Puschel Illanes, Klaus; Ferreccio Readi, Catterina
    Mortality rates for cervical cancer (CC) in Chile are higher than those of developed countries and it has an unequal socioeconomic distribution. The recognition of human papilloma virus (HPV) as the causal agent of cervical cancer in the early 80's changed the prevention paradigms. Current goals are to prevent HPV infection by vaccination before the onset of sexual activity and to detect HPV infection in women older than 30 years. This article reviews CC prevention and early detection methods, discusses relevant evidence to support a change in Chile and presents an innovation proposal. A strategy of primary screening based on HPV detection followed by triage of HPV-positive women by colposcopy in primary care or by cytological or molecular reflex testing is proposed. Due to the existence in Chile of a well-organized nationwide CC prevention program, the replacement of a low-sensitivity screening test such as the Papanicolau test with a highly sensitive one such as HPV detection, could quickly improve the effectiveness of the program. The program also has a network of personnel qualified to conduct naked-eye inspections of the cervix, who could easily be trained to perform triage colposcopy. The incorporation of new prevention strategies could reduce the deaths of Chilean women and correct inequities.
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    Registro Electrónico Nacional de Prescripción de Estupefacientes y Psicotrópicos: una mirada a posibles ventajas y dificultades de implementación
    (Pontificia Universidad Católica de Chile, 2024) Altermatt Couratier, Fernando René; Leon Stehr, Paula Jacinta; Goic Boroevic, Carolina; Leniz Martelli, Javiera; Ramos Vergara, Paulina Cecilia; Neyem, Hugo Andrés; Verges Gómez, Álvaro Javier; Aranguiz Villagran, Matías Andrés; Centro de Políticas Públicas UC; Pontificia Universidad Católica de Chile. Escuela de Medicina; Pontificia Universidad Católica de Chile. Facultad de Ingeniería; Pontificia Universidad Católica de Chile. Facultad de Derecho; Universidad de los Andes. Escuela de Psicología