Browsing by Author "Zitko, Pedro"

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    Association Between Adolescent Suicide and Sociodemographic Factors in Chile Cross-Sectional Ecological Study
    (HOGREFE & HUBER PUBLISHERS, 2015) Cuadrado, Cristobal; Zitko, Pedro; Covarrubias, Trinidad; Hernandez, Dunia; Sade, Cristina; Klein, Carolina; Gomez, Alejandro
    Background: Adolescent suicide rates (ASR) are a matter of concern worldwide. Causes of this trend are not understood and could correspond to socioeconomic factors such as inequality. Aim: To investigate sociodemographic variables related to ASR, particularly the potential association with indicators of socioeconomic inequality. Method: Cross-sectional ecological study analyzing data from 29 health districts with univariate and multivariable multilevel Poisson models. Results: ASR were higher in male adolescents and at increasing age. No association was found between ASR and inequality (Gini coefficient and 20/20 ratio). Analysis revealed that living in a single-parent family is associated with ASR. Conclusions: The usual demographic patterns of adolescent suicide apply in Chile. An emerging variable of interest is single-parent family. No cross-sectional association between social inequality and ASR was found based on conflicting evidence. These results should be explored in future prospective population studies to further understand associated social factors.
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    Caracterización del metabolismo óseo mineral en pacientes con enfermedad renal crónica en hemodiálisis en el Servicio de Salud Metropolitano Sur, Santiago de Chile
    (2015) Ruiz de Arechavaleta, Andrea; Quintero, Nerio; Parra, E. U., Daniela; Jara Contreras, Aquiles; Russo, Moises; Zitko, Pedro; Pefaur, Jacqueline
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    Changes in cardiovascular mortality in Chile during the COVID-19 pandemic
    (2022) Chang, Sheng-Wei; Zitko, Pedro; Passi-Solar, Alvaro; Danaei, Goodarz; Margozzini, Paula
    Objectives The COVID-19 pandemic has impacted regular cardiovascular healthcare access and delivery. Service utilisation has declined, and excess cardiovascular mortality has been reported in several countries. We aim to estimate excess cardiovascular deaths in Chile during 2020. Methods We collected mortality data from the Chilean Department of Statistics and Health Information and refined them using the maps of Global Burden of Disease Studies in 2017 and 2010. We conducted a time series analysis using quasi-Poisson distribution to predict cardiovascular mortality in 2020 and compared it with observed numbers and calculated attributable fractions (AFs) with 95% uncertainty intervals, as a whole and by sex, age group and type of cardiovascular disease. Results During 2015-2020, 173 283 cardiovascular deaths were recorded, with 28 141 deaths in 2020. The observation in 2020 was lower than our projection in the overall data (-4.0% (-5.0% to -2.8%)) and in male (-11.7% (-13% to -10.3%)). However, positive AFs were noted among female (5.0% (3.2% to 6.8%)), people in age group 80-89 years (11.0% (8.6% to 13.5%)) and people who died from hypertensive heart diseases (18.9% (14.7% to 23.5%)). Conclusions Less overall cardiovascular deaths were observed in 2020 compared with our projection, possibly associated with competing risks from COVID-19 infection in men. Nonetheless, excess cardiovascular deaths were observed among women, people in the age group 80-89 years and people who died from hypertensive heart diseases suggesting possible negative cardiovascular impacts brought by the pandemic on these vulnerable groups.
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    Chronic Musculoskeletal Pain and Chronic Widespread Pain in Chile Prevalence Study Performed as Part of the National Health Survey
    (2021) Duran, Josefina; Zitko, Pedro; Barrios, Paola; Margozzini, Paula
    Objectives: Chronic musculoskeletal pain (CMP) causes significant health loss worldwide. Given that cultural factors may affect pain processing, it is key to have more information regarding CMP epidemiology in Latin America. In this study, we aimed to determine the prevalence of CMP and chronic widespread pain (CWP) in Chile.
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    ¿Cómo se ha medido la posición social en investigación en salud? Una revisión de la literatura internacional
    (2011) Cabieses Valdez, Báltica Beatriz; Zitko, Pedro; Pinedo, R.; Espinoza, M.; Albor, C.
    Social status (SS) is a multidimensional variable that is used widely in health research. There is no single optimal method for estimating social status. Rather, in each case the measurement may vary depending on the research subject, the base theory considered, the population of interest, the event of interest and, in some cases, the available information. This literature review develops the following topics related to SS measurement, based on the international scientific sources available electronically: i) identification of the role of SS in the context of social epidemiology research, ii) description of the principal indicators and methodological approaches used to measure SS in health research, and iii) analysis of the distinct difficulties of SS measurement in specific populations such as ethnic groups, women, children, the elderly, and in rural vs. urban contexts. The review finally makes it possible to describe some of the implications of SS measurement in Latin American countries.
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    Cost analysis of chronic pain due to musculoskeletal disorders in Chile
    (2022) Espinoza, Manuel A.; Bilbeny, Norberto; Abbott, Tomas; Carcamo, Cesar; Zitko, Pedro; Zamorano, Paula; Balmaceda, Carlos
    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 annual cost for chronic pain in Chile is USD 943,413,490, corresponding an 80% to the five diseases studied. The highest costs are related to therapeutic management, followed by productivity losses and sick leave days. Low back pain and fibromyalgia are both the costlier chronic pain-related musculoskeletal diseases. We can conclude that the magnitude of the cost in our country's approach to chronic pain is related to increased productivity losses and sick leave payments. Incorporating actions to ensure access and financial coverage and new care strategies that reorganize care delivery to more integrated and comprehensive care could potentially impact costs in both patients and the health system. Finally, the impact of the COVID-19 pandemic will probably deepen even more this problem.
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    Determinants of access to health care for depression in 49 countries: A multilevel analysis
    (2018) Araya, Ricardo; Zitko, Pedro; Markkula, Niina; Rai, Dheeraj; Jones, Kelvyn
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    Different Alternatives to Assess the Burden of Disease Using Attributable Fraction on a Disability Variable: The Case of Pain and Chronic Musculoskeletal Disorders in Chile
    (2021) Zitko, Pedro; Bilbeny, Norberto; Vargas, Constanza; Balmaceda, Carlos; Eberhard, Maria E.; Ahumada, Marisol; Rodriguez, Maria F.; Flores, Javiera; Markkula, Niina; Espinoza, Manuel A.
    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.
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    First 'training in clinical research methodologies in Chile' (EMIC-Chile). Psychoeducational foundations
    (2010) Cabieses Valdez, Báltica Beatriz; Espinoza, M.; Pedreros, C.; Zitko, Pedro; Cerda, J.; Bambs S., Claudia
    EMIC-Chile ("Entrenamiento en Metodologías para la Investigación Clínica en Chile") is an academic project developed in Chile during 2008 to train health professionals in clinical research. The purpose of this initiative was to improve the quality of rese
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    Implementing a Community Model of Mental Health Care in Chile: Impact on Psychiatric Emergency Visits
    (2017) Zitko, Pedro; Ramírez, J.; Markkula, N.; Norambuena, P.; Ortiz, A.; Sepúlveda, R.
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    Influence of school-related factors on smoking among Chilean adolescents: a cross-sectional multilevel study
    (2018) Gaete, Jorge.; Ortúzar, Catalina.; Zitko, Pedro; Montgomery, Alan.; Araya, Ricardo.
    Abstract Background Adolescent tobacco smoking is a major health concern in Chile. Schools may be able to influence adolescent behaviour regarding smoking; however, this topic has received limited research attention in Latin-American countries. Moreover, the prevalence of cigarette smoking varies between schools, and some of this variability may be explained by school factors. This article examines the inter-school variability in student smoking in a large sample of Chilean schools and identifies the school- and student-level characteristics associated with cigarette smoking. Methods This cross-sectional study used self-reported student-level data from 45,273 students from 1462 schools and official data from these schools provided by the Chilean Ministry of Education (2007). Student smoking behaviour was used as an outcome, and individual-level and school-level features were used as explanatory variables. Logistic multilevel modelling was used to analyse the data. Results The mean prevalence of smoking in the 1462 schools was 39.9 %. The null model indicated that 8 % of the variance in smoking behaviour was explained by schools; and in the final model, controlled by individual- and school-level variables, the variance explained by schools dropped to 2.4 %. The main school-level variables explaining the school influence were school bonding, school truancy and school achievement. Conclusions This is the first study to examine the extent to which student smoking varies between Chilean schools and to identify some of the school factors associated with this inter-school variability. Although most variation in smoking prevalence lies between students within schools, there is sufficient between-school variation to be of interest to educators and policy makers.
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    Lobectomía en ratas. modelo quirúrgico experimental. Resultados en la densidad Alveolar
    (2014) Martínez M., Mónica; Velázquez, Nelson; Flores A., Emilio; Navarrete Hederra, Andrés; Zúñiga H., Felipe; Zitko, Pedro; García Bruce, Cristián Jorge; González Bombardiere, Sergio; Zúñiga Rocha, Sergio
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    Loss of Health State Utilities Attributable to Obesity
    (2023) Del Rio, Francisco; Zitko, Pedro; Santis, Rodrigo; Babul, Marcela; Santis, Florencia
    Objectives: This study aimed to quantify the association between the loss of health state utilities (LHSU) and obesity, considering different obesity categories. This is relevant to interventions economic evaluations and for public policy decision planning. Methods: Using data from the Chilean National Health Survey, this study uses linear regression models and counterfactual scenarios to calculate the prevalent burden, population averages, and total sum of LHSU attributable to obesity for the Chilean national level on people older than 15 years, year 2017. Adjustments for socioeconomic status and associated noncommunicable diseases (NCDs) are considered. Calculating the LHSU using these methods enables the approximation of loss Results: The raw obesity LHSU burden was 9.1% (95% uncertainty interval [UI] 5.1-13). When adjustment is considered, the LHSU attributable to obesity reaches 4.6% (95% UI 0.6-8.5) being responsible for 121045 prevalent QALYs. Socioeconomic status adjusted analysis of higher body mass index (BMI, in kg/m2) categories of obesity shows a dose-response effect for LHSU, being the BMI >= 40 category with the highest population average of attributable LHSU (10.1; 95% UI 5.5-14.5, scale 0 [full health] to 100 [dead]). Burden for BMI >= 35 categories showed the biggest change after NCD adjustment. Conclusions: Obesity carries a significant burden of QALY loss. Policy decision-making addressing obesity should focus specially on the BMI >= 40 group. NCD comorbidity should be considered for policies addressing the BMI >= 35 group.
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    Prevalence, burden of disease, and lost in health state utilities attributable to chronic musculoskeletal disorders and pain in Chile
    (2021) Zitko, Pedro; Bilbeny Lojo, Norberto; Balmaceda, Carlos; Abbott, Tomás; Cárcamo Quezada, César; Espinoza Sepúlveda, Manuel Antonio
    Abstract 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. Musculoskeletal disorders are a significant cause of LHSU at the individual level, especially in the case of fibromyalgia. Chronic musculoskeletal pain caused 503,919 [283,940 - 815,132] DALYs in 2017, and roughly two hundred thousand LSHU at population level, which represents 9.7% [8.8–10.6] of the total LSHU occurred in that year. Discrepancy in the burden of musculoskeletal disorders was observed according to DALY or LSHU estimation. The pain and discomfort domain of LHSU accounted for around half of total LHSU in people with musculoskeletal disorders. Conclusion Chronic musculoskeletal pain is a major source of burden and LHSU. Fibromyalgia should deserve more attention in future studies. Using the attributable fraction offers a straightforward and flexible way to explore the burden of musculoskeletal disorders.
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    Prevalence, trends, correlates and treatment of depression in Chile in 2003 to 2010.
    (2017) Markkula, Niina; Zitko, Pedro; Peña, Sebastián; Margozzini Maira, Paula; Retamal C., Pedro
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    Priority setting for mental health research in Chile
    (2017) Zitko, Pedro; Borghero, Francesca.; Zavala Gaete, Cynthia; Markkula, Niina.; Santelices, Emilio.; Libuy, Nicolás.; Pemjean, Alfredo.
    Abstract Background Scientific knowledge is a fundamental tool for making informed health policy decisions, but the link between health research and public policy decision-making is often missing. This study aims to identify and prioritize a national set of research gaps in mental health. Methods A multi-approach method to identify gaps in knowledge was developed, including (1) document analysis and identification of possible research questions, (2) interviews to Ministry of Health key informants, (3) focus groups with different stakeholders, and (4) a web consultation addressed to academics. The identified gaps were translated to a standardized format of research questions. Criteria for prioritization were extracted from interviews and focus groups. Then, a team of various professionals applied them for scoring each question research. Findings Fifty-four people participated in the knowledge gaps identification process through an online consultation (n = 23) and focus groups (n = 18). Prioritization criteria identified were: extent of the knowledge gap, size of the objective population, potential benefit, vulnerability, urgency and applicability. 155 research questions were prioritized, of which 44% were related to evaluation of systems and/or health programs, and 26% to evaluation of interventions, including questions related to cost-effectiveness. 30% of the research questions came from the online consultation, and 36% from key informants. Users groups contributed with 10% of total research questions. Conclusion A final priority setting for mental health research was reached, making available for authorities and research agencies a list of 155 research questions ordered by relevance. The experience documented here could serve to other countries interested in developing a similar process.
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    Psychometric Evaluation of the Health State Description Questionnaire in Chile: A Proposal for a Latent Variable Approach for Valuating Health States
    (2021) Zitko, Pedro; Bakolis, Ioannis; Vitoratou, Silia; Chua, Kia-Chong; Margozzini, Paula; Markkula, Niina; Araya, Ricardo
    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.
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