Browsing by Author "Espinoza, Manuel A."

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    Estrategias para la prevención primaria y secundaria del cáncer gástrico: Consenso chileno de panel de expertos con técnica Delfi
    (2024) Corsi Sotelo, Oscar Felipe; Pizarro Rojas, Margarita Alicia; Rollán Rodríguez, Antonio; Silva Figueroa, Verónica; Araya Jofré, Raúl; Bufadel Godoy, María Ester; Cortés González, Pablo; González Donoso, Robinson; Fuentes López, Eduardo; Latorre Selvat, Gonzalo Ignacio; Medel Jara, Patricio Andrés; Reyes Placencia, Diego Armando; Pizarro Véliz, Mauricio; Garchitorena Marqués, María Jesus; Zegers Vial, María Trinidad; Crispi Galleguillos, Francisca; Espinoza, Manuel A.; Riquelme Pérez, Arnoldo Javier
    Introducción: El cáncer gástrico (CG) es la primera causa de muerte oncológica en Chile y la sexta en América Latina y el Caribe (LAC). Helicobacter pylori (H. pylori) es el principal carcinógeno gástrico y su tratamiento reduce la incidencia y mortalidad por CG. La endoscopia digestiva alta (EDA) permite la detección de condiciones premalignas y CG incipiente. No existen programas de búsqueda masiva de la infección por H. pylori ni cribado de las condiciones premalignas ni CG incipiente en LAC. El objetivo de este estudio es establecer recomendaciones para la prevención primaria y secundaria de CG en población asintomática de riesgo estándar en Chile. Métodos: Se realizaron dos talleres y un seminario sincrónicos con modalidad a distancia, con expertos chilenos. Se realizó un consenso por panel Delfi de 2 rondas hasta lograr>80% de acuerdo respecto a las estrategias de prevención primaria y secundaria propuestas para la población estratificada según grupos etarios. Resultados: Se realizaron 2 talleres y un seminario con participación de 10, 12 y 12 expertos, respectivamente. En el panel Delfi respondieron 25 de 37 (77,14%) y 28 de 52 expertos (53,85%). Para la población de 16-34 años no hubo consenso sobre testear y tratar de forma no invasiva para H. pylori y se descartó el uso de EDA. Entre 35-44 años se recomienda testear y tratar de forma no invasiva para H. pylori y evaluar posteriormente su erradicación con pruebas no invasivas (antígeno en deposiciones de H. pylori o prueba de aire espirado). En el grupo ≥45 años se recomienda una estrategia combinada mediante testear y tratar para H. pylori sumado a biomarcadores no invasivos (serología IgG contra H. pylori y pepsinógenos I y II séricos); luego un grupo seleccionado de sujetos, será derivado a EDA con biopsias gástricas (Protocolo Sydney), que serán utilizadas para estratificar riesgo según clasificación Operative Link for Gastritis Assessment (OLGA); cada 3 años en OLGA III-IV y cada 5 años en OLGA I-II.ConclusiónSe propone una estrategia de testear y tratar la infección por H. pylori (prevención primaria) en base a estudios no invasivos en la población de 35-44 años y una estrategia combinada (serología y EDA) en población ≥45 años (prevención primaria y secundaria). Estas estrategias son potencialmente aplicables por otros países de LAC.
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    Influence of SARS-CoV-2 mRNA Vaccine Booster among Cancer Patients on Active Treatment Previously Immunized with Inactivated versus mRNA Vaccines: A Prospective Cohort Study
    (2023) Mondaca Contreras, Sebastián Patricio; Walbaum, Benjamín; Corre, Nicole Le; Ferrés Garrido, Marcela Viviana; Valdés, Alejandro; Martínez-Valdebenito, Constanza; Ruiz-Tagle, Cinthya; Macanas Pirard, Patricia; Ross, Patricio; Cisternas, Betzabé; Pérez, Patricia; Cabrera, Olivia; Cerda, Valentina; Ormazábal, Ivana; Barrera Vásquez, Aldo Vincen; Prado, María E.; Venegas, María I.; Palma, Silvia; Broekhuizen, Richard; Kalergis, Alexis; Bueno, Susan M.; Espinoza, Manuel A.; Balcells Marty, María Elvira; Nervi Nattero, Bruno
    Cancer patients on chemotherapy have a lower immune response to SARS-CoV-2 vaccines. Therefore, through a prospective cohort study of patients with solid tumors receiving chemotherapy, we aimed to determine the immunogenicity of an mRNA vaccine booster (BNT162b2) among patients previously immunized with an inactivated (CoronaVac) or homologous (BNT162b2) SARS-CoV-2 vaccine. The primary outcome was the proportion of patients with anti-SARS-CoV-2 neutralizing antibody (NAb) seropositivity at 8–12 weeks post-booster. The secondary end points included IgG antibody (TAb) seropositivity and specific T-cell responses. A total of 109 patients were included. Eighty-four (77%) had heterologous vaccine schedules (two doses of CoronaVac followed by the BNT162b2 booster) and twenty-five had (23%) homologous vaccine schedules (three doses of BNT162b2). IgG antibody positivity for the homologous and heterologous regimen were 100% and 96% (p = 0.338), whereas NAb positivity reached 100% and 92% (p = 0.13), respectively. Absolute NAb positivity and Tab levels were associated with the homologous schedule (with a beta coefficient of 0.26 with p = 0.027 and a geometric mean ratio 1.41 with p = 0.044, respectively). Both the homologous and heterologous vaccine regimens elicited a strong humoral and cellular response after the BNT162b2 booster. The homologous regimen was associated with higher NAb positivity and Tab levels after adjusting for relevant covariates.
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    The socioeconomic distribution of life expectancy and healthy life expectancy in Chile
    (BioMed Central Ltd, 2023) Espinoza, Manuel A.; Severino Suárez, Rodrigo Alfredo; Balmaceda, Carlos; Abbott, Tomás; Cabieses, Báltica
    © 2023, BioMed Central Ltd., part of Springer Nature.Background: Life expectancy (LE) has usually been used as a metric to monitor population health. In the last few years, metrics such as Quality-Adjusted-Life-Expectancy (QALE) and Health-Adjusted-Life- Expectancy (HALE) have gained popularity in health research, given their capacity to capture health related quality of life, providing a more comprehensive approach to the health concept. We aimed to estimate the distribution of the LE, QALEs and HALEs across Socioeconomic Status in the Chilean population. Methods: Based on life tables constructed using Chiang II´s method, we estimated the LE of the population in Chile by age strata. Probabilities of dying were estimated from mortality data obtained from national registries. Then, life tables were stratified into five socioeconomic quintiles, based on age-adjusted years of education (pre-school, early years to year 1, primary level, secondary level, technical or university). Quality weights (utilities) were estimated for age strata and SES, using the National Health Survey (ENS 2017). Utilities were calculated using the EQ-5D data of the ENS 2017 and the validated value set for Chile. We applied Sullivan´s method to adjust years lived and convert them into QALEs and HALEs. Results: LE at birth for Chile was estimated in 80.4 years, which is consistent with demographic national data. QALE and HALE at birth were 69.8 and 62.4 respectively. Men are expected to live 6.1% less than women. However, this trend is reversed when looking at QALEs and HALEs, indicating the concentration of higher morbidity in women compared to men. The distribution of all these metrics across SES showed a clear gradient in favour of a better-off population-based on education quintiles. The absolute and relative gaps between the lowest and highest quintile were 15.24 years and 1.21 for LE; 18.57 HALYs and 1.38 for HALEs; and 21.92 QALYs and 1.41 for QALEs. More pronounced gradients and higher gaps were observed at younger age intervals. Conclusion: The distribution of LE, QALE and HALEs in Chile shows a clear gradient favouring better-off populations that decreases over people´s lives. Differences in LE favouring women contrast with differences in HALEs and QALEs which favour men, suggesting the need of implementing gender-focused policies to address the case-mix complexity. The magnitude of inequalities is greater than in other high-income countries and can be explained by structural social inequalities and inequalities in access to healthcare.