Multivariate Adaptive Regression Splines (MARS) is a non-parametric modelling method that extends the linear model, incorporating nonlinearities and interactions between variables. It is a flexible tool that automates the construction of predictive models: selecting relevant variables, transforming the predictor variables, processing missing values and preventing overshooting using a self-test. It is also able to predict, taking into account structural factors that might influence the outcome variable, thereby generating hypothetical models. The end result could identify relevant cut-off points in data series. It is rarely used in health, so it is proposed as a tool for the evaluation of relevant public health indicators. For demonstrative purposes, data series regarding the mortality of children under 5 years of age in Costa Rica were used, comprising the period 1978-2008.
The accreditation process of primary healthcare centers in Chile has not had the same progress as in hospitals, which show high levels of compliance. The purpose of this research is to characterize the communes that have accredited family healthcare centers (CESFAMs) through socio-economic, municipal management, clinical management, and population variables by performing a principal components analysis (PCA) with biplot analysis and a grouping of communes through a hierarchical analysis. The biplot analysis and hierarchical analysis yielded the formation of three large groups of communes with accredited CESFAMs, characterized mainly by population size, number of people registered in the municipal health system, socioeconomic indicators, and financial management and clinical management variables. It was found that the communes that have accredited CESFAMs are characterized by dissimilar behavior in relation to the variables analyzed. Through the model used, it was possible to establish at least three groups of communes according to their behavior against these variables. Of these, the variables of a municipal financial nature were not decisive in achieving the accreditation of the CESFAMs of these communes. Therefore, it is possible that there are other variables or factors that could be facilitating the achievement of accreditation processes.
Diseño y evaluación de proceso de una intervención comunitaria para la detección precoz del primer episodio de psicosis en Chile Introducción: La esquizofrenia es una enfermedad mental que genera discapacidad, afectando la calidad de vida de la persona y de sus cuidadores. Las investigaciones demuestran que un menor tiempo de psicosis no tratada durante el primer episodio se asocia con un mejor pronóstico. Objetivo: En este trabajo se describe el diseño y evaluación de proceso de una intervención comunitaria para la detección precoz del primer episodio de psicosis, que fue aplicada en tres sectores del país (comunas de Iquique, La Granja y El Bosque) ligados a un servicio de salud mental. Material y método: Para la evaluación se utilizó una metodología cualitativa de tipo etnográfica, basada en entrevistas semi-estructuradas y entrevistas grupales con los diferentes tipos de participantes (profesores, coordinadores, profesionales médicos y no médicos). Resultados: La evaluación de proceso de esta intervención permitió concluir que contribuyó al cumplimiento de los objetivos de la intervención de manera heterogénea; se obtuvo una buena participación de médicos y profesores; la capacitación fue bien evaluada. Conclusiones: Las recomendaciones principales fueron: 1) obtener respaldo político (autoridades sanitarias locales), 2) crear y mantener vínculos cercanos con el equipo investigador, y 3) adecuar la intervención a los valores y/o necesidades de la comunidad.
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