[Strategies on critical levels and nodes to improve self-management in people with cardiovascular risk factors in COVID-19 pandemic conditions]. / Estrategias sobre niveles y nodos críticos para mejorar el automanejo en personas con factores de riesgo cardiovascular en condiciones de pandemia por COVID-19.

BACKGROUND: Chile faced the Sars-Cov-2 pandemic, which coexisted with food-nutritional problems related to non-communicable diseases (NCDs). Due to this context, individuals with chronic conditions had less chance to receive medical attention due to the restructuring of the public health system. OBJECTIVE: The present study aimed to identify strategies that integrate the individual, community, and structural levels to improve health control in habitual and critical situations. METHODS: The study included individuals attending the Cardiovascular Health Program (Programa de Salud Cardiovascular) at the primary care level in the capital city of Santiago during the COVID-19 pandemic. Nine hundred forty individuals attending the Cardiovascular Health Program answered a 40-question telephonic interview. With the results of the analysis (convergence analyses, the complement of quantitative and qualitative results), we performed a seminar with key stakeholders from the Ministry of Health and the primary care level. RESULTS: Our study describes integrative strategies that include the individual level, the community level, and structural aspects. These strategies may improve healthcare management among people with NCDs and could be helpful to face interruptions of health benefits and improve health control in everyday and critical situations. The strategies include three levels: 1) Cardiovascular Health Program redesign; 2) facing health attendance discontinuities, and 3) structural measures. CONCLUSION: It is necessary to re-evaluate primary care policies in light of these proposed strategies for sharing responsibility and empowering users about their abilities.

[Proposal for a conceptual model for the study of food environments in ChileProposta de um modelo conceitual para o estudo de ambientes alimentares no Chile]. / Propuesta de un modelo conceptual para el estudio de los ambientes alimentarios en Chile.

OBJECTIVE: Describe a proposal for a conceptual model to systematize the factors affecting food environments and the ways in which these factors are expressed in food behaviors in the Chilean population. METHODS: Study conducted in Chile, with four sequential and iterative stages: literature review, initial discussion of the preliminary model, development of a second model and further discussion with experts, and development of a definitive conceptual model. RESULTS: A conceptual model was developed, including five interrelated food environments with distinctive characteristics: domestic environment, street environment, institutional and organizational environment, restaurant environment, and food supply environment. The food system and food culture are considered the broadest variables in the model. The social determinants of the food environments and eating habits constitute structural and intermediate factors in these environments. The food industry as well as food and nutrition policies are more directly related to food environments. Finally, individuals and social cohesiveness are included in the model, since individuals and groups move within food environments. Conclusions. This model presents a set of definitions, concepts and relationships with complex and multidirectional interactions. The model, therefore, contributes to a comprehensive understanding of how food environments condition food behavior.

OBJETIVO: Propor um modelo conceitual para sistematizar os fatores que condicionam os ambientes alimentares e como eles são expressos no comportamento alimentar da população chilena. MÉTODOS: Estudo realizado no Chile que compreendeu quatro etapas sequenciais e iterativas: revisão da literatura, abertura de discussão do modelo preliminar, geração de um segundo modelo e nova discussão com especialistas e elaboração do modelo conceitual definitivo. RESULTADOS: Foi elaborado um modelo conceitual que engloba cinco ambientes alimentares inter-relacionados, apesar de terem características distintas: ambiente doméstico, ambiente público, ambiente institucional e organizacional, ambiente de restauração e ambiente de abastecimento. O sistema alimentar e fatores culturais são as variáveis mais amplas do modelo. Os determinantes sociais dos ambientes alimentares e da alimentação constituem fatores estruturais e intermediários destes ambientes. A indústria alimentícia e políticas de alimentação e nutrição têm uma relação mais direta com os ambientes. Por último, são incluídos no modelo os indivíduos e a coesão social, visto que são os próprios indivíduos ou grupos de indivíduos que circulam dentro dos ambientes alimentares. CONCLUSÕES: Este modelo representa um conjunto de definições, conceitos e relações com interações complexas e multidirecionais. Ele contribui para compreender como um todo o fenômeno de como os ambientes alimentares estão condicionados ao comportamento alimentar.

[Epidemiology, physiopathology and diagnosis of pulmonary hypertension in hepatic (PH) cirrhosis]. / Epidemiología, fisiopatología y diagnóstico de la hipertensión arterial pulmonar (HAP) en el cirrótico.

Liver cirrhosis is a complex and progressive disease associated with high mortality. In developing countries, alcoholic liver disease is the most common form of liver cirrhosis, followed by chronic viral disease, especially hepatitis C virus infection. Cirrhosis is associated with systemic and splanchnic hemodynamic abnormalities, including increased vascular volume, decreased systemic vascular resistance, and increased cardiac output. At the splanchnic vascular bed, increases in portal flow and intrahepatic resistance have been described, inducing portal hypertension. Pulmonary arterial hypertension is a progressive disease of pulmonary circulation, without left ventricle and valvular heart disease; it is closely related with structural changes in pulmonary arteries. Idiopathic pulmonary arterial hypertension is related to abnormalities in cellular signals, inducing arterial hypertrophy and increased vascular tone. Porto-pulmonary hypertension includes simultaneous portal and pulmonary arterial hypertension. To confirm disease, it is important to exclude concomitant heart disease. Porto-pulmonary hypertension requires important components: portal hypertension, shear vascular stress, and cellular activation with pulmonary arterial hypertrophy. In this short manuscript, the epidemiology, patho-physiology, and diagnostic criteria of the disease are reviewed to optimize early diagnosis and treatment.

Effectiveness of a Gamification Strategy to Prevent Childhood Obesity in Schools: A Cluster Controlled Trial.

OBJECTIVE: The aim of this study was to examine the effectiveness of a school-based gamification strategy to prevent childhood obesity. METHODS: Schools were randomized in Santiago, Chile, between March and May 2018 to control or to receive a nutrition and physical activity intervention using a gamification strategy (i.e., the use of points, levels, and rewards) to achieve healthy challenges. The intervention was delivered for 7 months and participants were assessed at 4 and 7 months. Primary outcomes were mean difference in BMI z score and waist circumference (WC) between trial arms at 7 months. Secondary outcomes were mean difference in BMI and systolic and diastolic blood pressure between trial arms at 7 months.  RESULTS: A total of 24 schools (5 controls) and 2,197 students (653 controls) were analyzed. Mean BMI z score was lower in the intervention arm compared with control (adjusted mean difference -0.133, 95% CI: -0.25 to -0.01), whereas no evidence of reduction in WC was found. Mean BMI and systolic blood pressure were lower in the intervention arm compared with control. No evidence of reduction in diastolic blood pressure was found. CONCLUSIONS: The multicomponent intervention was effective in preventing obesity but not in reducing WC. Gamification is a potentially powerful tool to increase the effectiveness of school-based interventions to prevent obesity.

Two-year controlled effectiveness trial of a school-based intervention to prevent obesity in Chilean children.

OBJECTIVE: Obesity prevalence among Chilean children is 19.4%. The present study aimed to assess the effectiveness of a school-based obesity prevention programme. DESIGN: Non-randomized controlled study. The intervention included activities in nutrition and physical activity, fully applied the first year and partially in the second one. Primary outcomes were BMI Z-score (BMIZ) and obesity prevalence; secondary outcomes were waist circumference and triceps skinfold thickness. Time effects were assessed by changes in BMI-related variables by gender and period (ANOVA and Tukey test), while intervention effects were determined by comparing changes in (i) obesity prevalence by gender and period (PROC GENMOD) and (ii) BMIZ according gender, age and period (PROC MIXED). SETTING: Primary schools in the Chilean cities of Casablanca (intervention group) and Quillota (control group). SUBJECTS: One thousand seven hundred and fifty-nine children from three schools (intervention group) and 671 from one school (control group). RESULTS: Over the two years, obesity prevalence and BMIZ declined significantly in the intervention group; from 17.0% to 12.3% and 14.1% to 10.3% in boys and girls, respectively, and from 0.62 to 0.53 and 0.64 to 0.58, respectively. In the control group, obesity remained stable at about 21% and 15%, while BMIZ increased significantly in the second year. BMIZ declined in both genders and all age categories in the intervention group during the first year (significant only in younger boys). No changes occurred during the summer, while during the second year, BMIZ increased in boys and girls from both groups (significant only in the younger control boys). Obesity declined significantly only in boys during the first year. CONCLUSION: Effectiveness was greater in the first school year and more evident in younger boys.

Estrategias sobre niveles y nodos críticos para mejorar el automanejo en personas con factores de riesgo cardiovascular en condiciones de pandemia por COVID-19

El país se ha visto enfrentado a la pandemia por Sars-Cov-2, que coexiste con problemas alimentario-nutricionales relacionados con enfermedades no trasmisibles (ENT). En esta situación, las personas con ENT han tenido menos probabilidades de recibir atención de salud debido a la reestructuración del sistema de salud. En este contexto se desarrolló un proyecto que tuvo como objetivo general evaluar la autogestión del cuidado y acceso a prestaciones de salud en personas con factores de riesgo cardiovascular pertenecientes al Programa de Salud Cardiovascular (PSCV) de la Atención Primaria de Salud (APS) de la Región Metropolitana, en condiciones de pandemia por COVID-19. El objetivo del presente trabajo fue describir estrategias que integren aspectos individuales, comunitarios y estructurales para mejorar el automanejo en personas con ENT con el fin de afrontar interrupciones de las prestaciones en salud y para mejorar el control en condiciones normales y en futuras crisis. Las estrategias propuestas se originaron a partir del análisis de convergencia y complementariedad de los resultados cuantitativos y cualitativos del estudio y de un seminario con actores clave de la APS. Las propuestas fueron organizadas en tres niveles 1) rediseño del programa de salud cardiovascular; 2) respuesta a la discontinuidad de la atención en salud y 3) medidas estructurales. Conclusión: Es necesario reevaluar las políticas de atención primaria a la luz de estas estrategias propuestas, con el fin de que la salud sea una responsabilidad compartida y a la vez empoderar a los usuarios-as sobre sus propias habilidades.

Background: Chile faced the Sars-Cov-2 pandemic, which coexisted with food-nutritional problems related to non-communicable diseases (NCDs). Due to this context, individuals with chronic conditions had less chance to receive medical attention due to the restructuring of the public health system. Objective: The present study aimed to identify strategies that integrate the individual, community, and structural levels to improve health control in habitual and critical situations. Methods: The study included individuals attending the Cardiovascular Health Program (Programa de Salud Cardiovascular) at the primary care level in the capital city of Santiago during the COVID-19 pandemic. Nine hundred forty individuals attending the Cardiovascular Health Program answered a 40-question telephonic interview. With the results of the analysis (convergence analyses, the complement of quantitative and qualitative results), we performed a seminar with key stakeholders from the Ministry of Health and the primary care level. Results: Our study describes integrative strategies that include the individual level, the community level, and structural aspects. These strategies may improve healthcare management among people with NCDs and could be helpful to face interruptions of health benefits and improve health control in everyday and critical situations. The strategies include three levels: 1) Cardiovascular Health Program redesign; 2) facing health attendance discontinuities, and 3) structural measures. Conclusion: It is necessary to re-evaluate primary care policies in light of these proposed strategies for sharing responsibility and empowering users about their abilities.

Propuesta de un modelo conceptual para el estudio de los ambientes alimentarios en Chile / Proposal for a conceptual model for the study of food environments in Chile / Proposta de um modelo conceitual para o estudo de ambientes alimentares no Chile

RESUMEN Objetivo Describir una propuesta de modelo conceptual para sistematizar los factores que condicionan los ambientes alimentarios y la forma en que estos se expresan en la conducta alimentaria de la población chilena. Métodos Estudio realizado en Chile que incluyó cuatro etapas secuenciales e iterativas: revisión de la literatura, apertura de discusión del modelo preliminar, generación de un segundo modelo y nueva discusión con expertos y elaboración de modelo conceptual definitivo. Resultados Se elaboró un modelo conceptual que incluye cinco ambientes alimentarios interrelacionados, aunque con características distintivas: ambiente doméstico, ambiente vía pública, ambiente institucional y organizacional, ambiente de restauración y ambiente de abastecimiento. Se sitúan al sistema alimentario y a la cultura como las variables más amplias del modelo. Los determinantes sociales de los ambientes alimentarios y alimentación constituyen los factores estructurales e intermedios de estos ambientes. En una relación más directa con los ambientes, se hallan la industria alimentaria y las políticas en alimentación y nutrición. Por último, se incluye al individuo y la cohesión social como parte del modelo, ya que son los individuos o los grupos quienes transitan dentro de los ambientes alimentarios. Conclusiones Este modelo representa un conjunto de definiciones, conceptos y relaciones que tienen una interacción compleja y multidireccional, por lo que el modelo contribuye a comprender de forma integral el fenómeno de cómo son condicionados los ambientes alimentarios sobre la conducta alimentaria.

SUMMARY Objective Describe a proposal for a conceptual model to systematize the factors affecting food environments and the ways in which these factors are expressed in food behaviors in the Chilean population. Methods Study conducted in Chile, with four sequential and iterative stages: literature review, initial discussion of the preliminary model, development of a second model and further discussion with experts, and development of a definitive conceptual model. Results A conceptual model was developed, including five interrelated food environments with distinctive characteristics: domestic environment, street environment, institutional and organizational environment, restaurant environment, and food supply environment. The food system and food culture are considered the broadest variables in the model. The social determinants of the food environments and eating habits constitute structural and intermediate factors in these environments. The food industry as well as food and nutrition policies are more directly related to food environments. Finally, individuals and social cohesiveness are included in the model, since individuals and groups move within food environments. Conclusions This model presents a set of definitions, concepts and relationships with complex and multidirectional interactions. The model, therefore, contributes to a comprehensive understanding of how food environments condition food behavior.

RESUMO Objetivo Propor um modelo conceitual para sistematizar os fatores que condicionam os ambientes alimentares e como eles são expressos no comportamento alimentar da população chilena. Métodos Estudo realizado no Chile que compreendeu quatro etapas sequenciais e iterativas: revisão da literatura, abertura de discussão do modelo preliminar, geração de um segundo modelo e nova discussão com especialistas e elaboração do modelo conceitual definitivo. Resultados Foi elaborado um modelo conceitual que engloba cinco ambientes alimentares inter-relacionados, apesar de terem características distintas: ambiente doméstico, ambiente público, ambiente institucional e organizacional, ambiente de restauração e ambiente de abastecimento. O sistema alimentar e fatores culturais são as variáveis mais amplas do modelo. Os determinantes sociais dos ambientes alimentares e da alimentação constituem fatores estruturais e intermediários destes ambientes. A indústria alimentícia e políticas de alimentação e nutrição têm uma relação mais direta com os ambientes. Por último, são incluídos no modelo os indivíduos e a coesão social, visto que são os próprios indivíduos ou grupos de indivíduos que circulam dentro dos ambientes alimentares. Conclusões Este modelo representa um conjunto de definições, conceitos e relações com interações complexas e multidirecionais. Ele contribui para compreender como um todo o fenômeno de como os ambientes alimentares estão condicionados ao comportamento alimentar.

[Effectiveness of a dietary and physical activity intervention to prevent obesity in school age children]. / Efectividad de una intervención en educación alimentaria y actividad física para prevenir obesidad en escolares de la ciudad de Casablanca, Chile (2003-2004).

BACKGROUND: With the aim of contributing to he Healthy Goal 2010 of reducing significantly the prevalence of childhood obesity we developed and implemented during 2003 and 2004, a school-based obesity prevention intervention which included nutrition education and the promotion of physical activity. AIM: To report the results of the intervention. MATERIAL AND METHODS: The sample included 1760 children (1st to 7th grade) from 3 elementary public schools in Casablanca (experimental group) and 671 from a similar school located in Quillota, a neighboring city (control). Primary outcomes were body mass index (BMI) Z score, the mile and shuttle-run tests and obesity prevalence. We also compared changes in waist circumference and triceps skinfold between both groups. Effectiveness of the intervention was assessed by analyzing separately the group *age* time interaction for the first 3 outcomes (follow-up-baseline), using a mixed model of covariance and by comparing variations in obesity prevalence between both groups. RESULTS: There was a significant decline in BMI Z scores in experimental schools for both genders, but greater in boys (p <0.001 versus p =0.0034 in girls), while in controls, BMI Z scores increased. Obesity prevalence declined significantly in experimental schools; from 17 to 12.3% and from 14.1 to 10.3% in boys and girls respectively, while in the control group, it remained unchanged. Also, triceps skinfold in girls from Casablanca increased significantly less than that of control girls. CONCLUSION: This intervention proved that it is possible to reduce significantly the prevalence of obesity in Chilean schoolchildren attending public elementary schools.

[Nutritional status and aerobic capacity among children attending public elementary schools in Chile]. / Estado nutricional y resistencia aeróbica en escolares de educación básica: línea base de un Proyecto de Promoción de la Salud.

BACKGROUND: The Chilean Ministry of Health has developed a health promotion program called "Vida Chile", whose aim is to target risk factors for chronic diseases. To achieve this, school-based initiatives in nutrition and physical activity have been implemented. The evaluation of these initiatives includes a baseline assessment of these two variables. AIM: Baseline assessment of the nutritional status and aerobic capacity of elementary school children (1st to 8th grade). MATERIAL AND METHODS: Children from seven public schools were studied. Weight, height, triceps skinfold thickness and waist circumference were measured. To test the aerobic capacity, the 20-m Shuttle Run Test (Navette) was utilized. RESULTS: The assessment included 4,271 children, mean age was 10.2 years. The percentile of body mass index, as compared to the CDC 2000 Reference was 67.8 +/- 26.7 and 68 +/- 26.7 for boys and girls, respectively. The prevalence of obesity among children from 6 to 8 years, was 20.3 and 17.7% for boys and girls, respectively. Approximately 30% of males and 15% of females with normal weight had a good aerobic resistance, compared to 15 and 4% of their overweight counterparts. Aerobic capacity decreased with increasing age. CONCLUSIONS: There is a high prevalence of obesity and a deficient level of aerobic capacity among children attending public schools in Chile.

Concordancia entre índice cintura-talla y otros criterios para clasificar obesidad abdominal en escolares chilenos / Concordance between waist to height index and other classification criteria for abdominal obesity in chilean school children

Fundamento: La obesidad en escolares chilenos de primero básico ha aumentado de un 7% en 1987 a un 22% el 2010. El índice de cintura talla (ICT) detecta precozmente factores de riesgo cardiovascular. Objetivo: Comparar las concordancias diagnósticas de obesidad abdominal (OA) entre el ICT >0,5 y dos puntos de corte de circunferencia de cintura (CC) en escolares chilenos pertenecientes a la Estrategia Global contra la Obesidad (EGO). Métodos: Se realizó un estudio analítico de corte transversal de selección aleatoria de una muestra de 1062 escolares chilenos de ambos sexos de 6 a 9 años, de tres regiones. Se midió peso, talla y CC. Se usó estadística descriptiva, tablas de contingencia y test kappa. Resultados: El 34,7% presentó un ICT >0,5. La prevalencia de ICT > 0,5 fue superior en niñas vs los niños (55,7% vs 44,3% p=0,01). Se observó un 28,6% de acuerdos para OA entre ICT >0,5 vs Ferranti (p75) (Kappa=0,71 p= 0,000) vs 16,5% (Kappa=0,54 p= 0,000) con Cook (p90) en la totalidad de la muestra. Conclusiones: Un ICT > 0,5 concuerda mejor con un p75 de población NHANES. Debe analizarse la especificidad poblacional del punto de corte, el desarrollo físico de los niños y su asociación con otros factores de riesgo (AU)

Background: Obesity in first grade Chilean children has increased from 7% in 1987 to 22% in 2010. The waist to height ratio (WHtR) can detect early cardiovascular risk factors. Objective: To compare the diagnostic concordance of abdominal obesity (AO) between WHtR> 0.5 and two cutoffs of waist circumference (WC) in schools where the Global Strategy against Obesity (EGO) was implemented. Methods: We performed a cross-sectional analytical study on a sample of 1062 students of both sexes aged 6 to 9 years, in three regions of Chile. We measured weight, height and WC. We used descriptive statistics, contingency tables and kappa test. Results: 34.7% presented WHtR > 0.5. The prevalence of WHtR > 0.5 was higher in girls than boys (55.7% vs 44.3% p = 0.009). A concordance of 28.6% was observed between WHtR > 0.5 and AO diagnosed by Ferranti criteria (p75) (Kappa = 0.71 p = 0.000); while 16.5% of concordance (Kappa = 0.54 p = 0.000) was found in diagnostic by Cook criteria (p90). Conclusions: A WHtR > 0.5 agrees better with a p75 from NHANES population. Consideration should be done in relation with population-specific cut off point, the physical development of children and its association with other risk factors (AU)