Temporal and Spatial Trends of Adverse Pregnancy and Birth Outcomes in a Sample of Births from a Public Hospital in Chile.

Understanding temporal and spatial trends in pregnancy and birth outcomes within an urban area is important for the monitoring of health indicators of a population. We conducted a retrospective cohort study of all births in the public hospital of Temuco, a medium-sized city in Southern Chile between 2009 and 2016 (n = 17,237). Information on adverse pregnancy and birth outcomes, as well as spatial and maternal characteristics (insurance type, employment, smoking, age, and overweight/obesity), was collected from medical charts. Home addresses were geocoded and assigned to neighborhood. We tested whether births and prevalence of adverse pregnancy outcomes changed over time, whether birth events were spatially clustered (Moran's I statistic), and whether neighborhood deprivation was correlated to outcomes (Spearman's rho). We observed decreases in eclampsia, hypertensive disorders of pregnancy, and small for gestational age, while gestational diabetes, preterm birth, and low birth weight increased over the study period (all p < 0.01 for trend), with little changes after adjusting for maternal characteristics. We observed neighborhood clusters for birth rate, preterm birth, and low birth weight. Neighborhood deprivation was negatively correlated with low birth weight and preterm birth, but not correlated with eclampsia, preeclampsia, hypertensive disorders of pregnancy, small for gestational age, gestational diabetes, nor stillbirth. Several encouraging downward trends and some increases in adverse pregnancy and birth outcomes, which, overall, were not explained by changes in maternal characteristics were observed. Identified clusters of higher adverse birth outcomes may be used to evaluate preventive health coverage in this setting.

FilmArray® Meningoencephalitis panel in the diagnosis of central nervous system infections: stewardship and cost analysis in a paediatric hospital in Chile.

BACKGROUND: Central nervous system (CNS) infection has been an ongoing concern in paediatrics. The FilmArray® Meningoencephalitis (FAME) panel has greater sensitivity in identifying the aetiology of CNS infections. This study's objective was to compare the aetiological identification and hospitalization costs among patients with suspected CNS infection before and after the use of FAME. METHODS: An analytical observational study was carried out using a retrospective cohort for the pre-intervention (pre-FAME use) period and a prospective cohort for the post-intervention (post-FAME use) period in children with suspected CNS infection. RESULTS: A total of 409 CSF samples were analysed, 297 pre-intervention and 112 post-intervention. In the pre-intervention period, a total of 85.5% of patients required hospitalization, and in the post-intervention period 92.7% required hospitalization (p < 0.05). Median of ICU days was significantly lower in the post-intervention period than it was in the pre-intervention period. The overall positivity was 9.4 and 26.8%, respectively (p < 0.001). At ages 6 months and below, we found an increase in overall positivity from 2.6 to 28.1%, along with an increased detection of viral agents, S. agalactiae, S. pneumoniae, and N. meningitidis. The use of this diagnostic technology saved between $2916 and $12,240 USD in the cost of ICU bed-days. FAME use provided the opportunity for more accurate aetiological diagnosis of the infections and thus the provision of adequate appropriate treatment. CONCLUSIONS: The cost/benefit ratio between FAME cost and ICU bed-day cost savings is favourable. Implementation of FAME in Chilean public hospitals saves public resources and improves the accuracy of aetiological diagnosis.

Epidemic trends, public health response and health system capacity: the Chilean experience in four months of the COVID-19 pandemic.

OBJECTIVES: To report the surveillance of COVID-19 pandemic in Chile and analyse the response to public health interventions implemented from 3 March to 30 June 2020 and to assess the risks of collapse of the health care system. METHODS: We analysed the effective reproductive number, underreporting of cases, burden of critical beds, case fatality ratio and number of diagnostic RT-PCR for SARS-CoV-2. RESULTS: After an accelerated onset, the COVID-19 pandemic seemed to be relatively controlled in Chile (late April 2020), with reproductive numbers close to 1.00. However, at this time, the load of infected patients was high, with an important number of underreported cases; the diagnostic effort was still limited and heterogeneous across regions. After 1 May up to 30 June a marked exponential increase in the number of cases was observed with a peak on June 14. In this last period the occupation of intensive care unit beds increased to saturation level (89% nationally; 95% in the Metropolitan Region). CONCLUSIONS: Our findings suggest that the implemented public health interventions have been initially effective in decreasing the spread of the pandemic. Premature decisions to relax these interventions may have resulted in a rebound in cases with a rapid saturation of the health care system.

OBJETIVOS: Informar sobre la vigilancia de la pandemia por COVID-19 en Chile, analizar la respuesta a las intervenciones de salud pública implementadas desde el 3 de marzo hasta el 30 de junio de 2020 y evaluar los riesgos de colapso del sistema de salud. MÉTODOS: Se analizó el número reproductivo efectivo, el subregistro de casos, la carga sobre las camas de cuidados intensivos disponibles, la tasa de letalidad y el número de pruebas diagnósticas de RT-PCR efectuadas para el SARS-CoV-2. RESULTADOS: Tras un inicio acelerado, la pandemia por COVID-19 parecía estar relativamente controlada en Chile a finales de abril de 2020, con números reproductivos cercanos a 1,00. Sin embargo, en ese momento, la carga de pacientes infectados activos era elevada, con un número importante de casos no notificados; la capacidad diagnóstica era todavía limitada y heterogénea entre las regiones del país. Desde el 1 de mayo hasta el 30 de junio se observó un marcado incremento exponencial en el número de casos, con un pico el 14 de junio. En este último período la ocupación de camas en las unidades de cuidados intensivos aumentó hasta el nivel de saturación (89% a nivel nacional; 95% en la Región Metropolitana). CONCLUSIONES: Nuestros hallazgos sugieren que las intervenciones de salud pública implementadas parecen haber sido efectivas inicialmente para disminuir la propagación de la pandemia. Las decisiones prematuras de relajar estas intervenciones pueden haber ocasionado un rebote en los casos con una rápida saturación del sistema de atención de salud.

[Eating behavior disorders in patients hospitalized in a Mental Health Service]. / Trastornos de la alimentación en pacientes hospitalizados en un Servicio de Salud Mental Pediátrico.

INTRODUCTION: Eating disorders (ED) have a high prevalence during adolescence, associated with high morbidity and mortality. In our country, there are no data that characterize adolescent inpatients with ED. OBJECTIVE: To describe and analyze hospitalizations of children and adolescents due to ED admitted in a Pediatric Mental Health Service (PMHS). PATIENTS AND METHOD: Data were collected from the clinical record of patients with ED hospitalized in the PMHS of the Hospital Roberto del Río during 2005-2015. The following admission variables were studied: cause for hospitalization, ED type, nu tritional status, systemic involvement, and psychosocial variables (psychiatric comorbidities, family functioning, abuse, and suicide ideation/attempt). The t-Student test was used for quantitative varia bles and the chi-square or Fisher Test for qualitative variables for the comparison between groups. RESULTS: 93 patients were included, with an average age of 14.6 years, 84% of them were women. The most frequent diagnosis was anorexia nervosa (AN) (71%) and the most frequent cause for hospita lization was the failure of outpatient treatment, followed by suicide ideation/attempt. At admission, 40% of the patients had malnutrition, 96% psychiatric comorbidity, and 88% family dysfunction. CONCLUSION: AN was the most frequent ED among inpatients and the failure of outpatient treatment was the main cause for hospitalization. The latter could be explained, in part, by the high prevalence of family dysfunction and psychiatric comorbidity of patients and their families which would com plicate outpatient treatment.

[Perception of following gluten-free diet and adherence to treatment in pediatric patients with celiac disease]. / Percepción de estar haciendo bien la dieta sin gluten y adherencia al tratamiento en pacientes pediátricos con enfermedad celíaca.

INTRODUCTION: Celiac disease (CD) is a chronic immune-mediated enteropathy present in ~1% of population. Gluten-free diet (GFD) is the only treatment for this condition and the main limitation of its efficacy is the lack of adherence. OBJECTIVE: To assess factors influencing adherence to GFD in pediatric patients and measure the concordance between serological results and a nutritional adhe rence questionnaire. PATIENTS AND METHODS: celiac patients younger than 18 years of age, diagnosed CD following ESPGHAN criteria, on GFD for at least 6 months and consulting at Hospital Roberto del Río, Santiago, in 2008-2016, were assessed. Clinical presentation, nutritional evaluation and fac tors related to adherence to treatment (diet) were registered. A subsample answered Biaggi's nutri tional questionnaire. RESULTS: Of 65 evaluated patients, 44% and 30,1% adhered to GFD according to blood autoantibodies (TTG and EMA) and the adherence questionnaire, respectively. "Age at debut" (p = 0.049), "perception of following GFD correctly" (p = 0.002) and "behavior in social events" (p = 0.005) were significantly associated with adherence to GFD. There was concordance between serological test and Biagi's questionnaire (p = 0.0001). DISCUSSION: Adherence to GFD was lower than reported in literature. Intervention of some of the identified variables associated with adherence may help improving follow-up of celiac patients, especially those that due to diverse situations cannot measure their antibodies periodically.

[Health education trough the development of scientific skills in Chilean schools]. / Educación en salud a través del desarrollo de habilidades científicas en escolares chilenos.

OBJECTIVE:: To describe the interests, preferred topics and learning in public health issues emerging from Chilean students with their participation in a science education experience. MATERIALS AND METHODS:: A qualitative exploratory study was conducted in 29 school research groups through the project Salud Con-Ciencia en tu Barrio, based on a content analysis of texts and narratives of students. RESULTS:: Students prioritize the situation of abandoned animals, waste management, security and urban infrastructure, mainly. They view the role of social actors, the positive/negative impacts on the community, valuing the knowledge gained through observation neighborhoods and interaction with neighbors. CONCLUSIONS:: Scientific inquiry school in the neighborhood context provides teaching strategies for the promotion of local health, develops basic notions of community health and motivation in students linked to the socio-environmental reality of their neighborhoods.

[Risk factor of intestinal colonization with vancomycin resistant Enterococcus spp in hospitalized pediatric patients with oncological disease]. / Factores de riesgo de colonización por Enterococcus spp resistente a vancomicina en pacientes pediátricos hospitalizados con patología oncológica.

BACKGROUND: The isolation of vancomycin-resistant Enterococcus spp (ERV) has increased significantly within the last few years, along with the risk of infection and dissemination of these bacteria. Our aim was to determine risk factors (RF) for intestinal colonization in hospitalized pediatric patients with oncological disease at Hospital de Niños Roberto del Río. METHODS: Between January 2012 and December 2013 a transversal study was performed with 107 rectal swabs and processed with a PCR for ERV. The patients were classified as "colonized with ERV" and "not colonized with ERV" and we evaluated possible RF for intestinal colonization in both groups. RESULTS: VRE colonization was found in 51 patients (52%). The median of time elapsed between oncological diagnosis and VRE colonization was 35 days. The significant RF associated with VRE colonization were days of hospitalization prior to study, neutropenia and treatment with antibiotics within 30 days prior to study and mucositis. CONCLUSIONS: According to the RF revealed in this study we may suggest prevention standards to avoid ERV colonization. This is the first investigation in our country in hospitalized pediatric patients with oncological disease and processed with a multiplex PCR for ERV, therefore it is a great contribution about this subject in Chile.

[Association of exhaled nitric oxide with asthma and atopy among children living in Santiago, Chile]. / Óxido nítrico exhalado, asma y atopia: análisis en un panel de niños en Santiago, Chile.

BACKGROUND: Chronic airway inflammation is a central process in asthma. Measurement of exhaled nitric oxide (eNO) is a non-invasive biomarker of eosinophilic airway inflammation. AIM: To measure eNO levels in a population of asthmatic and non-asthmatic children and to evaluate their relationship with asthma and atopy. MATERIAL AND METHODS: We studied 143 asthmatic and non-asthmatic children aged 6 to 14 years attended a hospital and primary health service. Participants were tested for allergies and followed during the winter months of 2010 and 2011. They were visited regularly at their homes and eNO levels were measured on each visit using a handheld equipment. Mean eNO distribution were compared by the presence of asthma or atopy using t-test and regression models. RESULTS: No significant differences for mean eNO levels were detected, according to presence of asthma or atopy, by any of the statistical methods used. Regression models showed significant effects for age but not for sex. CONCLUSIONS: There were no differences in eNO levels in the studied children by the presence of asthma or atopy.

Urinary Arsenic Concentration and Its Relationship with Bronchial Asthma in Children from Arica, Chile.

In the city of Arica, northern Chile, the population has been involuntarily exposed to arsenic of natural and anthropogenic origin. This study aims to evaluate the association between urinary arsenic concentration and bronchial asthma diagnosis in the children of Arica. A cross-sectional analysis of a database of 1892 subjects under 18 years of age enrolled in the Environmental Health Centre between 2009 and 2021 was carried out. Arsenic exposure was obtained from a urine sample and bronchial asthma diagnosis from the database of the system for the management of explicit health guarantees. Logistic regression models were used to assess the association between inorganic arsenic and asthma. The median inorganic arsenic was 15 µg/L, and the prevalence of asthma was 7.4%. After adjusting for sex, age, ethnicity, and urinary creatinine, children with the highest tertile of urinary arsenic concentration (≥21.4 µg/L) had a greater chance of developing asthma (odds ratio (OR) 1.90; 95% confidence interval (CI) [1.13-3.18]). When exploring the modifying effect of ethnicity, the association increased among children belonging to any ethnic group (OR 3.51, 95%CI [1.43-8.65]). These findings suggest a relationship between arsenic exposure and bronchial asthma in children. While further studies are needed to assess the impact of arsenic on respiratory health, mitigation efforts to reduce arsenic exposure should be maintained.

Quality of automatic geocoding tools: a study using addresses from hospital record files in Temuco, Chile.

Automatic geocoding methods have become popular in recent years, facilitating the study of the association between health outcomes and the place of living. However, rather few studies have evaluated geocoding quality, with most of them being performed in the US and Europe. This article aims to compare the quality of three automatic online geocoding tools against a reference method. A subsample of 300 handwritten addresses from hospital records was geocoded using Bing, Google Earth, and Google Maps. Match rates were higher (> 80%) for Google Maps and Google Earth compared with Bing. However, the accuracy of the addresses was better for Bing with a larger proportion (> 70%) of addresses with positional errors below 20m. Generally, performance did not vary for each method for different socioeconomic status. Overall, the methods showed an acceptable, but heterogeneous performance, which may be a warning against the use of automatic methods without assessing quality in other municipalities, particularly in Chile and Latin America.

[Characterization and temporal evolution of mortality due to zoonoses under mandatory declaration, between the years 1997 and 2018]. / Caracterización y evolución temporal de la mortalidad por zoonosis bajo declaración obligatoria, entre los años 1997 y 2018.

BACKGROUND: Zoonoses are diseases transmitted from an animal host to humans or vice versa. In Chile, the zoonoses of mandatory notification are brucellosis, anthrax, trichinosis, hydatidosis, leptospirosis, dengue, Chagas disease, hantavirosis and rabies. AIM: To assess the trend and characterize the mortality from zoonoses of mandatory notification in Chile between 1997-2018. METHODS: An official mortality and population data were used. Relative, general and specific mortality rates were described according to sociodemographic variables. Crude and adjusted annual mortality rates (direct method) were calculated. Temporal trend was evaluated with the Prais-Winsten regression model. RESULTS: Between 1997 and 2018, the mortality rate due to zoonosis of mandatory notification corresponded to 0.13% (2152 deaths) of the total mortality, being Chagas disease (59.2%), hydatidosis (24.6%) and hantavirosis (13.5%) the main causes. The general adjusted mortality rate decreased significantly (B: -0.017; IC95%: -0.024; -0.009) as did hydatidosis (B: -0.011; IC95%: -0.013; -0.008), and only hantavirosis showed an increase trend (not significant). CONCLUSION: Mortality due to zoonoses decreased during the period; only hantavirosis showed an increasing trend. It is suggested to focus on strategies to prevent contagion and mortality by hantavirosis, as well as to improve access to treatment for the other zoonoses.

Work Task Association with Lead Urine and Blood Concentrations in Informal Electronic Waste Recyclers in Thailand and Chile.

The informal recycling of electronic waste ("e-waste") is a lucrative business for workers in low- and middle-income countries across the globe. Workers dismantle e-waste to recover valuable materials that can be sold for income. However, workers expose themselves and the surrounding environment to hazardous agents during the process, including toxic metals like lead (Pb). To assess which tools, tasks, and job characteristics result in higher concentrations of urine and blood lead levels among workers, ten random samples of 2 min video clips were analyzed per participant from video recordings of workers at e-waste recycling sites in Thailand and Chile to enumerate potential predictors of lead burden. Blood and urine samples were collected from participants to measure lead concentration. Boosted regression trees (BRTs) were run to determine the relative importance of video-derived work variables and demographics, and their relationship with the urine and blood concentrations. Of 45 variables considered, five job characteristics consisting of close-toed shoes (relative importance of 43.9%), the use of blunt striking instruments (14%), bending the back (5.7%), dismantling random parts (4.4%), and bending the neck (3.5%) were observed to be the most important predictors of urinary Pb levels. A further five job characteristics, including lifting objects <20 lbs. (6.2%), the use of screwdrivers (4.2%), the use of pliers/scissors (4.2%), repetitive arm motion (3.3%), and lifting objects >20 pounds (3.2%) were observed to be among the most important factors of blood Pb levels. Overall, our findings indicate ten job characteristics that may strongly influence Pb levels in e-waste recycling workers' urine and blood.

[Estimates of the spatial distribution of the relative risk of mortality of the main zoonoses in Chile: Chagas disease, hydatidosis, Hantavirus cardiopulmonary syndrome and leptospirosis]. / Estimaciones de la distribución espacial del riesgo relativo de mortalidad por las principales zoonosis en Chile: enfermedad de Chagas, hidatidosis, síndrome cardiopulmonar por hantavirus y leptospirosis.

BACKGROUND: Zoonoses are infections caused by all types of etiological transmissible agents from vertebrate animals to humans. During the last decades, the risk to health caused by different zoonoses has been a consequence of the natural distribution of the different etiological agents and by the emergence and reemergence of these diseases. AIM: To study the distribution of the risk of mortality of the four main zoonoses in continental Chile, based on national mortality data, with the objective of visualizing geographically where to focus the control efforts of these diseases. METHODS: Relative risk was estimated by means of Bayesian Statistics. RESULTS: The distribution in Chile of the main zoonoses was obtained. DISCUSSION/CONCLUSION: The risk maps obtained show a parasitic disease transmitted by high-risk vectors in the north, Chagas disease; a parasitic disease of biological communities in which man is an accidental host, associated with livestock areas, more prevalent in the south, hydatidosis; a bacterial disease transmitted by vertebrates, especially by rodents, where water is an important vehicle, dominant in the center, leptospirosis; and a viral disease transmitted by rodents, very dominant in the south, the hantavirus infection.

Health Assessment of Electronic Waste Workers in Chile: Participant Characterization.

Little research has been done to evaluate the occupational health of electronic waste (e-waste) recycling workers in Latin America. The objective of this study was to complete comprehensive health evaluations on e-waste recycling workers in Chile and to compare those that work in informal (i.e., independent) to those that work in formal (i.e., established company) settings. A cross-sectional study in the summer of 2017 recruited 78 informal recycling workers from two cities and 15 formal e-waste recycling workers from a single recycling facility to assess exposures and health outcomes. Participants completed a health questionnaire and underwent a full health assessment. Herein, only health questionnaire data are reported. Participants were primarily male, middle-aged, married with children, and had worked in e-waste recycling for an average of 12 years. Participants generally reported good health status, and their prevalence of chronic diseases was comparable to national rates. Workers frequently reported exposures to several occupational stressors, including noise and insufficient income, as well as other mental health stressors. Occupational injuries were commonly reported and use of safety equipment was low. Only a few significant differences, generally of a rather small magnitude, were found between informal and formal workers. In conclusion, from survey data, we did not identify major risks to health among e-waste workers, and only minor differences between workers in informal and formal settings.

[Threats, challenges and opportunities for paediatric environmental health in Europe, Latin America and the Caribbean]. / Amenazas, desafíos y oportunidades para la salud medioambiental pediátrica en Europa, América Latina y el Caribe.

In a world that is increasingly technological and interconnected, but also more violent, overexploited and polluted, Paediatric Environmental Health (PEH) is one of the best contributions to improve global health. Few areas of the planet have a high affinity with common values and interests, such as the European Union (EU), Latin America and the Caribbean (LAC). The investments and actions of the PEH in pre- and postnatal periods during the first two decades of life will generate countless benefits in the health and well-being during the human life span. Detecting, reducing, or eliminating physical, chemical, biological and social pollutants is one of the main missions and actions of the PEH. In this special article, an update review is presented on the threats, challenges and cooperation opportunities in PEH among bio-health professionals and other social sectors involved, from the EU and LAC. New professional profiles, knowledge structures and architectures for engagement emerge. Courageous leaderships, new substantial resources, broad social changes, and the necessary collaboration between the two regions will be required to improve the health of present and future generations.

[Evaluation of bone mineral density in children with vertical infection by HIV]. / Evaluación de la densidad mineral ósea en niños con infección vertical por VIH.

Changes in bone mineral density (BMD) are common in adults infected with human immunodeficiency virus (HIV). There are few studies evaluating bone involvement in children infected. OBJECTIVE: To evaluate BMD in vertically HIV-infected children. METHODS: We studied 53 infected children (8-18 years) from five hospitals. Disease status, nutritional assessment, vitamin D (25-OHD) levels and immunological status were recorded. BMD was measured by densitometry. Descriptive analysis, comparison of means and simple and multiple linear regression were used. RESULTS: 88.7% children were in stage B and C, 57% were eutrophic and 18.9% had short stature. 33.3% had 25-OHD levels < 20 ng / ml. 11%, 6% and 4% of the children had BMD <-2DE in hip, spine and whole body respectively. BMD was correlated with BMI, height, disease stage and years of treatment. Only protease inhibitors (PIs) maintained their significance when adjusted for other variables. CONCLUSION: children infected with HIV had lower BMD by age compared to NHANES III data. The severity of the disease, height, zBMI, years of treatment with antiretrovirals, mainly IP, are related to the reduction of bone mass.

Air pollution, PM2.5 composition, source factors, and respiratory symptoms in asthmatic and nonasthmatic children in Santiago, Chile.

The objective of this study was to determine the association of respiratory symptoms and medication use and exposure to various air pollutants, PM2.5 components, and source factors in a panel of asthmatic and nonasthmatic children in Santiago, Chile. To this end, 174 children (90 asthmatics and 84 nonasthmatics) were followed throughout the winter months of 2010 and 2011. During the study period, children filled out daily diaries to record respiratory symptoms and medication use. Air pollution data were obtained from government central site measurements and a PM2.5 characterization campaign. PM2.5 source factors were obtained using positive matrix factorization (PMF). Associations of symptoms and exposure to pollutants and source-factor daily scores were modeled separately for asthmatic and nonasthmatic children using mixed logistic regression models with random intercepts, controlling for weather, day of the week, year, and viral outbreaks. Overall, high concentrations of air pollutants and PM2.5 components were observed. Six source factors were identified by PMF (motor vehicles, marine aerosol, copper smelter, secondary sulfates, wood burning, and soil dust). Overall, single pollutant models showed significant and strong associations between 7-day exposures for several criteria pollutants (PM2.5, NO2, O3), PM2.5 components (OC, K, S, Se, V), and source factors (secondary sulfate) and coughing, wheezing and three other respiratory symptoms in both in asthmatic and nonasthmatic children. No associations were found for use of rescue inhalers in asthmatics. Two-pollutant models showed that several associations remained significant after including PM2.5, and other criteria pollutants, in the models, particularly components and source factors associated with industrial sources. In conclusion, exposure to air pollutants, especially PM2.5, NO2, and O3, were found to exacerbate respiratory symptoms in both asthmatic and nonasthmatic children. Some of the results suggest that PM2.5 components associated with a secondary sulfate source may have a greater impact on some symptoms than PM2.5. In general, the results of this study show important associations at concentrations close or below current air quality standards.

Quality of automatic geocoding tools: a study using addresses from hospital record files in Temuco, Chile / Calidad de las herramientas automáticas de geocodificación: un estudio usando direcciones de fichas de registro hospitalario en Temuco, Chile / A qualidade das ferramentas de geocodificação automática: um estudo utilizando endereços de prontuários hospitalares em Temuco, Chile

Abstract: Automatic geocoding methods have become popular in recent years, facilitating the study of the association between health outcomes and the place of living. However, rather few studies have evaluated geocoding quality, with most of them being performed in the US and Europe. This article aims to compare the quality of three automatic online geocoding tools against a reference method. A subsample of 300 handwritten addresses from hospital records was geocoded using Bing, Google Earth, and Google Maps. Match rates were higher (> 80%) for Google Maps and Google Earth compared with Bing. However, the accuracy of the addresses was better for Bing with a larger proportion (> 70%) of addresses with positional errors below 20m. Generally, performance did not vary for each method for different socioeconomic status. Overall, the methods showed an acceptable, but heterogeneous performance, which may be a warning against the use of automatic methods without assessing quality in other municipalities, particularly in Chile and Latin America.

Resumen: Los métodos automáticos de geocodificación se han convertido en algo popular durante los últimos años para facilitar el estudio de la asociación entre resultados de salud y lugar para vivir. No obstante, más bien pocos estudios han evaluado la calidad de la geocodificación, siendo realizados la mayoría de ellos en EE.UU. y Europa. El objetivo de este artículo es comparar la calidad de tres herramientas automáticas de geocodificación en línea frente a un método de referencia. La submuestra de 300 direcciones escritas a mano, procedentes del registro hospitalario, se geocodificaron usando Bing, Google Earth y Google Maps. Los porcentajes de coincidencia fueron mayores (> 80%) en el caso de Google Maps y Google Earth comparados con Bing. Sin embargo, la precisión de las direcciones fue mejor con Bing, en una proporción más grande (> 70%) de direcciones que tenían errores de posición por debajo de 20m. En general, el rendimiento no varió en cada método para diferentes niveles estatus socioeconómico. En general, los métodos mostraron un rendimiento aceptable, pero heterogéneo. Esto previene contra el uso de métodos automáticos sin evaluar la calidad en otras ciudades, particularmente en Chile y Latinoamérica.

Resumo: Os métodos de geocodificação automática se tornaram populares nos últimos anos para facilitar o estudo da associação entre desfechos de saúde e lugar de residência. Entretanto, poucos estudos avaliaram a qualidade da geocodificação, e a maioria dos estudos existentes foi realizada nos Estados Unidos e Europa. O estudo teve como objetivo comparar a qualidade de três ferramentas de geocodificação eletrônica automática em relação a um método de referência. Foi geocodificada uma subamostra de 300 endereços anotados à mão em prontuários hospitalares, usando Bing, Google Earth e Google Maps. As taxas de correspondência dos registros foram mais altas (> 80%) com Google Maps e Google Earth, comparado com Bing. Entretanto, a acurácia dos endereços foi melhor com Bing, com uma proporção maior (> 70%) de endereços com erros de localização menores que 20 metros. Em geral, o desempeno não variou para cada método de acordo com condição socioeconômica. Os métodos apresentaram desempenho geral aceitável, porém heterogêneo. Os resultados servem de alerta contra o uso de métodos automáticos sem avaliar a qualidade em outras cidades, particularmente no Chile e no resto da América Latina.

Contaminación atmosférica y asma en niños / Outdoor air pollution and asthma in children

El asma en niños es una condición prevalente y con un significativo impacto en la calidad de vida del niño y su cuidador. Un alto porcentaje de los niños están expuestos a la contaminación atmosférica, lo que se traduce en un significativo impacto en su salud respiratoria. Los niños son un grupo especialmente vulnerable por razones fisiológicas, medioambientales y de comportamientos propios de la edad. Existe suficiente evidencia que algunos contaminantes atmosféricos son capaces de aumentar los síntomas de asma y desencadenar exacerbaciones en niños asmáticos. También existe evidencia creciente que la exposición prolongada y precoz a contaminantes atmosféricos pueden aumentar el riesgo de desarrollar asma, especialmente los contaminantes relacionados con el tráfico vehicular. Estos efectos adversos disminuyen cuando disminuye la contaminación atmosférica producto de las regulaciones ambientales. Estudios sobre la carga atribuible estiman que un 13% de los nuevos niños asmáticos pueden deberse a la contaminación atmosférica. El sistema respiratorio y el sistema inmunológico del niño están en desarrollo, por lo que exposiciones a contaminantes atmosféricos pueden tener consecuencias de largo plazo. Existen varios mecanismos identificados que apoyan los resultados de los estudios epidemiológicos destacando el daño por estrés oxidativo. Los médicos que atienden niños tienen que tomar en cuenta este conocimiento e incorporarlo a su práctica clínica.

Asthma in children is a prevalent condition with a significant impact on the quality of life of the child and their caregiver. A high percentage of children are exposed to air pollution, which has a significant impact on their respiratory health. Children are a particularly vulnerable group for age-specific physiological, environmental and behavioral reasons. There is sufficient evidence that some air pollutants are capable of increasing asthma symptoms and triggering exacerbations in asthmatic children. There is also growing evidence that early and prolonged exposure to air pollutants can increase the risk of developing asthma, especially traffic-related air pollution. These adverse effects decrease when atmospheric pollution decreases as a result of environmental regulations. Studies on attributable burden estimate that 13% of new asthmatics in children may occur due to air pollution. The respiratory system and the immune system of the child are developing, so exposure to air pollutants can have long-term consequences. There are several identified mechanisms that support the results of epidemiological studies highlighting damage from oxidative stress. Physicians caring for children need to take this knowledge into account and incorporate it into their clinical practice.