[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.

Regional variation in weight-for-height z-scores and surface area/body mass ratio of Chilean children from birth to 3 years of age.

OBJECTIVE: The objectives of the study were to see how much of the variation in weight-for-height z-scores (WHZ) and surface area/body mass ratio (SA/mass) were associated with regional (county) differences including mean temperature. SUBJECTS AND METHODS: Longitudinal data were obtained from routine medical check-ups on 8,373 children from nine counties across Chile. WHZ and SA/mass were calculated from weight and height from birth to 3-years old at 6 monthly intervals. County of birth was used as an independent variable after controlling for sociodemographic factors. Sequential repeated-measures ANOVAs were used to analyze the changes in WHZ and SA/mass over the seven measurements from birth to 3 years of age. Simple and partial Pearson correlations were calculated between WHZ and annual mean temperature and between SA/mass and annual mean temperature after controlling for socioeconomic factors. RESULTS: County of birth was significantly (p < 0.001) associated with both WHZ and SA/mass. There was a progressive decrease in WHZ means and a progressive increase in SA/mass means from colder to warmer counties. Significant negative correlation in WHZ (r < -0.864) and significant positive correlations in SA/mass (r > 0.821) were found with the annual mean temperature from 18 months of age onwards and in the overall mean age. CONCLUSION: This study suggests that WHZ and SA/mass variation may be influenced by ecogeographical factors in this Chilean sample.

Dietary practices in ancient populations from northern Chile during the transition to agriculture (Tarapacá region, 1000 BC-AD 900).

OBJECTIVE: The goal of this research is to understand the relevance of diet diversity during the transition to agriculture, in ancient populations from northern Chile, especially considering the significance of marine resources and crops in a lesser degree. METHODS: A total of 14 human individuals were sampled from the Tarapacá 40 cemetery. Both bone and tooth samples were collected. Samples were studied from bone/dentine collagen for carbon and nitrogen isotopic analysis; and bone/enamel apatite for carbon isotope analysis. Inferential statistical analyses were performed in order to compare Tarapacá 40 stable carbon and nitrogen isotope values with other Formative and Late Intermediate Period groups. A nonparametrical hypothesis Kruskal-Wallis test was used. RESULTS: The results show that the individuals from Tarapacá 40 are intermediate to the values observed for terrestrial and marine fauna as well as C3 and C4 plants. CONCLUSIONS: A gradual transition to crop consumption, especially maize, is suggested. This complemented the earlier hunter-gatherer tradition of marine resources and wild fruit consumption. Contrarily to the predictions made by some archaeologists, the results obtained for northern Chile contrast with the classical perspective of a "Neolithic Revolution" in which transition to agriculture occurred more abruptly and linearly.

Correction: Effects of sociodemographic and health factors on the self-management of non-communicable diseases among Chilean adults during the Covid-19 pandemic.

[This corrects the article DOI: 10.1371/journal.pgph.0000763.].

Effects of sociodemographic and health factors on the self-management of non-communicable diseases among Chilean adults during the Covid-19 pandemic.

Individuals with non-communicable diseases (NCDs) are potentially at increased vulnerability during the Covid-19 pandemic and require additional help to reduce risk. Self-management is one effective strategy and this study investigated the effect of sociodemographic and health factors on the self-management of some non-communicable diseases, namely hypertension, type 2 diabetes mellitus and dyslipidemia, among Chilean adults during the Covid-19 pandemic. A cross-sectional telephone survey was carried out on 910 participants with NCDs, from Santiago, Chile. An adapted and validated version of the "Partners in Health" scale was used to measure self-management. Exploratory Factor analysis yielded five dimensions of this scale: Disease Knowledge, Healthcare Team Relationship, General Self-Management and Daily Routines, Drug Access and Intake, and Monitoring and Decision-Making. The average of these dimensions was calculated to create a new variable Self-Management Mean, which was used as a dependent variable together with the five separate dimensions. Independent variables included age, gender, years of schooling, number of diseases, the percentage of Multidimensional Poverty Index in the commune of residence, and self-rated health status. Beta regressions and ANOVA for the Beta regression residuals were utilized for analyses. Beta regression model explained 8.1% of the variance in Self-Management Mean. Age, years of schooling, number of diseases and self-rated health status were statistically associated with Self-Management Mean and dimensions related to daily routines and health decision making, such as Disease Knowledge, General Self-Management and Daily Routines, and Monitoring and Decision-Making. Gender and the percentage of Multidimensional Poverty Index in the commune of residence were insignificant. Strategies for self-management of NCDs during a crisis should consider age, years of schooling, number of diseases, and self-rated health status in their design.

Relationship between age at giving fortified powdered cow's milk and cessation of breastfeeding on the nutritional status of a Chilean child cohort followed from birth to 3 years of age.

BACKGROUND/OBJECTIVES: To examine how much of the variation in weight-for-height (WHZ) z-scores were associated with age at which breastfeeding ceased and provision of fortified cow's milk (Leche Purita Fortificada, LPF) commenced in a cohort of children studied from birth to 3 years of age. SUBJECTS/METHODS: Longitudinal data were obtained from routine medical check-ups on 8373 children from nine Chilean counties through convenience sampling. WHZ z-scores were generated at six-monthly intervals using WHO 2006 standards from birth to 3 years old (seven measurements). Age of cessation of breastfeeding and age of commencement of LPF were the independent variables. Repeated-measures ANOVA were used to analyse the changes in WHZ over the seven measurements. Binomial generalised estimating equations (GEE) were used to analyse the effect of each independent variable on the change from normal to overweight, and normal to obese over the seven measurements. RESULTS: ANOVA indicated that children given LPF milk before 3 months of age had, on average, higher mean WHZ of about 0.11 SD from 18 months of age onwards (p < 0.001). GEE analyses showed that children given LPF before 3 months of age were significantly more likely to be overweight or obese (OR = 1) compared with children given LPF later (overweight OR: 0.809-0.970, p = 0.009, obese (OR: 0.666-0.901, p = 0.001). CONCLUSIONS: Early intake of LPF increases WHZ and is a risk factor for overweight and obesity in young children, while prolonged breastfeeding acts as protective factor against obesity.

Trends of weight gain and prevalence of overweight and obesity from birth to three years of age.

OBJECTIVE: To examine the changes in children's weight-for-height at six monthly intervals between birth and three years old (3yo) from different counties across Chile and to determine if children had overweight or obesity, and if so, whether it was a transient or persistent change. SUBJECTS AND METHODS: Longitudinal data were obtained from routine medical check-ups and 8,373 children were selected from nine counties in Chile through a non-randomised sample design. Weight-for-height z-scores (WHZ) were generated and categorized as wasted, normal, overweight, and obese using WHO standards. Repeated-measures ANOVA were used to analyse the changes in WHZ over the seven measurements as well as based on having normal, overweight, or obese WHZ at 3yo. The number of times having overweight or obesity was counted (from 0 to 7 times). The timing of having overweight and obesity was computed as well as all combinations of the patterns. RESULTS: Mean WHZ significantly increased up to 18months of age and declined thereafter (p<<0.001). Overall mean WHZ was 0.743, prevalence of overweight 31.2% and prevalence of obesity 10.0%. Children categorised with overweight or obesity at 3yo showed significantly higher and sustained pattern of weight gain compared with children with normal WHZ. Once a child had overweight or obesity they tended to remain with it and did not return to a weight-for-height in the normal range. CONCLUSION: The increasing prevalence of overweight and obesity in Chilean children is of concern. There is a need for greater healthcare promotion and prevention of this disease from infancy.

Reliability of age estimation from iliac auricular surface in a subactual Chilean sample.

The aim of this study was to test the reliability of Osborne et al. (2004) [8] age estimation based on the iliac auricular surface of the ilium. We selected 172 skeletons with documented sex and age-at-death and established six uniformly distributed age intervals for analysis. ANOVA was employed to assess the association of the documented age with sex and the auricular surface classification. We employed Bonferroni post-hoc tests to find any statistical differences across documented ages within each phase of Osborne's criteria. While the ANOVA showed a significant association between the documented age and the auricular surface classification, post-hoc tests found that phases 2 and 3 were the only consecutive phases with significant differences. We argue that a lack of statistical significance between consecutive phases undermines the reliability of this method for forensic purposes especially in middle adults. It may be possible that the collapse of intermediate phases would increase the accuracy of this method.

Estudio piloto: descripción de la carga global de trabajo, el factor físico-biomecánico y percepción de molestias músculo-esqueléticas en trabajadoras embarazadas / Pilot study: Description of global workload, biomechanical factor and perception of mus culoskeletal discomfort in pregnant workers

Se ha identificado una sobrecarga laboral en mujeres durante el embarazo. Suelen presentar una alta prevalencia de trastornos mús culo-esqueléticos, no obstante existe poca evidencia sobre su progresión en los trimestres y asociación con carga de trabajo. OBJETIVO: Describir la carga de trabajo, factor físico biomecánico y percepción de molestias músculo-esqueléticas (PMME) en trabajadoras embara zadas. MATERIAL Y MÉTODO: Estudio de diseño observacional, descriptivo y transversal. Muestreo por conveniencia de 80 mujeres emba razadas de la Unidad de Medicina Materno Fetal del Hospital Clínico de la Universidad de Chile. Se describe la muestra a través de la evaluación de carga de trabajo, factores físicos biomecánicos, dificultades percibidas al realizar su tarea mediante una hoja de recolección de información diseñada específicamente para la investigación, usan do metodología en ergonomía. RESULTADOS: Las PMME presentan una prevalencia de un 90%, destacando la zona de la espalda baja y cadera/nalgas/muslos. Las posturas mantenidas o forzadas fueron el factor más prevalente. Una de cada 6 embarazadas refirieron continuar realizando manejo manual de carga. La mayoría de las trabaja doras presentaron un alto riesgo en su carga de trabajo. CONCLUSIONES PRINCIPALES: Las embarazadas están expuestas a altos niveles de carga de trabajo determinado por exigencia mental.

It have been detected overload work among women during preg nancy. Often they present a high prevalence on HYPERLINK “https://www.google.cl/search?q=work+related+musculoskeletal+disorder&spell=1&sa=X&ved=0ahUKEwiw2IS2gePTAhWDD5AKHbK5DcoQvwUIIigA” work related musculoskeletal disorder; however there is little evidence about their progression during the pregnancy's trimester and the association with work load. OBJECTIVE: Describe work load, physical and biomechanical factors, perception of musculoskeletal discomfort (PMSD) in pregnant women. MATERIALS AND METHODS: Observational, descriptive and cross-sectional study. Sampling by convenience of 80 pregnant women of the Maternal-fetal care unit of the Clinical Hospital of the University of Chile. The sample is described trough the evaluation of workload, physical and biome chanical factors, trouble performing tasks by means of a sheet of collection of information created for this investigation, using ergo nomics methodology. RESULTS: The PMSD present a prevalence of 90%, stands out the lower back and hips/buttocks/thigh areas. The forced or maintained postures ware the most prevalent factor. One in six pregnant women referred continuing performing weight manual handling tasks. Most of the women presents high workload. MAIN CONCLUSION: Pregnant women are exposed to high levels of workload determined by mental exigence.

Programa de ergonomía participativa para la prevención de trastornos musculoesqueléticos: aplicación en una empresa del Sector Industrial / Participative ergonomic program for prevention of musculoskeletal disorders application in a company of industrial sector

Se propone como estrategia para el control de los Trastornos Musculoequeléticos (TME) un Programa de Ergonomía Participativa (PEP). La aplicación de este programa se divide en 5 etapas: Análisis de empresa, evaluación de riesgos ergonómicos, construcción del plan de acción, ejecución del plan de acción y verificación de medidas de control. La base que sustenta al PEP es la conformación de un Grupo de Ergonomía en la empresa (Grupo Ergo), quien estará a cargo de la identificación, evaluación e implementación de medidas de control con la asesoría de un profesional de Ergonomía. Las metodologías de evaluación de riesgos a utilizar por el Grupo Ergo serán las indicadas en la Normativa Chilena (Ley 20.001 DS N°63/2005 y Decreto N°4 que modifica el DS N°594) que exigen la aplicación de las herramientas: Manual Asessments Charts (MAC) para identificar y evaluar tareas de Manejo Manual de Carga en Levantamiento-descenso, transporte, levantamiento, descenso en equipo y las tablas de Liberty Mutual para tareas de empuje y arrastre de carga; y, por otra parte, la Norma Técnica de Trastornos Musculoequeléticos de Extremidad Superior (MINSAL, 2011) establece la aplicación de una Lista de chequeo contenida en la Norma ISO 11228-3 para la identificación y evaluación de tareas que involucren movimientos repetitivos, postura, fuerza, tiempos de recuperación y factores adicionales, respectivamente. Se presenta la aplicación del PEP en una empresa del rubro industrial chileno, planteándose como objetivo cumplir con las etapas del programa en un periodo de 4 meses. Se establece como objetivo del PEP lograr implementar un 70% de las medidas consideradas denivel "simples". Los resultados reflejaron el cumplimiento de las etapas, logrando implementar un 79% de las medidas simples y un 27% de las medidas complejas. Pese a que es una experiencia primaria en Chile, se pudieron observar beneficios indirectos en la ejecución del PEP, tales como generar una cultura en la empresa respecto a temas de Ergonomía, lograr el compromiso de los ejecutivos en la implementación de las medidas de control y el cumplimiento de legislación chilena respecto a Ergonomía.

It is proposed as a strategy to control Musculoskeletal disorders (MSDs) Participatory Ergonomics Program (PEP). The implementation of this program is divided into 5 stages: Company Analysis, ergonomic risk assessment, construction of the action plan, implementation of the action plan and verification of control measures. The base that sustains the PEP is the creation of a Group of Ergonomics in the company (Ergo Group), who will be responsible for the identification, evaluation and implementation of control measures with the assistance of a professional ergonomics. The risk assessment methodologies to be used by Ergo Group shall be indicated in Chilean law (Law 20,001 DS No. 63/2005 and Decree No. 4 amending DS No. 594) that requires the application of tools: Manual assessments charts (MAC) to identify and evaluate tasks Burden Handling Manual lifting-lowering, transport, lifting, lowering team and Liberty Mutual tables to pushing and load dragging tasks, and, moreover, the Technical Regulations Musculoskeletal disorders Upper Extremity (MINSAL, 2011) establishes the application of a checklist contained in ISO 11228-3 for the identification and evaluation of tasks that include repetitive movements, posture, strength, recovery times and additional factors, respectively. The implementation of PEP is presented in a company of the Chilean industrial sector, setting out as objective to comply with the program steps over a period of 4 months. It sets the objective of achieving PEP implement 70% of the measures consider of "simple" level. The results showed compliance with stages, achieving 79% implement simple measures and 27% of complex measures. Although it is a primary experience in Chile, indirect benefits could be observed in the implementation of PEP, such as a culture in the company on issues of ergonomics, to achieve the commitment of the executive in the implementation of control measures and compliance with Chilean legislation on Ergonomics.

Identificación de riesgos biomecánicos de los/as trabajadores en plantas de proceso de salmón para la prevención de disfunción dolorosa de extremidad superior (DDES) / Identification of biomechanical risks / as workers salmon processing plants for the prevention of upper extremity painful dysfunction (DDES)

Investigación realizada en 3 plantas procesadoras de Salmón de la Provincia de Chiloé, Chile. Se obtuvo una muestra de 150 trabajadores sanos, de ambos sexos, los que fueron grabados en 2 planos y 2 ciclos de trabajo. Los datos que se obtuvieron fueron analizados a través de CheckList-OCRA y procesados estadísticamente mediante el Software IBM SPSS Statistics. Los resultados indican que en las tareas realizadas por los trabajadores los factores de riesgo biomecánicos más críticos y que tienen mayor importancia en el valor del índice intrínseco (CheckList OCRA) son: Postura (valores de correlación 0,89 y 0,87 para la extremidad superior derecha e izquierda, respectivamente); Fuerza (valores de correlación 0,86 y 0,87 para la extremidad superior derecha e izquierda, respectivamente); y, Frecuencia (valores de correlación 0,81 y 0,71 para la extremidad superior derecha e izquierda, respectivamente). Por otra parte, de un total de 21 puestos evaluados, un 67% (14) presentan un nivel de riesgo "alto" (valores de índice intrínseco sobre 22,5). De estos, la mayor cantidad de trabajadores se concentra en los puestos de Despinado Manual y Decorado (70% del total de la muestra). Las conclusiones de la investigación apuntan a que los mayores esfuerzos de prevención se debieran enfocar en los puestos críticos (nivel de riesgo alto-medio), principalmente hacia aquellos que involucran a una mayor masa de trabajadores (Despinado Manual y Decorado). Estas indicaciones debiesen estar dirigidas al mejoramiento de la técnica de trabajo, eliminación de acciones técnicas inútiles, perfeccionamiento de herramientas, rediseño de la línea de producción y layout, además de rotación de funciones.

Research conducted in 3 salmon processing plants in the province of Chiloé, Chile. A sample of 150 healthy workers of both sexes was obtained, which was recorded in 2 planes and 2 cycles. The data obtained were analyzed through CheckList-OCRA and processed statistically using IBM SPSS Statistics Software. The results indicate that the tasks performed by workers factors most critical biomechanical risk and that are most important intrinsic value index (CheckList OCRA) are: Posture (correlation values 0,89 and 0,87 for the tip upper right and left, respectively); Strength (correlation values 0,87 and 0,86 for the upper right and left end, respectively); and frequency (correlation values 0,81 and 0,71 for the right upper extremity and left, respectively). Moreover, a total of 21 seats tested, 67% (14) have a level of "high" (values intrinsic rate of 22,5) risk. Of these, the largest number of workers are concentrated in positions of despinado Manual and Scenery (70% of total sample). The research findings suggest that older Prevention efforts should focus on critical positions (middle-level high risk), mainly to those involving a greater mass of workers (despinado Manual and decorado). These indications are slated to be aimed at improving technical work, elimination of unnecessary technical actions, improved tools, redesigning the production line layout, plus rotation functions.

Desarrollo de tablas de evaluación y factores de ponderación del riesgo asociado a tipos de técnicas de manipulación en tareas con manipulación manual de cargas dinámico-asimétricas / Development of evaluation tables and weighting factors of risk associated to types of handling techniques in Manual handing tasks of dynamic-asymmetric Loads

OBJETIVO: Describir factor de ponderación de riesgo del factor técnica de manipulación combinada (5 técnicas), analizando sus diferencias en condición dinámico-asimétrica, considerando la carga biomecánica en los segmentos extremidades superiores y columna. MÉTODO: Estudio cuasiexperimental, analítico y transversal, muestra por conveniencia de 100 sujetos (hombres y mujeres) en edad laboral, de la comunidad universitaria de la Universidad de Chile, evaluando cinco técnicas de manipulación de carga, utilizando sistema optoelectrónico, 3D Static Strength Prediction Program, electromiografía de superficie y percepción de esfuerzo. RESULTADOS: En extremidades superiores, se describen diferencias significativas entre técnicas en todas las variables de análisis biomecánico: el patrón de torque, activación muscular y percepción de esfuerzo es mayor en la técnica simétrica sobre hombros y asimétrica que en las otras técnicas. A nivel de columna, la actividad electromiográfica a nivel de erectores espinales entre técnicas es estadísticamente significativa. CONCLUSIÓN: Las técnicas con mayor carga biomecánica son las técnicas "Simétrica sobre Hombro" y "Asimétrica". La técnica "Simétrica a nivel de caderas" genera una carga intermedia, las técnicas "Simétrica a nivel de tronco" y de "Una mano" tienden a ser similares y las menos exigentes.

To describe risk weighting factor of combined manipulation technique factor (5 Technical), analyzing their differences in dynamic-asymmetrical condition, considering the biomechanical load on the upper limbs and spine segments. METHOD: Quasi-experimental, analytical and cross-sectional study, convenience sample of 100 subjects (male and female) in working age, from University of Chile community, assessing five load-handling techniques using optoelectronic system, 3D Static Strength Prediction Program, surface electromyography and perceived exertion. RESULTS: in upper extremities, significant differences in all variables techniques of biomechanical analysis are described: the pattern of torque, muscle activation and perceived exertion is higher in the symmetric on shoulders and asymmetric technique than the other techniques. In a column level, the electromyographic activity in a spinal erector level between techniques is statistically significant. CONCLUSION: The techniques with more biomechanical loading are "Symmetric on Shoulder" and "asymmetric" techniques. The "symmetrical hips level" technique generates an intermediate charge, techniques "trunk level Symmetric" and "One hand" tend to be similar and less demanding.