Exposure of 4-year to 24-year olds to tobacco imagery on prime-time Chilean television.

INTRODUCTION: The extent of the population's exposure to tobacco imagery across all genres of regular TV programming and the contribution of each of these genres is unknown, except for UK broadcast channels. The objective of this study is to estimate the exposure of young people to tobacco imagery on Chilean prime-time television and the programme source contributing to such exposure. METHODS: Programmes aired during 3 weeks in 2019 from the 15 highest audience channels in Chile were content-analysed for the occurrence of tobacco categorised as actual use, implied use, tobacco paraphernalia, tobacco brand appearances and whether they violated Chilean smoke-free law for each 1 min interval (92 639). The exposure of young people to tobacco content was estimated using media viewership figures. RESULTS: Young people received 29, 11 and 4 million tobacco impressions of any type, explicit use and smoke-free violation, respectively, at a rate of 21.8, 8.0 and 2.1 thousand impressions per hour of TV viewing. The main sources of exposure to tobacco impressions were feature films and animated productions, which were almost entirely non-Chilean. Finally, young people were exposed to tobacco brand impressions primarily through films, effectively circumventing the advertising ban in Chile. DISCUSSION: Television programming is a source of significant youth exposure to tobacco imagery, including branding impressions. To conform to the WHO FCTC, Chile should prohibit tobacco branding in any TV programme and require strong anti-tobacco advertisements prior to any TV programme portraying tobacco.

Exposure to tobacco impressions during prime-time TV among Chilean minors by sex and socioeconomic status.

INTRODUCTION: We tested if tobacco impressions were delivered differentially to prime-time TV watching minors by sex and socioeconomic status. METHODS: Programs aired during prime-time for three random weeks in 2019 from the 15 highest audience channels in Chile were content-analyzed for the occurrence of tobacco for each one-minute interval of 92639 recorded. Such occurrences were categorized as actual use and whether they violated Chilean smoke-free law or tobacco brand appearances. We estimated the number of persons per hour (p/h) exposed to tobacco impressions for the 4 to 17 years age group by sex and socioeconomic status (SES). RESULTS: Minors spent over a billion p/h watching TV during the observation period. Minors were exposed to tobacco explicit use, branding and smoke-free violation impressions for 9.7 million, 1.2 million, and 1.0 million p/h, respectively. The odds ratios (OR) of exposure to total tobacco impressions were always greater among boys with higher SES compared to boys with low SES. However, they were greater among girls of low SES compared to those of high SES for all types of impressions. The OR of exposure to tobacco branding was higher among girls of any SES compared to boys of any SES. CONCLUSIONS: Minors need protection from tobacco imagery on television, particularly girls of low SES. To that end, new legislation should implement all measures to counter depictions of tobacco in entertainment media, as recommended in the WHO FCTC Article 13 guidelines. This should require strong anti-tobacco advertisements before any TV program portraying tobacco targeting minor audiences, particularly girls of low SES. Given that Chile has one of the highest prevalences in the world of current cigarette smoking among young females, the potential contribution of tobacco impressions on TV to smoking differentials across female socioeconomic groups should be further studied.

Hospitalización domiciliaria: aspectos conceptuales y su aplicación en el Hospital Padre Hurtado, Santiago de Chile. Descripción de funcionamiento y su rol durante la primera ola de la pandemia COVID-19 / Description of the operation of a home hospitalization unit in a public hospital at Santiago, Chile

This article briefly discloses what home hospitalization consists of, its different models of care, and the benefits and difficulties associated with it. We also describe the operation of the home hospitalization unit of the Padre Hurtado Hospital in Santiago de Chile and the role it took in the context of the first wave of the COVID-19 Pandemic, specifically between March and August of the year 2020. We aim to share our experience with this emerging form of hospitalization that is already working in Chilean public hospitals. We also hope that this hospitalization modality will continue to grow over the years.

Seroprevalencia y estimación del impacto de la infección por SARS-CoV-2 en personas mayores residentes en centros de larga estadía en Chile / Seroprevalence and estimation of the impact of SARS-CoV-2 infection in older adults residing in Long-term Care Facilities in Chile

INTRODUCTION: Older adults are at a higher risk of severe illness and death from COVID-19. This vulnerability increases in those who live in long-term care facilities due to overcrowding, greater physical dependence, and contact with health workers. Evidence on the impact of the pandemic on these establishments in lowand middle-income countries has been scant. This study aims to determine the seroprevalence of SARS-CoV-2 in older people residing in long-term care facilities and estimate the impact of infection after the first wave of the pandemic. METHODS: A cross-sectional design with 2099 residents in three regions of Chile was carried out between September and November 2020. Measurement of antibodies was performed with a rapid test. The impact of SARS-CoV-2 infection was estimated with seropositive residents, those who had a history of positive polymerase chain reaction tests, and those who died from COVID-19. Bivariate analysis with the region, sex, age, history of COVID-19, physical dependence, and serological results were performed. In addition, we performed a correlation analysis between the seroprevalence of the centers by the municipality and the rate of confirmed cases. RESULTS: The seroprevalence of SARS-CoV-2 antibodies in the three regions was 14.7% (95% confidence interval: 13.2 to 16.3%), the infection impact was 46.4%, and the fatality rate was 19.6%. A significant correlation was found between the seroprevalence of older adults residing in long-term care facilities and the cumulative incidence by municipalities. CONCLUSIONS: The seroprevalence of older adults residing in long-term care facilities was higher than the general population. The high impact of infection among this population at the end of the first wave of the COVID-19 pandemic is similar to other countries. The centers' environment is directly related to COVID-19 infection. Morbidity and mortality monitoring systems should be implemented promptly to establish prevention and control measures.

INTRODUCCIÓN: Las personas mayores tienen más riesgo de enfermar gravemente y fallecer por COVID-19. Esta vulnerabilidad aumenta en quienes viven en establecimientos de larga estadía, debido a hacinamiento, mayor dependencia física y contacto con los trabajadores. La evidencia sobre el impacto de la pandemia de estos establecimientos en países de medianos y bajos ingresos ha sido escasa. El objetivo es determinar la seroprevalencia de la infección por SARS-CoV-2 en personas mayores que residen en establecimientos de larga estadía. Así como estimar el impacto global de la infección después de la primera ola de la pandemia. MÉTODOS: Diseño transversal con 2099 residentes en tres regiones de Chile, realizado entre septiembre y noviembre 2020. Anticuerpos fueron medidos con test rápido contra SARS-CoV-2. Se estimó el impacto de la infección con los residentes seropositivos, los residentes con antecedentes de reacción en cadena de la polimerasa de transcripción inversa positiva, y residentes que murieron por COVID-19. Análisis bivariado entre el resultado serológico y región, sexo, edad, antecedentes de COVID-19 y dependencia física fueron realizados. Además, realizamos un análisis de correlación entre la seroprevalencia de los centros por municipio y la tasa acumulada de casos confirmados. RESULTADOS: La seroprevalencia de anticuerpos en las tres regiones fue 14,7% (intervalo de confianza del 95%: 13,2 a 16,3%). El impacto real de la infección se estimó en 46,4% y la tasa de letalidad en 19,6%. La seroprevalencia de los residentes de los centros por comuna se correlacionó positiva y significativamente con la frecuencia de la enfermedad a nivel comunal. CONCLUSIONES: Seroprevalencia superior a la de la población general, observándose un alto impacto de la infección por COVID-19 al final de la primera ola de la pandemia. El lugar en el que se encuentran los establecimientos está directamente relacionado con la tasa de seroprevalencia en ellos. Sistemas de vigilancia epidemiológica deben aplicarse con prontitud para establecer medidas de prevención y control.

Compliance with the smoking ban in enclosed, semiopen and open areas of workplaces and public places in Chile.

OBJECTIVE: To assess the national level of compliance with the Chilean comprehensive smoke-free legislation by observing healthcare facilities, education centres, government offices, hospitality venues and private workplaces, by type of area within workplaces and public places: enclosed, semiopen and open. METHODOLOGY: In this cross-sectional observational study, we studied a national representative sample of 3253 venues obtained through a two-stage cluster sampling design. First, 57 municipalities were randomly selected, proportionally to the total number of venues of interest. Second, within each selected municipality, a maximum of 12 venues of each sector was selected systematically from a list of existing sites. We determined the non-compliance level by estimating the percentage of the visited venues where smoking was observed or suspected in banned areas of the premises. RESULTS: Smoking or suspicion thereof was not observed in any enclosed area of any establishment. However, smoking violations were observed in semiopen areas ranging from less than 0.5% of schools and healthcare centres to around 10% of hospitality venues or 23.0% of higher education centres. Smoking violations were also observed in outdoor areas of 6.7% and 1.6% of the health centres and schools, respectively. DISCUSSION: The stark contrast in compliance with the smoking ban between the enclosed areas and the semiopen areas may be a consequence of the complex definition of semiopen areas in the regulations. The study also reflects the need to improve the overall enforcement of the smoke-free law, particularly in universities and hospitality venues.

Compliance with the smoking ban in urban public transportation in Chile.

INTRODUCTION: The aim of the study is to assess the national level of compliance with the Chilean smoke-free legislation in the urban public transportation system. METHODS: In this cross-sectional observational study, we studied a national representative sample of 475 vehicles obtained through a two-stage cluster sampling design in 2018. First, 57 municipalities were randomly selected, proportionally to the total number of public transportation vehicles. Second, within each municipality, a convenience sample of up to 4 taxis, 4 buses, and 2 metro coaches was observed. We determined the non-compliance level by systematic direct observation of smoking inside the cabin of the vehicle. We estimated the percentage of the visited vehicles where smoking was observed inside the cabin of the vehicle. RESULTS: The observation of metros, buses and taxis was completed in 24, 52, and 48, of the 57 sampled municipalities, respectively. Smoking was observed inside of about 2% of buses and 7% of taxis. Smoking was not observed in metro carriages. Overall, smoking was observed in almost 3% of the vehicles studied. A 3% noncompliance could expose a significant number of persons in public transportation to secondhand smoke, given that every 100 inhabitants results in about 84 rides a day of almost one hour duration. There are few comparable studies to put in an international context our results. In 2018, the year in which we collected the data, WHO considered that compliance with the law in public transportation was maximum. Our compliance estimate was lower, however WHO used a different methodology and its scope also included the inter-urban mobility, which we did not. CONCLUSIONS: The study highlights the need to improve the enforcement of the smoke-free law in the transportation system in Chile, which presently is almost non-existent.

Hepatitis B and C virus infection among HIV patients within the public and private healthcare systems in Chile: A cross-sectional serosurvey.

BACKGROUND: Coinfections of HIV patients with hepatitis B virus (HBV) and hepatitis C virus (HCV) are mayor public health problems, contributing to the emerging burden of HIV-associated hepatic mortality. Coinfection rates vary geographically, depending on various factors such as predominant transmission modes, HBV vaccination rates, and prevalence of HBV and HCV in the general population. In South America, the epidemiology of coinfections is uncertain, since systematic studies are scarce. Our study aimed to analyze rates of HBV and HCV infection in people living with HIV attending centers of the public and private health system in Chile. METHODS: We performed a cross-sectional study including a public university hospital and a private health center in Santiago, Metropolitan Region in Chile. Serum samples were used to determine serological markers of hepatitis B (HBsAg, anti-HBs, anti-HBc total, HBeAg, anti-HBe) and anti-HCV. Demographic, clinical and laboratory data were obtained from medical records. RESULTS: 399 patients were included (353 from public, 46 from private health center). Most (92.8%) were male, with a median age of 38.3 years; 99.4% acquired HIV through sexual contact (75.0% MSM); 25.7% had AIDS and 90.4% were on ART. In 78.9%, viral loads were <40 cps/mL; the median CD4 cell count was 468 cells/mm3. According to their serological status, 37.6% of patients were HBV naïve (susceptible), 6.5% were vaccinated, 43.6% had resolved HBV infection, and 5.8% were chronically infected. The rate of vaccination was 4.5% in the public and 21.7% in the private system. HCV coinfection was found in 1.0% of all patients. CONCLUSION: HBV coinfection rate was within the range of other South American countries, but lower than in non-industrialized regions in Asia and Africa. A low percentage of patients were HBV vaccinated, especially within the public system. HCV coinfection rate was very low, most probably due to the rareness of injecting drug use.

El deterioro de la tuberculosis en Chile / Worsening situation of tuberculosis in Chile

Background: Recent data suggest an increase in tuberculosis (TB) incidence in Chile. Aim: To evaluate recent epidemiological trends, geographic extension and potential factors associated with TB reemergence in Chile. Material and Methods: Data analysis from official sources and trend analysis. Results: TB incidence rate increased from 12.3 (2014) to 14.7 (2017) per 100,000 inhabitants. Morbidity rates also increased in nine out of 15 regions. The proportion of TB cases in specific groups has also increased in the last six years: HIV/AIDS (68%), immigrants (118%), drug users/alcoholics (267%) and homeless people (370%). Several indicators of the national TB program performance have deteriorated including TB case detection, HIV co-infection study and contact tracing activities. Overall results indicate a higher than expected case-fatality ratio (> 3%), high rates of loss from follow-up (> 5%), and low percentage of cohort healing rate (< 90%). This decline is associated with a Control Program with scarce human resources whose central budget decreased by 90% from 2008 to 2014. New molecular diagnostic tools and liquid media culture were only recently implemented. Conclusions: TB trends and overall program performance indicators have deteriorated in recent years in Chile and several factors appear to be involved. Multiple strategies will be required to rectify this situation.

¿Sirven las ayudas técnicas a las personas mayores? Percepción desde la Atención Primaria sobre esta Garantía Explícita en Salud, Santiago, Chile / Are technical aids useful for elderly people? The perception of primary health care-based informants about this Explicit Health Guarantee in Santiago, Chile

OBJETIVO: Conocer la percepción de informantes clave pertenecientes a la red de Atención Primaria de Salud en Chile, respecto al proceso de gestión asistencial y el impacto del programa nacional de Garantías Explícitas en Salud (GES) sobre la entrega de ayudas técnicas a personas mayores. MATERIALES Y MÉTODOS: Un estudio cualitativo basado en análisis de casos múltiples, en el cual se realizó entrevistas semi-estructuradas a 8 informantes clave de la red asistencial, fue desarrollado en 2015 en tres comunas de Santiago, Chile. El análisis de la información recogida se realizó mediante análisis de contenido, y se finalizó el muestreo de máxima variación al saturar la información. Se resguardaron los criterios de rigor científico y el protocolo fue aprobado por un Comité de Ética. RESULTADOS: Hay una percepción de cobertura y detección de necesidad como adecuada en pacientes bajo control, aunque desde la perspectiva de los informantes, hay desconocimiento de esta garantía en la población. La necesidad es detectada por cualquier profesional de salud, pero la indicación es exclusivamente médica, lo que genera barreras de acceso. Hay una entrega oportuna; sin embargo, no se realiza seguimiento ni se aprecia como parte de una atención integral. Se percibe que la ayuda técnica es de calidad y la articulación de la red es adecuada, aunque no hay retroalimentación a Atención Primaria de Salud. El impacto lo consideran positivo en pacientes y familiares: mejora la ejecución de actividades diarias y genera mayor autonomía y capacidad de desplazamiento. CONCLUSIONES: Existe una percepción positiva de este programa GES y su impacto en la mejoría en la calidad de vida de vida de los pacientes. Pero, la entrega de ayudas técnicas se encuentra desvinculada de una atención integral, por ende, este programa prioriza sólo la garantía de oportunidad.

OBJECTIVE: To assess the perception of key informants working in Primary Health Care in Chile, regarding the administration and impact of the national Explicit Health Guarantees (GES) program which provides technical aids to vulnerable elderly adults. MATERIAL AND METHODS: A qualitative study, based on multiple case analysis of semi--structured interviews with 8 key informants of the healthcare network, was conducted in 2015 in three municipalities of Santiago, Chile. The collected information was analyzed by means of content analysis, and máximum variation sampling was carried out until the data saturation point was reached. Rigorous scientific criteria were safeguarded, and the study protocol was approved by an Ethics Committee. RESULTS: Patients deemed the program's coverage and detection of needs to be adequate, although informants conveyed that the general population is largely unaware of the program. While any health professional can detect a patient's need for technical aids, only physicians can prescribe the devices, which generates access barriers. Technical aid delivery is timely; however, it is not monitored or considered to form part of a comprehensive care system. Assistive devices are perceived to be high quality, and the delivery network coordination is seen as adequate, although there is no feedback to Primary Health Care. The program's impact is considered positive among patients and family members, as it improves the performance of daily activities and generates greater autonomy and mobility. CONCLUSIONS: This GES program is positively perceived and viewed to improve patients' quality of life. However, the delivery of technical aids is disconnected from an integral care approach, and thus the program only prioritizes the guarantee of opportunity.

Correlates of compliance with national comprehensive smoke-free laws.

OBJECTIVE: To explore correlates of high compliance with smoking bans in a cross-sectional data set from the 41 countries with national comprehensive smoke-free laws in 2014 and complete data on compliance and enforcement. METHODS: Outcome variable: compliance with a national comprehensive smoke-free law in each country was obtained for 2014 from the WHO global report on the global tobacco epidemic. Explanatory variables: legal enforcement requirements, penalties, infrastructure and strategy were obtained through a separate survey of governments. Also, country socioeconomic and demographic characteristics including the level of corruption control were included. ANALYSIS: an initial bivariate analysis determined the significance of each potentially relevant explanatory variable of high compliance. Differences in compliance were tested using the exact logistic regression. RESULTS: High compliance with the national comprehensive smoke-free law was associated with the involvement of the local jurisdictions in providing training and/or guidance for inspections (OR=10.3, 95% CI 1.7 to 117.7) and a perception of high corruption control efforts in the country (OR=7.2, 95% CI 1.1 to 85.8). DISCUSSION: The results show the importance of the depth of the enforcement infrastructure and effort represented by the degree to which the local government is involved in enforcement. They also show the significance of fighting corruption in the enforcement process, including the attempts of the tobacco industry to undermine the process, to achieve high levels of compliance with the law. The results point out to the need to invest minimal but essential enforcement resources given that national comprehensive smoke-free laws are self-enforcing in many but not all countries and sectors.

Características clínicas y factores pronósticos de la enfermedad meningocóccica: un estudio de serie de casos en Chile durante el brote 2012-2013 / Clinical features and prognostic factors of meningococcal disease: a case series study in Chile during the 2012-2013 outbreak

Introduction: Meningococcal disease (MD) is a major global problem because of its case fatality rate and sequels. Since 2012 cases of serogroup W have increased in Chile, with nonspecific clinical presentation, high case fatality rate and serious consequences. Objective: To characterize the evolution and outcome of MD cases between January 2012 and March 2013 in Chile. Material and Methods: Case series considering149 MD cases of 7 regions. A questionnaire was applied and clinical records were reviewed, including individual, agent, clinical course and healthcare process variables. The analysis allowed to obtain estimates of the OR as likelihoodof dying. Results: 51.5% was meningococcemia, the case fatality rate reached 27%, prevailing serogroup W (46.6%). Factors that increased the probability of dying: > age, belonging to indigenous people, having lived a stressful event, having diarrhea, impaired consciousness, cardiovascular symptoms, low oxygen saturation and low Glasgow coma scale score. Discussion: The case fatality rate exceeded normal levels and was higher in serogroup W. Increasing in this serogroup, associated to the increased presence of nonspecific symptoms or rapid progression to septicemia, hit a health system accustomed to more classic meningococcal disease presentation, which could partly explain the observed increased fatality rate.

Introducción: La enfermedad meningocóccica (EM) es un importante problema mundial por su letalidad y secuelas. Desde 2012 aumentaron en Chile los casos por serogrupo W, con presentación clínica inespecífica, elevada letalidad y secuelas graves. Objetivo: Caracterizar la evolución y desenlace de EM en casos desde enero de 2012 a marzo de 2013 en Chile. Material y Método: Serie de 149 casos de EM de siete regiones. Se aplicó un cuestionario y se revisaron registros clínicos, incluyendo variables del individuo, agente, curso clínico y proceso de atención. Los análisis permitieron obtener OR como estimadores de la probabilidad de fallecer. Resultados: El 51,5% se presentó como meningococcemia, la letalidad alcanzó a 27%, predominando el serogrupo W (46,6%). Aumentaron la probabilidad de fallecer: una mayor edad, pertenencia a pueblos originarios, haber vivido evento estresante, presentar diarrea, compromiso de conciencia, síntomas cardiovasculares, baja saturación de oxígeno y bajo puntaje de Glasgow. Discusión: La letalidad superó las frecuencias habituales y fue mayor en el serogrupo W. El aumento de este serogrupo, asociado a la mayor presencia de síntomas inespecíficos o a la rápida progresión a septicemia, impactó en un sistema de salud habituado a cuadros más clásicos de EM, lo que podría explicar en parte, la mayor letalidad observada.

Barreras y facilitadores para el control prenatal en adolescentes: resultados de un estudio cualitativo en Chile / Barriers and facilitators to antenatal care in adolescents: results of a qualitative study in Chile

Objetivo. Analizar barreras y facilitadores de acceso a control prenatal en adolescentes urbanas de 15-19 años en Santiago, Chile. Material y métodos. Estudio cualitativo con 17 madres adolescentes basado en la teoría fundamentada. Se realizaron 11 entrevistas semiestructuradas y un grupo focal. Resultados. La negación y ocultamiento del embarazo es la principal barrera para ingresar a control en el grupo de acceso tardío; no se identificaron facilitadores. Para mantenerse en control, todas las participantes identifican como facilitador contar con una figura de apoyo. La vulnerabilidad familiar y social explica que algunas adolescentes ingresen a control tardíamente. Conclusión. La presencia de facilitadores es determinante para el ingreso oportuno y mantenerse en control, ya que reduce o anula el efecto de las barreras. El sistema de salud debe constituirse en un facilitador que acompañe desde muy temprano a las adolescentes favoreciendo un vínculo de confianza y respeto.

Objective. Analyze barriers and facilitators of access to prenatal care in pregnant urban adolescents between 15-19 years of age in Santiago, Chile. Materials and methods. Qualitative study based on grounded theory with 17 adolescent mothers. Eleven semi-structured interviews and one focus group were conducted. Results. The denial and concealment of pregnancy is the main barrier to start the prenatal care in the "delayed access group". This group does not identify facilitators. For maintenance in antenatal care, all participants identified a support figure as a facilitator. Family and social vulnerabilities explain why some adolescents start the prenatal care late. Conclusion. The presence of facilitators is crucial for both, the timely entry and the maintenance in antenatal care because they reduce or nullify the effect of barriers. The health system must become a facilitator to accompany adolescents and promote a bond of trust and respect.

Tropical high-altitude Andean lakes located above the tree line attenuate UV-A radiation more strongly than typical temperate alpine lakes.

Tropical high-altitude Andean lakes are physically harsh ecosystems. Located above the treeline (≥4000 m a.s.l.), they share common features with temperate alpine lakes, which impose extreme conditions on their aquatic organisms: e.g., strong winds, broad diel variations in water temperature, and intense solar ultraviolet radiation (UVR). However, because of their latitude, they differ in two major ecological characteristics: they lack ice cover during the winter and they do not present summer water column stratification. We sampled 26 tropical high-altitude Andean lakes from three regions of the Bolivian Eastern Andes Cordillera during the wet period (austral summer). We performed an ordination to better describe the typology of Andean lakes in relation to the environmental variables, and we assessed the relationships among them, focussing on the UV-A transparency (360 nm) throughout the water column. We found a positive correlation between UV-A transparency calculated as Z(1%) (the depth which reaches 1% of the surface UV-A), the lake maximum depth and Secchi transparency (r = 0.61). Z(1%) of UV-A was smaller in shallow lakes than in deep lakes, indicating that shallow lakes are less transparent to UV-A than deep lakes. We hypothesize that, compared to shallow lakes, deep lakes (maximum depth > 10 m) may have lower dissolved organic carbon (DOC) concentrations (that absorb UV radiation) due to lower temperature and reduced macrophyte cover. Based on our data, tropical high-altitude Andean lakes are less transparent to UV-A (K(d) range = 1.4-11.0 m(-1); Z(1%) depth range = 0.4-3.2 m) than typical temperate alpine lakes (1-6 m(-1), 3-45 m, respectively). Moreover, they differ in vertical profiles of UV-A, chlorophyll-a, and temperature, suggesting that they may have a distinct ecological functioning. Such peculiarities justify treating tropical high-altitude Andean lakes as a separate category of alpine lakes. Tropical high-altitude Andean lakes have been poorly studied. Thus they deserve more in-depth studies in the face of global changes regarding the use of their UV transparency as a sentinel proxy of climate changes, particularly global warming.

Major cardiovascular risk factors in Latin America: a comparison with the United States. The Latin American Consortium of Studies in Obesity (LASO).

BACKGROUND: Limited knowledge on the prevalence and distribution of risk factors impairs the planning and implementation of cardiovascular prevention programs in the Latin American and Caribbean (LAC) region. METHODS AND FINDINGS: Prevalence of hypertension, diabetes mellitus, abnormal lipoprotein levels, obesity, and smoking were estimated from individual-level patient data pooled from population-based surveys (1998-2007, n=31,009) from eight LAC countries and from a national survey of the United States (US) population (1999-2004) Age and gender specific prevalence were estimated and age-gender adjusted comparisons between both populations were conducted. Prevalence of diabetes mellitus, hypertension, and low high-density lipoprotein (HDL)-cholesterol in LAC were 5% (95% confidence interval [95% CI]: 3.4, 7.9), 20.2% (95% CI: 12.5, 31), and 53.3% (95% CI: 47, 63.4), respectively. Compared to LAC region's average, the prevalence of each risk factor tended to be lower in Peru and higher in Chile. LAC women had higher prevalence of obesity and low HDL-cholesterol than men. Obesity, hypercholesterolemia, and hypertriglyceridemia were more prevalent in the US population than in LAC population (31 vs. 16.1%, 16.8 vs. 8.9%, and 36.2 vs. 26.5%, respectively). However, the prevalence of low HDL-cholesterol was higher in LAC than in the US (53.3 vs. 33.7%). CONCLUSIONS: Major cardiovascular risk factors are highly prevalent in LAC region, in particular low HDL-cholesterol. In addition, marked differences do exist in this prevalence profile between LAC and the US. The observed patterns of obesity-related risk factors and their current and future impact on the burden of cardiovascular diseases remain to be explained.

Implementación del regulamento sanitario internacional (2005): reporte de progreso / International health regulations (2005) implementation: progress report

El siguiente documento da cuenta del grado de avance en la implementación del RSI (2005) en Chile, de acuerdo a las áreas de trabajo sugeridas por la Organización Mundial de la Salud (OMS), las que por facilidad del informe se han organizado en las siguientes: 1) Impulso de las alianzas con otros sectores, 2) Fortalecimiento de los sistemas nacionales de vigilancia, prevención, control y respuesta a las enfermedades, que incluye el fortalecimiento de los sistemas de alerta y respuesta, 3) Fortalecimiento de la Seguridad Sanitaria en los Viajes y el Transporte, 4) Fortalecimiento de la gestión de riesgos específicos, 5) Respaldo de los derechos, obligaciones y procedimientos, 6) Realización de estudios y vigilancia de los progresos. En cada una de las secciones se señalan el objetivo y los avances, considerando para su descripción los resultados previstos para cada una de las áreas de trabajo.

The following document realizes the degree of progress of the IHR (2005) in Chile, according to the work areas suggested by WHO, which for ease of report has been organized into: 1) promotion of partnerships with other sectors, 2) Strengthening ofthe surveillance, prevention, control and disease response national systems, including strengthening of alert and response systems, 3) Strengthening of health safety in travels and transportation, 4) Strengthening of specific risk management, 5) Support of rights, obligations and procedures, 6) Research and progress monitoring. En each section it is noted the objective and advances, considering for description the expected results for each work areas.

Púrpura de Schõnlein-Henoch, presentación en el adulto / Schõnlein-Henoch purpura, presentation in the adult

Los síndromes plurigandulares autoinmunes se definen por la coexistencia de al menos dos insuficiencias glandulares a consecuencia de una pérdida de la inmunotolerancia. Existen 4 tipos, siendo el tipo 2 el más frecuente. Es condición indispensable la presencia de insuficiencia suprarrenal primaria para hacer el diagnóstico de éste último, pudiendo muchas veces ésta preceder a las otras endocrinopatías que lo conforman: enfermedad tiroidea autoinmune y/o diabetes mellitus tipo 1. La insuficiencia suprarrenal primaria se caracteriza por la producción adrenal deficiente de cortisol, mineralocorticoides y andrógenos. Es una enfermedad poco frecuente que se presenta habitualmente en mujeres en edad media, siendo su etiología más prevalente la adrenalitis autoinmune. Se discute el caso de una paciente de 35 años que consulta por híperpigmentación de piel y episodios presincopales como presentación de una Enfermedad de Addison. La paciente presentó además amenorrea de 8 años de evolución y un bocio grado II lo cual nos llevó a plantear que era portadora de un sindrome plurigandular autoinmune tipo 2.

Importance of animal/human health interface in potential Public Health Emergencies of International Concern in the Americas / Importancia de la interfaz entre la salud humana y la sanidad animal en las posibles emergencias de salud pública de importancia internacional en la Región de las Américas

This study analyzed the importance of zoonoses and communicable diseases common to man and animals as potential Public Health Emergencies of International Concern to build an evidence base for future efforts to reduce risk of infection at the animal/human health interface. The events recorded in the World Health Organization (WHO) Event Management System (EMS) database for the Americas during the 18 months since the implementation of the 2005 revised version of WHO's International Health Regulations (15 June 2007-31 December 2008) were the main source for this analysis. Of the 110 events recorded by the EMS for the Americas during the study period, 86 were classified as communicable diseases-77 (70.0 percent) "within the animal/human health interface," 9 (8.2 percent) "not common to man and animals," 16 (14.5 percent) "syndromes with unknown etiologies," and 8 (7.3 percent) "product-related/ other." Of the 77 events within the animal/human health interface, 48 were "substantiated" (the presence of hazard was confirmed and/or human cases occurred clearly in excess of normal expectancy). These results confirm previous research and underscore the importance of the animal/human health interface as well as inter-sectoral collaboration.

En este estudio se analizó la importancia de las zoonosis y las enfermedades transmisibles comunes a los seres humanos y los animales como posibles emergencias de salud pública de importancia internacional, a fin de sentar una base científica para las actividades futuras destinadas a reducir el riesgo de infección en la interfaz entre animales y seres humanos. La fuente principal para este análisis fueron los eventos registrados en la base de datos del Sistema de Gestión de Eventos de la Organización Mundial de la Salud (OMS) para las Américas durante los 18 meses que transcurrieron (15 de junio del 2007 al 31 de diciembre del 2008) desde la puesta en marcha del Reglamento Sanitario Internacional de la OMS (versión revisada en el 2005). De los 110 eventos registrados por el Sistema de Gestión de Eventos para las Américas durante el período de estudio, 86 se clasificaron como enfermedades transmisibles -77 (70,0 por ciento) como "dentro de la interfaz entre animales y seres humanos" y 9 (8,2 por ciento) como "no comunes a seres humanos y animales"-, 16 (14,5 por ciento) como "síndromes de etiología desconocida", y 8 (7,3 por ciento) como "relacionados con productos/otros". De los 77 eventos comprendidos dentro de la interfaz entre animales y seres humanos, se fundamentaron 48 (se confirmó la presencia del riesgo u ocurrieron casos en seres humanos que claramente superaron los casos esperados). Estos resultados confirman las investigaciones anteriores y destacan la importancia de la interfaz entre la salud humana y la sanidad animal, así como la importancia de la colaboración intersectorial.

Sistema de vigilancia de rotavirus en hospitales centinelas en Chile / Rotavirus surveillance system in Chilean sentinel hospitals

OBJETIVO: las diarreas son una de las principales causas de morbilidad y mortalidad en el mundo. En Chile, su vigilancia es una prioridad, muy en particular las causadas por rotavirus para conocer su epidemiología, incluidos los serotipos circulantes y detectar brotes oportunamente. MÉTODOS: se implementó un sistema de vigilancia en 8 hospitales pedißtricos, considerados sitio centinela por cubrir 62 por ciento de la población menor de 5 años de las regiones Metropolitana, Valparaíso y Bio-Bio. Se utilizaron las definiciones de caso estandarizadas por la Organización Mundial de la Salud. Las muestras fueron analizadas en los laboratorios del Instituto de Salud Pública con la técnica inmunoensayo enzimßtico en el formato de ELISA. El sistema se basa en un formulario electrónico en línea, sobre plataforma de programación PHP versión 5.2.6, diseñado para creación de páginas web dinßmicas, accesible mediante clave o password de los terminales del centro centinela, de la Secretaria Regional Ministerial de Salud e Instituto de Salud Pública, donde se introducen las variables semanal y mensualmente de forma definitiva. El anßlisis se realiza en el programa estadístico Epinfo-2000. RESULTADOS: en 8 meses de vigilancia, se estudiaron 599 muestras de deposiciones, 164 positivas a rotavirus (27,4 por ciento), tasa de 0,2 por 1 000 habitantes. Al sexo masculino pertenece 56 por ciento, el menor de 2 años es el más afectado (69 por ciento). CONCLUSIONES: la implementación del sistema de vigilancia centinela para rotavirus constituye una herramienta útil para conocer el comportamiento de esta enfermedad y contribuir a la toma de decisiones por los programas nacionales de salud.

OBJECTIVE: diarrheas are one of the main causes of morbidity and mortality worldwide. In Chile, diarrhea surveillance is a priority, particularly those caused by rotavitus, in order to find out their epidemiology including circulating serotypes and to promptly detect possible outbreaks. METHODS: a surveillance system was implemented in 8 pediatric hospitals considered as sentinel sites because they cover 62 percent of the under 5 years-old population from Metropolitana, Valparaiso and Bio-Bio regions. The standardized case definitions of the World Health Organization were used. The sample analysis was based on ELISA method in the Public Health Institute laboratories. The surveillance system is based on an online electronic form supported on PHP platform, 5.2.6 version, designed to create dynamic and accessible webpages through passwords from the sentinel center terminals of the Regional Ministerial Department of Health and the Public Health Institute; the variables are weekly and monthly introduced. The statistical analysis is carried out through Epinfo-2000. RESULTS: five hundred and ninety nine fecal samples were analyzed in eight months; 164 of them were positive to rotavirus (27.4 percent) for a rate of 0.2 per 1000 pop. Fifty six percent were males whereas under 2 years-old group was the most affected (69 percent). CONCLUSIONS: the implementation of the sentinel rotavirus surveillance system is a useful tool for the analysis of this disease behavior and for decision-making in the health national programs.

Distribution patterns, population status and conservation of Melanosuchus niger and Caiman yacare (Crocodylia, Alligatoridae) in oxbow lakes of the Ichilo river floodplain, Bolivia

Caiman yacare (lagarto) and Melanosuchus niger (black caiman), sympatric species in the Bolivian Amazon basin, have been severely overexploited in the past. We present the results of a standardized survey of C. yacare and M. niger populations in order to evaluate their actual population status in twelve oxbow lakes of the Ichilo River floodplain. Additionally we explored the effect of environmental and anthropogenic variables on caiman distribution patterns. The average density of C. yacare and M. niger in the shoreline of floodplain lakes was of 6 and 1 ind/km, respectively. For both species, the population was composed mainly of juvenile individuals. We used regression tree analysis (RTA) to assess patterns of M. niger and C. yacare densities with eight environmental and two anthropogenic variables. The RTA analysis showed that the variation in the densities of both C. yacare (52.4 %) and M. niger (36.8 %) was related to water conductivity. For C. yacare, higher densities occurred at higher values of water conductivity, while M. niger densities followed an opposite trend, resulting in relatively well spatially segregated populations of the two species. After excluding conductivity, Lake-River Distance (LRD) was shown to be the main splitting variable in the RTA analysis. The observed distribution patterns may be the result of the historical post-hunting situation, in combination with differences in habitat selection by the two species, and competitive exclusion processes between the two species. M. niger, a species reported to be recovering slowly from previous low population levels, appears relatively well protected in the Ichilo river floodplain. Rev. Biol. Trop. 56 (2): 909-929. Epub 2008 June 30.

Caiman yacare (lagarto) y Melanosuchus niger (caiman negro), son dos especies simpátricas para la cuenca amazónica Boliviana que han sido severamente sobreexlotadas en el pasado. El objetivo de la presente investigación es el de evaluar el estado actual de su población en doce lagunas meándricas de la planicie del río Ichilo. Se realizaron conteos nocturnos de ambas especies entre octubre y diciembre de 1999 y diciembre del año 2000. La perturbación antropogénica fue medida como el número de días por año por pescador que visitan las lagunas. El promedio de individuos observados en las orillas de las lagunas estudiadas fue de de 6 ind./km para C. yacare y de 1 ind./km para M. Níger. Para ambas especies la población estuvo compuesta mayormente por jóvenes. Los análisis de correspondencia canónica (CCA) separaron las lagunas que se encontraron cerca del río, dominadas por C. yacare, de las remotas, dominadas por M. níger. El "Análisis de Árboles de Regresión" (RTA por las siglas en inglés) de ocho variables ambientales y dos antropogénicas explicó un 52.4% de la variación de la densidad de C. yacare y un 36% de M. niger con la conductividad del agua. La alta conductividad coincidió con densidades mayores de C. yacare (lo opuesto para M. niger). Si se excluye la conductividad, la distancia de la laguna al río es el principal predictor. Factores históricos y humanos podrían estar jugando un papel importante en los patrones de distribución y abundancia de ambas especies en combinación con diferencias en la selección de habitats y/o procesos de competición exclusiva entre las dos especies. La especie M. niger se recupera muy lentamente de los bajos niveles de densidad poblacional previos y está protegida en lagunas alejadas del canal principal del Río.

Baseline assessment of prevalence and geographical distribution of HPV types in Chile using self-collected vaginal samples.

BACKGROUND: Chile has broad variations in weather, economics and population from the far desert north (Region 1) to the cold, icy south (Region 12). A home-based self-collected vaginal sampling was nested in the 2003 Chilean population-based health survey in order to explore the possibility of a type-specific geographical variation for human papillomavirus METHODS: The population was a national probability sample of people 17 years of age and over. Consenting women provided self-collected cervicovaginal swabs in universal collection media (UCM). DNA was extracted and typed to 37 HPV genotypes using PGMY consensus PCR and line blot assay. Weighted prevalence rates and adjusted OR were calculated. RESULTS: Of the 1,883 women participating in the health survey, 1,219 (64.7%) provided a cervicovaginal sample and in 1,110 (56.2% of participants and 66.5% of those eligible) the samples were adequate for analysis. Refusal rate was 16.9%. HPV prevalence was 29.2% (15.1% high-risk HPV and 14.1% low-risk HPV). Predominant high-risk types were HPV 16, 52, 51, 56 and 58. Predominant low-risk HPVs were HPV 84, CP6108, 62, 53 and 61. High-risk and low-risk HPV rates were inversely correlated between the regions. High-risk HPV prevalence was highest among the youngest women, whereas low-risk HPV increased slightly with age. CONCLUSION: Self-obtained vaginal sampling is adequate for monitoring HPV in the community, for identifying high-risk areas, and for surveying the long term impact of interventions.