Behavioral and subjective health changes in US and Mexico border residing participants in two promotora-led chronic disease preventive interventions.

Chronic diseases are the primary health burden among Mexican-origin populations and health promotion efforts have not been able to change negative population trends. This research presents behavioral and subjective health impacts of two related community health worker (CHW) interventions conducted in the US-Mexico border region. Pasos Adelante (United States) and Meta Salud (Mexico) are 12-13 week CHW-led preventive interventions implemented with Mexico-origin adults. Curricula include active learning modules to promote healthy dietary changes and increasing physical activity; they also incorporate strategies to promote social support, empowerment and group exercise components responsive to their communities. Questionnaire data at baseline (N = 347 for Pasos; 171 for Meta Salud), program completion and 3-month follow-up were analyzed. Results showed statistically significant improvements in multiple reported dietary, physical activity and subjective health indicators. Furthermore, at follow-up across both cohorts there were ≥10% improvements in participants' meeting recommended physical activity guidelines, consumption of whole milk, days of poor mental health and self-rated health. While this study identifies some robust health improvements and contributes to the evidence base for these interventions current dissemination, the lack of change observed for some targeted behaviors (e.g. time sitting) suggests they may have stronger overall impacts with curricula refinement.

Conceptual basis for an integrated system for the management of a protected area. Examples from its application in a mediterranean area.

Improving the efficiency of management in protected areas is imperative in a generalized context of limited conservation budgets. However, this is overlooked due to flaws in problem definition, general disregard for cost information, and a lack of suitable tools for measuring costs and management quality. This study describes an innovative methodological framework, implemented in the web application SIGEIN, focused on maximizing the quality of management against its costs, establishing an explicit justification for any decision. The tool integrates, with this aim, a procedure for prioritizing management objects according to a conservation value, modified by a functional criterion; a project management module; and a module for management of continuous assessment. This appraisal associates the relevance of the conservation targets, the efficacy of the methods employed, both resource and personnel investments, and the resulting costs. Preliminary results of a prototypical SIGEIN application on the Site of Community Importance Chafarinas Islands are included.

Effect of Agave tequilana age, cultivation field location and yeast strain on tequila fermentation process.

The effect of yeast strain, the agave age and the cultivation field location of agave were evaluated using kinetic parameters and volatile compound production in the tequila fermentation process. Fermentations were carried out with Agave juice obtained from two cultivation fields (CF1 and CF2), as well as two ages (4 and 8 years) and two Saccharomyces cerevisiae yeast strains (GU3 and AR5) isolated from tequila fermentation must. Sugar consumption and ethanol production varied as a function of cultivation field and agave age. The production of ethyl acetate, 1-propanol, isobutanol and amyl alcohols were influenced in varying degrees by yeast strain, agave age and cultivation field. Methanol production was only affected by the agave age and 2-phenylethanol was influenced only by yeast strain. This work showed that the use of younger Agave tequilana for tequila fermentation resulted in differences in sugar consumption, ethanol and volatile compounds production at the end of fermentation, which could affect the sensory quality of the final product.

Bodyweight gain to predict treatment outcome in patients with pulmonary tuberculosis in Peru.

SETTING: Tuberculosis control programmes of two health care centres in the central rainforest of Peru. OBJECTIVE: To evaluate if bodyweight gain (BWG) predicts treatment outcome in patients with pulmonary tuberculosis (PTB). DESIGN: Retrospective cohort study of adults with PTB diagnosed between 1995 and 2004. BWG was assessed after month 1 of treatment, after the initial phase and at the end of treatment. Patients were stratified into two BWG categories, < or = 5% and >5%. Failures and relapses were grouped together as unsuccessful treatment outcome. RESULTS: A total of 650 patients were included: 7.2% (n = 47) had an unsuccessful outcome. Unsuccessful outcome was associated with BWG < or = 5% at the end of treatment (RR 2.05, 95%CI 1.10-3.80), but not at the completion of month 1 (RR 0.99, 95%CI 0.52-1.88) or at completion of the initial phase (RR 1.46, 95%CI 0.82-2.57). Median BWG at completion of the initial phase was higher in cured patients (P = 0.007). BWG < or = 5% at end of treatment (RR 2.35, 95%CI 1.17-4.72), initial sputum smear 2+ (RR 2.48, 95%CI 1.14-5.31) and positive smear microscopy at month 2 (RR 4.0, 95%CI 1.30-12.31) were independent predictors of unsuccessful treatment outcome. CONCLUSION: BWG < or = 5% at the end of treatment, high bacterial load and lack of sputum conversion correlate with unsuccessful treatment outcome in this setting. New discriminative cut-offs for BWG are proposed.

[Bronchogenic cyst with atypical localization]. / Quiste broncogénico de localización atípica.

Bronchogenic congenital cysts are uncommon. They most frequently develop into the lung parenchyma. Rarely, mediastinal site may occur due to intestinal origin. Bronchogenic cysts seldom arise in the posterior mediastinum. Computerized tomography of the chest allowed a diagnosis of a posterior mediastinal bronchogenic cyst in our patient with poor symptoms. Cyst aspiration and MRI (magnetic resonance imaging) also provide the diagnosis. Treatment is by surgical excision if symptoms occur and have good prognosis.

[Development of products for the elderly population: vitamin enriched pudding]. / Desarrollo de productos para el adulto mayor: budin enriquecido con vitaminas.

An instant dessert powder, pudding type was developed to be consumed at lunch or dinner time. The dessert was designed to be prepared in skim milk and meets the nutritional needs of elderly people. The dessert contains modified starch, carragenine, vegetal fat, sacharose. Each serving has been enriched with 30% of the daily vitamin requirement advised for adults over 51 years old. The optimized process was carried out according to the Karlsruhe test. Each serving consists of 22g powder prepared in proportion of 18% in skim milk. The optimized dessert powder was controlled by means of physical, chemical and microbiological analyses. The sensory quality was determined in the ready to eat product and the acceptability level was measured in a group of people selected according to the characteristics of the target population. The dessert powder contains 1.1% protein, 5.2% fats, 89.76% carbohidrates, and provides 409 Kcal/100g. Both the sensory and microbiological quality were good and the level of acceptance reached 98%.

Evaluación del seguimiento de 29 niños chilenos con la enfermedad de la orina olor a jarabe de arce clásica / Follow up evaluation of 29 chilean children with classical maple syrup urine disease

Introduction: Maple Syrup Urine Disease (MSUD) is caused by a defect of the ketoacid dehydrogenase enzyme complex of the branched amino acids Valine, Isoleucine and Leucine (VIL). The treatment consists of a leucine-restricted diet. Objective: To evaluate the long-term follow-up in children with MSUD. Methodology: 29 records were reviewed of patients with MSUD, of which 24 were clinically identified (> 5th day of life), 4 cases by MSUD family history and one by neonatal screening (< 5th day of life). Leucine (Leu) levels were measured at diagnosis (Biotronic 2000) and during follow-up (mass spectrometry). The number of decompensation events, Total Intellectual Quotient (TIQ, Bayley and Wechsler scale) and nutritional status were also measured. STATA statistical software version 9.2 was applied (p≤0.05). Results: Mean age at diagnosis was 14 days old. In all cases the diagnosis was confirmed by elevated levels of Leu and alloisoleucin. When comparing the TIQ of 19 cases over 3 years old with their age at diagnosis, it was observed that those cases screened by the 5th day of life had a TIQ 84.6 ± 13, while those diagnosed later had a TIQ 73 ± 17 (p≤0.05). In assessing the number of hospitalizations that occurred during follow-up, we determined that the 5 cases screened early never had a metabolic crisis and had a higher TIQ than those who had had one or more decompensation (92 and 74, respectively, p≤0.05). An inverse correlation was observed between the Leu+Isoleucine value and TIQ. Conclusion: The diagnosis before the 5th day of life and a good metabolic control during follow-up, enables children with MSUD to have normal cognitive development.

La enfermedad de la orina olor a jarabe de arce (EOJA) se produce por un defecto del complejo enzimático deshidrogenasa de los cetoácidos de los aminoácidos ramificados: Valina, Isoleucina, Leucina (VIL). El tratamiento es una dieta restringida en leucina (Leu). Objetivo: evaluar el seguimiento a largo plazo en niños con EOJA. Metodología: Se revisaron 29 fichas de pacientes EOJA, 24 fueron pesquisados por clínica (> 5to día de vida) y 4 casos por antecedentes familiares con EOJA y 1 por pesquisa neonatal (< 5to día de vida). Se midió nivel de Leu al diagnóstico (Biotronic 2000) y durante el seguimiento (Espectrometría de masa), número de descompensaciones, Coeficiente Intelectual Total (CIT) (Escalas de Bayley y Wechsler) y estado nutricional. Se aplicó programa estadístico STATA versión 9.2 (p≤0.05). Resultados: La edad de diagnóstico fue a los 14 días de edad. En todos se confirmó el diagnóstico por los niveles elevados de Leu y presencia de alloisoleucina. Al comparar el CIT de los 19 casos mayores de 3 años con la edad de diagnóstico, se observó que aquellos casos pesquisados antes del 5to día tenían un CIT de 84,6±13, a diferencia de los diagnosticados posteriormente que tenían un CIT=73±17 (p≤0.05). Al evaluar el número de descompensaciones ocurridas durante el seguimiento, se determinó que los 5 casos nunca habían tenido una crisis metabólica, tuvieron un CI mayor que aquellos que habían tenido una o más descompensaciones (92 y 74 respectivamente) (p≤0.05). Cuando se correlacionó el valor de Leu+Iso de seguimiento con el CIT, se observó una correlación inversamente proporcional. Conclusión: el diagnóstico antes de los 5to día de vida y un buen control metabólico durante el seguimiento, permite que los niños con EOJA tengan un desarrollo cognitivo normal.

Edulcorantes no nutritivos e ingesta diaria admisible en adultos y niños de peso normal y obesos de tres niveles socioeconómicos, y un grupo de diabéticos de la Región Metropolitana / Non-caloric sweeteners and daily acceptable intake in adults and children with normal weight and obesity from three different socioeconomic levels, and a diabetic group from Metropolitan Region

Introduction: There is wide availability of products containing sweeteners but there is no regulation on its consumption. Objective: To establish if adults and children with normal weight or obesity from three socioeconomic levels, and a group of adults and children with diabetes; do not exceed ADI levels for some sweeteners. Methods: Group 1 (477 adults, Group 2 (516 children) from socioeconomic levels: ABC1, C2 and C3, normal nutritional status and obesity, and group 3 (218) adults and children with diabetes. The daily intake of sweeteners was recorded, including: aspartame (ASP), acesulfame K (AK), cyclamate (CICL), saccharin (SAC), sucralose (SUC) and stevia (STV). Results: 85% adults and 75%% of children consumed products with sweeteners, and of these 50% were instant powdered beverages, soft drinks or diet yogurts. When comparing the consumption between groups 1 and 2, group 1 consumed a larger amount of sweeteners (p<0.05). Group 1 ABC1 ate more AK, ASP and SUC than C2 and C3 (p<0.05). Group 3 did not surpass the acceptable daily intake of AK, ASP, SUC and STE, but 5.8% of adults and 25% of diabetic children exceeded the ADI for SAC. Conclusions: The 97.5% and the 98.8% had a safe consumption of artificial sweeteners. It should be emphasized that 5.8% of adults and 25% of diabetic children exceeded the maximum ADI for SAC, finding that suggests to be continued long-term studies to elucidate whether this has implications for health.

Introducción: Existe gran disponibilidad de productos con edulcorantes pero no existe regulación sobre su consumo. Objetivo: determinar si individuos adultos y niños con estado nutricional normal u obesidad de tres niveles socioeconómicos y un grupo de adultos y niños con diabetes, no excedían la ingesta diaria admisible de los edulcorantes permitidos. Metodología: Grupo 1 (477 adultos) y grupo 2 (516 niños) de niveles socioeconómicos (NSE): ABC1, C2 y C3, estado nutricional normal y obesos, y grupo 3 (218) adultos y niños diabéticos. Se registró la ingesta diaria de edulcorantes incluyéndose: aspartame (ASP), acesulfamo K (AK), ciclamato (CICL), sacarina (SAC), sucralosa (SUC) y estevia (STV). Resultados: El 85 % adultos y 75 % de niños consumían productos con edulcorantes y de estos el 50% eran bebidas instantáneas en polvo, bebidas gaseosas o yogurts dietéticos. Al comparar la ingesta de edulcorantes entre los grupos 1 y 2, el grupo 1 tuvo una mayor ingesta (p<0.05) que el grupo 2. El grupo 1 del NSE ABC1, consumió mas AK, ASP y SUC que NSE C2 y C3 (p<0.05). En el grupo 3, el 5.8% de adultos y el 25% de niños diabéticos sobrepasaron el IDA sólo para SAC. Conclusiones: El 97.5% adultos y el 98.8% niños tuvieron ingesta dentro del nivel seguro en cada edulcorante. Se debe enfatizar que el 5,8% de adultos y 25% de niños diabéticos excedieron el IDA máximo para SAC, hallazgo que sugiere continuar con estudios a largo plazo que permitan dilucidar si esto tiene repercusión para la salud.

Prevalencia de hipolactasia en escolares de la Región Metropolitana / Prevalence of hypolactasia in chilean schoolchildren from Santiago city

adult primary hypolactasia results from the genetically programmed decrease of intestinal lactase after weaning. It is estimated that about 75% of the adult population in the world is hypolactasic. Aim: To determine the prevalence of hypolactasia in school children in the Metropolitan Area and its relation to the consumption of dairy products and calcium. Subjects and methods: A cross-sectional study was performed in 326 schoolchildren aged 7 to 18 years belonging to 6 educational establishments from different socioeconomic levels in Santiago. A lactose hydrogen breath test was performed in each subject and gastrointestinal symptoms were registered during the test. A survey of dairy product consumption was carried out to determine calcium intake. Results: Hypolactasia was detected in 42.3% of the subjects and those had a higher prevalence of gastrointestinal symptoms compared to the lactase-persistent subjects (81.9% vs. 70.2%, P = 0.019). In addition, digestive symptoms were also more severe in the hipolactasic children (p <0.00000). Calcium intake from dairy sources was 492.5 ± 22.5 mg/d, with no differences according to the hipolactasic/lactase-persistent status of the subjects or their socioeconomic stratum. This intake covers only 37.9 ± 1.7% of the recommended intakes of calcium. Conclusions: a high percentage of hypolactasia and low dietary intake of calcium from dairy origin was detected in the school population evaluated. These data are important to develop new strategies to increase the consumption of calcium-containing foodstuffs and improve bone health in the population.

La hipolactasia primaria del adulto resulta de la disminución genéticamente programada de la lactasa intestinal después del destete. Se estima que alrededor del 75% de la población adulta en el mundo presentaría es hipolactásica. Objetivo: Determinar la prevalencia de hipolactasia en escolares de la Región Metropolitana y su relación con el consumo de productos lácteos y de calcio. Sujetos y métodos: Se realizó un estudio transversal en una muestra de 326 escolares de 7 a 18 años pertenecientes a 6 establecimientos educacionales de distintos niveles socioeconómicos en Santiago. A cada sujeto se les realizó una prueba de hidrógeno en aire espirado (HBT) con lactosa y se registró la aparición de sintomatología digestiva durante la prueba. También se realizó una encuesta de tendencia de consumo de productos lácteos para determinar la ingesta de calcio. Resultados: 42.3% de los escolares eran hipolactásicos y presentaron una mayor prevalencia de sintomatología digestiva comparado con aquellos sujetos lactasa-persistente(81.9% vs. 70.2%; p=0.019); dicha sintomatología, además, fué más intensa en los hipolactásicos(p<0.00). La ingesta de calcio de origen lácteo fue de 492.5±22.5 mg/día, sin diferencias según el estado hipolactásico/lactasa-persistente o el nivel socioeconómico de los sujetos. Dicha ingesta cubre sólo el 37.9±1.7% de los aportes recomendados de calcio. Conclusiones: la población de escolares estudiada se caracteriza por tener un porcentaje de hipolactasia alta y aportes dietarios de calcio de origen lácteo bajos. Estos datos son de importancia para desarrollar programas destinados a aumentar el consumo de calcio para mejorar la salud ósea de la población.

Síndrome de fenilquetonuria materna, un nuevo desafío para Chile / Maternal phenylketonuria syndrome, a new challenge for Chile

Phenylquetonuria (PKU) is a hereditary disease, caused by the deficiency or absence of the enzyme phenylalanine hydroxylase, which produces an abnormal conversion of phenylalanine (Phe) to tyrosine. If PKU is not diagnosed and treated during the neonatal period, blood accumulation of Phe causes neurological damage. Chile has a neonatal screening program for PKU and congenital hypothyroidism since 1992; this program has diagnosed 162 PKU patients in Chile, which are being followed-up in INTA, Universidad de Chile. Nowadays, there are 20 PKU patients in adolescence, so we face a new challenge such as maternal PKU syndrome. This syndrome refers to the teratogenic effect of Phe in a pregnant PKU female. The most frequent anomalies are intrauterine growth retardation, microcephaly, global development retardation and congenital heart defects. Their occurrence is directly related to maternal Phe during pregnancy. In order to assure a normal pregnancy and to prevent this syndrome, levels of Phe in blood should be kept between 2 and 6 mgldl prior to conception and throughout pregnancy. Considering this challenge, INTA has proposed a strict protocol of follow-up to improve the compliance to nutritional therapy and prevent maternal PKU syndrome.

La fenilquetonuria (PKU) es una patología hereditaria, producida por la deficiencia o ausencia de la enzima fenilalanina hidroxilasa, lo que impide la metabolización normal de la fenilalanina (FA) a tirosina. La acumulación de fenilalanina en la sangre ocasiona daño neurológico si no es diagnosticada y tratada desde el periodo neonatal. Desde 1992 Chile tiene un programa de pesquisa neonatal de PKU e hipotiroidismo congénito, lo que ha permitido diagnosticar 162 casos con PKU, los que mantienen un seguimiento integral en el INTA, de la Universidad de Chile. Actualmente hay 20 PKU en etapa de adolescencia, por lo que nos enfrentamos a un nuevo desafío, el síndrome de PKU materna. Este síndrome se refiere al efecto teratogénico de la FA en una embarazada con PKU. Las alteraciones más características son el retraso del crecimiento intrauterino, la microcefalia, el retraso global del desarrollo y los defectos cardiacos congénitos. La presencia de estas alteraciones está directamente relacionada con los niveles de FA de la madre durante el embarazo. Para asegurar un embarazo normal y prevenir este síndrome se recomienda la mantención de niveles de FA entre 2 y 6 mg/dl, desde el período preconcepcional y durante todo el embarazo. El INTA considerando este desafío, ha propuesto un protocolo de seguimiento estricto preconcepcional y durante el embarazo con el objetivo de favorecer la adherencia al tratamiento nutricional y prevenir el síndrome de PKU materna.

[Work absenteeism in a mining company: trends in 1985-1988]. / Ausentismo laboral en una empresa minera: tendencia 1985-1988.

The magnitude of medical and non medical absenteeism among male workers performing rotative shifts in a high altitude mining company was studied. There was a general rate of absenteeism of 8.8 absent days per 100 labor days, which means that 31.8% of the total labor force was absent every month. Absenteeism due to medical causes correspond to a mean of 85% of total lost days during the four years of the study. Common diseases (digestive, respiratory, and osteo-muscular diseases, traumatisms and poisonings) give account 84.3% of these lost days. Among these, respiratory diseases had the higher prevalence and traumatisms and osteo-muscular diseases the higher severity (with values over 10 days off). The production areas and people working in shifts had the higher prevalences of medical absenteeism. The numbers of days off for medical causes almost doubled during the four year period and in 1988 represented 14% of all the salaries paid during the year. This increasing tendency was associated with a massive entrance to private health systems. It is concluded that the problem of medical absenteeism in this company is complex and growing and its attenuation requires preventive measures.

[Ill-defined causes of death in the elderly]. / Causas de muerte mal definidas en senescentes.

Over one-half of death certificates from elderly people contain ill-defined causes of death. Usually, signs and symptoms rather than causes of death are registered. Electrolyte imbalance, decubitus ulcer, atherosclerosis, diabetes, etc are some of the most frequently quoted conditions. Adequate preventive programs are jeopardized by lack of more precise information regarding the cause of death and relevant associated conditions in the elderly.

[Inventory of reptiles in 2 semi-arid zones from Northeastern of the Peninsula de Araya, Sucre State, Venezuela]. / Inventario de reptiles en dos zonas semiaridas del Noreste de la Peninsula de Araya, Estado Sucre, Venezuela.

The fauna of reptiles in two localities from Northeastern Peninsula de Araya (Guayacán and El Morahal), Sucre State, Venezuela, was evaluated. Both zones are characterized by a vegetation of thorny tropical mount type, and semiarid climate of scarce precipitations (less than 700 mm). Field trips were made between june 1997 and june 1998. The samples were collected both during day and night, with the aid of conventional accessories. The information was complemented with visual registrations and bibliography revision. A total of 21 species were captured and/or observed, distributed in 10 families belonging to 2 of the 3 orders present in Venezuela. The most important families from the point of view of the diversity of species, were the Gekkonidae (2.00 bits/species) for the lizards and the Colubridae (2.33 bits/species) among the snakes. It was also reported one species of tortoises and three of cinegetic interest, being Cnemidophorus lemniscatus, Ameiva bifrontata y Tropidurus hispidus the only species of constant presence during the study.

[Smoking in Santiago, 1993-94]. / Tabaquismo en Santiago, 1993-94.

The aim of this work was to study smoking habits, alcohol and drug use and living standards in a random sample of 1000 dwellings and 4700 people of Santiago through periodic surveys during 1993 and 1994. Forty nine percent of dwellings had at least one inhabitant that was a daily smoker and 73% had at least one occasional smoker. Thirty seven percent of subjects older than 15 years were smokers (40% of men and 35% of women), 27% were presumably addicted to tobacco and 16% former smokers. Alcohol abuse had a prevalence of 2.3%. The highest prevalence of smoking was noticed in low socioeconomical strata. Smoking was not related to educational level or emotional disturbances. Frequency of alcohol abuse or marihuana use was 8.8 times higher in former smokers and 25 times higher in actual smokers, compared to people that never smoked. Comparing these results with previous population surveys, the prevalence of smoking increased in the period 1971-1986 from 47 to 51% in men and from 26 to 43% in women. On the other hand, during the period 1986-1994 the prevalence decreased from 51 to 40% in men and from 43 to 35% in women.

[Medical care in 7 Chilean cities]. / Atención médica en siete ciudades Chilenas.

BACKGROUND: In countries with an intermediate development level such as Chile, health care is the main factor that improves the health status of the community. AIM: To inform the results of morbidity and medical care surveys performed in the Chilean cities of Antofagasta, La Serena, Concepción, Temuco, Llay Llay, Tiltil y Lampa-Batuco. MATERIAL AND METHODS: A random sample of 951 dwellings with 4,192 people was selected and studied three times, in 1995 and 1996. All health events (acute and chronic disease episodes, accidents, health examinations, dental care) and the main features of medical care were registered in the interviews which covered a 2-week period each time. RESULTS: Half of sick people received medical care and the rest was managed with self care techniques. Sixty nine percent of subjects with acute diseases received medical care, compared to 32% of those with chronic diseases. The National Health Fund (FONASA) financed most of these medical attentions, half of these were done in private centers and the rest in public premises. Private centers took care of 71% of acute patients, 48% of chronic patients and 27% of health controls. The proportion of private care in different cities paralleled the income of their populations. An estimation of 3.5 medical attentions per capita per year in these cities can be reached. Health care was considered very good by 33% of patients, as good by 55%, as regular by 9% and as deficient by 3%. Quality of care of private centers was perceived as better than that of public centers. Eighty five percent of sick people that did not seek medical care, did so due to the mildness of their ailments. People had to afford a mean of US$ 30 per episode of acute disease, US$ 32 per episode of chronic disease and US$ 56 per each dental attention. CONCLUSIONS: Two thirds of patients with acute diseases and one third of patients with chronic diseases received medical care during the study period.

[Characteristics and management of morbidity in seven Chilean cities]. / Características y manejo de la morbilidad en siete ciudades chilenas.

BACKGROUND: Health population inquiries give information about morbidity as perceived by people, the quality of medical care and the costs of diseases. AIM: To inform the results on morbidity and medical care surveys performed in the Chilean cities of Antofagasta, La Serena, Concepción, Temuco, Llay Llay, Tiltil y Lampa-Batuco. MATERIAL AND METHODS: A random sample of 951 dwellings with 4.192 people was selected and studied three times, in 1995 and 1996. All health events (acute and chronic disease episodes, accidents, health examinations, dental care) and the main features of medical care were registered in the interviews which covered a 2-week period each time. RESULTS: Health events were registered in 30.1% people. When extrapolating fortnight findings to a one year period, each person had 2.37 annual episodes of acute diseases, 0.94 health examinations and 0.69 dental attentions. The prevalence of chronic diseases was 13.2%. The frequency of health events was higher among women and in elders. Hospital stays and deaths were less frequent in higher income levels. Most acute diseases were respiratory illnesses, followed by communicable diseases. The most important chronic diseases detected were hypertension, diabetes mellitus, bronchial asthma and heart diseases. Medical care was provided in 66% of acute and 34% of chronic diseases. CONCLUSIONS: When comparing these results with previous surveys, an increase in the frequency of acute and chronic diseases is found.