Frecuencia de referencias ambulatorias injustificadas, en base a diagnósticos no pertinentes, realizadas a un hospital peruano de tercer nivel / Frequency of unjustified ambulatory referrals bases on no pertinent diagnosis sent to a third level Peruvian hospital

Objetivo: Determinar la frecuencia y describir las características de referencias injustificadas, en base a diagnósticos no pertinentes, enviadas al servicio de consulta externa adultos de un hospital de tercer nivel. Material y métodos: Estudio transversal, observacional y descriptivo, realizado en el Hospital Cayetano Heredia (HCH) en el periodo abril a diciembre del 2019. Se utilizaron los datos del aplicativo "REFCON" con una población de 99 891 referencias. Para la variable "justificación de la referencia", se utilizó un listado de diagnósticos que no deberían derivarse a hospitales de la DIRIS Lima Norte. Adicionalmente, se estudiaron las variables de edad, sexo, grupo etario, especialidad de destino, categoría del EESS de origen, distrito de origen, y diagnóstico del grupo de referencias injustificadas. Se utilizó estadística descriptiva. Resultados: La frecuencia de referencias injustificadas fue de 8,4 %. El 34,2 % fue de pacientes adultos; el 65,8 %, de adultos mayores; y el 67 %, de pacientes mujeres Las especialidades con más referencias injustificadas fueron cardiología, geriatría, medicina interna, medicina familiar y neurología. Los diagnósticos injustificados más frecuentes fueron hipertensión esencial, lumbago no especificado y cefalea. Conclusiones: La frecuencia de referencias injustificadas al HCH por diagnósticos no pertinentes fue 8,4 %, tasa similar a otros dos estudios, pese a la emisión de una lista de diagnósticos que no deberían derivarse a hospitales de la DIRIS Lima Norte.

SUMMARY Objective: To determine the frequency and to describe the characteristics of unjustified ambulatory referrals bases on no pertinent diagnosis done at an adult outpatient clinic of a third level Peruvian hospital. Methods: A cross-sectional study was carried-out from April to December 2019 at Hospital Cayetano Heredia. Data were extracted from REFCON with a population of 99 891 referrals. To justify the reference, a list of diagnosis that does not require referral was used. In addition, variables such as age, sex, specialty of destination, category of EESS, district of origin and diagnosis of the unjustified referral. Descriptive statistics was used. Results: the frequency of unjustified referrals was 8.4%; 34.2% comprised the adult population; 65.8% were elder and 67% were female. Specialties with more unjustified referrals were geriatrics, internal medicine, family medicine and neurology. The most common unjustified diagnosis was essential hypertension, nonspecific low back pain and headache. Conclusions: Despite of socializing a list of unjustified referral diagnosis a frequency of 8,4% remain in this category, which is like results from two previous studies.

The influence of body composition on the six-minute walk test in Chilean preschool and school children.

INTRODUCTION: Background: the six minutes' walk test (6MWT) measures submaximal physical activity. Objective: this study determines the association of children´s nutritional status and body composition with the results of the 6MWT. Methods: a sample of 1419 Chilean children, 4 to 10 years of age, were assessed including anthropometry, body composition by validated equations, the 6MWT test, and in 50 % of the sample heart rate prior the test, at one minute into the test, and at one minute posttest with a Polar watch. Results: the distance walked ranged from 473.1 ± 47.8 meters in preschool children to 584.2 ± 65.7 meters in school children. In heart rate there was a significant difference between obese and eutrophic children. The distance walked in the 6MWT was positively associated with fat-free mass (p < 0.05) and BMI (R2 = 0.49). Body composition influences 6MWT quartile distribution, as well as nutritional status. Age and height explained 49 % of the variance (R2 = 0.42 and 0.47, respectively) in the 6MWT, and there are significant differences in this variable by sex, body composition, and nutritional status. Conclusions: body composition was associated with walking performance in children. Thus, it is important to evaluate height and body composition when assessing the six-minute walk test because of this important relationship.

INTRODUCCIÓN: Introducción: el test de la marcha de seis minutos (TM6M) mide una actividad física submáxima. Este estudio evaluó el efecto del test de la marcha sobre la composición corporal y el estado nutricional en niños. Métodos: en una muestra de 1419 niños chilenos de 4 a 10 años de edad se evaluaron la antropometría, la composición corporal por ecuaciones validadas, el TM6M y, en el 50 % de la muesta, la frecuencia cardíaca mediante un reloj Polar. Resultados: la distancia caminada varió desde 473,1 ± 47,8 metros en los niños preescolares hasta 584,2 ± 65,7 metros en los escolares. En la frecuencia cardíaca hubo una diferencia significativa entre niños obesos y eutróficos. La distancia caminada se asoció positivamente con la masa libre de grasa (R2 = 0,37) y el IMC (R2 = 0,49). Por otra parte, la composición corporal varía en función de los cuartiles de composición corporal y el estado nutricional. La edad y la altura explicaron el 49 % de la varianza de la prueba (R2 = 0,42 and 0,47, respectivamente). Existen diferencias significativas en la distancia recorrida en el TM6M en función del sexo, la composición corporal y el estado nutricional. Conclusiones: composición corporal, talla e IMC se asociaron a la distancia recorrida en el TM6M. Por tanto, se sugiere medir estas variables cuando se evalúe el test de marcha de seis minutos.

At the crossroads: can desalination be a suitable public policy solution to address water scarcity in Chile's mining zones?

Water scarcity is a global issue that is threatening social and economic development. One approach to alleviating scarcity is the incorporation of new water sources into supply systems, including desalinated seawater for industrial and municipal use. In Chile, large volumes of water are used in water-scarce regions where mining takes place, alongside agriculture and small communities. This situation has driven a debate around policies to increase the use of seawater to satisfy the water demand of the mining industry. The economic, social and environmental implications of such a policy, however, are poorly understood and the current regulatory framework to address concerns and uncertainties is inadequate. This paper presents a technical, legal, economic and environmental appraisal of such a policy and considers options to improve outcomes. The appraisal suggests that clear regulations derived from economic, social and environmental analysis must be generated to provide legal certainty and reduce risks. Alternative or complementary water supply options should be allowed where mining operations can demonstrate negligible hydrological and social impacts or use innovative solutions such as stakeholder water rights swaps and water efficiency technologies. We provide insight that will help to drive a better policymaking process aimed at tackling water scarcity in Chile and in similar areas of the world.

In preschool children, physical activity during school time can significantly increase by intensifying locomotor activities during physical education classes.

OBJECTIVES: After categorizing preschool children into "active and low active" according to their moderate and vigorous physical activity (MVPA) in PE classes (PE), we compared these two groups within each sex and by sex in: (a) % MVPA and MVPA minutes accrued from each fundamental motor skill (FMS) during PE and (b) % MVPA during school time. RESULTS: 532 children (mean age 5.2 years, 50% girls) were selected from a nationwide program which provides 3 weekly PE. Children wore accelerometers during one school day which included PE. We recorded the type and duration of each activity indicated by the teacher, classifying each one into the corresponding FMS, extracting its MVPA minutes from the accelerometer software. Children were categorized into active and low active. Comparisons used T-tests. In PE, active children accumulate 40 and 36 percentage points (pp) more MVPA minutes (boys and girls respectively), while during school time, 4 pp more in each sex. Girls are significantly less active. Just considering locomotion, active boys and girls accumulate 11 more MVPA minutes during PE. Active boys surpass the MVPA guideline for PE, while active girls almost reach it. Low active children (especially girls) should intensify locomotor activities during PE.

Preschool children's physical activity intensity during school time: Influence of school schedule.

Chile's Physical Activity Report Card graded the overall index on PA behavior with an F The Ministry of Sports is implementing since 2014 "Jardín Activo" (JA program) which recommends 3 weekly teacher-led PE lessons for preschool children, on half or full day attendance. We determined the effectiveness of the JA program (contribution to MVPA during school time) and assessed if effectiveness varied according to schedule. 596 five y olds, (50% boys) were selected from 66 schools; 52.9% attended half day and 47.1% full day. Children wore accelerometers during school time a day with and one without PE lesson (JA day/non JA day). We compared PA intensity between both these days by gender, using descriptive statistics and t-tests and determined the differential effect on PA intensity, between non JA and JA days by school schedule, using mixed models analyses We compared ß of sedentary and of MVPA by schedule with t-tests. Significant differences were found in PA intensity between both days within each gender. Minutes being sedentary were significantly less during JA days (14 and 15 min in boys and girls respectively); MVPA significantly higher in JA days (11 and 10 min respectively). % time children were sedentary and % they engaged in MVPA differed by schedule. Sedentary minutes were significantly higher (ß - 16.2 vs - 13.2) in half day, while the increase in MVPA was significantly higher (ß 12.5 vs 9.7) in full day. The JA program is effective, especially when children attend school full time.

Population balance modelling of particle flocculation with attention to aggregate restructuring and permeability.

A population balance model based on a detailed literature review is used to describe coagulation and flocculation kinetics as well as the time evolution of aggregate size distribution in a turbulent shear flow simultaneously with the breakage and restructuring of aggregates. The fractal nature and permeability of the aggregates and their evolution with time are also part of the model. Restructuring is absent in coagulation with soluble salts, but is present in flocculation caused by large polyelectrolyte molecules; in the latter, aggregates never reach a steady-state size, but a size that decreases gradually through particle and polymer rearrangement. The model is tested against available experimental data for monodisperse polystyrene particles coagulated with hydrated aluminium sulphate at different shear rates, and precipitated calcium carbonate flocculated with a cationic polyelectrolyte of very high molecular weight at different flocculant dosages. The numerical solution of the model requires adjusting three parameters, i.e, maximum collision efficiency (αmax), critical force needed for the breakage of the aggregates (B) and rate of aggregate restructuring (γ), which are obtained from minimising the difference between experimental data and model predictions. The model studied for the two very different systems shows excellent agreement with experimental flocculation kinetics and a reasonably good fit for aggregate size distributions. The model is most sensitive to the fragmentation rate through parameter B, somewhat less to the collision efficiency through parameter αmax and little to γ. When the aggregates undergo restructuring, properties such as permeability, breakage rate and collision rate change considerably over time. When the aggregates are permeable, the collision frequency is significantly smaller than when they are impervious.

ANTHROPOMETRIC CHARACTERISTICS AND PHYSICAL FITNESS LEVEL IN RELATION TO BODY WEIGHT STATUS IN CHILEAN PRESCHOOL CHILDREN.

The purpose of this study was to describe anthropometric and physical fitness characteristics of low-income Chilean preschool children and to examine whether weight status influences children's performance on fitness tests. A total of 434 preschool children (246 boys; 5.48 ± 0.31 years) participated in our study. Anthropometry (weight, height, body mass index -BMI- and waist circumference) and fitness tests (handgrip strength test, standing long jump and 20 m sprint) were assessed by trained nutritionists and physical education teachers, respectively. Significant differences in anthropometry and fitness tests between boys and girls were found. The prevalence of overweight was higher in girls; in contrast to that of obesity. Compared to normal-weight children, overweight/obese boys and girls were heavier and had greater waist circumference (P < 0.001), were taller (P ≤ 0.002), and showed higher performance in handgrip strength (P ≤ 0.027) but not in standing long jump nor 20 m sprint (P ≥ 0.052). Screening physical fitness levels in overweight/obese preschool children could be an important tool in order to design an efficacy physical activity programme.

El objetivo de este estudio fue describir las características antropométricas y el nivel de condición física de preescolares chilenos de bajo nivel socioeconómico y examinar si el estado ponderal influye en el rendimiento de los niños en las pruebas de condición física. Un total de 434 preescolares (246 niños; 5,48 ± 0,31 años) participaron en nuestro estudio. Antropometría (peso, talla, índice de masa corporal ­IMC­ y perímetro de cintura) y tests de condición física (test de fuerza de prensión manual, test de salto de longitud y 20 m sprint) fueron evaluados por nutricionistas entrenados y profesores de educación física, respectivamente. Se encontraron diferencias significativas en antropometría y tests de condición física entre niños y niñas. La prevalencia de sobrepeso fue mayor en las niñas; en contraste con la de la obesidad. En comparación con los preescolares con normopeso, los niños y niñas con sobrepeso/obesidad pesaron más y tuvieron mayor perímetro de cintura (P < 0.001), eran más altos (P ≤ 0.002) y mostraron mayor rendimiento en el test de fuerza de prensión manual (P ≤ 0.027), pero no en el test de salto de longitud ni en el test de sprint de 20 m (P ≥ 0.052). Detectar los niveles de condición física en preescolares con sobrepeso/obesidad puede ser una herramienta importante para diseñar programas eficaces de actividad física.

Anthropometric characteristics and physical fitness level in relation to body weight status in Chilean preschool children / Características antropométricas y nivel de condición física en relación con el estado ponderal en niños chilenos de edad preescolar

The purpose of this study was to describe anthropometric and physical fitness characteristics of low-income Chilean preschool children and to examine whether weight status influences children’s performance on fitness tests. A total of 434 preschool children (246 boys; 5.48 ± 0.31 years) participated in our study. Anthropometry (weight, height, body mass index -BMI- and waist circumference) and fitness tests (handgrip strength test, standing long jump and 20 m sprint) were assessed by trained nutritionists and physical education teachers, respectively. Significant differences in anthropometry and fitness tests between boys and girls were found. The prevalence of overweight was higher in girls; in contrast to that of obesity. Compared to normal-weight children, overweight/obese boys and girls were heavier and had greater waist circumference (P < 0.001), were taller (P ≤ 0.002), and showed higher performance in handgrip strength (P ≤ 0.027) but not in standing long jump nor 20 m sprint (P ≥ 0.052). Screening physical fitness levels in overweight/obese preschool children could be an important tool in order to design an efficacy physical activity programme (AU)

El objetivo de este estudio fue describir las características antropométricas y el nivel de condición física de preescolares chilenos de bajo nivel socioeconómico y examinar si el estado ponderal influye en el rendimiento de los niños en las pruebas de condición física. Un total de 434 preescolares (246 niños; 5,48 ± 0,31 años) participaron en nuestro estudio. Antropometría (peso, talla, índice de masa corporal –IMC– y perímetro de cintura) y tests de condición física (test de fuerza de prensión manual, test de salto de longitud y 20 m sprint) fueron evaluados por nutricionistas entrenados y profesores de educación física, respectivamente. Se encontraron diferencias significativas en antropometría y tests de condición física entre niños y niñas. La prevalencia de sobrepeso fue mayor en las niñas; en contraste con la de la obesidad. En comparación con los preescolares con normopeso, los niños y niñas con sobrepeso/obesidad pesaron más y tuvieron mayor perímetro de cintura (P < 0.001), eran más altos (P ≤ 0.002) y mostraron mayor rendimiento en el test de fuerza de prensión manual (P ≤ 0.027), pero no en el test de salto de longitud ni en el test de sprint de 20 m (P ≥ 0.052). Detectar los niveles de condición física en preescolares con sobrepeso/obesidad puede ser una herramienta importante para diseñar programas eficaces de actividad física (AU)

Pilot nutrition and physical activity intervention for preschool children attending daycare centres (JUNJI): primary and secondary outcomes.

INTRODUCTION: A pilot intervention was conducted to promote physical activity and nutrition in public preschool education (near half a million children in Chile), in order to prevent obesity. OBJECTIVE: To assess the primary (body fat) and secondary outcomes (physical activity and energy intake) of a nutrition and physical activity pilot intervention for preschool children, attending day care centres. METHODS: A pilot intervention in six day care centres selected at random (n = 530), in 4-5 years old preschool children, Santiago, Chile intending to: provide nutritional and physical activity education to educators and health promotion activities for the family, which in turn, will affect the primary (body fat), and secondary outcomes (physical activity pattern and energy food intake) were measured in a representative subsample of 120 intervened and 145 controls children. RESULTS: In relation to secondary outcomes monitoring, moderate-vigorous activity was duplicated in the intervention group (+5.4% and +4.7%, respectively), in both obese and eutrophic children. Energy intake decreased in 11.7% in obese and 7.5% in eutrophic children. Dietary fat intake was reduced (-11 g in obese and -8.4 g in eutrophic children). Intervened obese children reduced body fat in 1.5%, meanwhile in control obese children, body fat increased 1.3% (p < 0.01). CONCLUSIONS: The pilot intervention demonstrated the feasibility to influence dietary risk factors and physical activity at the day care centres and families. Therefore, the implementation of the validated intervention program will be tested in different weather conditions, to prevent unhealthy habits in preschool children and their families.

Introducción: Intervención piloto en nutrición y actividad física para prevenir obesidad en la educación preescolar (cerca de medio millón de niños en Chile). Objetivo: Evaluar los resultados primarios (grasa corporal) y secundarios (actividad física e ingesta energética) de una intervención piloto para niños/as asistentes a guarderías infantiles. Métodos: Intervención piloto en seis guarderías seleccionadas al azar (n = 530 preescolares), 4-5 años en Santiago de Chile, con el objeto de: a) proporcionar educación en nutrición y actividad física para los educadores; b) actividades de promoción de la salud para la familia. El objetivo primario (grasa corporal), y los resultados secundarios (patrón de actividad física y la ingesta energética) se midieron en 265 preescolares (120 intervenidos y 145 niños controles). Resultados: La actividad física moderada- intensa se duplicó en los intervenidos (+5,4% y +4,7%, respectivamente), tanto en niños obesos y eutróficos. La ingesta energética se redujo en 11,7% en obesos y 7,5% en los eutróficos y la de grasa en (-11 g en obesos y -8,4 g en niños eutróficos). Los niños obesos intervenidos redujeron la grasa corporal en 1,5%, mientras que en los niños controles obesos, se incrementó 1,3% (p < 0,01). Conclusiones: La intervención piloto demostró la viabilidad de influir en los factores de riesgo dietarios y de actividad física en las guarderías y en las familias. Por lo tanto, la ejecución del proyecto piloto se pondrá a prueba en diferentes condiciones climáticas, para prevenir hábitos no saludables en los preescolares y sus familias.

School-based obesity prevention intervention in Chilean children: effective in controlling, but not reducing obesity.

OBJECTIVE: To evaluate the effectiveness of a 12-month multicomponent obesity prevention intervention. Setting. 9 elementary schools in Santiago, Chile. Subjects. 6-8 y old low-income children (N = 1474). DESIGN: Randomized controlled study; 5 intervention/4 control schools. We trained teachers to deliver nutrition contents and improve the quality of PE classes. We determined % healthy snacks brought from home, children's nutrition knowledge, nutritional status, duration of PE classes, and % time in moderate/vigorous activity (MVA). Effectiveness was determined by comparing Δ BMI Z between intervention and control children using PROCMIXED. RESULTS: % obesity increased in boys from both types of schools and in girls from control schools, while decreasing in girls from intervention schools (all nonsignificant). % class time in MVA declined (24.5-16.2) while remaining unchanged (24.8-23.7%) in classes conducted by untrained and trained teachers, respectively. In boys, BMI Z declined (1.33-1.24) and increased (1.22-1.35) in intervention and control schools, respectively. In girls, BMI Z remained unchanged in intervention schools, while increasing significantly in control schools (0.91-1.06, P = 0.024). Interaction group ∗ time was significant for boys (P < 0.0001) and girls (P = 0.004). CONCLUSIONS: This intervention was effective in controlling obesity, but not preventing it. Even though impact was small, results showed that when no intervention is implemented, obesity increases.

Pilot nutrition and physical activity intervention for preschool children attending daycare centres (JUNJI); primary and secondary outcomes / Intervención piloto en nutrición y actividad física para preescolares asistentes a jardines infantiles (JUNJI); resultados primarios y secundarios

Introduction: A pilot intervention was conducted to promote physical activity and nutrition in public preschool education (near half a million children in Chile), in order to prevent obesity. Objective: To assess the primary (body fat) and secondary outcomes (physical activity and energy intake) of a nutrition and physical activity pilot intervention for preschool children, attending day care centres. Methods: A pilot intervention in six day care centres selected at random (n = 530), in 4-5 years old preschool children, Santiago, Chile intending to: provide nutritional and physical activity education to educators and health promotion activities for the family, which in turn, will affect the primary (body fat), and secondary outcomes (physical activity pattern and energy food intake) were measured in a representative subsample of 120 intervened and 145 controls children. Results: In relation to secondary outcomes monitoring, moderate-vigorous activity was duplicated in the intervention group (+5.4% and +4.7%, respectively), in both obese and eutrophic children. Energy intake decreased in 11.7% in obese and 7.5% in eutrophic children. Dietary fat intake was reduced (-11 g in obese and -8.4 g in eutrophic children). Intervened obese children reduced body fat in 1.5%, meanwhile in control obese children, body fat increased 1.3% (p < 0.01). Conclusions: The pilot intervention demonstrated the feasibility to influence dietary risk factors and physical activity at the day care centres and families. Therefore, the implementation of the validated intervention program will be tested in different weather conditions, to prevent unhealthy habits in preschool children and their families (AU)

Introducción: Intervención piloto en nutrición y actividad física para prevenir obesidad en la educación preescolar (cerca de medio millón de niños en Chile). Objetivo: Evaluar los resultados primarios (grasa corporal) y secundarios (actividad física e ingesta energética) de una intervención piloto para niños/as asistentes a guarderías infantiles. Métodos: Intervención piloto en seis guarderías seleccionadas al azar (n = 530 preescolares), 4-5 años en Santiago de Chile, con el objeto de: a) proporcionar educación en nutrición y actividad física para los educadores; b) actividades de promoción de la salud para la familia. El objetivo primario (grasa corporal), y los resultados secundarios (patrón de actividad física y la ingesta energética) se midieron en 265 preescolares (120 intervenidos y 145 niños controles). Resultados: La actividad física moderada- intensa se duplicó en los intervenidos (+5,4% y +4,7%, respectivamente), tanto en niños obesos y eutróficos. La ingesta energética se redujo en 11,7% en obesos y 7,5% en los eutróficos y la de grasa en (-11 g en obesos y -8,4 g en niños eutróficos). Los niños obesos intervenidos redujeron la grasa corporal en 1,5%, mientras que en los niños controles obesos, se incrementó 1,3% (p < 0,01). Conclusiones: La intervención piloto demostró la viabilidad de influir en los factores de riesgo dietarios y de actividad física en las guarderías y en las familias. Por lo tanto, la ejecución del proyecto piloto se pondrá a prueba en diferentes condiciones climáticas, para prevenir hábitos no saludables en los preescolares y sus familias (AU)

Nanoscale adhesive forces between silica surfaces in aqueous solutions.

Nanoscale adhesive forces between a colloidal silica probe and a flat silica substrate were measured with an atomic force microscope (AFM) in a range of aqueous NaCl, CaCl2, and AlCl3 solutions, with concentrations ranging from 10(-)(6) to 10(-)(2) M at pH ∼5.1. Notably, the measured force curves reveal large pull-off forces in water which increase in electrolyte solutions, with jump-off-contact occurring as a gradual detachment of the probe from the flat substrate rather than as a sharp discontinuous jump. The measured force curves also show that the number and size of the steps increase with concentration and notably with electrolyte valence. For the higher concentration and valence the steps become jumps. We propose that these nanoscale adhesive forces between mineral surfaces in aqueous solutions may arise from newly born cavities or persistent subnanometer bubbles. Formation of cavities or nanobubbles cannot be observed directly in our experiments; however, we cannot disregard them as responsible for the discontinuities in the measured force data. A simple model based on several cavities bridging the two surfaces we show that is able to capture all the features in the measured force curves. The silica surfaces used are clean but not intentionally hydroxylated, as contact angle measurements show, and as such may be responsible for the cavities.

School-based obesity prevention interventions for Chilean children during the past decades: lessons learned.

Obesity in Chilean children has increased markedly over the past decades. School-based obesity prevention interventions have been launched by the Ministry of Health and academic groups to tackle this condition. We summarize the main characteristics of the interventions that we have conducted and reflect on the lessons learned. Since 2002, we conducted 1 pilot study, a 2-y controlled intervention including 6- to 12-y-old children (Casablanca), another pilot study, and a 2-y controlled intervention including teachers and their 4- to 9-y-old students (Macul). Both interventions consisted of training teachers to deliver contents on healthy eating, increasing physical education classes, and, additionally in Macul, teachers participated in a wellness program. BMI Z-score and obesity prevalence were compared among children in intervention and control schools by year and among students of intervention and control teachers. In the Casablanca study, the impact was greatest on the younger children during the first school year when the study received the full funding that was required. In Macul, although intervention teachers exhibited improvements in anthropometry and blood measures, the impact on the children was not related to their results. The main lessons learned from these experiences are random allocation of schools, although methodologically desirable, is not always possible; participation of parents is very limited; obesity is not recognized as a problem; and increasing physical activity and implementing training programs for teachers is difficult due to an inflexible curriculum and lack of teachers' time. Unless these barriers are overcome, obesity prevention programs will not produce positive and lasting outcomes.

Evaluación de una intervención en educación alimentaria y actividad física para prevenir obesidad infantil en escuelas públicas de Santiago de Chile

El objetivo de este estudio fue evaluar una intervención en educación nutricional y actividad física para prevenir obesidad en escolares chilenos, mediante seguimiento longitudinal de tres años. La muestra incluyó 597 niños de 4 a 7 años asistentes a 7 escuelas públicas de una comuna de bajo nivel socioeconómico de Santiago. Los principales aspectos de la intervención fueron: capacitación de profesores para que apliquen un programa de educación nutricional, aumento de las clases de educación física de 3 a 4 sesiones semanales y mejoría de su calidad. Se midió: Peso (P), Talla (T), circunferencia de cintura (CC) y test de caminata de 6 minutos (TM6). Se calculó IMC, Z IMC, % de escolares normales (N), sobrepeso (SP) y obesos (OB), CC > percentil 90 (NHANES III) y condición física (T6M/talla). Se evaluaron los cambios anuales de Z IMC, CC, TM6 y TM6/talla usando el test de repeticiones de ANOVA y el test de proporciones. Se evaluaron cambios en conocimientos sobre alimentación saludable en 2 de los 3 años. Los resultados mostraron que el porcentaje de obesidad (17%) no cambió los primeros dos años, sin embargo aumentó el tercer año a un 19,3%; Z IMC aumentó de 0,3 a 0,38 (p=0,052) en los N, sin cambio en SP y disminuyendo significativamente en los OB (2,73 a 2,41 p<0,0001). % CC >percentil 90 disminuyó en los SP y OB. El incremento en el TM6 fue mayor en los N. La condición física mejoró en todos los niños, pero fue significativo sólo en los N (p=0,0002). Hubo un aumento significativo en los conocimientos alimentarios. Se concluye que a pesar de una disminución en el Z IMC de los OB y una mejoría en la condición física de los N y de los conocimientos en todos los escolares, la obesidad aumentó al tercer año. Este estudio muestra que a nivel escolar es necesario implementar intervenciones más intensas y con otro tipo de metodologías, para impedir que la obesidad infantil continúe aumentando.

Evaluation of an obesity prevention intervention which includednutrition education and physical activity applied in public schools of Santiago, Chile . The main objective of this study was to assess the effectiveness of an obesity prevention intervention which included nutrition education and physical activity applied to low income Chilean children in a longitudinal three-year follow-up study. Participants included all 4-7 year old children from 7 public schools located in a low socioeconomic district of Santiago. The main aspects of the intervention were: training of teachers so they could apply an educational program on healthy eating, increase in physical education classes from 3 to 4 per week, and improvement of their quality. Weight, height, waist circumference (WC) and the 6-minute walk distance (6MWD) were assessed yearly in 597 children. We calculated BMI, BMI Z, % normal (N), overweight (OW) and obesity (OB), WC > 90th percentile (NHANES III) and fitness (6MWD/ height). Annual changes in BMI Z, WC, 6MWD and fitness were assessed, using repeated measures ANOVA and the test of proportions. Knowledge in healthy eating was assessed during 2 of the 3 years. Results showed that % OB remained unchanged for 2 years (17%) but increased to 19.3 % at follow-up. BMI Z increased from 0.3 to 0.38 (p= 0.052) in the N, remained unchanged in the OW, while decreasing significantly in the OB (2.73 to 2.41 p< 0.0001). % WC > 90 th percentile decreased in the OW and OB; 6 MWD was higher in the OW, but the increase in distance overtime was greater among the N. Overall fitness improved, however it was only significant among the N (p= 0.0002). There was a significant increase in food knowledge. We conclude that in spite of a decrease in BMI Z of the OB, an improvement in fitness in the N and food knowledge in all the children, obesity increased at follow- up. This study shows that in school-based obesity programs it is necessary to apply more intense interventions with another type of methodology; otherwise this condition will continue to rise.

[Evaluation of an obesity prevention intervention which included nutrition education and physical activity applied in public schools of Santiago, Chile]. / Evaluación de una intervención en educación alimentaria y actividad física para prevenir obesidad infantil en escuelas públicas de Santiago de Chile.

The main objective of this study was to assess the effectiveness of an obesity prevention intervention which included nutrition education and physical activity applied to low income Chilean children in a longitudinal three-year follow-up study. Participants included all 4-7 year old children from 7 public schools located in a low socioeconomic district of Santiago. The main aspects of the intervention were: training of teachers so they could apply an educational program on healthy eating, increase in physical education classes from 3 to 4 per week, and improvement of their quality. Weight, height, waist circumference (WC) and the 6-minute walk distance (6MWD) were assessed yearly in 597 children. We calculated BMI, BMI Z, % normal (N), overweight (OW) and obesity (OB), WC > 90th percentile (NHANES III) and fitness (6MWD/height). Annual changes in BMI Z, WC, 6MWD and fitness were assessed, using repeated measures ANOVA and the test of proportions. Knowledge in healthy eating was assessed during 2 of the 3 years. Results showed that % OB remained unchanged for 2 years (17%) but increased to 19.3% at follow-up. BMI Z increased from 0.3 to 0.38 (p = 0.052) in the N, remained unchanged in the OW, while decreasing significantly in the OB (2.73 to 2.41 p < 0.0001). % WC > 90 th percentile decreased in the OW and OB; 6 MWD was higher in the OW, but the increase in distance overtime was greater among the N. Overall fitness improved, however it was only significant among the N (p = 0.0002). There was a significant increase in food knowledge. We conclude that in spite of a decrease in BMI Z of the OB, an improvement in fitness in the N and food knowledge in all the children, obesity increased at follow-up. This study shows that in school-based obesity programs it is necessary to apply more intense interventions with another type of methodology; otherwise this condition will continue to rise.

[Effect of counselling school teachers on healthy lifestyle on the impact of a program to reduce childhood obesity]. / Estrategia de prevención de obesidad en escolares: Efecto de un programa aplicado a sus profesores (2007-2008).

BACKGROUND: In 2007, a preventive strategy for childhood obesity, that included food education and an increase in physical activity, was implemented in seven public schools located in Santiago. In four of these schools, a counseling program about healthy lifestyles for teachers was also carried out. AIM: To test if counseling had an effect in the intervention for children. MATERIAL AND METHODS: Anthropometric measures were assessed in children at baseline and after two years of intervention. Teachers were also evaluated with anthropometry and a blood sample was obtained to measure blood glucose and serum lipids. RESULTS: Four hundred twelve children from schools whose teachers had counseling and 237 children from schools whose teachers did not have it were evaluated. Twenty-eight teachers with and 19 with no counseling were assessed. In children, the overall prevalence of obesity decreased from 20.2 to 18.3% (p = 0.03). This reduction was only significant among females. BMIZ score decreased significantly in children of both genders. No effect of counseling was observed on weight reduction. Among teachers that received counseling, the prevalence of obesity decreased from 25 to 22.4%, with significant improvements in blood glucose and HDL cholesterol. CONCLUSIONS: Counseling directed at teachers did not improve the effect of a program to reduce obesity among schoolchildren.

Estrategia de prevención de obesidad en escolares: Efecto de un programa aplicado a sus profesores (2007-2008) / Effect of counselling school teachers on healthy lifestyle on the impact of a program to reduce childhood obesity

Background: In 2007, a preventive strategy for childhood obesity, that included food education and an increase in physical activity, was implemented in seven public schools located in Santiago. In four of these schools, a counseling program about healthy lifestyles for teachers was also carried out. Aim: To test if counseling had an effect in the intervention for children. Material and Methods: Anthropometric measures were assessed in children at baseline and after two years of intervention. Teachers were also evaluated with anthropometry and a blood sample was obtained to measure blood glucose and serum lipids. Results: Four hundred twelve children from schools whose teachers had counseling and 237 children from schools whose teachers did not have it were evaluated. Twenty-eight teachers with and 19 with no counseling were assessed. In children, the overall prevalence of obesity decreased from 20.2 to 18.3 percent (p = 0.03). This reduction was only significant among females. BMIZ score decreased significantly in children of both genders. No effect of counseling was observed on weight reduction. Among teachers that received counseling, the prevalence of obesity decreased from 25 to 22.4 percent, with significant improvements in blood glucose and HDL cholesterol. Conclusions: Counseling directed at teachers did not improve the effect of a program to reduce obesity among schoolchildren.

[Obesity prevention in preschool and schoolchildren attending public schools from a district of Santiago, Chile: pilot project 2006]. / Prevención de obesidad en preescolares y escolares de escuelas municipales de una Comuna de Santiago de Chile: proyecto piloto 2006.

Childhood obesity in Chile has been recognized as a public health problem. In 2006, we developed a school-based obesity prevention pilot project to intervene during 5 months preschool and schoolchildren from 1st to 4th grades attending 7 public schools located in a district of Santiago, Chile of medium-low and low SES. The objective of this project was to evaluate the feasibility of implementing a longer intervention giving recommendations to the educational authorities to better implement it. We trained teachers to apply educational activities ( in nutrition and physical activity) for the children in the 7 schools, but additionally in 4 of these schools, teachers of those grades participated in a Counselling program on healthy lifestyle applied individually, anthropometric evaluation and blood tests. The initiatives were evaluated on a sample of 522 schoolchildren (nutritional status and physical fitness), 38 teachers with Counselling (BMI, waist circumference or WC, blood sugar, HDL, triglycerides, cholesterol) and 19 teachers with no counselling (BMI and WC). Additionally, we evaluated the quality of PE classes. The results on the children show a trend on only the younger ones to decrease the % obesity, improving significantly their physical fitness. In teachers with counselling, a trend toward decreasing BMI and WC was observed, while biochemical parameters remained unchanged. We showed that it is feasible to implement a longer intervention recommending improving the quality of PE classes and allowing more time to train teachers and for individual counselling.

Prevención de obesidad en preescolares y escolares de escuelas municipales de una comuna de Santiago de Chile: proyecto piloto 2006 / Obesity prevention in preschool and schoolchildren attending public schools from a district of Santiago, Chile: pilot project 2006

La obesidad infantil en Chile ha sido reconocida como un problema de salud pública prioritario. En el año 2006 desarrollamos un proyecto piloto de intervención de 5 meses para prevenir obesidad en preescolares y escolares de pre-kinder a 4º grado en 7 escuelas públicas de una comuna de clase media-baja de Santiago de Chile. El objetivo del proyecto fue evaluar la factibilidad de implementar una intervención de más largo plazo y darle sugerencias a las autoridades para poder hacerlo en mejor forma. En las 7 escuelas se implementaron actividades educativas dirigidas a los niños, en los ámbitos de alimentación saludable y fomento de la actividad física, pero además en 4 de éstas, se implementó un programa para los profesores. Este consistió en Consejería personalizada en hábitos de vida saludable, evaluaciones antropométricas y bioquímica. Las iniciativas se evaluaron en una muestra de 522 escolares (estado nutricional y aptitud física) y en 38 profesores intervenidos (IMC, circunferencia de cintura, glicemia, HDL, colesterol total y triglicéridos) y los 19 sin intervención (IMC y circunferencia de cintura). Se determinó además la calidad de las clases de educación física. Los resultados muestran una tendencia en los escolares de menor edad de disminuir el por ciento de obesidad, mejorando significativamente la aptitud física. En los profesores intervenidos se aprecia una tendencia a disminuir el IMC y circunferencia de cintura, mientras que los parámetros bioquímicos no variaron. Se muestra que es factible implementar un programa de más larga duración recomendando mejorar las clases de educación física y aumentar el tiempo disponible para Consejería y capacitación de profesores.

Childhood obesity in Chile has been recognized as a public health problem. In 2006, we developed a school-based obesity prevention pilot project to intervene during 5 months preschool and schoolchildren from 1st to 4th grades attending 7 public schools located in a district of Santiago, Chile of medium-low and low SES. The objective of this project was to evaluate the feasibility of implementing a longer intervention giving recommendations to the educational authorities to better implement it. We trained teachers to apply educational activities ( in nutrition and physical activity) for the children in the 7 schools, but additionally in 4 of these schools, teachers of those grades participated in a Counselling program on healthy lifestyle applied individually, anthropometric evaluation and blood tests. The initiatives were evaluated on a sample of 522 schoolchildren (nutritional status and physical fitness), 38 teachers with Counselling (BMI, waist circumference or WC, blood sugar, HDL, triglycerides, cholesterol) and 19 teachers with no Counselling (BMI and WC). Additionally, we evaluated the quality of PE classes. The results on the children show a trend on only the younger ones to decrease the percent obesity, improving significantly their physical fitness. In teachers with Counselling, a trend toward decreasing BMI and WC was observed, while biochemical parameters remained unchanged. We showed that it is feasible to implement a longer intervention recommending improving the quality of PE classes and allowing more time to train teachers and for individual Counselling.