Sensibilización durante la asistencia circulatoria de corta duración. Determinantes, tratamiento y pronóstico después del trasplante cardiaco / Sensitization during short-term mechanical circulatory support. Determinants, therapeutic management, and outcomes after heart transplant

Introducción y objetivos: El desarrollo de anticuerpos contra antígenos leucocitarios humanos es una complicación conocida de la asistencia ventricular de larga duración. El propósito del presente estudio es evaluar su incidencia durante el empleo de dispositivos de asistencia ventricular de corta duración (DAVC) (CentriMag), sus determinantes y su repercusión en los resultados del trasplante cardiaco. Métodos: Estudio retrospectivo con pacientes tratados con DAVC como puente al trasplante entre 2009 y 2019. Se consideró sensibilización un panel reactivo de anticuerpos calculado> 10%. Las variables de respuesta fueron supervivencia y supervivencia libre de rechazo agudo (RA). Resultados: Se trató con DAVC a 89 pacientes, con una mediana de edad de 56,0 [intervalo intercuartílico, 50,0-59,9] años y el 16,8% de mujeres, durante una mediana de 23,6 [16,6-35,0] días. El 12,4% se sensibilizó durante la asistencia. El único determinante independiente de la sensibilización fue el sexo femenino (OR=8,67; IC95%, 1,93-38,8; p=0,005). De los 89 pacientes, 21 fallecieron durante la asistencia y 68 se sometieron a trasplante. De los pacientes trasplantados, 8 (11,8%) fallecieron y 20 (29,4%) tuvieron algún episodio de RA tras un seguimiento promedio de 49,6 ±31,2 meses tras el trasplante. Tras ajuste multivariable, la sensibilización aumentó el riesgo de RA (HR=3,64; IC95%, 1,42-9,33; p=0,007), con una tendencia no significativa a mayor mortalidad (HR=4,07; IC95%, 0,96-17,3; p=0,057). Conclusiones: La sensibilización relacionada con los DAVC es posible, predomina en el sexo femenino y se asocia de manera significativa con el RA, con una tendencia no significativa a mayor mortalidad (AU)

Introduction and objectives: The development of human-leukocyte antigen antibodies is a well-known adverse effect of the use of long-term ventricular assist devices (VADs). The aim of this study was to determine the incidence of sensitization during short-term mechanical circulatory support with VAD (CentriMag), its determinants, and its impact on posttransplant outcomes. Methods: We performed a retrospective review of patients who were bridged to transplant with short-term VAD from 2009 to 2019. Sensitization was defined as a calculated panel-reactive antibody> 10%. The endpoints included overall survival and rejection-free survival. Results: A total of 89 patients (median age 56.0 [interquartile range, 50.0-59.9] years, 16.8% female) received a short-term VAD as a bridge to transplant. The median duration of support was 23.6 [interquartile range, 16.6-35.0] days. Eleven patients (12.4%) became sensitized during support. The only factor significantly associated with sensitization was female sex (OR, 8.67; 95%CI, 1.93–38.8; P=.005). Of the 89 patients, 21 patients died during support; 68 patients underwent heart transplant. After a mean follow-up of 49.6 ±31.2 months, 8 patients (11.8%) died and 20 (29.4%) had at least 1 rejection episode. On multivariate analysis, sensitization was an independent predictor of acute rejection (HR, 3.64; 95%CI, 1.42-9.33; P=.007), with a nonstatistically significant trend to higher mortality (HR, 4.07; 95%CI, 0.96-17.3; P=.057). Conclusions: Sensitization with short-term VADs can occur and is significantly associated with female sex and with rejection. Sensitization also showed a nonstatistically significant trend to higher mortality (AU)

[Nasal congestion as an autonomic symptom accompanying migraine attacks]. / Congestion nasal como sintoma autonomico acompañante de crisis migranosas.

TITLE: Congestion nasal como sintoma autonomico acompañante de crisis migranosas.

[Clinical characteristics of vestibular migraine: considerations in a series of 41 patients]. / Caracteristicas clinicas de la migraña vestibular: consideraciones en una serie de 41 pacientes.

INTRODUCTION: After years of debate about its being approached from headaches and its denomination, vestibular migraine has recently been included in the research appendix of the 3rd edition of the International Headache Classification. AIM: To analyse the characteristics of a series of patients with vestibular migraine who visited because of headaches. PATIENTS AND METHODS: Our sample consisted of patients who were attended in a headache unit between January 2014 and December 2015. The demographic variables and the characteristics of both migraine and vestibular symptoms were considered, and cases with other otorhinolaryngological conditions were excluded. RESULTS: The sample was finally made up of 41 patients (11 males, 30 females) with a mean age of 31.8 ± 13.3 years at the time they were included in the study. Sixteen patients (39%) met criteria for chronic migraine and two (4.9%) presented visual auras. The vestibular symptoms were considered severe in eight cases (19.5%) and occurred in 74.6% of the migraine attacks. Vertigo was described as internal in 18 cases (43.9%), external in 22 (53.7%) and mixed in one case (2.4%). The most frequent symptom was positional vertigo (n = 25; 61%), followed by that induced by head movements (n = 18; 43.9%) and spontaneous (n = 15; 36.6%). Accompanying symptoms included tinnitus (n = 12; 29.3%) and a feeling of fullness in the ear (n = 8; 19.5%). CONCLUSION: It is not uncommon to identify symptoms consistent with vestibular migraine in patients who visit a headache unit; they are patients whose day-to-day activities are not usually affected by their vertigo.

TITLE: Caracteristicas clinicas de la migraña vestibular: consideraciones en una serie de 41 pacientes.Introduccion. Tras años de debates sobre su enfoque desde las cefaleas y su denominacion, la migraña vestibular ha sido recientemente incluida en el apendice de investigacion de la III edicion de la Clasificacion Internacional de Cefaleas. Objetivo. Analizar las caracteristicas de una serie de pacientes con migraña vestibular en los que el motivo de consulta fue la cefalea. Pacientes y metodos. Pacientes atendidos en una unidad de cefaleas entre enero de 2014 y diciembre de 2015. Se consideran las variables demograficas y caracteristicas tanto de la migraña como de los sintomas vestibulares, y se excluyen los casos con otras patologias otorrinolaringologicas. Resultados. Se incluyen 41 pacientes (11 varones, 30 mujeres) con una edad media de 31,8 ± 13,3 años en el momento de la inclusion. Dieciseis pacientes (39%) reunian criterios de migraña cronica y dos (4,9%) presentaban auras visuales. Los sintomas vestibulares fueron considerados graves en ocho casos (19,5%) y ocurrian en un 74,6% de los episodios de migraña. El vertigo se describia como interno en 18 casos (43,9%), externo en 22 (53,7%) y mixto en uno (2,4%). El sintoma mas frecuente fue el vertigo posicional (n = 25; 61%), seguido del inducido por movimientos cefalicos (n = 18; 43,9%) y el espontaneo (n = 15; 36,6%). Como sintomas acompañantes se observaron acufenos (n = 12; 29,3%) y pletora aural (n = 8; 19,5%). Conclusion. La identificacion de sintomas compatibles con una migraña vestibular no es excepcional en los pacientes que acuden a una unidad de cefaleas; se trata de pacientes en los que el vertigo no suele interferir en sus actividades habituales.

Consumo, hábitos alimentarios y habilidades culinarias en alumnos de tercero a quinto año básico y sus padres / Food consumption, dietary behaviour and cooking skills in third to fifth grade school-age children and parents

The objective of this study was to describe food consumption, dietary behaviour and culinary habits in third to fifth grade students and their families through surveys and focus groups to implement nutrition education interventions in healthy eating habits at schools. Surveys in parents and children demonstrated that healthy food consumption was under the Chilean Dietary Guidelines recommendations. Consumption of fruits, vegetables and dairy food in parents was less than in children, but non-healthy food consumption was also less in parents. In dietary behavior 22% of children consumed breakfast at home and also at school, and 33% consumed double lunch. Snack was carried from home in 60% of children, but 72% carried money to buy non-healthy snacks at school. Parents said that they had norms related to dietary behavior at home, but 60% watched TV during dinner and 96% had afternoon tea and just 42.2% had dinner. Regarding culinary habits, students had the skills to prepare simple food but did not have the skills to prepare a dish. The mothers said they had the culinary skills but they cook simple food like pasta, rice and potatoes. Focus groups confirmed survey findings, identifying three profiles in mothers and separating eating behaviour during the weekdays and weekend. Its notorious that mothers consuming a healthy diet were those who had more health problems. Barriers to healthy eating were lack of time and money. Surveys and focus groups showed a good access by parents and children to Information and Communication Technologies. In conclusion, it is urgent to design nutrition education programs to create healthy eating habits considering the current situation in food consumption, dietary behaviour and culinary habits in students and their parents.

El objetivo de este estudio fue describir el consumo, los hábitos alimentarios y las habilidades culinarias en alumnos de tercero a quinto año básico y de su familia por medio de encuestas y grupos focales para realizar intervenciones educativas en alimentación saludable en el ámbito escolar. Para ello se realizaron encuestas a alumnos y padres, que se complementaron con grupos focales. Según las encuestas, el consumo de alimentos saludables en alumnos y padres estuvo por debajo de lo recomendado en las Guías Alimentarias. El consumo de frutas, verduras y lácteos en los padres fue menor que en los hijos, pero consumieron menos alimentos no saludables. En hábitos, 22% de los niños tomaba doble desayuno y 33% doble almuerzo. Un 60% llevaba colación de la casa, pero 72% llevaba dinero destinado a compra de alimentos poco saludables. Los padres decían tener normas, pero un 60% veía televisión cuando comía, 96% tomaba once y 42,2% cenaba. En habilidades culinarias, los alumnos podían preparar alimentos simples, pero no un plato de comida. Las madres decían tener habilidades culinarias, pero cocinaban en forma ocasional y comida básica como papas, arroz y fideos. Los grupos focales confirmaron lo anterior, identificando tres perfiles de madres y diferenciando lo que comen en la semana con los fines de semana. Destaca el perfil de madres que se alimenta saludable, que eran las que han tenido un problema de salud. Las barreras para alimentarse bien son el alto costo y la falta de tiempo. Las encuestas y grupos focales mostraron un buen acceso de padres e hijos a las Tecnologías de la Información y Comunicación. Lo anterior demuestra el imperativo de contar con programas de educación nutricional prácticos para crear hábitos de alimentación saludable que consideren la situación actual de consumo, hábitos alimentarios y habilidades culinarias de los alumnos y sus padres.

Migraciones en países de América Latina: Características de la población pediátrica / Migrations in Latin American countries: Characteristics of the pediatric population Abstract

Introducción: Las migraciones constituyen un fenómeno creciente en América Latina (AL), pero hay poca información sobre la magnitud en población pediátrica y asociación con variables sociodemográficas. Objetivo: Estudiar la asociación de variables sociodemográficas con la tasa de inmigración de población pediátrica en países de AL. Material y métodos: Se buscó información sobre migraciones en países de AL en: Organización Internacional para Migraciones, Organización Panamericana de la Salud y Programa de Naciones Unidas para el Desarrollo. Se efectuaron correlaciones o comparación entre países de variables económicas y demográficas: ingreso nacional bruto per cápita (INB), índice de desarrollo humano (IDH), coeficiente de desigualdad Gini (CG) y tasa de alfabetización (% adultos alfabetizados, TA), con tasa neta de migración por país (TNM) y de niños < 15 años (IN15). Resultados: La TNM fue positiva para Costa Rica, Panamá, Venezuela, Chile y Argentina. No observamos asociación entre TNM con: INB, IDH, CG y TA. Hubo una asociación de IN15 con CG (r = 0,668, p = 0,01), con INB (r = -0,720; p = 0,01), con TA (r = -0,755; p = 0,01) y con IDH (r = -0,799; p = 0,01). La IN15 fue más baja en países de AL con mayor INB vs. aquellos con menor INB (Fisher, p < 0,0001). Conclusiones: Hay una asociación inversa entre INB per cápita, IDH, TA y directa del CG, con la proporción de IN15 de cada país. No observamos una asociación entre TNM con IDH, TA, CG. Debe analizarse el impacto en salud de estas migraciones infantiles.

Introduction: Migration is a growing phenomenon among Latin American countries (LAC) as well as others; however, scarce information is available studying its impact on paediatric groups and its association with socioeconomic variables. Objective: To study the association among socioeconomic variables and the immigration rate of paediatric population in LAC. Material and methods: Official rates of migration of LAC were obtained from: International Organization for Migration, Pan American Health Organization, and United Nations Development Programme. Demographic and socioeconomic information was also obtained for: gross domestic product (GDP), human development index (HDI), Gini coefficient of inequality (GC), alphabetization rate for adults (AA), net migration rate (NMR), and immigration of children < 15 years (IM15). Description, linear correlations and analysis of differences between groups of countries were assessed. Results: The NMR was positive for Costa Rica, Panama, Venezuela, Chile and Argentina. No association among NMR and GDP, HDI, GC, AA was found. A correlation of IM15 was found with: GC (r = 0.668, P = .01), with GDP (r = -0.720; P = .01), AA (r = -0.755; P = .01) and with HDI (r = -0.799; P = .01). Rate of IM15 was lower in LA countries with advanced/medium development (GDP> median) vs those with low development (Fisher, P < .0001). Conclusions: There is a direct inverse association between GDP per capita, HDI, AA and GC and the proportion of each country IN15. We did not observe an association between NMR and HDI, AA, and GC. The health impact of these migrations should be analysed.

[Migrations in Latin American countries. Characteristics of the pediatric population]. / Migraciones en países de América Latina. Características de la población pediátrica.

INTRODUCTION: Migration is a growing phenomenon among Latin American countries (LAC) as well as others; however, scarce information is available studying its impact on paediatric groups and its association with socioeconomic variables. OBJECTIVE: To study the association among socioeconomic variables and the immigration rate of paediatric population in LAC. MATERIAL AND METHODS: Official rates of migration of LAC were obtained from: International Organization for Migration, Pan American Health Organization, and United Nations Development Programme. Demographic and socioeconomic information was also obtained for: gross domestic product (GDP), human development index (HDI), Gini coefficient of inequality (GC), alphabetization rate for adults (AA), net migration rate (NMR), and immigration of children<15 years (IM15). Description, linear correlations and analysis of differences between groups of countries were assessed. RESULTS: The NMR was positive for Costa Rica, Panama, Venezuela, Chile and Argentina. No association among NMR and GDP, HDI, GC, AA was found. A correlation of IM15 was found with: GC (r=0.668, P=.01), with GDP (r=-0.720; P=.01), AA (r=-0.755; P=.01) and with HDI (r=-0.799; P=.01). Rate of IM15 was lower in LA countries with advanced/medium development (GDP>median) vs those with low development (Fisher, P<.0001). CONCLUSIONS: There is a direct inverse association between GDP per capita, HDI, AA and GC and the proportion of each country IN15. We did not observe an association between NMR and HDI, AA, and GC. The health impact of these migrations should be analysed.

Focal hyperhidrosis secondary to eccrine naevus successfully treated with botulinum toxin type A.

Eccrine naevus (EN) is a rare skin hamartoma included in the organoid group of epidermal naevi, histologically defined as focal hyperplasia and/or hypertrophy of eccrine glands. Clinically, EN usually presents as hyperhidrotic patches with no visible skin changes, frequently located on the forearms. The decision to treat EN or not usually depends on the grade of hyperhidrosis, but there is no therapeutic consensus because of the rarity of this condition. We present a case diagnosed as EN in an adult patient with severe localized hyperhidrosis, which was successfully treated with botulinum toxin.

Evaluación de un programa de entrega de frutas con educación nutricional en escuelas públicas rurales de la Región Metropolitana, Chile / Evaluation of a fruits delivery program with nutrition education in rural public schools from the Metropolitan Region, Chile

The objective of this study was to assess the delivery of fruits with nutrition education in rural schools measuring its impact on food knowledge, food consumption and children nutritional status. A longitudinal quasi-experimental study of one year was carried out in an experimental group with delivery of fruits plus nutrition education, compared with a control group. Subjects were 784 school children (preschool to 8th grade) in 5 basic schools in María Pinto and 192 in the control group in Curacaví. Nutritional status, food knowledge, food consumption, the amount of fruit distributed and customer satisfaction were evaluated. Results showed that 85% of preschool to 2nd grade and 68.2% 3th to 8th grade children reported to consume fruit as a snack at least 3 times perweek. In children from 3th to 8th grade dairy consumption (more than 2 times per day) increased from 62% to 74%, respectively (p<0.01). Consumption of fruit more than 2 times per day increased to 34.9%, and legumes intake more than twice per week increased 37.7% to 51.7% (p<0.0001). In preschool from 57.6% to 76.2% and vegetables consumption more than 2 times per day increased from 26.8% to 2nd grade children there was a significant increase in healthy food knowledge in the period of the intervention (p<0.0001), while in children from 3th to 8th grade there was a significant improvement in consumption of fish and dairy food (p<0.0001). In the control group there were no changes either in food knowledge or in fruit consumption, and no changes in nutritional status were observed in both groups. In conclusion, the success of the program resides in the improvement of food knowledge and fruit consumption as a protective factor. To achieve an impact in nutritional status is necessary the long-term continuity of the program.

El objetivo de la presente investigación fue evaluar la entrega de fruta, con educación nutricional en escuelas básicas rurales midiendo su impacto en conocimiento, consumo y estado nutricional de los niños. Para ello se realizó un estudio cuasi-experimental, de seguimiento longitudinal de un año de duración en niños intervenidos con educación nutricional y entrega de frutas, comparados con un grupo control. La muestra fue de 784 niños de prekinder a 8° básico de 5 escuelas de María Pinto y 192 de una escuela control en Curacaví. Se evaluó el estado nutricional, consumo de alimentos seleccionados, conocimientos sobre alimentación saludable y consumo de la fruta entregada y satisfacción de usuarios. Resultados: el 85% de los niños de prekinder a 2° básico y el 68,2% de 3° a 8° básico reportaron consumir fruta de colación 3 días a la semana. En niños de 3° a 8° básico aumentó el consumo en 2 o más porciones al día de lácteos, de 62% a 74% (p<0,01). El consumo diario de 2 o más frutas aumentó de 57,6% a 76,2% y de 2 o más porciones de verduras de 26,8% a 34,9% y las legumbres 2 o más veces por semana aumentaron de 37,7% a 51,7% (p<0,0001). Hubo un aumento significativo en el conocimiento de una alimentación saludable entre el inicio y final (p<0,0001) en niños de prekinder a 2° básico; en los de 3° a 8° básico el cambio fue significativo en pescados y lácteos (p<0,0001). El grupo control no presentó cambios en el conocimiento ni consumo (p>0,1). No hubo cambios significativos en el estado nutricional del grupo intervenido ni del control. Se concluye que el programa fue exitoso ya que se cumplió el propósito de aumentar el conocimiento y consumo de fruta como un factor protector de la salud y que para lograr impacto en el estado nutricional se requiere darle continuidad en el tiempo.

Raciones de desayuno y almuerzo entregadas a preescolares por el Programa de Alimentación Escolar (PAE): calorías aportadas y consumidas / National School Food Program: calories provided and consumed by preschool children for breakfast and lunch

Chile's School Feeding Program delivers approximately 215,000 and 1.3 million breakfast and lunch trays daily to preschool and school children attending public schools. In 2011 we carried out a study with the objective to determine Kcal provided and consumed from breakfast and lunch trays respectively, acceptance" of the preparations and assess if there was an association between K cal consumed and nutritional status. The sample included 199 5 y old children from 6 schools located in 3 low income districts of Santiago (2 per district). K cal consumed was determined by the difference in weight of each preparation from 429 and 1491 breakfast and lunch trays, respectively. Almost 50% of the children were overweight. 10.8% and 30% of the breakfast and lunch trays respectively provided less K cal than indicated, while in 50% of them, there was an excess. In 22.5% of breakfast and lunch trays added together, consumption exceeded the amount indicated. The correlation between consumption of the preparation and acceptance was good. Salads showed low acceptability. No relation was found between K cal consumed and nutritional status. This program should include a revision of the combination of food preparations and their correct portioning as a means of addressing the high prevalence of childhood obesity.

El Programa de Alimentación Escolar de Chile (PAE) entrega diariamente 215.000 raciones de desayuno y almuerzo a preescolares y 1.3 millones a escolares de escuelas públicas y subvencionadas del país. El año 2011 efectuamos un estudio cuyo objetivo fue determinar las Kcal aportadas y consumidas en el desayuno y almuerzo, determinar si las preparaciones les gustaban a los niños y verificar si habría una relación entre Kcal consumidas y estado nutricional. La muestra incluyó a 199 niños de 5 años de 6 escuelas de 3 comunas (2 por comuna) de nivel bajo de Santiago. Se determinaron las K cal consumidas por la técnica de pesaje por diferencia en 429 y 1491 bandejas de desayuno y almuerzo respectivamente. Cerca del 50% de los niños tenía sobrepeso. En 10,8% y 30% de las bandejas de desayuno y almuerzo respectivamente el aporte calórico fue inferior a lo indicado; en 50% fue superior. En 22,5 % de las bandejas de ambos servicios, el consumo fue superior a lo establecido. Hubo una buena correlación entre consumo de la preparación y si les gustó. Las ensaladas mostraron baja aceptabilidad. No hubo relación entre estado nutricional y el consumo de calorías. Frente a la alta prevalencia de obesidad, se recomienda revisar la combinación de preparaciones y el porcionamiento de éstas.

Intervención en alimentación y nutrición para mineros con factores de riesgo cardiovascular, basada en la investigación formativa / Food and nutrition intervention for miners with cardiovascular risk factors, based on formative research

We designed and implemented an intervention to improve the diet of 94 miners with cardiovascular risk of a mining company. The diagnosis included a qualitative study of the desires, motivations and barriers that workers have to lead a healthy life, a survey of food consumption and checking the institutional food service. Anthropometric and biochemical data were provided by the company. Based on the results, the intervention included improving the supply of healthy foods and conducting the communication campaign "Minero 100% Filete", workshops and nutritional counseling for them and their families. After 8 months of intervention we found a significant increase in the consumption of fruits and vegetables and a decreased consumption of fried, cured and red meats. There was no significant change in BMI. However, there were significant decreases in systolic blood pressure, blood glucose levels, triglycerides and an increase in HDL cholesterol. Although the program was well received by the workers, it is acknowledged that there are significant adverse factors which merit improvement.

Se diseñó e implementó una intervención de 8 meses para mejorar la alimentación de 94 mineros con factores de riesgo cardiovascular. El diagnóstico incluyó un estudio cualitativo de los deseos, motivaciones y barreras de los trabajadores, una encuesta de consumo de alimentos y la revisión del aporte de la alimentación institucional. Los datos antropométricos y bioquímicos fueron proporcionados por la compañía minera. Con esta base, se solicitó mejorar la oferta de alimentos saludables y se realizó la campaña comunicacional "Minero 100% Filete", consejería nutricional, y talleres con las familias. Al finalizar la intervención se observó un aumento significativo del consumo de frutas y verduras y una disminución del consumo de frituras, cecinas y carnes rojas. No hubo cambios significativos en el IMC. Se registraron disminuciones significativas en la presión arterial sistólica, glicemia, triglicéridos y un aumento del colesterol HDL. El programa fue bien aceptado por los trabajadores, pero se reconocen factores ambientales adversos importantes de mejorar.

Conocimientos y consumo alimentario en escolares, sus padres y profesores: un análisis comparativo / Food knowledge and food consumption in school-age children, parents and teachers: a comparative analysis

The objective of this study was to conduct a comparative analysis about food knowledge and food consumption in preschool and school-age children, their parents and teachers to establish a baseline for a nutrition education intervention model in schools. For that purpose, surveys were administered about healthy and non-healthy food knowledge and food consumption. Results showed an excellent healthy food knowledge and food consumption in children. In parents, despite a good knowledge about healthy food, consumption was unhealthy. The same situation was found in teachers. Distribution of food during the day showed that 98% of parents had breakfast; 96% had lunch, and 77% had an afternoon snack instead of dinner (just 55% had dinner). The number of pre-school age parents who ate dinner was significantly higher than school-age parents. Pre-school age parents did not give money to their children to buy snacks at the school; however, a third of the school-age parents gave money to their children. This demonstrates a major care for healthy food in pre-school age children that is not maintained during the first school grades. This study shows the need to design food and nutrition education programs considering the present food knowledge and food consumption of pre-school and school age children, their parents and teachers.

El objetivo de este estudio fue hacer un análisis comparativo del conocimiento y consumo alimentario entre los escolares, sus padres y profesores, que sirva como línea de base para un modelo de intervención educativa en alimentación y nutrición en el ámbito escolar. Para ello se realizaron encuestas a niños y niñas de prekinder, kínder, primero y segundo año básico, sus padres y profesores acerca del conocimiento y consumo de alimentos saludables y no saludables. Se encontró un excelente conocimiento en los niños de lo que era una alimentación saludable, con un adecuado consumo de ellos. En los padres, en cambio, a pesar de tener conocimientos adecuados, su consumo era muy poco saludable, al igual que en los profesores. Respecto a la distribución de las comidas en el día, un 98% de los padres señaló que toman desayuno; un 96% que almuerzan y un 77% que toman té u once. En la noche cenan tan sólo un 55%, siendo este hábito significativamente mayor en los padres de prekinder y kínder que en los de 1° y 2° año básico. Los padres de prebásica no dan dinero Conducta de los padres en a sus hijos para que compren golosinas en la escuela; sin embargo un 33% de los padres de primero y segundo básico si lo hacen, lo que demuestra que existe una mayor preocupación por la alimentación saludable en los niños más pequeños, que se pierde cuando ingresan a la educación básica. Todo lo anterior demuestra que es imperativo contar con programas de educación alimentaria y nutricional que considere la situación actual de conocimientos y hábitos de consumo de los niños, sus padres y profesores, para que los incluya en forma conjunta en la educación alimentaria nutricional.

Prevalencia del sindrome metabolico en niños y adolescentes chilenos con historia familiar de enfermedades cronicas no transmisibles

La historia familiar (HF) de Enfermedades Crónicas no Transmisibles (ECNT), aumentaría el riesgo de síndrome metabólico (SM). En Chile, el SM afecta al 27% de niños con sobrepeso, y la hiperglicemia de ayuno (HA) es el trastorno menos prevalente (4.0%). El objetivo fue estudiar la prevalencia del SM y de los factores de riesgo cardiovascular (FRCV) en niños con sobrepeso e HF de ECNT analizando su asociación con el número de parientes afectados y con la historia parental (HP). En 183 niños con IMC ≥p85 de 11,8 ± 1,8 años (86 varones) e HF (padres y/o abuelos) de ECNT, se evaluó el z IMC (CDC / NCHS), el perímetro de cintura, la presión arterial, la glicemia, la insulina, los triglicéridos y el colesterol-HDL. El SM y los FRCV fueron diagnosticados por el criterio de Cook y la insulinoresistencia (IR) por el HOMA-IR. Se utilizaron Chi², ANOVA, t Student y Willcoxon. La HF de DM2, hipertensión arterial y dislipidemia fue de 81,4 %, 88,0 % y 71,6 % respectivamente. La prevalencia del SM fue de 46,5%, asociándose a la magnitud del sobrepeso y a la HP de ECNT. La prevalencia de hipertrigliceridemia y de hiperglicemia de ayuno fueron de 54,6% y 31,4% respectivamente. No hubo asociación entre el número de parientes con HF y el perfil cardiovascular y metabólico del niño. Se concluye, que la HF de ECNT, se asocia a una mayor prevalencia del SM, de dislipidemia y de hiperglicemia de ayuno que la observada en población general de niños con sobrepeso.

Metabolic syndrome prevalence in Chilean children and adolescent with family history of chronic noncommunicable diseases. . Family history (FH+) of non transmisible chronic diseases (NTCD) increase MetS risk. In Chile, the MetS affects 27% of overweight children, and fasting hyperglycemia is very low prevalent (4,0%). The objective was to study the prevalence of MetS and the cardiovascular risk factors (CVRF) in overweight children with a family background of NTCD and analyze its association with the number of relatives witth NTCD and with parental history (PH). In 183 overweight children (BMI ≥p85) mean age 11,8 ± 1,8 (86 males) with a FH+ (parental or grandparental) of NTCD, were assessed the BMI z (CDC / NCHS), waist circumference, blood arterial pressure, fasting Glucose and Insulin (RIA), triglycerides, HDL chol. The MetS and the CVRF were diagnosed using the Cook phenotype and the insulin resistance (IR) through the HOMA-IR. Chi², ANOVA, t Student and Willcoxon test were performed. The frequency of FH+ of DM2, hypertension and dyslipidemia were 81,4 %, 88,0 % and 71,6 % respectively. The MeTS prevalence was 46,5 % associated to overweight magnitude an parental history of NTCD. The prevalence of hypertriglyceridemia was 54,6%, while fasting hyperglycemia affected 31,4% of the sample. There was no association between number of relatives with NTCD and CV risk profile. We conclude that in overweight children with FH+ of NTCD, the prevalence of MetS, dyslipidemia and fasting hyperglycemia are significantly higher, than those observed in the general population of obese children.

Etapas del cambio, motivaciones y barreras relacionadas con el consumo de frutas y verduras y la actividad física en madres de preescolares atendidas en centros de atención primaria de salud / Stages of change, motivations and barriers related to the consumption of fruits and vegetables and physical activity in mothers of preschool children attending primary health centers

In order to design effective interventions for the prevention of childhood obesity the stages of change, motivations and barriers related to the consumption of five daily portions of fruit and vegetables and physical activity were determined in 323 mothers of preschool children attending Primary Health Centers, through the application of a previously validated survey. Only 5% of them consumed 5 or more portions with the majority (61.3%) consuming 1 to 2 portions. The main motivations to eat 5 portions were "I like them" and "to lose weight" while the main barrier was "I forget to eat them". With respect to physical activity, 33.1% considered themselves on the maintenance stage and 18.9% on the action stage. Main motivations were: "Makes me feel good", "To lose weight". Main barrier: "I don't have time". It is suggested that educational interventions consider the mother attitudes and beliefs to be more effective.

Con el fin de diseñar intervenciones efectivas que contribuyan a prevenir la obesidad infantil, se determinaron las etapas del cambio de la conducta, las motivaciones y barreras para consumir 5 porciones diarias de frutas y verduras y realizar actividad física en 323 madres de preescolares atendidas en Centros de Atención Primaria de Salud, mediante la aplicación de una encuesta validada en estudios previos. Sólo el 5% de ellas consumía 5 o más porciones diarias, la mayoría consumía 1 a 2 porciones (61,3%). Las principales motivaciones para comer 5 porciones fueron: "me gustan" y "para perder peso". La principal barrera "se me olvida comerlas". En la actividad física, el 33,1% indicó encontrarse en la etapa de mantenimiento y el 18,9% en acción. Las principales motivaciones: "me hace sentir bien" y "para perder peso". La principal barrera: "no tengo tiempo". Se sugiere que las intervenciones educativas consideren las actitudes y creencias de las madres, para ser más efectivas.

[Intake and energy metabolism in a sample of overweight and obese Chilean adolescents]. / Ingesta y metabolismo energético en una muestra de adolescentes chilenos con sobrepeso y obesidad.

BACKGROUND: In the last decades, a seven to nine fold increase in the prevalence of teenage obesity and overweight has occurred. AIM: To assess energy intake and metabolism in a sample of overweight and obese adolescents. MATERIAL AND METHODS: In a sample of 113 overweight and obese Chilean adolescents (aged 13 to 16 years, 67 females) we studied anthropometry, body composition by deuterium isotope dilution water, resting energy expenditure by indirect calorimetry and 24-h diet and physical activity recalls. RESULTS: Most participants (87% of men and 67.2% of women) had an intake that was adequate compared to requirements (fAO/WHO 2005). However, 82.6% of men and 83.6% of women showed reduced energy expenditure. The sample was classified as sedentary, with a physical activity level of 1.29. CONCLUSIONS: In our sample of overweight and obese adolescents there was a sedentary behavior, resulting in low energy expenditure that would explain a sustained caloric retention. Preventive and therapeutic interventions should encourage the increase in physical activity.

Ingesta y metabolismo energético en una muestra de adolescentes chilenos con sobrepeso y obesidad / Intake and energy metabolism in a sample of overweight and obese Chilean adolescents

Background: In the last decades, a seven to nine fold increase in the prevalence of teenage obesity and overweight has occurred. Aim: To assess energy intake and metabolism in a sample of overweight and obese adolescents. Material and Methods: In a sample of 113 overweight and obese Chilean adolescents (aged 13 to 16 years, 67 females) we studied anthropometry, body composition by deuterium isotope dilution water, resting energy expenditure by indirect calorimetry and 24-h diet and physical activity recalls. Results: Most participants (87 percent of men and 67.2 percent of women) had an intake that was adequate compared to requirements (fAO/WHO 2005). However, 82.6 percent of men and 83.6 percent of women showed reduced energy expenditure. The sample was classifed as sedentary, with a physical activity level of 1.29. Conclusions: In our sample of overweight and obese adolescents there was a sedentary behavior, resulting in low energy expenditure that would explain a sustained caloric retention. Preventive and therapeutic interventions should encourage the increase in physical activity.

Valoración de la utilidad del test detector de la proteínatransportadora de ácidos grasos específica del miocardio(h-FABP) en los infartos agudos de miocardio (IAM)diagnosticados en el medio extrahospitalario / Assessment of a heart-type fatty acid-binding protein test in the prehospital diagnosis of acute myocardial infarction

Objetivo: Valorar el test de la proteína cardiaca citoplasmática transportadora de ácidos grasos (h-FABP) como prueba complementaria para el diagnóstico del infarto agudo de miocardio (IAM) en el medio prehospitalario, y especialmente para aquellos pacientes con una clínica de menos de 3 horas de evolución. Método: Estudio prospectivo transversal en pacientes con sospecha de IAM atendidos por 3 unidades de soporte vital avanzado del Servicio de Salud de Castilla-La Mancha(SESCAM). Se recogieron datos clínico-epidemiológicos, un registro electrocardiográfico y se les realizó un test rápido de determinación de h-FABP. Se realizó un seguimiento hospitalario del caso y se consideró su diagnóstico final en el hospital como el patrón oro. Se calcularon los índices de rendimiento diagnóstico de la prueba. Resultados: Se incluyeron 73 pacientes. En 21 casos se repitió la determinación de h-FABP, ya que se detectó cierta dificultad en la lectura y conservación del test, y en 7 casos(9,6%) fue considerado finalmente nulo. En 50 se los 66 casos restantes con resultado legible de h-FABP dicha prueba se realizó durante las primeras 3 horas del inicio de los síntomas. En estos casos, la h-FABP obtuvo una sensibilidad del 91% (intervalo de confianza del 95%: 76%-98%), una especificidad del 37% (15%-65%), una eficiencia del 74% (64%-85%), un valor predictivo positivo del 76% (60%-88%) y un valor predictivo negativo del 67% (30%-93%). Cuando se consideró a la totalidad de pacientes sin tener en cuenta el tiempo transcurrido desde el inicio de la clínica, la h-FABP incrementó (..) (AU)

Objective: To assess the usefulness of testing for heart-type fatty acid-binding protein (h-FABP) to obtain complementary information for the diagnosis of acute myocardial infarction (AMI) in the prehospital setting, particularly in patients whose symptoms began less than 3 hours earlier. Methods: Prospective cross-sectional study in patients with probable AMI attended by 3 advanced life support units belonging to the health service of Castile-La Mancha, Spain. The recorded variables were clinical and epidemiologic data, electrocardiograms, and the results of a rapid h-FABP test. The patients were followed while in hospital, and the definitive diagnosis was considered to be the one eventually made in hospital. Indices reflecting the diagnostic yield of the test were calculated. Results: Seventy-three patients were tested. The h-FABP test had to be repeated for 21 patients because of problems related to storage of the strips or interpreting the results, and in 7 cases (9.6%) test results were judged unusable. In 50of the 66 patients for whom readable h-FABP results were obtained, the test was done within 3 hours of the onset of symptoms. In this group, the h-FABP test achieved a sensitivity of 91% (95% confidence interval [CI]), 76%-98%),specificity of 37% (95% CI, 15%-65%), efficiency of 74% (95% CI, 64%-85%), positive predictive value of 76% (95%CI, 60%-88%), and negative predictive value of 67% (95% CI, 30%-93%). The specificity of the h-FABP test was higher when calculated for the entire patient sample regardless of time elapsed since the onset of symptoms, but the other indices were similar. The diagnostic yield of the test was lower in patients with atypical clinical pictures and/or electrocardiograms than in those with more characteristic signs and (..) (AU)

Consumo de verduras y frutas en centros de salud y supermercados, de la Región Matropolitana de Chile: programa 5 al día / Vegetables and fruits consumption in health centres and supermarkets in the Chilean Metropolitan Region: 5 a day program

Objetivo: Evaluar la frecuencia de consumo de verduras y frutas y el conocimiento del mensaje "5 al día", en usuarios de Supermercados y de Centros de Salud Pública, para ser utilizados como línea base para planificar una intervención bimodal, controlada, para la promoción del consumo de frutas y verduras. Sujetos y métodos: a 1897 adultos entre 17 y 60 años, del área urbana de la Región Metropolitana, se les aplicó una encuesta de frecuencia de consumo, etapa de cambio de conducta y conocimiento del mensaje. Resultados: 58.8 por ciento señaló consumir entre 1-2 porciones/día y 33.5 por ciento entre 3-4. 91,2 por ciento indicó que ha mantenido este consumo por más de seis meses, 7,7 por ciento cumple con la recomendación "5 al día" sólo 9,4 por ciento conocía el mensaje. No hubo diferencias significativas entre los grupos de intervención salvo en el nivel educacional y en el número de porciones de consumo diario. Conclusiones: El consumo de verduras y frutas estuvo bajo la recomendación en todos los grupos estudiados y existe un desconocimiento del mensaje promocional 5 al día.

Objective: To evaluate the consumption frequency of vegetables and fruits and the knowledge of the 5 a day message in users of supermarkets and Public Health Centers to be utilized as a baseline to plan a bimodal controlled intervention for the promotion of fruits and vegetables consumption. Individuals and methods: A frequency consumption survey, the behavioral change stage and the message understanding was applied to 1.897 adults aged between 17 and 60 years in the urban area of the Metropolitan Region. Results: 58.8 percent stated that they ate between 1 -2 portions! day, 33.5 percent between 3-4,91.2 percent indicated that they had maintained this consumption for over six months and 7.7 percent complied with the recommendation of 5 a day; only 9.4 percent knew the message. There were no significant differences among the intervention groups except in the educational level and the number of daily consumption portions. Conclusions: The consumption of vegetables and fruits was under the recommendation in all the studied groups and there is a lack of knowledge regarding the 5 a day promotional message.

Motivaciones y barreras para consumir 5 porciones de frutas y verduras al día en madres de escolares y profesores de enseñanza básica / Motivation and barriers in the consumption of five daily servings of fruit and vegetables by mothers of school age children and primary school teachers

Como línea base para diseñar intervenciones más efectivas en promoción y educación, se estudió las etapas del cambio, motivaciones y barreras relacionadas con el consumo de 5 porciones diarias de frutas y verduras en 463 madres de escolares de distinto nivel socioeconómico (NSE) y 412 profesores de enseñanza básica. Estos grupos fueron escogidos por su influencia en la formación de hábitos en los niños. Para determinar las etapas del cambio, se aplicó un instrumento diseñado y validado por el Instituto Americano de Investigación del Cáncer, adaptado en Chile, contestado voluntariamente por los participantes. El 58 por ciento de las madres y el 61 por ciento de los profesores comían 1 a 2 porciones de frutas y verduras al día; el 29,4 y 32,3 por ciento 3 a 4 porciones, y sólo el 10,3 y 4,1 por ciento las 5 porciones, respectivamente. Entre las principales motivaciones para comer 5 porciones destacaron “me gustan”, para “prevenir enfermedades”, “me hacen sentir bien” y “para bajar de peso”. Entre las barreras: “se me olvida comerlas”, “no tengo tiempo”, “no me quitan el hambre” y “me da flojera prepararlas”, sin diferencias por NSE. El precio de las frutas y verduras fue considerado una barrera por el 15,1 por ciento de las madres de NSE medio alto y el 26,4 por ciento de las de NSE medio bajo (p<0,002). En los profesores, estas cifras alcanzaron al 25,4 por ciento en los hombres y al 11,7 por ciento en las mujeres (p<0,002). Se concluye que es necesario implementar intervenciones específicas para lograr que madres y profesores apoyen este saludable hábito en los niños.

As a baseline for the promotion of health and the design of educational interventions, the benefits, barriers and stages of change related to the consumption of five daily servings of fruit and vegetables were studied in 463 mothers of school age children from different socioeconomic levels (SEL) and 412 primary school teachers in 3 cities in Chile. These groups were selected because of their influence over children’s eating habits. For the evaluation of stages changes, a questionnaire designed by the American Institute for Cancer Research was adapted and applied. The questionnaire was answered voluntarily by the participants. 58 percent of the mothers and 60 percent of the teachers ate 1-2 servings of fruit and vegetables daily; 29.4 and 32.3 percent ate 3-4 servings and only 10 and 4 percent respectively ate 5 servings. Benefits reported from fruit and vegetable consumption in both groups were pleasure, wellness, a sense of well being and weight management. Barriers mentioned were forgetfulness, time constraints, non-satisfaction of appetite and lack of motivation. The price of fruit and vegetables was considered high by 15.1 percent of mothers of medium high SEL and by 26.4 percent of medium low SEL (p<0.002). Among teachers, 25.4 percent of men and 11.7 percent of women also considered price as a barrier (p<0.002). Such results show that both mothers and teachers need specific interventions to improve their own motivation for eating more fruit and vegetables and to thus support this healthy eating habit in children.

[Value of a clinical test for assessing physical activity in children]. / Valor de un test clínico para evaluar actividad física en niños.

BACKGROUND: An appropriate measurement of physical activity (PA) in children is useful, since inactivity is associated to obesity, cardiovascular and metabolic risk. AIM: To assess the reliability of the INTA questionnaire of PA, to compare the derived PA score with accelerometry and to assess its ability to identify excessively inactive children. MATERIAL AND METHODS: One hundred eighty children aged 8 to 13 years answered an interviewer-administered questionnaire about their usual PA, consisting in 5 items (recumbent, seated, walking, playing outdoor, sports). The answers were converted to a PA score with a 0-10 points scale. Reliability was tested in 87 children by test/retest conducted 3-5 days apart. The PA score was compared with 3-day accelerometry in 77 of 93 children (35 obese and 42 non obese). Receiver operating characteristic (ROC) curves were used to determine the optimal cut-point for identify an excessively sedentary child. RESULTS: The test/retest reliability of the questionnaire was 0.69 to 0.93 (Lin coefficient). Accelerometry was significantly associated with PA score (RHO: 0.60, p =0.008), outdoor plays (RHO: 0.37, p =0.0009) and practicing of sports (RHO: 0.33, p =0.003). Obese children were less active than non obese children, according both to PA score and to accelerometry. The optimal cut-point for classifying a child as too sedentary was a score of 5 (sensitivity =0.89). CONCLUSIONS: The INTA-test is a valuable instrument for measuring usual PA in clinical practice and is easy to administer.

Valor de un test clínico para evaluar actividad física en niños / Value of a clinical test for assessing physical activity in children

Background: An appropriate measurement of physical activity (PA) in children is useful, since inactivity is associated to obesity, cardiovascular and metabolic risk. Aim: To assess the reliability of the INTA questionnaire of PA, to compare the derived PA score with accelerometry and to assess its ability to identify excessively inactive children. Material and methods: One hundred eighty children aged 8 to 13 years answered an interviewer-administered questionnaire about their usual PA, consisting in 5 items (recumbent, seated, walking, playing outdoor, sports). The answers were converted to a PA score with a 0-10 points scale. Reliability was tested in 87 children by test/retest conducted 3-5 days apart. The PA score was compared with 3-day accelerometry in 77 of 93 children (35 obese and 42 non obese). Receiver operating characteristic (ROC) curves were used to determine the optimal cut-point for identify an excessively sedentary child. Results: The test/retest reliability of the questionnaire was 0.69 to 0.93 (Lin coefficient). Accelerometry was significantly associated with PA score (RHO: 0.60, p =0.008), outdoor plays (RHO: 0.37, p =0.0009) and practicing of sports (RHO: 0.33, p =0.003). Obese children were less active than non obese children, according both to PA score and to accelerometry. The optimal cut-point for classifying a child as too sedentary was a score of 5 (sensitivity =0.89). Conclusions: The INTA-test is a valuable instrument for measuring usual PA in clinical practice and is easy to administer.