Baseline situational analysis in Bangladesh, Jordan, Paraguay, the Philippines, Ukraine, and Zimbabwe for the WHO Special Initiative for Mental Health: Universal Health Coverage for Mental Health.

INTRODUCTION: Mental, neurological and substance use conditions lead to tremendous suffering, yet globally access to effective care is limited. In line with the 13th General Programme of Work (GPW 13), in 2019 the World Health Organization (WHO) launched the WHO Special Initiative for Mental Health: Universal Health Coverage for Mental Health to advance mental health policies, advocacy, and human rights and to scale up access to quality and affordable care for people living with mental health conditions. Six countries were selected as 'early-adopter' countries for the WHO Special Initiative for Mental Health in the initial phase. Our objective was to rapidly and comprehensively assess the strength of mental health systems in each country with the goal of informing national priority-setting at the outset of the Initiative. METHODS: We used a modified version of the Program for Improving Mental Health Care (PRIME) situational analysis tool. We used a participatory process to document national demographic and population health characteristics; environmental, sociopolitical, and health-related threats; the status of mental health policies and plans; the prevalence of mental disorders and treatment coverage; and the availability of resources for mental health. RESULTS: Each country had distinct needs, though several common themes emerged. Most were dealing with crises with serious implications for population mental health. None had sufficient mental health services to meet their needs. All aimed to decentralize and deinstitutionalize mental health services, to integrate mental health care into primary health care, and to devote more financial and human resources to mental health systems. All cited insufficient and inequitably distributed specialist human resources for mental health as a major impediment. CONCLUSIONS: This rapid assessment facilitated priority-setting for mental health system strengthening by national stakeholders. Next steps include convening design workshops in each country and initiating monitoring and evaluation procedures.

Prevention of doxorubicin-induced Cardiotoxicity by pharmacological non-hypoxic myocardial preconditioning based on Docosahexaenoic Acid (DHA) and carvedilol direct antioxidant effects: study protocol for a pilot, randomized, double-blind, controlled trial (CarDHA trial).

BACKGROUND: Anthracycline-induced cardiotoxicity (AIC), a condition associated with multiple mechanisms of damage, including oxidative stress, has been associated with poor clinical outcomes. Carvedilol, a ß-blocker with unique antioxidant properties, emerged as a strategy to prevent AIC, but recent trials question its effectiveness. Some evidence suggests that the antioxidant, not the ß-blocker effect, could prevent related cardiotoxicity. However, carvedilol's antioxidant effects are probably not enough to prevent cardiotoxicity manifestations in certain cases. We hypothesize that breast cancer patients taking carvedilol as well as a non-hypoxic myocardial preconditioning based on docosahexaenoic acid (DHA), an enhancer of cardiac endogenous antioxidant capacity, will develop less subclinical cardiotoxicity manifestations than patients randomized to double placebo. METHODS/DESIGN: We designed a pilot, randomized controlled, two-arm clinical trial with 32 patients to evaluate the effects of non-hypoxic cardiac preconditioning (DHA) plus carvedilol on subclinical cardiotoxicity in breast cancer patients undergoing anthracycline treatment. The trial includes four co-primary endpoints: changes in left ventricular ejection fraction (LVEF) determined by cardiac magnetic resonance (CMR); changes in global longitudinal strain (GLS) determined by two-dimensional echocardiography (ECHO); elevation in serum biomarkers (hs-cTnT and NT-ProBNP); and one electrocardiographic variable (QTc interval). Secondary endpoints include other imaging, biomarkers and the occurrence of major adverse cardiac events during follow-up. The enrollment and follow-up for clinical outcomes is ongoing. DISCUSSION: We expect a group of anthracycline-treated breast cancer patients exposed to carvedilol and non-hypoxic myocardial preconditioning with DHA to show less subclinical cardiotoxicity manifestations than a comparable group exposed to placebo. TRIAL REGISTRATION: ISRCTN registry, ID: ISRCTN69560410. Registered on 8 June 2016.

Early Oxidative Stress Response in Patients with Severe Aortic Stenosis Undergoing Transcatheter and Surgical Aortic Valve Replacement: A Transatlantic Study.

Myocardial ischemia/reperfusion-related oxidative stress as a result of cardiopulmonary bypass is thought to contribute to the adverse clinical outcomes following surgical aortic valve replacement (SAVR). Although the acute response following this procedure has been well characterized, much less is known about the nature and extent of oxidative stress induced by the transcatheter aortic valve replacement (TAVR) procedure. We therefore sought to examine and directly compare the oxidative stress response in patients undergoing TAVR and SAVR. A total of 60 patients were prospectively enrolled in this exploratory study, 38 patients undergoing TAVR and 22 patients SAVR. Reduced and oxidized glutathione (GSH, GSSG) in red blood cells as well as the ferric-reducing ability of plasma (FRAP) and plasma concentrations of 8-isoprostanes were measured at baseline (S1), during early reperfusion (S2), and 6-8 hours (S3) following aortic valve replacement (AVR). TAVR and SAVR were successful in all patients. Patients undergoing TAVR were older (79.3 ± 9.5 vs. 74.2 ± 4.1 years; P < 0.01) and had a higher mean STS risk score (6.6 ± 4.8 vs. 3.2 ± 3.0; P < 0.001) than patients undergoing SAVR. At baseline, FRAP and 8-isoprostane plasma concentrations were similar between the two groups, but erythrocytic GSH concentrations were significantly lower in the TAVR group. After AVR, FRAP was markedly higher in the TAVR group, whereas 8-isoprostane concentrations were significantly elevated in the SAVR group. In conclusion, TAVR appears not to cause acute oxidative stress and may even improve the antioxidant capacity in the extracellular compartment.

The population impact of obesity, sedentary lifestyle, and tobacco and alcohol consumption on the prevalence of type 2 diabetes: Analysis of a health population survey in Chile, 2010.

AIM: To estimate the impact of tobacco use, sedentary lifestyle, obesity and alcohol consumption on type 2 diabetes mellitus (T2DM) prevalence in the Chilean population. METHODS: The study-included 5,293 subjects with fasting glycaemia levels from the nationwide cross-sectional health survey in 2010, commissioned by the Ministry of Health, Chile. Crude and Adjusted Odds Ratio to T2DM and its corresponding 95% confidence interval were estimated through logistic regressions. Attributable fractions and population attributable fractions were estimated. RESULTS: T2DM prevalence was 9.5%. Sedentary lifestyles and obesity were significant risk factors for T2DM. 52,4% of T2DM could be avoided if these individuals were not obese, and at a population level, 23% of T2DM could be preventable if obesity did not exist. A 64% of T2DM is explained by sedentariness, and if people would become active, a 62,2% of the cases of diabetes could be avoided. INTERPRETATION: About 79% of T2DM cases in Chile could be prevented with cost-effective strategies focused on preventing sedentary lifestyle and obesity. It's therefore urgent to implement evidence-based public health polices, aimed to decrease the prevalence of T2DM, by controlling its risk factors and consequently, reducing the complications from T2DM.

Occupational exposure to polycyclic aromatic hydrocarbons: A cross-sectional study in bars and restaurants in Santiago, Chile.

OBJECTIVE: To evaluate indoor polycyclic aromatic hydrocarbon (PAH) concentrations in bars and restaurants and identify the main determinants of airborne PAH concentrations. METHODS: This study included 57 bars/restaurants in Santiago, Chile. PAH concentrations (ng/m(3) ) were measured using photoelectric aerosol sensor equipment (PAS 2000CE model). Nicotine concentrations (µg/m(3) ) were measured using active sampling pumps followed by gas-chromatography. Linear regression models were used to identify determinants of PAH concentrations. RESULTS: PAH concentrations were higher in venues that allowed smoking compared to smoke-free venues. After adjusting, the air PAH concentrations were 1.40 (0.64-3.10) and 3.34 (1.43-7.83) ng/m(3) higher for tertiles 2 and 3 of air nicotine compared to the lowest tertile. CONCLUSIONS: In hospitality venues where smoking is allowed, secondhand smoke exposure is a major source of PAHs in the environment. This research further supports the importance of implementing complete smoking bans to protect service industry workers from PAH exposure. Am. J. Ind. Med. 59:887-896, 2016. © 2016 Wiley Periodicals, Inc.

Public Health Perspectives on Aquaculture.

Nearly half of all seafood consumed globally comes from aquaculture, a method of food production that has expanded rapidly in recent years. Increasing seafood consumption has been proposed as part of a strategy to combat the current non-communicable disease (NCD) pandemic, but public health, environmental, social, and production challenges related to certain types of aquaculture production must be addressed. Resolving these complicated human health and ecologic trade-offs requires systems thinking and collaboration across many fields; the One Health concept is an integrative approach that brings veterinary and human health experts together to combat zoonotic disease. We propose applying and expanding the One Health approach to facilitate collaboration among stakeholders focused on increasing consumption of seafood and expanding aquaculture production, using methods that minimize risks to public health, animal health, and ecology. This expanded application of One Health may also have relevance to other complex systems with similar trade-offs.

Definición de perfiles de nutrientes: requisito para promover cambios alimentarios en la población / Nutrient profiles: an essential requirement for promoting dietary changes in the population

Introducción: Las enfermedades no transmisibles son la primera causa de mortalidad a nivel mundial. Para prevenirlas, un grupo de expertos recomendó la reducción del consumo de grasas saturadas, trans, sodio y azúcares. Para informar a la población respecto del alto contenido de nutrientes de los alimentos, es necesario poder identificarlos, para lo cual se requiere desarrollar una metodología que sustente la clasificación de “alto en”. Métodos: Se hizo una búsqueda bibliográfica en PubMed focalizada en artículos científicos y en documentos técnicos de gobiernos que hubiesen implementado estas reglamentaciones. Resultados: La definición de perfil de nutrientes es relativamente nueva, y ha sido liderada por países europeos, destacando Reino Unido. Proponen un modelo que contiene diversas fases: definir el propósito de uso, y población objetivo; decidir si el criterio abarcará todos los alimentos o por categorías; decidir los nutrientes, la base sobre la cual se expresará el contenido del nutriente; si el tipo de modelo será categórico o continuo y el punto de corte. Las decisiones que se tomen tienen repercusiones sobre la conducta alimentaria de la población, ya que podrían inducir a los consumidores a preferir alimentos saludables o alimentos más saludables dentro de una misma categoría. Conclusión: La definición de perfiles de nutrientes es crucial para poder apoyar políticas públicas de cambio en los hábitos alimentarios de la población. Es recomendable hacer estas definiciones en grupos de expertos y con datos nacionales que reflejen el consumo alimentario a nivel de población.

Introduction: Non-communicable diseases are the leading cause of mortality worldwide. To prevent them, an expert panel recommended reducing consumption of saturated and trans fats, sodium and sugars. To inform the public about the high content of these nutrients, it is necessary to identify the foods that fit the criteria “high in”, for which the Development of a methodology that supports the classification of “high”, is required. Methods: Literature search of PubMed articles that focused on scientific and technical documents from governments which had implemented these regulations. Results: The nutrient profile definition is relatively new, and has been led by European countries, especially UK. They proposed a model containing several phases: to define the purpose of use and target population, to decide if the criteria encompass all foods or by categories, to decide the nutrients to be used, the based on which the nutrient content will be expressed, if the type of model will be categorical or continuous and the cutoff point. The decisions will have an impact on feeding behavior of the population, and could lead consumers to prefer healthy foods or healthier foods within the same category. Conclusion: The definition of nutrient profiles is crucial in order to support public policies aimed to change eating habits of the population. It is advisable to make these definitions in expert groups meetings and the use of national data that reflects food consumption at population level.

Enfermedades no transmisibles: emergencia de salud pública en cámara lenta: un desafío para Chile / Non communicable diseases: a slow speed emergency: a challenge for Chile

Las enfermedades no transmisibles (ENTs), cardiovasculares, cáncer, diabetes y enfermedades respiratorias crónicas son la principal causa de muerte en Chile y en el mundo. Cuatro factores de riesgo conductuales: tabaquismo, dieta no saludable, actividad física insuficiente y el consumo perjudicial de alcohol, asociados a la transición económica, la urbanización acelerada y el estilo de vida del siglo XXI, son en gran parte la causa de estas enfermedades, las que emergen como un desafío macroeconómico para el desarrollo. La pandemia de ENTs tiene su origen en la pobreza y afecta en forma desproporcionada a los más desposeídos. Las intervenciones que han demostrado ser más efectivas para reducir las ENTs son aquellas dirigidas a prevenir los factores de riesgo señalados a nivel poblacional. Aunque Chile ha suscrito las principales iniciativas propuestas por la OMS para combatir los factores de riesgo señalados, su implementación es aún incompleta. El país ha avanzado en muchos aspectos, pero tiene importantes desafíos en términos de la vigilancia de las ENTs, el fortalecimiento de la APS, incluyendo los recursos humanos y financiamiento, y la incorporación de tecnologías. Abordar los factores de riesgo y los determinantes sociales de la salud excede la capacidad del sector salud y requiere una respuesta multisectorial con la participación del sector público, privado, la sociedad civil y la colaboración internacional. La reunión de alto nivel en Naciones Unidas en septiembre 2011, sobre Prevención y Control de las Enfermedades no Transmisibles señala el inicio de un proceso para abordar las ENTs para el cual se requiere el liderazgo del Estado de Chile para prevenir o mitigar el impacto de estas enfermedades en las personas, particularmente en aquellas más vulnerables.

Non communicable diseases (NCDs) are the main cause of death worldwide and in Chile. Behavioural risk factors – tobacco, an unhealthy diet, insufficient physical exercise, and alcohol abuse, together with the economic transition, swift urbanization and the 21st century lifestyles are the main cause of these conditions, which in turn are a macroeconomic challenge to development. The NCDs pandemic is rooted in poverty and particularly affects the poor. The interventions that have proved to be most effective in reducing the NCDs are those aimed at the prevention, at population level, of the above mentioned factors. Although Chile has accepted the main initiatives proposed by WHO in order to fight those factors, their implementation is still not complete. Progress has been achieved in some aspects, but important challenges remain in the areas of epidemiological surveillance of NCDs, and of PHC strengthening particularly in regard to human, financial and technological resources. The task of addressing the risk factors and the social determinants of health excedes the capability of the health care sector and requires a multisectorial response, with the participation of the public and private sectors, civil society and international collaboration. The UN high level Meeting on Prevention and Control of NCDs, in September 2011, marks the beginning of a process for which the leadership of the Chilean Government is required in order to prevent or mitigate the impact of these diseases on individuals, and particulrly on the most vulnerable ones.

Tabaquismo ambiental en Chile: necesidad de reformular la actual ley / Environmental tobacco smoke in Chile: need to reform the current legislation

Desde mediados de los años 50, se ha demostrado científicamente la asociación causal entre exposición a tabaquismo ambiental y diversas patologías en todas las etapas de la vida. La Organización Mundial de la Salud promovió un Convenio Marco (CMCT), para disminuir la carga de enfermedad, discapacidad y muerte evitable producida por el tabaquismo, el que fue ratificado por el Parlamento chileno, no obstante necesita ser corregida para lograr una eliminación de la exposición a tabaco en espacios de uso público. Posterior a la implementación de la ley anti-tabaco en Chile, se evaluó el efecto de la restricción parcial de fumar constatándose que los niveles de nicotina ambiental se mantienen altos, independientemente del estatus de fumador del local (fumador, mixto o no fumador). Las áreas “libres de humo” en locales mixtos presentaron niveles más altos de nicotina que locales para no fumadores, los sistemas de ventilación y barrera son insuficientes para eliminar completamente el humo de tabaco, algunos clientes no respetan la prohibición de fumar, y trabajadores y clientes están altamente expuestos al humo de tabaco. La actual legislación no protege a las personas de los riesgos de la exposición a humo de tabaco. Basados en la evidencia científica irrefutable se hace imperiosa una modificación de la actual ley anti-tabaco por una que prohíba completamente fumar en lugares públicos. Los legisladores y autoridad sanitaria tienen un rol de protección que es insoslayable por lo que están llamados a hacer las modificaciones necesarias para garantizar a todos la protección de su salud.

El ambiente laboral como fuente de exposición a humo de tabaco ambiental: Estudio en trabajadores de bares y restaurantes de Santiago, Chile / The work environment as a source of exposure to secondhand smoke: a study in workers of bars and restaurants of Santiago, Chile

Background: Secondhand smoke (SHS) is an established cause of morbidity and mortality among non-smokers. The workplace is an important source of exposure, especially among workers of restaurants, bars and nightclubs. Aim: To estimate the daily occupational exposure to SHS among non-smoking workers of bars and restaurants of Santiago, Chile. Material and Methods: Environmental vapor-phase nico-tine was measured for 95 non-smoking workers of bars and restaurants of Santiago, using passive personal samplers during a daily work shift and outside the workplace. Results: The median occupational exposure to air nicotine was 9.18 µg/m³ (P25-P75 3.15-25.67 µg/m³). Higher concentrations were found among workers of places with no smoking restrictions (22.72 µg/m³; P25-P75 5.73-34.85 µg/m³), bar workers (20.75 µg/m³, P25-P75 5.03-44.67 µg/m³), waiters (20.57 µg/m³, PP25-P75 5.66-42.73 µg/m3) and bartenders (10.37 µg/m³, P25-P75 9.75-25.67 µg/m³). The median concentration of nicotine outside the workplace was 1.79 µg/m³ (P25-P75 1.02-3.00 µg/m³). Occupational exposure was 4.77 times higher compared to the non-work exposure. Conclusions: Workers of bars and restaurants are exposed to high levels of SHS at the workplace. Moreover, occupational exposure among these non-smoking workers is, in most cases, the main source of daily exposure to this pollutant.

Secondhand tobacco smoke in bars and restaurants in Santiago, Chile: evaluation of partial smoking ban legislation in public places.

OBJECTIVE: To compare air nicotine concentrations according to the smoking policy selected by bars/restaurants in Santiago, Chile before and after the enactment of partial smoking ban legislation in 2007 (establishments could be smoke free, have segregated (mixed) smoking and non-smoking areas, or allow smoking in all areas). METHODS: The study measured air nicotine concentrations over 7 days to characterise secondhand smoke exposure in 30 bars/restaurants in 2008. Owner/manager interviews and physical inspections were conducted. RESULTS: Median IQR air nicotine concentrations measured in all venues were 4.38 (0.61-13.62) µg/m(3). Air nicotine concentrations were higher in bars (median 7.22, IQR 2.48-15.64 µg/m(3)) compared to restaurants (1.12, 0.15-9.22 µg/m(3)). By smoking status, nicotine concentrations were higher in smoking venues (13.46, 5.31-16.87 µg/m(3)), followed by smoking areas in mixed venues (9.22, 5.09-14.90 µg/m(3)) and non-smoking areas in mixed venues (0.99, 0.19-1.27 µg/m(3)). Air nicotine concentrations were markedly lower in smoke-free venues (0.12, 0.11-0.46 µg/m(3)). After adjustment for differences in volume and ventilation, air nicotine concentrations were 3.2, 35.5 and 56.2 times higher in non-smoking areas in mixed venues, smoking areas in mixed venues and smoking venues, respectively, compared to smoke-free venues. CONCLUSIONS: Exposure to secondhand smoke remains high in bars and restaurants in Santiago, Chile. These findings demonstrate that the partial smoking ban legislation enacted in Chile in 2007 provides no protection to employees working in those venues. Enacting a comprehensive smoke-free legislation which protects all people from exposure to secondhand smoke in all public places and workplaces is urgently needed.

[The work environment as a source of exposure to secondhand smoke: a study in workers of bars and restaurants of Santiago, Chile]. / El ambiente laboral como fuente de exposición a humo de tabaco ambiental: estudio en trabajadores de bares y restaurantes de Santiago, Chile.

BACKGROUND: Secondhand smoke (SHS) is an established cause of morbidity and mortality among non-smokers. The workplace is an important source of exposure, especially among workers of restaurants, bars and nightclubs. AIM: To estimate the daily occupational exposure to SHS among non-smoking workers of bars and restaurants of Santiago, Chile. MATERIAL AND METHODS: Environmental vapor-phase nicotine was measured for 95 non-smoking workers of bars and restaurants of Santiago, using passive personal samplers during a daily work shift and outside the workplace. RESULTS: The median occupational exposure to air nicotine was 9.18 µg/m³ (P25-P75 3.15-25.67 µg/m³). Higher concentrations were found among workers of places with no smoking restrictions (22.72 µg/m³; P25-P75 5.73-34.85 µg/m³), bar workers (20.75 µg/m³, P25-P75 5.03-44.67 µg/m³), waiters (20.57 µg/m³, PP25-P75 5.66-42.73 µg/m3) and bartenders (10.37 µg/m³, P25-P75 9.75-25.67 µg/m³). The median concentration of nicotine outside the workplace was 1.79 µg/m³ (P25-P75 1.02-3.00 µg/m³). Occupational exposure was 4.77 times higher compared to the non-work exposure. CONCLUSIONS: Workers of bars and restaurants are exposed to high levels of SHS at the workplace. Moreover, occupational exposure among these non-smoking workers is, in most cases, the main source of daily exposure to this pollutant.

[Nutritional surveillance in Chilean schoolchildren: validity of the information]. / Vigilancia nutricional en escolares chilenos: Validez de la información.

BACKGROUND: Anthropometry is used to survey health and nutritional situation of the population. Therefore the quality of the information that is being used must be evaluated. AIM: To estimate the agreement in weight, height and nutritional status in schoolchildren, comparing measurements made by teachers in schools and a standardized and supervised team of professionals. MATERIAL AND METHODS: Cross sectional study including 927 schoolchildren in 31 schools from 7 counties of Santiago. Schools were randomly chosen and the universe of children attending to first grade was measured. Weight, height and nutritional status collected by teachers and researches, were compared. RESULTS: Total agreement for nutritional status reached 0.67, random-weighted Kappa was 0.40 and weighted Kappa, 0.42. Teachers tended to over diagnose under-nutrition and under diagnose overweight and obesity measuring 270 grams less than the qualified team (p <0.001) and 1.7 cm more in height (p <0.001), what is reflected in a difference of less than one point in body mass index (p <0.001). Discrepancies in height and body mass index were higher in extreme values. CONCLUSIONS: There is a low agreement between the measurements taken by the research team and teachers. Even though there are discrepancies between measurements, high levels of overweight and low prevalences of stunting and underweight are kept, reflecting problems with exactitude, but not bias. Corrective actions to improve the quality of information, which should include training programs for teachers, instrument maintenance, supervision and verification system for data entry, are needed.

Vigilancia nutricional en escolares chilenos: validez de la información / Nutritional surveillance in Chilean schoolchildren: validity ofthe information

Background: Anthropometry is used to survey health and nutritional situation of the population. Therefore the quality of the information that is being used must be evaluated. Aim: To estímate the agreement in weight, height and nutritional status in schoolchildren, comparing measurements made by teachers in schools and a standardized and supervised team of professionals. Material and methods: Cross sectional study including 927 schoolchildren in 31 schools from 7 counties of Santiago. Schools were randomly chosen and the universe of children attending to first grade was measured. Weight, height and nutritional status collected by teachers and researches, were compared. Results: Total agreement for nutritional status reached 0.67, random-weighted Kappa was 0.40 and weighted Kappa, 0.42. Teachers tended to over diagnose under-nutrition and under diagnose overweight and obesíty measuríng 270 grams less than the qualified team (p <0.001) and 1.7 cm more in height (p <0.001), what is reflected in a difference of less than one point in body mass index (p <0.001). Discrepancies in height and body mass índex were higher in extreme valúes. Conclusions: There is a low agreement between the measurements taken by the research team and teachers. Even though there are discrepancies between measurements, high levéis of overweight and low prevalences of stunting and underweight are kept, reílecting problems with exactitude, but not bias. Corrective actions to improve the quality of information, which should include training programs for teachers, instrument maintenance, supervisión and verification system for data entry, are needed.

Factores determinantes del exceso de peso en escolares: Un estudio multinivel / Determinant factors of excess of weight in school children: a multilevel study

Background: Rates of obesity reach high levels in Chile, with geographic, social and school variations. Aim: To identify factors at two levels associated with excessive weight in school children: child-family characteristics and school-neighborhood. Material and methods: Using a cross-sectional and multi-step design, seven counties with the highest prevalence of obesity were identified, and schools were randomly chosen from within the 1st, 3 and 5 quintiles of the school strata (same level of obesity prevalence). Within each school, twelve 2nd grade children were randomly chosen (n =42 schools and 504 students). Nutritional status, food intake, eating habits and physical activity were measured. Socio demographic, economic characteristics and nutritional status of the parents were assessed. Home size and facilities for children physical activities were assessed, as well as school infrastructure and management. Results: Most of the explained variance (97 percent) in the Body Mass Index (BMI) was due to individual-level factors: sedentary children behaviour (JS coefficient 1.6, standard error (SE) 0.052), maternal obesity (ß 0.94; SE 0.25), paternal obesity (ß 0.83; SE 0.28) and hours watching television (ß 0.789, SE 0.297). The same risk factors were predictive of obesity: child sedentary behaviours odds ratio (OR): 3-98, 95 percent) confidence interval (CI): 2.44-6.48, maternal obesity (OR 1.91, CI 1.21-3-02) and being woman (OR 1.75, CI 1.01-2.76). Conclusions: BMI and obesity are associated with children behaviour or biological and cultural conditions of their families and not with school characteristics.

[Determinant factors of excess of weight in school children: a multilevel study]. / Factores determinantes del exceso de peso en escolares: Un estudio multinivel.

BACKGROUND: Rates of obesity reach high levels in Chile, with geographic, social and school variations. AIM: To identify factors at two levels associated with excessive weight in school children: child-family characteristics and school-neighborhood. MATERIAL AND METHODS: Using a cross-sectional and multi-step design, seven counties with the highest prevalence of obesity were identified, and schools were randomly chosen from within the 1st, 3 and 5 quintiles of the school strata (same level of obesity prevalence). Within each school, twelve 2nd grade children were randomly chosen (n =42 schools and 504 students). Nutritional status, food intake, eating habits and physical activity were measured. Socio demographic, economic characteristics and nutritional status of the parents were assessed. Home size and facilities for children physical activities were assessed, as well as school infrastructure and management. RESULTS: Most of the explained variance (97%) in the Body Mass Index (BMI) was due to individual-level factors: sedentary children behaviour (JS coefficient 1.6, standard error (SE) 0.052), maternal obesity (ss 0.94; SE 0.25), paternal obesity (ss 0.83; SE 0.28) and hours watching television (ss 0.789, SE 0.297). The same risk factors were predictive of obesity: child sedentary behaviours odds ratio (OR): 3-98, 95%) confidence interval (CI): 2.44-6.48, maternal obesity (OR 1.91, CI 1.21-3-02) and being woman (OR 1.75, CI 1.01-2.76). CONCLUSIONS: BMI and obesity are associated with children behaviour or biological and cultural conditions of their families and not with school characteristics.

[Smoking and chronic obstructive pulmonary disease: attributable risk determination]. / Tabaquismo y enfermedad pulmonar obstructiva crónica: determinación de fracciones atribuibles.

BACKGROUND: Smoking is the main risk factor for Chronic Obstructive Pulmonary Disease (COPD), an important cause of morbidity and mortality. AIM: To estimate smoking attributable risk and population attributable risk in COPD patients attended in Public Health Services of Santiago. MATERIALS AND METHODS: A case control study matched by sex and age was carried out. Crude and adjusted attributable risks as well as population attributable risk were estimated, controlled by potential confounders and by interaction variables. RESULTS: Mean ages for cases and controls were 68 and 67 years respectively. When compared to the control group, COPD patients had a higher smoking prevalence (at least 100 cigarettes in their life span: 89.7% vs 60.3%; p <0.01). Among COPD patients, heavy smokers proportion was 4 times higher than in controls, they smoked for more years (43 vs 31; p <0.01) and more cigarettes per day (18 vs 5; p <0.01). Adjusted attributable risk was 87% (95% Confidence Interval (CI): 63.7-94.8). If a patient smoked at least 100 cigarettes in his/her life span and this risk was 92.7% (CI: 82.4-96.9) for heavy smokers. Projecting this index to Santiago inhabitants, about 87,000 individuals older than 40 years would be suffering COPD due to smoking. CONCLUSIONS: This article confirms the strong association between smoking and COPD. Attributable risks are high and significant, even when they are adjusted by confounding variables. Women had a higher risk than men, at lower levels of tobacco consumption.

[Study of variables associated with skin cancer in Chile using principal component analysis]. / Estudio de variables asociadas al cáncer de piel en Chile mediante análisis de componentes principales.

BACKGROUND: The incidence of skin cancer in Chile has increased in recent years. OBJECTIVE: To associate variables with skin cancer in Chile through indices generated using multivariate descriptive statistical techniques. MATERIAL AND METHOD: During May 2004, information was gathered from demographic, meteorological and clinical data from Chile corresponding to fiscal year 2001, the latest complete, official information available for the country's Health Services as a whole. The variables developed by the following were studied: the National Statistics Institute (INE), the Ministry of Health (MINSAL), the Ministry of Planning and Cooperation (MIDEPLAN), the National Health Fund (FONASA), the Chilean Meteorological Directorate, Federico Santa María Technical University and the Directorate-General for Water. A Principal Component Analysis (PCA) was then performed on the data obtained. RESULTS: The first three principal components were selected, with a cumulative explained variance percentage of 54.48 %. The first principal component explains 24.92 % of the variance, and is related to climatic and geographic variables. The second principal component explains 15.77 % of the variance, and is mainly related to FONASA's beneficiary population and the poverty rate. The mortality rate from skin cancer runs significantly against this component. The third principal component explains 13.79 % of the variance, and is related to population characteristics, such as total catchment population, female population and urban population. CONCLUSION: Performing PCA is useful in studying the factors associated with skin cancer.

[A proposal of new indices for hospital management]. / Propuesta de índices de gestión de servicios médico-quirúrgicos hospitalarios mediante técnicas estadísticas multivariantes.

BACKGROUND: Diagnosis related groups (DRGs) are the most reliable patient classification system in hospital management. When this information is unavailable, other reliable classification system must be used. AIM: To obtain useful indices for hospital management, based on descriptive multivariate techniques. MATERIAL AND METHODS: Data on admissions to a University Hospital during 2003 were analyzed. Number of discharges, lethality rate, re-admission rate, number of outpatient consultations, length of hospital stay and surgical complexity index were analyzed, using information obtained by the Operations Management Department. The Principal Components Analysis (PCA) technique was applied and the R correlation matrix was used. RESULTS: A total of 24,345 discharges were analyzed. The first two principal components were selected, accounting cumulatively for 76% of data variability (47% for the first and 29% for the second). CONCLUSIONS: The first component may be assimilated to a new index representing the difficulty of the attended cases, which we have termed Case Complexity. The second principal component would explain the number of attended persons, which we have termed Case Load. These two indices allow us to classify hospital services.