Establishing the health and wellbeing needs of mining host community in Brazil, Chile and Peru: a mixed-method approach to identify priority areas for action to help communities meet their SDG3 targets.

BACKGROUND: The global mining industry is an important partner in advancing the 2030 Agenda for Sustainable Development. In 2018, Anglo American plc published their Sustainable Mining Plan, containing a goal for improving health and wellbeing aligned with the Sustainable Development Goal 3 (SDG3) targets. Having formed an independent multidisciplinary research consortium, we designed and implemented a mixed-methods approach to attain a deeper understanding of SDG3 priorities within the local context of communities hosting Anglo American mining operations located in Latin America. METHODS: In 2019, within the host communities of three mining operations in Chile, three in Brazil, and one in Peru, we conducted a qualitative study which included stakeholder workshops and key informant interviews. We also quantitatively appraised existing health data. Findings emerging from the qualitative and quantitative assessments were compared to identify health and wellbeing priority areas for action relevant to each community. RESULTS: Across the three countries, 120 people took part in workshops and 35 in interviews. In these workshops and interviews, non-communicable diseases (SDG3.4), harmful alcohol consumption (SDG3.5), and pollution, particularly air pollution (SDG3.9), were consistently identified as areas for priority action. There were similarities in the reporting of individual, interpersonal, community, societal, and structural factors underlying these priority areas across the different communities. The availability of quantitative data was generally good at the state level, becoming increasing sparse as we focused on smaller geographies. The priorities identified in the quantitative assessments generally aligned with those highlighted in the qualitative data. CONCLUSIONS: We highlight the importance of engaging with local populations to understand and address health needs. To address the priorities identified, intervention packages tailored to the specific needs of host communities, that tackle associated upstream societal level factors, are required. To facilitate this, appropriate monitoring systems and epidemiological investigations should be implemented to better understand the local context and quantify health issues. In the host communities, it is essential for the mining sector to be a key health partner in promoting integrated programmes that contribute to achieving the priority objectives and targets aligned with the SDG3 agenda.

Subjective Assessments of Quality of Life Are Independently Associated with Depressive Symptoms among Older Adults Enrolled in Primary Care in Chile.

In Chile, depressive symptoms are highly prevalent among Chilean older adults, and research that examines the factors associated with them is scarce. This study aimed to determine if subjective assessments of quality of life are associated with positive screen for depressive symptoms among older adults enrolled in primary care in Chile. The participants of the study were people aged 70 years or more enrolled in primary care centers in three Chilean cities. The 15-item Geriatric Depression Scale was used to determine depressive symptoms. Multivariate logistic models were used to determine the associations. Overall, 17.28% men, and 26.47% women (p = 0.003) screened positive for depression. Subjective assessments of quality of life, including self-perceived health, memory, quality of life, and pain, were associated with a positive screen for depression. Only 17.65% of men and 43.55% of women who screened positive for depressive symptoms reported a diagnosis of depression. Assessments of quality of life in health checks of older adults in primary care could contribute to narrow the diagnosis and treatment gap by improving the ability to identify those who are more likely to experience depressive symptoms.

Prevalence of diseases and conditions which impact on oral health and oral health self-care among older chilean.

OBJECTIVE: The aim is to describe the prevalence of chronic diseases and conditions that may affect the oral health and oral health self-care of independent living Chilean older adults. METHOD: In all, 4,766 residents aged 60 years and older took part in the study. Participants were interviewed using an 11-module instrument, including demographic data, quality of life, nutritional status, systemic diseases, and lists of medications. RESULTS: Participants with cognitive impediments (n = 553) were eliminated from further analysis. Of the remaining 4,213, 61.2% were female. The mean age was 71.1 (SD = 7.8) years. A total of 19.6% reported no medical conditions, 53.1% reported one or two conditions, and 27.3% reported between three and nine conditions. The most commonly reported conditions were high blood pressure (78.0%), diabetes (26.5%), depression (23.4%), and cardiovascular disease (18.7%). Seventy-six percent reported taking medication, with an average of 3.4 drugs per person. Among those taking medication, 70.2% were taking at least one that may cause salivary hypofunction. DISCUSSION: With the aging of Chile and the reciprocal links between oral disease and chronic diseases, policies and innovative initiatives need to be implemented so that programs become affordable and accessible for this population.

Desigualdades socioeconómicas en el proceso de discapacidad en una cohorte de adultos mayores de Santiago de Chile / Socioeconomic inequalities in the onset and progression of disability in a cohort of older people in Santiago (Chile)

Objetivo: Describir y comparar las desigualdades socioeconómicas en el proceso de discapacidad de adultos mayores chilenos residentes en la comunidad, aportando información inédita sobre esta dinámica en Chile. Métodos: Diseño longitudinal de 10 años de seguimiento (2000-2010) de una muestra representativa y probabilística de la cohorte SABE (Salud, Bienestar y Envejecimiento). Este artículo está basado en un 78% (1019) de la muestra inicial de sujetos de 60 y más años de edad que viven en Santiago, capital de Chile. La limitación funcional se definió combinando seis actividades básicas de la vida diaria, siete instrumentales y siete de movilidad (limitado, no limitado). El nivel socioeconómico (alto, medio y bajo) sintetiza variables de calidad de vivienda, equipamiento del hogar, ingresos y educación. Resultados: La prevalencia inicial de limitación funcional fue del 47,3% (intervalo de confianza del 95%: 44,2-50,4), con un marcado gradiente socioeconómico (bajo 60,1%, medio 47,5%, alto 28,7%; p<0,001). Al final del seguimiento, los mayores de nivel socioeconómico bajo se mantuvieron limitados y los de alto funcionalmente sanos. La incidencia de limitación funcional sigue un gradiente socioeconómico (5,33, 6,59 y 7,73 por 100 años-persona para los niveles bajo, medio y alto). Para la mortalidad también se observan importantes desigualdades. Conclusiones: Este estudio corrobora la estratificación social de la funcionalidad y de la muerte, sugiriendo que la edad no es un nivelador. En Latinoamérica, las políticas sociales deberían orientarse a reducir estas desigualdades, buscando prevenir la exposición a riesgos y compensar carencias (en particular entre los más pobres) para minimizar la transformación de un impedimento en limitación y de una limitación en discapacidad (AU)

Objective: To describe and compare socioeconomic inequalities in the onset and progression of disability in a cohort of Chilean community-dwelling older people that provides unprecedented information about this process in Chile. Methods: The data were drawn from a 10-year longitudinal study (2000-2010) that followed a probabilistic and representative sample of the SABE (Health, Welfare and Aging) cohort. The present study was based on 78% (1019) of the baseline sample of adults aged 60 years or more living in Santiago, Chile. Functional limitation was defined on the basis of a combination of six basic activities of daily living, seven instrumental activities, and seven mobility activities (limited, no limited). Socioeconomic position (high, medium and low) was assessed by combining measures of household equipment, wealth, and education. Results: The initial prevalence of functional limitation was 47.3% (95%CI: 44.2-50.4) with a clear socioeconomic gradient (60.1% low, 47.5% medium, and 28.7% high; p<0.001). At the end of the follow-up, older adults with low socioeconomic status remained functionally limited while those with high socioeconomic status remained non-limited. The incidence density of functional limitation also followed a socioeconomic gradient (5.33, 6.59 and 7.73 per 100 years-person for low, medium and high socioeconomic status). Social inequalities were also observed for mortality. Conclusion: This study corroborates the social stratification of functional status and mortality, suggesting that aging is not a leveler of inequalities. In Latin-American countries, policies should aim to reduce inequalities by attempting to limit exposure to risk factors and to compensate for deficiencies (especially among the poorest older people) in order to prevent the progression of functional impairment to disability (AU)

Self-assessed oral-health status and quality of life of older Chilean.

This study aims to examine the self-assessed oral health status and quality of life (QoL) of independent living Chilean older adults, and their distribution by selected socio-demographic characteristics. The study conducted a secondary analysis of data collected as part of a larger study of dependency which involved 4766 independent living older adults, 60 years of age and older, residents of all Chilean Regions. Participants were interviewed using an 11-module instrument. The majority (61.2%) were female. Mean age was 72.3 (s.d. 8.5) years. 47.5% lived with their spouses/partners. The majority had primary education (63.4%), were under the National Health Fund (87.9%), and lived in urban locations (68.3%). The majority (56%) perceived their QoL to be 'Excellent/Very good'; another 37.5% self-assessed their QoL as 'Average'; and 6.6% self-assessed his/her QoL as being 'Bad/Very bad'. 21.7% of participants reported no natural teeth; 43.1% had 'the majority' of teeth missing; 29.9% had 'A few' teeth missing; and 5.3% reported no missing teeth. The probability of being edentulous was explored using LRA. Age; health conditions; education; gender and region of residence remained statistically significant [χ(2)(13)=379.05; p<0.001]. Those who self-reported their QoL as 'Average/Bad' were more likely to be edentulous than those who self-reported their QoL as Good/Excellent (OR=1.5; 95% CI 1.10-2.00). Despite general improvements in oral health among Chilean older adults, this study found poor oral health among older adults is compounded by poor QoL, and substantial inequalities in oral health outcomes by location, levels of education and income.

[Socioeconomic inequalities in the onset and progression of disability in a cohort of older people in Santiago (Chile)]. / Desigualdades socioeconómicas en el proceso de discapacidad en una cohorte de adultos mayores de Santiago de Chile.

OBJECTIVE: To describe and compare socioeconomic inequalities in the onset and progression of disability in a cohort of Chilean community-dwelling older people that provides unprecedented information about this process in Chile. METHODS: The data were drawn from a 10-year longitudinal study (2000-2010) that followed a probabilistic and representative sample of the SABE (Health, Welfare and Aging) cohort. The present study was based on 78% (1019) of the baseline sample of adults aged 60 years or more living in Santiago, Chile. Functional limitation was defined on the basis of a combination of six basic activities of daily living, seven instrumental activities, and seven mobility activities (limited, no limited). Socioeconomic position (high, medium and low) was assessed by combining measures of household equipment, wealth, and education. RESULTS: The initial prevalence of functional limitation was 47.3% (95%CI: 44.2-50.4) with a clear socioeconomic gradient (60.1% low, 47.5% medium, and 28.7% high; p<0.001). At the end of the follow-up, older adults with low socioeconomic status remained functionally limited while those with high socioeconomic status remained non-limited. The incidence density of functional limitation also followed a socioeconomic gradient (5.33, 6.59 and 7.73 per 100 years-person for low, medium and high socioeconomic status). Social inequalities were also observed for mortality. CONCLUSION: This study corroborates the social stratification of functional status and mortality, suggesting that aging is not a leveler of inequalities. In Latin-American countries, policies should aim to reduce inequalities by attempting to limit exposure to risk factors and to compensate for deficiencies (especially among the poorest older people) in order to prevent the progression of functional impairment to disability.

Efecto sobre la salud de las desigualdades socioeconómicas en el adulto mayor: Resultados basales del estudio expectativa de vida saludable y discapacidad relacionada con la obesidad (Alexandros) / Socioeconomic inequalities in active life expectancy and disability related to obesity among older people

Background: The rapid increase in life expectancy in Chile, with obesity as the main nutritional problem in all age groups, makes it necessary to ask whether the years gained are healthy. Aim: To study the trajectories of disability associated with obesity in Chilean elderly groups from different socio-economic and demographic backgrounds. Material and Methods: Longitudinal study of 3 cohorts of older adults from Santiago: the SABE cohort including 1235 people born before 1940; the Alexandros cohort including 950 people born between 1940 and 1948 from Primary Health Care centers and the ISAPRES cohort of 266 people from private health insurance registries (ISAPRES) born before 1947. An interview yielded socio demographic data and history of diseases. Anthropometric measurements and hand dynamometry were performed. Cognitive status was assessed by the mini mental state examination, depressive symptoms through the geriatric depression socore-5 and functional limitations through self-reporting of basic (ADL), instrumental (IADL) and advanced daily living (AADL) activities. Results: We report here baseline results from ISAPRES and SABE cohorts. Important social and gender differentials were observed. After adjustment by age and gender, a significant lower frequency of limitations in ADL (odds ratio (OR) = 0.17; 95 percent confidence intervals (CI): 0.079-0.343), IADL (OR = 0.27; 95 percentCI: 0.159-0.452), and AADL (OR = 0.42; 95 percentCI: 0.298-0.599) persisted in the ISAPRE cohort, compared to the SABE cohort. Obesity was associated with functional limitations only in AADL (OR = 1.65; 95 percentCI: 1.18-2.31) and hand dynamometry was associated with lower functional limitation in ADL, IADL and AADL. Conclusions: This study demonstrates profound socio-economic and gender inequalities in older people, thus showing that the years of healthy life gained are not the same for the whole society.

[Socioeconomic inequalities in active life expectancy and disability related to obesity among older people]. / Efecto sobre la salud de las desigualdades socioeconómicas en el adulto mayor: Resultados basales del estudio expectativa de vida saludable y discapacidad relacionada con la obesidad (Alexandros).

BACKGROUND: The rapid increase in life expectancy in Chile, with obesity as the main nutritional problem in all age groups, makes it necessary to ask whether the years gained are healthy. AIM: To study the trajectories of disability associated with obesity in Chilean elderly groups from different socio-economic and demographic backgrounds. MATERIAL AND METHODS: Longitudinal study of 3 cohorts of older adults from Santiago: the SABE cohort including 1235 people born before 1940; the Alexandros cohort including 950 people born between 1940 and 1948 from Primary Health Care centers and the ISAPRES cohort of 266 people from private health insurance registries (ISAPRES) born before 1947. An interview yielded socio demographic data and history of diseases. Anthropometric measurements and hand dynamometry were performed. Cognitive status was assessed by the Mini Mental State Examination, depressive symptoms through the geriatric depression score-5 and functional limitations through self-reporting of basic (ADL), instrumental (IADL) and advanced daily living (AADL) activities. RESULTS: We report here baseline results from ISAPRES and SABE cohorts. Important social and gender differentials were observed. After adjustment by age and gender, a significant lower frequency of limitations in ADL (odds ratio (OR) = 0.17; 95% confidence intervals (CI): 0.079-0.343), IADL (OR = 0.27; 95%CI: 0.159-0.452), and AADL (OR = 0.42; 95%CI: 0.298-0.599) persisted in the ISAPRE cohort, compared to the SABE cohort. Obesity was associated with functional limitations only in AADL (OR = 1.65; 95%CI: 1.18-2.31) and hand dynamometry was associated with lower functional limitation in ADL, IADL and AADL. CONCLUSIONS: This study demonstrates profound socio-economic and gender inequalities in older people, thus showing that the years of healthy life gained are not the same for the whole society.

Factores de riesgo cardiovascular en estudiantes universitarios chilenos / Cardiovascular risk factors in Chilean university students

Objetivo. Evaluar la prevalencia de factores de riesgo cardiovascular en universitarios asintomáticos de ambos sexos, de entre 18 y 25 años de edad. Material y métodos. La muestra quedó integrada por 1,301 estudiantes. En una submuestra de 293 sujetos se midieron lípidos séricos, con un analizador químico Hitachi 717. La obesidad se estimó considerando el índice de masa corporal (IMC); el antecedente familiar de infarto, así como el consumo de cigarrillos y el nivel de actividad física se determinaron mediante un cuestionario de autoevaluación. Se contruyeron tablas de contingencia para estudiar asociaciones entre factores de riesgo lipídicos y no lipídicos, usando la prueba X² de Pearson. Se realizó un análisis de regresión múltiples para determinar la relación de cada una de las variables lipídicas (colesterol total, colesterol-lipoproteína de baja densidad, colesterol-lipoproteína de alta densidad y triglicéridos), así como de las no lipídicas (edad, peso, estatura, IMC, sexo, presión arterial alta, conducta sedentaria y antecedente familiar de infarto precroz). Resultados. Se encontraron niveles de riesgo lipídico en 29.2 por ciento de los casos para colesterol total, en 16.2 por ciento para lipoproteína de baja densidad y en 5 por ciento para lipoproteína de alta densidad. Entre los factores de riesgo no lipídicos más prevalentes, estaban el consumo de cigarrillos, con 46.1 por ciento, y el sedentarismo, que alcanzó 60.8 por ciento. La obesidad, la hipertensión arterial y el antecedente familiar alcanzaron 1.9, 4.6 y 11 por ciento, respectivamente. Se observó una asociación entre el perfil lipídico de riesgo, la obesidad, la conducta fumadora y el antecedente familiar. Conclusiones. Los resultados mostraron una alta prevalencia de sedentarismo y conducta fumadora, asociada a un perfil lipídico de riesgo. Se deduce la necesidad imperiosa de diseñar programas de intervención con el fin de modificar el estilo de vida y prevenir la posible presencia de enfermedades cardiovasculares en la vida adulta de los jóvenes