Growth deficits in Chilean school children.

Stunting is highly prevalent in Latin American countries regardless of socioeconomic performance. The purpose of this study was to identify risk factors of growth deficit among children starting primary education whose parents were of short stature compared with those whose parents were not of short stature, in the poorest districts of Santiago, Chile. A case-control study was carried out with two types of cases. Case 1 included children whose height was between -1.0 and -3.0 (SD) of the height/age of the National Center for Health Statistics/World Health Organization standard and whose parent's height was below -2.0 SD (n = 115). Case 2 included stunted children (as defined previously) whose parent's height was above -2 SD (n = 76). Controls were children whose stature was +/-0.5 SD and whose parent's height was also above -2 SD (n = 115). Logistic regression models were carried out for case 1 and 2 children compared with the controls. Similar risk factors were found in both models, without any significant interaction: these included history of malnutrition, drunkenness in the family, lack of health care, unhygienic housing conditions, small length at birth and short period of exclusive breastfeeding. The most important risk factors for case 1 children were a history of malnutrition [with an odds ratio (OR) of 5.26 and confidence interval (CI) of 2.68-10.34] and short length at birth (OR = 4.87, CI 2.18-10.92). For case 2 children, the most important risk factors were a history of malnutrition (OR = 4.58, CI 2.20-9.53) and unhygienic housing conditions (OR = 4.29, CI 1.76-10.48). In conclusion, similar factors explained growth deficits in children starting primary school independent of the parent's height, suggesting that genetics would have a limited impact at this age and at this socioeconomic level. To reduce stunting in countries with an epidemiological profile such as that of Chile, it is still important to reduce adverse environmental conditions.

[Nutritional status of school children from indigenous and non indigenous ancestry]. / Comparación del estado nutricional entre escolares indígenas y no indígenas.

BACKGROUND: The few studies in Chile assessing the nutritional status of indigenous children show a high prevalence of stunting, excess weight and feeding problems. AIM: To compare anthropometric indices in children from indigenous and non indigenous ancestry. SUBJECTS AND METHODS: School children aged 6 to 8 years old, living in locations with three clear cut levels of social vulnerability were studied. Children were considered indigenous if their last names, as well as those of their parents were of Mapuche origin. Non indigenous were those whose last names were of Spanish origin. RESULTS: Four hundred and fifty indigenous and 684 non indigenous children were studied. Indigenous children from high vulnerability communities were approximately 0.5 z score shorter than those of non indigenous origin. Heights of indigenous and non indigenous children were similar in communities with intermediate and low social vulnerability. The proportion of the lower segment followed the same trend. Weight/height ratios were higher among indigenous children in the three vulnerability levels. Among indigenous children coming from areas of low vulnerability arm circumference was 1 cm broader than that of their non indigenous counterparts. CONCLUSIONS: Stunting is prevalent among school children from areas of high socioeconomic vulnerability, mainly rural, and independent from ethnicity. Among indigenous school children overweight and a broader arm circumference are frequent. These results urgently call for located and specific nutrition interventions.

[Accreditation professional degrees and teaching institutions: the case of Chile]. / Acreditación de títulos profesionales e instituciones formadoras: el caso de Chile.

Accreditation has acquired special relevance for the habilitation of professional practice, considering the proliferation of teaching institutions, the variety of training programs and the increasing amount of professionals requiring accreditation or revalidation of their titles. The internationalization of professional activities requires global and uniform accreditation procedures to avoid inequalities in evaluation of different professionals coming from abroad or from Chile. In the scope of medical practice, these concepts acquire special relevance, considering the appearance of new medical schools in the last decade and the increasing number of foreign physicians that need to revalidate their titles. In the period between January 1996 and September 1997, 192 foreign physicians applied to revalidate their titles and only 55 were approved. Therefore, the establishment of and effective evaluation system will correct deficiencies in the accreditation process and will promote the revision of training programs and the progress of teaching institutions. The organisms that will require to be accredited must be confident that this action will improve the quality of Chilean professional training.

[Is there a relationship between parent's short height and their children's? Social interclass epidemiologic study]. / La baja estatura de los hijos se relaciona con la de sus padres? Estudio epidemiológico interclase social.

BACKGROUND: Stunting is a prevalent problem in developing countries and may affect up to 50% of school age children. AIM: To search for a relationship between the short stature of school age children of opposing socioeconomic levels and that of their parents. SUBJECTS AND METHODS: One thousand, eight hundred and forty two children of low socioeconomic level and 2,770 children of high socioeconomic level were initially measured. Those with a z score for height below -1 were selected (251 of low socioeconomic level and 157 of high socioeconomic level) and the height of their parents was measured. RESULTS: Mothers and fathers of low socioeconomic level were 6.1 and 7.4 cm shorter than their counterparts of high socioeconomic level. The z score for height of low socioeconomic level children was significantly better than that of their parents and the relative risk for stunting was 2 when one of the parents had a short stature. Among children of high socioeconomic level, the relative risk of stunting was 4.8 and 11, when the mother or the father had a short stature, respectively. CONCLUSIONS: The better height adequacy of low socioeconomic level children, compared to their parents, suggests that the new generations are growing better than their ancestors. Among children of high socioeconomic level, whose growth potential is fully expressed, the parents height is a good predictor of stunting.

[Nutritional status of school children from different socioeconomic levels]. / Estado nutricional en escolares de nivel socioeconómico opuesto.

The aim of this work was to compare the nutritional status of children from low and high socioeconomic levels. Weight, height, mid arm circumference and tricipital skinfold thickness were measured in 1,842 children of low and 2,770 of high socioeconomic status. Mean weight, height, and mid arm muscular circumference were higher in children of high socioeconomic status. Also, growth failure and overweight had a higher frequency among children of low socioeconomic status. Mean weight, height and mid arm circumference were higher in males of both groups. Among children of low socioeconomic status, height/age ratios were lower in men and weight/height ratios were higher in women. These differences were not observed in children of high socioeconomic level. We conclude that adverse environmental conditions, lower physical activity and indigenous ancestors may alter the nutritional status of children of low socioeconomic levels.

[Training in nutrition for specialists in pediatrics]. / Capacitación en nutrición en la formación de especialistas en pediatría.

Training in nutrition does not seem a priority in postgraduate programs in Pediatrics; rotations in Nutrition units have been, at the most, electives. We hereby report our teaching experience with respect to 51 residents in Pediatrics that stayed for 4 to 6 weeks at the Nutrition Unit in the years 1981 to 1987. A diagnostic test of 40 multiple choice questions was applied the first day of work at the Nutrition Unit; the same subjects were evaluated at the end of their stay, by means of a short essay test, designed to evaluate the candidate's proficiency in problem solving. Overall results revealed that 17% of residents answered correctly 70% or more of the questions in the diagnostic test, proportion that improved to 45% of residents in the final test. However, when we studied the performance of each subject with himself we were surprised by the fact that 16 residents (31%) had impaired their initial scores. Tentative explanations for this observation could be: lack of interest for this subspeciality as compared to others (intensive care, for instance), poor studiousness, high requirements of the tests applied, etc. Whichever might be the case, we think that, given both the development of new techniques of nutritional support (not necessarily intensive) and the high number of moderate and severely malnourished children under 6 years of age in Chile, training in Nutrition should be emphasized.

[National medical grading]. / Calcificación médica nacional.

A new, common system for grading medical graduates from the 6 Chilean Schools of Medicine has been agreed by consensus: the National Medical Grading. This was an evident need since up to now each school applied a different criterion to qualify its graduates; the resulting disparity in the scores with which graduates applied for the National calls in postgraduate training programs, general practice positions and the like, elicited uneasiness both among graduates and academic staff. In the new system, the final grade is calculated giving equal relative importance to the marks in licensure (60%), internships (30%) and final clinical examinations (10%). The National Medical Grading has been applied for the first time by the Ministry of Health in the 1989 call, and by the University of Chile and Catholic University's Medical Schools (call for postgraduate training programs). It is hoped that within 2 or 3 years a National Medical Examination will be designed and applied.

Steatorrhea in patients with intrahepatic cholestasis of pregnancy.

A prospective study was undertaken to evaluate fat malabsorption during intrahepatic cholestasis of pregnancy (ICP), a disease characterized by a mild cholestasis of short duration appearing in otherwise healthy young women. An abnormal fecal fat excretion (mean 15.8 g/24 h, range 6-31 g/24 h) was demonstrated in 10 of 12 patients with the icteric form of ICP and in 2 of 11 patients with pruritus gravidarum. The increased fecal fat excretion was generally asymptomatic, could be detected as early as 3 wk after the clinical onset of ICP, remained stable during the affected pregnancies, and returned to normal from 3 to 9 wk after delivery. Steatorrhea correlated with the severity of ICP, estimated by serum levels of bilirubin, total bile salts, and glutamic pyruvic transaminase. A significant fall in the maternal weight/height index was detected after the onset of ICP, being more intense in patients with steatorrhea than in those without it (to 92.6% +/- 3.0% of initial values versus 96.7% +/- 2.8%, respectively; p less than 0.05). A high risk of premature deliveries and fetal distress was demonstrated in these patients, also correlating with the severity of ICP. No direct relationship could be established between steatorrhea or maternal nutritional impairment and fetal prognosis.

Evaluacion nutricional de pacientes pediatricos con tumores solidos. / Nutritional evaluation of pediatric patients with solid tumors

El analisis de los cambios nutricionales durante las distintas etapas de tratamiento de pacientes pediatricos con tumores solidos, nos permite plantear que la etapa mas critica a que se ven enfrentados los pacientes con linfomas de Hodgkin es la radioterapia. En los linfomas no Hodgkin, la induccion y radioterapia, y para los otros tumores estudiados, la de tratamiento intensivo (quimioterapia, radioterapia y cirugia). Al igual que lo senalado en la literatura, hemos podido constatar que el estado nutricional constituye un importante factor pronostico. Es por esto que creemos necesario un control precoz y periodico de el, a fin de proporcionar un apoyo nutricional oportuno

Evaluacion nutricional de pacientes pediatricos oncologicos. / Nutritional evaluation of pediatric oncologic patients

El analisis de los cambios nutricionales, durante las distintas etapas del tratamiento de las leucemias linfoblasticas nos permiten plantear que la etapa mas critica es la de profilaxis del SNC. En las leucemias no linfoblasticas, las etapas mas criticas son las de induccion y profilaxis Las infecciones intercurrentes, dependiendo de su gravedad, repercuten en grado variable durante la induccion, especialmente en las leucemias linfoblasticas. Estos hallazgos hacen necesario una vigilancia precoz y periodica del estado nutricional con el fin de previnir y detectar oportunamente deterioros, al conocer las etapas de mayor riesgo. El apoyo nutricional, debera ulitizar alimentacion hipercalorica fraccionada, con o sin orexigenos o alimentacion intensiva segun sea el caso

[Environment, nutrition and intellectual development]. / Medio ambiente, nutrición y desarrollo intelectual.

The differential effects of malnutrition and psychosocial cultural deprivation (PSAC) upon intellectual performance and psychomotor development were studied in 52 preschool children attending nursery schools in urban Santiago (Chile). Nutritional status was evaluated according to Gómez, intellectual performance according to Weschler's scale (WISP and WISC tests), psychomotor development according to the Denver Developmental Screening Test and PSAC according to a numerical scale constructed from maternal I.Q.; socioeconomic status (Graffar) and a psychological questionnaire the correlational analysis, undernutrition was assigned a single value calculated from the severity and duration of the disease. An inverse correlation of - 0.36 existed between malnutrition and intellectual performance, and of - 0.39 between malnutrition and psychomotor development. Also, there was an inverse and significant correlation of - 0.73 between PSAC and psychomotor development; there was no correlation between PSAC and intellectual performance. Verbal I.Q. was more affected (r = - 0.52) than manual I.Q. (r = - 0.18) and children malnourished during the first 6 months of life attained lower scores of I.Q. than normals. The duration of malnutrition (mild in all cases) had no influence upon subsequent I.Q. This study was the basis for a rehabilitation program (educational-nutritional) to be applied in preschool children from nonprivileged areas.