[Seasonal variation of acute myocardial infarction deaths in Chile]. / Variación estacional de las defunciones por infarto agudo del miocardio en Chile.

BACKGROUND: Hospitalization and deaths due to cardiovascular diseases (CVD), have a peak in frequency during winter. AIM: To assess the existence of seasonal variation in deaths due to acute myocardial infarction (AMI) in Chile. MATERIAL AND METHODS: Analysis of death report databases available at the website of the Chilean Ministry of Health. The seasonality of deaths due to AMI (codes ICD-10 I21, I22, I23) occuring in Chile between 2001-2016 were analyzed using a geometric model assuming a sinusoidal cyclic pattern. RESULTS: During the period 2001-2016, a total of 94,788 deaths due to AMI were registered, corresponding to 93,349 corrected deaths. Of the latter, 29.2% occurred in winter, 24.9% in spring, 24.0% in autumn and 21.8% in summer. The geometric model showed a marked sinusoidal pattern for the aggregated data. The peak-to-low ratio of deaths was 1.41 (95% CI 1.38-1.44). The peak of deaths occurred during July in 14 out of 16 years analyzed. CONCLUSIONS: In Chile, deaths due to AMI have a marked seasonal pattern, characterized by a higher number of deaths in winter and a lower number in summer.

Early left atrial dysfunction is associated with suboptimal cardiovascular health.

AIMS: Two-dimensional speckle-tracking echocardiography can assess left atrial (LA) function by measuring atrial volumes and deformation parameters (strain, strain rate). This cross-sectional analysis explores the association between ideal CV health (CVH), LA function, and systemic biomarkers in healthy individuals from the Chilean MAUCO Cohort. METHODS: We enrolled 95 MAUCO participants with different levels of CVH (mean age: 51 ± 8 years). We categorized participants into low or high CVH groups: A: 0-2, or B: 3-6 CVH risk factors. 2D echocardiography, glucose, insulin, total cholesterol, triglycerides, proBNP, hsCRP, insulin resistance index (HOMA), and right and left atrial strain (RASs and LASs, respectively) were determined. RESULTS: LASs was lower in Group A, while systolic and diastolic blood pressure (BP), body mass index (BMI), insulin, HOMA, total cholesterol, triglycerides, and LV and RV end-diastolic volume were significantly higher in Group A than Group B (P < .01). Change in LASs was inversely correlated with insulin (P = .040), HOMA (P = .013), total cholesterol (P = .039), glycemia (P = .018), and BMI (P = .0.037). CONCLUSION: LASs during the reservoir phase was diminished in subjects with a lower level of CVH. Higher insulin, HOMA, total cholesterol, glycemia, and BMI values were associated with decreased LA deformation during the reservoir phase. Morphofunctional alterations of the LA were also identified in the group with suboptimal CVH, as well as BP values in the range of hypertension. LA dysfunction in an asymptomatic population, along with metabolic syndrome, could be an early event in the continuum of CV damage.

[Prevalence of smoking among Chilean older people]. / Tabaquismo en el adulto mayor: un freno al envejecimiento saludable en la población chilena.

BACKGROUND: Smoking is one of the main causes of death among adults worldwide. AIM: To characterize smoking among Chilean older people, according to sociodemographic and clinical variables. MATERIAL AND METHODS: Secondary analysis of data obtained during the National Health Survey 2009-10, selecting individuals aged 60 years and older. Expansion factors were used due to the complex design of the sample. Prevalence and characteristics of smoking were calculated, according to age, sex, educational level, marital status, healthcare insurance system and comorbidities. RESULTS: Nineteen percent of older people were actual smokers, and 85% of these smokers were aged between 60 and 69 years. Forty-five percent were highly dependent to nicotine and 73% reported their intention to quit smoking. CONCLUSIONS: There is a high prevalence of tobacco smoking among Chilean older people. Prevention measures are needed.

Infant morbidity and mortality attributable to prenatal smoking in Chile.

OBJECTIVE: To estimate annual infant morbidity and mortality attributable to prenatal smoking in Chile during 2008-2012. METHODS: Population-attributable fractions (PAFs) for several infant outcomes were calculated based on previous study estimates of prenatal smoking prevalence and odds ratios associated with exposure (prenatal smoking relative to non-prenatal smoking). Prenatal smoking-attributable infant morbidity and mortality cases were calculated by multiplying the average annual number of morbidity and mortality cases registered in Chile during 2008-2012 by the corresponding PAF. RESULTS: PAFs for 1) births ≤ 27 weeks; 2) births at 28-33 weeks; 3) births at 34-36 weeks; and 4) full-term low-birth-weight infants were 12.3%, 10.6%, 5.5%, and 27.4% respectively. PAFs for deaths caused by preterm-related causes and deaths caused by sudden infant death syndrome were 11.9% and 40.0% respectively. Annually, 2 054 cases of preterm-birth and full-term low-birth-weight (1 in 9 cases), 68 deaths caused by preterm-related causes (1 in 8 cases), and 26 deaths caused by sudden infant death syndrome (1 in 3 cases) were attributable to prenatal smoking. CONCLUSIONS: In Chile, infant morbidity and mortality attributable to prenatal smoking are unacceptably high. Comprehensive individual and population-based interventions for tobacco control should be a public health priority in the country, particularly among female adolescents and young women who will be the mothers of future generations.

Study protocol for the Maule Cohort (MAUCO) of chronic diseases, Chile 2014-2024.

BACKGROUND: Maule Cohort (MAUCO), a Chilean cohort study, seeks to analyze the natural history of chronic diseases in the agricultural county of Molina (40,000 inhabitants) in the Maule Region, Chile. Molina´s population is of particular interest because in the last few decades it changed from being undernourished to suffering excess caloric intake, and it currently has the highest national rates of cardiovascular diseases, stomach cancer and gallbladder cancer. Between 2009 and 2011 Molina´s poverty rate dropped from 24.1 % to 13.5 % (national average 20.4 %); in this period the county went from insufficient to almost complete basic sanitation. Despite these advances, chemical pollutants in the food and air are increasing. Thus, in Molina risk factors typical of both under-developed and developed countries coexist, generating a unique profile associated with inflammation, oxidative stress and chronic diseases. METHODS/DESIGN: MAUCO is the core project of the recently established Advanced Center for Chronic Diseases (ACCDiS), Universidad de Chile & Pontificia Universidad Católica de Chile. In this study, we are enrolling and following 10,000 adults aged 38 to 74 years over 10 years. All eligible Molina residents will be enrolled. Participants were identified through a household census. Consenting individuals answer an epidemiological survey exploring risk factors (psycho-social, pesticides, diet, alcohol, and physical activity), medical history and physical and cognitive conditions; provide fasting blood, urine, and saliva samples; receive an electrocardiogram, abdominal ultrasound and bio-impedance test; and take a hand-grip strength test. These subjects will be re-interviewed after 2, 5 and 7 years. Active surveillance of health events is in place throughout the regional healthcare system. The MAUCO Bio-Bank will store 30 to 50 aliquots per subject using an NIH/NCI biorepository system for secure and anonymous linkage of samples with data. DISCUSSION: MAUCO´s results will help design public health interventions tailored to agricultural populations in Latin America.

[An elevated neutrophil/lymphocyte ratio is associated with poor prognosis in stage II resected colon cancer]. / Un índice neutrófilo/linfocito elevado se asocia a peor pronóstico en cáncer de colon etapa II resecado.

BACKGROUND: The neutrophil/lymphocyte ratio is an effective marker of inflammation ana can have prognostic value in surgical patients. AIM: To evaluate the effect of an increased neutrophil/lymphocyte ratio (NLR) on perioperative complications ana overall ana disease-free survival in patients undergoing elective resection for stage II colon cancer. MATERIAL AND METHODS: Data was obtained from clinical charts, preoperative blood results and hospital records of all patients undergoing an elective curative resection for colon cancer, between 2000 and 2007. Preoperative NLR was calculated. Follow-up was obtained from a prospectively maintained colorectal cancer database, clinical records and questionnaires. Uni and multivariable analysis were performed to identify associations, and survival analysis was performed using Kaplan-Meier curves. RESULTS: One hundred twenty two patients with a mean age of 69 years (52% males), were evaluated. Median follow-up was 73 months, and overall survival for 1 and 5 years was 95% and 68%, respectively. On a multivariable analysis after adjusting for age, sex, tumor depth invasion, use of adjuvant therapies and American Society of Anesthesiology preoperative risk score, an NLR > 5 was associated with an increased perioperative complication rate (odds ratio: 3.06, p = 0.033). Kaplan-Meier survival analysis showed a worse overall and disease-free survival for patients with NLR greater than five. CONCLUSIONS: A preoperative NLR of five or more is associated with greater perioperative morbidity and worse oncological outcomes in patients undergoing resection for elective stage II colon cancer.

"Appagalo" a Customized Mobile Health Intervention (mHealth) for Smoking Cessation in Women: A Randomized Controlled Trial.

BACKGROUND: Almost 30% of Chilean women report cigarette smoking with important repercussions on their health. OBJECTIVE: Design and test a mobile phone intervention for smoking cessation in young women. STUDY DESIGN: A mobile application (app) was created using the best available evidence and consumer input. Its effectiveness was assessed through a randomized clinical trial. STUDY PARTICIPANTS: Women 18 to 44 years old from middle-class neighborhoods in Santiago, Chile. Inclusion criteria were intention to quit cigarette smoking in the following month and having a smartphone cell phone. Women with positive screening for risky alcohol consumption were excluded. INTERVENTION: App with content to support cigarette smoking cessation over 6 months. The control arm included an app that delivered general messages to promote permanence in the study. Telephone follow-up was performed at 6 weeks, and at 3 and 6 months after randomization. MAIN OUTCOME MEASURE: No smoking in the past 7 days at 6 weeks from enrolment. Intention-to-treat analysis was carried out using SPSS 17.0 with a significance level set at .05. RESULTS: 309 women entered the study. Mean number of cigarettes smoked in a day was 8.8. 58.6% of the participants (n = 181) completed the follow-up for the primary outcome. With intention-to-treat analysis, 9.7% of participants in the intervention group reported not having smoked any cigarettes in the last 7 days vs 3.2% in the control group (RR 2.98 CI 95% 1.11-8.0, P = .022). Additionally, 12.3% vs 1.9% of the participants in the intervention group and control group reported continuous abstinence at 6 weeks, respectively (RR 6.29 95% CI 1.9-20.8, P < .001). Continuous abstinence was also significant at 6 months (P-value of .036). CONCLUSIONS: The "Appagalo" app is an effective tool to support smoking cessation in young women. It is a simple mHealth alternative for smoking cessation that can contribute to improving women's health in the Americas and worldwide.

Low prevalence of "ideal cardiovascular health" in a community-based population: the heart strategies concentrating on risk evaluation (Heart SCORE) study.

BACKGROUND: Cardiovascular health is a new construct defined by the American Heart Association (AHA) as part of its 2020 Impact Goal definition. The applicability of this construct to community-based populations and the distributions of its components by race and sex have not been reported. METHODS AND RESULTS: The AHA construct of cardiovascular health and the AHA ideal health behaviors index and ideal health factors index were evaluated among 1933 participants (mean age 59 years; 44% blacks; 66% women) in the community-based Heart Strategies Concentrating on Risk Evaluation (Heart SCORE) study. One of 1933 participants (0.1%) met all 7 components of the AHA's definition of ideal cardiovascular health. Less than 10% of participants met ≥ 5 components of ideal cardiovascular health in all subgroups (by race, sex, age, and income level). Thirty-nine subjects (2.0%) had all 4 components of the ideal health behaviors index and 27 (1.4%) had all 3 components of the ideal health factors index. Blacks had significantly fewer ideal cardiovascular health components than whites (2.0 ± 1.2 versus 2.6 ± 1.4; P < 0.001). After adjustment by sex, age, and income level, blacks had 82% lower odds of having ≥ 5 components of ideal cardiovascular health (odds ratio 0.18, 95% confidence interval, 0.10 to 0.34; P<0.001). No interaction was found between race and sex. CONCLUSION: The prevalence of ideal cardiovascular health is extremely low in a middle-aged community-based study population. Comprehensive individual and population-based interventions must be developed to support the attainment of the AHA's 2020 Impact Goal for cardiovascular health.

Weight loss and metabolic improvement in morbidly obese subjects implanted for 1 year with an endoscopic duodenal-jejunal bypass liner.

OBJECTIVE: To evaluate safety, weight loss, and cardiometabolic changes in obese subjects implanted with the duodenal-jejunal bypass liner (DJBL) for 1 year. BACKGROUND: The DJBL is an endoscopic implant that mimics the duodenal-jejunal bypass component of the Roux-en-Y gastric bypass. Previous reports have shown significant weight loss and improvement in type 2 diabetes for up to 6 months. METHODS: Morbidly obese subjects were enrolled in a single arm, open label, prospective trial and implanted with the DJBL. Primary endpoints included safety and weight change from baseline to week 52. Secondary endpoints included changes in waist circumference, blood pressure, lipids, glycemic control, and metabolic syndrome. RESULTS: The DJBL was implanted endoscopically in 39 of 42 subjects (age: 36 ± 10 years; 80% female; weight: 109 ± 18 kg; BMI: 43.7 ± 5.9 kg/m); 24 completed 52 weeks of follow-up. Three subjects could not be implanted due to short duodenal bulb. Implantation time was 24 ± 2 minutes. There were no procedure-related complications and there were 15 early endoscopic removals. In the 52-week completer population, total body weight change from baseline was -22.1 ± 2.1 kg (P < 0.0001) corresponding to 19.9 ± 1.8% of total body weight and 47.0 ± 4.4% excess of weight loss. There were also significant improvements in waist circumference, blood pressure, total and low-density lipoprotein cholesterol, triglycerides, and fasting glucose. CONCLUSIONS: The DJBL is safe when implanted for 1 year, and results in significant weight loss and improvements in cardiometabolic risk factors. These results suggest that this device may be suitable for the treatment of morbid obesity and its related comorbidities. This study was registered at www.clinicaltrials.gov (NCT00985491).

Anatomic hepatectomy as a definitive treatment for hepatolithiasis: a cohort study.

BACKGROUND: Treatment requirements in hepatolithiasis may vary and may involve a multidisciplinary approach. Surgical resection has been proposed as a definitive treatment. OBJECTIVES: This study aimed to evaluate the clinical results of anatomic liver resection among Chilean patients with hepatolithiasis. METHODS: An historical cohort study was conducted. Patients who underwent hepatectomy as a definitive treatment for hepatolithiasis from January 1990 to December 2010 were included. Patients with a preoperative diagnosis of cholangiocarcinoma were excluded. Preoperative, operative and postoperative variables were evaluated. RESULTS: A total of 52 patients underwent hepatectomy for hepatolithiasis. The mean ± standard deviation patient age was 49.8 ± 11.8 years (range: 24-78 years); 65.4% of study subjects were female. A total of 75.0% of subjects had a history of previous cholecystectomy. The main presenting symptom was abdominal pain (82.7%). Hepatic involvement was noted in the left lobe in 57.7%, the right lobe in 34.6% and bilaterally in 7.7% of subjects. The rate of postoperative clearance of the biliary tree was 90.4%. Postoperative morbidity was 30.8% and there were no postoperative deaths. Three patients had recurrence of hepatolithiasis, which was associated with Caroli's disease in two of them. Overall 5-year survival was 94.5%. CONCLUSIONS: Anatomic liver resection is an effective treatment in selected patients with hepatolithiasis and is associated with low morbidity and no mortality. At longterm follow-up, anatomic hepatectomy in these patients was associated with a lower rate of recurrence.

Childhood Socioeconomic Position and Cardiovascular Disease Among Older Women and Men: The Moderating Role of Parenthood Onset.

Objectives: Based on a life-course approach, the purpose of this study is to analyze how the age at the birth of a first child moderates the relationship between childhood socioeconomic position (SEP) and cardiovascular diseases (CVD) incidence in old age, separately for women and men. Methods: We used a rich and representative life history survey of people aged from 65 to 75 living in Santiago, Chile (n = 802), and weighted multivariate statistical models. Data collection process involved the use of face-to-face life history calendars, administered by well-trained interviewers. Results: Early motherhood increases the risk of suffering CVD among older women with a disadvantaged childhood SEP, while late motherhood decreases it. By contrast, early fatherhood decreases CVD risk among older men with an adverse childhood SEP, while late fatherhood increases it. Conclusion: Our findings about the moderating role of parenthood onset on CVD risk among older women and men with a disadvantaged childhood SEP contributes to public health reflections on unexplored cardiovascular risk factors, which lead to substantial changes in women's and men's life courses, and might optimize cardiovascular prevention strategies.

Associations between cumulative social risk, psychosocial risk, and ideal cardiovascular health: Insights from the HeartSCORE study.

Background: Limited studies have assessed the effects of psychosocial risk factors on achievement of ideal cardiovascular health (CVH). Methods: Using the Heart Strategies Concentrating on Risk Evaluation (HeartSCORE) cohort, we examined the cross-sectional associations of cumulative social risk (CSR) and three psychosocial factors (depression, stress, perceived discrimination) with ideal CVH. CSR was calculated by assigning one point for each of: low family income, low education level, minority race (Black), and single-living status. Ideal CVH was calculated by assigning one point for ideal levels of each factor in American Heart Association's Life's Simple 7. Ideal CVH was dichotomized into fewer versus higher by combining participants achieving <3 versus ≥3 factors. Logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) of having fewer ideal CVH factors. Psychosocial factors were assessed as mediators of the association between CSR and ideal CVH. Results: We included 2000 participants (mean age 59.1 [7.5] years, 34.6% male, 42.7% Black, and 29.1% with low income), among whom 60.6% had <3 ideal CVH factors. The odds of having fewer ideal CVH factors increased significantly with increasing CSR scores from 1 to 2, to ≥3 compared to individuals with CSR score of zero, after adjusting for age and sex (OR [95% CIs]: 1.77 [1.41 - 2.22]; 2.09 [1.62 - 2.69] 2.67 [1.97 - 3.62], respectively). Taking the components of ideal CVH separately, higher CSR was directly associated with odds of being in 'non-ideal' category for six of the seven factors, but was inversely associated with probability of being in 'non-ideal' category for cholesterol. The association was modestly attenuated after adjusting for depression, stress, and perceived discrimination (corresponding OR [95% CI]: 1.69 [1.34 - 2.12], 1.96 [1.51 - 2.55], 2.34 [1.71 - 3.20]). The psychosocial factors appeared to mediate between 10% and 20% of relationship between CSR and ideal CVH. Conclusions: Increased CSR was associated with lower probability of achieving ideal CVH factors. A modest amount of the effect of CSR on ideal CVH appeared to be mediated by depression, stress and perceived discrimination. Public health strategies aimed at improving ideal cardiovascular health may benefit from including interventions targeting social and psychosocial risk factors.

Black race is associated with digital artery endothelial dysfunction: results from the Heart SCORE study.

AIMS: We evaluated whether black race is independently associated with arterial endothelial dysfunction. The pathophysiological basis for race-related differences in cardiovascular disease (CVD) risk has not been established. Endothelial dysfunction, which precedes obstructive atherosclerotic disease, may contribute to CVD disparities. Accordingly, we evaluated race-related differences in digital pulse amplitude tonometry (PAT) response to an endothelium-dependent vasodilatory stimulus. METHODS AND RESULTS: A total of 1377 subjects (41% black; mean age 58.5 ± 7.5 years; 67% female) enrolled in the Heart Strategies Concentrating on Risk Evaluation (Heart SCORE) study underwent assessment of digital pulse amplitude response to forearm occlusion-induced hyperaemia. The response was measured as a PAT ratio of hyperaemia:baseline pulse amplitude in a finger that was subject to hyperaemic stimulus divided by this same ratio in a control finger on the contralateral arm which did not undergo forearm occlusion, expressed as the natural logarithm. The average PAT ratio was significantly lower in blacks compared with whites (0.67 ± 0.44 vs. 0.80 ± 0.46, P < 0.001), signifying greater endothelial dysfunction in blacks. Black race was independently correlated with lower PAT ratio. This finding was consistent across all Framingham risk strata. Adjusted analyses showed significant gender-race interactions. With white women serving as the referent group, parameter estimates for lower PAT ratio in ascending order were as follows: black males (t = -6.93, P < 0.0001); white males (t = -3.31, P = 0.001); and black females (t = -1.12, P = 0.26). CONCLUSION: Our findings indicate that black race is independently associated with arterial endothelial dysfunction. Racial differences in CVD risk may be related, in part, to race-related differences in endothelial dysfunction.

Association between Lifetime Tobacco Use and Alcohol Consumption Trajectories and Cardiovascular and Chronic Respiratory Diseases among Older People.

Background: We identify representative types of simultaneous tobacco use and alcohol consumption trajectories across the life course and estimate their association with cardiovascular and chronic respiratory diseases (CVDs and CRDs) among older people in Chile. Methods: We used data from a population-representative, face-to-face and longitudinal-retrospective survey focused on people aged 65-75 (N = 802). To reconstruct trajectory types, we employed weighted multichannel sequence analysis. Then, we estimated their associations with CVDs and CRDs through weighted logistic regression models. Results: Long-term exposure to tobacco use and alcohol consumption across life are associated with the highest CVD and CRD risks. Long-term nonsmokers and nondrinkers do not necessarily show the lowest CVDs and CRDs risks if these patterns are accompanied by health risk factors such as obesity or social disadvantages such as lower educational levels. Additionally, trajectories showing regular consumption in one domain but only in specific periods of life, whether early or late, while maintaining little or no consumption across life in the other domain, lead to lower CVDs or CRDs risks than trajectories indicating permanent consumption in both domains. Conclusions: A policy approach that considers CVDs and CRDs as conditions that strongly depend on previous individual experiences in diverse life domains can contribute to the improved design and evaluation of preventive strategies of tobacco use and alcohol consumption across the life course.

Lifetime employment, tobacco use, and alcohol consumption trajectories and cardiovascular diseases in old age.

Despite the great advances of life course epidemiology studies during the last decade in understanding the general health effects of employment trajectories, research has yet to evaluate the effects of employment trajectories along with other major risk factors, such as tobacco and alcohol consumption, on cardiovascular diseases (CVDs)-the main cause of deaths worldwide. This is highly relevant, since health advantages in one domain (e.g., being a permanent formal full-time worker) may offset health disadvantages in other domains (e.g., being a regular smoker or alcohol consumer); conversely, disadvantages in both domains may interact, leading to even greater health risks. Considering these knowledge gaps, this research has two main objectives: (1) to reconstruct simultaneous employment, tobacco use, and alcohol consumption trajectories over the life course (from birth to old age) and (2) to measure the association between these trajectories and CVD in old age. Drawing on a rich and comprehensive life history dataset and using multichannel sequence and regression analyses, we analyzed a cohort of individuals aged 65-75 in Chile, a Latin American country with high social inequalities and scarce research on this matter. Our study shows that following a trajectory of formal employment together with no tobacco and alcohol use reduces CVD risk by 36 percentage points relative to a similar employment trajectory but with regular tobacco and alcohol use. Even with an employment trajectory characterized by constant informal employment or permanent inactivity, a life course free of regular tobacco and alcohol use shows protective effects against CVD. This study stresses the importance of health policies that consider CVD as a condition that strongly depends on individual experiences in multiple life domains and across different life stages.

Usefulness of the American Heart Association's Ideal Cardiovascular Health Measure to Predict Long-term Major Adverse Cardiovascular Events (From the Heart SCORE Study).

To further reduce the burden of cardiovascular disease (CVD) and expand prevention efforts, the American Heart Association (AHA) introduced in 2010 the concept of Ideal Cardiovascular Health (ICH), which includes 7 metrics (smoking status, body mass index, physical activity, diet, total cholesterol, blood pressure, and fasting plasma glucose). Limited data exist on the relation between ICH and long-term CVD risk. The Heart Strategies Concentrating on Risk Evaluation (Heart SCORE) study cohort was used to examine the relation between ICH and incident major adverse cardiovascular events (MACE: first occurrence of death, myocardial infarction, stroke, acute ischemic syndrome, or coronary revascularization). The 7 factors of the ICH were scored at study entry on a 0 to 2 scale, resulting in possible range of 0 to 14, with higher scores representing "better" health. Cox regression analyses were used to estimate hazard ratios (HR) of MACE, along with 95% confidence intervals. Over a median follow-up of 12 years, the study population (n = 1,863, 67% women, 42% Black race, mean age 59 years [range 45 to 75]) had 218 MACE. In unadjusted analysis, the ICH score (per 1 unit) was associated with an estimated 12% lower risk of MACE (HR [95% Confidence Interval]: 0.88 [0.82, 0.93]). Adjusting for demographics, education, and quality of life, ICH score was associated with a 10% lower risk of MACE (HR 0.90 [0.84, 0.96]). In a community-based sample of adults, the AHA ICH construct, which includes 7 modifiable CVD risk factors, appears to be a valid measure for predicting long-term risk of MACE.

[Laparoscopic approach for intestinal passage reconstruction after Hartmann's operation: experience with 30 patients]. / Abordaje laparoscópico para la reconstrucción de tránsito intestinal post-Hartmann: experiencia de un centro sobre 30 pacientes.

INTRODUCTION: Intestinal passage reconstruction after Hartmann's (PRH) operation is associated with a high morbidity and mortality of about 1%. Despite the increasing use of laparoscopy as an alternative in PRH, there is a lack of patient series at international level. PATIENTS AND METHODS: The prospective series of patients subjected to (PRH) by laparoscopy was analysed using the demographic parameters, ASA classification, reason for primary surgery, time between initial surgery and reconstruction, operation time, conversion to open surgery, bowel rest recovery time, complications, hospital stay and follow up. RESULTS: A total of 30 patients with a mean age of 61.5 ± 13 years were operated on using laparoscopy. The ASA classification was 1.8 ± 0.3 the BMI was 26.1 ± 2 Kg/m(2). A total of 63% were admitted due to complicated Hinchley III or IV acute diverticulitis. The interval between initial surgery and the passage reconstruction was 7.1 ± 2 months. Conversion to open surgery was necessary in three cases. The mean intestinal passage recovery was 2.1 ± 1 days and the hospital stay was 5.6 ± 1 days. The long-term complications were one mechanic ileum due to bridles and one case of anastomotic stenosis. CONCLUSIONS: The post-Hartmann laparoscopic passage reconstruction is associated with a short intestinal motility recovery time, as well as a less prolonged hospital stay compared to an open surgery series. Randomised studies are needed to determine whether laparoscopic reconstruction is superior to the conventional technique.

Science and Health Policies to Tackle Chronic Diseases in Chile.

Chile has experienced rapid epidemiological transitions characterized by decreasing infant mortality, population aging, and a shift towards obesity with an increase in noncommunicable diseases (NCDs). Today, tobacco, alcohol, and ultraprocessed foods are the main risk factors for these diseases. Based on Chile's experience in tobacco control, we discuss paths to make progress in population evidence-based strategies to improve overall community health.

Cardiovascular Disease Prognostic Models in Latin America and the Caribbean: A Systematic Review.

BACKGROUND: Cardiovascular prognostic models guide treatment allocation and support clinical decisions. Whether there are valid models for Latin American and Caribbean (LAC) populations is unknown. OBJECTIVE: This study sought to identify and critically appraise cardiovascular prognostic models developed, tested, or recalibrated in LAC populations. METHODS: The systematic review followed the CHARMS (CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies) framework (PROSPERO [International Prospective Register of Systemic Reviews]: CRD42018096553). Reports were included if they followed a prospective design and presented a multivariable prognostic model; reports were excluded if they studied symptomatic individuals or patients. The following search engines were used: EMBASE, MEDLINE, Scopus, SciELO, and LILACS. Risk of bias assessment was conducted with PROBAST (Prediction model Risk Of Bias ASsessment Tool). No quantitative summary was conducted due to large heterogeneity. RESULTS: From 2,506 search results, 8 studies (N = 130,482 participants) were included for qualitative synthesis. We could not identify any cardiovascular prognostic model developed for LAC populations; reviewed reports evaluated available models or conducted a recalibration analysis. Only 1 study included a Caribbean population (Puerto Rico); 3 studies were retrieved from Chile; 2 from Argentina, Brazil, Colombia, and Uruguay; and 1 from Mexico. Four studies included population-based samples, and the other 4 included people affiliated to a health facility (e.g., prevention clinics). Most studied participants were older than 50 years, and there were more women in 5 reports. The Framingham model was assessed 6 times, and the American College of Cardiology/American Heart Association pooled equation was assessed twice. Across the prognostic models assessed, calibration varied widely from one population to another, showing great overestimation particularly in some subgroups (e.g., highest risk). Discrimination (e.g., C-statistic) was acceptable for most models; for Framingham it ranged from 0.66 to 0.76. The American College of Cardiology/American Heart Association pooled equation showed the best discrimination (0.78). That there were few outcome events was the most important methodological limitation of the identified studies. CONCLUSIONS: No cardiovascular prognostic models have been developed in LAC, hampering key evidence to inform public health and clinical practice. Validation studies need to improve methodological issues.

Variants in ABCG8 and TRAF3 genes confer risk for gallstone disease in admixed Latinos with Mapuche Native American ancestry.

Latin Americans and Chilean Amerindians have the highest prevalence of gallstone disease (GSD) and gallbladder cancer (GBC) in the world. A handful of loci have been associated with GSD in populations of predominantly European ancestry, however, they only explain a small portion of the genetic component of the disease. Here, we performed a genome-wide association study (GWAS) for GSD in 1,095 admixed Chilean Latinos with Mapuche Native American ancestry. Disease status was assessed by cholecystectomy or abdominal ultrasonography. Top-10 candidate variants surpassing the suggestive cutoff of P < 1 × 10-5 in the discovery cohort were genotyped in an independent replication sample composed of 1,643 individuals. Variants with positive replication were further examined in two European GSD populations and a Chilean GBC cohort. We consistently replicated the association of ABCG8 gene with GSD (rs11887534, P = 3.24 × 10-8, OR = 1.74) and identified TRAF3 (rs12882491, P = 1.11 × 10-7, OR = 1.40) as a novel candidate gene for the disease in admixed Chilean Latinos. ABCG8 and TRAF3 variants also conferred risk to GBC. Gene expression analyses indicated that TRAF3 was significantly decreased in gallbladder (P = 0.015) and duodenal mucosa (P = 0.001) of GSD individuals compared to healthy controls, where according to GTEx data in the small intestine, the presence of the risk allele contributes to the observed effect. We conclude that ABCG8 and TRAF3 genes are associated with GSD and GBC in admixed Latinos and that decreased TRAF3 levels could enhance gallbladder inflammation as is observed in GSD and GSD-associated GBC.