Redistribution of heart failure as the cause of death: the Atherosclerosis Risk in Communities Study.

BACKGROUND: Heart failure is sometimes incorrectly listed as the underlying cause of death (UCD) on death certificates, thus compromising the accuracy and comparability of mortality statistics. Statistical redistribution of the UCD has been used to examine the effect of misclassification of the UCD attributed to heart failure, but sex- and race-specific redistribution of deaths on coronary heart disease (CHD) mortality in the United States has not been examined. METHODS: We used coarsened exact matching to infer the UCD of vital records with heart failure as the UCD from 1999 to 2010 for decedents 55 years old and older from states encompassing regions under surveillance by the Atherosclerosis Risk in Communities (ARIC) Study (Maryland, Minnesota, Mississippi, and North Carolina). Records with heart failure as the UCD were matched on decedent characteristics (five-year age groups, sex, race, education, year of death, and state) to records with heart failure listed among the multiple causes of death. Each heart failure death was then redistributed to plausible UCDs proportional to the frequency among matched records. RESULTS: After redistribution the proportion of deaths increased for CHD, chronic obstructive pulmonary disease, diabetes, hypertensive heart disease, and cardiomyopathy, P < 0.001. The percent increase in CHD mortality after redistribution was the highest in Mississippi (12%) and lowest in Maryland (1.6%), with variations by year, race, and sex. Redistribution proportions for CHD were similar to CHD death classification by a panel of expert reviewers in the ARIC study. CONCLUSIONS: Redistribution of ill-defined UCD would improve the accuracy and comparability of mortality statistics used to allocate public health resources and monitor mortality trends.

Diabetes mortality: trends and multi-country analysis of the Americas from 2000 to 2019.

BACKGROUND: Diabetes has been increasing worldwide and is now among the 10 leading causes of death globally. Diabetic kidney disease (DKD), a complication of poorly managed diabetes, is related to high mortality risk. To better understand the situation in the Americas region, we evaluated diabetes and DKD mortality trends over the past 20 years. METHODS: We analysed diabetes and DKD mortality for 33 countries in the Americas from 2000 to 2019. Data were extracted from the World Health Organization (WHO) Global Health Estimates and the World Population Prospects, 2019 Revision, estimating annual age-standardized mortality rates (ASMR) and gaps in the distribution of diabetes and DKD mortality by sex and country. Trend analyses were based on the annual average percentage of change (AAPC). RESULTS: From 2000 to 2019, the overall mortality trend from diabetes in the Americas remained stable [AAPC: -0.2% (95% CI: -0.4%-0.0%]; however, it showed important differences by sex and by country over time. By contrast, DKD mortality increased 1.5% (1.3%-1.6%) per year, rising faster in men than women, with differences between countries. Central America, Mexico and the Latin Caribbean showed significant increases in mortality for both diseases, especially DKD. In contrast in North America, diabetes mortality decreased whereas DKD mortality increased. CONCLUSIONS: The increase in DKD mortality is evidence of poorly controlled diabetes in the region. The lack of programmes on prevention of complications, self-care management and gaps in quality health care may explain this trend and highlight the urgent need to build more robust health systems based on primary care, prioritizing diabetes prevention and control.

Compliance with eye and foot preventive care in people with self-reported diabetes in Latin America and the Caribbean: Pooled, cross-sectional analysis of nine national surveys.

AIMS: To estimate the proportion of people with self-reported diabetes receiving eye and foot examinations in Latin America and the Caribbean (LAC). METHODS: Cross-sectional analysis of national health surveys in nine countries. Adults aged 25-64 years with self-reported diabetes. We quantified the proportion who reported having an eye examination in the last two years or a foot examination in the last year. We fitted multilevel Poisson regressions to assess socio-demographic (age and sex) and clinical (oral hypoglycemic medication and insulin treatment) variables associated with having had examinations. RESULTS: There were 7435 people with self-reported diabetes included in the analysis. In three countries (Chile [64%; 95% CI: 56%-71%], British Virgin Islands [58%; 95% CI: 51%-65%], and Brazil [54%; 95% CI: 50%-58%]), >50% of people with diabetes reported having had an eye examination in the last two years. Fewer participants (<50% across all countries) reported having had a foot examination in the last year, with Ecuador having the lowest proportion (12%; 95% CI: 8%-17%). Older people, and those taking oral medication or insulin, were more likely to have eye/foot examinations. CONCLUSIONS: The proportion of eye and foot examinations in people with self-reported diabetes across nine countries in LAC is low.

A cross-sectional study on the quality of life and psychosocial risk of migrant workers. / Estudio transversal sobre la calidad de vida y el riesgo psicosocial de trabajadores migrantes.

Introduction: Migration figures place Chile as one of the South American countries with the highest rate of migrants. The present study estimated the relationship between sociodemographic characteristics, quality of life, and psychosocial occupational risks in migrant workers from the Maule region. Methods: Cross-sectional study with migrant workers between 18 and 60 years of age residing in the Maule region (n = 145). The applied questionnaires were: a psychosocial risk questionnaire, a health and quality of life questionnaire, and a sociodemographic questionnaire. A bivariate statistical analysis was performed using nonparametric Mann-Whitney U tests, Kruskal Wallis, Spearman correlation, and multiple linear regression models. Results: In Chile, 21% of the migrants maintained the same work activity as in their country of origin. Although the quality of life in physical and mental health is adequate, 52% have low psychological demands at work, 48.9% have low levels of active work and development skills, 57.7% have a high-risk level of compensation and self-esteem, and 65.5% have a high-risk level of double presence at work. Migrants with a higher quality of life in the physical health dimension have a lower risk of maintaining a balance between effort and reward; they worked 44 hours a week and did not work directly at Maule. Migrants with a higher quality of life in the mental health dimension have a lower risk of emotional demands, perceive greater social support in the company, and are less concerned about domestic chores. Conclusions: Migrants with lower quality of life in the physical health dimension presented less compensation at work and recognition, came to work directly in the region, and had jobs with fewer contract hours. Workers with lower quality of life in their mental health exhibited a greater risk of psychological demands at work and perceived low social support in the company; they were concerned about having to respond to domestic and salaried work.

Introducción: Las cifras migratorias sitúan a Chile como uno de los países sudamericanos con mayor número de migrantes. El presente estudio estimó la relación entre características sociodemográficas, calidad de vida y riesgos psicosociales laborales en migrantes trabajadores de la región del Maule. Métodos: Estudio transversal con trabajadores migrantes entre 18 y 60 años, residentes en la Región del Maule (n = 145). Las encuestas aplicadas fueron: Cuestionario de riesgo psicosocial, Cuestionario de salud y calidad de vida y Cuestionario sociodemográfico. Se realizó un análisis estadístico bivariado con pruebas no paramétricas de U de Mann Whitney, Kruskal Wallis, correlación de Spearman y modelos de regresión lineal múltiple. Resultados: Un 21% de los migrantes mantuvo en Chile la misma actividad laboral a la que se dedicaban en su país de origen. Si bien la calidad de vida de la salud física y mental es adecuada, 52% presenta bajas demandas psicológicas en el trabajo, 48,9% bajos niveles de trabajo activo y habilidades de desarrollo, 57,7% tiene un nivel de alto riesgo en la compensación y la autoestima, y 65,5% un nivel de alto riesgo de doble presencia en el trabajo. Los migrantes con mayor calidad de vida en la dimensión salud física presentan menor riesgo de mantener el equilibrio entre el esfuerzo y recompensa, poseen un trabajo de 44 horas a la semana y no llegaron a trabajar directamente al Maule. Los migrantes con mayor calidad de vida en la dimensión salud mental poseen menor riesgo en las demandas emocionales, perciben mayor apoyo social en la empresa y menor preocupación por las tareas domésticas. Conclusiones: Los migrantes con menor calidad de vida en la dimensión salud física, presentan menores compensaciones en el trabajo, bajo reconocimiento, llegaron directamente a trabajar a la región y poseían trabajos con menos horas de contrato. Los trabajadores con menor calidad de vida en su salud mental exhiben mayor riesgo en las exigencias psicológicas en el trabajo, perciben bajo apoyo social en la empresa y preocupación por responder al trabajo doméstico y al asalariado.

Psychometric Validation of a Questionnaire to Assess Perception and Knowledge About Exposure to Pesticides in Rural Schoolchildren of Maule, Chile.

Exposure to pesticides during infancy is associated with numerous adverse health outcomes. The assessment of knowledge and perception of pesticides exposure and risk among children has not been thoroughly studied. The aim of the study was to evaluate the reliability and validity of a questionnaire that measures the knowledge and perception of exposure to organophosphate pesticides among rural schoolchildren. The questionnaire was administered to 151 schoolchildren between 9 and 13years from four Chilean rural schools. An internal consistency analysis of the ordinal alpha coefficient and a polychoric factor analysis for categorical data were used. The results show that the ordinal alpha was 0.95. Polychoric matrices of rotated components show the 17 questions summarized pesticide knowledge in five factors extracted after promax rotation. This factorial model explains 56.3% of the variance. The questions were grouped as follows: knowledge about pesticides (Factor 1); knowledge of health effects related to pesticides exposure (Factor 2); pesticide exposure through the growing of fruits and vegetables (Factor 3); perception and action against pesticides exposure at school (Factor 4); and perception and action against pesticides exposure at home (Factor 5). The questionnaire provides a useful tool for examining pesticide exposure in agricultural regions, allowing younger community members to participate.

Estudio transversal sobre la calidad de vida y el riesgo psicosocial de trabajadores migrantes / A cross-sectional study on the quality of life and psychosocial risk of migrant workers

INTRODUCIÓN: Las cifras migratorias sitúan a Chile como uno de los países sudamericanos con mayor número de migrantes. El presente estudio estimó la relación entre características sociodemográficas, calidad de vida y riesgos psicosociales laborales en migrantes trabajadores de la región del Maule. MÉTODOS: Estudio transversal con trabajadores migrantes entre 18 y 60 años, residentes en la Región del Maule (n = 145). Las encuestas aplicadas fueron: Cuestionario de riesgo psicosocial, Cuestionario de salud y calidad de vida y Cuestionario sociodemográfico. Se realizó un análisis estadístico bivariado con pruebas no paramétricas de U de Mann Whitney, Kruskal Wallis, correlación de Spearman y modelos de regresión lineal múltiple. RESULTADOS: Un 21% de los migrantes mantuvo en Chile la misma actividad laboral a la que se dedicaban en su país de origen. Si bien la calidad de vida de la salud física y mental es adecuada, 52% presenta bajas demandas psicológicas en el trabajo, 48,9% bajos niveles de trabajo activo y habilidades de desarrollo, 57,7% tiene un nivel de alto riesgo en la compensación y la autoestima, y 65,5% un nivel de alto riesgo de doble presencia en el trabajo. Los migrantes con mayor calidad de vida en la dimensión salud física presentan menor riesgo de mantener el equilibrio entre el esfuerzo y recompensa, poseen un trabajo de 44 horas a la semana y no llegaron a trabajar directamente al Maule. Los migrantes con mayor calidad de vida en la dimensión salud mental poseen menor riesgo en las demandas emocionales, perciben mayor apoyo social en la empresa y menor preocupación por las tareas domésticas. CONCLUSIONES: Los migrantes con menor calidad de vida en la dimensión salud física, presentan menores compensaciones en el trabajo, bajo reconocimiento, llegaron directamente a trabajar a la región y poseían trabajos con menos horas de contrato. Los trabajadores con menor calidad de vida en su salud mental exhiben mayor riesgo en las exigencias psicológicas en el trabajo, perciben bajo apoyo social en la empresa y preocupación por responder al trabajo doméstico y al asalariado.

INTRODUCTION: Migration figures place Chile as one of the South American countries with the highest rate of migrants. The present study estimated the relationship between sociodemographic characteristics, quality of life, and psychosocial occupational risks in migrant workers from the Maule region. METHODS: Cross-sectional study with migrant workers between 18 and 60 years of age residing in the Maule region (n = 145). The applied questionnaires were: a psychosocial risk questionnaire, a health and quality of life questionnaire, and a sociodemographic questionnaire. A bivariate statistical analysis was performed using nonparametric Mann-Whitney U tests, Kruskal Wallis, Spearman correlation, and multiple linear regression models. RESULTS: In Chile, 21% of the migrants maintained the same work activity as in their country of origin. Although the quality of life in physical and mental health is adequate, 52% have low psychological demands at work, 48.9% have low levels of active work and development skills, 57.7% have a high-risk level of compensation and self-esteem, and 65.5% have a high-risk level of double presence at work. Migrants with a higher quality of life in the physical health dimension have a lower risk of maintaining a balance between effort and reward; they worked 44 hours a week and did not work directly at Maule. Migrants with a higher quality of life in the mental health dimension have a lower risk of emotional demands, perceive greater social support in the company, and are less concerned about domestic chores. CONCLUSIONS: Migrants with lower quality of life in the physical health dimension presented less compensation at work and recognition, came to work directly in the region, and had jobs with fewer contract hours. Workers with lower quality of life in their mental health exhibited a greater risk of psychological demands at work and perceived low social support in the company; they were concerned about having to respond to domestic and salaried work.

Reliability of cause of death coding: an international comparison.

This study evaluates the agreement of nosologic coding of cardiovascular causes of death between a Chilean coder and one in the United States, in a stratified random sample of death certificates of persons aged ≥ 60, issued in 2008 in the Valparaíso and Metropolitan regions, Chile. All causes of death were converted to ICD-10 codes in parallel by both coders. Concordance was analyzed with inter-coder agreement and Cohen's kappa coefficient by level of specification ICD-10 code for the underlying cause and the total causes of death coding. Inter-coder agreement was 76.4% for all causes of death and 80.6% for the underlying cause (agreement at the four-digit level), with differences by the level of specification of the ICD-10 code, by line of the death certificate, and by number of causes of death per certificate. Cohen's kappa coefficient was 0.76 (95%CI: 0.68-0.84) for the underlying cause and 0.75 (95%CI: 0.74-0.77) for the total causes of death. In conclusion, causes of death coding and inter-coder agreement for cardiovascular diseases in two regions of Chile are comparable to an external benchmark and with reports from other countries.

Reliability of cause of death coding: an international comparison / Concordancia en la codificación de causas de muerte: una comparación internacional / Confiabilidade de codificação das causas de óbito: uma comparação internacional

This study evaluates the agreement of nosologic coding of cardiovascular causes of death between a Chilean coder and one in the United States, in a stratified random sample of death certificates of persons aged ≥ 60, issued in 2008 in the Valparaíso and Metropolitan regions, Chile. All causes of death were converted to ICD-10 codes in parallel by both coders. Concordance was analyzed with inter-coder agreement and Cohen’s kappa coefficient by level of specification ICD-10 code for the underlying cause and the total causes of death coding. Inter-coder agreement was 76.4% for all causes of death and 80.6% for the underlying cause (agreement at the four-digit level), with differences by the level of specification of the ICD-10 code, by line of the death certificate, and by number of causes of death per certificate. Cohen's kappa coefficient was 0.76 (95%CI: 0.68-0.84) for the underlying cause and 0.75 (95%CI: 0.74-0.77) for the total causes of death. In conclusion, causes of death coding and inter-coder agreement for cardiovascular diseases in two regions of Chile are comparable to an external benchmark and with reports from other countries.

Este estudo avaliou a confiabilidade na codificação das causas de óbitos cardiovasculares entre um codificador no Chile e outro nos Estados Unidos, em uma amostra aleatória estratificada de declarações de óbito de pessoas ≥ 60 anos, emitidas em 2008 nas regiões de Valparaíso e Metropolitana do Chile. Todas as causas da morte foram convertidas em códigos CID-10 em paralelo por ambos os codificadores. A confiabilidade foi avaliada de acordo com o intercodificador e o coeficiente kappa de Cohen, segundo o nível de especificação do código CID-10 para a codificação de causa básica e para todas as causas de óbito. A concordância intercodificador foi de 76,4% para todas as causas de morte e 80,6% para a causa básica (acordo no nível de quatro dígitos), com diferenças por nível de especificação do código CID-10, linha da declaração de óbito, e por número de causas de morte por declaração de óbito. O coeficiente kappa foi 0,76 (IC95%: 0,68-0,84) para a causa básica e 0,75 (IC95%: 0,74-0,77) para todas as causas de óbito. Em conclusão, a codificação das causas de morte cardiovasculares e acordo intercodificador em duas regiões do Chile são comparáveis a uma referência externa e com os relatórios de outros países.

Este estudio evalúa la concordancia en la codificación de causas de muerte cardiovasculares entre un codificador en Chile y otro en EEUU en una muestra aleatoria estratificada de certificados de defunción de personas ≥ 60 años, emitidos el 2008 en las Regiones de Valparaíso y Metropolitana de Chile. Todas las causas de muerte fueron convertidas a códigos CIE-10 en paralelo por ambas codificadoras. La concordancia se analizó con el acuerdo inter-codificador y el coeficiente kappa de Cohen, según nivel de especificación del código CIE-10 para la codificación de la causa básica y para el total de causas de muerte. El acuerdo inter-codificador fue 76,4% para el total de causas de muerte y 80,6% para la causa básica (acuerdo a nivel de cuatro dígitos), con diferencias según nivel de especificación del código CIE, línea del certificado y número de causas de muerte por certificado. El coeficiente kappa de Cohen fue 0,76 (IC95%: 0,68-0,84) para la causa básica y 0.75 (IC95%: 0.74-0.77) para el total de causas de muerte. En conclusión, la codificación de causas de muerte cardiovasculares y el acuerdo inter-codificador en dos regiones de Chile son comparables a una referencia externa y a informes internacionales.

Depresión en adultos mayores: un desafío para la atención primaria / Late life depression: a challenge for primary care clinics

Actualmente, la mayor esperanza de vida de la población genera continuos desafíos tendientes a mejorar la efectividad en la detección y tratamiento de enfermedades físicas y mentales en los adultos mayores. Dentro de tales patologías destaca la enfermedad depresiva, tanto por su elevada prevalencia como por las serias consecuencias que acarrea. La atención primaria de salud, constituye un lugar privilegiado para detectar y tratar este trastorno. En el presente artículo se revisan antecedentes sobre detección, diagnóstico y tratamiento de la depresión en adultos mayores pertenecientes a este nivel, estableciendo como necesidad primordial el fortalecer la investigación clínica nacional en esta materia.

Currently, the longer life expectancy of the population generates continuous challenges in order to improve the effectiveness in the detection andtreatment of physical and mental illnesses in the elderly. Among these, depressive disorder is striking,because of its high prevalence as well as its serious consequences. Primary health clinics are a privileged place for the detection and treatment of this disorder. Data about detection, diagnosis and treatment of depression in the elderly in this level are analyzed in the present article, establishing thestrengthening of the national clinical research in this area as a primary need.