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

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.

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.

Atención de salud mental antes y durante la pandemia COVID-19 en centros de salud pública de una municipalidad de Chile / Mental health care before and during the COVID-19 pandemic in public healthcare centers of a Chilean municipality

Introducción A nivel mundial, la pandemia por COVID-19 ha afectado la atención en salud mental de las personas. El presente estudio tiene como propósito describir la atención de salud mental en el primer semestre de la pandemia COVID-19 del año 2020, comparado con el primer semestre del año 2019 en los establecimientos de salud pública de la comuna de Chillán, Chile. Métodos Estudio ecológico descriptivo. Se analizaron de manera agregada los casos atendidos considerando la pandemia, cantidad de ingresos, motivo de consulta, sexo y edad para los años 2019 y 2020, observando prevalencias, porcentajes y comparación estadística con pruebas no paramétricas. Resultados La prevalencia de casos por ingresos al programa de salud mental de atención primaria en salud/especialidad se mantuvo similar entre el primer semestre del año 2019 y el primer semestre del año 2020. La mayor proporción de casos de salud mental se concentran en los trastornos de humor (afectivos) y trastornos de ansiedad. Se observaron diferencias estadísticamente significativas entre el año 2019 y 2020 en el número de atenciones por ingresos en salud mental para los trastornos mentales y del comportamiento debido a consumo sustancias psicotrópicas, trastornos por consumo perjudicial o dependencia a drogas y trastornos de personalidad. Conclusión Es prioritario que en Chile se aumente la cobertura en la atención primaria de salud mental, los datos entregados en este estudio muestran a nivel exploratorio que la situación inicial de la pandemia pudo haber afectado el acceso a la atención oportuna de las personas más vulnerables con trastornos de salud mental.

Introduction Globally, the COVID-19 pandemic has affected people's mental health care. This study aims to describe mental health care in the first semester of the COVID-19 pandemic of the year 2020 compared to the first semester of the year 2019 in the public health establishments of the commune of Chillán, Chile. Methods A descriptive ecological study. The treated cases were analyzed in aggregate, considering the pandemic, amount of admissions, the reason for consultation, sex, and age for the years 2019 and 2020. Prevalence, percentages, and statistical analysis were evaluated using non-parametric tests. Results The prevalence of cases due to admissions to the mental health program in primary health care remained similar between the first semester of 2019 and the first semester of 2020. Most mental health cases concentrate on mood (affective) and anxiety disorders. Statistically significant differences were observed between 2019 and 2020 in the number of mental health admissions for mental and behavioral disorders due to psychotropic substances, harmful use disorders, drug dependence, and personality disorders. Conclusions It is a priority for Chile to increase coverage in primary mental health care. The data provided in this study show at an exploratory level that the initial situation of the pandemic could have affected access to timely care for the most vulnerable people with mental disorders.

Beneficios de los espacios verdes y actividad física en el bienestar y salud de las personas / Benefits of green spaces and physical activity for the well-being and health of people

BACKGROUND: Physical environment can influence well-being, quality of life and health and population health in several ways. Exposure to green spaces improves the physical and mental health of individuals. Chile has privileged conditions for outdoor activities that could benefit millions of people. However, a small percentage of the Chilean population is exposed to green spaces in the recommended amounts to promote health. AIM: To describe the benefits of green spaces on physical and mental health and their relationship with the practice of physical activity. MATERIAL AND METHODS: Review of the scientific literature in English in the Web of Science (WoS) electronic database published between 2006-2019. RESULTS: In addition to the direct benefits of green spaces, there are synergistic effects of performing physical activities in these environments such as feelings of good health, satisfaction with life and pleasure, increased physiological relaxation, positive emotions, mental well-being, restoration of attention, decreased perceived stress and a reduction negative affections. CONCLUSIONS: This review supports strategies for improving access to green spaces in urban areas coupled with physical activity promotion in these settings. Health and urban planning stakeholders should consider these aspects in future programs.

Modelamiento del síndrome cardiopulmonar por hantavirus / Modeling of hantavirus cardiopulmonary syndrome

INTRODUCCIÓN: El síndrome cardiopulmonar por hantavirus es una enfermedad causada por un virus perteneciente al orden bunyanvirales, y transmitida hacia los humanos a través de roedores. Esta enfermedad en Chile es considerada endémica, la cual tiene una alta tasa de letalidad. En la actualidad existen estudios que evidencian el contagio entre personas del virus Andes, cuya localidad se concentra en los países de Argentina y Chile. OBJETIVOS: Analizar la posibilidad de transmisión de hantavirus entre humanos, mediante un modelo matemático tipo SEIR. MÉTODOS: Se plantea un modelo matemático tipo SEIR (susceptible, expuesto, infeccioso y recuperado) para expresar la dinámica de la enfermedad por hantavirus, incluyendo la posibilidad de transmisión entre humanos y la percepción del riesgo. Resultados: El máximo de contagio entre humanos disminuye cerca de 25% tras aumentar la percepción de riesgo de las personas, mediante la reducción de la tasa de resistencia al cambio y aumento la velocidad de reaccionar de las personas. CONCLUSIONES: Es urgente revisar las estrategias de comunicación de riesgo y medidas de prevención ante esta posibilidad de contagios masivos entre humanos, además de fortalecer la investigación y proyectar el desarrollo de una vacuna para proteger las poblaciones expuestas a esta enfermedad con alta tasa de letalidad.

INTRODUCTION: Hantavirus cardiopulmonary syndrome is an infection caused by rodents of the Bunyanvirales family towards humans. This disease in Chile is considered endemic, which has a high fatality rate. At present, some studies show the contagion between people of the Andes virus, whose locality is concentrated in Argentina and Chile. OBJECTIVES: Analyze the possibility of hantavirus transmission between humans using an SEIR-type mathematical model. METHODS: An SEIR (Susceptible, Exposed, Infectious and Recovered) mathematical model to express the dynamics of hantavirus disease is proposed, including the possibility of human-to-human transmission and the perception of risk. RESULTS: The peak of human-to-human contagion decreases by about 25% after increasing people's perception of risk by reducing the rate of resistance to changeand increasing the speed of people's reaction. CONCLUSIONS: It is urgent to review risk communication strategies and prevention measures in the face of this possibility of massive human-tohuman infections, in addition to strengthening research and planning the development of a vaccine to protect populations exposed to this disease with a high fatality rate.

Aspectos éticos del uso de identificadores biométricos / Bioethical aspects of the use of biometric identifiers / Aspectos éticos do uso de identificadores biométricos

La biometría ha tenido una rápida expansión como tecnología, siendo cada vez más accesible para el público general, prestando utilidad a los gobiernos y a la sociedad en el manejo de la seguridad ciudadana. Se aplica para la verificación o la identificación de la identidad de un individuo y, desde un punto de vista puramente técnico, constituye un problema de reconocimiento de patrones. En Chile, el marco legal acerca del manejo de datos personales no incluye específicamente a la biometría. A la fecha, se encuentra en trámite un nuevo proyecto de ley que considera tanto los datos biométricos como los perfiles biológicos. En otros países, los informes de las últimas dos décadas, que analizan el uso de biometría, plantean como principal foco de preocupación, desde el punto de vista ético, el derecho a la privacidad de los individuos, entregándose orientaciones prácticas acerca de la aplicación apropiada de estas tecnologías. Finalmente, desde un breve análisis de la biopolítica, se contextualiza el papel que cumple la biometría y los requerimientos éticos básicos para su desarrollo en dicho marco.

Biometrics has had a rapid expansion as a technology, being increasingly accessible to the public, and lending utility to governments and society in the management of citizen security. It is applied either for verification or for identification of an individual's identity and technically constitutes a problem of pattern recognition. In Chile, the existing legal framework regarding the handling of personal data does not include specific biometrics in its regulation. A new bill that considers both biometric data and Biological profiles is in process. In addition, we revised the international reports of the last two decades that analyze the use of biometrics. The primary focus of concern of these documents, from the ethical point of view, is the right to privacy of individuals, giving practical guidance and discussion regarding the elements necessary for the application of these novel technologies in an appropriate ethically manner. Finally, we contextualize from a brief analysis of biopolitics the role of biometrics and the basic ethical requirements for its development in that framework.

A biometria teve uma rápida expansão como tecnologia, sendo cada vez mais acessível para o público geral, sendo de utilidade para os governos e à sociedade no manejo da segurança cidadã. Ela pode ser aplicada para a verificação ou estabelecimento da identidade de um indivíduo e, desde um ponto de vista puramente técnico, constitui um problema de reconhecimento de padrões. No Chile, o contexto legal acerca do manejo de dados pessoais não inclui especificamente a biometria. Atualmente, encontra-se tramitando um novo projeto de lei que considera tanto os dados biométricos como os perfis biológicos. Em outros países, os informes das últimas duas décadas que analisam o uso da biometria, propõem como principal foco de preocupação, do ponto de vista ético, o direito à privacidade dos indivíduos, entregando-se orientações práticas acerca da aplicação apropriada destas tecnologias. Finalmente, desde uma breve análise da bio-política, contextualiza-se o papel que cumpre a biometria e os requerimentos éticos básicos para seu desenvolvimento em tal contexto legal.

Occupational exposure to pesticides and health symptoms among family farmers in Brazil

ABSTRACT OBJECTIVE: To explore the association of occupational pesticide exposure with acute and mental health symptoms. METHODS: Cross-sectional survey carried out with 78 Brazilian family farmers, who were pesticide applicators and helpers conveniently selected. Symptoms and exposure data were collected by interviews, and mental health outcomes by the Self-Reporting Questionnaire. Blood samples were analyzed to assess cholinesterase levels. Exposure indicators and symptoms were compared between applicators and helpers, and Poisson regression was performed to estimate prevalence ratios. RESULTS: Farmers reported exposure to multiple pesticides from early ages; they worked without safety training, technical support, and full protective equipment, and they had a high prevalence of acute and mental health symptoms (e.g., headache, mucosal irritation, tachycardia, and depressive signs). Applicators had more cholinesterase changes than helpers, but less symptoms. Helpers used less personal protection and had significantly higher prevalence ratio of headache, dyspnea, wheezing, cough, poor digestion, tiredness, and feeling worthless, after adjustment. CONCLUSIONS: Acute and mental health symptoms were observed, both among farmers and helpers. Thus, surveillance actions must be reinforced in Brazil, technical support and safety training improved, focused on applicators and helpers, who are occupationally and environmentally exposed to pesticides. Agricultural practices of these groups with less pesticide use should receive incentive.

Bioética y justicia ambiental: el caso de presencia de plaguicidas en escolares de comunidades rurales / Bioética e justiça ambiental: o caso da presença de pesticidas em escolares de comunidades rurais / Bioethics and environmental justice: the case of the presence of pesticides in schoolchildren in rural communities

Resumen: Una serie de estudios evidencian las consecuencias en la salud de las personas expuestas a plaguicidas, ya sea por la actividad laboral como por vivir o estudiar cerca de predios agrícolas. La exposición ocupacional a una serie de insecticidas, herbicidas y fungicidas está asociada principalmente a cáncer, daño neurocognitivo y motor, polineuropatía periférica, depresión y ansiedad, malformaciones en niños al nacer, dificultades endocrinas y en el sistema reproductivo, daño renal y genotóxicos. A través de una revisión de la literatura, el objetivo del siguiente artículo consistió en dilucidar la situación de exposición a plaguicidas en comunidades escolares rurales y aplicar elementos de la bioética y justicia ambiental para proponer un cambio y acciones que permitan mejorar su calidad de vida y salud, por el derecho a vivir libres de contaminación ambiental. La justicia ambiental busca mucho más que la equidad y el tratamiento justo y de calidad similar al de otras comunidades no vulnerables, apunta a hacer que las mismas comunidades exijan la necesidad de una sociedad más igualitaria que vele por el derecho a vivir en un medio ambiente limpio.

Resumo: Uma série de estudos evidenciam as conseqüências na saúde das pessoas expostas a pesticidas, seja por atividade de trabalho como por viver ou estudar perdo de prédiso agrícolas. A exposição ocupacional a uma série de inseticidas, herbicidas e fungicidas está associada principalmente a câncer, dano neurocognitivo e motor, polineuropatia periférica, depressão e ansiedade, mal formações em crianças ao nascer, dificuldade endócrinas e no sistema reprodutivo, dano renal e genotóxicos. Através de uma revisão da literatura, o objetivo do artigo seguinte consistiu em elucidar a situação de exposição a pesticidas em comunidades escolares rurais e aplicar elementos de bioética e justiça ambiental para propor uma mudança e ações que permitam melhorar sua qualidade de vida e saúde, pelo direito a viver livre de contaminação ambiental. A justiça ambiental busca muito mais que a equidade e o tratamento justo e de qualidade similar ao de outras comunidades não vulneráveis, tenta fazer que as mesmas comunidades exijam a necessidade de uma sociedade mais igualitária que vele pelo direito a viver em um meio ambiente limpo.

Abstract: A series of studies show the health consequences of people exposed to pesticides either because of their work activity or because they live or study near agricultural land. Occupational exposure to a series of insecticides, herbicides and fungicides is mainly associated with cancer, neurocognitive and motor damage, peripheral polyneuropathy, depression and anxiety, malformations in children at birth, endocrine and reproductive system difficulties, kidney damage and genotoxic effects. Through a review of the literature, the objective of the following article was to elucidate the situation of exposure to pesticides in rural school communities, unveil the bioethical dilemmas in which they are located and the need to apply elements of environmental justice to generate a change and actions to improve their quality of life and health, for the right to live free of environmental pollution. Environmental justice seeks much more than equity and fair treatment and quality similar to that of other non-vulnerable communities, aims to make the same communities demand the need for a more egalitarian society that ensures the right to live in an environment cleansed.

Calidad de vida y sobrecarga en cuidadores de escolares con discapacidad intelectual / Quality of life and overload in caregivers of school children with intellectual disabilities

Existe escasa evidencia sobre calidad de vida y sobrecarga emocional de cuidadores de estudiantes con discapacidad intelectual. Las investigaciones de los últimos años abordan esta problemática desde la persona adulta con discapacidad grave, ya sea física y neurológica, por ende existe la necesidad de identificar la calidad de vida y nivel de sobrecarga del cuidador a cargo de un estudiante con discapacidad intelectual o retos múltiples. El objetivo de este estudio consistió en evaluar la sobrecarga y calidad de vida de cuidadores de escolares con discapacidad intelectual y retos múltiples de Curicó, Chile. Se realizó un diseño transversal, con una muestra de 137 cuidadores de escolares con discapacidad intelectual leve, moderada y discapacidades múltiples de escuelas municipales, y se aplicaron el Cuestionario de Sobrecarga del Cuidador de Zarit y el Cuestionario de Salud de Calidad de Vida SF36. Los resultados mostraron que el mayor número de escolares se encontró en el nivel de discapacidad intelectual leve con un 62.9%, luego un 19.3% para retos múltiples y un 17.9% para discapacidad moderada. Los cuidadores de niños con discapacidades múltiples presentaron un mayor nivel de sobrecarga emocional y menor calidad de vida en la función, dolor corporal y salud general. Se concluye que es necesario el desarrollo de propuestas, tanto en el ámbito de salud como de educación, que integre a la familia en el proceso formativo y que vele por la calidad de vida de los cuidadores principales de estudiantes con discapacidades, con el fin de fortalecer los procesos de inclusión social y educativa de los escolares.

There is little evidence on the quality of life and emotional overload of caregivers of students with intellectual disabilities. Research of recent years address this problem from the adult with severe disability, whether physical or neurological, therefore there is a need to identify the quality of life and overburden level of the caregiver in charge of a student with intellectual disability or multiple challenges. The objective was to evaluate the overload and quality of life of caregivers of students with intellectual and multiple disabilities of Curicó, Chile. We did across-sectional design, with a sample of 137 caregivers of school children with mild, moderate intellectual disability and multiple disabilities of municipal schools, we applied the Zarit Burden Interview scale for caregivers and the SF36 Health Survey. The average age of caregivers of people with disabilities (n = 140) was 40 years(SD = 12), with a minimum age of 18 and a maximum of 66 years. Regarding the marital status of the caregivers (Table 1), 48.6% corresponded to married, 23.6% single, 13.6% cohabiting, 4.3% widowed and 10% separated. With regard to kinship, 73.6% corresponds to the mother of the scholar with a disability. A greater percentage of the caregivers attended the complete secondary education (32.1%), followed by the basic complete with 20.0%, and without studies with 1.4%. The majority of the respondents were primary caregivers of children in the first cycle of education (56.0%) and 72.0% reported living with 4 or more people in the home. The results showed that the highest number of school children was found at the level of mild intellectual disability with 62.9% following multiple challenges (19.3%) and moderate disability with 17.9%. The 48.1% of the total caregivers of children with multiple challenges presented an intense level of overload. This relationship is statistically significant (χ²= 12.4, p = .015) which indicates that caregivers of students with multiple disabilities present a greater burden. Caregivers of children with multiple disabilities presented a higher level of emotional overload and lower quality of life in the body pain function. The final model of multiple linear regression for the dependent variable overload of the caregiver that presents the best goodness of fit presented an association between multiple challenges and greater overload of the caregiver adjusted by the kinship of the caregiver with the scholar. The data indicate that there is a difference of up to 5.8 points in the overload among caregivers of students with mild, moderate intellectual disability and multiple challenges. We concluded that it is necessary to develop proposals in both health and education that integrates the family in the training process and that ensures the quality of life of the main caregivers of students with disabilities, in order to strengthen the processes of social and educational inclusion of the schoolchildren. At the same time, the results obtained provide key background for future research, in terms of support and information that is required to improve the quality of life of caregivers of students with disabilities, while allowing optimal development for children and thus reduce the level of stress and overload of the family. In the same way, it addresses a paradigm of school inclusion that goes beyond curricular adaptations, allows to propose a comprehensive view among all involved, recognizing that the higher the level of disability, the greater the perception of emotional overload and physical discomfort, being necessary incorporate other support networks for caregivers and their family in general, however, it is considered key that the financing of these activities and intervention be intersectoral, involving entities inthe area of health, education, social-community and work among the most important.

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.

Aspectos legales y bioéticos de intervenciones e investigaciones en personas con discapacidad intelectual en Chile / Aspectos legais e bioéticos de intervenções e pesquisas em pessoas com descapacidade intelectual no Chile / Legal and bioethical issues of interventions and research in persons with intellectual disability in Chile

El trabajo presenta una revisión y discusión de los aspectos legales y éticos que protegen a los sujetos con discapacidad intelectual en la participación de investigaciones o intervenciones terapéuticas en Chile, además de reflexionar sobre situaciones de diagnóstico y tratamiento que generan conflicto respecto de los derechos de las personas con discapacidad intelectual. Los temas específicos se vinculan con la decisión autónoma y capacidad en el consentimiento informado, los derechos de las personas con discapacidad intelectual, la evaluación de la capacidad y la reflexión sobre algunos dilemas bioéticos en el tratamiento y evaluación de la discapacidad intelectual. Se propone reconocer el derecho de las personas con discapacidad intelectual a decidir por sí mismos y ser reconocidos en igualdad de oportunidades y derechos, desarrollar procedimientos y protocolos para la evaluación de la capacidad estandarizados y adaptados a la diversidad cultural del país, y que cuidadores, familiares y profesionales consideren no solo las normativas frente a la investigación y tratamiento, sino también la opinión y decisión de las personas con discapacidad, e informarles en qué consisten dichas experiencias, considerando sus características individuales.

This article presents a review and discussion of ethical and legal issues which protect subjects with intellectual disability in their participation in research or therapeutic interventions in Chile, moreover reflecting on situations of diagnosis and treatment which generate conflict with respect to the rights of persons with intellectual disability. The specific topics are linked to autonomous decision and capacity in informed consent, the rights of persons with intellectual disability, the evaluation of capacity and the reflection on some bioethical dilemmas in the treatment and evaluation of intellectual disability. The following is proposed: to recognize the rights of persons with intellectual disability to decide by themselves and the recognition of equal rights and opportunities to develop procedures and protocols standardized and adapted for cultural diversity in the country for evaluating capacity. Furthermore, caretakers, family members and professionals should consider not only regulations for research and treatment, but also the opinion and decision of persons with disabilities and inform them about such experiences considering their individual characteristics.

O trabalho apresenta uma revisão e discussão dos aspectos legais e éticos que protegem os sujeitos com descapacidade intelectual na participação deinvestigações ou intervenções terapêuticas no Chile, além de refletir sobre situações de diagnóstico e tratamento que geram conflito a respeito dos direitos das pessoas com descapacidade intelectual. Os temas específicos se vinculam com a decisão autônoma e capacidade do consentimento informado, os direitos das pessoas com descapacidade intelectual, a avaliação da capacidade e a reflexão sobre alguns dilemas bioéticos no tratamento e avaliação da descapacidade intelectual. Propõe-se reconhecer o direito das pessoas com descapacidade intelectual para decidir por si mesmas e ser reconhecidas em igualdade de oportunidades e direitos, desenvolver procedimentos e protocolos padrões para a avaliação da capacidade e adaptados à diversidade cultural do país, e que cuidadores, familiares e profissionais considerem não só as normativas frente à investigação e tratamento, mas também a opinião e decisão das pessoas com descapacidade, e informar-lhes em que consistem as ditas experiências, considerando suas características individuais.

Calidad de vida profesional de trabajadoras de una escuela de estudiantes con discapacidades múltiples / Professional quality of life of women workers in a school for students with multiple disabilities

El propósito del siguiente estudio consistió en explorar la salud física, mental y calidad de vida en el trabajo de profesoras, profesionales y asistentes de educación que atienden a escolares con discapacidades múltiples. A través de un método cualitativo de estudio de caso, se entrevistaron a 15 trabajadoras de una escuela especial para niños con discapacidades múltiples. También se aplicó el Cuestionario de Salud General abreviado (GHQ-12), el Inventario de Burnout de Maslach (MBI) y el Cuestionario de Calidad de Vida Profesional (CVP-35). Los resultados de los cuestionarios indicaron que cerca de la mitad de las trabajadoras (40%) presentaron riesgo en su salud mental y cansancio emocional. Más de 90% poseía una baja despersonalización, alta realización personal y una buena calidad de vida global en el trabajo. Por otro lado, se percibe en las entrevistas cansancio físico, agresiones de parte de los escolares, lesiones musculares por fuerza mal realizada y sensación de existir una carga de trabajo mal distribuida que generan en las trabajadoras un malestar encubierto. El buen clima laboral y liderazgo participativo de parte de la dirección puede facilitar el desarrollo de una intervención efectiva que permita mejorar la calidad del trabajo y el estado de salud física de las trabajadoras.

The purpose of this study was to explore the physical and mental health, and quality of life among teachers, education professionals and paraprofessionals serving students with multiple disabilities. Using a qualitative case study-based approach, 15 women workers were interviewed in a school for children with multiple disabilities. In addition, they completed the short version of the General Health Questionnaire (GHQ- 12), the Maslach Burnout Inventory (MBI) and the Quality of Professional Life Questionnaire (CVP-35). Results indicated that about half of the workers (40%) presented an increased risk of poor mental health and emotional exhaustion. More than 90% had a low level of depersonalization, but high sense of personal accomplishment and a good overall quality of life at work. However, the interviews uncovered evidence of physical fatigue, aggression by pupils, musculoskeletal injury due to by sudden heavy lifting and sensation of a poorly distributed workload that generates undisclosed discomfort in the workers. The presence of a good working environment and participative leadership from upper management could conceivably facilitate the development of an effective intervention to improve the quality of work and physical health of women workers.

Aspectos bioéticos no controle e na aplicação de praguicidas no Chile / Bioethical aspects of control and application of pest control substances in Chile / Aspectos bioéticos en el control y aplicación de plaguicidas en Chile

En Chile, la venta y aplicación de plaguicidas ha ido en aumento, y si bien existen normativas sobre su importación, comercialización, control y aplicación, estas no son efectivas en la regulación del su uso por la población, sobre todo no ocupacional. El Senado chileno rechazo un proyecto de ley que prohibía el uso de los plaguicidas considerados a nivel mundial como altamente peligrosos, lo que ha derivado en un fuerte reclamo de organizaciones no gubernamentales y comunidades agrícolas expuestas a estos tóxicos, señalando errores en los procesos de legislación de los agroquímicos y desinformación sobre los efectos y riesgos de toxicidad principalmente crónica en quienes se ven expuestos a los pesticidas. El siguiente trabajo discute la escasa preocupación bioética de parte de las autoridades y la ciudadanía por los efectos que están generando los pesticidas en la población y el medio ambiente, reveladas en la continuidad de la comercialización y aplicación de plaguicidas de elevada toxicidad, y en la presencia de residuos de pesticidas en los productos vegetales que se comercializan a nivel nacional...

In Chile, pest control substances selling and application is increasing, and although there are regulations about importation, commercialization, control and application, these are not effective in the regulation of their use by the population, mainly no occupational. Chilean Senate rejected a bill which prohibits the use of pest control substances considered highly dangerous worldly, what has led to strong claims of nongovernmental organizations and agricultural communities exposed to these toxics, highlighting errors in the legislation process for agro chemists and lack of information about effects and risks of toxicity, mainly chronic for those exposed to pest control substances. This study discuss the scarce bioethics concern by authorities and citizens about the effects being generated by pest control substances in the population and the environment, revealed in the continuity of commercialization and application of highly toxic pest control substances, and in the presence of pest control residues in vegetable products commercialize at national level...

No Chile, a venda e aplicação de praguicidas tem tido aumento, e se bem existem normas sobre sua importação, comercialização, controle e aplicação, estas não são efetivas na regulação do seu uso pela população, sobretudo não ocupacional. O Senado chileno recusou um projeto de lei que proibia o uso dos praguicidas considerados em nivel mundial como altamente perigosos, o que derivou forte reclamação de organizações não governamentais e comunidades agrícolas expostas a estes tóxicos, assinalando erros nos processos de legislação dos agroquímicos e desinformação sobre os efeitos e riscos de toxicidade, principalmente crônica naqueles que se veem expostos aos pesticidas. Este trabalho discute a escassa preocupação bioética de parte das autoridades e da cidadania pelos efeitos que estão gerando os pesticidas na população e no meio ambiente, reveladas na continuidade da comercialização e aplicação de praguicidas de elevada toxicidade, e na presença de resíduos de pesticidas nos produtos vegetales que se comercializam em nivel nacional...

Integración familiar de jóvenes con discapacidad intelectual moderada, pertenecientes a un hogar de menores / Reinstating youngsters with moderate mental disability from a group home for minors back to their families

El trabajo que se informa presenta una descripción y evaluación de un estudio de casos de reintegración familiar de tres jóvenes con discapacidad intelectual moderada pertenecientes a un hogar de menores, desarrollado durante tres años. La metodología utilizada estuvo centrada principalmente en el enfoque biográfico, con la técnica de relatos de vida. Además de presentar las características de sus familias, específicamente de sus madres, los resultados aportan antecedentes claves para poder potenciar el sistema de integración familiar actual que existe para la atención de niños, niñas y jóvenes con necesidades educativas especiales. De los tres casos, sólo uno concretó la reintegración familiar de la joven discapacitada, el segundo está en proceso de finalizar la integración y en el tercero, la madre desertó. Se observa que es compleja la integración en las familias de los menores que asisten a centros de protección. Como factores claves para el éxito de la intervención, se reconocen las redes de apoyo sociales y familiares, las estrategias individuales para revincularse con la hija y resignificar su discapacidad, el apoyo de la institución y el trabajo multidisciplinario. Finalmente se concluye a partir de estos casos, cuáles serían los aspectos esenciales que permiten realmente que los menores crezcan y vivan en familia como seres íntegros y plenos. Para ello se requiere contar con un plan de intervención y un seguimiento constante del proceso, en el que se trabaje no sólo con la madre o tutor principal del menor, sino que también se incorpore a toda la familia en el proceso.

The article presents a description and evaluation of a three year case study of three youngsters with moderate mental disability from a group home for minors. We used a biography approach, and a life story technique. Through this technique, the person articulates his or her past, present and future in an interview or an open interaction. Our goal was to understand and face the mothers' life experiences in order to create an intervention method based on their own reality and perspective. Apart from presenting the children's family characteristics, particularly that of their mothers, the results bring out key information that strengthen and promote the current system of family integration for children and youngsters with special educational needs. Out of the three cases, only one family achieved the reinstatement of their child with a disability; the second family is in the process of finishing the reinstatement, and in a third case, the mother abandoned the process. Based on these experiences, reinstating a child who was looked after by a child care and protection center back to his or her family, is a complex issue. The family plays a fundamental role in the process of bringing their child back into their homes, and is a key factor for a successful intervention. Families who have a support network, both at an individual and social level, have better possibilities of reinstating their child back into the family. Another important point to consider is individual strategies mothers use to renew the bond with their child, which are influenced by the stages they are going through regarding the adaptation process and acceptance of the disability. Other aspects that influence whether families abandon the reinstatement process or not are the type of disability, the cause of transfer to the care and protection center, the stage that each mother is going through regarding their child's disability linked to their vital cycle, the mothers' age and their constant denial in coping with disability and their maternal roles. The family reinstatement program is recognized as a good system which allows children with disabilities to achieve better growth and development with their families, while acknowledging at the same time, that adoption is practically nonexistent. This system requires constant interventions and follow-ups, not only with the tutor, but also including the whole family in the process. Moreover, multi-disciplinary work at home, in community institutions and in other social levels that bring support to the family's readjustment of their internal bonds and structure, should be considered key interventions. Strengthening parental figures helps parents change their perspective regarding their child's disability, and is crucial in accomplishing true social integration, as well as allowing children to grow and live in a family as wholesome and complete beings.