Trend and factors associated with adverse birth weight in Uruguayan children between 2009 and 2015 / Tendencia y factores asociados al peso al nacer adverso en niños uruguayos entre los años 2009 y 2015

Abstract Objectives: to identify trendand factors associated with adverse birth weight. Methods: cross-sectional design. The analysis uses the 2009-2015 Uruguay Perinatal Computer Systemdata on 303,625 newborns. Results: the prevalence of macrosomia (> 3,999g) has increased from 7.0% to 8.4%. The prevalence of low birth weight (LBW) (< 2,500g) decreased, standing at 6.6% in the last year. The factors that determines more possibilities of LBW were preeclampsia (OR = 4.80; CI95%= 4.57-5.05), inadequate controls (OR = 2.29; CI95%= 2.20-2.39), shorter duration of pregnancy (OR = 2.52; CI95%= 2.50-2.55), previous hypertension (OR = 2.11; CI95%= 1.96-2.27), hypertensive disease of pregnancy (OR = 1.82; CI95%= 1.74-1.90), low prematernal maternal weight (OR = 1.65; CI95%= 1.58-1.74). Macrosomia was associated with type 1 diabetes (OR = 2.21; CI95%= 1.86-2.61), Type 2 or Gestational (OR = 1.78; CI95%= 1.70-1.87), obesity maternal (OR = 2.33; CI95%= 2.24-2.43) and longer gestation duration (OR = 2.62; CI95%= 2.53-2.72). Conclusions: the LBW decreases while the macrosomia increases. The health and nutritional status of women at the beginning of pregnancy, pathologies of the last trimester, smoking, shorter duration of pregnancy and inadequate controls are associated with BPN. Overweight, obesity and metabolic diseases determine macrosomia.

Resumen Objetivos: identificar tendencia y factores asociados al peso al nacer adverso. Métodos: diseño transversal, se analizaron nacimientos entre 2009-2015. El análisis utilizó el Sistema Informático Perinatal de Uruguay, de 2009-2015, datos de 303.625 recién nacidos. Resultados: la prevalencia de macrosomía (>3.999g) aumentó de 7% a 8,4%. La prevalencia de bajo peso al nacer (BPN) (<2.500g) disminuyó situándose en 6,6% en el último año. Los factores que determinaron mayores posibilidades de BPN fueron preeclampsia (OR=4,80; IC95%= 4,57-5,05), inadecuados controles (OR = 2,29; IC95%= 2,20-2,39), menor duración de la gestación (OR = 2,52; IC95%= 2,50-2,55), hipertensión arterial previa (OR = 2,11; IC95%= 1,96-2,27), enfermedad hipertensiva del embarazo (OR = 1,82; IC95%= 1,74-1,90), bajo peso materno pregestacional (OR = 1,65; IC95%= 1,58-1,74). Macrosomía se asoció con diabetes tipo 1 (OR = 2,21; IC95%= 1,86-2,61), tipo 2 o Gestacional (OR = 1,78; IC95%= 1,70-1,87), obesidad materna (OR = 2,33; IC95%= 2,242,43) y duración de gestación (OR = 2,62; IC95%= 2,53-2,72). Conclusiones: existe una tendencia a disminución del BPNy aumento de la macrosomía. La salud y estado nutricional de la mujer al inicio de la gestación, patologías del último trimestre, tabaquismo, menor duración de la gestación e inadecuados controles se asocian a BPN. El sobrepeso, la obesidad y enfermedades metabólicas determinan macrosomía.

Salud y nutrición del niño indígena chileno (Mapuche) / The health and nutrition of indigenous children in Chile (Mapuche) / Saúde e nutrição da criança indígena chilena (Mapuche)

El objetivo de este trabajo fue realizar una revisión de la situación de salud y nutrición del niño indígena chileno, específicamente del Mapuche, en lo publicado en las bases de datos de referencias bibliográficas y en investigaciones específicas que tienen base poblacional. Para este trabajo se buscó lo publicado en PubMed, LILACS, organismos nacionales e internacionales, durante los últimos 15 años. Desde el 2006 hasta el 2015 la proporción de pobres era mayor en los indígenas, con disminución de la brecha de 16% el 2006 a 7,7% el 2015 (p < 0,001). En la primera década de este siglo la mortalidad infantil en los niños indígenas tenía una tasa de 17,1/1.000 nacidos vivos, mientras en los no indígenas era de de 8,8/1.000 y, en el seguimiento de cinco años, la brecha se mantuvo (p < 0,001). Los recién nacidos con peso < 2,500g el año 2000 no superaban el 6% (5,6% en no indígenas y 5,2% en los indígenas). La talla baja al ingreso a la escuela era 8,4% en los escolares indígenas y 3,1% en los no indígenas, disminuyendo a 3,7 en los indígenas y 2,6% en los no indígenas el 2004, la obesidad en cambio aumentó más en los indígenas, llegando a 24,2 y 25,3% en los no indígenas (p < 0,001). La menarquia se presentó cuatro meses más tarde en las indígenas (12,7 años) y el índice de masa corporal, circunferencia de cintura y el porcentaje de grasa, fueron significativamente mayores en las indígenas en el momento de la telarquia, así como la frecuencia de exceso de peso (55% vs. 42% en las no indígenas). Los niños Mapuche presentan una condición de salud y nutrición favorable, comparada con los indígenas de otros países del continente, sin embargo, aun existe una brecha adversa -comparada con los no indígenas-, en que la desigualdad desfavorece al niño indígena y esta debe ser reconocida y corregida.

The aim of this study was to conduct a review of the health and nutritional status of Chilean indigenous children, specifically Mapuche children, as published in the literature and specific population-based studies. The searches were conducted in PubMed and LILACS in the last 15 years. From 2006 to 2015, the poverty rate was higher in the indigenous population, with a decrease in the gap from 16% in 2006 to 7.7% in 2015 (p < 0.001). In the first decade of this century, infant mortality in indigenous children was 17.1/1,000 live births, while in non-indigenous children it was 8.8/1,000, and the gap was maintained in the five-year follow-up (p < 0.001). Newborns with birthweight < 2,500g in the year 2000 did not reach 6% (5.6% in non-indigenous and 5.2% in indigenous children). Low height at first school enrollment was 8.4% in indigenous schoolchildren and 3.1% in non-indigenous children, decreasing to 3.7% in indigenous children and 2.6% in non-indigenous children in 2004, while obesity increased more in indigenous children, reaching 24.2% in indigenous and 25.3% in non-indigenous children (p < 0.001). Menarche appeared four months later on average in indigenous girls (12.7 years), and body mass index, waist circumference, and fat mass were significantly greater in indigenous girls at the time of thelarche, as was the overweight rate (55%, vs. 42% in non-indigenous). Mapuche children show favorable health and nutritional status compared to indigenous children elsewhere in Latin America, but there is still an adverse gap compared to non-indigenous Chilean children. This inequality affecting indigenous Chilean children should be acknowledged and corrected.

O objetivo deste trabalho foi realizar una revisão da situação da saúde e nutrição da criança indígena chilena, especificamente da Mapuche, nas publicações relacionadas em bases de dados de referências bibliográficas e em pesquisas específicas que têm base populacional. A pesquisa foi realizada em publicações relacionadas: PubMed, LILACS, organismos nacionais e internacionais, nos últimos 15 anos. Desde 2006 até 2015 a proporção de pobres era maior nos indígenas, com diminuição de uma diferença de 16% em 2006 a 7,7% em 2015 (p < 0.001). Na primeira década de este século a mortalidade infantil nas crianças indígenas teve una taxa de 17,1/1.000 nascidas vivas, enquanto nos não indígenas era de 8,8/1.000 e, em um acompanhamento de cinco anos, a diferença se manteve (p < 0,001). Os recém-nascidos com peso < 2.500g no ano de 2000 não superavam 6% (5,6% em não indígenas e 5,2% nos indígenas). A baixa estatura ao momento do ingresso na escola era 8,4% nos escolares indígenas e 3,1% nos não indígenas, diminuindo a 3,7 nos indígenas e 2,6% nos não indígenas em 2004, a obesidade pelo contrário teve um aumento maior nos indígenas, chegando a 24,2 e 25,3% nos não indígenas (p < 0,001). A menarca ocorreu quatro meses mais tarde nas indígenas (12,7 anos) e o índice de massa corporal, circunferência da cintura e a porcentagem da gordura, foram significativamente maiores nas indígenas no período da telarca, à semelhança da frequência do sobrepeso (55% vs. 42% nas não indígenas). As crianças Mapuche apresentam uma condição de saúde e nutrição favorável, comparada com os indígenas de outros países do continente, no entanto, ainda existe uma brecha adversa - comparada com os não indígenas - , onde a desigualdade desfavorece a criança indígena e por isso deve ser reconhecida e corrigida.

Patrón de tabaquismo y nivel socioeconómico en dos cohortes de adultos jóvenes / Pattern of smoking and socioeconomic status in two cohorts of young adults

Background: One in five deaths that occur in Chile can be attributed to smoking whose prevalence remains high, despite interventions aimed at reducing it. Aim: To compare the prevalence of smoking and its intensity among young adults born 15 years apart and determine their association with socioeconomic status (SES). Material and Methods: Two cohorts of young adults living in the Valparaiso Region of Chile were evaluated in the third decade of life. Cohort 1 was evaluated between 2000 and 2002 (n = 1232) and cohort 2 between 2014 and 2017 (n = 1078). Results: In cohort 1, 57.5% (95% Confidence Interval (CI) 54.6-58.7) of the subjects reported smoking, with a median of 3 (Interquartile range (ICR:1-6) cigarettes/day. This percentage fell to 40.2% (CI: 37.5-43.1) with a similar median in cohort 2. Analyzing cohort 2, the odds ratio (OR) for smoking was 2.24 (CI 1.48-3.38) in the medium SES, compared with the medium high SES. The figures for low medium and low SES were 2.72 (CI: 1.85-3.99) and 3.01 (1.85-4.88). Similarly, in this cohort there was a significantly higher risk of being a heavy smoker in lower SES. No associations between smoking or its intensity and SES were observed in cohort 1. Conclusions: Smoking behavior has decreased among young adults evaluated at the same age in two generational cohorts in the third decade of life. In the most recent cohort analyzed, smoking and its intensity increase along with a decrease in SES.

Clarificando el rol de la mentalización en el desarrollo de las funciones ejecutivas / Clarifying the Role of Mentalization in the Development of Executive Functions

Resumen Las funciones ejecutivas son un grupo de habilidades que permiten la generación de respuestas adaptativas a las exigencias medioambientales. A su vez, la capacidad de mentalización refiere a la forma en que los humanos son capaces de discernir los estados mentales, intenciones y creencias de otros a través de la conducta observada. Este trabajo clarifica la forma en que debiéramos entender la relación entre estos dos conceptos. Tras revisar algunos de los aspectos más fundamentales de los conceptos en cuestión, se propone que la mentalización fundamenta, organiza y potencia el desarrollo de las funciones ejecutivas, esto, en oposición a la tesis dominante de Carlson, Moses y Brenton (2002) que indica que las funciones ejecutivas son las que fundamentan el desarrollo de la habilidad de mentalización. Luego de revisar la actual evidencia empírica que apoya la alternativa propuesta, se exploran algunas aplicaciones de esta en el estudio de la naturaleza neurofisiológica de lo social, la naturaleza subjetiva de la conciencia y el dominio de la psicopatología.

Abstract Executive functions are a set of abilities that allow the production of adaptive behaviours to specific challenges from the environment. Mentalization refers to the way in which humans are able to discern mental states, intentions and beliefs of others through observed behaviour. This paper clarifies the way in which we should understand the relationship between these two concepts. After presenting some of the most fundamental aspects of these concepts, it is proposed that mentalization underlies, organizes, and enhances the development of executive functions, this, contrary to the dominant approach defended by Carlson Moses, and Brenton (2002) that suggests that executive functions underlie the development of mentalization. After reviewing empirical evidence for the defended alternative, the last section explores some of its applications in areas such as the study of the neurophysiological nature of the social, the subjective nature of consciousness, and the domain of psychopathology.

Brechas de desigualdad en salud en niños migrantes versus locales en Chile / Health inequality gap in inmigrant versus local children in Chile

Resumen Introducción: Los niños y jóvenes migrantes internacionales enfrentan diferentes retos en salud en comparación con la población local, en particular si se enfrentan a ambientes inseguros o a condi ciones sociales adversas. Este estudio busca identificar brechas existentes en resultados de salud de la niñez entre población migrante internacional y chilena. Métodos: Este estudio analiza tres fuentes de información: (i)Nacer en Chile: Datos de consulta antenatal recolectados de los registros electrónicos de las mujeres usuarias del programa Chile Crece Contigo, de todos los centros de salud familiar (CESFAM) de administración municipal de la comuna de Recoleta el año 2012; (ii)Crecer en Chile: Datos de encuesta poblacional "Caracterización Socioeconómica Nacional" CASEN 2013 y (iii)En-fermar en Chile: Datos de todos los egresos hospitalarios de 2012, proporcionada por el departamento de estadística e información en salud (DEIS) del Ministerio de Salud. Resultados: (i) Nacer en Chile: Hay mayor proporción de inmigrantes con riesgo biopsicosocial (62,3% vs 50,1% en chilenas) y con ingreso tardío al programa (63,1% vs 33,4%). Hay menos cesáreas en inmigrantes que en chilenas (24,2% vs 33,6%). (ii) Crecer en Chile: Existe una mayor proporción de niños migrantes fuera del sistema escolar y una mayor proporción en pobreza multidimensional (40% vs 23,2%). (iii) Enfermar en Chile: En migrantes entre 7-14 años es más frecuente egresar hospitalariamente por traumatismos/ otras causas externas (23,6% vs 16,7% en chilenos). Conclusiones: Este estudio entrega nueva evi dencia sobre necesidades urgentes de salud de nuestros niños en Chile. Este es un imperativo ético, legal y moral, independiente de la condición migratoria.

Abstract Introduction: Children and young international migrants face different health challenges compa red with the local population, particularly if they live in insecure environments or adverse social conditions. This study seeks to identify gaps in health outcomes of children between immigrant and local population in Chile. Methods: This study analyses data from three sources: (i) Born in Chile: Electronic records of antenatal visits from all municipal antenatal clinics of Recoleta in 2012; (ii) Growing up in Chile: Population survey "National Socioeconomic Characterization" (CASEN) from 2013 and (iii) Getting sick in Chile: Data of all hospital discharges in 2012, provided by the department of statistics and health information (DEIS) of the Ministry of Health. Results: (I) Born in Chile: Im migrants more frequently have psychosocial risk (62.3% vs 50.1% in Chileans) and enter later into the program (63.1% vs 33.4% enter later than 14 weeks of pregnancy). All birth outcomes were better among immigrants (e.g. caesarean sections rates: 24.2% immigrants vs % Chileans). (ii) Growing up in Chile: A higher proportion of migrant children is outside the school system and lives in multidi mensional poverty (40% immigrants vs 23.2% Chileans). (iii) Getting sick in Chile: Injuries and other external causes were more frequent cause of hospitalisation among migrants (23.6%) than the local population (16.7%) aged between 7 and 14 years. Conclusions: Addressing the needs of the children in Chile, regardless of their immigration status, is an ethical, legal and moral imperative.

Índice, carga glicémica y fibra dietética de los alimentos y su asociación con resistencia a la insulina en adultos chilenos / Glycemic index, glycemic load and dietary fiber of foods and its association with insulin resistance in Chilean adults

El Índice y Carga Glicémica (IG y CG) categorizan los alimentos según su capacidad de incrementar la glicemia, considerando cantidad y calidad de hidratos de carbono consumidos. Diferentes estudios han postulado que una dieta con IG y CG altos y bajo consumo de fibra incrementan la glicemia e insulinemia, aunque con resultados heterogéneos.El objetivo de este estudio fue analizar la asociación entre IG, CG e ingesta de fibra y valores HOMA-IR en adultos jóvenes. En una muestra representativa de 738 personas que tenían entre 32 y 38 años, nacidos en el Hospital de Limache, Región de Valparaíso, Chile, se recogió información socioeconómica, de salud, se determinó estado nutricional, glicemia, insulina basal y HOMA, y con la encuesta de frecuencia de consumo se estimó IG, CG e ingesta de fibra. Se construyeron modelos de regresión múltiple, controlando efectos de confusión e interacción. En modelos ajustados, se observó que por cada 10 unidades que aumenta el IG y CG de la dieta en individuos con exceso de peso, aumenta el HOMA-IR en 0,31 (p=0,042) y 0,03 (p=0,012), respectivamente y por cada 10 gramos que aumenta la fibra total y soluble, disminuye el HOMA-IR en 0,10 (p=0,04) y 0,62 (p=0,034) respectivamente. En personas sin exceso de peso no hubo estos efectos. Existe una asociación directa entre el aumento de IG y CG de los alimentos y el incremento de HOMA-IR sólo en individuos con exceso de peso y una asociación inversa entre ingesta de fibra dietética total y soluble y HOMA-IR(AU)

Glycemic index, glycemic load and dietary fiber of foods and its association with insulin resistance in Chilean adults. Glycemic index and glycemic load (GI and GL) categorize foods according to their ability to increase blood sugar levels, considering quantity and quality of carbohydrates consumed. Different studies have postulated that a high GI and GL diet and low fiber intake increased glycemia and insulinemia, although with heterogeneous results. The aim of this study was to analyze the association between GI, GL and fiber intake and HOMA-IR values in young adults. In a representative sample of 738 people aged between 32 and 38 years old, born in the Limache’s Hospital, Valparaiso, Chile, socioeconomic and health information, nutritional status, basal glycemia, insulin and HOMA were collected. With a food frequency questionnaire, GI, GL and fiber intake were estimated. Multiple regression models were constructed, controlling confounding and interaction effects. In adjusted models, it was found that for every 10 units that increases diet GI and GL in overweight individuals, HOMA- IR increases in 0.31 (p = 0.042) and 0.03 (p = 0.012) respectively, and for every 10 grams that increases total and soluble fiber intake, HOMA-IR reduces in 0.10 (p = 0.04) and 0.62 (p = 0.034) respectively. In people without overweight such effects were not observed. There was a direct association bet- ween increased GI and GL foods and increased HOMA-IR only in individuals with overweight and an inverse association between total and soluble fiber intake and HOMA-IR(AU)

Síndrome metabólico e inflamación en adultos: un estudio poblacional / Association of C reactive protein levels with metabolic syndrome in adults: a population-based study

Background: Metabolic syndrome is highly prevalent among adults in Chile and represents a health risk. Aim: To determine the relationship between metabolic syndrome (MetS) and its components, with C reactive protein levels (CRP) as an inflammation marker. Material and Methods: The population studied consisted of 736 individuals born in a hospital from Valparaíso Region, aged between 32-38 years at the time of the study. MetS was identified according to the Adult Treatment Panel (ATP) III guidelines and inflammation was measured using ultra-sensitive CRP. This parameter was classified as normal for values from 0 to 3 mg/L, high for values from 3.01 to 10 mg/L and very high for values > 10 mg/L. Results: Median CRP was in the normal range (1.9 mg/L, interquartile range 0.7-5.2) and was higher among women than men (2.2 and 1.4 mg/L respectively, p < 0.01). Twenty seven percent of participants had MetS. One-fourth had high blood glucose values, one-third had high triglyceride levels and 28% had blood pressure values over those established as normal in MetS. Elevated waist circumference (WC) and low HDL cholesterol were found among almost 50% of participants. A relationship between MetS and high CRP was only found among men with an Odds ratio (OR) of 2.04 (95% confidence intervals (CI): 1.11-3.73). The same association was observed for high triglyceride levels with an OR of 2.02 (CI: 1.17-3.49) and high WC with an OR of 3.89 (CI: 2.06-7.36). Among women, the only relationship observed was between abdominal obesity and very high CRP with an OR of 2. 65 (CI: 1.20-5.84). Conclusions: Metabolic syndrome, high triglyceride levels, and abdominal obesity were associated with inflammation only in men.

Variación secular de los nacimientos, peso y longitud al nacer: perspectiva local / Secular variation of births, weight and length at birth: Local perspective

Objetivo: Analizar la evolución de los nacimientos y medidas antropométricas al nacer entre 1974-2011 en el Hospital de Limache, Región de Valparaíso, Chile. Pacientes y métodos: Se construyeron series de tiempo de nacimientos, peso y longitud al nacer, peso y talla baja al nacer. Se modelaron las tendencias con regresiones multivariadas usándose splines para representar los cambios de tendencia por década. Resultados: La serie comprende 17.574 nacimientos. Hubo un aumento de los nacimientos/año en los 70 (30/año) y disminución de 17 y 22 nacimientos/año en los 80 y 90 (p < 0,001); después, sin tendencia significativa. Los recién nacidos entre 2000-2011 registran 266 g más que los de la década de los 70 (p < 0,001), alcanzando actualmente en promedio 3.530 g. El bajo peso al nacer disminuyó de 8% en los 70 a 1,1% después de 2000. La longitud al nacer incrementó 1 cm en 37 años, con disminución de la talla baja de 7,6% a 2,1% en el periodo estudiado. Conclusión: Los nacimientos en el Hospital de Limache disminuyeron y las medidas antropométricas al nacer mejoraron; sin embargo, hay que considerar los posibles sesgos que distorsionan estas estimaciones.

Objective: To analyse the outcomes of births and anthropometric measurements at birth of children born between 1974 and 2011 at Limache Hospital (Valparaíso, Chile). Patients and method: Times series were constructed of births, weight and length at birth, and low weight and length at birth. The trend was modelled with linear and logistical regressions using splines to represent breaks in the trend by decade. Results: The series includes 17,574 births. There was an increase in births per year in the 1970s (30/year) and declines in them to 17 and 22 births/year in the 1980s and 1990s, respectively (P < .001), with no significant trend thereafter. Newborns from 2000 to 2011 weighed 266 grams more than those in the 1970s (P < .001), and have now reached a mean weight of 3,530 g. Low birthweight fell from 8% in the 1970s to 1.1% after 2000. Birth length increased by 1 cm in the 37 years studied, with a reduction of low birth length from 7.6% to 2.1% during the period. Conclusion: Live births in the Limache Hospital declined, and anthropometric measurements at birth improved in the years analysed. This information is useful in developing interventions, taking into account the possible selection biases that could distort these estimates and their interpretation.

Ingesta de bebidas azucaradas analcohólicas e índice de masa corporal en escolares chilenos / Intake of sugar-sweetened non-alcoholic beverages and body mass index: A national sample of Chilean school children

Objetivo. Estimar la asociación entre la ingesta de bebidas azucaradas analcohólicas y el índice de masa corporal (IMC) en escolares chilenos. Material y métodos. Se analizaron datos de frecuencia de consumo de alimentos en escolares de entre 6 y 18 años de edad. Se estimó la asociación entre el consumo de bebidas azucaradas y el IMC a través de modelos de regresión lineal multivariada. Resultados. El 92% (IC95%:90-94) consume bebidas azucaradas diariamente, con medianas de ingesta de 424 ml (p25-p75:212-707). En los escolares de 6 a 13 años, cada incremento de una porción diaria de gaseosas y refrescos con azúcar se asocia con 0.13 puntajes z más de IMC (IC95%:0.04-0.2;p=0.01). Conclusiones. El consumo de bebidas azucaradas en escolares chilenos es diario y alcanza medianas de ingesta cercanas a medio litro. Existe asociación entre el consumo de bebidas azucaradas y mayor IMC.

Objective. To estimate the association between the intake of sugar-sweetened non-alcoholic beverages and body mass index (BMI) in Chilean school children. Materials and methods. Food consumption frequency data were analyzed for school children aged 6 to 18. The association between consumption of sugar-sweetened beverages and BMI was estimated by multivariate lineal regression models. Results. Sugar-sweetened beverages are consumed on a daily basis by 92% (95%CI:90-94) of subjects with daily intake medians of 424 mL (p25-p75:212-707). Every extra daily portion of sugar-sweetened beverages consumed by school children aged 6 to 13 is associated with 0.13 BMI z-scores (95%CI:0.04-0.2;p=0.01). Conclusions. School children consume sugar-sweetened beverages daily with intake medians close to 0.5L. There is an association between sugar-sweetened beverage consumption and higher BMI in Chilean school children.

Clinical relevance of rhinovirus infections among adult hospitalized patients

Human rhinovirus (HRV) is an emerging viral pathogen. Aim: To characterize a group of patients admitted due to infection by this agent in a general hospital in Chile. Methods: Cases were identified by RT-PCR for 1 year through active surveillance of patients admitted with severe respiratory illness. Diagnosis was not available during hospitalization. Thirty-two cases were identified, 90% were ≥60 years old or had co-morbid conditions. Human rhinovirus-related admissions represented 23.7% of hospitalization due to severe acute respiratory infections among adults and ranked second to influenza (37.8%). Patients presented with pneumonia (68.8%), decompensated chronic lung conditions (21.9%), heart failure or influenza-like illness (6.3% each). Admission to intensive or intermediate care units was required by 31.2% and in-hospital mortality reached 12.5%. A CURB-65 score ≥3 was significantly associated to in-hospital mortality (p < 0.05). Most patients received antibiotics (90%). Conclusions: Human rhinovirus infections in elderly patients with co-morbid conditions are associated with hospitalizations, requiring critical or semi-critical antibiotics use. A high CURB-65 score was associated to in-hospital mortality. .

Consumo de frutas, verduras y presión arterial: Un estudio poblacional / Fruit and vegetable intake, and blood pressure: A population research

Se ha descrito que consumir frutas y verduras disminuye la presión arterial. Sin embargo, no está clara la magnitud del efecto según la cantidad consumida. El objetivo de este estudio fue analizar la asociación entre consumo de frutas y verduras, y presión arterial. Se realizó un estudio transversal en una muestra aleatoria de 777 adultos entre 32 y 38 años de la Región de Valparaíso, Chile. Se midió presión arterial sistólica (PAS) y diastólica (PAD), y se aplicó una encuesta de tendencia de consumo cuantificada del último mes. La ingesta de frutas y verduras se dividió en tres grupos: menor a 200 g, 200 a 400 g, mayor a 400 g. Para el análisis se utilizaron modelos de regresión lineal múltiple ajustados por sexo, IMC, actividad física, nivel socioeconómico, tabaquismo e ingesta de sodio. Se observó que a medida que aumenta la ingesta de frutas y verduras disminuye la presión arterial sistólica(β=-3,37; IC 95%: -6,45 a -0,29; en consumo entre 200 y 400 g) (β=- 4,02; IC 95%: -7,06 a -0,98; en consumo mayor a 400 g), mientras que en la presión diastólica solamente se ve el efecto en los que cumplen la recomendación de la OMS de consumir más de 400 g al día (β-2,87; IC=-5,17 a -0,57). Se concluye que consumir frutas y verduras en cantidades mayores a 400 g, tiene un efecto protector en el aumento de la presión arterial tanto sistólica como diastólica.

Consuming fruits and vegetables is known to lower blood pressure. However, it is unclear how much should be consumed in order to achieve this effect. The aim of this study was to analyze the association between fruit and vegetable consumption and blood pressure. A cross-sectional study was conducted among a random sample of 777 adults between the ages of 32 and 38 from the Region of Valparaiso, Chile. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured, and a survey was carried out to quantify consumption trends over the past month. The fruit and vegetable intake was divided into three groups: less than 200 g, 200-400 g, and more than 400 g. In the analysis, multiple linear regression models were used and were adjusted for sex, BMI, physical activity, socioeconomic status, smoking, and sodium intake. It was observed that increasing intake of fruits and vegetables lowers the systolic blood pressure (β = -3.37 , 95% CI : -6.45 to -0.29; for consumption between 200 and 400 g ) (β =-4.02 , 95% CI: -7.06 to -0.98; for consumption great than 400 g), while an effect on diastolic pressure is only seen in those who meet the WHO recommendation of consuming more than 400 g per day (β -2,87, CI = -5.17 to -0.57). In conclusion, consuming fruits and vegetables in amounts larger than 400 g per day, provides a protective effect against increases in both systolic and diastolic blood pressure.

Evolución del síndrome metabólico y de sus componentes en un seguimiento de 10 años en adultos de la Región de Valparaíso / Evolution of the metabolic syndrome and its components in a follow up of 10 years in adults from Valparaíso region

Background: Metabolic syndrome is a risk factor for cardiovascular diseases and cancer. Its frequency is increasing steadily Aim: To evaluate the prevalence of metabolic syndrome (MS) and its components in a 10-year tracking study of young adults. Material and Methods: Concurrent cohort study of subjects born between 1974 and 1978. They were evaluated between 2000 and 2002 and between 2010 and 2012 to determine the frequency of MS and its components (high blood glucose, waist circumference [WC], triglycerides, blood pressure and low HDL cholesterol), according to ATP III criteria. Attrition was handled using the reciprocal of the probability of remaining in the study. Result: During the first evaluation, the prevalence of metabolic syndrome was 9.3%, confidence interval (CI): 7.5-11.1), with no gender differences. Ten years later, the prevalence of MS increased significantly to 27.6% (CI: 24.7-29.9) and was more common in women than men (30.4 and 23.8% respectively, p < 0.014). The components of MS also increased from one period to another: hyperglycemia, from 5.2% (CI: 4-7) to 24.4% (CI: 22-27); high triglyceride levels from 17.6% (CI: 15-20) to 35.3% (CI: 32-38); high blood pressure from 14.7 (CI: 13-18) to 30.2% (IC: 28-33) and high WC: 16.9% (CI: 15-19) to 41.5% (CI: 39-45). In both evaluations, there was a greater frequency of high triglycerides and high blood pressure among men, and greater frequency of low HDL and high WC among women. Hyperglycemia only showed differences by gender in the second measurement, and was greater among men. Conclusions: There was a marked increase in metabolic syndrome and its components in a 10-year interval, which is a warning sign of future cardiovascular risk.

Índice cintura estatura como predictor de riesgo de hipertensión arterial en población adulta joven: ¿Es mejor indicador que la circunferencia de cintura?

El objetivo de este estudio fue estimar la asociación entre los valores de circunferencia de cintura (CC) y del índice cintura estatura (C/E) con la presión arterial (PA) y determinar cual de estos indicadores presenta la mejor asociación en una población adulta joven de una zona semi-rural de Chile. Se realizó un estudio transversal analítico en 998 personas entre 22 y 28 años nacidas en el Hospital de Limache, V Región del país quienes fueron encuestados sobre antecedentes socioeconómicos y familiares, junto con mediciones de PA y antropometría entre los años 2000 y 2003. Se realizó un modelo de regresión lineal de asociación univariada entre distintas variables de control y PA; luego se construyó un modelo entre CC y C/E con PA con ajuste por variables de control. El promedio de PA fue 114,6/72,5 mmHg (± 13,5/8,8), CC 83,9 cm (±11,3), C/E 0,52 (±0,07). La edad, sexo masculino, peso, talla y consumo de alcohol aumentaron la PA (p<0,05), la escolaridad en cambio la disminuyó (p<0,05). Se obtuvo una asociación directa entre CC y PA (β=0,27 para la PAS y 0,33 para la PAD) y entre C/E y PA (β=32,7 para PAS y 23,9 para PAD) (p<0,01). Al ajustar, esta asociación disminuye pero persiste significativa y es similar entre CC con la PA en comparación con C/E y PA (R2 0,20 y 0,37 para PAS; 0,20 y 0,36 para PAD respectivamente). En nuestra población la CC y C/E se asociaron significativamente con la PA, con una fuerza similar entre ambas.

Waist: height ratio as a predictor of risk of hypertension in young adults: Is it better indicator that waist circumference?. The objective was to determine the association between values of waist circumference (WC) and waist: height ratio (W/H) with blood pressure (BP) and to estimate which of these indicators present the best association with BP in a young adult population of a semi-rural area of Chile. We performed a cross sectional study in 998 people between 22 and 28 years, born in the Limache Hospital, V Region of the country who were surveyed for socioeconomic and family background, BP and anthropometric measurements were also taken during 2000 and 2003. Linear regression model was apply between control variables and BP, then models between WC and W/H and BP were built adjusting by control variables. The mean of BP was 114,6 / 72,5 mmHg (± 13,5/8,8), WC 83,9 cm (± 11,3), W/H 0,52 (± 0,07). Age, being male, weight, height and alcohol consumption increased the BP (p < 0,05), scholarity instead decreased it (p <0,05). A direct association was observed between WC and BP (β = 0,7for SBP and 0,33 for DBP) and between W/H and BP (β = 32,75 for SBP and 23,90 for DBP) (p <0.01). These association decreases but remain significant after adjustement. There was a similar association between WC with BP compared with W/H (R2 0,20 and 0,37 for SBP; 0,20 y 0,36 for DBP respectively). In our population WC and W/H were significantly associated with BP, with a similar force between them.

Edad de menarquia y ascendencia indígena: Un estudio poblacional en Chile / Age at menarche and indigenous ancestry: A population study in Chile

Background: The age at menarche may influence decisively health and disease in women. It also indicates the beginning of the reproductive period and, as a consequence, the possibility of biological continuity for the human species. Genetic and environmental determinants define the age of menarche and can explain differences found among different populations. Aim: To determine the age at menarche among adolescents with different levels of indigenous descent (parental indigenous surnames), considering the effect of socioeconomic and demographic factors. Material and Methods: An observational study of historic cohorts of8.624 girls from the Arauca-nía Region (central-southern Chile) was carried out. Data were collected by health professionals using a previously validated questionnaire. Occurrence of menarche was estimated through survival analysis and compared between groups (according to indigenous parental surnames) adjusted for parents' income and educational level and provenance (rural/urban). Results: Estimated median age of menarche was 151 months (95% Cl: 150-151). In female with four indigenous surnames, menarche occurred two months later than girls without indigenous surnames and with two indigenous surnames (p < 0,001). In girls whose parents had lowest level of schooling, the difference increased to eight months later (p < 0,005). Conclusions: Age at menarche in the group with higher indigenous descent is later even if socio-economic conditions remain stable. Genetic factors might play an important role, however conditions of vulnerability can influence and further delay the onset of reproductive competency.

Socioeconomic status and age at menarche in indigenous and non-indigenous Chilean adolescents / Nivel socioeconómico y edad de la menarquia en adolescentes chilenas indígenas y no indígenas

The objective was to analyze the relationship between socioeconomic status and age at menarche among indigenous and non-indigenous girls in the Araucanía Region of Chile, controlling for nutritional status and mother's age at menarche. A total of 8,624 randomly selected girls from 168 schools were screened, resulting in the selection of 207 indigenous and 200 non-indigenous girls who had recently experienced menarche. Age at menarche was 149.6±10.7 months in the indigenous group and 146.6±10.8 months in the non-indigenous group. Among the non-indigenous, the analysis showed no significant association between age at menarche and socioeconomic status. In the indigenous group, age at menarche among girls with low socioeconomic status was 5.4 months later than among those with higher socioeconomic status. There were no differences in nutritional status according to socioeconomic level. Obesity was associated with earlier menarche. Menarche occurred earlier than in previous generations. An inverse relationship between socioeconomic status and age at menarche was seen in the indigenous group only; low socioeconomic status was associated with delayed menarche, regardless of nutritional status or mother's age at menarche.

El objetivo fue analizar la relación entre nivel socioeconómico y edad de menarquia en adolescentes indígenas y no indígenas de la Región de la Araucanía, Chile, controlando el efecto del estado nutricional, y la edad de menarquia de las madres. Se estudiaron 8.624 niñas de 168 escuelas elegidas aleatoriamente, seleccionando 207 indígenas y 200 no indígenas que habían tenido recientemente la menarquia. La edad de menarquia ocurrió a los 149,6±10,7 meses en indígenas y a los 146,6±10,8 meses en no indígenas. En el grupo no indígena, hubo una relación significativa entre edad de menarquia y nivel socioeconómico. En el grupo indígena, edad de menarquia del nivel socioeconómico bajo fue de 5,4 meses más tarde que el nivel socioeconómico más alto. No se observaron diferencias de estado nutricional por nivel socioeconómico. La obesidad adelantó la menarquia y la edad de menarquia ocurrió antes que la de sus madres. Existe una relación inversa entre nivel socioeconómico y edad de menarquia sólo en el grupo indígena; en los niveles socioeconómicos más bajos la edad de menarquia se retrasa independiente del estado nutricional y de la edad de menarquia de la madre.

Vigilancia de influenza en Chile: 2010 / Influenza surveillance in Chile: 2010

Se analizó el comportamiento de la influenza en el 2010, a través de los componentes de la vigilancia. Desde la semana epidemiológica (SE) 32 aumenta la notificación de ETI en los centinela, con un máximo de casos en la SE 37 (tasa 80 por 105), inferior a 2009. Este aumento coincide con el alza de las consultas respiratorias (especialmente infecciones respiratorias agudas altas e influenza) que llega a 43 por ciento en la SE 36. Destaca la cocirculación de influenza AH1N1 (2009) y H3N2, con predominio de esta última y un máximo en la SE 36. La gravedad (hospitalizaciones por infecciones respiratorias agudas graves y fallecidos) fue menor que en 2009 y se concentró en los casos de H3N2. El aumento observado el 2010 fue de intensidad elevada, de carácter epidémico, y se desplazó a los meses de agosto-septiembre. Se requiere mantener y reforzar los componentes de la vigilancia influenza en el actual período pospandémico.

It was analyzed the 2010 influenza behaviour through surveillance components. Since epidemiologic week (EW) 32, influenza like disease notification increases in sentinel centers, with a maximum of cases on EW 37 (rate of 80 per 105), less than2009. This increase coincide with the rise in respiratory hospital visits (especially upper acute respiratory infections) reaching 43 percent on EW 36. it is registered co-circulation of influenza AH1N1 (2009) and H3N2, the last prevailing over the first one anda maximum on EW 36. Severity (severe acute respiratory infections hospitalizations and deaths) was lower than 2009 and was concentrated in H3N2 cases. The observed increase in 2010 was of high intensity, epidemic nature and shifted to August-September. It is required maintaining and reinforcing influenza surveillance components, in the current pos-pandemic period.

Inicio del brote de Influenza A (H1N1) pandémica en Chile: caracterización genética de los primeros casos detectados / Genetic characterization of the virus causing H1N1 influenza pandemic in Chile: Analysis of the first detected cases

Background: Following the announcement of the Influenza A(H1N1) pandemic by the World Health Organization in April 2009, a surveillance program was carried out in Chile to detect the introduction of the virus in the country and to monitor its propagation and impact. Aim: To describe the onset of the outbreak and the genetic characterization of the pandemic H1N1 influenza virus in the first detected cases in Chile. Material and Methods: Analysis of18 clinical samples coming from suspicious patients, received in a National Reference Laboratory. RNA reverse transcription and real time influenza gene DNA amplification was carried out in a 7500 Fast and Step One Real Time PCR Systems of Applied Biosystems and MxPro-Mx3000P thermocycler from Stratagene. Super Script III Platinum One-Step Quantitative RT-PCR was used. Results: The virus was first detected in three persons returning from the Dominican Republic via Panamá and a child from the east zone of Santiago. Genetic characterization of the virus showed that the child was infected by a different variant of the pandemic virus than the three persons returning from the Caribbean. Conclusions: The onset of the Influenza outbreak in Chile apparently carne from two different epidemiological groups. The spread of the virus detected in the voyagers was limited immediately However the virus of the fourth case was found in different regions of Chile.

Actividad física y su asociación con factores de riesgo cardiovascular: Un estudio en adultos jóvenes / Physical activity and cardiovascular risk factors among Chilean young men and women

Background: Physical activity (PA) has a protective role in cardiovascular diseases. Aim: To quantify PA in young adults and to correlate it with cardiovascular risk factors. Material and Methods: A cross-sectional study was performed employing the international physical activity questionnaire (IPAQ), to measure the PA of 983 randomly selected young adults from Valparaiso region born between 1974 and 1978. Its results were associated with levels of obesity, insulin resistance and cardiovascular risk factors defined by the National Cholesterol Education Program-Adult Treatment Panel III (NCEP- ATP III) Results: Mean physical activity among men and women was 3731 ± 3923 and 1360 ± 2303 METs-minutes/week, respectively (p < 0.001). Fifty percent of women and 21.5 percent of men had an insuffcient level of physical activity (p < 0.001). Sixty percent of men and 23.4 percent of women had an intense level of physical activity (p < 0.001). There was an inverse association of physical activity and insulin resistance. A high physical activity was protective, specially among men, against a low HDL cholesterol level and high triglyceride levels with Odds Ratios of 0.59 (confdence interval (CI): 0,35-0.98) and 0.49 (CI: 0,27-0,87) respectively, after adjusting for body mass index and age. Conclusions: In this sample, men had higher levels of physical activity, that was protective against insulin resistance and the presence of cardiovascular risk factors.

Búsqueda de mutaciones en el gen UL 97 asociadas a resistencia a ganciclovir en citomegalovirus obtenidos desde muestras biológicas de pacientes chilenos / Presence of mutations associated with ganciclovir resistance in cytomegalovirus UL 97 gene

Background: Long term use of ganciclovir (GCV) is associated with acquired resistance to it. Ninety percent of the responsible mutations occur in cytomegalovirus (CMV) UL 97 gene. Aim: To search for these mutations, comparing nucleotide sequences of CMV-positive samples from post transplant and immunocompromised patients receiving GCV, with sequences of CMV isolates obtained from subjects not exposed to the drug. Patients and Methods: Codons 440 to 465 of gene UL 97, in-cluding the most common mutations causing resistance to GCV, were amplifed in 33 plasma samples from patients exposed to GCV and in 15 urine samples of newborns. Both populations and their nucleotide sequences were compared with the prototype strain CMV AD169. Results: Samples of exposed patients had multiple mutations but only one had a mutation associated with clinical resistance (M460I). Eight subjects had the D605E mutation, whose role in resistance is controversial. The remaining 150 mutations were silent mutations. Conclusions: A low frequency of mutations associated with CMV resistance to GCV was found in these exposed and unexposed samples. These mutations may refect coexistence of multiple genetic variants of CMV. The absence of clinical expression of resistance, even with these mutations, can be explained by the use of GCV for a shorter lapse than that associated with the appearance of resistance.

Características alimentarías de adolescentes chilenas indígenas y no indígenas / Eating characteristics of Chilean indigenous and non-indigenous adolescent girls

Durante la infancia y adolescencia se establecen los hábitos alimentarios, los que posteriormente determinarán el comportamiento alimentario. Diversos autores han indicado la aculturación del pueblo mapuche hacia la cultura occidental. El objetivo de este trabajo fue analizar las características de la alimentación de adolescentes indígenas y no indígenas de la Región de La Araucanía, Chile. Se utilizó un diseño transversal, con una muestra probabilística de 281 adolescentes, 139 indígenas y 142 no indígenas de 168 escuelas. Se les aplicó una encuesta alimentaria de frecuencia de consumo modificada, para conocer hábitos alimentarios y consumo de alimentos autóctonos mapuche. Los tiempos de comida fueron similares en ambos grupos étnicos, siendo la cena la menos consumida. El consumo total de colaciones a la semana tuvo una mediana de 7 con un espacio intercuartilico (EI) de 5 a 10 (sin diferencias entre grupos étnicos), de las cuales 2 eran saludables (EI=1 a 3). Los indígenas tuvieron más alta probabilidad de consumo de alimentos autóctonos: mote (OR=2,00;IC=0,93-4,29), muday (OR=3,45;IC=1,90-6,27) y yuyo (OR=4,40;IC=2,06-9,39). Se concluye que las conductas y hábitos alimentarios de las adolescentes indígenas son similares a las no indígenas, aunque las primeras todavía consumen más alimentos autóctonos.

During childhood and adolescence, eating habits become established which are instrumental in determining eating behavior later in life. Various authors have described the acculturation of the Mapuche people toward Western culture. The objective of this study was to analyze the eating characteristics of indigenous and non-indigenous adolescent girls in the Araucanía Region of Chile. A cross-sectional design was used with a probabilistic sample of 281 adolescents comprised of 139 indigenous and 142 non-indigenous girls attending 168 elementary schools. A modified food frequency questionnaire was applied, designed to obtain information about eating habits and consumption of Mapuche foods. The eating schedules are similar in both ethnic groups, with dinner being the meal that is least consumed. Total snack consumption per week has a mean of 7 with an interquartile range (IQR) of 5 to 10 without any differences between ethnic groups; of these snacks, only 2 were healthy (IQR=1 to 3). The indigenous girls had a higher probability of consumption of native foods including mote (boiled wheat) (OR=2.00; IC=0.93-4.29), muday (fermented cereal alcohol) (OR=3.45; IC=1.90-6.27), and yuyo (field mustard) (OR=4.40; IC=2.06-9.39). The study’s conclusion is that the the eating habits and behavior of indigenous adolescents are similar to those of non-indigenous girls, though the former still consume more indigenous foods.