Asociación entre variables demográficas y socioeconómicas y mortalidad por cirrosis y otras enfermedades del hígado / Association between demographic and socioeconomic variables and mortality due to cirrhosis and other liver diseases

Background Cirrhosis is a serious public health problem worldwide. There are geographical, socioeconomic and demographic differences in mortality due to the disease. Aim To establish an association between mortality from cirrhosis and other chronic liver diseases and socioeconomic and demographic indicators in communes of the two largest regions of Chile, the Metropolitan Region (RM) and Bíobío. Material and Methods Analysis of the mortality data from the Chilean Ministry of Health. Multiple regression models of smoothed standardized mortality ratios at the community level between 2001 and 2008, were carried out for men and women in relation to socioeconomic and demographic indicators. Results Quite dissimilar phenomena were observed in these two regions. In RM, the risk of death is associated with urban communes of lower educational level (R2 = 53.6% in men, R2 = 62.3% in women). In men of the Bíobío Region, the risk decreases along with the percentage of population belonging to originary populations (R2 = 9.1%). In women, the model also includes a variable that represents the service sector (R2 = 15.0%), that represents a greater risk. Conclusions The association of mortality due to liver disease with other variables, changes according to the territory in which it is studied. Therefore, specific local studies are required to address this problem in depth. These studies will contribute to the design of locally relevant public policies, aimed at addressing health inequities and the prevention of liver diseases.

Epidemiología de las muertes prematuras en Chile en la década 2001-2010 / Epidemiology of premature deaths in Chile between 2001 and 2010

Background: Years of potential life lost (YPLL) is a parameter that allows to analyze premature deaths. Aim: To study the causes, differences by gender, geographic variations and the trend of premature deaths in the last decade in Chile. Material and Methods: Using death databases published by the Ministry of Health, YPLL were calculated for the decade 2001-2010, using the method proposed by the Organization for Economic Cooperation and Development. Results: The standardized annual average YPLL rate in Chile in the study period was 4.703 per 100,000 inhabitants. Trauma, cancer and cardiovascular diseases accounted for 68% of YPLL. The male/female YPLL ratio was 2.07; for trauma and mental disorders, the male/female ratio for YPLL was over 5; for cardiovascular and respiratory diseases the male/female ratio was over two. Regions with a higher proportion of rural areas had higher YPLL rates. Conclusions: The main causes of YPLL are potentially preventable. Further studies should be carried out to identify risk factors for premature death.

Descripción epidemiológica de la mortalidad por cáncer de mama en mujeres en Chile / Epidemiological analysis of breast cancer mortality in women in Chile

Background: Among women, breast cancer is the leading cause of death due to cancer worldwide. Aim: To describe the epidemiology of breast cancer mortality in Chilean women by age, time trend and explore its ecological association with socio-demographic variables. Material and Methods: Descriptive study of age specific death rates (2009-2013), and time trend analysis of crude mortality rates (1995-2013) using RiskDiff analysis. Additionally, time trend analysis of age specific death rates was done using Jointpoint regression. The relationship between county mortality risk and socio-demographic variables in the period 2001-2008 was done through an ecological analysis. Socio-demographic variables were: education, income, occupation, housing and living in rural areas. Results: Breast cancer mortality in Chilean women increases with age, with a sharp increase from 80 years old on. In the 1995-2013 period the increase in the crude death rate was 21.8%, this increment was due to changes in demographic structure (43.4%) and decrease in risk (21.7%). The county relative risk of breast cancer mortality is positively associated with education level and negatively associated with living in rural areas. Conclusions: The risk of dying from breast cancer in women has decreased in the period 1995-2013. Nonetheless, the crude death rate has increased in the same period. At an ecological level (counties), breast cancer mortality in Chile is associated with a higher socioeconomic status, measured by educational level and living in rural areas.

Mortalidad por cáncer pulmonar en Chile: tendencia y proyección a seis años con modelos lineales dinámicos bayesianos / Mortalidade por câncer de pulmão no Chile: tendência e projeção de seis anos com modelos lineares dinâmicos bayesianos / Lung cancer mortality trends in Chile and six-year projections using Bayesian dynamic linear models

El objetivo fue analizar la tendencia de la tasa de mortalidad por cáncer de pulmón en Chile, durante el periodo 1990-2009 y proyectar estas tasas a seis años. La información de mortalidad fue obtenida del Ministerio de Salud de Chile. Para calcular las tasas se utilizaron las proyecciones de población según el Censo de 2002. Las tasas se estandarizaron usando la población mundial como referencia. Se ajustaron modelos lineales dinámicos bayesianos para estimar la tendencia entre 1990-2009 y proyectar el periodo 2010-2015. Durante el periodo se observa una reducción del 19,9% de la tasa de mortalidad en hombres, mientras que en mujeres, la tendencia es creciente con aumento de 28,4%. El modelo de segundo orden entregó un mejor ajuste en hombres y el de primer orden en mujeres. Entre 2010 y 2015, se mantiene la tendencia decreciente en hombres, en cambio se proyecta una estabilización en la tendencia de mortalidad por cáncer pulmonar en mujeres en Chile. Este tipo de análisis es útil para implementar sistemas de vigilancia epidemiológica y evaluar estrategias.

O objetivo foi analisar a tendência da taxa de mortalidade por câncer de pulmão no Chile, durante 1990-2009 e projetar estas taxas em seis anos. As informações sobre a mortalidade foram obtidas no Ministério da Saúde do Chile. Para calcular as taxas foram utilizadas projeções da população de acordo com o Censo de 2002. As taxas foram padronizadas utilizando-se a população mundial como referência. Modelos lineares dinâmicos bayesianos foram ajustados para estimar a tendência entre 1990-2009 e projetar o período 2010-2015. Durante o período, observa-se uma redução da taxa de mortalidade de 19,9% nos homens, entretanto nas mulheres a tendência é de crescimento, com o aumento de 28,4%. O modelo de segunda ordem deu um melhor ajuste para os homens e mulheres de primeira ordem. Entre 2010 e 2015, a tendência descendente é mantida entre os homens, no entanto, projetando uma tendência de estabilização da mortalidade por câncer de pulmão em mulheres no Chile. Este tipo de análise pode ser útil para implementar sistemas de vigilância epidemiológica e avaliar estratégias.

The objectives were to analyze lung cancer mortality trends in Chile from 1990 to 2009, and to project the rates six years forward. Lung cancer mortality data were obtained from the Chilean Ministry of Health. To obtain mortality rates, population projections were used, based on the 2002 National Census. Rates were adjusted using the world standard population as reference. Bayesian dynamic linear models were fitted to estimate trends from 1990 to 2009 and to obtain projections for 2010-2015. During the period under study, there was a 19.9% reduction in the lung cancer mortality rate in men. In women, there was increase of 28.4%. The second-order model showed a better fit for men, and the first-order model a better fit for women. Between 2010 and 2015 the downward trend continued in men, while a trend to stabilization was projected for lung cancer mortality in women in Chile. This analytical approach could be useful implement surveillance systems for chronic non-communicable disease and to evaluate preventive strategies.

Patrón de comportamiento tipo A, ira y enfermedades cardiovasculares (ECV) en población urbana chilena / Type A Behavior Pattern, Anger and Cardiovascular Disease (CVD) in Chilean Urban Population

Un aumento de las enfermedades cardiovasculares (ECV) mundialmente, la existencia de un porcentaje más alto que el promedio nacional de éstas para la región de Maule (Chile), y una atención incrementada en el análisis de factores psicológicos, motivan el análisis del Patrón de Comportamiento Tipo A (PCTA) y la ira respecto de las ECV. Se trabajó con 1007 participantes de 18 a 74 años (ciudadanos de Talca, Chile), mayoritariamente mujeres, quienes respondieron un cuestionario (información socio demográfica, hábitos alimentarios y de estilo de vida), la Escala Retiro de Patrón de Conducta tipo A (ERCTAa), y el Inventario de Ira de Novaco. Se les midió peso, masa corporal, presión arterial y sangre, como factores de riesgo cardiovascular. Los participantes son altamente sedentarios (79.9%), tabáquicos (53.6%), hipercolesterolémicos (44.5%), con sobrepeso (40.7%) y obesidad (32.6%), un cuarto de los cuales presenta hiperglicemia e hipertensión y con PCTA equirepartido según sexo. Es la ausencia de PCTA (ó presencia de PCTB) la que aparece asociada a factores tradicionales de riesgo cardiovascular (FRCV). La ira alta se presenta más en mujeres que en hombres (2.1% vs. 0.3%; c²(3) = 27.99, p<.0001), disminuyendo para ambos sexos con la edad, pero los infartos acaecen igualmente según sexo.

A worldwide raise in the number of cardiovascular disease (CVD) and the existence of a higher percentage in Maule (Chile) than the national media, and increased attention in the analysis of psychological factors motivate to analyze the Type A Behavior Pattern (TABP) and anger in relation to CVD. The sample was 1007 adults between 18 and 74 years old (citizens of Talca, Chile), mostly women. They provided information about their demographic details, eating habits and lifestyle, answered the Novaco's Anger Inventory and the Retiro Scale of Type A Behavior (RSTAB), and also were taken measurements like weight, body mass index and blood pressure and blood tests related to risk factors to traditional cardiovascular diseases. The results show Overall, that the participants appear highly sedentary (79.9%) with relatively high levels of tabaquism (53.6%), and hypercholesterolemia (44.5%), overweight (40.7%) and obesity (32.6%). A quarter of the sample also presents hyperglycemic indexes, hypertension and TABP unequally distributed by sex. The absence of PCTA (or PCTB presence) appeared mostly associated with traditional cardiovascular risk factors (CRF). Regarding anger, women present more high than men (2.1% against 0.3%; c²(3) = 27.99, p<.0001), decreasing for both sexes with age, while also befall stroke by sex.

Efecto de la lactancia materna y variables psicosociales sobre el desarrollo psicomotor en niños de 12 meses de edad / Effect of breast feeding an psychosocial variables upon psychomotor development of 12 months old infants

El objetivo de este trabajo fue evaluar la participación de variables psicosociales en la relación entre lactancia materna (LM) y desarrollo psicomotor (DPM) en díadas con distinta duración de LM. Se estudió 138 díadas madre-hijo, divididas en 2 grupos: 86 recibieron LM como única fuente de alimentación láctea por al menos 6 meses (grupo LM prolongada); y 52 fueron destetados antes de los 45 días de edad (grupo con destete precoz). De acuerdo a un diseño prospectivo no experimental se recolectó información del embarazo, parto y alimentación. A los 6-7 meses de edadse observó en el hogar una situación de alimentaciónláctea, registrando patrones interaccionales madre-hijo. A los 12 meses se evaluó el DPM (Escala de Bayle). Se midió además temperamento infantil, estimulación en el hogar, depresión materna, y stress en el hogar. Los resultados muestran que los grupos son similares en características familiares, y difieren en experiencia de contacto precoz y experiencia de primeras, mamadas, ambas a favor del grupo con LM prolongada. Además, las díadas de este grupo muestran patrones de interacción madre-hijo más ricos y variados, y alcanzan mayor sincronía y reciprocidad en la relación. Los índices promedio de desarrollo mental (MDI) y motor (PDI) son similares en ambos grupos. Las variables explicatorias del MDI y PDI son distintas en cada grupo. Las díadas que practican LM prolongada conformarían desde un punto de vista psicosocial-un grupo diferente al con destete precoz