Asociación entre deterioro del flujo espiratorio máximo y prevalencia de enfermedades cardiovasculares y metabólicas en población adulta chilena: hallazgos preliminares de la Cohorte del Maule (MAUCO) / Peak expiratory flow and prevalence of cardiovascular and metabolic diseases in a Chilean adult population: preliminary findings from the Maule Cohort (MAUCO)

Introducción: La enfermedad respiratoria crónica determina alta morbimortalidad y frecuencia de comorbilidades cardiometabólicas. Evaluamos la asociación entre flujo espiratorio máximo (FEM) y algunas condiciones cardiometabólicas en adultos de una zona semirural, en la medición basal de la cohorte MAUCO (MAUle COhort). Material y Método: Estudio transversal (3.465 adultos, 40-74 años). Se midió el flujo espiratorio máximo (FEM) (mini-Wright, estándar ATS) utilizándose valores de Gregg y Nunn (FEM deteriorado ≤ 80% del teórico). Se obtuvo autorreporte/mediciones de hipertensión arterial (HTA), enfermedad cerebrovascular (ECV), infarto al miocardio (IAM), diabetes mellitus 2 (DM2), presión arterial, glicemia, colesterol, peso y talla. Actividad física y tabaquismo se evaluaron por encuesta, previa aprobación Ética. Se calcularon medidas de asociación, prevalencia y Odds Ratio (OR). Resultados: Muestra de 63,9% de mujeres edad media 55 (± 9) años, escolaridad media 9 (± 4) años. 84,7% tuvo exceso de peso, 81,5% inactividad física 29,4% fumadores actuales. Prevalencia de FEM bajo: 50,6% (IC 95% 48,9-52,3). El autorreporte fue: ACV 2,2% IAM 3,3, sospecha de hipertensión 24% y DM2 2,7%. Los OR crudos fueron significativos en mujeres que autorreportaron HTA, ECV, IAM y autorreporte/sospecha de DM2, y en hombres con autorreporte de ECV, sospecha de DM2 y autorreporte/sospecha de HTA. La asociación se mantuvo post-ajuste en mujeres para autorreporte de IAM y deterioro moderado (OR = 2,49) y severo del FEM (OR = 2,60) y en hombres para sospecha de DM2 y deterioro leve (OR = 5,24) y severo del FEM (OR = 6,19). Conclusiones: FEM resultó significativamente asociado con las enfermedades cardiometabólicas seleccionadas, con efecto sexo- específico para IAM (mujeres) y sospecha de DM2 (hombres). Se constata alta prevalencia de FEM alterado, y de enfermedades cardiometabólicas crónicas en la población estudiada.

Introduction: Chronic respiratory diseases determine high morbimortality and cardiometabolic comorbidities. We evaluated the association between peak expiratory flow (PEF) and cardiometabolic conditions in adults in a semi-rural area, in the baseline of MAUCO cohort (MAUle COhort). Material and Method: Cross-sectional study (3,465 adults, 40-74 years). Peak expiratory flow (PEF) (mini-Wright, ATS standard) was measured (Gregg & Nunn; impaired PEF ≤ 80% predicted). Self-reported/measured hypertension (HT), cerebrovascular disease (CVD), myocardial infarction (AMI), diabetes mellitus 2 (DM2), blood pressure, glycemia, cholesterol, weight and height were obtained. Physical activity and smoking were surveyed, after Ethical approval. Association's measures, prevalence and Odds Ratio (OR) were calculated. Results: Sample of 63.9% of women, mean age 55 (± 9) years, schooling 9 (± 4) years. 84.7% had overweight, 81.5%physical inactivity 29.4% smokers. Low PEF: 50.6% (48.9-52.3). Self-reported was: CVD 2.2% AMI 3.3%, suspicion of hypertension 24% and DM2 2.7%. Crude OR`s were significant for women by self-reported hypertension, stroke, AMI and self-reported/suspicion DM2; in men for self-reported CVD, suspected DM2 and self-reported/suspected hypertension. The association remained post-adjusted in women self-reported AMI -moderate deterioration (OR = 2.49) and severe PEF (OR = 2.60) and in men suspected DM2 and mild (OR = 5.24) and severe deteriorated PEF (OR = 6.19). Conclusions: PEF was significantly associated with cardiometabolic diseases; sex- specific findings for AMI (women) and suspicion of DM2 (men). High prevalence of altered PEF and chronic cardiometabolic diseases were detected among the studied population.

Flujo espiratorio máximo: caracterización en un estudio en población adulta chilena; resultados basales de la cohorte del Maule (MAUCO) / Peak expiratory flow rate: characterization study in Chilean adult population; baseline results of the Maule cohort (MAUCO)

Resumen Introducción: Las enfermedades respiratorias crónicas tienen alta prevalencia en países en desarrollo, en poblaciones rurales y deprivadas. El flujo espiratorio máximo (FEM) obtenido mediante espiración forzada tiene uso clínico y de investigación. Describimos valores de medición del FEM en la medición basal de un estudio de cohorte en curso (Cohorte del Maule-MAUCO). Material y Método: Diseño transversal en 3.465 adultos (40-74 años) con registros de FEM (ATS). (Flujómetro Mini-Wright), usando valores de Gregg y Nunn. Valores < 80% del predicho se consideraron disminuidos. Se obtuvo sexo, edad, nivel educacional, actividad física y tabaquismo; se calculó índice de masa corporal (IMC) usando mediciones antropométricas. Resultados: La muestra tuvo 63,9% de mujeres; edad media de 55 (± 9) años, escolaridad de 9 (± 4) años; sobrepeso y obesidad fueron 43,1% y 41,5%: 81,5% fueron inactivos y 29,4% fumadores actuales. El valor medio de FEM fue 330 (± 80) L/min (mujeres) y 460 (± 119) L/min (hombres): el FEM disminuido alcanzó el 50,6% ([48,9-52,3]) con diferencias según edad, educación, IMC y actividad física. Conclusiones: Se observó alta prevalencia de FEM disminuido con variaciones según sexo, edad, escolaridad, IMC e inactividad física. Como otros estudios latinoamericanos, los valores bajos también fueron altamente prevalentes, sugiriendo sobreestimación de valores predichos al usar valores de Gregg & Nunn. Estos resultados sugieren la conveniencia de estudiar factores ambientales locales.

Introduction: Chronic respiratory (CRD) diseases show high prevalence in developing countries, rural and deprived populations. Peak expiratory flow rate (PEFR) is a functional measurement obtained through forced expiratory used for clinical and research purposes. We described PEFR in a rural setting in an ongoing cohort study (Maule Cohort-MAUCO). Material and Method: Cross-sectional design in 3,465 adults (40-74 years) with PEFR ATS standard records (Mini-Wright flowmeter) using Gregg and Nunn values. PEFR ≤ 80% predicted were considered decreased. Sex, age, educational level, physical activity and tobacco smoking were obtained. Body mass index (BMI) was calculated based on anthropometrical measurements. Main Results: Sample had 63.9% of women; mean age of 55 (± 9) years, schooling of 9 (± 4) years. Overweight and obesity were 43.1% and 41.5%. Physical inactivity was 81.5% and 29.4% were current smokers. PEFR mean value was 330 (± 80) L/min (women) and 460 (± 119) L/min (men): Decreased PEFR was 50.6% ([48.9-52.3]) with significant differences by age, schooling, BMI and physical activity. Conclusions: High prevalence of decreased PEFR was observed: PEFR showed variations according to sex, age, schooling, BMI and physical activity. As other Latin-American studies show, low values were also highly prevalent, suggesting that Gregg & Nunn overestimated PEFR values. These results suggests the convenience of studying local environmental factors.

Consumo de tabaco: Algunos antecedentes epidemiológicos / Tobacco consumption: epidemiological background

Resumen Hay varias razones que respaldan la persistencia de altas cifras sobre consumo de tabaco en Chile. Entre los principales impulsores podemos destacar la fuerte influencia de la industria tabacalera y la debilidad de las Políticas Nacionales de Salud en la prevención, control y regulación del consume de tabaco a nivel poblacional. Uno de los principales resultados de salud derivados del consumo de tabaco es la dependencia de la nicotina, la principal barrera clínica y psicológica para que los fumadores dejen de fumar. Las actualizaciones de la legislación chilena aún muestran un efecto limitado a nivel de población adulta, según datos proporcionados por la Encuesta Nacional de Salud 2010, pero promisorios a nivel adolescentes según investigación local e internacional sobre población escolar (SENDA) y recientemente por la Encuesta Global de Jóvenes por el Tabaco (EMTJ 2016) La provision de acciones estructurales dirigidas a población general necesita ser complementada, con el fin de alentar y apoyar a los fumadores a dejar de fumar, considerando su rol fundamental en el control de la epidemia del tabaco, debido a la persistencia del consumo de tabaco en la población general. Consideramos que el abandono del tabaco debe ser un objetivo estratégico de prevención secundaria a considerar que permita aumentar el espectro de acciones propuestas por el Convenio Marco para el Control del Tabaco en Chile

There are several reasons supporting the persistence of high figures on tobacco smoking in Chile. Among the main drivers we can highlight the strong influence of the tobacco industry and the weakness of National Health Policies on the prevention, control and regulation of tobacco consumption at the population level. One of the main health outcomes derived for smoking consumption is nicotine dependence, the main clinical and psychological barrier for smokers to quit tobacco smoking. Even the Chilean legislation updates still show limited effect at adult population level, according to data provided from National Health Survey 2010, but promissory information from local and international research on scholar population (SENDA) and recently by the Global Youth for Tobacco Survey (EMTJ 2016). The provision of structural actions directed to general populations need to be complemented for other, in order to encourage and support smokers to quit, considering their sensitive cornerstone role controlling the tobacco epidemics due the persistence of tobacco consumption in the general population. We consider that smoking cessation should be a strategic secondary prevention target to be considered that allow to increase the spectrum of actions proposed by the Framework Convention on Tobacco control in Chile

Cobertura de la estrategia preventiva de cáncer gástrico en Chile: resultados de la Encuesta Nacional de Salud 2009-2010 / Coverage of diagnostic upper gastrointestinal endoscopy for the prevention of gastric cancer in Chile: results from the 2009-2010 National Health Survey

Background: In Chile, gastric cancer (GC) is a major cause of cancer related deaths. The current screening strategy consists of an upper gastrointestinal endoscopy (UGE) for people aged 40 years or more with epigastric pain. Aim: To evaluate the diagnostic coverage of the use of UGE for early detection of GC in Chile. Material and Methods: As part of the digestive module of the 2009-10 National Health Survey, 5293 adults over 15 years were asked about the presence of epigastric pain, possible upper gastrointestinal bleeding (PUGB), use of proton pump inhibitors (PPIs) or histamine H2-receptor antagonists (H2RAs), family history of GC and having performed an UGE. Results: Persistent epigastric pain was observed in 3.4% of the population. PUGB signs were observed in 3.3% of the population. The prevalence of PPIs and H2RAs use was 4.3% and 2.2% respectively, reaching 21.6% in people aged 70 years and older. Life span prevalence of UGE was 18.3%, with differences by region, health insurance and educational level. UGE coverage in people aged 40 years or older with and without persistent epigastric pain was 14.4% and 3.2% respectively (Odds ratio 4.8, p < 0.01). The prevalence of UGE was similar among people with or without PUGB or family history of CG. Conclusions: The estimated coverage of the current GC prevention strategy in Chile is 14.4%, evaluated at a population level. Further studies are required to determine the impact of this strategy on early GC diagnosis and mortality.

Cobertura de la estrategia preventiva de cáncer de vesícula biliar en Chile: Resultados de la Encuesta Nacional de Salud 2009-2010 / Coverage of the gallbladder cancer prevention strategy in Chile: results from the 2009-2010 National Health Survey

Background: In Chile, gallbladder cancer (GBC) is one of the most important causes of death and gallstone disease (GSD) is its main risk factor. Abdominal ultrasonography (AU) is used for the diagnosis of GSD and cholecystectomy is used to prevent it. Aim: To estimate GSD prevalence in the general population and to assess the diagnostic and therapeutic coverage of GSD as a preventive strategy for GBC in Chile. Material and Methods: A standardized digestive symptoms questionnaire of the 2009-2010 Chilean National Health Survey was answered by 5412 adults over 15 years old. Self-reports of AU, GBD and cholecystectomies were recorded. Results: The prevalence of biliary-type pain was 7.1%. During the last five years, the prevalence of AU was 16%. GSD was reported in 20% of these tests and 84% of them were asymptomatic. The prevalence of AU was significantly lower in Araucanía region and among people with less than 12 years of education. Life cholecystectomy prevalence was 11% and reached 40% in people aged over 60 years. Women accounted for 75% of total cholecystectomies. Twenty-one percent of individuals who referred biliary-type pain, were studied with an AU. Only 60% of people with GSD confirmed by AU underwent a cholecystectomy. Conclusions: GSD affects at least 27% of the Chilean adult population. Important deficits and inequities in GSD diagnostic and therapeutic coverage were identified.

Proposición de nuevas ecuaciones para calcular valores espirométricos de referencia en población chilena adulta: Sociedad Chilena de Enfermedades Respiratorias (SER) / New spirometric reference equations for healthy Chilean adults

Background: To correctly interpret spirometric results, reference values should come from the same population. Current spirometric reference equations have been under scrutiny due to deficiencies to fit adequately for Chilean population, specially, for those aged over 65 years old. Aim: To develop new spirometric reference values for Chilean adults, based on national studies in which spirometries were performed in healthy non-smoker adults. Material and Methods: A standardized database of spirometric values was developed combining spirometric data collected from five population-based studies, in which healthy nonsmoker adults participated. Spirometries from 448 males aged 19 to 84 years and from 726 females aged 19 to 94 years, obtained according to guidelines from the American Thoracic and European Respiratory Societies, were analyzed. Using multiple regression models, which included height, gender, and age, the theoretical value and inferior limits of normality were calculated for 1st second (FEV1), forced vital capacity (FVC), FEV1/FVC, and forced mid-expiratory flow rate (FEF25-75). Results: Reference values and lower limits of normality (LLN) were constructed for Chilean adults of both genders. The new proposed set of equations had a better fit, when compared with the current reference values used in Chile. Conclusions: The new spirometric references values derived from this study, fit better than currently used ones. Therefore, they should be used as new references values for Chilean adults.

Población de 80 y más años en Chile: una visión preliminar desde el punto de vista epidemiológico / Aged 80 And over populAtion in Chile:A preliminary epidemiological Approach

Chile está en fase avanzada de transición epidemiológica predominando las enfermedades crónicas como problemas de salud. La creciente expectativa de vida al nacer ha permitido configurar una numerosa cohorte de adultos de 80 años y más que superó su expectativa al nacer. El análisis de este subgrupo, es indispensable para el adecuado cuidado de su salud. La alta mortalidad de este grupo deriva de enfermedades circulatorias, tumorales y respiratorias. Los AVISA complementan la información epidemiológica de este grupo, agregando a las patologías señaladas otras condiciones específicas que orientan mejor a identificar sus prioridades en salud. La Encuesta Nacional de Salud 2009-10, por el carácter inclusivo de su muestra, revela en este grupo de edad el predominio de las enfermedades crónicas (hipertensión arterial, diabetes, dislipidemias) y de sus factores de riesgo. Se pesquisan altos niveles de deterioro cognitivo, de hipotiroidismo y de síntomas músculoesqueléticos, persistiendo rezagos de factores de riesgo conductuales (tabaco, alcohol). La cobertura efectiva de las enfermedades crónicas prevalentes debe constituirse en un objetivo clínico a mejorar en este grupo de edad.

Chile is facing an advanced epidemiological transition process with non communicable diseases (NCD) as a main health problem by 2010. Due to an increasing trend in life expectancy at birth and better living conditions, a large cohort of elderly people 80 or more exceeded largely their original life expectancy. To adjust the health care of this particular subpopulation is mandatory to describe their particular characteristics. The observed high mortality rate of this group is mainly explained by cardiovascular diseases, malignant neoplasms and respiratory diseases. Health indexes like DALY´sexpand the scope of health problems of frail elderly, adding additional information about health conditions who allows a better setting in order to identify main health priorities of this group. Due to their comprehensive sampling design, the Chilean health survey 2009-10 could confirm the importance of NCD (hypertension, diabetes, and hypercholesterolemia) and their main risk factors in this age group. High prevalences of cognitive impairment, hypothyroidism and musculoskeletal symptoms were detected among 80 or more years old population, remaining behavioural risk factors (eg. alcohol and tobacco consumption) as delayed health problems. Improving coverage, screening and better clinical control are high-priority tasks for this particular age group.

Estrategias para el enfrentamiento del cólera: La experiencia chilena desde una perspectiva de salud pública / Strategies for dealing with cholera disease: A public health perspective of the Chilean experience

Más de 700.000 casos y alrededor de 6.000 muertes se produjeron en la última epidemia de cólera registrada en América Latina, ocurrida en 1991. Esta se inició en el Perú y se propagó de país en país, afectando a la mayor parte de la región, incluyendo Chile. Comparado al Perú, la epidemia en Chile tuvo consecuencias menores debido a las medidas adoptadas por el Sistema Nacional de Servicios de Salud, en conjunto con otras entidades del Estado. Dentro de estas medidas destacan el establecimiento del Consejo Nacional de Salud, la planificación estratégica de los Servicios de Salud, el fortalecimiento de los Sistemas de Vigilancia Epidemiológica y de Laboratorios Clínicos y Ambientales, la educación de la población y las estrategias de prevención. La mantención de las medidas de sanidad ambiental y la colaboración de la población son fundamentales para evitar la aparición futura de la enfermedad.

During the latest Latin American epidemic of cholera (1991), more than 70,000 cases were identified and over 6,000 deaths occurred. Cholera started in Peru and expanded to the rest of Latin American countries, including Chile. Compared to Peru, the epidemic in Chile had minor consequences due to the strategies adopted by the National System of Health Services, together with other public institutions. These strategies included the establishment of a National Committee for Cholera, strategic planning of health services, strengthening of epidemiologic surveillance systems and of clinical and environmental laboratories, education of the population, and preventive strategies, among others. Maintenance of environmental health measures and the population’s collaboration are essential to avoid future emergence of this disease.

Sintomatología respiratoria y enfermedad pulmonar obstructiva crónica y su asociación a contaminación intradomiciliaria en el área metropolitana de Santiago: estudio platino / Association between indoor pollution, respiratory symptoms and COPD in Santiago, Chile: platino study

The aim of this study is to report the association between indoor pollution (IP), chronic respiratory symptoms (CRS) and chronic obstructive pulmonary disease (COPD). Data provided from PLATINO study considering a sample of 1.208 subjects 40 and over years old population in Santiago, Chile. Analyses regarding indoor air pollution variables, smoking, environmental tobacco smoke (ETS) and lifetime exposure to occupational dust and CRS and COPD as main outcomes was performed. Crude and adjusted prevalence odds ratios (POR) were calculated using logistic regression, adjusting for potential confounders. Variables explaining higher COPD risk were age > 60 years (POR 3.94, CI95 percent 2.87-5.41, p < 0.01) and males (POR 2.08, CI95 percent 1.53-2.83, p < 0.01). Exposure to coal IP was associated with CRS (POR 1.41, CI95 percent 1.05-1.89; p = 0.024), as well as exposure to firewood IP (POR 1.42, CI95 percent 1.04-1.93; p = 0.029) and ETS (POR 2.15, CI95 percent 1.24-3.73, p = 0.006). Exposure to coal, firewood and ETS are independent risk factors for CRS. Association between exposure to IP and COPD was not observed.

El objetivo de la comunicación fue evaluar la asociación entre contaminación intradomiciliaria (CID) y la presencia de síntomas respiratorios crónicos (SRC) y Enfermedad Pulmonar Obstructiva Crónica (EPOC). Se analizó información del estudio de prevalencia Platino en base a una muestra de población general de 1.208 sujetos de 40 y más años de Santiago, Chile. Se analizó la CID derivada del uso de combustibles sólidos, exposición a humo ambiental (EHAT) y el reporte de exposición previa a polvo de origen ocupacional calculando Odds Ratio de Prevalencia (ORP) crudos y ajustados por potenciales variables confundentes. Las variables que determinan mayor riesgo de EPOC fueron edad mayor 60 años (ORP 3,9; IC95 por ciento 2,9-5,4; p < 0,01) y sexo masculino (OR 2,08; IC95 por ciento 1,5-2,8; p < 0,01). La CID derivada de carbón se asoció con síntomas respiratorios crónicos (ORP 1,4; IC95 por ciento 1,05-1,89; p = 0,024), al igual que el antecedente de exposición a humo de leña (ORP 1,4, IC95 por ciento 1,04-1,9; p = 0,029) y EHAT (ORP 2,1, IC95 por ciento 1,2-3,7; p = 0,006). La exposición a carbón, leña y EHAT constituyen factores de riesgo independientes para presentar SRC. No se encontró asociación entre CID y EPOC.

Nomogramas de ecuaciones de referencia espirométrica SER 2009 / Spirometric nomograms for Chilean normal adults

As a result of the availability of programmes to detect and treat respiratory disease in Chile there has been a greater use of spirometry in diagnosis. To be able to correctly interpret spirometry results there must be reference patterns which, ideally come from the same population in which they will be used. In order to facilitate the use and application of new spirometric reference equations recently calculated for the adult population, there follows a series of nomograms. These nomograms have been designed for each of the following parameters: gender, age, and size of subjects between 19 and 50 years old and also for subjects over 51 years old. These equations are taken from 5 national studies. These studies included a population which complied with universal criteria to determine reference values ( 1.174 subjects, between 19 and 94 years old), spirometries were carried out on this population following international recommendations (ATS).

La actual disponibilidad de programas de detección y tratamiento de enfermedades respiratorias en Chile ha determinado una mayor utilización de la espirometría en el diagnóstico de dichas enfermedades. La adecuada interpretación de los resultados de la espirometría requiere disponer de patrones de referencia idealmente originados en la misma población en la cual se utilizarón. Para facilitar el uso y aplicación de nuevas ecuaciones de referencia espirométricas recientemente modeladas en población adulta chilena, se presentan nomogramas diseñados para cada uno de los parámetros en base al género, edad y talla para sujetos entre 19 y 50 años y en mayores de 51 años. Estas ecuaciones derivan de 5 estudios nacionales que incluyeron población que cumplió criterios universales para determinar valores de referencia, (1.174 sujetos, 19 a 94 años), que efectuaron espirometrías siguiendo recomendaciones internacionales (ATS).

Influencia del nivel socioeconómico (NSE) en el asma bronquial y cambios en su prevalencia en población escolar en un periodo de 6 años / Changes in asthma prevalence among school children during a 6 -year period: Influence of socioeconomic status

Background: Asthma prevalence is increasing worldwide, especially in developing countries. Aim: To determine the prevalence of asthma diagnosis andrelated symptoms in children, its changes during a 6-year period and the influence exerted by socioeconomic status. Materials and methods: Cross-sectional study conducted among schoolchildren of Santiago. A sample of 4,561 children aged 6-7 and 13-14 years attending public schools (central district, medium-low and low socioeconomic status) and private schools (eastern districts, high socioecomic status) were surveyed. Dependent variables were asthma diagnosis (AD), wheezing during the last 12 months (WHE12) and frequency of episodes of wheezing (FEW). Prevalence odds ratios were calculated using regression models, adjusted for several confounding variables. Results: AD prevalence for the group as a whole was higher in boys than in girls (13.2% and 10.8%, respectively, p =0.016). Prevalence rate of AD was also higher for children aged 13-14 than 6-7 years (13.8% and 10.1%, respectively p <0.01). An inverse association was found between SES and WHE12. Higher maternal education level was associated with lower prevalence of WHE12 in both age groups and with lower prevalence of FEW in 6-7 year-old children. Paternal education level was positively associated with AD among younger children. At the central district, increasing trends of WHE12 and FEW prevalence were observed during 1994-2000 among 6-7 years children. Conclusions: A significant association was observed between socioeconomic status, asthma diagnosis and symptoms in school children living in Santiago. Data support an increasing trend of asthma prevalence and severity among 6-7 year-old children during the period 1994-2000.

Cambio climático y enfermedades infecciosas: un nuevo escenario epidemiológico / Climate change and infectious diseases: a novel epidemiological scenario

For the international scientific community, it is undoubted that planetary temperature is increasing, being projected an average raise of 1.0 °C-3.5 °C by the year 2100. Forecasted consequences are diverse, most of them adverse for human health, including the establishment of favorable epidemiological scenarios for the emergence and reemergence of infectious diseases. The present article summarizes the available evidence regarding the mechanisms that promote climate change, its environmental effects and its consequences on human health. In order to accomplish this objective, demonstrated changes in the dynamics of zoonotic, vectorial, food and water-borne diseases are described. The position of Chile in the international community is commented, as well as múltiple pending challenges, among which outstands the importance of incorporating professionals that work in the health sector to the national debate.

Para la comunidad científica mundial, el aumento progresivo de la temperatura del clima planetario es un hecho inequívoco, proyectándose para el año 2100 un incremento de la temperatura promedio de 1,0 °C - 3,5 °C. Las consecuencias pronosticadas son muy diversas, siendo en su mayoría adversas para la salud humana, entre las cuales se incluyen el establecimiento de escenarios epidemiológicos propicios para la emergencia y reemergencia de enfermedades infecciosas. El presente artículo sintetiza la evidencia disponible en torno a los mecanismos generadores del cambio climático, sus efectos medioambientales y sus consecuencias sobre la salud humana. Para ello, se describen cambios ya objetivados en la dinámica de enfermedades zoonóticas y vectoriales y de enfermedades transmitidas por agua y alimentos. Se comenta la posición de Chile en el concierto internacional y sus múltiples desafíos pendientes, destacándose la importancia de incorporar al debate nacional a profesionales que trabajan en el sector salud.