Estudio de prevalencia de síndrome de apneas obstructivas del sueño en la población adulta chilena. Subestudio de la Encuesta Nacional de Salud, 2016/17 / Prevalence of obstructive sleep apnea syndrome in Chilean adults. A sub-study of the national health survey, 2016/17

Background: Obstructive sleep apnea syndrome (OSAS) affects approximately 10%-20% of adults and is associated with obesity, hypertension and metabolic syndrome. Aim: To assess the prevalence and risk factors associated with OSAS in Chilean adults. Material and Methods: A standardized sleep questionnaire and respiratory polygraphy at home were conducted on adults aged 18 years or more, residing in the Metropolitan Region and enrolled in the 2016/17 National Health Survey. Results: Two-hundred and five people between 18 and 84 years old (46% men, mean age 50 years) underwent overnight respiratory polygraphy at home. The estimated obstructive sleep apnea prevalence was 49% (62% men, 31% women) considering an apnea-hypopnea index ≥ 5 respiratory events/hour, and 16% (21% men, 13% women) considering an apnea-hypopnea index ≥ 15 respiratory events/hour. The prevalence of obstructive sleep apnea continuously increased along with age for men and women, with a later onset for women. Age, gender, body mass index, cervical and waist circumference, snoring, reporting of apnea by proxies, self-reported cardiovascular and metabolic diseases such as hypertension, diabetes and dyslipidemia, were significantly associated with OSAS. No association was found with insomnia and daytime sleepiness. Conclusions: The prevalence and risk factors associated to obstructive sleep apnea syndrome were high among these adults.

Rendimiento de los cuestionarios de sueño en el diagnóstico de síndrome de apneas obstructivas del sueño en población chilena. Subestudio de la Encuesta Nacional de Salud, 2016/17 / Performance of sleep questionnaires for the diagnosis of obstructive sleep apnea syndrome

Background The diagnosis of obstructive sleep apnea syndrome (OSAS) is based on nocturnal records: polysomnography or respiratory polygraphy. However, their high costs limit their use. Aim To examine the predictive value of three sleep questionnaires (STOP, STOP-Bang, Epworth Sleepiness Scale (ESS) in the screening of OSAS in Chilean adults. Material and Methods During the National Health Survey 2016/17, 205 adults aged 50.7 ± 15.0 years (46% males) living in the Metropolitan Region answered sleep questionnaires and underwent an ambulatory respiratory polygraphy. The sensitivity, specificity, positive and negative predictive values and receiver operating characteristic curves of sleep questionnaires were calculated. Results Fifty nine percent of participants had OSAS which was moderate to severe in 26%. The clinical variables associated with OSAS were age, male gender, hypertension, dyslipidemia, overweight, cervical and waist circumferences, history of regular snoring and witnessed apneas. Daytime somnolence, insomnia and unrefreshing sleep were not associated to OSAS risk. STOP, STOP-Bang and ESS questionnaires classified 64%, 71% and 12% of cases as high risk for OSAS, respectively. The STOP and STOP-Bang questionnaires had the highest sensitivity to predict OSAS (76% and 89%, respectively) while the ESS had the highest specificity (91%). Conclusions The sleep questionnaires allowed to identify the subjects at high risk for OSAS in this sample of adults from the Metropolitan Region.

Situación epidemiológica del tabaquismo en Chile / Tobacco consumption in Chile: an epidemiological approach

El artículo presenta una caracterización del consumo de tabaco en Chile, utilizando para ello el modelo ecológico de enfermedades transmisibles, analizándolo como enfermedad crónica de carácter epidémica. Se comentan características del hospedero, agente etiológico, reservorio, ambiente y vector, en relación al tabaco. El consumo de cigarrillo evoluciona rápidamente en sociedades desarrolladas hacia bajas prevalencias en actuales. Globalmente la situación es heterogénea, persistiendo países como Chile, con consumo elevado y de difícil control. La prevalencia de fumadores actuales es de 40,6 por ciento, estimándose que un tercio de ellos podrían ser dependientes a la nicotina. En base al modelo de progresión de la epidemia de tabaquismo (López et al), se postula que Chile se encuentra en la Etapa III de la epidemia, caracterizada por alto consumo de tabaco en varones, prevalencia aun en aumento en mujeres e incipiente manifestación de carga de enfermedad atribuible al tabaco. Chile ha modificado recientemente su legislación sobre tabaco (venta y publicidad, preservación de aire libre de humo de tabaco, restricción al consumo y aumento de impuestos), lo que augura mejores perspectivas de control. El modelo de progresión epidémica muestra buena capacidad predictiva, sugiriendo para Chile para las próximas décadas, aumento en enfermedades atribuibles al tabaco (cardiovasculares, respiratorias crónicas y tumores malignos), superado el umbral de tiempo de exposición a prevalencias elevadas. A través de este análisis se identifican oportunidades de intervención tanto a nivel clínico como de salud pública, y se sugieren medidas específicas para optimizar el control y tratamiento del tabaquismo en nuestro país...

An epidemiological description about tobacco consumption in Chile is introduced in this article, based on the ecological model about transmission derived from communicable diseases. The logic of epidemic diseases and epidemiologic triad is translated and applied to the case of tobacco consumption looking for main characteristics of etiological agent (tobacco products), host, environment, main vector and their reservoir. Global trends on smoking behavior has been rapidly changed from high rates to unexpected low rates in developed world, reached due to successful strategies on prevention and control. Chile shows a complex profile, with high rates of smoking in general population, among adolescents and young adults and women. The tobacco epidemic progression model (Lopez et al 1994) is analyzed in order to understand its timing, changes in smoking prevalence and the burden of tobacco attributable burden of diseases. Chile is probably placed in an early stage of phase III of the proposed epidemic model on tobacco consumption, facing the next decades, raising trends in mortality rates due to chronic cardiovascular and respiratory diseases and malignant tumors, after the threshold of minimal time exposure time has been surpassed. Crucial support coming from health and teaching professional is expecting for better Chilean policies on prevention, control and treatment of smoking...

Orientaciones para una consultoría estadística satisfactoria / Statistical support in medical research

Una debilidad fundamental en el desarrollo y difusión de la información científica está dada por el inadecuado apoyo estadístico en la preparación de protocolos de investigación, el procesamiento y manejo de datos y la elaboración de artículos científicos. Para superar esta limitación es preciso considerar en el trabajo científico el aporte del profesional estadístico desde el inicio. Instituciones académicas que cuentan con adecuado desarrollo académico de la estadística (docencia, investigación aplicada y desarrollo propio de la disciplina) han propuesto lineamientos generales para regular la interacción entre profesionales del área biomédica y estadística. Algunas de estas recomendaciones, así como reglas generales de adecuadas prácticas entre médicos y estadísticos, son expuestas en el presente artículo

Asma bronquial y enfermedades atópicas como problema emergente de salud pública: nuevas hipótesis etiológicas: la experiencia de sociedades desarrolladas / New etiological clues in asthma and atopic diseases as an emergent challenge in public health: lessons from the developed world

Developed countries report increasing trends in the prevalence of asthma and atopic diseases over the last 40 years. This change cannot be attributed to artefactual effects. Emerging from these information, new approaches have been generated to explore these novel findings. Among the most important new factors to be explored, scientific research is pointing out to variables related with physical environment, socio-economic and genetic background, anthrophometry at birth, nutritional status, diet, exercise and hormonal profile. Changes in the epidemiology of asthma and atopic conditions in developed countries were also preceded by increases in the prevalence of chronic diseases and their risk factors. Chile does not have information about time trends on these diseases, but several studies are reporting a high prevalence of asthma among adults. Conversely, results from the collaborative ISAAC study carried out in children, have shown a relative low prevalence of asthma in Chilean children. An increasing trend in chronic diseases and their risk factors has been reported in Chile, suggesting an epidemiological pattern similar to that experienced by industrialised countries, when the prevalence of asthma and atopic began to increase. This article review current information about etiological research emphasising the need to develop local research on asthma and atopic diseases taking into account our epidemiological situation

Síntomas respiratorios y reflejo tusígeno en poblaciones expuestas a distinto grado de contaminación ambiental / Respiratory symptoms and cough reflex in populations exposed to different degrees of pollution

Background: Santiago is a city with a high degree of environmental pollution caused by particulate matter and ozone, producing adverse effects in the respiratory system. Aim: to compare respiratory symptoms and cough reflex in adults from Santiago and from a rural area with low levels of environmental pollution. Subjects and methods: one hundred twenty six non smoker adults from Santiago and 116 from a rural area with low levels of pollution answered a respiratory symptoms questionnaire. Of these 101 subjects from Santiago and 116 from the rural area inbaled doubling concentrations of capsaicin from 0.5 to 500 µM or until five coughs were elicited. The lowest concentration eliciting 2 or more coughs (CD2) or 5 or more coughs (CD5) was recorded. Levels of environmental particulate matter were also recorded in both locations. Results: Levels of particulate matter were 102 ñ 41 an 64 ñ 24 µg/m3 in Santiago and the rural area respectively. People from Santiago had higher rates throat clearing, cough and pblegm. CD2 geometric mean and confidence limits in Santiago and the rural area were observed between both locations. Multivariate analysis disclosed the variable location (city) as the only independent predictor of respiratory symptoms. Conclusions: the increased CD2 found in Santiago suggests that the higher rates of respiratory symptoms related to air pollution can be associated to a decreased sensitivity of the cough reflex

Fractura de la cadera: estudio de casos y controles en la región metropolitana I / Hip fracture: study of cases and controls at metropolitan region I

Hip fracture is a preventable cause of disability among elderly people. To study factors associated to hip fractures in Chile. Patients admitted to seven public hospitals in Chile, whith hip fracture not due to major accidents, were considered as cases. To each, at least one age and sex matched hospitalized control, without or neoplasic diseases, was assigned. All patients were subjected to an inquiry, using an instrument devised by the WHO. Two hundred sixty eight cases and 501 controls were studied. Cases and controls has similar educational and labor histories. The right hip was fractures in 47 percent of cases and the left in the rest. Compared with controls, cases had a higher body mass index; loss of height during life, rate of hysterectomy, incidence of smoking and a lower consumption of diary products. Cases had a higher risk of falls inside their homes and controls outside. The obtained information may contribute to the development of preventive measures and reduce the public health impact of hip fracture

La osteoporosis en Chile: fractura de cadera / The osteoporosis in Chile: hip fractures

Se selecciona la fractura de cadera como modelo para estudiar el riesgo de fractura osteoporótica en los adultos. Se calculan los egresos hospitalarios por fractura de cadera, en ambos sexos, por tramos etarios a partir de 50 años para el año 1990. Se comprueba un significativo aumento de la tasa de egresos a medida que aumenta la edad. Este efecto es mayor en mujeres. Se entrevista un total de 156 pacientes con fracturas de cadera en los hospitales de la Región Metropolitana, durante 1994. Se muestran los hallazgos en diferentes rubros