Asociación entre nivel educacional y sospecha de deterioro cognitivo en personas mayores chilenas: resultados de la Encuesta Nacional de Salud 2016-2017 / Association between educational level and suspicion of cognitive imparirment in Chilean older people

BACKGROUND: A low education level has been associated with cognitive impairment in older adults. AIM: To determine the association between educational attainment and suspicion of cognitive imparirment in older Chilean population. MATERIAL AND METHODS: Data from 2,005 adults aged ≥ 60 years assessed during 2016-2017 Chilean National Health Survey were included. Education was self-reported and categorized as primary: ≤ 8 years; secondary: 9 to 12 years and beyond secondary: > 12 years. suspicion of cognitive imparirment was assessed with the Mini-Mental questionnaire. RESULTS: Men and women with low education attainment had a higher prevalence of cognitive impairment (33% [95% confidence intervals (CI): 24; 41] and 27% [95% CI: 21; 33], respectively). Men who reported less schooling (≤ 8 years) were more likely to be at risk of suspicion of cognitive imparirment (Odds ratio (OR): 4.53 [95% CI: 1.10, 18.62]) compared to their peers. Women showed a substantially higher magnitude of association than men. The probability of suspicion of cognitive imparirment increased 9-times (OR: 9.96 [95% CI: 1.24; 79.6]) for 9-12 years and 18-times for ≤ 8 years of education (OR: 18.8 [95% CI: 2.42; 146.1]) compared to women with higher education. CONCLUSIONS: Older adults with low education attainment had an increased likelihood of developing suspicion of cognitive imparirment. However, the risk differs by sex, being higher in women than men.

Fuerza de prensión manual y calidad de vida en personas mayores autovalentes / Hand grip strength and quality of life in functional elderly

Introducción: Durante el envejecimiento se observa involución de algunos sistemas corporales. Entre estos cambios, los que afectan al sistema osteomuscular como la sarcopenia y la debilidad muscular, pueden alterar el desarrollo de actividades de la vida diaria, y por lo tanto, afectar la calidad de vida relacionada con la salud. Objetivo: Determinar la relación entre la fuerza de prensión manual y la calidad de vida relacionada con la salud en personas mayores. Métodos: Estudio descriptivo, correlacional. Evaluó 79 personas mayores (63 mujeres y 16 hombres) entre 65 y 78 años, de tres organizaciones sociales de la ciudad de Talca, Chile, seleccionados a través de un muestreo no probabilístico por conveniencia. Para medir la fuerza de prensión manual se utilizó un dinamómetro de mano y el cuestionario SF-36 fue usado para valorar la calidad de vida relacionada con la salud. Resultados: Se observaron relaciones significativas entre la fuerza de prensión manual y las dimensiones de la calidad de vida función física (p = 0,03; r = 0,76), dolor corporal (p = 0,01; r = 0,44) y salud general (p = 0,05; r = 0,48). Conclusiones: Existe relación entre la fuerza de prensión manual y tres dimensiones de la calidad de vida relacionada con la salud de personas mayores. Estos hallazgos corroboran la relevancia de evaluar la fuerza muscular en personas mayores como un marcador de salud y calidad de vida en estas(AU)

Introduction: During aging, involution of some body systems is observed. Among these changes, those that affect the musculoskeletal system such as sarcopenia and muscle weakness can alter the development of activities of daily life, and therefore affect health-related quality of life. Objective: to determine the relationship between hand grip strength and quality of life in elderly. Methods: Cross-sectional study. A total of 79 elderly (63 women and 13 men) between 65 and 78 years of age from three social organizations of Talca, Chile was included. A non-probabilistic convenience sample was used. To measure manual grip strength and the SF-36 questionnaire was used. Results: Significant relationships between hand grip strength and dimensions of quality of life, physical function (p = 0,03; r = 0,76), body pain (p = 0,01; r = 0,44) and general health (p = 0,05; r = 0,48) were observed. Conclusions: There is a relationship between hand grip strength and three measurements of quality of life in elderly. These findings corroborate the relevance of evaluating muscle strength in older people as a marker of health and quality of life in elderly(AU)

Prevalencia de debilidad muscular en personas mayores chilenas: resultados de la Encuesta Nacional de Salud 2016-2017

Background: Handgrip strength is an indicator of frailty in older people. Aim: To determine the prevalence of low handgrip strength in older Chilean adults. Material and Methods: A cross-sectional analysis of 244 individuals aged 60 years or more, participating in the 2016-2017 Chilean National Health Survey, was carried out. Handgrip strength was evaluated by a hand dynamometer and low grip strength was determined as a grip strength ≤ 15 kg and ≤ 27 kg for women and men, respectively. Results: Twenty nine percent of participants had low grip strength. The average grip strength among 60-year-old men and women was 34.7 and 22.1 kg, respectively. These figures decreased to 28.8 kg and 17.2 kg among 90-year-old men and women, respectively. The prevalence of low grip strength in men and women aged 60 years was 18%. In 90-year-old men and women, these figures increased to 79% and 56.3%, respectively. Conclusions: The prevalence of low grip strength increased substantially with age.

Personas mayores en Chile: el nuevo desafío social, económico y sanitario del Siglo XXI / Older people in Chile: the new social, economic and health challenge for the 21st century

Ageing will be one of the most significant social transformations of the 21st century worldwide. In the last 40 years, Chile has tripled its older adult population. As a result, by 2050 the country will have the highest proportion of older adults in Latin America. This remarkable growth reinforces the need to identify their current situation and to revise what is the society doing to maintain older people as active members. In this context, this narrative revision aimed to describe the sociodemographic, epidemiologic and sociocultural profile of the older Chilean adults. Besides, programs and public policies focused on the improvement of their quality of life were identified.

¿Cuál es la prevalencia de obesidad metabólicamente saludable en población chilena? / What is the prevalence of metabolically healthy obesity in Chile?

RESUMEN La obesidad es un importante factor de riesgo cardiovascular. No obstante, no todas las personas obesas tienen un perfil metabólico alterado ni todas las personas normo-peso poseen un perfil metabólico normal. Objetivo: determinar la prevalencia de diferentes fenotipos metabólicos asocia-dos al estado nutricional en Chile. Métodos: se incluyeron 1.733 participantes de la Encuesta Nacional de Salud 2009-2010. El estado nutricional (obesidad o normo-peso) fue determinado a través del IMC mientras que la condición metabólica (saludable o no) en base a cuatro parámetros: glicemia, presión arterial, colesterol HDL y triglicéridos. Con estos parámetros de determinaron 4 fenotipos, entre ellos, MUNO: metabólicamente no saludable no obeso y MHO: obeso metabólicamente saludable. Resultados: La prevalencia de MHO fue de 3,3% mientras que un 17,4% presentaba MUNO. Adicionalmente, la prevalencia de MHO disminuyó en la medida que aumentó la edad y la mayor proporción de individuos metabólicamente saludables se encontraba en el grupo de altos ingresos y con un nivel educacional superior (técnico-universitario). Conclusión: Se evidencia una baja prevalencia de MHO, así como también una alta prevalencia de individuos MUNO en la población chilena. Futuras acciones preventivas deberían no sólo considerar el estado nutricional sino también la condición metabólica de la población.

ABSTRACT Obesity is an important cardiovascular risk factor. However, not all obese individuals have an unhealthy metabolic pro-file and vice versa. Therefore, the aim of this study was to determine the prevalence of different metabolic phenotypes by nutritional status in Chile. Methods: 1,733 individuals from the National Health Survey 2009-10 were included in this study. Nutritional status (obesity or normal-weight) was determined by BMI whereas metabolic profile was determined through four parameters: Glycaemia, blood pressure, HDL cholesterol and triglycerides. Four metabolic phenotypes were derived, among them: MUNO: metabolically unhealthy and non-obese and MHO: metabolically healthy obesity. Results: The prevalence of MHO in the Chilean population was 3.3% while the prevalence of MUNO was 17.4%. Moreover, the prevalence of MHO decreased as age increased and a greater proportion of metabolically healthy individuals were in the highest gross income group and in the technical-university educational level. Conclusion: This study shows a low prevalence of MHO and a higher prevalence of MUNO in the Chilean population. Future preventive actions should take into account not only the nutritional status, but also the metabolic profile of the population.

Factores asociados a sedentarismo en Chile: evidencia de la Encuesta Nacional de Salud 2009-2010 / Correlates of sedentary behaviors in Chile: evidence from the National Health Survey 2009-2010

Background: Sedentary behaviors are one of the major risk factors for cardiovascular diseases. Aim: To identify factors associated with high sedentary behaviors in the Chilean population. Material and Methods: We included 5,040 participants from the Chilean National Health Survey 2009-2010. Physical activity level and sedentary behavior (sitting time) were measured using the Global Physical Activity Questionnaire (GPAQ v2). Highly sedentary behaviors were determined as > 4 hours per day of sitting time. Logistic regression was used to identify correlates of highly sedentary behavior. Results: Forty seven percent of the study population reported spending more than 4 hours per day sitting. The prevalence was higher in women. The main factors associated with high sedentary behavior were: high income levels (Odds ratio (OR):1.91 [95% Confidence intervals (CI:1.61-2.27]); being woman (OR:1.39 [95% CI:1.24-1.56]): having central obesity (OR:1.15 [95% CI:1.02-1.30]), being physically inactive (OR:2.35 [95% CI:2.06-2.68]), and living in an urban area (OR:1.92 [95% CI:1.63-2.26]). Other factors associates with high sedentary behavior were: being smoker, having a television set, computer and private car at their homes. Participants reporting a poor self-reported health and wellbeing and those with diabetes or metabolic syndrome were more likely to be highly sedentary. Conclusions: The main factors associated with high levels of sedentary behavior are socio-demographic issues, lifestyles and health status.

Factores mal evaluados en encuestas de satisfacción aplicadas a usuarios de atención primaria en Latinoamérica / Poorly evaluated factors in satisfaction surveys applied to users of Primary care in Latin America / Fatores mal avaliados em questionários de satisfação aplicados aos usuários de atenção primária na América Latina

ResumenEl objetivo de este manuscrito es identificar los factores mal evaluados en encuestas de satisfacción usuaria aplicadas a poblaciones atendidas en centros de atención primaria en Latinoamérica. La metodología consistió en una revisión de literatura. La búsqueda bibliográfica se realizó en las bases de datos LILACS, SCIELO, REDALYC, CUIDEN, REDIB, DIALNET, PUBLINDEX y EBSCO. Inicialmente, se obtuvo 21 estudios de los cuales se seleccionó ocho de acuerdo con criterios de inclusión. El resultado principal estriba en que entre los factores mal evaluados figuran acceso a la atención, puntualidad de la atención, tiempos de espera, demora en los trámites previos a la atención, suficiencia del personal, la entrega de medicamentos gratuitos, entrega de la información sobre derechos y deberes, resolución del problema de salud, ajuste del horario a las necesidades de los usuarios, infraestructura, ambientes y comodidad y, finalmente, las indicaciones claras de la receta. Se concluye que es indiscutible la importancia de medir la satisfacción usuaria, más en atención primaria, debido a que es la puerta de entrada al contexto sanitario. Identificar factores mal evaluados por medio de encuestas, permite orientar intervenciones respecto de lo que se quiere mejorar, así como satisfacer las expectativas del paciente y mejorar la calidad de la atención.

AbstractThe aim of this manuscript is to identify poorly evaluated factors in user satisfaction surveys applied to populations in primary care centers in Latin America. The methodology consists of a literature review. The bibliographic search was done in the databases LILACS, SCIELO, REDALYC, CUIDEN, REDIB, DIALNET, PUBLINDEX and EBSCO. Initially, 21 studies were obtained, of which eight were selected according to the inclusion criteria. The main outcome is that the main poorly evaluated factors are the following: access to care, timeliness of care, waiting time, pre-service procedure delay, staff adequacy, delivery of free medication, information on legal rights and duties, health problem resolution, adjustment of the schedule to the needs of the users, infrastructure, environment and comfort and, finally, the clear indications of the prescription. It is concluded that the importance of measuring user satisfaction, especially in primary care, is indisputable because it is the gateway to the health context. Identifying factors that are poorly evaluated in surveys, allows for interventions to be guided by needs improvement, as well as to satisfy the patient's expectations and to improve the quality of care.

ResumoO objetivo do manuscrito é identificar que foram fatores mal avaliado em pesquisas de satisfação do usuário aplicadas a populações atendidas em centros de cuidados primários na América Latina. A metodologia consistiu em uma revisão da literatura. A pesquisa bibliográfica foi realizada nas bases de dados Lilacs, Scielo, RedALyC, CUIDEN, REDIB, DialNet, Publindex e EBSCO. Inicialmente, 21 estudos foram obtidos, dos quais foram selecionados oito de acordo com critérios de inclusão. O principal resultado é que o acesso aos cuidados, a oportunidade de tratamentos, tempos de espera, atraso nos procedimentos de pré-atendimento, adequação do pessoal, fornecimento de medicamentos gratuitos, a entrega dos direitos e deveres de informação, a resolução do problema de saúde, o ajuste da programação para o necessidades dos usuários, infra-estrutura, ambientes e conforto e, finalmente, as indicações claras da prescrição. Conclui-se que a importância de medir a satisfação do usuário, mais em cuidados de saúde primários, é indiscutível Porque o gateway é o contexto da saúde. Que os fatores de Identificação são mal avaliado através de inquéritos, para ser guiado intervenções Permite sobre o que é desejado para ser melhorada, bem como para satisfazer as expectativas do paciente e melhorar a qualidade do atendimento.

Mayores niveles de transporte activo se asocian a un menor nivel de adiposidad y menor riesgo de obesidad: resultados de la Encuesta Nacional de Salud 2009-2010 / Association of active commuting with obesity: findings from the Chilean National Health Survey 2009-2010

Background: Active commuting is associated with a lower risk for obesity in developed countries. Aim: To investigate the association between active commuting and obesity risk in Chile. Material and Methods: Active commuting was measured using the Global Physical Activity Questionnaire (GPAQ v2) in 5,293 participants from the Chilean National Health Survey 2009-2010. Body mass index (BMI) and waist circumference (WC) were the study outcomes. The association between active commuting and obesity was investigated using linear and logistic regression analysis. Results: Thirty four percent of responders [95% confidence intervals (CI): 32.6-35.1] were passive commuters. Active commuters had a lower BMI and WC than their passive counterparts. Thirty minutes increment in active commuting were associated with a −0.20 kg.m-2 lower BMI [95% CI: −0.33 to −0.07, p < 0.01] and a −076 cm lower WC [95% CI: −1.08 to −0.43, p < 0.01]. The odds of having a BMI > 25 kg.m-2 was 0.93 [95% CI: 0.88 to 0.98, p = 0.01] per every 30 minutes' increment in active commuting, whereas the odds for central obesity was 0.87 [95% CI: 0.82 to 0.92, p < 0.01]. Conclusions: Active commuting is associated with a lower adiposity and lower risk for obesity in Chilean adults.

Menor peso corporal, de índice de masa corporal y de perímetro de cintura se asocian a una disminución en factores de riesgo cardiovascular en población chilena: Findings from the Chilean health surveyç / Effects of a lower body weight or waist circumference on cardiovascular risk

Background: Overall and central obesity are important risk factors for cardiovascular disease. Aim: To investigate the association of body weight, body mass index (BMI) and waist circumference (WC) with cardiovascular risk factors in Chile. Material and Methods: We included 5,157 participants from the National Health Survey 2009-2010. Prevalence of type 2 diabetes, hypertension, metabolic syndrome and dyslipidemia (high total cholesterol and triglyceride levels and low HDL-cholesterol) were defined using international recommendations. BMI and WC were measured using standardized protocols. Results: A five percent lower body weight, BMI and WC were associated with a significant reduction in cardiovascular risk factors. For each 5% reduction in body weight, the risk for hypertension decreased by 8 and 9% in women and men respectively. Similar risk reductions were observed for diabetes (9 and 11% respectively), metabolic syndrome (23 and 30% respectively), low HDL cholesterol (13 and 13% respectively), high triglyceride levels (16 and 18% respectively) and total cholesterol (8 and 10% respectively). Similar findings were observed for BMI and WC. Conclusions: Lower body weight, BMI or WC are associated with important reductions in cardiovascular risk factors. A 5% reduction in these adiposity markers could be a perfectly feasible goal for lifestyle interventions.

Altos niveles de adiposidad se asocian a un deterioro en la salud metabólica en adultos chilenos / Higher adiposity levels are associated with detrimental metabolic health in Chilean adults

RESUMEN Antecedentes: El exceso de grasa corporal es uno de los principales factores de riesgo de enfermedades cardiometabólicas. Objetivo: Investigar las asociaciones entre indicadores de adiposidad y metabólicos en población adulta chilena. Métodos: Estudio observacional de corte transversal en 475 adultos, a quienes se evaluó el índice de masa corporal (IMC), perímetro cintura (PC) y porcentaje de masa grasa (%MG). Se midió presión arterial, glicemia, insulina, HOMA-IR, colesterol total, triglicéridos, colesterol HDL y LDL, alanina-amino transpeptidasa, gama-glutamil transpeptidasa, leptina y proteína C-reactiva ultra sensible (PCRus). La asociación entre indicadores de adiposidad y marcadores metabólicos fue determinada mediante regresión lineal múltiple. Resultados: Los tertiles superiores de IMC, PC y %MG se asociaron significativamente (p< 0,05) con niveles bajos de colesterol HDL y altos de insulina, HOMAIR, triglicéridos, colesterol total, colesterol LDL, ALT, GGT, PCRus y leptina; esto para ambos sexos. Se observó además que los valores de presión arterial sistólica y presión arterial diastólica, fueron significativamente mayores en mujeres en relación a un mayor IMC. Conclusión: A medida que aumentó el nivel de adiposidad, se deterioran los marcadores de salud cardiovascular y metabólica, independientemente del indicador de adiposidad empleado.

ABSTRACT Background: Adiposity is positively associated with metabolic and inflammatory markers, which increase the risk of developing metabolic disease related to obesity. Aim: To investigate the association between adiposity markers and metabolic health in Chilean adults. Methods: We conducted a cross-sectional study with 475 participants. Body mass index (BMI), waist circumference (WC) and body fat (using 4 skinfold) were measured. The outcomes of interest were blood pressure, fasting glucose, insulin, HOMA-IR, total cholesterol, triglycerides (TG), HDL and LDL cholesterol,γ-glutamyltransferase (GGT), alanine aminotransferase (ALT), leptin and high sensitive C-reactive protein (hsCRP). The association between adiposity and metabolic outcomes were investigated using multiple linear regression analysis. Results: Individuals in the highest tertile for BMI, WC and body fat had a lower concentration of HDL-cholesterol and higher concentration of insulin, HOMA-IR, TG, LDL and total cholesterol, GGT, ALT, leptin and hsCRP. Blood pressure was higher with increasing BMI in females only. There was no significant association between fasting glucose and any of the adiposity markers. Conclusion: Higher adiposity levels were associated with a detrimental metabolic health. The effect of higher BMI, WC and body fat were similar across metabolic markers.

Associação entre estresse, riscos psicossociais e qualidade do emprego de trabalhadores assalariados chilenos: uma perspectiva de gênero / Asociaciones entre distrés, riesgos psicosociales y calidad del empleo en trabajadores/as asalariados/as en Chile: una perspectiva de género / Psychosocial risks, quality of employment, and workplace stress in Chilean wage-earning workers: a gender perspective

Resumo: O estudo estimou a prevalência de estresse no trabalho no Chile e suas associações com a exposição ocupacional ao risco psicossocial e qualidade do emprego, considerando as diferenças de gênero. Estudo transversal considerando uma amostra representativa nacional de 3.010 trabalhadores/as (1.486 mulheres e 1.524 homens). Dezoito por cento da amostra relataram estresse (23,8% mulheres vs. 14,8% de homens). Aqueles expostos a riscos psicossociais têm mais chances de sofrer estresse do que os não expostos, e as mulheres têm uma maior chance de sofrer estresse do que os homens. Homens e mulheres em empregos precários têm uma chance maior de estresse em comparação com aqueles com menos precariedade do emprego. No entanto, as mulheres em empregos precários têm uma maior chance de sofrer de estresse do que os homens em cargos semelhantes. Conclui-se que as mulheres têm uma maior proporção de empregos precários, estão mais expostas a riscos psicossociais e têm maior estresse, demonstrando a existência de uma dupla discriminação, social e de gênero, no mercado de trabalho no Chile.

Resumen: El estudio estimó la prevalencia de distrés laboral en Chile y sus asociaciones con exposición a riesgo psicosocial laboral y calidad del empleo, considerando diferencias de género. El estudio transversal consideró una muestra probabilística representativa a nivel nacional de 3.010 asalariados/as en Chile (1.486 mujeres y 1.524 hombres). Un 18% reporta distrés (23,8% mujeres versus 14,8% hombres). Los expuestos a riesgos psicosociales tienen mayor chance de experimentar distrés que los no expuestos, y las mujeres presentan una chance de sufrir distrés mayor que los hombres. Hombres y mujeres en empleos precarios tienen una chance mayor de presentar distrés al compararse con quienes tienen menos precariedad laboral. No obstante, mujeres en empleos precarios tienen mayor chance de sufrir distrés que los hombres en empleos similares. Se concluye que las mujeres ocupan empleos precarios en mayor proporción, están más expuestas a riesgos psicosociales y presentan mayor distrés, evidenciando la existencia de una doble discriminación-social y de género-en el mercado laboral en Chile.

Abstract: This study aimed to estimate the prevalence of work-related stress in Chile and its association with exposure to workplace psychosocial risks and quality of employment, considering gender differences. The cross-sectional study included a representative probabilistic national sample of 3,010 salaried workers (1,486 women and 1,524 men). Eighteen percent reported work-related stress (23.8% of women and 14.8% of men). People exposed to psychosocial risks had a higher probability of experiencing stress, and women were more likely to suffer stress than men. Women and men in precarious work showed increased likelihood of distress, compared to workers with less precarious jobs. However, women in precarious jobs were more likely to suffer stress than men in the same situation. The study concluded that women had more precarious jobs, experienced greater exposure to psychosocial risks, and suffered more stress than men. This is evidence of double discrimination (social and gender-based) in the Chilean labor market.

Parálisis de Bell: evolución natural / Bell's palsy: its natural clinical course

Se realiza un estudio descriptivo y prospectivo de la evolución natural de 115 pacientes con parálisis facial periférica idiopática sin tratamiento ni kinesiterapia específica, reunidos entre abril de 1986 y mayo de 1987. Se analizan los factores pronósticos, en base al protocolo de Adour modificado. Se efectuaron 762 controles. La recuperación fue satisfactoria en un 91,6%. No hubo diferencia en la evolución según edad, sexo, lado afectado y patología agregada. Analizando la evolución del compromiso de los músculos considerados por separado, se observa un gran sincronismo en su recuperación final. Sin embargo, los pacientes que tuvieron una parálisis facial incompleta lograron una mejoría precoz dentro del primer mes (p<0.001). Se concluye que en el material estudiado, la evolución natural fue altamente satisfactoria; que el tipo de parálisis incompleta o completa es un indicador pronóstico del tiempo necesario para obtener la recuperación de la motilidad facial y que el control de la recuperación funcional de un solo músculo puede ser suficiente indicador evolutivo de la parálisis facial periférica

Insuficiencia hepática aguda grave: análisis de 22 casos y revisión de la literatura / Severe acute hepatic failure: analysis of 22 cases and review of literature

Se revisan 22 casos de insuficiencia hepática aguda grave atendidos en el Hospital San Juan de Dios desde Enero de 1975 hasta Junio de 1986. Dieciocho de los casos (61,1%) fueron mujeres. La causa de la insuficiencia hepática aguda grave fue en el 27% hepatitis viral, 18% daño hepático por drogas y en 55% no se pudo establecer con seguridad. La mortalidad fue de 63,6%. Se analizan los datos disponibles en la bibliografía sobre la etiología, cuadro clínico, patogenia, pronóstico y tratamiento de la insuficiencia hepática aguda grave