Women's education level, maternal health facilities, abortion legislation and maternal deaths: a natural experiment in Chile from 1957 to 2007.

BACKGROUND: The aim of this study was to assess the main factors related to maternal mortality reduction in large time series available in Chile in context of the United Nations' Millennium Development Goals (MDGs). METHODS: Time series of maternal mortality ratio (MMR) from official data (National Institute of Statistics, 1957-2007) along with parallel time series of education years, income per capita, fertility rate (TFR), birth order, clean water, sanitary sewer, and delivery by skilled attendants were analysed using autoregressive models (ARIMA). Historical changes on the mortality trend including the effect of different educational and maternal health policies implemented in 1965, and legislation that prohibited abortion in 1989 were assessed utilizing segmented regression techniques. RESULTS: During the 50-year study period, the MMR decreased from 293.7 to 18.2/100,000 live births, a decrease of 93.8%. Women's education level modulated the effects of TFR, birth order, delivery by skilled attendants, clean water, and sanitary sewer access. In the fully adjusted model, for every additional year of maternal education there was a corresponding decrease in the MMR of 29.3/100,000 live births. A rapid phase of decline between 1965 and 1981 (-13.29/100,000 live births each year) and a slow phase between 1981 and 2007 (-1.59/100,000 live births each year) were identified. After abortion was prohibited, the MMR decreased from 41.3 to 12.7 per 100,000 live births (-69.2%). The slope of the MMR did not appear to be altered by the change in abortion law. CONCLUSION: Increasing education level appears to favourably impact the downward trend in the MMR, modulating other key factors such as access and utilization of maternal health facilities, changes in women's reproductive behaviour and improvements of the sanitary system. Consequently, different MDGs can act synergistically to improve maternal health. The reduction in the MMR is not related to the legal status of abortion.

Estatura, factores de riesgo cardiovascular y riesgo de mortalidad en adultos: Proyecto San Francisco, Chile / Height, an early life predictor of cardiovascular risk factors and mortality in chilean adults: the San Francisco Project cohort study

Antecedentes: Una relación inversa entre estatura y riesgo de mortalidad ha sido establecida en estudios prospectivos de países desarrollados. Sin embargo, dicha asociación prácticamente permanece inexplorada en sociedades latinoamericanas en rápida transición económica y epidemiológica. Diseño: De un universo de 11.600 adultos viviendo en el centro urbano de Mostazal, Chile, se realizó un estudio de cohorte prospectivo de una muestra aleatoria ponderada de 795 sujetos seguidos durante 8 años. Método: Desde 1997 a 1999 se evaluó la estatura (percentiles 50 y 75 por sexo), hipertensión, diabetes, dislipidemia, obesidad, tabaquismo, consumo de alcohol y antecedentes hereditarios de enfermedad cardiovascular. El riesgo relativo de mortalidad por cualquier causa fue estimado a través de modelos de regresión de Cox ajustando por edad, sexo, factores de riesgo, educación e ingreso. Resultados: Se observó una relación inversa entre la estatura adulta y los factores de riesgo cardiovascular. En el modelo completamente ajustado el riesgo de mortalidad por cualquier causa asociado a la estatura fue 0,75 (IC 95 por ciento 0,66 - 0,85; p tendencia <0,001). Los factores de riesgo cardiovascular tradicionales solo explicaron 22 por ciento de la asociación inversa establecida entre estatura y mortalidad. Conclusión: En sociedades en transición económica como Chile, la estatura aparece como un factor de riesgo independiente de mortalidad. En esta cohorte de adultos chilenos, los factores de riesgo cardiovascular tradicionales solo explicaron parcialmente la relación inversa entre estatura y mortalidad.

Background: The inverse relationship between height and mortality risk has been well established in developed countries, but remains practically unexplored in Latin American societies. Setting: Chile, 11,600 adults living in the urban centre of Mostazal. Design: Prospective cohort study of a weighted random sample of 795 subjects followed during 8 years. Methods: Height (percentiles 50 and 75 by sex) along hypertension, diabetes, dyslipidemia, obesity, smoking, alcohol consumption and hereditary cardiovascular disease were assessed at baseline. Relative risks of all-cause mortality with 95% confidence intervals were computed in Cox regression models adjusting for age, gender, cardiovascular risk factors and joint-effects of other socioeconomic measures. Results: A significant inverse relationship between cardiovascular risk factors and height was observed. The risk of all cause mortality was 0.75 (95 percent CI 0.66 - 0.85; p-for trend <0.001) after full adjustments. Traditional cardiovascular risk factors explained only 22 percent of the association for height with mortality risk. Conclusions: In this adult cohort, traditional cardiovascular risk factors only explained partially the inverse relationship between height and all-cause mortality. Similar to developed countries, in economic transitioning societies such as Chile, height is an independent risk factor, likely reflecting different early exposure patterns that influence the health status during the life course.

Early life and adult socioeconomic influences on mortality risk: preliminary report of a 'pauper rich' paradox in a Chilean adult cohort.

PURPOSE: The inverse relationship between early life and adult socioeconomic measures and mortality risk has been well established in developed countries, but remains practically unexplored in Latin American societies. The setting was Chile; the study included 11,600 adults living in the urban center of San Francisco de Mostazal. This was a prospective cohort study of a weighted random sample of 795 subjects followed up during 8 years. METHODS: Education (elementary, high school and college), height (percentiles 50 and 75), and income (population quartiles) were assessed at baseline. Relative risks of all-cause mortality were computed in Cox regression models adjusting for age, gender, body mass index, smoking status, and joint effects of the socioeconomic measures. RESULTS: A graded inverse relationship with all-cause mortality was observed for education (risk: 1.0, 0.67, and 0.30, p for trend < 0.01) and height (risk: 1.0, 0.75, and 0.56, p for trend < 0.01), but not for income (p for trend = 0.94). CONCLUSIONS: These findings suggest a 'pauper rich' paradox in transitioning Latin American economies. Income level does not seem sufficient to improve survival in cohorts exposed to adverse early life influences reflected by education and height.

[Acute traumatic transection of the thoracic aorta: endovascular treatment]. / Transección traumática aguda de la aorta torácica: tratamiento endovascular.

Traumatic rupture of the aorta has a near 80% mortality. Most patients die on the site of the accident. Conventional surgical repair of these lesions has a high morbidity and mortality, generally associated to the severity of associated lesions. Over the last decade, endovascular treatment has become an effective therapeutic alternative. We report a 40 years old male, that suffered a traumatic rupture of the descending thoracic aorta in a car accident. A successful endovascular repair was performed, installing an endoprothesis on the site of the lesion, using a femoral artery approach. The patient had a good postoperative evolution and was discharged from the hospital once complete rehabilitation of his associated lesions was obtained.

Traumatismo hepático / Hepatic trauma

Se analizó los resultados obtenidos en el tratamiento de 35 pacientes con traumatismos hepático (1984-1991). La mayoría de sexo masculino, edad promedio 27,5 años. El 94% fue debido contusión y el 80% tenía lesiones asociadas. Catorce eran menores (Grado I ó II) y los 21 restantes eran traumatismos hepáticos complejos. (Grado III, IV ó V). Tres se trataron en forma conservadora. La indicación quirúrgica inicial fue clínica en 17 ó mediante un lavado peritoneal en 11. El 66% pudo ser tratado con medidas simples (electrocoagulación o hepatorrafia simple). En las restantes se utilizó hepatotomía (8,6%) o resección (20%). Como medidas adicionales se utilizó packing (4), toracotomía y clampeo aórtico (4), shunt cavo (2) y Balón de Morimoto (1). Doce pacientes presentaron complicaciones, siendo reintervenidos siete (21,9%). Fallecen por el traumatismo hepático seis pacientes (17,1%), cinco de ellos por hemorragia