Cómo intervenir y prevenir el retraso del crecimiento en niños menores de cinco años de hogares incluidos en el Sisbén de Caldas / How to intervene and prevent stunting of children from homes belonging to the Sisbén in Caldas

Resumen Introducción. El retraso del crecimiento o la desnutrición crónica (baja estatura para la edad) indica un fracaso en el logro del potencial genético con el que nacemos. Objetivo. Estimar modelos predictivos de retraso del crecimiento en hogares con menores de cinco años en el departamento de Caldas, inscritos en el Sistema de Identificación de Potenciales Beneficiarios de Programas Sociales (Sisbén). Materiales y métodos. Se hizo un estudio analítico en todos los hogares (N=56.987) incluidos en la base de datos del Sisbén III con presencia de menores de cinco años (N=33.244). Las variables estudiadas fueron las características demográficas y socioeconómicas, el acceso a la salud, la vivienda, la pobreza, la educación, el mercado laboral y el retraso del crecimiento. El análisis multivariado se realizó en dos fases: en la primera, se llevó a cabo un análisis exploratorio en los hogares mediante un análisis de clasificación jerárquica (conglomerado) y, luego, se estimó un modelo no lineal predictivo (probit) con el retraso del crecimiento como variable dependiente. Resultados. La mayor proporción de retraso del crecimiento en los menores de cinco años se encontró en la subregión Centro Sur, en la cabecera municipal y en los hogares con ingresos menores de USD$65 mensuales. Conclusión. La pobreza de los hogares caldenses con jefatura femenina en los que viven los menores de cinco años inscritos en el Sisbén, es el mayor predictor de su retraso en el crecimiento.

Abstract Introduction: Growth retardation or chronic malnutrition (low height for age) indicates a failure in the natural genetic potential that allows us to growth. Objective: To estimate predictive models of growth retardation in households with children younger than five years in the department of Caldas and registered in the identification system of potential beneficiaries of social programs ( Sistema de Identificación de Potenciales Beneficiarios de Programas Sociales, Sisbén ). Materials and methods: We conducted an analytical study in all households (N=56,987) included in the Sisbén III database with the presence of children younger than five years (N=33,244). The variables under study were demographic and socioeconomic characteristics, health service access, housing, poverty, education, job market, and growth retardation. The multivariate analysis was done in two phases: first, an exploratory analysis of households using hierarchical classification (cluster), then estimation of a nonlinear predictive model (probit) with growth retardation as the dependent variable. Results. The largest proportion of growth retardation in children younger than five years was found in southcentral Caldas, in urban centers, and households with monthly income lower than USD$ 65. Conclusion. Poverty in Caldas women-headed households with children younger than five years registered in the Sisbén was the main predictor of growth retardation.

[How to intervene and prevent stunting of children from homes belonging to the Sisbén in Caldas].

INTRODUCTION: Growth retardation or chronic malnutrition (low height for age) indicates a failure in the natural genetic potential that allows us to growth. OBJECTIVE: To estimate predictive models of growth retardation in households with children younger than five years in the department of Caldas and registered in the identification system of potential beneficiaries of social programs (Sistema de Identificación de Potenciales Beneficiarios de Programas Sociales, Sisbén). MATERIALS AND METHODS: We conducted an analytical study in all households (N=56,987) included in the Sisbén III database with the presence of children younger than five years (N=33,244). The variables under study were demographic and socioeconomic characteristics, health service access, housing, poverty, education, job market, and growth retardation. The multivariate analysis was done in two phases: first, an exploratory analysis of households using hierarchical classification (cluster), then estimation of a nonlinear predictive model (probit) with growth retardation as the dependent variable. RESULTS: The largest proportion of growth retardation in children younger than five years was found in southcentral Caldas, in urban centers, and households with monthly income lower than USD$ 65. CONCLUSION: Poverty in Caldas women-headed households with children younger than five years registered in the Sisbén was the main predictor of growth retardation.

Exposición a pantallas, sobrepeso y desacondicionamiento físico en niños y niñas / Exposure to screens, being overweight and physical deconditioning in children

Antecedentes. El sobrepeso y la obesidad infantil son un problema grave de salud. La actividad física determina la capacidad cardiorespiratoria. Los datos relacionados con el sobrepeso, obesidad y exposición a pantallas no son concluyentes.Métodos. Encuestamos a niños y niñas de edades entre 10 y 12 años acerca del tiempo frente a pantallas. Adicionalmente realizamos mediciones antropométricas y funcionales.Resultados. Estudiamos a 325 niños y niñas. El tiempo promedio frente a pantallas fue de 4.96 horas/día, permaneciendo los hombres más tiempo frente a pantallas. La prevalencia de sobrepeso fue de 22.8% y de obesidad 2.8%. El estudio no demostró diferencias antropométricas entre los sujetos con permanencias superiores e inferiores a 2 horas/día frente a pantallas.Conclusiones. Es elevado el número de horas de exposición frente a pantallas.

Maximal aerobic power in patients with chronic low back pain: a comparison with healthy subjects.

The objective of the study was to compare the maximal aerobic capacity of patients with chronic low back pain with healthy asymptomatic controls matched for age, gender and level of physical activity at work and during sports activities. Reported data in the literature with respect to aerobic capacity in patients with chronic low back pain are not conclusive. Nevertheless, based on the assumption that chronic low back pain leads to deconditioning, physical training programs are widely used as a treatment. A total of 70 patients with chronic low back pain and 70 healthy asymptomatic subjects completed questionnaires regarding demographics and performed a graded maximal exercise test until exhaustion on a cycle ergometer. The maximal aerobic power was measured by indirect calorimetry. Heart rate, respiratory exchange ratio and blood lactate levels were also measured. The test was considered maximal when VO2max achievement criteria were obtained. VO2max values were compared among groups. The absolute and normalized for weight values of VO2max measured in patients with chronic low back pain were significantly lower than that of the control group. Independent comparison between men and women showed that absolute values of VO2max are also significantly lower in men and women with chronic low back pain. Women reached absolute and normalized for weight VO2max values significantly lower than those of men, both in chronic low back pain and control group. In conclusion, chronic low back pain patients, especially women, seem to have a reduced aerobic capacity compared to healthy asymptomatic subjects.

Aerobic fitness and limiting factors of maximal performance in chronic low back pain patients.

BACKGROUND: Studies of measurement of maximal aerobic uptake in patients with chronic low back pain have shown inconsistent results and none has focused on clinical endpoints of ergometry tests. OBJECTIVE: To determine the level of cardiorespiratory fitness and to establish factors limiting the maximal effort during the ergometry. METHODS: Patients with chronic low back pain performed a graded maximal exercise test. Clinical endpoints of the test were determined and grouped as "maximal effort" and "symptom-limited effort" endpoints. RESULTS: 101 patients aged 29.8 +/- 7.5 achieved a VO2 max value of 30.0 (+/- 7.27) ml.kg(-1).min(-1). In men and women independently, a linear regression analysis demonstrated that VO2 max was inversely and weakly related to age. When compared to normative categories of VO2 max, men and women were situated in the fair category. Quadriceps/leg fatigue was reported by 47.5% of patients and was the most frequent limiting factor of the tests. "Symptom limited effort" endpoints were reported by 54.4% of the subjects. CONCLUSIONS: Clinical limiting factors of maximal exertion interfere the achievement of maximal oxygen uptake in patients with low back pain during ergometry. Further, there exists an association among the clinical endpoints of the tests and the VO2 value achieved. CLBP patients have a lower level of aerobic fitness than healthy controls.

A new non exercise-based VO2max prediction equation for patients with chronic low back pain.

UNLABELLED: INTRODUCTION The measurement of the maximal oxygen uptake as a parameter of cardiorespiratory fitness is useful in exercise prescription in functional restoration programs but this measurement requires the subject's maximal exertion which is not always possible in patients with chronic low back pain. The purpose of this study was to develop a regression equation to predict maximal oxygen uptake based on non-exercise data in adult patients with chronic low back pain. METHODS: Cross sectional study in which 70 participants completed a maximal graded exercise test in cycle ergometer to assess maximal oxygen uptake. RESULTS: Patients achieved a mean +/- SD value of VO(2)max of 30.8 (+/-7.7) ml kg(-1) min(-1). The regression model included as data of non-exercise the patient's gender, body mass index and the intensity of physical activity during leisure time. Multiple linear regression analysis generated the following formula (R (2) = 38.3, SEE = 6.08 ml kg(-1) min(-1)): VO(2)max (ml kg(-1) min(-1)) = 35.3377 - 0.475411 x BMI + 0.155232 x PALT + 7.97682 x gender; where BMI = body mass index, PALT = physical activity during leisure time, women = 0, men = 1. The Durbin Watson statistic showed no problems with serial autocorrelation (D-W = 1.86). The Kolmogorov-Smirnov normality test demonstrated that the errors are distributed normally. CONCLUSIONS: This study provides a new and relatively precise non-exercise regression model to predict VO(2)max in patients with chronic low back pain.

Physical deconditioning in chronic low back pain.

OBJECTIVE: To establish the level of cardiorespiratory fitness and the rate of decrease in maximal aerobic capacity according to age in patients with chronic low back pain and compare these with normative data. DESIGN: Prospective case series with historical controls. SUBJECTS/PATIENTS: Seventy patients with chronic low back pain. METHODS: A maximal cycle ergometer protocol was used to measure VO2max, heart rate, respiratory exchange ratio and blood lactate levels. RESULTS: Seventy patients achieved absolute and normalized for weight VO2max values of 2.17 (standard deviation (SD) 0.65) l/min and 30.79 (SD 7.77) ml/kg/min, respectively. Absolute VO2max was poorly related to age in both men and women with chronic low back pain (r = -0.22 and r = -0.28, respectively). VO2max normalized for weight was also inversely related to age in both men and women (r = -0.36 and r = -0.42, respectively). The rate of VO2max decline between 20 and 59 years was -3.3 ml/kg/min/decade for the entire population and -1.2 and -5.4 ml/kg/min/decade in men and women, respectively. CONCLUSION: The level of physical fitness of patients with chronic low back pain is comparable to the physical fitness of healthy, but poorly conditioned subjects. Patients with chronic low back pain show a VO2max decline with ageing that is slower than of active subjects.

[Dental fluorosis in primary school students of the department of Caldas, Colombia]. / Fluorosis dental en escolares del departamento de Caldas, Colombia.

BACKGROUND: A prevalence survey of dental fluorosis was conducted among primary school students in Caldas, a small province in west central Colombia. MATERIALS AND METHODS: The cross-sectional study compared the prevalence of dental fluorosis in the four regions of Caldas. In the urban area, a probabilistic sample was selected and,in the rural areas, students were sampled in locations that were readily accessible. One thousand sixty-one students were examined while at school in daylight conditions. The surveillance tool applied was the Dean Index. Univariate and bivariate analyses were made with a chi-square test being applied for the latter to show independence among variables. RESULTS: Sixty-three percent (95% CI: 60-66%) of primary school students were affected by fluorosis to some degree of severity. Among them, 56% (95% CI: 52-59) were classified in the mild and very mild degrees, whereas 7% (95% CI: 2-16) were classified as moderate or severe. A statistically significant association between the region variable and dental fluorosis was observed. However, no association was found with gender, area, schooling or age variables. Within Caldas, the eastern region showed the lowest prevalence (47.9%) in contrast to the other three areas (northern, central-south and western) where prevalences exceeded 68%. CONCLUSIONS: At least two of three primary school students in Caldas suffer from some degree of dental fluorosis.

Fluorosis dental en escolares del departamento de Caldas, Colombia / Dental fluorosis in primary school students of the department of Caldas, Colombia

Objetivo. Determinar la prevalencia de fluorosis dental en los escolares del departamento de Caldas en el 2002.Materiales y métodos. Se realizó un estudio de corte transversal en escolares de las cuatro regiones del departamento, para lo cual se seleccionó una muestra probabilística para el área urbana y por conveniencia para la rural. Se examinaron 1.061 escolares en las mismas instalaciones de los establecimientos educativos, en condiciones de luz natural y utilizando los criterios de Dean. Se llevó a cabo análisis univariado y bivariado; para el último se empleó c2 como prueba de independencia entre variables. Resultados. Se encontró que el 63,3 por ciento (IC95 por ciento: 60,0 a 66,1) de los escolares de Caldas estaba afectado por fluorosis dental en algún grado. El 56,3 por ciento(IC95 por ciento: 52 a 59) de los escolares se encontró en las categorías muy leve y leve, mientras el 7 por ciento(IC95 por ciento: 2 a 16) se hallaba en las categorías moderada y grave. Se observó asociación estadísticamente significativa de la variable región con fluorosis dental, pero no con las variables sexo, área, nivel de escolaridad y edad. La región Oriente mostró una menor prevalencia (47,9 por ciento) con relación a las otras tres áreas (Norte, Centro-Sur y Occidente) que presentaron prevalencias superiores al 68 por ciento. Conclusiones. La fluorosis dental se presenta en algún grado en dos de cada tres escolares