The socioeconomic distribution of life expectancy and healthy life expectancy in Chile.

BACKGROUND: Life expectancy (LE) has usually been used as a metric to monitor population health. In the last few years, metrics such as Quality-Adjusted-Life-Expectancy (QALE) and Health-Adjusted-Life- Expectancy (HALE) have gained popularity in health research, given their capacity to capture health related quality of life, providing a more comprehensive approach to the health concept. We aimed to estimate the distribution of the LE, QALEs and HALEs across Socioeconomic Status in the Chilean population. METHODS: Based on life tables constructed using Chiang II´s method, we estimated the LE of the population in Chile by age strata. Probabilities of dying were estimated from mortality data obtained from national registries. Then, life tables were stratified into five socioeconomic quintiles, based on age-adjusted years of education (pre-school, early years to year 1, primary level, secondary level, technical or university). Quality weights (utilities) were estimated for age strata and SES, using the National Health Survey (ENS 2017). Utilities were calculated using the EQ-5D data of the ENS 2017 and the validated value set for Chile. We applied Sullivan´s method to adjust years lived and convert them into QALEs and HALEs. RESULTS: LE at birth for Chile was estimated in 80.4 years, which is consistent with demographic national data. QALE and HALE at birth were 69.8 and 62.4 respectively. Men are expected to live 6.1% less than women. However, this trend is reversed when looking at QALEs and HALEs, indicating the concentration of higher morbidity in women compared to men. The distribution of all these metrics across SES showed a clear gradient in favour of a better-off population-based on education quintiles. The absolute and relative gaps between the lowest and highest quintile were 15.24 years and 1.21 for LE; 18.57 HALYs and 1.38 for HALEs; and 21.92 QALYs and 1.41 for QALEs. More pronounced gradients and higher gaps were observed at younger age intervals. CONCLUSION: The distribution of LE, QALE and HALEs in Chile shows a clear gradient favouring better-off populations that decreases over people´s lives. Differences in LE favouring women contrast with differences in HALEs and QALEs which favour men, suggesting the need of implementing gender-focused policies to address the case-mix complexity. The magnitude of inequalities is greater than in other high-income countries and can be explained by structural social inequalities and inequalities in access to healthcare.

The risks of the new morbidities acquired during pediatric onco-critical care and their life-shortening effects.

OBJECTIVE: The authors investigated the functional status at ICU admission and at hospital discharge, and the impact of dysfunctions on survivors' lifespan. METHOD: Single-center retrospective cohort. The FSS (Functional Status Scale) was calculated at ICU admission and at hospital discharge. A new morbidity was defined as an increase in FSS ≥ 3. RESULTS: Among 1002 patients, there were 855 survivors. Of these, 194 (22.6%) had died by the end of the study; 45 (5.3%) had a new morbidity. Means in the motor domain at admission and discharge were 1.37 (SD: 0.82) and 1.53 (SD 0.95, p = 0.002). In the feeding domain, the means were 1.19 (SD 0.63) and 1.30 (SD 0.76), p = 0.002; global means were 6.93 (SD 2.45) and 7.2 (SD 2.94), p = 0.007.  Acute respiratory failure requiring mechanical ventilation, the score PRISM IV, age < 5 years, and central nervous system tumors were independent predictors of new morbidity. New morbidity correlated with lower odds of survival after hospital discharge, considering all causes of death (p = 0.014), and was independently predictive of death (Cox hazard ratio = 1.98). In Weibull models, shortening in the life span of 14.2% (p = 0.014) was estimated as a new morbidity. CONCLUSIONS: New morbidities are related to age, disease severity at admission, and SNC tumors. New morbidities, in turn, correlate with lower probabilities of survival and shortening of the remaining life span. Physical rehabilitation interventions in this population of children may have the potential to provide an increase in lifespan.

The risks of the new morbidities acquired during pediatric onco-critical care and their life-shortening effects

Abstract Objective: The authors investigated the functional status at ICU admission and at hospital discharge, and the impact of dysfunctions on survivors' lifespan. Method: Single-center retrospective cohort. The FSS (Functional Status Scale) was calculated at ICU admission and at hospital discharge. A new morbidity was defined as an increase in FSS ≥ 3. Results: Among 1002 patients, there were 855 survivors. Of these, 194 (22.6%) had died by the end of the study; 45 (5.3%) had a new morbidity. Means in the motor domain at admission and discharge were 1.37 (SD: 0.82) and 1.53 (SD 0.95, p = 0.002). In the feeding domain, the means were 1.19 (SD 0.63) and 1.30 (SD 0.76), p = 0.002; global means were 6.93 (SD 2.45) and 7.2 (SD 2.94), p = 0.007. Acute respiratory failure requiring mechanical ventilation, the score PRISM IV, age < 5 years, and central nervous system tumors were independent predictors of new morbidity. New morbidity correlated with lower odds of survival after hospital discharge, considering all causes of death (p = 0.014), and was independently predictive of death (Cox hazard ratio = 1.98). In Weibull models, shortening in the life span of 14.2% (p = 0.014) was estimated as a new morbidity. Conclusions: New morbidities are related to age, disease severity at admission, and SNC tumors. New morbidities, in turn, correlate with lower probabilities of survival and shortening of the remaining life span. Physical rehabilitation interventions in this population of children may have the potential to provide an increase in lifespan.

Caracterización sobre los pacientes operados de cáncer colorrectal tratados con quimioterapia adyuvante en Camagüey

Introducción: El cáncer colorrectal es un problema de salud creciente en el mundo, el aumento en la expectativa de vida de las poblaciones, el continuo mejoramiento de las técnicas de tamizaje y la búsqueda activa de casos, son las razones por las cuales cada año se informa un aumento en el número global de casos diagnosticados con cáncer. Objetivo: Caracterizar a los pacientes operados de cáncer colorrectal tratados con quimioterapia. Métodos: Se realizó un estudio observacional, descriptivo de corte transversal, en pacientes atendidos en la consulta multidisciplinaria de cáncer colorrectal. El universo lo conformaron todos los pacientes que acudieron a consulta en ese período, la muestra a criterio de los autores la conformaron 55 pacientes tratados con quimioterapia adyuvantes por cáncer colorrectal. La fuente primaria de la investigación estuvo dada por la historia clínica. Resultados: En cuanto a la relación sexo y edad, se observó una mayor frecuencia del grupo de 70-79 años y en el sexo femenino. Según la localización topográfica existió predominio en colon sigmoides con 33 pacientes para un 60 % de la muestra estudiada. La variante histológica adenocarcinoma moderadamente diferenciado fue la de mayor presentación. Predominaron los pacientes en estadio IIIa de la enfermedad. El esquema de quimioterapia usado con mayor frecuencia fue el Folfox. Conclusiones: En la muestra, la mayoría de los pacientes estuvieron incluidos en el grupo etáreo entre 70-79 años de edad. La localización topográfica más frecuente fue el colon sigmoide y el tipo histológico, el adenocarcinoma moderadamente diferenciado. Predominaron los pacientes en el estadio IIIa y el tratamiento con quimioterapia adyuvante más utilizado fue el esquema de Folfox.

Introduction: Colorectal cancer is a growing health problem in the world, the increase in the life expectancy of populations, the continuous improvement of screening techniques and the active search for cases, are the reasons why an increase in the global number of cases diagnosed with cancer is reported each year. Objective: To characterize the patients operated on for colorectal cancer treated with adjuvant chemotherapy. Methods: An observational, descriptive, cross-sectional study was carried out in patients seen at the multidisciplinary colorectal cancer clinic. The universe was made up of all the patients who attended the consultation in that period, the sample at the authors' criteria was made up of 55 patients treated with adjuvant chemotherapy for colorectal cancer. The primary source of the investigation was given by the clinical history. Results: Regarding the relationship between sex and age, a higher frequency was observed in the group of 70-79 years and in the female sex. Regarding the topographic location, there was a predominance in the sigmoid colon with 33 patients for 60% of the sample studied. The moderately differentiated adenocarcinoma histological variant was the one with the highest presentation. Patients in stage IIIa of the disease were more frequent. The most frequently used chemotherapy regimen was Folfox. Conclusions: In the sample, most of the patients were included in the age group between 70-79 years of age. The most frequent topographic location was the sigmoid colon and the histological type was moderately differentiated adenocarcinoma. Patients in stage IIIa predominated and the most widely used adjuvant chemotherapy treatment was the Folfox regimen.

Años de vida saludable perdidos por diabetes mellitus en Cuba / Years of Healthy Life Lost Due to Diabetes Mellitus in Cuba

Introducción: El reciente incremento de la prevalencia de la diabetes mellitus en Cuba sucedió con mayor celeridad, y las políticas encaminadas a su control requieren de su cuantificación sistemática. Objetivo: Identificar las diferencias en Cuba, según provincia y sexo, de los años de vida saludable perdidos por la diabetes mellitus en el 2015. Métodos: En el estudio de extensión nacional se obtuvieron los años de vida saludable perdidos como resultado de la suma de los años perdidos de vida potencial por mortalidad prematura y los años de vida perdidos por morbilidad y otros indicadores para identificar la mortalidad temprana en el año 2015. Resultados: En todas las provincias los índices de años de vida saludable perdidos por morbilidad superaron los de mortalidad prematura con predominio del sexo femenino, mientras en la mayoría de las provincias, las edades de las defunciones fueron más tempranas en el masculino. Las diferencias halladas permitieron agrupar a Artemisa, La Habana, Mayabeque, Matanzas, Villa Clara, Cienfuegos, Santi Spíritus y Camagüey, con los mayores promedios de años perdidos por morbilidad y fallecimientos más tardíos, y al resto de las provincias cubanas, con los menores años perdidos por morbilidad, pero con defunciones en edades más tempranas. Conclusiones: Las pérdidas de años de vida saludable difieren según el sexo y la provincia. Este conocimiento permite la identificación de diferentes patrones de morbimortalidad útiles para orientar las acciones de prevención y control de la enfermedad para cada territorio(AU)

Introduction: The recent increase in the prevalence of diabetes mellitus in Cuba occurred more rapidly, and policies aimed at its control require systematic quantification. Objective: To identify the differences in Cuba, according to province and sex, of the years of healthy life lost due to diabetes mellitus in 2015. Methods: The national extension study collected data on the healthy years of life lost as a result of the sum of years lost from potential life due to premature mortality and years of life lost due to morbidity and other indicators to identify early mortality in 2015. Results: In all provinces, the rates of years of healthy life lost due to morbidity exceeded those of premature mortality with a predominance of women, while in most provinces, the ages of death were earlier in the male sex. The differences found allowed to group Artemisa, Havana, Mayabeque, Matanzas, Villa Clara, Cienfuegos, Santi Spíritus and Camagüey provincesn with the highest averages of years lost due to morbidity and later deaths, and the rest of the Cuban provinces, with the lowest years lost due to morbidity, but with deaths at younger ages. Conclusions: Losses of years of healthy life differ by sex and province. This knowledge allows the identification of different patterns of morbidity and mortality useful to guide the prevention and control actions of the disease for each territory(AU)

Vida saudável? Os discursos construídos no Instagram pelo médico Mohamad Barakat / Healthy life? The discourses constructed by the doctor Mohamad Barakat on Instagram / ¿Vida saludable? Los discursos construidos por el médico Mohamad Barakat en Instagram

Em meio ao crescimento da participação de médicos nas mídias sociais digitais, este artigo objetiva analisar os discursos sobre vida saudável produzidos no Instagram pelo médico Mohamad Barakat (@doutorbarakat). O corpus é composto por stories selecionados a partir de uma coleta diária realizada ao longo de três meses em 2020. Como referencial teórico-metodológico recorre-se à semiótica discursiva e à semiótica plástica. Os resultados apontam a construção do discurso de vida saudável revestido por temas como rotina, estilo de vida, comportamento, aconselhamento e autocuidado, figurativizados por elementos de comprovação e reforçados pelo arranjo expressivo, em que a presença do médico é marcada por informalidade, intimidade e proximidade. Uma concepção de vida saudável que dialoga com a otimização de si discutida por Paula Sibilia e Marianna Ferreira Jorge e com a busca da aptidão levantada por Zygmunt Bauman

Amid growing physician participation in digital social media, this article aims to analyse the discourses on healthy living produced on Instagram by doctor Mohamad Barakat (@doutorbarakat). The corpus consists of stories selected from a daily collection carried out over three months in 2020. As a theoretical and methodological reference, discursive semiotics and plastic semiotics are used. The results reveal the construction of the healthy life discourse covered by themes such as routine, lifestyle, behaviour, counselling and self-care, figuratively represented by elements evidencing them and reinforced by the expressive arrangement, in which the presence of the doctor is characterized by informality, intimacy and proximity. A conception of healthy life that dialogues with the optimization of oneself discussed by Paula Sibilia and Marianna Ferreira Jorge and with the search for fitness approached by Zygmunt Bauman

En medio del crecimiento de la participación de los médicos en las redes sociales digitales, este artículo tiene como objetivo analizar los discursos sobre vida saludable producidos en el Instagram por el médico Mohamad Barakat (@doutorbarakat). El corpus está compuesto por relatos seleccionados de una compilación diaria realizada durante tres meses en 2020. Como referente teórico-metodológico, han sido utilizadas la semiótica discursiva y la semiótica plástica. Los resultados revelan la construcción del discurso de vida saludable revestido por temas como la rutina, el estilo de vida, el comportamiento, las recomendaciones y el autocuidado, figurado por elementos de comprobación y reforzados por el arreglo expresivo, en el cual la presencia del médico es caracterizada por la informalidad, intimidad y proximidad. Una concepción de vida saludable que dialoga con la optimización de sí mismo discutida por Paula Sibilia y Marianna Ferreira Jorge y con la búsqueda de la aptitud planteada por Zigmunt Bauman

Science-based policy: targeted nutrition for all ages and the role of bioactives.

Globally, there has been a marked increase in longevity, but it is also apparent that significant inequalities remain, especially the inequality related to insufficient 'health' to enjoy or at least survive those later years. The major causes include lack of access to proper nutrition and healthcare services, and often the basic information to make the personal decisions related to diet and healthcare options and opportunities. Proper nutrition can be the best predictor of a long healthy life expectancy and, conversely, when inadequate and/or improper a prognosticator of a sharply curtailed expectancy. There is a dichotomy in both developed and developing countries as their populations are experiencing the phenomenon of being 'over fed and under nourished', i.e., caloric/energy excess and lack of essential nutrients, leading to health deficiencies, skyrocketing global obesity rates, excess chronic diseases, and premature mortality. There is need for new and/or innovative approaches to promoting health as individuals' age, and for public health programs to be a proactive blessing and not an archaic status quo 'eat your vegetables' mandate. A framework for progress has been proposed and published by the World Health Organization in their Global Strategy and Action Plan on Ageing and Health (WHO (2017) Advancing the right to health: the vital role of law. https://apps.who.int/iris/bitstream/handle/10665/252815/9789241511384-eng.pdf?sequence=1&isAllowed=y . Accessed 07 Jun 2021; WHO (2020a) What is Health Promotion. www.who.int/healthpromotion/fact-sheet/en/ . Accessed 07 Jun 2021; WHO (2020b) NCD mortality and morbidity. www.who.int/gho/ncd/mortality_morbidity/en/ . Accessed 07 Jun 2021). Couple this WHO mandate with current academic research into the processes of ageing, and the ingredients or regimens that have shown benefit and/or promise of such benefits. Now is the time for public health policy to 'not let the perfect be the enemy of the good,' but to progressively make health-promoting nutrition recommendations.

Facilitadores y barreras percibidos en la práctica de la actividad física en adolescentes escolarizados en Piedecuesta (Santander), en 2016: análisis cualitativo / Perceived facilitators and barriers to physical activity in adolescents in Piedecuesta (Santander), in 2016: qualitative analysis / Facilitadores e barreiras evidentes na prática da atividade física nos adolescentes em idade escolar em Piedecuesta Santander, em 2016: Análise qualitativa

Resumen Objetivo: Describir la percepción que tienen adolescentes escolarizados entre 12 y 16 años, en Piedecuesta (Santander), en 2016, sobre los facilitadores y las barreras que influyen en la práctica de la actividad física. Metodología: Análisis cualitativo desde un enfoque fenomenológico, con la participación de 20 adolescentes escolarizados que, mediante entrevistas semiestructuradas y un grupo focal, conversaron sobre la práctica, los beneficios, los entornos y la influencia y la compañía en relación con la actividad física, para identificar barreras y facilitadores. Resultados: La práctica de la actividad física se limitaba a las clases de educación física en la mayoría de los casos. El compañero principal en la práctica extracurricular era el padre del mismo sexo. La actividad física representaba una oportunidad para el disfrute, mejorar la salud física y mental, así como la contextura corporal, y para romper con la rutina diaria. La falta de tiempo por compromisos académicos fue la razón principal para no realizar actividad física. Los lugares públicos no siempre estaban disponibles, a menudo no se consideraban seguros. En la escuela, el espacio y las instalaciones eran inadecuados, y el uso estaba restringido. Conclusiones: La escuela es un punto de convergencia importante para la práctica de la actividad física, lo que sugiere la necesidad de fortalecer el plan de estudios al respecto; este entorno es un facilitador potencial para aumentar el nivel de actividad física en adolescentes. También se percibe como barrera, dado que la práctica interfiere con las actividades académicas. Las mejoras en la seguridad y el atractivo estético en el entorno comunitario se visibilizan como un facilitador para promover la actividad física.

Abstract Objective: Describe the perception of adolescents aged between 12 and 16 years, in Piedecuesta (Santander), in 2016, about the facilitators and barriers that influence physical activity. Methodology: Qualitative analysis from a phenomenological approach, with the participation of 20 adolescents who talked about the practice, benefits, environments, influence and company in connection with physical activity , to identify barriers and facilitators, through semi-structured interviews and a focus group. Results: Physical activity was limited to physical education classes in most cases. The main companion in extracurricular physical activity was the parent of the same sex. Physical activity represented an opportunity for enjoyment, improvement of physical and mental health, as well as body composition, and to have a break in their daily routine. Lack of time due to academic commitments was the main reason for not doing physical activity. Public places were not always available and they were often not considered to be safe. Space and facilities at school were inadequate, and their use was restricted.. Conclusions: The school is an important point of convergence for doing physical activity, suggesting the need to strengthen the curriculum in this respect; this environment is a potential facilitator to increasing the level of physical activity in adolescents. It can also be seen as a barrier, given that the practice interferes with academic activities. Improvements in safety and aesthetic appeal in the surrounding community are seen as a facilitator to promoting physical activity.

Resumo Objetivo: Descrever a percepção que os adolescentes entre 12 e 17 anos de Piedecuesta em Santander, tiveram em 2016 sobre os facilitadores e as barreiras que influenciaram na prática da atividade física. Metodologia: Análise qualitativa partindo de um foco fenomenológico, com a participação de 20 adolescentes em idade escolar que, através de entrevistas semiestruturadas e um grupo focal, conversaram sobre a prática, os benefícios, os entornos, a influência e o acompanhamento relacionados com a atividade física, para identificar barreiras e facilitadores. Resultados: Na maioria dos casos, a prática da atividade física limitava-se às aulas de educação física. O companheiro principal na prática extracurricular era o genitor ou genitora do mesmo sexo. A atividade física representava uma oportunidade para disfrutar, melhorar a saúde física e mental, além da estrutura corporal e para sair da rotina diária. A falta de tempo devido às responsabilidades escolares foi a principal razão para não realizarem atividade física. Os lugares públicos nem sempre estavam disponíveis e geralmente não são considerados seguros. Na escola, o espaço e as instalações eram inadequados e o uso estava restrito. Conclusões: A escola é um importante ponto de convergência para a prática da atividade física, o que determina a necessidade de fortalecer o currículo relacionado; esse ambiente é um facilitador potencial para aumentar o nível de atividade física nos adolescentes. Também se percebe como barreira, já que a prática interfere com as atividades escolares. As melhorias na segurança e um espaço comunitário mais atraente do ponto de vista estético são determinantes como facilitadores para a promoção da atividade física.

Un programa de prevención temprana de la obesidad: "HaViSa UC" (2009-2019) / An Early Obesity Prevention Program: HaViSa UC (2009-2019)

Resumen: Introducción: La prevención es la solución definitiva al grave problema epidemiológico nutricional de la niñez en nuestro país y el mundo, que es la obesidad. Objetivo: Describir los resultados de un programa de prevención de la obesidad en lactantes y preescolares, a diez años de su inicio. Sujetos y Método: Estudio retrospectivo, cuasi experimental, de la prevalencia de sobrepeso y obesidad, en niños y niñas asistentes a las salas-cuna y jardines infantiles de la Universidad Católica de Chile, desde la implementación en 2009 de un programa de promoción precoz de hábitos de vida saludable en alimentación y actividad física (HaViSa-UC), hasta 2019. Se obtuvo aprobación ética y se analizaron los registros anuales de las evaluaciones antropométricas (referencia OMS 2006), de cada mes de marzo, en los centros de tres campus universitarios, utilizando el programa Minitab 17. Las acciones implementadas por el HaViSa-UC fueron: evaluación del estado nutricional y comunicación con los padres, entrega de una alimentación saludable, promoción de un hábito activo de vida y educa ción para favorecer hábitos saludables de vida. Resultados: El promedio anual fue de 319 asistentes, 14% menores de dos años y 49,5% niñas. En marzo 2009 se detectó 32,6% de sobrepeso y 8,6% de obesidad, cifras que disminuyeron y se estabilizaron, alcanzando en marzo de 2019 a 23,8% y 4,7% respectivamente. Los eutróficos aumentaron desde 56,9% a 67,4%, sin aumentar el bajo peso. En el mismo período, zP/T bajó desde 0,84 ± 0,94 a 0,55 ± 0,87 (p = 0,00), y zT/E aumentó desde -0,36 ± 0,87 a -0,32 ± 0,90 (p > 0,05). Conclusión: Desde la implementación del programa HaViSa, en esta muestra de lactantes y preescolares la frecuencia de obesidad bajó en 45,4% y el sobrepeso en 27%, con estabilidad al cabo de diez años.

Abstract: Introduction: Prevention is the definitive solution to the serious nutritional epidemiological pro blem of children in our country and the world, obesity. Objective: To describe the results of an obesi ty prevention program for infants and preschoolers, ten years after its implementation. Subjects and Methods: Retrospective, and quasi-experimental study of the overweight and obesity prevalence, in children attending three nursery and preschool centers located at the Universidad Católica de Chile, since the implementation of a multidimensional program for early promotion of healthy lifestyle habits (HaViSa-UC) between 2009 and 2019. This study obtained ethical approval. Annual records of anthropometric assessment (WHO 2006) were analyzed using Minitab 17 software. The actions applied by the HaViSa-UC program were the assessment of nutritional status and communication with parents, delivery of healthy food, promotion of an active lifestyle, and education to encourage such healthy habits. Results: The annual mean was 319 subjects, 14% younger than two years old, and 49.5% were girls. In March 2009 (baseline), 32.6% had overweight and 8.6% obesity; both figures decreased reaching 23.8% and 4.7% respectively, in March 2019. Normal weight increased from 56.9 to 67.4% and malnutrition presented no increase. In the same period, zW/H dropped from 0.84 ± 0.94 to 0.55 ± 0.87 (p: 0.00), and zH/A increased from -0.36 ± 0.87 to -0.32 ± 0.90 (p > 0.05). Con clusion: Since the implementation of the HaViSa-UC Program, the frequency of obesity decreased by 45.4% and overweight by 27.2% in this sample of infants and preschoolers, remaining stable after 10 years.

El envejecimiento de la población chilena y los desafíos para la salud y el bienestar de las personas mayores / The aging of the chilean population and the challenges for health and wellbeing of older people

El envejecimiento de la población es un fenómeno global. El proceso ha adquirido mayor velocidad en países en desarrollo que la que tuvo en países desarrollados, los que enfrentan el proceso en un contexto de desarrollo socio-económico muy inferior. Chile es el país que ha aumentado más rápidamente la expectativa de vida al nacer (EVN) en la región, constituyéndose en el país con la mayor expectativa de vida de Sudamérica, con 79,5 años. Los logros económicos y socio-sanitarios alcanzados colocan a Chile entre los países de altos ingresos, sin embargo, persisten importantes desigualdades en la distribución del ingreso, lo que impacta negativamente en los indicadores de salud de los adultos mayores. En el estudio Alexandros se observó que, si bien la expectativa de vida es superior en las mujeres que en los hombres, la diferencia corresponde a expectativa de vida con discapacidad. El seguimiento de la cohorte SABE Chile mostró además importantes diferencias en la prevalencia e incidencia de limitación funcional entre los niveles socioeconómicos alto, medio y bajo en desmedro de estos últimos CONCLUSIONES Chile enfrenta un rápido envejecimiento poblacional en un contexto de profunda desigualdad socioeconómica, de género y urbano-rural en los adultos mayores, lo que plantea a la sociedad múltiples desafíos que deben ser enfrentados a la brevedad. La disminución de la brecha entre expectativa de vida total y expectativa de vida saludable, es posible a través de estilos de vida saludable y participación social sumado a un cuidado de la salud integrado y centrado en la persona.

The aging of the population is a global phenomenon. The process has gained greater speed in developing countries than it had in developed countries, which face the process in a much lower socio-economic development context. In the regional context, Chile is the country that has most rapidly increased life expectancy at birth (LEB), becoming the country with the highest life expectancy in South America, which currently reaches 79,5 years. The economic and socio-sanitary achievements of the country place Chile among the high-income countries, however important inequalities persist in the distribution of income, which negatively impacts the health indicators of older adults. In the Alexandros study, it was observed that although LE is higher in women than in men, life expectancy with disabilities is higher in women than in men. The follow-up of the SABE Chile cohort also showed important differences in the prevalence and incidence of functional limitation between high, medium and low socioeconomic levels at the expense of the latter CONCLUSIONS Chile faces rapid population aging in a context of profound socioeconomic, gender and urban-rural inequality in older people, which poses to society multiple challenges that must be addressed shortly. The reduction of the gap between total life expectancy and healthy life expectancy is possible promoting healthy lifestyles and social participation and providing a people centred, integrated health care.

Accesibilidad al agua como alternativa para promover su consumo en la Universidad de Panamá / Accessibility to drinking water as an alternative to promote its consumption at the Universidad de Panamá

RESUMEN Objetivo Identificar la capacidad de brindar un buen acceso a instalaciones y equipos que propicien el consumo de agua dentro de la Universidad de Panamá, como parte de su compromiso de promover comportamientos que beneficien la salud en esta comunidad. Metodología Se realizó un estudio estadístico descriptivo y análisis multivariado, utilizando la técnica de análisis de correspondencia entre las variables "Estamentos Universitarios" (estudiantes, docentes y administrativos) vs "Acceso a fuentes de agua" y el "Acceso a fuentes de agua" vs "Insumos para facilitar el consumo de agua". Resultados El 66,3% de los encuestados reconocieron al agua como la bebida más accesible para consumo, proveniente principalmente de las fuentes de agua, seguido del agua embotellada. Conclusiones Este trabajo pone de manifiesto el reconocimiento de la importancia del consumo de agua en la población universitaria, sugiriendo que la Universidad de Panamá provee de condiciones en infraestructura para que haya accesibilidad a ella, promoviendo así hábitos de consumo saludables, cumpliendo con su compromiso con la salud de la población.(AU)

ABSTRACT Objective To identify the capacity to provide appropriate access to facilities and equipment that encourage drinking water consumption at the Universidad de Panamá, as part of its commitment to promote behaviors that benefit the health of this community. Materials and Methods A descriptive statistical study and a multivariate analysis were carried out using the correspondence analysis technique to explore relationships among the variables "University Group" (students, teachers and administrative staff) vs. "Access to water sources" and "Access to water sources" vs. "Inputs to facilitate water consumption". Results 66.3% of the population surveyed recognized drinking water as the most accessible drink for consumption, mainly from water sources, followed by bottled water. Conclusions This work highlights the importance of promoting water consumption in the university population, suggesting that the Universidad de Panamá has infrastructure conditions that allow water intake, thus promoting healthy habits and fulfilling its commitment to the health of the population.(AU)

Expectativa de vida livre de fatores de risco relacionados ao estilo de vida na população brasileira / Life expectancy free of lifestyle-related risk factors in the Brazilian population

Com o aumento da expectativa de vida no Brasil, faz-se essencial conhecer a saúde e a qualidade dos anos vividos por essa população mais longeva. Nesse cenário, as Doenças Crônicas Não Transmissíveis (DCNT) apontam como principais causas de limitações, incapacidades e morbimortalidade. Mensurar os fatores de risco relacionados ao estilo de vida para DCNT é premissa indispensável para atender a esta demanda por meio de políticas públicas eficazes. Os objetivos deste trabalho foram: (1) identificar perfis multidimensionais de fatores de risco relacionados ao estilo de vida, descrevendo as prevalências dos perfis e características sociodemográficas e de autopercepção de saúde associadas; (2) estimar a expectativa de vida livre de fatores de risco relacionados ao estilo de vida na população brasileira. Foram utilizados dados da Pesquisa Nacional de Saúde (PNS) 2013. Para a identificação dos perfis de estilo de vida foi utilizado o método Grade of Membership (GoM), com dados de 45.881 indivíduos acima de 30 anos, a partir de 12 variáveis relacionadas a estilo de vida. A análise de características associadas a estes perfis foi realizada por meio do teste Quiquadrado de Pearson e Regressão logística incondicional. As prevalências do perfil saudável e as tábuas de vida da população brasileira para o ano de 2013 foram utilizadas, no método de Sullivan, para o cálculo da expectativa de vida livre de fatores de risco relacionados ao estilo de vida, nesta etapa foram selecionados os indivíduos com idade entre 30 e 69 anos, totalizando 40.942. Foram identificados dois perfis: um perfil denominado de "perfil saudável" (61,6%; IC95% 61,1 ­ 62,2), caracterizado pelo consumo adequado de frutas e vegetais, peixes, e consumo não regular de refrigerante, carne com gordura e feijão, pelo excesso de peso e atividade física recomendada no lazer. E outro perfil intitulado de "perfil de risco" (38,4%; IC95% 37,8 ­ 38,9), caracterizado pelo não consumo de marcadores saudáveis, exceto o consumo de feijão, pelo consumo de todos os marcadores não saudáveis de alimentação, substituir refeições por lanches, consumo de álcool, uso de tabaco, por não serem fisicamente ativos no lazer e por serem eutróficos. O perfil saudável se associou ao sexo feminino, idosos, brancos, residentes no Norte e Nordeste, viúvos, casados, com maior escolaridade e melhor autoavaliação de saúde. Já o perfil de risco se associou ao sexo masculino, adultos jovens, residentes no Centro-oeste e Sul, solteiros, com menor escolaridade e pior autoavaliação de saúde. O tempo estimado a ser vivido pelos brasileiros livre de fatores de risco relacionados ao estilo de vida, aos 30 anos de idade, foi de 33,5 anos para as mulheres e 25,5 anos para os homens. O sexo feminino apresentou maior expectativa de vida livre de fatores de risco em todas as idades. Os achados do presente estudo evidenciam a associação do estilo de vida às características sociodemográficas e contribuem para a discussão sobre desigualdades de gênero existente na morbimortalidade. Os homens brasileiros vivem menos tempo livre de fatores de risco relacionados ao estilo de vida, o que pode contribuir com as elevadas taxas de mortalidade prematura (AU).

The increase in life expectancy in Brazil makes it essential to know the health and the quality of the years lived by the country's longest-lived population. In this context, Chronic Non-communicable Diseases (NCDs) point out as the main causes of limitations, disabilities and morbimortality. Measuring of lifestyle-related modifiable risk factors for NCDs is an indispensable premise for meeting this emerging demand through effective public policy. The objectives of this study were: (1) to identify multidimensional profiles of lifestyle-related risk factors, describing the prevalence of the sociodemographic and self-perceived health profiles and their characteristics; (2) to estimate life expectancy free from lifestyle-related risk factors in the Brazilian population. This study based on data from the National Health Survey (Pesquisa Nacional de Saude, PNS) published in 2013. Grade of Membership (GoM) method was used to identify lifestyle profiles, with data from 45,881 individuals over 30 years by applying the inclusion of 12 lifestyle-related variables. The analysis of the characteristics associated with these profiles was done through Pearson's chi-square test and unconditional logistic regression. The prevalence of the healthy profile and the Brazilian population's life table for 2013 were used in the Sullivan's method to calculate life expectancy free of lifestyle-related risk factors. In this stage, individuals aged between 30 and 69 years were selected, totalling 40,942. Two profiles were identified: a profile called "healthy profile" (61.6%; 95% CI 61.1 - 62.2), characterized by adequate consumption of fruits and vegetables, fish, and non-regular consumption of soda, meat with fat and beans. The profile was also characterized by overweight and for meeting the recommendations for physical activity at leisure time. The second profile was entitled "risk profile" (38.4%; 95% CI 37.8 - 38.9), characterized by non-consumption of healthy markers, except bean consumption, by the consumption of all unhealthy markers of eating, replacing meals with snacks, alcohol consumption and tobacco use. The second profile was also characterized for not being physically active at leisure and for being eutrophic. The healthy profile was associated with females, elderlies, white populations, residents of the North and Northeast regions of Brazil, widowed, married, high-educated populations and individuals who evaluate their health habits positively. The risk profile was associated with males, young adults, residents of the Midwest and South regions of Brazil, singles, less educated populations and individuals who evaluate their health habits negatively. The estimated lifetime for Brazilians free of lifestylerelated risk factors at age 30 was 33.5 years for women and 25.5 years for men. Females had a higher life expectancy free of risk factors at all ages in relation to males. The findings of the present study show the association of lifestyle-related risk factors with sociodemographic characteristics and contribute to the discussion of gender inequalities when it comes to morbimortality. Brazilian men live less time free of lifestyle-related risk factors, which may contribute to the high rates of premature mortality among them (AU).

Estado nutricional, factores sociodemográficos y de salud en estudiantes de nuevo ingreso a la UAZ / Nutritional status and social-demographical and health factors among newly enrolled students at UAZ / Estado nutricional, fatores sociodemográficos e de saúde em estudantes de novo ingresso à UAZ

Introducción El sobrepeso y obesidad son factores de riesgo para desarrollar complicaciones a corto y largo plazo. La población de nuevo ingreso a la universidad se considera un colectivo, especialmente, vulnerable desde el punto de vista nutricional. Objetivo Describir el estado nutricional, factores sociodemográficos y de salud en estudiantes de nuevo ingreso a la UAZ. Metodología Estudio de tipo observacional, transversal y descriptivo, que se realizó a 3,972 estudiantes universitarios de nuevo ingreso. Se logró el consentimiento verbal de los alumnos. Se capacitaron y estandarizaron a los pasantes de enfermería, medicina y nutrición, para llevar a cabo las mediciones. Se obtuvo información del estado nutricional, factores sociodemográficos y salud, así como mediciones antropométricas. Resultados Los hombres tienen mayor prevalencia de sobrepeso (24.1%) y obesidad (9.2%) que las mujeres (p < 0.001). Los hombres realizan mayor actividad física (73.6% vs 51.1%), consumen más alcohol (58.3% vs 34.3%) y tabaco (20.8% vs 9.5%) (p < 0.000). Se encontró una asociación positiva en los momios de sobrepeso en relación con los hombres (RM=1.22, IC 95% 1.02-1.45), edad de 19 años (RM=1.36, IC 95% 1.02-1.45), en las áreas de ciencias de la salud (RM=1.88, IC 95% 1.05-3.35), ciencias sociales (RM=1.93, IC 95% 1.06-3.48), humanidades y educativas (RM=1.90, IC 95% 1.01-3.53), ingenierías y tecnologías (RM=1.83, IC 95% 1.01-3.30). Discusión y conclusión Se puede contribuir a reducir las prevalencias de sobrepeso y obesidad de los estudiantes, a través de intervenciones dirigidas a modificar las conductas de riesgo durante la estancia universitaria, mejorar la alimentación y promover estilos de vida saludables.

Introduction Obesity and overweight are risk factors to developing short and long-term health-related complications; and newly enrolled university students are considered a vulnerable group in terms of their nutritional progression status. Objective To describe the nutritional status, and social-demographical and health factors among newly enrolled students at UAZ. Methodology This is an observational, transversal, and descriptive study on a sample of 3,972 newly enrolled university students who verbally consented on their participation. Nursing, medicine, and nutrition intern students were trained to carry out diverse assessments related to the nutritional status, social-demographical and health factors, and anthropometric data on the sample. Results Newly enrolled male students showed a higher prevalence of overweight (24.1%) and obesity (9.2%) in comparison to their female counterparts (p < .001). Male students showed having more physical activity (73.6% vs 51.1%) but also consuming more alcohol (58.3% vs 34.3%) and tobacco (20.8% vs 9.5%) (p < .000). Positive associations were found between the overweight numbers and, being male (RM=1.22, CI 95% 1.02-1.45), being 19 years old (RM = 1.36, CI 95% 1.02-1.45), being in the areas of health sciences (RM=1.88, CI 95% 1.05-3.35), being in the areas of social sciences (RM=1.93, CI 95% 1.06-3.48), being in the areas of humanities and education (RM=1.90, CI 95% 1.01-3.53), and being in the areas of engineering and technology (RM=1.83, CI 95% 1.01-3.30). Discussion and conclusion It is necessary to address to obesity and overweight problems among university students through interventions aimed at modifying risky behaviors during their university stay, improving the quality of nutrition, and promoting healthy life-styles.

Introdução O sobrepeso e a obesidade são fatores de risco para desenvolver complicações a curto e longo prazo. A população de novo ingresso à universidade considera-se um coletivo, especialmente, vulnerável desde o ponto de vista nutricional. Objetivo Descrever o estado nutricional, fatores sociodemográficos e de saúde em estudantes de novo ingresso à UAZ. Metodologia Estudo de tipo observacional, transversal e descritivo, que se realizou a 3,972 estudantes universitários de novo ingresso. Conseguiu-se o consentimento verbal dos alunos. Capacitaram-se e padronizaram os formados de enfermagem, medicina e nutrição, para levar a cabo as medições. Obteve-se informação do estado nutricional, fatores sociodemográficos e saúde, assim como medições antropométricas. Resultados Os homens de novo ingresso têm maior prevalência de sobrepeso (24.1%) e obesidade (9.2%) quanto as mulheres (p < 0.001). Homens realizam mais atividade física que mulheres (73.6% vs. 51.1%), consomem mais álcool (58.3% vs. 34.3%) e tabaco (20.8% vs. 9.5%) (p < 0.000). Encontrou-se uma associação positiva nas chances de sobrepeso em relação com aos homens (RM = 1.22, IC 95% 1.02-1.45), ter 19 anos de idade (RM = 1.36, IC 95% 1.02-1.45) nas áreas de ciências da saúde (RM = 1.88, IC 95% 1.05-3.35), ciências sociais (RM = 1.93, IC 95% 1.06-3.48), humanidades e educativas (RM = 1.90, IC 95% 1.01-3.53), engenharias e tecnologias (RM = 1.83, IC 95% 1.01-3.30). Discussão e conclusão Pode-se contribuir a reduzir as prevalências de sobrepeso e obesidade dos estudantes, a través de intervenções dirigidas a modificar as condutas de risco durante a permanência universitária, melhorar a alimentação e promover estilos de vida saudáveis.

Osteoporose e Expectativa de Vida Saudável: estimativas para o Brasil em 2008 / Osteoporosis and Healthy Life Expectancy: estimates for Brazil in 2008

Resumo Introdução Estimar a expectativa de vida com osteoporose (EVCO) e a expectativa de vida livre de osteoporose (EVLH) ao nascer e aos 20, 40, 60 e 80 anos, no Brasil, em 2008. Método Empregou-se o método de Sullivan, combinando a tábua de vida e as prevalências de osteoporose. Foram utilizadas as tábuas de vida publicadas pelo Instituto Brasileiro de Geografia e Estatística para 2008 e as prevalências de osteoporose do inquérito Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (VIGITEL) do mesmo ano. Resultados Em 2008, ao nascer, um homem poderia esperar viver, em média, 69,1 anos e, desses, 1,3 ano seria vivido com osteoporose. No caso das mulheres, a esperança de vida seria maior (76,7 anos), assim como a expectativa de vida com osteoporose (7,9 anos). Ao alcançar a idade de 60 anos, as mulheres poderiam esperar viver, em média, por mais 22,7 anos, sendo 7,0 desses anos (31,0%) com osteoporose. Já para os homens, na mesma idade, apenas 1,3 ano (6,6%) dos 19,5 anos remanescentes seriam vividos com osteoporose. Conclusão Os resultados chamam atenção para a necessidade de considerar as diferenças entre os sexos em relação à demanda por cuidado.

Abstract Objective Estimate osteoporosis life expectancy and osteoporosis-free life expectancy for Brazilians in 2008 at birth and at 20, 40, 60 and 80 years. Method The Sullivan method is used to combine the period life tables from the Brazilian Institute of Geography and Statistics and the prevalence of osteoporosis according to the Protective and Risk Factors for Chronic Diseases by Telephone Survey (Vigitel Brazil 2008). Results The main results of the study indicate that at birth, a man could expect to live, on average, 69.1 years and of these, 1.3 years would be with osteoporosis. For women, life expectancy was higher (76.7 years), as was osteoporosis life expectancy (7.9 years). Upon reaching the age of 60, women could expect to live another 22.7 years on average, 7.0 of those (31.0%) with osteoporosis. As for men the same age, only 1.3 years (6.6%) of the remaining 19.5 years would be spent with osteoporosis. Conclusion The results call attention to the need to consider the differences between the sexes in relation to the demand for care.

Inequalities in healthy life expectancy by Brazilian geographic regions: findings from the National Health Survey, 2013.

BACKGROUND: The demographic shift and epidemiologic transition in Brazil have drawn attention to ways of measuring population health that complement studies of mortality. In this paper, we investigate regional differences in healthy life expectancy based on information from the National Health Survey (PNS), 2013. METHODS: In the survey, a three-stage cluster sampling (census tracts, households and individuals) with stratification of the primary sampling units and random selection in all stages was used to select 60,202 Brazilian adults (18 years and over). Healthy life expectancies (HLE) were estimated by Sullivan's method according to sex, age and geographic region, using poor self-rated health for defining unhealthy status. Logistic regression models were used to investigate socioeconomic and regional inequalities in poor self-rated health, after controlling by sex and age. RESULTS: Wide disparities by geographic region were found with the worst indicators in the North and Northeast regions, whether considering educational attainment, material deprivation, or health care utilization. Life expectancy at birth for women and men living in the richest regions was 5 years longer than for those living in the less wealthy regions. Modeling the variation across regions for poor self-rated health, statistically significant effects (p < 0.001) were found for the North and Northeast when compared to the Southeast, even after controlling for age, sex, diagnosis of at least one non-communicable chronic disease, and schooling or socioeconomic class. Marked regional inequalities in HLE were found, with the loss of healthy life much higher among residents of the poorest regions, especially among the elderly. CONCLUSIONS: By combining data on self-rated health status and mortality in a single indicator, Healthy Life Expectancy, this study demonstrated the excess burden of poor health experienced by populations in the less wealthy regions of Brazil. To mitigate the effects of social exclusion, the development of strategies at the regional level is essential to provide health care to all persons in need, reduce risk exposures, support prevention policies for adoption of healthy behaviors. Such strategies should prioritize population groups that will experience the greatest impact from such interventions.

Estimativas de expectativa de vida com doenças crônicas de coluna no Brasil / Estimates of life expectancy for individuals with chronic spinal diseases in Brazil

As doenças crônicas de coluna, entre elas as deformidades e as dores musculares, são importantes causas de morbidade entre adultos e idosos. O objetivo deste estudo foi estimar a expectativa de vida de brasileiros com doenças crônicas de coluna, por sexo e idade, nos anos de 2003 e 2008. Empregou-se o método de Sullivan, combinando a tábua de vida e as prevalências de doen ças crônicas de coluna. Foram utilizadas as tá buas de vida publicadas pelo Instituto Brasileiro de Geografia e Estatística e as prevalências de enfermidades crônicas de coluna da Pesquisa Nacio nal por Amostra Domiciliar (PNAD), dos anos selecionados. Os principais resultados indicam que, no Brasil, ao nascer em 2008, um homem poderia esperar viver 69,1 anos, 15% dos quais com doenças crônicas de coluna. Já as mulheres que nasceram neste mesmo ano, apresentavam uma expectativa de vida de 76,7 anos e espera riam viver um quinto de sua vida com problemas crônicos de coluna. No período analisado, concomitantemente aos ganhos na expectativa de vida, ocorreu um crescimento na expectativa de vida saudável, ou seja, nos anos de vida livre de doenças crônicas da coluna, tanto em termos absolutos como relativos.

Chronic spinal diseases, including deformities and muscular pain, are significant causes of morbidity among adults and the elderly. The scope of this study is to assess the life expectancy of Brazilians with chronic spinal diseases by sex and age between 2003 and 2008. The Sullivan method was used, combining the mortality/actuarial table with the prevalence of chronic spinal diseases. The mortality/actuarial tables published by the Brazilian Institute of Geography and Statistics (IBGE) were used and the prevalence of chronic spinal diseases was taken from the Brazilian Household Sample Survey (PNAD) for the years under scrutiny. The main results indicate that a man born in Brazil in 2008 could expect to live for 69.1 years, of which 15% with chronic spinal diseases. However, women born in the same year had a life expectancy of 76.7 years and could expect to live a fifth of their lives with chronic spinal diseases. Over the period under analysis, concurrently with gains in life expectancy, there was an increase in healthy life expectancy, or length of life lived without chronic spinal diseases, both in absolute and relative terms.

Cómo lograr una vida saludable / How to achieve a healthy life

A nivel mundial, el impacto de las enfermedades crónicas no trasmisibles que pueden ser prevenidas está creciendo de forma sostenida y representan la causa de defunción más importante, con un 63% del número total de muertes anuales. En todo el mundo las enfermedades cardiovasculares ocupan el primer lugar de las muertes por enfermedades crónicas, seguidas del cáncer, las enfermedades respiratorias y la diabetes. Venezuela no escapa de esta realidad, ya que dentro de los cinco principales motivos de muerte en la población, cuatro están relacionados con enfermedades crónicas no trasmisibles: Enfermedades del corazón como primera causa, seguida de muertes ocurridas por diversos tipos de Cáncer y Enfermedades Cerebrovasculares que ocupa el tercer lugar, pero no menos importante las cifras de muertes registradas por Diabetes que ocupan el quinto lugar. Estas enfermedades comparten cuatro factores de riesgo: mala alimentación, inactividad física, el consumo de tabaco y el uso nocivo del alcohol. Es evidente que el llamado a realizar cambios en el estilo de vida es una prioridad en el tema de salud mundial. Es hora de crear conciencia, fundamentando valores sociales y responsabilidades públicas que orienten a desarrollar estrategias y conductas que permitan preservar la salud y mejorar la calidad de vida. Una vida saludable es la base de una sociedad sana, que garantiza a sus individuos gozar plenamente sus años de vida. En base a estos cambios, ha surgido la idea de aportar una lista de pasos, que sirvan como herramienta a la sociedad en general, para poner en práctica conductas saludables, para asegurarse, en un gran porcentaje, una mejor y mayor longevidad: una nutrición adecuada, una actividad física apropiada, evitar hábitos nocivos y tener una buena actitud ante la vida, son sin duda las mejore cualidades para lograr una vida saludable(AU)

Globally, the impacts of chronic non transmissible diseases that can be prevented is growing steadily and are the leading cause of death, representing 63% of all annual deaths. Worldwide cardiovascular diseases rank first in deaths from chronic disease, followed by cancer, respiratory diseases and diabetes. Venezuela does not escape this reality, where four out of five main reasons of death within the population, are related to chronic non transmissible diseases: Heart disease is the leading cause, followed by deaths from various types of cancer and cerebrovascular diseases. Deaths caused by diabetes rank fifth. These diseases share four risk factors: poor nutrition, physical inactivity, smoking and alcohol abusement. The importance of making changes in our lifestyle is a priority for global health. It’s time to raise awareness through social values and public responsibilities to guide and develop strategies and behaviors which preserve health and improve quality of life. Healthy living is the key for a healthy society, which guarantees its individuals to fully enjoy their life. Based on these changes, there has been pointed out a list of steps that can be used to practice healthy behaviors and ensure a better and longer life: proper nutrition, appropriate physical activity, avoid harmful habits and have a good life attitude, are certainly better qualities for a healthy life(AU)

Esperanza de vida saludable asociada a la diabetes en Cuba: años 1990 y 2003 / A healthy life expectancy associated with diabetes in Cuba: years 1990 and 2003

OBJETIVO: identificar posibles diferencias en la carga integral (combinando mortalidad y morbilidad) de la diabetes entre grupos de edad, provincias y sexos; así como evaluar su comportamiento en el tiempo (años 1990 y 2003). MÉTODOS: se utilizó el indicador esperanza de vida saludable, en particular una alternativa que considera la mortalidad y morbilidad por enfermedades específicas (en este caso la diabetes). Para el cálculo del indicador se obtuvo la esperanza de vida usual (no ajustada) a partir de la tabla de vida, considerando solo la mortalidad por diabetes. La esperanza de vida así obtenida se ajustó a partir de la morbilidad (prevalencia y severidad) por esta condición. Se calculó el indicador por sexos, grupos de edades, provincias, y para 1990 y 2003. Se llevó a cabo un análisis de conglomerado con el propósito de resumir e integrar los resultados por provincias. RESULTADOS: la mayoría de los resultados son consistentes para Cuba y la casi totalidad de las provincias para ambos años. Se observó una mayor afectación del sexo femenino (ej. Cuba, 2003, grupo de menos de 1 año, esperanza de vida saludable de 99,17 en hombres vs. 98,67 en mujeres), incremento del aporte de la morbilidad con la edad que alcanza las mayores cifras en el grupo de 60 a 64 años. La evolución de 1990 a 2003 es ascendente para la esperanza de vida y el aporte de la morbilidad, y descendente para la esperanza de vida saludable (ej: Cuba, mujeres, grupo de menos de 1 año, de 99,59 a 99,76; de 0,7 a 1,09 por ciento; y 98,89 a 98,76, respectivamente). Se identificaron provincias con un mayor impacto en términos de esperanza de vida saludable, estas resultaron: Ciudad de La Habana, La Habana, Matanzas (en 1990) y Camagüey (en 2003). CONCLUSIONES: la afectación por diabetes en términos de esperanza de vida saludable se incrementó en el período de estudio en el país, a pesar de la disminución del aporte de la mortalidad(AU)

OBJECTIVE: to identify the possible differences in integral burden (combining mortality and morbidity) of diabetes among the age groups, provinces, sexes, as well as to assesses its behavior in the time (years 1990 and 2003). METHODS: authors used a healthy life expectancy indicator, particularly, an alternative considering the mortality and the morbidity as specific diseases (in this case, diabetes). To estimate the indicator we achieved a common life expectancy (no-adjusted) from a life table, considering only the diabetes mortality. The life expectancy thus obtained was adjusted from morbidity (prevalence and severity) due this condition. We estimated the indicator by sex, age groups, and provinces and also for 1990 and 2003. A cluster analysis was made to resume and to integrate the results by provinces. RESULTS: most of results are consistent for Cuba and almost as the whole of provinces for both years. There was a higher affectation of female sex (e.g.: Cuba, 2003, group aged under one, healthy life expectancy of 99,17 in men versus 98.67 in women), increase of mortality contribution with the age achieving the higher figures in 60-64 age group. The course of 1990 to 2003 is rising for life expectancy and mortality contribution and descending for a healthy life expectancy (e.g. Cuba: women aged under one from 99.59 to 99.76; from 0.7 to 1.09 percent, and from 98.89 to 98.76, respectively). We identified provinces with a higher impact in terms of healthy life expectancy including: Ciudad de La Habana, La Habana, Matanzas (in 1990) and Camaguey (in 2003). CONCLUSIONS: affectation due to diabetes in terms of a healthy life expectancy increased during national study period, despite the decrease of mortality contribution(AU)

Esperanza de vida saludable asociada a la diabetes en Cuba: años 1990 y 2003 / A healthy life expectancy associated with diabetes in Cuba: years 1990 and 2003

OBJETIVO: identificar posibles diferencias en la carga integral (combinando mortalidad y morbilidad) de la diabetes entre grupos de edad, provincias y sexos; así como evaluar su comportamiento en el tiempo (años 1990 y 2003). MÉTODOS: se utilizó el indicador esperanza de vida saludable, en particular una alternativa que considera la mortalidad y morbilidad por enfermedades específicas (en este caso la diabetes). Para el cálculo del indicador se obtuvo la esperanza de vida usual (no ajustada) a partir de la tabla de vida, considerando solo la mortalidad por diabetes. La esperanza de vida así obtenida se ajustó a partir de la morbilidad (prevalencia y severidad) por esta condición. Se calculó el indicador por sexos, grupos de edades, provincias, y para 1990 y 2003. Se llevó a cabo un análisis de conglomerado con el propósito de resumir e integrar los resultados por provincias. RESULTADOS: la mayoría de los resultados son consistentes para Cuba y la casi totalidad de las provincias para ambos años. Se observó una mayor afectación del sexo femenino (ej. Cuba, 2003, grupo de menos de 1 año, esperanza de vida saludable de 99,17 en hombres vs. 98,67 en mujeres), incremento del aporte de la morbilidad con la edad que alcanza las mayores cifras en el grupo de 60 a 64 años. La evolución de 1990 a 2003 es ascendente para la esperanza de vida y el aporte de la morbilidad, y descendente para la esperanza de vida saludable (ej: Cuba, mujeres, grupo de menos de 1 año, de 99,59 a 99,76; de 0,7 a 1,09 por ciento; y 98,89 a 98,76, respectivamente). Se identificaron provincias con un mayor impacto en términos de esperanza de vida saludable, estas resultaron: Ciudad de La Habana, La Habana, Matanzas (en 1990) y Camagüey (en 2003). CONCLUSIONES: la afectación por diabetes en términos de esperanza de vida saludable se incrementó en el período de estudio en el país, a pesar de la disminución del aporte de la mortalidad(AU)

OBJECTIVE: to identify the possible differences in integral burden (combining mortality and morbidity) of diabetes among the age groups, provinces, sexes, as well as to assesses its behavior in the time (years 1990 and 2003). METHODS: authors used a healthy life expectancy indicator, particularly, an alternative considering the mortality and the morbidity as specific diseases (in this case, diabetes). To estimate the indicator we achieved a common life expectancy (no-adjusted) from a life table, considering only the diabetes mortality. The life expectancy thus obtained was adjusted from morbidity (prevalence and severity) due this condition. We estimated the indicator by sex, age groups, and provinces and also for 1990 and 2003. A cluster analysis was made to resume and to integrate the results by provinces. RESULTS: most of results are consistent for Cuba and almost as the whole of provinces for both years. There was a higher affectation of female sex (e.g.: Cuba, 2003, group aged under one, healthy life expectancy of 99,17 in men versus 98.67 in women), increase of mortality contribution with the age achieving the higher figures in 60-64 age group. The course of 1990 to 2003 is rising for life expectancy and mortality contribution and descending for a healthy life expectancy (e.g. Cuba: women aged under one from 99.59 to 99.76; from 0.7 to 1.09 percent, and from 98.89 to 98.76, respectively). We identified provinces with a higher impact in terms of healthy life expectancy including: Ciudad de La Habana, La Habana, Matanzas (in 1990) and Camaguey (in 2003). CONCLUSIONS: affectation due to diabetes in terms of a healthy life expectancy increased during national study period, despite the decrease of mortality contribution(AU)

Densidade de médicos e expectativa de vida saudável na América Latina e no Caribe / Physician's density and healthy life expectancy in Latin America and Caribbean

Objetivo. Este estudo visa a mostrar a importância do médico como indicador de saúde e como variável relevante na qualidade de vida da população da América Latina e do Caribe. Método. Foram analisados os dados mais recentes disponíveis do arquivo de dados WHO Statistical Information System (WHOSIS) da Organização Mundial da Saúde referentes a trinta países da América Latina e do Caribe. As variáveis coletadas foram: densidade de médicos (número de médicos por dez mil habitantes), expectativa de vida saudável ao nascimento e idade média da população. Os métodos estatísticos aplicados foram correlação de Pearson e regressão logarítmica. A significância estatística considerada foi p < 0,05. Resultados. A densidade média de médicos nos países da América Latina e do Caribe foi 15 ± 13 médicos por dez mil habitantes; a média de idade da população foi 26 ± 4,3 anos; a expectativa de vida saudável ao nascimento média foi 61 ± 4,8 anos. As variáveis expectativa de vida saudável e a média de idade mostraram correlação positiva com a densidade de médicos. A regressão logarítmica mostra aumento progressivo da expectativa de vida pelo aumento da densidade de médicos. Conclusão. O estudo permitiu sugerir relação entre a quantidade de médicos de um país e a expectativa de vida saudável em sua população. Os dados apontam para a necessidade de novos estudos que se aprofundem no tema, dando continuidade à busca constante pela qualidade de vida e pelo perfil de saúde elevado nas populações.

Objective. This study aims to show the importance of the physician as a health indicator and as an important variable in the quality of life of the Latin America and Caribbean population.Method. We analyzed the most recent data available from the WHO Statistical Information System (WHOSIS) World Health Organization (WHO) database for thirty countries of Latin America and Caribbean. The variables studied were: density of physicians (number of doctors per 10.000 inhabitants), healthy life expectancy at birth and mean population age. The statistical methods used were Pearson's correlation and logarithmic regression. The statistical significance was p < 0.05.Results. The average density of doctors in Latin America and Caribbean was 15 ± 13 doctors per 10.000 inhabitants, the mean population age was 26 ± 4.3 years, and the healthy life expectancy at birth averaged 61 ± 4.8 years old. The variables healthy life expectancy at birth and mean age showed a positive correlation with physician's density. The logarithmic regression showed a progressive increase in life expectancy along with anincreasing physician's density. Conclusion. This study suggests a link between the number of physicians in a due country and its healthy lifeexpectancy and furthermore confirms the physician's role as an important health promoting factor. The results also point to the necessity of further research to better define the health profile and characteristics of these populations.