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Background: The purpose was to determine the proportion of 9- to 11-year-old children meeting the 24-hour movement guidelines (24-HMG) in a low-income town from Chile. Methods: Physical activity, sedentary behavior (recreational screen), and sleep times were measured with both questionnaire and accelerometer in 258 children from third to sixth grade. Meeting the 24-HMG was defined as having ≥60 minutes per day of moderate to vigorous physical activity, ≤2 hour day of screen time, and 9 to 11 hours of sleep per night. Compliance rates were calculated as self-reported 24-HMG, with all estimations based on questionnaires, and mixed 24-HMG, in which physical activity and sleep were determined with an accelerometer and sedentary behavior was determined with a questionnaire. Results: About 198 children (10.1 [0.8] y, range 9–11 y) provided valid data for estimating self-reported 24-HMG, and 141 for mixed 24-HMG. Only 3.2% and 0.7% met the 24-HMG when using the self-reported and mixed methods, respectively. When assessing individual recommendations, 13.1% and 3.7% of the sample were physically active based on the self-report and accelerometer, respectively. About a quarter met the sedentary behavior recommendations, while around 50% met the sleep recommendations with both self-reported and mixed methods. Conclusions: An extremely low percentage of the participants met the 24-HMG. Multicomponent initiatives must be implemented to promote healthy movement behaviors in Chilean children.

Introduction 24-hour movement behaviours (physical activity, sedentary behaviour and sleep) during the early years are associated with health and developmental outcomes, prompting the WHO to develop Global guidelines for physical activity, sedentary behaviour and sleep for children under 5 years of age. Prevalence data on 24-hour movement behaviours is lacking, particularly in low-income and middle-income countries (LMICs). This paper describes the development of the SUNRISE International Study of Movement Behaviours in the Early Years protocol, designed to address this gap. Methods and analysis SUNRISE is the first international cross-sectional study that aims to determine the proportion of 3- and 4-year-old children who meet the WHO Global guidelines. The study will assess if proportions differ by gender, urban/rural location and/or socioeconomic status. Executive function, motor skills and adiposity will be assessed and potential correlates of 24-hour movement behaviours examined. Pilot research from 24 countries (14 LMICs) informed the study design and protocol. Data are collected locally by research staff from partnering institutions who are trained throughout the research process. Piloting of all measures to determine protocol acceptability and feasibility was interrupted by COVID-19 but is nearing completion. At the time of publication 41 countries are participating in the SUNRISE study. Ethics and dissemination The SUNRISE protocol has received ethics approved from the University of Wollongong, Australia, and in each country by the applicable ethics committees. Approval is also sought from any relevant government departments or organisations. The results will inform global efforts to prevent childhood obesity and ensure young children reach their health and developmental potential. Findings on the correlates of movement behaviours can guide future interventions to improve the movement behaviours in culturally specific ways. Study findings will be disseminated via publications, conference presentations and may contribute to the development of local guidelines and public health interventions. Funding Agencies|American Council on Exercise, USA; Beijing Health System High Level Talents Training Project, China [2015-3-88]; Biomedical Research Foundation, Dhaka, Bangladesh [BRF-19-01]; Canadian Institutes of Health Research Frederick Banting and Charles Best Canada Graduate Scholarship (CGS-M)Canadian Institutes of Health Research (CIHR); Canadian Institutes of Health Research Planning and Dissemination GrantCanadian Institutes of Health Research (CIHR) [155265]; Civilian Research Development Foundation (CRDF) Global [OISE-20-66864-1]; Department of National Planning and Monitoring, PNG Government [02704]; Early Start, University of Wollongong, Australia; Faculty of Health Sciences at the University of the Witwatersrand, Johannesburg, South Africa; Fogarty International Center (FIC) of the National Institutes of Health [D43 TW010137]; Geran Universiti Penyelidikan (GUP), Universiti Kebangsaan Malaysia [GUP-2018-142]; Global Challenges Program, University of Wollongong, Australia [888/006/497]; Harry Crossley Foundation, South Africa; National Institute of Education-Ministry of Education, Singapore [OER 04/19 TWP]; Pham Ngoc Thach University of Medicine, Vietnam [1319/QD-TDHYKPNT]; Sasakawa Sports Research Grant, Sasakawa Sports Foundation, Japan [190A2-004]; Stella de Silva Research grant from Sri Lanka College of Paediatricians, Sri Lanka; The DST-NRF Centre for Excellence in Human Development at the University of Witwatersrand, Johannesburg, South Africa; International Society of Behavioral Nutrition and Physical Activity, Pioneers Program (ISBNPA-2021); The University Research Coordination Office of the De La Salle University, Philippines [29 IR S 3TAY192021]; Universidad de La Frontera Research Directorate, Chile [DI20-0093, DFP19-0012, DI20-1002]; WHO European Office for Prevention and Control of Noncommunicable Diseases

Carlos Cristi-Montero received funding for the Cogni-Action Project from the National Commission for Scientific and Technological Research CONICYT/FONDECYT INICIACION 2016 grant No. 11160703 (Chile), and the National Research and Development Agency (ANID) from Chile-2019, Postdoctoral Grant No. 74200071., The first aim was to compare differences between school vulnerability groups, fitness levels, and their combination in adolescent cognitive performance. The second aim was to determine the mediation role of fitness in the association between school vulnerability and cognitive performance. A total of 912 Chilean adolescents aged 10–14 years participated in this study. The school vulnerability index (SVI) assigned by the Chilean Government was categorized into high-, mid-, or low-SVI. Adolescents were classified as fit or unfit according to their global fitness z-score computed from their cardiorespiratory (CRF), muscular (MF), and speed/agility fitness (SAF) adjusted for age and sex. A global cognitive scorewas estimated through eight tasks based on a neurocognitive battery. Covariance and mediation analyses were performed, adjusted for sex, schools, body mass index, and peak high velocity. Independent analyses showed that the higher SVI, the lower the cognitive performance (F(6,905) = 18.5; p < 0.001). Conversely, fit adolescents presented a higher cognitive performance than their unfit peers (F(5,906) = 8.93; p < 0.001). The combined analysis found cognitive differences between fit and unfit adolescents in both the high- and mid-SVI levels (Cohen’s d = 0.32). No differences were found between fit participants belonging to higher SVI groups and unfit participants belonging to lower SVI groups. Mediation percentages of 9.0%, 5.6%, 7.1%, and 2.8% were observed for the global fitness score, CRF, MF, and SAF, respectively. The mediation effect was significant between lowwith mid-high-SVI levels but not between mid- and high-SVI levels. These findings suggest that an adequate physical fitness level should be deemed a protective social factor associated with bridging the cognitive gap linked to school vulnerability in adolescents. This favourable influence seems to be most significant in adolescents belonging to a more adverse social background., National Commission for Scientific and Technological Research CONICYT/FONDECYT INICIACION (Chile) 11160703, National Research and Development Agency (ANID) from Chile 74200071

BackgroundThere is limited evidence about emotional and behavioral responses in toddlers and preschoolers during the coronavirus disease (COVID-19) pandemic, particularly in Latin America.ObjectiveTo assess associations between changes in movement behaviors (physical activity, screen time and sleeping) and emotional changes in toddlers and preschoolers during early stages of the pandemic in Chile.MethodsA cross-sectional study conducted from March 30th to April 27th, 2020. Main caregivers of 1-to 5-year-old children living in Chile answered an online survey that included questions about sociodemographic characteristics, changes in the child’s emotions and behaviors, movement behaviors and caregivers’ stress during the pandemic. Multiple linear regressions were used to assess the association between different factors and emotional changes in toddlers and preschoolers.ResultsIn total, 1727 caregivers provided complete data on emotional changes for children aged 2.9±1.36 years old, 47.9% girls. A large proportion of toddlers and preschoolers in Chile experienced emotional and behavioral changes. Most caregivers reported that children were ‘more affectionate’ (78.9%), ‘more restless’ (65.1%), and ‘more frustrated’ (54.1%) compared with pre-pandemic times. Apart from changes in movement behaviors, factors such as child age, caregivers’ age and stress, and residential area (urban/rural) were consistently associated with changes in emotions and behaviors.ConclusionThe pandemic substantially affected the emotions and behaviors of toddlers and preschoolers in Chile. Mental health promotion programs should consider multilevel approaches in which the promotion of movement behaviors and support for caregivers should be essential pieces for future responses.

Summary To prevent obesity among Latino youth in the United States and Latin America, it is necessary to understand the specific context and interplay of physical activity (PA) and the built environment (BE). This paper aims to advance the research agenda of BE and PA for obesity prevention in Latin America and among Latino youth in the United States by (1) identifying environmental indicators to inform the design of interventions and policy, (2) identifying interdisciplinary methodological approaches for the study of the complex association between BE and PA, and (3) presenting case studies of PA‐promoting BE programs. A group of U.S. and Latin American scientists collaboratively worked to propose innovative indicators of the BE, methodological approaches for the study of the complex association between BE and PA, and review case studies of PA‐promoting BE programs in both regions. The results identified gaps in knowledge, proposed environmental indicators (e.g., landscape, street design, mobility patterns, and crime and safety), reviewed methodological approaches (social network analysis, citizen science methods), and case studies illustrating PA‐promoting BE programs (i.e., play streets, active school transport, and school setting interventions). The obesity prevention among Latino and Latin American youth requires advanced research on BE and PA addressing context‐specific priorities and exchanging lessons learned.

Summary Childhood obesity is a major problem in Latin America and among US Latinos. Effective public health policies require contextually relevant evidence to guide them, which demands sustained research capacity. The objectives of this study are to determine research productivity in Latin America and in the United States focused on Latino populations and examine domains of research capacity (research infrastructure, training programs, mentoring, funding, and networks). We conducted a scoping review of indexed childhood obesity‐related articles published June 2015–December 2019. We collected data on perceptions of capacity for childhood obesity research among Latin American investigators through an online survey. We identified 612 childhood obesity‐related articles (505 from Latin America, 124 from the United States, and 17 US–Latin America collaborations). Brazil, Mexico, Chile, Colombia, and the United States are the top publishing countries. There are similar numbers of obesity, nutrition, and physical activity articles, but physical activity research capacity lagged in other domains (research training, funding, and networking opportunities). Complementary research areas, including sedentary behavior, systems science, and policy studies, are uncommon in Latin America but more prevalent in the United States, whereas sleep research is nascent across settings. Realizing the promise of an effective cross‐border collaborative childhood obesity prevention agenda will require committed investment in all domains of research capacity and across all relevant topics.

Background To better understand sedentary behaviour and favour international comparisons, more evidence from different countries are needed. However, there are a few tools available in Spanish to measure sedentary behaviour. This study aimed to culturally adapt, translate and validate the Past-day Adults’ Sedentary Time (PAST) questionnaire in Chilean adults compared with the ActivPAL. Method One hundred one workers wore an ActivPAL for 1 week and were asked to respond to the Spanish version of the PAST twice on different visits at a 7-day interval. The PAST assesses sedentary behaviour in several domains, including working time, during the previous day. Reliability was assessed with the intraclass correlation coefficient (ICC). Correlations and Bland-Altman methods were used to determine accuracy properties of the PAST compared with the ActivPAL. Results Seventy-seven participants provided valid data (51.0% male; age = 39.0 ± 12.39 years). The PAST showed moderate reliability (ICC = 0.63). For the total time in sedentary behavior per day, the PAST showed no correlation (r = 0.21, p = 0.07) and a mean bias of 54.9 min/day (LoA 95%: − 484.3, 594.2 min/day) with the ActivPAL. For the total time in SB at work, the PAST showed moderate reliability (ICC = 0.40), weak correlation (r = 0.37, p Conclusions The PAST performed better when estimating sedentary behaviour during working hours compared with the whole day. In this setting, accuracy properties were comparable with other self-report tools.

Given the importance of physical activity and sleep for health, different recommendations have been proposed for the pediatric population. The objective of this study was to determine the association between physical activity and sleep recommendations compliance and excess weight in school children from Temuco, Chile.Physical activity and sleep were measured using ActiGraph wGT3X-BT® accelerometers. Excess weight was categorized on two categories: absence (normal weight) or presence (overweight or obesity) based on body mass index.A total of 183 school children participated (54.1 % were females; mean age = 10.95 ± 1.07). Of them, 85.4 % did not meet physical activity recommendations, whereas 75.6% did not meet sleep recommendations. Significant differences were observed in favor of boys over girls in relation to moderate and vigorous physical activity (p = 0.002), but this was not the case for amount of sleep. School children with excess weight showed less time spent in moderate and vigorous activity (p = 0.004) and a lower amount of sleep (p = 0.010) than normal weight ones. Non-compliance with physical activity recommendations was associated with excess weight (odds ratio [OR] = 8.178; 95 % confidence interval [CI]: 1.465-45.635; p = 0.017), but this was not observed in relation to sleep recommendations.A high percentage of school children do not meet the recommendations for physical activity and sleep. Associations were observed by sex and presence of excess weight. Strategies are required to promote compliance with these recommendations in the pediatric population.Introducción. Dada la importancia que la actividad física y el sueño han adquirido para la salud, se han propuesto diversas recomendaciones para la población infantil. El propósito de este estudio fue determinar cómo se asocia el cumplimiento de las recomendaciones de actividad física y de sueño con el exceso de peso. Población y métodos. Para la medición de la actividad física y el sueño, se utilizaron acelerómetros ActiGraph wGT3X-BT®. Se determinó el índice de masa corporal para las categorizaciones de ausencia (peso normal) o presencia (sobrepeso-obesidad) de exceso de peso. Resultados. Participaron 183 escolares (54,1 % eran niñas, edad M = 10,95 ± 1,07). El 85,4 % no cumple con las recomendaciones de actividad física, mientras que el 75,6 % no cumple con las recomendaciones de sueño. Los niños se diferencian significativamente de las niñas en tiempo de actividades físicas moderadas y vigorosas (p = 0,002), mas no así en cantidad de sueño. Los escolares con exceso de peso presentan menos tiempo de actividades de intensidad moderada y vigorosa (p = 0,004) y una menor cantidad de sueño (p = 0,010) que los escolares de peso normal. El no cumplir las recomendaciones de actividad física se asociaría con el exceso de peso (razón de momios [OR, por su sigla en inglés] = 8,178; intervalo de confianza del 95 % [IC95 %]: 1,465-45,635; p = 0,017), lo que no se observó en las recomendaciones de sueño. Conclusiones. Un alto porcentaje de escolares no cumplen con las recomendaciones de actividad física y cantidad de sueño. Se observaron asociaciones según el sexo y la presencia de exceso de peso. Es necesario desarrollar estrategias para fomentar el cumplimiento de estas recomendaciones en la población infantil.

Background: Although evidence on the health effects of sedentary behavior (SB) has grown systematically in recent years, few developing countries have reported population levels of SB, especially in South America. Our objective was to describe time spent sitting in a representative sample from Chile categorized by age, gender, educational level, and body mass index (BMI). Methods: A national health survey was conducted in Chile in a nationally representative sample (n = 5411) in 2009–2010. Sitting time (ST) was measured with the Global Physical Activity Questionnaire Version 2. Results: Data were from 5031 participants (43.26 ± 0.41 years, mean ± SE; 40.3% male). Overall, there were no gender differences in mean ST (men: 158.10 ± 5.80 min/day, women 143.45 ± 4.77 min/day; p = 0.05). ST was lower in those who lived in rural areas compared with urban areas (99.4 min/day vs. 160.0 min/day; p = 0.001). ST increased significantly with increasing BMI, but only in men (p = 0.009), and was positively related to years of education in both men and women (p

The trajectory of aging is profoundly impacted by the physical and social environmental contexts in which we live. While “top–down” policy activities can have potentially wide impacts on such contexts, they often take time, resources, and political will, and therefore can be less accessible to underserved communities. This article describes a “bottom–up”, resident-engaged method to advance local environmental and policy change, called Our Voice, that can complement policy-level strategies for improving the health, function, and well-being of older adults. Using the World Health Organization’s age-friendly cities global strategy, we describe the Our Voice citizen science program of research that has specifically targeted older adults as environmental change agents to improve their own health and well-being as well as that of their communities. Results from 14 Our Voice studies that have occurred across five continents demonstrate that older adults can learn to use mobile technology to systematically capture and collectively analyze their own data. They can then successfully build consensus around high-priority issues that can be realistically changed and work effectively with local stakeholders to enact meaningful environmental and policy changes that can help to promote healthy aging. The article ends with recommended next steps for growing the resident-engaged citizen science field to advance the health and welfare of all older adults.

Background: Device measured physical activity (PA) allow better understanding on how PA is accrued during days. The purpose of this study was to describe pedometer-derived PA levels and patterns by gender in a population of Chilean children. Methods: 100 children were randomly selected from two low-income neighborhoods in Santiago, Chile. PA was measured with a wrist-worn pedometer for 7 consecutive days. Steps were summarized as total steps per hour and steps per day. PA hourly-patterns were compared across subgroups by age, gender, residence type and nutritional status. Results: 85 participants provided valid data (40 boys, 7.9±2.64 years, 47.8% overweight/obese). On an average day, children accumulated 11692.8±6061.8 steps with no differences between sexes (p=0.14). However, boys accumulated more steps in the morning and lunchtime than girls. Only 35.3% of the sample met PA guidelines (active), with no differences by sex (p=0.39). Active children in weekdays were more likely to meet the guidelines in weekend days (adjusted OR: 4.70, CI 95% 1.67-13.20) than those inactive in weekdays. Conclusion: PA guidelines compliance was relatively low. Step accumulation patterns differed between and within days including differences by gender in the morning and lunch time. This information may be used for designing feasible and equitable strategies for increasing the chances for meeting PA recommendations in both girls and boys. Resumen. Antecedentes: los métodos objetivos para medir la actividad física (AF) permiten una mejor comprensión de cómo se acumula la AF durante días. El propósito de este estudio fue describir los niveles y patrones de AF derivados del podómetro en una población de niños chilenos. Métodos: 100 niños participaron de dos barrios de bajos ingresos seleccionados al azar en Santiago de Chile. AF se midió con un podómetro de pulsera durante 7 días consecutivos. Los pasos se resumieron como pasos totales por hora y pasos por día. Los patrones de AF por hora se compararon entre los subgrupos por edad, sexo, tipo de residencia y estado nutricional. Resultados: 85 participantes proporcionaron datos válidos (40 niños, 7.9-2.64 años, 47.8% con sobrepeso / obesidad). En un día normal, los niños acumularon 11692.8±6061.8 pasos sin diferencias entre sexos (p = 0.14). Sin embargo, los niños acumularon más pasos en la mañana y mediodía que las niñas. Solo el 35.3% de la muestra cumplió con las recomendaciones de AF (activo), sin diferencias por sexo (p = 0.39). Los niños activos en los días de semana tenían más probabilidades de cumplir con las recomendaciones en los días de fin de semana (OR ajustado: 4.70, IC 95% 1.67-13.20) que los inactivos en los días de la semana. Conclusión: El cumplimiento de las recomendaciones de AF fue relativamente bajo. Los patrones de acumulación de pasos difieren entre y durante el día, incluyendo diferencias según sexo en relación a la acumulación de pasos en la mañana y almuerzo. Esta información puede ser utilizada para diseñar estrategias equitativas para aumentar las posibilidades de cumplir con las recomendaciones de AF tanto para niñas como para niños.

There is limited evidence on potential health benefits of active travel, independently of leisure-time physical activity (PA), with metabolic syndrome (MetS) in Latin-America.To investigate the relationship between active travel and metabolic syndrome (MetS) and its components in a national representative sample of Chilean adults.Cross-sectional study of 2864 randomly selected adults' participants enrolled in the 2009-2010 Chilean National Health Survey (CNHS). Self-reported PA was obtained with the validated Global PA Questionnaire and classifying participants into insufficiently active (150min/week) or active (≥150min/week). MetS was diagnosed from the modified Adult Treatment Panel (ATP) III criteria with national-specific abdominal obesity cut points. Multilevel logistic regression analysis was applied to estimate associations of travel PA with MetS and its components at a regional level, adjusted for socio-demographic characteristics and other types of PA.46.2% of the sample engaged in 150min/week of active travel and the prevalence of MetS was 33.7%. Mets was significantly lower among active travel participants. Active travel was associated with lower odds of MetS (OR 0.72; 95%CI 0.61-0.86), triglycerides (OR 0.77; 95%CI 0.64-0.92) and abdominal obesity (OR 0.82; 95%CI 0.69-0.97) after controlling for socio-demographics and other types of PA.Active travel was negatively associated with MetS, triglycerides and abdominal obesity. Efforts to increase regional active travel should be addressed as a measure to prevent and reduce the prevalence of MetS and disease burden in middle income countries.

Background: Physical inactivity is an important risk factor for cardiovascular diseases. Aim: To identify factors associated with physical inactivity in Chilean adults. Material and Methods: Participants from the Chilean Health Survey (5,133 individuals) were included in this study. Physical activity was measured using the Global physical activity questionnaire (GPAQ). Physical inactivity was defined as < 600 MET. min.week−1 of moderate to vigorous intensity physical activity. Logistic regression was used to identify correlates of physical inactivity. Results: The main finding of this study were that women (odds ratio (OR): 1.51 [95% confidence intervals (CI): 1.32-1.72]) were more likely to be inactive compared to men and that older adults were more likely to be inactive than their younger or middle age counterparts (OR: 3.06 [95% CI: 2.45-3.82]). Other correlates of physical inactivity were individuals with obesity (OR: 1.43 [95% CI: 1.20-1.70]), diabetes (OR: 1.96 [95% CI: 1.61-2.38]), hypertension (OR: 1.72 [95% CI: 1.50-1.97]), metabolic syndrome (OR: 1.42 [95% IC: 1.18-1.70]), a low education level (OR: 1.26 [95% CI: 1.06-1.49]) and higher levels of sedentary behavior (OR: 2.77 [95% CI: 2.36-3.25]). Conclusions: Women, older people and sedentary subjects with chronic non-transmissible conditions are at higher risk of being physically inactive.

Background: Sedentary behavior is a main risk factor for cardiovascular disease and mortality. Aim: To investigate the association between sedentary behavior and metabolic and cardiovascular risk factors. Material and methods: We assessed 322 participants aged between 18 to 65 years. Physical activity and sedentary behavior were measured with accelerometers (Actigraph®). Body mass index (BMI), waist circumference, percentage of body fat, diet and blood markers (glucose, lipid profile, insulin and HOMA-IR) were measured with standardized protocols. Results: Thirty four percent of participants were physically inactive and spent on average 8.7 h/day on sedentary activities. Per one hour increase in sedentary behavior there were significant adverse changes in glucose (4.79 mg/dl), insulin (2.73 pmol/l), HOMA-IR (0.75), BMI (0.69 kg/m2), waist circumference (1.95 cm), fat mass (1.03 %), total cholesterol (9.73 mg/dl), HDL-cholesterol (-3.50 mg/dl), LDL-cholesterol (10.7 mg/dl) and triglycerides (12.4 mg/dl). These findings were independent of main confounding factors including total physical activity, dietary factors, BMI and socio-demographics. Conclusions: The detrimental effect of sedentary behaviors on cardiometabolic and obesity-related traits is independent of physical activity levels. Therefore, reducing sedentary time should be targeted in the population apart from increasing their physical activity levels.

The coronavirus disease 2019 (COVID-19) pandemic, produced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread rapidly throughout the world. Latin American and the Caribbean countries have been harshly affected by the pandemic mainly due to less prepared healthcare systems and fragmented social safety nets. In the region, health status population-based indicators are worse than compared to the Organization for Economic Cooperation and Development. Recent evidence suggests that the progression and severity of COVID-19 are associated with the prior health status of individuals, and studies have shown that the case fatality rate is highly stratified among different populations. This narrative review aims to describe factors associated with adverse outcomes of COVID-19 in the context of social determinants of health in Latin American and Caribbean countries. In this review, we state that genetic and biological factors interact in a sophisticated way with social determinants of health, impacting the rapid spread of COVID-19 in Latin American and Caribbean countries. Behavioral factors, such as physical inactivity, smoking, and unhealthy diets, are related to chronic systemic inflammation. Also, air pollution can prolong inflammation and the hyper-activation of the immune system. Air pollutants could facilitate the spread of the virus. Finally, frailty and comorbidities can be associated with COVID-19 severity through increasing vulnerability to stressors and leading to more severe symptoms of COVID-19 disease, including a higher mortality risk. All these factors contribute to increasing the impact of COVID-19 in Latin American and Caribbean countries. We highlight the relevance of considering social determinants of health in Latin American and the Caribbean countries, not only in controlling the likelihood of getting the disease but also its progression and severity. All these social determinants can guide the design and implementation of tailored interventions promoting healthy lifestyle behaviors, which should lower the spread of the disease, its severity, and lethality.La pandemia de la enfermedad por coronavirus 2019 (COVID-19), producida por el virus SARS-CoV-2, se ha diseminado rápidamente a través del mundo. Los países de Latinoamérica y el Caribe han sido afectados duramente por la pandemia principalmente debido a falta de preparación de sus sistemas de salud y debido al fragmentado sistema de seguridad social. Además, en la región, el estado de salud de la población muestra peores indicadores de salud comparado con los países de la Organización para la Cooperación y el Desarrollo Económico. Evidencia reciente sugiere que la progresión y severidad de la COVID-19 están asociadas con el estado de salud basal del individuo, y algunos estudios han mostrado que la letalidad está altamente estratificada entre diferentes poblaciones. El objetivo de esta revisión narrativa es describir los factores asociados con peor evolución de la COVID-19 en el contexto de los determinantes sociales de la salud en los países de Latinoamérica y el Caribe. En esta revisión, se indica que los factores biológicos y genéticos interactúan de una manera sofisticada con los determinantes sociales de la salud, impactando la rápida diseminación de la COVID-19 en los países de Latinoamérica y el Caribe. Factores del comportamiento, como la inactividad física, fumar, y una dieta poco saludable, están relacionadas con una inflamación sistémica crónica. Además, la contaminación ambiental puede prolonger la inflamación y la hiperactivación del sistema inmune. Las partículas contaminantes del aire pueden facilitar la dispersión del virus. Finalmente, el síndrome de fragilidad y las comorbilidades están asociadas con severidad de la COVID-19, aumentando la vulnerabilidad ante factores estresantes y provocando síntomas más graves de la enfermedad COVID-19, aumentando el riesgo de mortalidad. Todos los factores mencionados, contribuyen a aumentar el impacto de la pandemia por COVID-19 en los países de Latinoamérica y el Caribe. Destacamos la relevancia de considerar los determinantes sociales de la salud en los países de Latinoamérica y el Caribe, no sólo para controlar el riesgo de contagio, sino también la progresión y severidad de la enfermedad. Los determinantes sociales pueden guiar el diseño y la implementación de intervenciones para promover los estilos de vida saludable, que puede contribuir a reducir la diseminación de la enfermedad, su severidad y letalidad.

Bicyclists are vulnerable road users who risk incurring severe injuries from traffic incidents involving motorists. However, the prevalence of severe bicycle injuries varies across countries and is not well-documented in Latin American countries. Studies from developed countries outside of Latin America have shown that individual and contextual factors are associated with severe injuries incurred by bicyclists in road traffic incidents with motorists, but it is not clear whether these factors are the same as those incurred by Latin American bicyclists. Moreover, most studies on bicyclist-motorist traffic incidents have treated injury severity as a binary variable for analysis although injuries range widely in severity. The aims of this study were to determine the prevalence of bicycle injuries from incidents between motorists and bicyclists in Chile and examine the associations between individual and contextual factors and bicyclist injury severity, treated as an ordinal outcome variable, in these incidents. Data on road traffic incidents between bicyclists and motorists from the 2016 Traffic Accident of Bicycle Riders and Consequences database of the Chilean Transport Ministry were analysed. Multilevel mixed-effects ordinal regression models were used to examine associations. In total, 81.2 % of 4093 traffic incidents between bicyclists and motorists resulted in nonfatal injuries to bicyclists and another 2.3 % resulted in fatalities. Most incidents involved collisions (84.3 %), and most were due to a motorist being distracted while driving (50.4 %). Severe bicyclist injuries were more likely when the incident involved a stationary cyclist who was struck, a collision between a moving bicycle and a moving motor vehicle, or an overturning motor vehicle striking a bicyclist (p0.001). Other factors included the motorist driving under the influence of alcohol (p = 0.05), the incident taking place in a mid-size community (p = 0.04), the incident occurring between 7:00 pm and 4:59 am (p0.01), and the injured bicyclist being under 18 years or 45+ years of age (p0.05). These findings suggest the need for educational programs that promote safe driving behaviour in the presence of bicyclists, better enforcement of laws and higher penalties for distracted or drunk driving, and provision of high-quality exclusive bicyclist infrastructure to address the vulnerability of the youngest and oldest bicyclists on shared roads, particularly in mid-size communities, and to provide better lighting on bikeways for evening bicycling, to reduce the high incidence of severe bicyclist injuries in motorist-bicyclist incidents.

Background: Sedentary behavior is a major risk factor for cardiovascular disease and mortality. Aim: To investigate whether the associations between sedentary behavior and cardiometabolic markers differs across physical activity levels. Materials and methods: Cross sectional study of 314 participants aged 18 to 65 years. Body mass index (BMI) and waist circumference were measured, and body fat was derived from the sum of four skinfolds. Physical activity was measured objectively using accelerometers (Actigraph GT1M, USA ®). A fasting blood sample was obtained to measure glucose, insulin, HOMA-IR, lipid profile and high sensitive C reactive protein (hsCRP). Those participants with an activity level >600 MET.min-1.week-1 were classified as physically active. Results: Thirty four percent of participants were physically inactive and spent an average of 8.7 h.day-1 in sedentary pursuits. Physically inactive individuals had poorer cardiometabolic health than their physically active counterparts. Per one hour decrease in overall sedentary behavior, there was a significant improvement in glucose (-8.46 and -4.68 mg.dl-1), insulin (-2.12 and -1.77 pmol.l-1 ), HOMA-IR (-0.81 and -0.56) BMI (-0.93 and -0.62 kg.m-2) and waist circumference (-2.32 and -1.65 cm) in physically active and inactive participants, respectively . Conclusions: Being physically active may modify the detrimental effects of sedentary behavior on cardiometabolic and obesity-related traits.

Background: A high level of cardiorespiratory fitness (CRF) is an important protector against cardiovascular and metabolic diseases. Aim: To explore the association of CRF with several metabolic markers and estimate the variation of these parameters by an increase of 1 MET change in CRF. Material and Methods: Cross-sectional study of 447 adults (56% women) without medical history of cardiometabolic diseases. Physical activity evaluated using accelerometry, body mass index (BMI), blood pressure, blood glucose and insulin and lipid profile were measured. HOMA-IR was calculated with fasting glucose and insulin levels. The submaximal Chester Step Test was used to measure CRF. Results: CRF was significantly associated with the level and intensity of physical activity, and all metabolic markers (p-trend < 0.05), except with diastolic blood pressure. It was estimated that 1-MET increase in CRF is associated with waist circumference (β -0.32 cm), fat mass (β -0.22%), insulin (β -0.67 pmol.l-1), HOMA-IR (β -0.17) and HDL cholesterol (β +1.46 mg.dl-1). All these associations were independent of main covariates such as age, sex, education, smoking and body mass index. Conclusions: A higher level of CRF is inversely associated with several metabolic markers that are risk factors for cardiovascular disease.

Background: The purpose was to assess metabolic equivalent (MET) values of common daily activities in middle-age and older adults in free-living environments and compare these with MET values listed in the compendium of physical activities (CPA). Methods: Sixty participants (mean age = 71.5, SD = 10.8) completed a semistructured protocol of sitting, lying, self-paced walking, and 4 self-selected activities in their residences. Oxygen consumption was measured using portable indirect calorimetry, to assess METs for each activity relative to VO2 at rest (VO2 during activity/VO2 at rest). MeasuredMET values for 20 different activities were compared with those in the CPA, for the total sample and for participants aged 55-64, 65-74, and 75-99 years. Results: Measured METs for sitting, walking, sweeping, trimming, and laundry were significantly different from the CPA values. Measured MET values for sedentary activities were lower in all age groups, and those for walking and household activities were higher in the youngest age group, than the CPA values. For gardening activities, there was a significant decline in measured METs with age. Conclusions: Some measured MET values in older people differed from those in the CPA. The values reported here may be useful for future research with younger, middle-age, and older-old people.

Background: Dyslipidemias in childhood increase the risk of cardiovascular events in adult life. Aim: To evaluate the prevalence of dyslipidemia and risk of atherogenicity based in the atherogenic index of plasma (AIP) in a sample of school children and adolescents. Material and Methods: Cross-sectional study of 208 children aged 10.4 ± 1.0 years (107 women). Demographic data were obtained, and a clinical evaluation was conducted, including pubertal development according to Tanner and anthropometric parameters. A fasting blood sample was obtained to measure total cholesterol (CT), HDL cholesterol (cHDL) and triglycerides (TG), glucose and insulin. LDL cholesterol (cLDL), Non-HDL cholesterol and the indices CT/cHDL, cLDL/cHDL and AIP (log[TG/cHDL]) were calculated. Risk categories according to AIP for the pediatric population were also determined (low: AIP < 0.11, intermediate: AIP 0.11-0.21, high: AIP > 0.21). Results: Thirty eight percent of participants had dyslipidemia, without differences by gender and pubertal development. The frequency of dyslipidemia was significantly higher in children with obesity (54%, p < 0.01) and a waist circumference over percentile 90 (61%; p < 0.01). The later conditions had also higher CT/cHDL, cLDL/cHDL and AIP. According to AIP, 54% of children had a high atherogenicity risk along with alterations in anthropometric parameters and insulin resistance. All anthropometric and insulin resistance parameters were significantly correlated with the AIP. Conclusions: There is a high prevalence of dyslipidemia in the studied population, which is associated with an increased cardiometabolic risk. The indices of atherogenicity and particularly AIP are correlated with nutritional status, abdominal obesity and parameters of insulin resistance.

Background The evidence showing the ill health effects of prolonged sedentary behaviour (SB) is growing. Most studies of SB in older adults have relied on self-report measures of SB. However, SB is difficult for older adults to recall and objective measures that combine accelerometry with inclinometry are now available for more accurately assessing SB. The aim of this systematic review was to assess the validity and reliability of these accelerometers for the assessment of SB in older adults. Methods EMBASE, PubMed and EBSCOhost databases were searched for articles published up to December 13, 2017. Articles were eligible if they: a) described reliability, calibration or validation studies of SB measurement in healthy, community-dwelling individuals, b) were published in English, Portuguese or Spanish, and c) were published or in press as journal articles in peer-reviewed journals. Results The review identified 15 studies in 17 papers. Of the included studies, 11 assessed the ActiGraph accelerometer. Of these, three examined reliability only, seven (in eight papers) examined validity only and one (in two papers) examined both. The strongest evidence from the studies reviewed is from studies that assessed the validity of the ActiGraph. These studies indicate that analysis of the data using 60-s epochs and a vertical magnitude cut-point

Background: Childhood and adolescent obesity is a major public health problem in Chile. Aim: To characterize cardiometabolic risk factors in a population of schoolchildren from Carahue, Chile. Material and Methods: Cross-sectional assessment of 208 children aged 10.4 ± 1.0 years (106 women). A clinical evaluation was carried out including pubertal development according to Tanner and anthropometric parameters. A fasting blood sample was obtained to measure glucose, insulin and lipid profile. HOMA-IR and Quicki indices were calculated. Insulin resistance (IR) was established according to Burrows criteria and Barja criteria, previously proposed for the Chilean pediatric population. The metabolic syndrome (MetS) was established using the modified Cook criteria. Results: Thirty eight percent of children had overweight and 33.1% obesity. MetS was only observed in obese subjects and the frequency in this subgroup was 38%. The prevalence of IR was 51% according to the Burrows criteria and 19% according to Barja criteria. It was more common in participants who were overweight, obese or had abdominal obesity. Children with insulin resistance according to Barja criteria, had worse anthropometric measures than their counterparts without resistance. When Burrows criteria was used, no differences in anthropometric measures were observed between participants with or without resistance. The frequency of MetS was 26 and 18% in children with insulin resistance according to Barja and Burrows criteria, respectively. Insulin levels and insulin sensitivity indexes were positively correlated with anthropometric parameters. Conclusions: There was a high prevalence of overweight, obesity and MetS in these participants. Our results suggest that the IR criteria according to Barja allows to identify cases with higher metabolic risk.

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.

Background To investigate the associations between combined categories of moderate-to-vigorous physical activity (MVPA) and sedentary behaviour (SB) with markers of adiposity and cardiovascular risk in adults. Methods Overall, 5040 participants (mean age 46.4 years and 59.3% women) from the cross-sectional Chilean National Health Survey 2009-2010 were included in this study. MVPA and SB were measured using the Global Physical Activity questionnaire. Four categories were computed using MVPA- and SB-specific cut-offs ('High-SB & Active', 'Low-SB & Active', 'High-SB & Inactive' and 'Low-SB & Inactive'). Results Compared to the reference group ('High-SB & Inactive'), those in 'High-SB & Active' and 'Low-SB & Active' were less likely to have an obese BMI (OR: 0.67 [0.54; 0.85], P = 0.0001 and 0.74 [0.59; 0.92] P = 0.0007, respectively) and less likely to have metabolic syndrome (OR: 0.63 [0.49; 0.82], P < 0.0001 and 0.72 [0.57; 0.91], P = 0.007), central obesity (OR: 0.79 [0.65; 0.96], P = 0.016 and 0.71 [0.59; 0.84], P < 0.0001), diabetes (OR: 0.45 [0.35; 0.59], P < 0.0001 and 0.44 [0.34; 0.56], P < 0.0001) and hypertension (OR: 0.52 [0.43; 0.63], P < 0.0001 and 0.60 [0.50; 0.72], P < 0.0001), respectively. Conclusions Being physically active and spending less time in SBs was associated with lower adiposity and improvements in cardiovascular risk factors.

Background: There is limited evidence on how active commuting is associated with health benefits in developing countries. The aim of this study therefore was to investigate the associations between active commuting and markers of adiposity and cardiometabolic risk in the Chilean adult population. Methods: In total, 5157 participants from the Chilean National Health Survey 2009–10 were included in this cross-sectional study. Active commuting was measured using the Global Physical Activity Questionnaire (GPAQ v2). Body mass index (BMI) and waist circumference (WC) were measured and used to define obesity and central obesity. Type 2 diabetes (T2D) and metabolic syndrome were determined using WHO and updated ATPIII-NCEP criteria, respectively. Results: The main finding of this study is that a 30 min increase in active commuting is associated with lower odds for BMI > 25.0 kg m−2 (0.93 [95% CI: 0.88–0.98, P = 0.010]). Similarly, the odds for central obesity was 0.87 [0.82–0.92, P < 0.0001]. Similar associations were found for T2D (0.81 [0.75–0.88], P < 0.0001) and metabolic syndrome (OR: 0.86 [0.80–0.92], P < 0.0001). Conclusion: Our findings show that active commuting is associated with lower adiposity and a healthier metabolic profile including lower risk for obesity, diabetes and metabolic syndrome.

Introduction The aim of this study was to analyze the association between neighborhood environment and the objective measures of physical activity (PA) according to nutritional status in the adult population. Methods A cross-sectional study design was employed. The information was collected from 161 representative subjects of the CESCAS study population from Temuco- Chile. The perception of the neighborhood environment was determined using the IPAQ Environmental- Module. PA was measured objectively by a triaxial accelerometer for 7 consecutive days. Weight and height were measured. The relationship between the residential environment and the PA levels was summarized through linear regression models stratified by nutritional status. Results The perceived residential environmental attributes that support active transport were positively associated with total moderate-vigorous PA (MVPA) (β 397 min/week, CI 80–714, p = 0.019) in people with normal nutritional status, but not in overweight and obese individuals. In addition, living near to a public transport stop was associated with higher levels of moderate PA only in normal-weight subjects (β 383 min/week, CI 72–694, p = 0.021). Also living in a neighborhood with traffic safety was associated with higher levels of light PA in normal-weight subjects (β 518 min/week, CI 208–829, p = 0.004). Conclusions There was no significant association between perceived neighborhood environment and PA in people with obesity.

Introduction Sedentary behavior (SB), physical inactivity and obesity are main risk factors for non-communicable diseases. However, it is unknow whether reallocating SB time with physical activity (PA) domains related to travel, occupational and leisure activities is associated with lower levels of adiposity. The aim of this study, therefore, was to examine independent associations and theoretical reallocations of SB and physical activity (PA) domains with obesity indicators in a nationally representative sample from Chile.. Methods Randomly selected participants were enrolled in the 2009–2010 Chilean National Health Survey. Cross-sectional self-reported SB and PA domains were collected using the Global PA Questionnaire. Isotemporal substitution modeling was applied to examine the potential effects of reallocating 10 min/day of SB with occupational or travel or LTPA in relation to Body Mass Index (BMI) and Waist Circumference (WC). Results 3552 participants aged between 15 and 65 years [mean (standard deviation); age = 40.2 (14.07) years, BMI = 27.7 (5.38) kg/m2, WC = 91.2 (24.09) cm] reported an overall sitting time of 196.3 min/day and spent 15.4 min/day in LTPA. LTPA was negatively associated to both BMI and WC independently of SB. Substituting 10 min/day of SB with an equal amount of travel PA resulted in lower BMI (B = −0.033 95% CI: -0.055; -0.011) and WC (B = −0.089 95% CI: -0.172; -0.007) independent of sociodemographic variables and sleep time. Notably, the strongest association with obesity indicators was observed when SB time was reallocated for LTPA (BMI B = −0.080 95% CI: -0.122; -0.037) and WC: (B = −0.373 95% CI: -0.500; -0.245).. Conclusion Replacing SB not only with LTPA but also travel PA appears to be favorably associated with lower levels of obesity indicators. Walking and cycling as part of our travel PA may be a more feasible way of increasing PA levels than moderate or vigorous intensities PA in the overall population, at lower costs and environmentally friendly..

A study was conducted to assess the validity of the Global Physical Activity Questionnaire (GPAQ) for measuring sedentary behaviour (SB) in the Chilean adult population. About 217 adults (93/124 male/female, 43.8 ± 15.75 years) who were randomly selected during National Health Survey 2009–2010 completed the protocol. The participants wore an ActiGraph GT3X (AG) for 7 consecutive days and then completed the GPAQ (single-item question for measuring time spent sitting in a usual day). Validity was examined using Spearman’s correlation, mean bias and limits of agreement (LoA), with AG (vertical axis

Physical inactivity is estimated to be the fourth leading cause of global mortality. Strategies to increase physical activity (PA) increasingly emphasize environmental and policy changes including the modification of neighborhood environments to promote walking and other forms of healthy activity. Open Streets (OS) initiatives, an important and growing strategy to modify neighborhood environments for PA, create temporary parks for recreational activity by closing streets to motor vehicle traffic, thereby offering health and community building benefits. We used the Stanford Neighborhood Discovery Tool (DT)-photo/voice software on a tablet-to train neighborhood residents to act as "citizen scientist" observers of the local built environment on a non-event day and during an OS initiative. The purposes of this project were as follows: (1) to assess adult residents' perceptions of neighborhood characteristics of the OS initiative in three socioeconomically diverse sites and (2) to test the DT for use in three international urban settings with OS initiatives; Bogota, Colombia; San Francisco, USA; and Temuco, Chile, among a multigenerational, multiethnic sample of adults including, for the first time, a vulnerable population of homeless adults (Bogota). Using the DT, participants walked an OS route taking photos and recording reasons for the photos, then completed a 25-item demographic/environmental observation survey and a 16-item Reflection Survey on perceived environmental changes. A total of 18 themes were reported by participants with areas of overlapping themes (e.g., Community and Social Connectedness) and areas where a single site reported a theme (e.g., Social Isolation in Older Adults). Ten of the 18 themes were identified by at least two sites including "Bike Resources" and "Services", indicating the value of programming at OS initiatives. The themes of "Festive Environment" and "Family Friendly Environment" reflect the quality of the overall environment for participants. Four themes (Community and Social Connectedness, Family Friendly Environment, PA, and Safety) were reported by all sites. Three of the four unifying themes were also ranked among the highest reported categories of "seemed better" on the Reflection Survey (Ease of Walking, Overall Safety of Neighborhood, and Friendliness of Environment), providing additional confirmation of the shared experience of social, health, and psychological benefits from OS initiatives. OS initiatives offer a global strategy for increasing neighborhood opportunities for PA and a potential site for training citizen scientists to document environmental influences on PA.

Sr. Editor: En el ano 2010, la Organizacion Mundial de la Salud estimo que 3,2 millones de personas mueren cada ano en el mundo debido a “inactividad fisica”, convirtiendose en el cuarto factor de riesgo mas importante asociado a mortalidad1. No obstante, durante la ultima decada el “sedentarismo” se ha convertido en otro potente factor de riesgo asociado a enfermedades cronicas no transmisibles y mortalidad1-3. Si bien ambos conceptos (“inactividad fisica” y “sedentarismo”) se relacionan4, es crucial entender que no son lo mismo1, y que ambos actuan de forma independiente sobre nuestra salud5. La conducta sedentaria es definida como la carencia de movimiento durante las horas de vigilia a lo largo del dia1, y es caracterizada por actividades que sobrepasan levemente el gasto energetico basal (~1 MET), como: ver television, estar acostado o sentado3,4. Las actividades sedentarias son la primera categoria de un continuum de clasificacion de actividad fisica (AF) basado en la intensidad de esta: 1) Actividades de tipo sedentarias (1 a 1,5 MET); 2) AF ligera (1,5 a 2,9 MET); 3) AF moderada (3 a 5,9 MET); y 4) AF vigorosa (? 6 MET). Leer mas...