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Background: Overweight during pregnancy has increased in Chile. In the region of La Araucania it occurs in 67% of pregnancies, which exceeds the national indicators. Aim: To analyze the secular trend during eight years of the nutritional status at the beginning of gestation, the excessive weight gain during pregnancy, and its association with individual factors in pregnant women cared the public health system of two Southern Chilean neighboring cities. Material and Methods: This is an analytical observational study with a cross-sectional and longitudinal trend design. We used an anonymized database with 17,270 reproductive data of urban pregnant women who were cared between 2009 and 2016. Trend analysis was performed to evaluate secular changes (nptrend < 0.05) in nutritional indicators and logistic regression to determine the association with individual characteristics. Results: In the study period, overweight at the beginning of pregnancy increased by 13.1 percentage points. Forty percent of pregnant women with normal initial body mass index, were overweight or obese at the end of pregnancy. The excessive weight gain decreased slightly (z=-3.33, p = 0.001), but unevenly in both cities. Adolescent pregnancy, a low education and low socio-economic level of household together with previous overweight and a family or personal history of chronic diseases are associated with excessive gestational weight gain. Conclusions: The results show social inequality. Female malnutrition by excess is a problem that must be addressed through a robust public policy, centered on primary health care level and with a focus on social determinants. Prenatal care provides a window of opportunity to intervene.

Objective. To estimate the point prevalence and likely ranges of pregnancy-induced hypertension, preeclampsia, gestational diabetes, low birth weight and preterm delivery in Latin America and the Caribbean, and evaluate the heterogeneity of the estimates. Methods. We conducted a systematic review and meta-analysis of observational studies reporting the prevalence of maternal and perinatal adverse outcomes in populations in Latin American and the Caribbean published between 2000 and 2019 in English, Spanish, or Portuguese. We searched PubMed, Embase, and LILACS. We estimated the point prevalence and evaluated overall heterogeneity and, in sub-group analyses, heterogeneity by study design and level of bias. Results. Of 1087 records retrieved, 50 articles were included in the review: two on hypertensive disorders of pregnancy, 14 on pre-eclampsia, six on gestational diabetes, nine on low birth weight and 19 on preterm birth. No meta-analysis for hypertensive disorders of pregnancy could be done because of the small number of studies. Point prevalence estimates and 95% confidence intervals (CIs) for pre-eclampsia, gestational diabetes, low birth weight, and preterm birth were: 6.6% (95% CI: 4.9%, 8.6%), 8.5% (95% CI: 3.9%, 14.7%), 8.5% (95% CI: 7.2%, 9.8%), and 10.0% (95% CI: 8.0%, 12.0%), respectively. We observed substantial heterogeneity overall and by study design. No major differences in estimates were observed by level of bias. Conclusions. The results of this study provide updated estimates of some of the most prevalent adverse pregnancy and perinatal outcomes in Latin America and the Caribbean. They highlight that important heterogeneity exists in prevalence estimates, which may reflect the diversity of populations in the region. Objetivo. Estimar la prevalencia puntual y los rangos probables de hipertensión provocada por embarazo, preeclampsia, diabetes gestacional, peso bajo al nacer y parto prematuro en América Latina y el Caribe, y evaluar la heterogeneidad de las estimaciones. Métodos. Se llevó a cabo una revisión sistemática y metanálisis de los estudios de observación que notificaron la prevalencia de resultados adversos perinatales y maternos en poblaciones de América Latina y el Caribe, publicados entre los años 2000 y 2019 en inglés, español o portugués. Se realizaron búsquedas en PubMed, Embase y LILACS. Se estimó la prevalencia puntual y se evaluó la heterogeneidad general y, en los análisis de subgrupos, la heterogeneidad según el diseño del estudio y nivel de sesgo. Resultados. De 1 087 registros recuperados, se incluyeron 50 artículos en la revisión: 2 sobre los trastornos hipertensivos en el embarazo, 14 sobre preeclampsia, 6 sobre la diabetes gestacional, 9 sobre peso bajo al nacer y 19 sobre parto prematuro. No se pudo realizar ningún metanálisis de los trastornos hipertensivos del embarazo debido al número reducido de estudios. Las estimaciones de prevalencia puntual y los intervalos de confianza (IC) del 95% para la preeclampsia, la diabetes gestacional, el peso bajo al nacer y el parto prematuro fueron: 6,6% (IC de 95%: 4,9%, 8,6%), 8,5% (IC de 95%: 3,9%, 14,7%), 8,5% (IC de 95%: 7,2%, 9,8%) y 10,0% (IC de 95%: 8,0%, 12,0%), respectivamente. Se observó una heterogeneidad significativa en general, así como según el diseño del estudio. No se advirtieron grandes diferencias en las estimaciones según el nivel del sesgo. Conclusiones. Los resultados de este estudio ofrecen cálculos actualizados de algunos de los resultados adversos perinatales y del embarazo con mayor prevalencia en América Latina y el Caribe. Estos resultados ponen de manifiesto que existe una gran heterogeneidad en las estimaciones de prevalencia, que podría reflejar la diversidad de la población de la región. Objetivo. Estimar a prevalência pontual e os intervalos prováveis de hipertensão induzida pela gravidez, pré-eclâmpsia, diabetes gestacional, baixo peso ao nascer e parto prematuro na América Latina e no Caribe e avaliar a heterogeneidade das estimativas. Métodos. Realizou-se uma revisão sistemática com metanálise de estudos observacionais que relatam a prevalência de desfechos maternos e perinatais adversos em populações da América Latina e do Caribe, publicados entre 2000 e 2019 em inglês, espanhol ou português. Os bancos de dados PubMed, Embase e LILACS foram pesquisados. Estimou-se a prevalência pontual e avaliou-se a heterogeneidade geral, bem como, em análises de subgrupo, a heterogeneidade por delineamento do estudo e o nível de viés. Resultados. De 1 087 registros encontrados, 50 artigos foram incluídos na revisão: dois sobre distúrbios hipertensivos da gravidez, 14 sobre pré-eclâmpsia, seis sobre diabetes gestacional, nove sobre baixo peso ao nascer e 19 sobre parto prematuro. Não foi possível realizar metanálise para distúrbios hipertensivos da gravidez devido ao pequeno número de estudos. As estimativas de prevalência pontual e intervalos de confiança de 95% (IC) para pré-eclâmpsia, diabetes gestacional, baixo peso ao nascer e parto prematuro foram: 6,6%; (IC 95%: 4,9–8,6%), 8,5% (IC 95%: 3,9–14,7%), 8,5% (IC 95%: 7,2–9,8%) e 10,0% (IC 95%: 8,0– 12,0%), respectivamente. Observou-se heterogeneidade considerável, tanto em geral como por delineamento de estudo. Não foram observadas diferenças importantes nas estimativas por nível de viés. Conclusões. Os resultados deste estudo fornecem estimativas atualizadas de alguns dos desfechos gestacionais e perinatais adversos mais prevalentes na América Latina e no Caribe. Destacam a existência de uma importante heterogeneidade nas estimativas de prevalência, o que pode refletir a diversidade das populações da região.

Research has shown that neighborhood disadvantage has an effect on BMI that is independent of individual disadvantage, much more pronounced in women than in men. The mechanisms that explain this gender-specific effect are not yet clear. Since women's body size dissatisfaction is closely linked to gender differences in BMI inequalities, the independent effect of neighborhood disadvantage on female BMI may relate to a local culture of acceptance of female large bodies, that could influence women's parameters for body size dissatisfaction. This study explored how the relation between female BMI, neighborhood income, individual income and education is influenced by body size dissatisfaction in a random sample of 882 women aged 20–60 that reside in two Chilean Municipalities. Data have a two level structure (women nested in 17 neighborhoods); it was collected by direct survey, height and weight were measured with portable instruments. Disadvantaged neighborhoods house mainly poor and low educated women, whereas the wealthier ones were inhabited mostly by affluent women with postsecondary education. The proportion of women without a husband/partner and with more than three children in disadvantaged neighborhoods was higher than better off areas. Multilevel linear regression showed that neighborhood disadvantage had an effect on female BMI that was independent of women's income and education, which was explained by body size dissatisfaction. The mean BMI for body size satisfaction among women in disadvantaged neighborhoods was 2 kg/m2 higher than in affluent areas, which suggests that a ‘culture of plus-size women’ would emerge in urban clusters of poverty. The findings signal that neighborhood effects on BMI would relate to the socioeconomic polarization of urban areas, with marked concentrations of poverty and wealth, and might be explained by the psychosocial pathways associated to social disadvantage that act in addition to the effects of material conditions to influence people's health.

Resumen Introducción: Chlamydia trachomatis es reconocida como el agente causal de una de las infecciones de transmisión sexual (ITS) más común y curable. En mujeres, puede ser gatillante de enfermedad inflamatoria pélvica, un factor de riesgo para infertilidad o adquisición de otras ITS. Objetivo: Determinar C. trachomatis en mujeres con diagnóstico clínico de vaginitis asociando factores sociodemográficos, sexuales, clínicos y microbiota vaginal. Pacientes y Métodos: Participaron 121 mujeres voluntarias > 18 años, con diagnóstico clínico de vaginitis y descarga vaginal anormal, atendidas en servicios de atención primaria en salud (APS) en Temuco-Chile. Se tomó muestra de flujo vaginal, determinándose C. trachomatis por una reacción de polimerasa en cadena convencional y microbiota vaginal por tinción de Gram. Se colectaron datos clínicos, sociodemográficos y sexuales mediante encuesta. Resultados: Rango de edad 18-61 años. La frecuencia de C. trachomatis fue 14,9%. Se asoció C. trachomatis a mayor número de parejas sexuales en los últimos 5 años (p = 0,001), relaciones sexuales oral más anal (p = 0,055) y juguetes sexuales (p = 0,027). Asociación no significativa hubo con vaginosis bacteriana 31,2% (p = 0,091) e inicio de la actividad sexual < 18 años 20,6% (p = 0,07). Conclusiones: Sería beneficioso incorporar en la semiología ginecológica de las mujeres atendidas en servicios de APS, los factores encontrados como favorecedores de infección por C. trachomatis, pues ello podría ayudar al manejo de esta ITS.

Missing data from air quality datasets is a common problem, but is much more severe in small cities or localities. This poses a great challenge for environmental epidemiology as high exposures to pollutants worldwide occur in these settings and gaps in datasets hinder health studies that could later inform local and international policies. Here, we propose the use of imputation methods as a tool to reconstruct air quality datasets and have applied this approach to an air quality dataset in Temuco, a mid-size city in Chile as a case-study. We attempted to reconstruct the database comparing five approaches: mean imputation, conditional mean imputation, K-Nearest Neighbor imputation, multiple imputation and Bayesian Principal Component Analysis imputation. As a base for the imputation methods, linear regression models were fitted for PM2.5 against other air quality and meteorological variables. Methods were challenged against validation sets where data was removed artificially. Imputation methods were able to reconstruct the dataset with good performance in terms of completeness, errors, and bias, even when challenged against the validations sets. The performance improved when including covariates from a second monitoring station in Temuco. K-Nearest Neighbor imputation showed slightly better performance than multiple imputation for error (25% vs. 27%) and bias (2.1% vs. 3.9%), but presented lower completeness (70% vs. 100%). In summary, our results show that the imputation methods can be a useful tool in reconstructing air quality datasets in a real-life situation.

Objective To determine the concordance between the clinical diagnosis of women with abnormal vaginal discharge (AVD) and laboratory results using molecular detection and observation of the vaginal microbiota. Methods Cross-sectional study conducted in 2018 in Temuco, Chile. A total of 25 midwives from 12 health centers participated. A total of 125 women>18 years old, volunteers, were recruited. The sample of the posterior vaginal fornix was obtained by speculoscopy. Characteristics of the discharge and of the external and internal genitalia were observed. Gram staining was used to observe vaginal microbiota, blastoconidia and pseudohyphae, and polymerase chain reaction was used for the detection of Trichomonas vaginalis and Candida albicans. The Cohen kappa coefficient was used in the concordance analysis. Results Out of a total of 125 women with AVD, 85.6% consulted spontaneously and 14.4% were diagnosed clinically during a routine check-up. Absolute concordance was significant (p=0.0012), with an agreement of 13.6%. The relative concordance was significant, but fair for bacterial vaginosis (Kappa=0.21; p=0.003) and candidiasis (Kappa=0.22; p=0.001), and slight for trichomoniasis (Kappa=0.14; p=0.009). The percentage of coincidence of the diagnoses (single or mixed) by laboratory and midwives was: bacterial vaginosis 63.2% (12/19), candidiasis 36.5% (27/74), and trichomoniasis 12.5% (4/32). There was 20% coinfection. A total of 36% of the clinical diagnoses of AVD had negative laboratory tests. Conclusion The vulvovaginitis conditions candidiasis and trichomoniasis appear to be overdiagnosed, and bacterial vaginosis appears to be underdiagnosed by the clinical diagnosis when compared with the laboratory diagnosis. The low concordance obtained shows the importance of complementing the clinical diagnosis with a laboratory study of AVD, particularly in women with failed treatments and/or coinfections with unspecific and varying signs and symptoms. Resumo Objetivo Determinar a concordância entre o diagnóstico clínico de mulheres com corrimento vaginal anormal (AVD) e os resultados laboratoriais por meio da detecção molecular e observação da microbiota vaginal. Métodos Estudo transversal realizado em 2018 em Temuco, Chile. Participaram 25 parteiras de 12 centros de saúde. Um total de 125 mulheres>18 anos, voluntárias, foramrecrutadas. A amostra do fórnice vaginal posterior foi obtida por especuloscopia. Foram observadas características da secreção e da genitália externa e interna. A coloração de Gram foi usada para observar a microbiota vaginal, blastoconídios e pseudo-hifas, e a reação em cadeia da polimerase foi usada para a detecção de Trichomonas vaginalis e Candida albicans. O coeficiente kappa de Cohen foi usado na análise de concordância. Resultados De um total de 125 mulheres com AVD, 85,6% consultaram espontaneamente e 14,4% foram diagnosticados clinicamente durante um check-up de rotina. A concordância absoluta foi significativa (p=0,0012), com concordância de 13,6%. A concordância relativa foi significativa, mas razoável para vaginose bacteriana (Kappa =0,21; p=0,003) e candidíase (Kappa=0,22; p=0,001), e leve para tricomoníase (Kappa=0,14; p=0,009). O percentual de coincidência dos diagnósticos (solteiros ou mistos) por laboratório e parteiras foi: vaginose bacteriana 63,2% (12/19), candidíase 36,5% (27/74) e tricomoníase 12,5% (4/32). Houve 20% de coinfecção. Umtotal de 36% dos diagnósticos clínicos de AVD tiveram exames laboratoriais negativos. Conclusão As condições de vulvovaginite candidíase e tricomoníase parecem ser sobrediagnosticadas, e a vaginose bacteriana parece ser subdiagnosticada pelo diagnóstico clínico quando comparado com o diagnóstico laboratorial. A baixa concordância obtida mostra a importância de complementar o diagnóstico clínico comestudo laboratorial de AVD, principalmente emmulheres com falha de tratamento e / ou coinfecções com sinais e sintomas inespecíficos e variáveis.

The Araucania region in Chile had the greatest COVID-19 incidence and lethality in Chile Aim: To describe the clinical characteristics and evolution of patients admitted for COVID-19 in a high complexity Hospital in the region of La Araucanía-Chile.Review of medical records of the first 169 patients aged 55 ± 17 years (50% women) admitted for COVID-19 between march and may, 2020 at a regional hospital in Temuco Chile.The most common comorbidities of these patients were hypertension, diabetes, and obesity. The symptom triad of cough, dyspnea and fever was present in 85%. Less frequent symptoms were diarrhea and vomiting. Biomarkers at admission such as ferritin, D-dimer, among others, were significantly higher among patients who required admission to the Intensive Care Unit. The presence of cough, dyspnea and fever were significantly associated with longer hospitalization time and requirement for mechanical ventilation. Hypertension and obesity were significantly associated with longer hospitalization stay. Eight percent of patients died.Symptoms such as cough, dyspnea and fever and specific biomarkers on admission were associated with a worse evolution of adult inpatients with COVID-19.

Chlamydia trachomatis is recognized as the causative agent of one of the most common and curable sexually transmitted infections (STIs). In women, it can be a trigger for pelvic inflammatory disease, a risk factor for infertility or acquisition of other STIs.To determine CT in women with vaginitis and associate it with sociodemographic, sexual, clinical, and vaginal microbiota factors.121 female volunteers18 years of age, with a clinical diagnosis of vaginitis and abnormal vaginal discharge, attending in primary health care services (PHC) in Temuco-Chile were recluted. A vaginal discharge sample was taken, determining C. trachomatis by polymerase chain reaction and vaginal microbiota by Gram stain. Clinical, sociodemographic and sexual data were collected by survey.Age range was 18-61 years. The frequency of C. trachomatis was 14.9%. C. trachomatis was associated with a higher number of sexual partners in the last 5 years (p = 0.001), oral plus anal sex (p = 0.055) and sex toys (p = 0.027); there was a non-significant association with bacterial vaginosis 31.2% (p = 0.091) and initiation of sexual activity18 years 20.6% (p = 0.07).It would be beneficial to incorporate in the gynecological semiology of the women attended in PHC services, the factors found to favor C. trachomatis infection, as this could help the management of this STI.

The aims of this study were to identify profiles of women based on their levels of emotional, external and restraint eating, and to determine differences in these eating styles profiles based on nutritional status, sociodemographic characteristics, stress, social support, and satisfaction with the body image. Questionnaires were administered to 884 women aged 20 to 60 living in two Chilean cities. Questionnaires included the Dutch Eating Behavior Questionnaire (DEBQ), the Medical Outcomes Study-Social Support Survey, and the Perceived Stress Scale (PSS). Satisfaction with body image was assessed using a body-image-related single question. Nutritional status and sociodemographic characteristics were also assessed. Latent Profile Analysis (LPA) was used to identify profiles based on the three eating styles measured by the DEBQ. LPA allowed to distinguish four eating styles profiles: "women with medium emotional and external eating, high dietary restraint" (Profile 1, 36.64%); "women with low emotional, external and restraint eating" (Profile 2, 25.25%), "women with high emotional, external and restraint eating" (Profile 3, 21.85%); and "women with very low emotional and external eating, low dietary restraint" (Profile 4, 16.26%). Profile 1 had a greater proportion of women moderately satisfied with their body image. Profiles 2 and 4 scored higher in perceived social support and had greater proportions of women satisfied with their body image. Profile 4 had a higher proportion of married or cohabiting women. Profile 3 scored higher in the PSS and had higher proportion of obese and unsatisfied with their body image women. These results suggest that interventions to reduce emotional, external and restraint eating should not only involve the women, but also their family members.

Resumo Objetivo explicar a estrutura motivacional que acompanha a decisão das mães que amamentam por mais de dois anos. Métodos estudo qualitativo em mulheres de zonas urbanas e rurais, entre e 20 e 44 anos de idade, nas comunas de Temuco e Padre Las Casas, Chile. A técnica empregada para coleta de dados foi a de entrevista em profundidade. O método indutivo de análise, baseado na Teoria Fundamentada em Dados ( Grounded Theory ), possibilitou um processo comparativo constante até alcançar a saturação teórica dos dados e as três etapas de codificação: aberta, axial e seletiva. Resultados oito mulheres concordaram em participar. Foram identificadas quatro dimensões: experiência de vida, autoanálise materna, estímulos da própria mãe e do filho e estímulos sociais e culturais, que estão subjacentes à estrutura motivacional que acompanha a decisão das mães de continuarem amamentando por mais de dois anos. Na infância, as motivações são principalmente intrínsecas (cultura familiar da amamentação). Na idade adulta, há motivações intrínsecas (sentimentos maternos, estímulos internos da mãe) e motivações transcendentes (estímulos da criança), que são reforçadas por estímulos originários do meio social e cultural (ambiente familiar). Conclusão para as mulheres, a infância é o período motivacional por excelência para integrar a amamentação como a melhor opção para alimentar seus filhos. Na idade adulta, a motivação transcendente se consolida no primeiro estágio da educação dos filhos e proporciona maior qualidade motivacional ao prolongamento do aleitamento materno. As políticas públicas devem focar suas ações nessas etapas da vida da mulher para melhorar os indicadores de amamentação. Resumen Objetivo Explicar la estructura motivacional que acompaña la decisión de madres que amamantan durante más de dos años. Métodos Estudio cualitativo en mujeres de zonas urbanas y rurales, entre 20 y 44 años de edad, en las comunas de Temuco y Padre Las Casas, Chile. La técnica empleada para la recolección de datos fue la de entrevistas en profundidad. El método inductivo de análisis, basado en la teoría fundamentada en datos ( Grounded Theory ), posibilitó un proceso comparativo constante hasta alcanzar la saturación teórica de los datos y las tres etapas de codificación: abierta, axial y selectiva. Resultados Ocho mujeres aceptaron participar. Se identificaron cuatro dimensiones: experiencia de vida, autoanálisis materno, estímulos de la propia madre y del hijo y estímulos sociales y culturales, que están por detrás de la estructura motivacional que acompaña la decisión de las madres de continuar amamantando durante más de dos años. En la infancia, las motivaciones son principalmente intrínsecas (cultura familiar de la lactancia). En la edad adulta, hay motivaciones intrínsecas (sentimientos maternos, estímulos internos de la madre) y motivaciones trascendentes (estímulos del niño), que se refuerzan con estímulos originarios del medio social y cultural (ambiente familiar). Conclusión Para las mujeres, la infancia es el período motivacional por excelencia para integrar la lactancia como la mejor opción para alimentar a sus hijos. En la edad adulta, la motivación trascendente se consolida en el primer nivel de la educación de los hijos y proporciona mayor calidad motivacional para la prolongación de la lactancia materna. Las políticas públicas deben centralizar sus acciones en estas etapas de la vida de la mujer para mejorar los indicadores de lactancia. Abstract Objective Our aim was to explain the motivational structure that accompanies the decision by mothers who breastfeed for more than two years. Methods Qualitative study in urban and rural women aged 20 to 44 years in the communes of Temuco and Padre Las Casas, Chile. The data collection technique was an in-depth interview. The inductive method of analysis based on Grounded Theory enabled a constant comparative process until the theoretical saturation of the data and the 3 coding stages: open, axial and selective. Results Eight women agreed to participate. Four dimensions were identified: life experience, maternal self-analysis, stimuli from the mother herself and from the child, and social and cultural stimuli, which underlie the motivational structure that accompanies the decision by mothers to continue breastfeeding for longer than two years. In childhood the motivations are mainly intrinsic (family culture of breastfeeding) and in adulthood there are intrinsic motivations (maternal feelings, mother’s internal stimuli) and transcendent motivations (stimuli from the child), with these being reinforced by stimuli originating from the social and cultural milieu (family surroundings). Conclusion For a woman, childhood is the motivational period par excellence to integrate breastfeeding as the best option for feeding her children. In adulthood, the transcendent motivation is consolidated in the first stage of child-rearing, affording greater motivational quality to the prolongation of breastfeeding. Public policies must focus their actions on these stages of a woman’s life to improve breastfeeding indicators.

Obesity in Chile disproportionately affects women of low socioeconomic status (SES). Research has shown that ideals of body size and differences in perceived social pressure for being slim across socioeconomic strata contribute to the social stratification of body size among women in modern societies. Thinness is most valued by high SES women, following western standards of Ideal body size.Aiming to understand the link between ideals of body size and SES, this qualitative study explored how 36 Chilean women construct their bodily ideals according to their social position. A purposive sample of women with different profiles with regard to educational attainment, nutritional status and body size (dis)satisfaction was defined, aiming to cover a diverse spectrum of bodily perceptions. Data were collected through semi structured interviews and approached through a thematic and narrative analysis.Drawing on Bourdieu's concepts of habitus, field, capital and embodiment of the social context, this study explains how ideals of body size and appearance are strongly linked to class-dependent gender roles and social roles. The existing gender and class inequalities in the Chilean social structure have been literally embodied by these women through a 'gendered class habitus'. Compliance with the thin ideal confers women different degrees of power according to their social position in different fields, such as in marriage and on the labour market, which turns thinness into an embodied form of capital.The societal dynamic behind obesity rates cannot be disregarded when approaching possible solutions. Promoting obesity-related lifestyle modification at an individual level might appear an over-simplistic and individualistic approach to a complex social issue. Context-oriented interventions that take cultural constructions of gender and social class into account might yield better results in the long term, while advocating for a more equitable society and social justice as a public health concern.

A rapidly growing body of research has recently shown beneficial health effect of urban green environment and natural spaces. Latin America is the world’s most urbanized region, with largest ...

espanolIntroduccion: La silicosis es una enfermedad pulmonar progresiva, irreversible, pero potencialmente prevenible. Conocer la percepcion de riesgo en trabajadores expuestos a silice es necesario para intervenir y reducir la incidencia de silicosis y otras enfermedades relacionadas. El objetivo de este estudio fue validar un Cuestionario de Percepcion de Riesgo de Exposicion Ocupacional a Silice (CuPREOS) en trabajadores expuestos, en distintas actividades laborales en Temuco, Chile. Material y metodo: Una etapa de exploracion con enfoque fenomenologico/ naturalista permitio conformar categorias de primer y segundo orden, que concluyo en una primera version del instrumento. Una segunda etapa incluyo analisis factorial exploratorio y confirmatorio. Resultados: Se develaron dos dimensiones subyacentes: a) evidencia de riesgo, en la que el trabajador manifiesta evaluar senales de alarma y b) ausencia de riesgo, en la que sopesa aspectos que contrarrestan las anteriores. Ambas configuran la estructura conceptual que conforma el CuPREOS de 9 items/preguntas, con una confiabilidad de 0.84 (alfa Cronbach). Los indicadores del analisis confirmatorio revelan un buen ajuste del modelo. Discusion: la percepcion de riesgo es un constructo que involucra complejidades sociales y culturales, su medicion debe ser sencilla y practica; su conocimiento permitiria decisiones mas efectivas en prevencion e intervencion. EnglishIntroduction: Silicosis is a progressive lung disease, irreversible, but potentially preventable. Knowing the perception of risk in workers exposed to silica is necessary to intervene and reduce the incidence of silicosis and other related diseases. The objective of this study was to validate a Questionnaire of risk perception of occupational expo sure to silica (CuPREOS) in exposed workers, in different work activities in Temuco, Chile. Material and method: A stage of explo ration with phenomenological/naturalist approach allowed to create categories of first and second order, which ended in a first version of the instrument. The second stage included exploratory and con firmatory factor analysis. Results: two underlying dimensions were revealed: a) evidence of risk, in which worker states to evaluate signals of alarm and b) absence of risk, in which he weighs aspects that counteract the previous ones. Both set up the conceptual frame work that sustain the CuPREOS of 9 items/questions, with a reliabil ity of 0.84 (Cronbach alfa). The confirmatory analysis indicators show a good fit of the model. Discussion: the perception of risk is a construct involving social and cultural complexities, its measurement should be simple and practical; its knowledge would enable more effective decision-making in prevention and intervention.

Background: Adverse effects of medications are an important cause of morbidity and hospital admissions. Errors in prescription or preparation of medications by pharmacy personnel are a factor that may influence these occurrence of the adverse effects Aim: To assess the frequency and type of errors in prescriptions and in their preparation at the pharmacy unit of a regional public hospital. Material and Methods: Prescriptions received by ambulatory patients and those being discharged from the hospital, were reviewed using a 12-item checklist. The preparation of such prescriptions at the pharmacy unit was also reviewed using a seven item checklist. Results: Seventy two percent of prescriptions had at least one error. The most common mistake was the impossibility of determining the concentration of the prescribed drug. Prescriptions for patients being discharged from the hospital had the higher number of errors. When a prescription had more than two drugs, the risk of error increased 2.4 times. Twenty four percent of prescription preparations had at least one error. The most common mistake was the labeling of drugs with incomplete medical indications. When a preparation included more than three drugs, the risk of preparation error increased 1.8 times. Conclusions: Prescription and preparation of medication delivered to patients had frequent errors. The most important risk factor for errors was the number of drugs prescribed.

Adverse effects of medications are an important cause of morbidity and hospital admissions. Errors in prescription or preparation of medications by pharmacy personnel are a factor that may influence these occurrence of the adverse effects Aim: To assess the frequency and type of errors in prescriptions and in their preparation at the pharmacy unit of a regional public hospital.Prescriptions received by ambulatory patients and those being discharged from the hospital, were reviewed using a 12-item checklist. The preparation of such prescriptions at the pharmacy unit was also reviewed using a seven item checklist.Seventy two percent of prescriptions had at least one error. The most common mistake was the impossibility of determining the concentration of the prescribed drug. Prescriptions for patients being discharged from the hospital had the higher number of errors. When a prescription had more than two drugs, the risk of error increased 2.4 times. Twenty four percent of prescription preparations had at least one error. The most common mistake was the labeling of drugs with incomplete medical indications. When a preparation included more than three drugs, the risk of preparation error increased 1.8 times.Prescription and preparation of medication delivered to patients had frequent errors. The most important risk factor for errors was the number of drugs prescribed.

Background: Parasitic infections in children reflect social inequalities throughout the world, especially in urban and rural territories. Aim: To assess inequalities in the prevalence of infections by protozoa and intestinal helminths and associated factors in children of different geographical areas from the commune of Puerto Montt. Material and methods: Cross-sectional study carried out in 103 students from one urban and two rural schools in the commune of Puerto Montt. A socio-demographic survey was applied and the presence parasitic infections was evaluated in serial stool samples. Results: The prevalence of Protozoan and intestinal helminthic infections were 37.5 and 68.1% in urban and rural areas respectively. A regression analysis showed that the differences between rural and urban children, disappear when the results are adjusted by family income and the quality of sewage disposal. In urban children, the prevalence of parasitic infections increases along with the decrease in family income. Conclusions: Income and sanitary conditions rather than being or urban or rural origin explain the variations in rates of childhood parasitic infections. Infections with protozoa and intestinal helminths are an indicator of social inequality in health.

Parasitic infections in children reflect social inequalities throughout the world, especially in urban and rural territories.To assess inequalities in the prevalence of infections by protozoa and intestinal helminths and associated factors in children of different geographical areas from the commune of Puerto Montt.Cross-sectional study carried out in 103 students from one urban and two rural schools in the commune of Puerto Montt. A socio-demographic survey was applied and the presence parasitic infections was evaluated in serial stool samples.The prevalence of Protozoan and intestinal helminthic infections were 37.5 and 68.1% in urban and rural areas respectively. A regression analysis showed that the differences between rural and urban children, disappear when the results are adjusted by family income and the quality of sewage disposal. In urban children, the prevalence of parasitic infections increases along with the decrease in family income.Income and sanitary conditions rather than being or urban or rural origin explain the variations in rates of childhood parasitic infections. Infections with protozoa and intestinal helminths are an indicator of social inequality in health.

To assess the validity and reliability of the chronic respiratory questionnaire (CRQ) in the measurement of HRQL in the Colombian population with COPD. A cross-sectional study was conducted with a sample of 200 patients diagnosed with COPD according to GOLD criteria. Convergence validity was evaluated by correlating the questionnaire results with other clinical variables such as exercise tolerance, forced expiratory volume at the first second (FEV1), and depression levels. HRQL measured through the CRQ correlated significantly with the 6-min walk test (r = 0.34), just as the dimensions fatigue (r = 0.37) and dyspnoea correlated with the FEV1 test (r = 0.21) and the dimensions emotional function and disease management with depression levels (r = −0.79). The Generalized Structured Component Analysis (GSCA) with the prespecified model is showed, and the total variance explained by the items in the model was 61.5 % (FIT = 0.615), unweighted least squares (GFI = 0.998), and standardised root mean square (SRMR = 0.084), indicating that the model fits adequately. The CRQ presents evidence of adequate validity and reliability in the Colombian population. Its use is recommended to measure HRQL in patients with COPD, although future validations will be needed to identify the property of sensitivity to change.

Background: The age at menarche may influence decisively health and disease in women. It also indicates the beginning of the reproductive period and, as a consequence, the possibility of biological continuity for the human species. Genetic and environmental determinants define the age of menarche and can explain differences found among different populations. Aim: To determine the age at menarche among adolescents with different levels of indigenous descent (parental indigenous surnames), considering the effect of socioeconomic and demographic factors. Material and Methods: An observational study of historic cohorts of8.624 girls from the Arauca-nia Region (central-southern Chile) was carried out. Data were collected by health professionals using a previously validated questionnaire. Occurrence of menarche was estimated through survival analysis and compared between groups (according to indigenous parental surnames) adjusted for parents' income and educational level and provenance (rural/urban). Results: Estimated median age of menarche was 151 months (95% Cl: 150-151). In female with four indigenous surnames, menarche occurred two months later than girls without indigenous surnames and with two indigenous surnames (p < 0,001). In girls whose parents had lowest level of schooling, the difference increased to eight months later (p < 0,005). Conclusions: Age at menarche in the group with higher indigenous descent is later even if socio-economic conditions remain stable. Genetic factors might play an important role, however conditions of vulnerability can influence and further delay the onset of reproductive competency.

The age at menarche may influence decisively health and disease in women. It also indicates the beginning of the reproductive period and, as a consequence, the possibility of biological continuity for the human species. Genetic and environmental determinants define the age of menarche and can explain differences found among different populations.To determine the age at menarche among adolescents with different levels of indigenous descent (parental indigenous surnames), considering the effect of socioeconomic and demographic factors.An observational study of historic cohorts of 8.624 girls from the Araucanía Region (central-southern Chile) was carried out. Data were collected by health professionals using a previously validated questionnaire. Occurrence of menarche was estimated through survival analysis and compared between groups (according to indigenous parental surnames) adjusted for parents' income and educational level and provenance (rural/urban).Estimated median age of menarche was 151 months (95% Cl: 150-151). In female with four indigenous surnames, menarche occurred two months later than girls without indigenous surnames and with two indigenous surnames (p0,001). In girls whose parents had lowest level of schooling, the difference increased to eight months later (p0,005).Age at menarche in the group with higher indigenous descent is later even if socio-economic conditions remain stable. Genetic factors might play an important role, however conditions of vulnerability can influence and further delay the onset of reproductive competency.

Objective to estimate the prevalence of poorer prenatal attachment and its association with psycho-affective factors in pregnant women during the third trimester. Design and setting cross-sectional study in Temuco, La Araucania Region, Chile. Measurements data were collected by structured interview with closed questions for the sociodemographic characterisation of the sample and measurement of six aspects: prenatal attachment, perceived stress, depression, perception of relationship with partner, subjective family support, and obstetric information regarding current and previous pregnancies. Participants 244 pregnant women selected by stratified random sampling in all centres ( n =5) of the public health system in Temuco, Chile, with proportional allocation. Findings the prevalence of poorer prenatal attachment was 24.3% (95% confidence interval 19–30%), and this was found to be associated with discontent with the pregnancy, unwanted pregnancy, higher levels of perceived stress, depression and low family support. Religious activity and work were found to modulate the association between poorer prenatal attachment and psycho-affective aspects. The percentage of unplanned pregnancies was high in this study (61.35), and although this does not have a direct influence on poorer prenatal attachment, it is associated with discontent with the pregnancy and unwanted pregnancy. Key conclusions and implications for practice the high proportion of poorer prenatal attachment during the third trimester of pregnancy associated with potentially detectable psychosocial factors means that early diagnosis and timely intervention during prenatal care are an essential challenge for midwives in their work. Any progress that can be made during pregnancy will favour the development of the bonding experience after birth, and thus the balanced development of the child.

To estimate the secular trend in age at menarche, comparing indigenous and nonindigenous women, and its relationship with socio-demographic, family and nutritional factors.A study (historical cohorts) of 688 indigenous and nonindigenous women, divided into four birth cohorts (1960-69, 1970-79, 1980-89, and 1990-96) in an area in central southern Chile was carried out. Data and measurements were collected by health professionals using a previously validated questionnaire. Age at menarche was self-reported (recall). Adjusted differences among cohorts were estimated using a multivariate regression model.A secular trend (P0.001) in age at menarche was found in both ethnic groups, with no significant differences between them (P0.05). In an adjusted model, a reduction in age at menarche was estimated at 3.7 months per decade between 1960 and 1990. This trend was moderated by higher socio-economic level, smaller number of siblings, and cohabitation with a single parent during infancy.The trend has occurred in a steady progression over time in indigenous women, whereas in nonindigenous women, it was slow initially but has accelerated in recent years. Nonindigenous women have maintained a slightly lower age of menarche than their indigenous counterparts.

Improvements in environmental conditions may result in an earlier onset of thelarche. However, its onset is not homogeneous among different population groups.To assess the relationship between nutritional status, ethnicity and age of thelarche.Cross-sectional study of girls in second through sixth grade, attending 165 schools located in Chile's Araucania region. Of these, 231 girls who presented thelarche (breast button) were selected. The girls' surnames were used to identify their ethnicity: indigenous had three or four last names of Mapuche indigenous origin (n =113), while non-indigenous were those who only had Chilean-Spanish last names (n =118). Weight, height, waist circumference and skinfold thicknesses were measured and socio-economic background information was collected through a home interview.The median age of thelarche was 10 years and 4 months, regardless of ethnic group. Multivariant models showed that an increase of one z score unit of body mass index (BMI) decreased the median age of thelarche by 5.6 months (CI: -7.24 to -3.90), controlling for the effect of different covariables. A decrease in one z score of height retards the median age of thelarche by 5.5 months (CI: 4.02 to 6.98). Ethnicity did not influence the age of thelarche.The age of thelarche found by us is similar to that reported in international studies, it comes earlier as weight increases, is delayed as height decreases and is not related to ethnicity.

Background: Improvements in environmental conditions may result in an earlier onset of thelarche. However, its onset is not homogeneous among different population groups. Aim: To assess the relationship between nutritional status, ethnicity and age of thelarche. Material and methods: Cross-sectional study of girls in second through sixth grade, attending 165 schools located in Chile's Araucania region. Of these, 231 girls who presented thelarche (breast button) were selected. The girls' surnames were used to identify their ethncity: indigenous had three or four last names of Mapuche indigenous origin (n =113), while non-indigenous were those who only had Chilean-Spanish last names (n =118). Weight, height, waist circumference and skinfold thicknesses were measured and socio-economic background information was collected through a home interview. Results: The median age of thelarche was 10 years and 4 months, regardless of ethnic group. Multivariant models showed that an increase of one z score unit of body mass index (BMI) decreased the median age of thelarche by 5.6 months (CI: -7.24 to -3.90), controlling for the effect of different covariables. A decrease in one z score of height retards the median age of thelarche by 5.5 months (CI: 4.02 to 6.98). Ethnicity did not influence the age of thelarche. Conclusions: The age of thelarche found by us is similar to that reported in international studies, it comes earlier as weight increases, is delayed as height decreases and is not related to ethnicity.

Studies done in Santiago, Chile show that menses return before the sixth month of puerperium in 50% of lactating women, even in those that continue with exclusive breast feeding.To study the length of lactational amenorrhea in a group of women living in Southern Chile.One hundred fourteen women giving exclusive breast feeding, were followed from the third postpartum month, to determine the length of lactational amenorrhea. Its relationship with general characteristics of the mothers and children and breast feeding pattern was also studied.Sixty six women (58%) recovered their menses before the 6th postpartum month and their length of lactational amenorrhea was 101 +/- 5 days. In the rest of the sample, the length was 277 +/- 10 days. No differences in characteristics of the mothers and children or breast feeding pattern, were observed between these two groups.A short lactational amenorrhea is common in the Chilean population. Clinical characteristics or pattern of breast feeding do not explain the length of LA in this population.

Background: Studies done in Santiago, Chile show that menses return before the sixth month of puerperium in 50% of lactating women, even in those that continue with exclusive breast feeding. Aim: To study the length of lactational amenorrhea in a group of women living in Southern Chile. Material and methods: One hundred fourteen women giving exclusive breast feeding, were followed from the third postpartum month, to determine the length of lactational amenorrhea. Its relationship with general characteristics of the mothers and children and breast feeding pattern was also studied. Results: Sixty six women (58%) recovered their menses before the 6th postpartum month and their length of lactational amenorrhea was 101 ± 5 days. In the rest of the sample, the length was 277 ± 10 days. No differences in characteristics of the mothers and children or breast feeding pattern, were observed between these two groups. Conclusions: A short lactational amenorrhea is common in the Chilean population. Clinical characteristics or pattern of breast feeding do not explain the length of LA in this population ( Rev Med Chile 2002; 130: 66-70)