Gonzalo Valdivia C

Consumo de tabaco en población menor de 18 años: estudio de prevalencia en escolares de Chile

Background: In Chile, there is no information about the prevalence of smoking among basic and high school students. Aim: To study the prevalence of smoking among school age population. Material and Methods: A cross sectional survey was conducted during 2001, assessing tobacco use and smoking habit in a representative sample of 15.119 randomly selected students. Results: Sixty four percent of students had smoked at least once in their lifetime. Eighteen percent of students smoked daily and 15%, occasionally. The figures for women were higher (19 and 18% respectively). The mean age for the first contact with smoking was 12.3 years and, for starting the smoking habit, 13.2 years. Smokers increased the amount of cigarettes during weekends. Higher prevalence rates of smoking were observed in students from the Southern region of the country and of lower socioeconomic levels. From the 3rd grade on, there is an increased risk of having contact with tobacco and smoking for the first time and from 6th grade on, this risk becomes permanent. The adjusted Odds Ratio to be a smoker is significantly higher when the mother is a current or irregular smoker (OR 1.9 95 CI; 1.7-2.0). Conclusions: High smoking prevalence rates were detected in this survey, mainly in women. The risk for smoking starts early during school life. Therefore, health promotion programs must include elementary and high school students (Rev Med Chile 2004; 132: 171-82)

Fracturas vertebrales, osteoporosis y vitamina D en la posmenopausia: Estudio en 555 mujeres en Chile

We recruited 555 postmenopausal women from Santiago, Chile, aged 55-84 years, who manifested interest in their bone health. All were healthy by self-declaration and bygeneral clinical and laboratory tests and had not taken any bone-active therapy. They allunderwent a spine and femoral neck (FN) densitometry and a digital lateral spine X-ray from T4 toL4 was obtained. PTH, calcidiol, and other parameters of calcium metabolism were also measured.

Prevalencia de síntomas de rinitis alérgica y su relación con factores de riesgo en escolares de Santiago, Chile

Background: The prevalence of asthma and allergic rhinitis experienced a steady increase in the last years, probably associated to changes in lifestyles. Aim: To assess the prevalence of allergic rhinitis, to evaluate changes over time (1994-2000), and to describe risk factors. Material and Methods: The International Study of Asthma and Allergies in Childhood (ISAAC) core questionnaire, with questions added about socioeconomic status (SES), was applied to 4594 children between 6-7 years old and 13-14 years old during october-december 2000. Attendance to public or private schools was also used a SES proxy. The results were compared with those of a similar survey in 5281 children, performed in 1994. Rhinitis symptoms (ever) (SR), rhinitis symptoms within last 12 months (SR12) and medical diagnosis of rhinitis (DR) were assessed. Results: There was a significant increase in the prevalence of SR, SR 12 and DR in both age groups in 2000, compared to 1994. SR older children showed a higher prevalence of SR compared with the youngest group (p=0.003). No age differences were observed in the prevalence of SR12 and DR. Both SR and SR12 were more prevalent at schools of medium and low-medium SES (p=0.003 and p=0.002 respectively). DR was significantly more prevalent among children of high SES. A better mother educational level was associated to higher prevalence of SR and SR12 (p=0.03 and p=0.04). Father educational level was associated to DR (p=0.007). The prevalence of SR12 was higher in households with carpets (p=0.017). The prevalence of DR was higher in houses with smokers (p=0.03) and gas heating (p=0.005). None of the three variables were related to gender. Conclusions: The prevalence of SR, SR12 and DR increased significantly in a short time period (6 years). Our results support a positive association between DR and high SES (Rev Med Chile 2006; 134: 456-64).

Cambios recientes en la mortalidad por cáncer de próstata en Chile: estudio de tendencias en el período 1955-2001

BACKGROUND By the year 2000, prostate cancer became the second leading cause of cancer death in Chilean men of all ages and is the leading cause of cancer deaths in men of eighty years of age or older. AIM To analyze the trends in mortality rates from prostate cancer in Chile in a fifty years series, estimating the rate of increase of such rates and their changes in time. MATERIAL AND METHODS A trend analysis for age standardized mortality rates was performed, using join point regression analysis, which allows estimation of the annual percent change of rates and to find significant changes in such trend. RESULTS Age standardized mortality rates in Chile reached their peak value in 1996, becoming apparently stable from then on. Crude rates have had a steady increase during the whole period. The trends analysis identified three different periods in the growth of the age standardized rates: a first one of slot increase in rates between 1955 and 1981 (0.9% annual increase), a second one of more aggressive growth starting in 1981 (2.6% annual increase), and a third period starting in 1996, in which rates slowly decline at an annual rate of 1%. CONCLUSIONS The tendency of prostate cancer seen in Chile resembles that of industrialized countries, with an increase in its age standardized death rates that suffers a downturn by the end of the past decade. Besides early detection techniques, a substantial part of the reduction in mortality from prostate cancer could be explained by therapeutic improvements.

Diseño de un índice pronóstico clínico para el manejo de la neumonía del adulto adquirida en la comunidad

2 days, altered mental status, absence of cough, fever and chills; low bloodpressure, tachypnea, hypoxemia and multilobar radiographic pulmonary infiltrates. A clinicalprognostic index derived from a logistic regression analysis including five independent variablesassociated with mortality (confusion, comorbidity, low systolic blood pressure, temperature <37.5

Influencia del nivel socioeconómico (NSE) en el asma bronquial y cambios en su prevalencia en población escolar en un periodo de 6 años

Antecedentes: La prevalencia de asma se encuentra mundialmente en aumento, especialmente en paises en desarrollo. Objetivos: Determinar la prevalencia de asma en escolares de Santiago, estudiando la influencia del nivel socioeconomico (NSE) y describir su evolucion en un periodo de 6 anos. Material y metodos: Estudio transversal en poblacion escolar de la Region Metropolitana. Se encuesto a 4.561 escolares de 6-7 y 13-14 anos provenientes de establecimientos publicos de la comuna de Santiago y de colegios particulares pagados ubicados en el sector oriente de la ciudad. Las variables estudiadas fueron diagnostico de asma (DA), sibilancias en los ultimos 12 meses (SIB12) y frecuencia de episodios de sibilancias (FES). Mediante modelos de regresion se calcularon odds ratios para la ocurrencia de estas variables segun la exposicion a diversas variables independientes. Resultados: La prevalencia de DA en el grupo completo de escolares fue mayor en escolares varones respecto de mujeres (13,2% vs . 10,8%) (p = 0,016), siendo estadisticamente mayor en escolares de 13-14 anos respecto del grupo de 6-7 anos (13,8%: vs .10,1%). (p -4 ). Se encontro una asociacion inversa significativa entre NSE y SIB12. Un mayor nivel de educacion materna se asocio a menor prevalencia de SIB12 en ambos grupos de edad y de FES en ninos de 6-7 anos. Un mayor nivel de instruccion paterna determino un incremento en DA entre los mas pequenos. Incrementos significativos en la prevalencia de SIB12 y FES fueron observados entre 1994 y 2000 unicamente en escolares de 6-7 anos de Santiago Centro. Conclusion: Se encontro asociacion significativa entre NSE y el diagnostico y sintomatologia del asma en escolares de Santiago, asi como un incremento de su prevalencia y severidad en el grupo de 6-7 anos en el periodo 1994–2000.

Cambio climático y enfermedades infecciosas: Un nuevo escenario epidemiológico

For the international scientific community, it is undoubted that planetary temperature is increasing, being projected an average raise of 1.0 degrees C-3.5 degrees C by the year 2100. Forecasted consequences are diverse, most of them adverse for human health, including the establishment of favorable epidemiological scenarios for the emergence and reemergence of infectious diseases. The present article summarizes the available evidence regarding the mechanisms that promote climate change, its environmental effects and its consequences on human health. In order to accomplish this objective, demonstrated changes in the dynamics of zoonotic, vectorial, food and water-borne diseases are described. The position of Chile in the international community is commented, as well as multiple pending challenges, among which outstands the importance of incorporating professionals that work in the health sector to the national debate.

Análisis crítico de ensayos clínicos randomizados publicados en revistas biomédicas chilenas

All trials identified byhand search by the Unit of Evaluation of Technologies in Health, were assessed for quality ofrandomization, blinding, analysis of results and other characteristics of trial design, along withthe application of Jadad’s Score, that assesses the methodological quality of clinical trials in ascale that ranges from 0 to 5.

Asma bronquial y enfermedades atópicas como problema emergente de Salud Pública: nuevas hipótesis etiológicas. La experiencia de sociedades desarrolladas

Developed countries report increasing trends in the prevalence of asthma and atopic diseases over the last 40 years. This change cannot be attributed to artefactual effects. Emerging from these information, new approaches have been generated to explore these novel findings. Among the most important new factors to be explored, scientific research is pointing out to variables related with physical environment, socio-economic and genetic background, anthrophometry at birth, nutritional status, diet, exercise and hormonal profile. Changes in the epidemiology of asthma and atopic conditions in developed countries were also preceded by increases in the prevalence of chronic diseases and their risk factors. Chile does not have information about time trends on these diseases, but several studies are reporting a high prevalence of asthma among adults. Conversely, results from the collaborative ISAAC study carried out in children, have shown a relative low prevalence of asthma in Chilean children. An increasing trend in chronic diseases and their risk factors has been reported in Chile, suggesting an epidemiological pattern similar to that experienced by industrialised countries, when the prevalence of asthma and atopic began to increase. This article review current information about etiological research emphasising the need to develop local research on asthma and atopic diseases taking into account our epidemiological situation

Mortalidad por fibrosis quística en Chile (1997-2003)

Demographic and CF mortality data reported bythe National Institute of Statistics during the period 1997-2003 were recorded, according to sexand age. Overall mortality rate for each year was estimated, as well as the average mortalityrate during the same period in patients younger than 1 year, 1-4 years, 5-9 years, 10-14 yearsand older than 15 years.