Marcia Erazo

Secondhand tobacco smoke in bars and restaurants in Santiago, Chile: evaluation of partial smoking ban legislation in public places

Objective To compare air nicotine concentrations according to the smoking policy selected by bars/restaurants in Santiago, Chile before and after the enactment of partial smoking ban legislation in 2007 (establishments could be smoke free, have segregated (mixed) smoking and non-smoking areas, or allow smoking in all areas). Methods The study measured air nicotine concentrations over 7 days to characterise secondhand smoke exposure in 30 bars/restaurants in 2008. Owner/manager interviews and physical inspections were conducted. Results Median IQR air nicotine concentrations measured in all venues were 4.38 (0.61–13.62) μg/m3. Air nicotine concentrations were higher in bars (median 7.22, IQR 2.48–15.64 μg/m3) compared to restaurants (1.12, 0.15–9.22 μg/m3). By smoking status, nicotine concentrations were higher in smoking venues (13.46, 5.31–16.87 μg/m3), followed by smoking areas in mixed venues (9.22, 5.09–14.90 μg/m3) and non-smoking areas in mixed venues (0.99, 0.19–1.27 μg/m3). Air nicotine concentrations were markedly lower in smoke-free venues (0.12, 0.11–0.46 μg/m3). After adjustment for differences in volume and ventilation, air nicotine concentrations were 3.2, 35.5 and 56.2 times higher in non-smoking areas in mixed venues, smoking areas in mixed venues and smoking venues, respectively, compared to smoke-free venues. Conclusions Exposure to secondhand smoke remains high in bars and restaurants in Santiago, Chile. These findings demonstrate that the partial smoking ban legislation enacted in Chile in 2007 provides no protection to employees working in those venues. Enacting a comprehensive smoke-free legislation which protects all people from exposure to secondhand smoke in all public places and workplaces is urgently needed.

Factores determinantes del exceso de peso en escolares: Un estudio multinivel

BACKGROUND Rates of obesity reach high levels in Chile, with geographic, social and school variations. AIM To identify factors at two levels associated with excessive weight in school children: child-family characteristics and school-neighborhood. MATERIAL AND METHODS Using a cross-sectional and multi-step design, seven counties with the highest prevalence of obesity were identified, and schools were randomly chosen from within the 1st, 3 and 5 quintiles of the school strata (same level of obesity prevalence). Within each school, twelve 2nd grade children were randomly chosen (n =42 schools and 504 students). Nutritional status, food intake, eating habits and physical activity were measured. Socio demographic, economic characteristics and nutritional status of the parents were assessed. Home size and facilities for children physical activities were assessed, as well as school infrastructure and management. RESULTS Most of the explained variance (97%) in the Body Mass Index (BMI) was due to individual-level factors: sedentary children behaviour (JS coefficient 1.6, standard error (SE) 0.052), maternal obesity (ss 0.94; SE 0.25), paternal obesity (ss 0.83; SE 0.28) and hours watching television (ss 0.789, SE 0.297). The same risk factors were predictive of obesity: child sedentary behaviours odds ratio (OR): 3-98, 95%) confidence interval (CI): 2.44-6.48, maternal obesity (OR 1.91, CI 1.21-3-02) and being woman (OR 1.75, CI 1.01-2.76). CONCLUSIONS BMI and obesity are associated with children behaviour or biological and cultural conditions of their families and not with school characteristics.

Factores de riesgo asociados al bajo peso al nacer

RISK FACTORS ASSOCIA TED TO LOW BIRTH WEIGHT In Chile there exists a percentage of children with low weight at birth wlzich is very similar to the rafe in developed countries. These children are in greater risk ofneurologic, metabo/ic and cognitive capacity development deficit, also requiring special ca re during their development. The present paper seeks to appraise tlze riskfactors of lmv weight at birth, so asto detect them in time and thus avoid their occurrence. Our study was centered on live-bom babies witlz birtlz weiglzts below 2.500 grams (n = 334), in the Maternity ofthe University ofC/zile Clínica! Hospital during the years 200I and 2002. The infonnation was obtained during prenatal attention and delivery; newboms witlz very lmv birtlz weight ( < 2.000 grams) were compared with tlzose weiglzing 2000 grams or more. The statistical analysis considered the evaluation of the quality and consistency oftlze data obtained,for whiclz purpose the Stata 8.0 program was used. It was observed tlzat the m a in factor associated witlz very low birtlz weight is prematurity ( 89% ), followed by extreme age of tlze nwtlzer (50. 7%) and, in the third place, preeclampsia ( 44.5% ). This study concludes that tlze risk factors of very low weight at birt/z lzave varia/ in tlze last decade. This is explained by tlze change in tlze epidemiologic profile wlziclz the Chilean population has experienced during the last years, changing tlze problems ofmalnutrition dueto deficitfor those of excess and the ministerial programs tlzat centered their efforts on the populations in nutritional risk, thus reducing malnutrition due to deficit. The low birtlz weight of a premature c/zild can be explained by the gain in weight of between 200 and 300 grams as mz average for each week of permanence within the u te rus, specially toward the end of gestation. As respects the extreme age ofthe mother, it can be confirmed tlzat adolescent girls presenta greater risk ofpremature delivery or low weightfullterm de/ivery due to a pre-conceptional deflcitary nutritional state (low weight gain during pregnancy and bad controls). In women of over 35 years of age, tlze point is raised that tlze existen ce of chronic patlwlogy (diabetes, lzypertension, etc.) would provide tlze grounds for an earlier delivery. Preecclampsia is a known risk factor for low weight at birth, whiclz produces alterations ofplacentation. This leads us to consider tlzat it is possible to forestal! the appearance of these factors and thus diminish tlze number (~f il({ants witlz very low birtlz weights.

Public Health Perspectives on Aquaculture

Nearly half of all seafood consumed globally comes from aquaculture, a method of food production that has expanded rapidly in recent years. Increasing seafood consumption has been proposed as part of a strategy to combat the current non-communicable disease (NCD) pandemic, but public health, environmental, social, and production challenges related to certain types of aquaculture production must be addressed. Resolving these complicated human health and ecologic trade-offs requires systems thinking and collaboration across many fields; the One Health concept is an integrative approach that brings veterinary and human health experts together to combat zoonotic disease. We propose applying and expanding the One Health approach to facilitate collaboration among stakeholders focused on increasing consumption of seafood and expanding aquaculture production, using methods that minimize risks to public health, animal health, and ecology. This expanded application of One Health may also have relevance to other complex systems with similar trade-offs.

Propuesta de índices de gestión de servicios médico-quirúrgicos hospitalarios mediante técnicas estadísticas multivariantes

Data on admissions to a University Hospital during 2003 were analyzed. Number ofdischarges, lethality rate, re-admission rate, number of outpatient consultations, length ofhospital stay and surgical complexity index were analyzed, using information obtained by theOperations Management Department. The Principal Components Analysis (PCA) technique wasapplied and the R correlation matrix was used.

Estatura de padres e hijos chilenos de diferente etnia y vulnerabilidad social

Objective. To analyze and compare the heights of firstyear school children and their parents, according to ethnic background and socioeconomic status. Material and methods. This is a cross-sectional study of indigenous and non-indigenous school children and their parents, belonging to three levels of social vulnerability: very high (poverty), medium, and very low. An indigenous school child was defined as any child having all four parental surnames of Mapuche origin; non-indigenous were those having Hispanic parental surname. Height was compared using Z scores, using WHO nutritional change reference values. Statistical analysis consisted in comparing differences of mean heights between parents and their children. Differences were assessed using Scheffe’s method. Results. Improvement in socioeconomic conditions was associated with increasing mean parental height (p<0.001), except for indigenous mothers, who showed no height increase. Fathers from highly impoverished counties were 4 cm shorter than those living in very low vulnerability areas; height differences reached 2 cm among mothers (p<0.001). Indigenous school children showed a positive height gradient with improving socioeconomic conditions (p<0.001). This was not observed among non-indigenous children. When comparing parental height with children’s height, children had a better height/age ratio than their parents (p<0.01). This was specially evident among indigenous school children, who had on average 1.4 Z scores more than their parents. Conclusions. The upward height gradient related to improved social conditions, and the bet

Occupational secondhand smoke is the main determinant of hair nicotine concentrations in bar and restaurant workers.

OBJECTIVE To evaluate the relative contribution of occupational vs. non-occupational secondhand tobacco smoke exposure to overall hair nicotine concentrations in non-smoking bar and restaurant employees. METHOD We recruited 76 non-smoking employees from venues that allowed smoking (n=9), had mixed policies (smoking and non-smoking areas, n=13) or were smoke-free (n=2) between April and August 2008 in Santiago, Chile. Employees used personal air nicotine samplers during working and non-working hours for a 24-h period to assess occupational vs. non-occupational secondhand tobacco smoke exposure and hair nicotine concentrations to assess overall secondhand tobacco smoke exposure. RESULTS Median hair nicotine concentrations were 1.5 ng/mg, interquartile range (IQR) 0.7 to 5.2 ng/mg. Time weighted average personal air nicotine concentrations were higher during working hours (median 9.7, IQR 3.3-25.4 µg/m(3)) compared to non-working hours (1.7, 1.0-3.1 µg/m(3)). Hair nicotine concentration was best predicted by personal air nicotine concentration at working hours. After adjustment, a 2-fold increase in personal air nicotine concentration in working hours was associated with a 42% increase in hair nicotine concentration (95% confidence interval 14-70%). Hair nicotine concentration was not associated with personal air nicotine concentration during non-working hours (non-occupational exposure). CONCLUSIONS Personal air nicotine concentration at working hours was the major determinant of hair nicotine concentrations in non-smoking employees from Santiago, Chile. Secondhand tobacco smoke exposure during working hours is a health hazard for hospitality employees working in venues where smoking is allowed.

Estudio de variables asociadas al cáncer de piel en Chile mediante análisis de componentes principales

Resumen Fundamento La incidencia de cancer de piel en Chile ha aumentado en los ultimos anos. Objetivo Asociar variables al cancer de piel en Chile a traves de indices generados mediante tecnicas estadisticas descriptivas multivariantes. Material y metodo Durante el mes de mayo de 2004 se recopilo informacion de datos demograficos, meteorologicos y clinicos de Chile, correspondientes al ejercicio 2001, ultima informacion completa y oficial disponible para la totalidad de los Servicios de Salud del pais. Se estudiaron las variables confeccionadas por el Instituto Nacional de Estadistica (INE), el Ministerio de Salud (MINSAL), el Ministerio de Planificacion y Cooperacion (MIDEPLAN), el Fondo Nacional de Salud (FONASA), la Direccion Meteorologica de Chile, la Universidad Tecnica Federico Santa Maria y la Direccion General de Aguas. Se aplico a los datos obtenidos un analisis de components principales (ACP). Resultados Se seleccionaron las tres primeras components principales, con un porcentaje acumulado de variabilidad explicada de 54,48 %. La primera componente principal explica el 24,92 % de la variabilidad y tiene relacion con variables del orden climatico y geografico. La segunda componente principal explica el 15,77 % de la variabilidad y se relaciona principalmente con la poblacion beneficiaria de FONASA y el indice de pobreza. En ella se opone de manera importante la tasa de letalidad por cancer cutaneo. La tercera componente principal explica el 13,79% de la variabilidad y se relaciona con caracteristicas poblacionales como poblacion total asignada, poblacion femenina y poblacion urbana. Conclusion La aplicacion del ACP es util para el estudio de los factores asociados con el cancer de piel.

Vigilancia nutricional en escolares chilenos: Validez de la información

Total agreement for nutritional status reached 0.67, random-weighted Kappa was 0.40 andweighted Kappa, 0.42. Teachers tended to over diagnose under-nutrition and under diagnoseoverweight and obesity, measuring 270 grams less than the qualified team (p <0.001) and 1.7cm more in height (p <0.001), what is reflected in a difference of less than one point in bodymass index (p <0.001). Discrepancies in height and body mass index were higher in extremevalues.

The population impact of obesity, sedentary lifestyle, and tobacco and alcohol consumption on the prevalence of type 2 diabetes: Analysis of a health population survey in Chile, 2010

Aim To estimate the impact of tobacco use, sedentary lifestyle, obesity and alcohol consumption on type 2 diabetes mellitus (T2DM) prevalence in the Chilean population. Methods The study-included 5,293 subjects with fasting glycaemia levels from the nationwide cross-sectional health survey in 2010, commissioned by the Ministry of Health, Chile. Crude and Adjusted Odds Ratio to T2DM and its corresponding 95% confidence interval were estimated through logistic regressions. Attributable fractions and population attributable fractions were estimated. Results T2DM prevalence was 9.5%. Sedentary lifestyles and obesity were significant risk factors for T2DM. 52,4% of T2DM could be avoided if these individuals were not obese, and at a population level, 23% of T2DM could be preventable if obesity did not exist. A 64% of T2DM is explained by sedentariness, and if people would become active, a 62,2% of the cases of diabetes could be avoided. Interpretation About 79% of T2DM cases in Chile could be prevented with cost-effective strategies focused on preventing sedentary lifestyle and obesity. It’s therefore urgent to implement evidence-based public health polices, aimed to decrease the prevalence of T2DM, by controlling its risk factors and consequently, reducing the complications from T2DM.