Background: Physical environment can influence well-being, quality of life and health and population health in several ways. Exposure to green spaces improves the physical and mental health of individuals. Chile has privileged conditions for outdoor activities that could benefit millions of people. However, a small percentage of the Chilean population is exposed to green spaces in the recommended amounts to promote health. Aim: To describe the benefits of green spaces on physical and mental health and their relationship with the practice of physical activity. Material and Methods: Review of the scientific literature in English in the Web of Science (WoS) electronic database published between 2006-2019. Results: In addition to the direct benefits of green spaces, there are synergistic effects of performing physical activities in these environments such as feelings of good health, satisfaction with life and pleasure, increased physiological relaxation, positive emotions, mental well-being, restoration of attention, decreased perceived stress and a reduction negative affections. Conclusions: This review supports strategies for improving access to green spaces in urban areas coupled with physical activity promotion in these settings. Health and urban planning stakeholders should consider these aspects in future programs.

Abstract: The Wechsler Intelligence Scale for Children - Fifth Edition is the most recent update to this scale, launched originally in 2014 in the United Stated. WISC-V includes several improvements from previous versions, such as an updated factorial structure that includes more indexes, new process scores and new procedures for norming. These improvements are particularly relevant in the Chilean context, since the previous version available in the country was the WISC-IIIv.ch, whose factorial structure dates from 1991, although it was standardized for Chilean population in 2007. This article presents the standardization process for the WISC-V, which includes the translation, adaptation and norming procedures for the Chilean population. It includes evidence for reliability and validity, and also results for various special groups samples, such as intellectual disability (24), attentional deficit disorder with hyperactivity (27), autism spectrum disorder (26), specific language disorder (56) and rural population (47). The Chilean data shows excellent reliability results and an excellent adjustment to the factorial model used in the North American version. This research provides evidence for convergent validity between WISC-V and other versions of these scales, such as the WAIS-IV and the WISC-IIIv.ch. Finally, we perform a comparison between private, voucher and public schools using this scale and a comparison between male and female performance in this scale. The main finding of this research is that the Chilean standardization of the WISC-V has excellent psychometric properties that allow recommending the use of this instrument in the country.

Resumen: La Escala Wechsler de Inteligencia para Niños - Quinta Edición es la más reciente actualización de estas escalas. Esta nueva edición fue lanzada el año 2014 en Estados Unidos y presenta mejoras relevantes respecto de versiones anteriores, como una estructura factorial actualizada que incluye un mayor número de indicadores, nuevos puntajes de proceso y nuevos procedimientos para la construcción de las normas. Estas mejoras son relevantes en el contexto nacional, puesto que la versión que estaba previamente disponible en Chile era WISC-IIIv.ch, cuya estructura factorial data del año 1991, aunque fue estandarizada el año 2007 para la población chilena. En este artículo se presenta el procedimiento de estandarización de WISC-V para la población chilena. Este procedimiento incluye la traducción, adaptación y construcción de normas. Se presenta evidencia de validez y confiabilidad, así como también los resultados de la aplicación del instrumento a muestras de grupos especiales, como discapacidad intelectual (24), trastorno de déficit atencional con hiperactividad (27), trastorno del espectro autista (26), trastorno específico del lenguaje (56) y población rural (47). Los resultados dan cuenta de excelentes resultados de confiabilidad, así como de un excelente ajuste al modelo factorial utilizado para la versión norteamericana. Por último, se presenta evidencia de validez convergente entre WISC-V y otras versiones de estas escalas de inteligencia, como WAIS-IV y WISC-IIIv.ch. También se presentan comparaciones de rendimiento entre los tres tipos de dependencia educativa existentes en Chile, así como también de comparaciones entre género. Los resultados de esta investigación dan cuenta que la estandarización chilena de WISC-V cuenta con excelentes características psicométricas que hacen recomendable su uso en el país.

Abstract In the last 25 years, Chile has had an expanding role as an agro-export country in the global economy, with efficient rates of productivity in the region, based on the technological development of agriculture, with of large monocultures whose productivity depends on the intensive application of agrochemicals. This form of agriculture has also lacked efficient regulations and surveillance, so it is difficult to estimate the real magnitude of the exposed population and its effects on health in the short or long term. This systematic review compiles the epidemiological evidence generated from studies conducted in several regions of Chile regarding pesticide exposure and health effects. Of the total number of articles, 50% included agricultural workers, 25% children, and 25% women of childbearing age, with the greatest effects being the neurotoxic (54%), genotoxic (31%) and reproductive (15%). The evidence collected shows that in Chile the levels of exposure to pesticides in the general and occupational population are higher than international studies levels. It is urgent to protect the health of both the occupational and general population and especially children through a stricter control of the sale and use of pesticides, with comprehensive surveillance systems in environmental health and educational actions in the social and cultural context of rural communities. It is a priority to strengthen research with national relevance on health effects, and strictly restrict the use of pesticides already prohibited in developed countries due to their high level of risk to human and environmental health.

Resumen En los últimos 25 años, Chile se ha consolidado como país agroexportador en la economía mundial. Posee una eficiente tasa de productividad basada en el desarrollo tecnológico de la agricultura, con vastas extensiones de monocultivos cuya productividad depende de la aplicación intensiva de plaguicidas, la cual se realiza con escasas regulaciones y fiscalizaciones, y se desconoce la magnitud del riesgo de exposición en la población y sus efectos en la salud a corto o largo plazo. Esta revisión sistemática recopila evidencia epidemiológica de varias regiones de Chile respecto a la exposición a plaguicidas y sus efectos en la salud poblacional. Del total de las publicaciones, el 50% se refieren a trabajadores agrícolas, el 25% a niños/as y el 25% a mujeres en edad fértil, y los efectos más observados son neurotóxicos (54%), genotóxicos (31%) y reproductivos (15%). La evidencia muestra que, en Chile, los niveles de exposición en población general y ocupacional son superiores a los encontrados en estudios internacionales. Es urgente proteger la salud tanto de la población ocupacional como de la general, en especial de los/las niños/as, a través de un mayor control en la venta y el uso de plaguicidas, con sistemas integrales de vigilancia en salud ambiental y acciones educativas en el contexto social y cultural de las comunidades rurales. Resulta prioritario potenciar la investigación sobre daños en salud y restringir legalmente de manera estricta el uso de plaguicidas peligrosos ya prohibidos en países desarrollados por su alto riesgo para la salud de las personas y el medio ambiente.

Abstract In the last 25 years, Chile has had an expanding role as an agro-export country in the global economy, with efficient rates of productivity in the region, based on the technological development of agriculture, with of large monocultures whose productivity depends on the intensive application of agrochemicals. This form of agriculture has also lacked efficient regulations and surveillance, so it is difficult to estimate the real magnitude of the exposed population and its effects on health in the short or long term. This systematic review compiles the epidemiological evidence generated from studies conducted in several regions of Chile regarding pesticide exposure and health effects. Of the total number of articles, 50% included agricultural workers, 25% children, and 25% women of childbearing age, with the greatest effects being the neurotoxic (54%), genotoxic (31%) and reproductive (15%). The evidence collected shows that in Chile the levels of exposure to pesticides in the general and occupational population are higher than international studies levels. It is urgent to protect the health of both the occupational and general population and especially children through a stricter control of the sale and use of pesticides, with comprehensive surveillance systems in environmental health and educational actions in the social and cultural context of rural communities. It is a priority to strengthen research with national relevance on health effects, and strictly restrict the use of pesticides already prohibited in developed countries due to their high level of risk to human and environmental health.

Resumen En los últimos 25 años, Chile se ha consolidado como país agroexportador en la economía mundial. Posee una eficiente tasa de productividad basada en el desarrollo tecnológico de la agricultura, con vastas extensiones de monocultivos cuya productividad depende de la aplicación intensiva de plaguicidas, la cual se realiza con escasas regulaciones y fiscalizaciones, y se desconoce la magnitud del riesgo de exposición en la población y sus efectos en la salud a corto o largo plazo. Esta revisión sistemática recopila evidencia epidemiológica de varias regiones de Chile respecto a la exposición a plaguicidas y sus efectos en la salud poblacional. Del total de las publicaciones, el 50% se refieren a trabajadores agrícolas, el 25% a niños/as y el 25% a mujeres en edad fértil, y los efectos más observados son neurotóxicos (54%), genotóxicos (31%) y reproductivos (15%). La evidencia muestra que, en Chile, los niveles de exposición en población general y ocupacional son superiores a los encontrados en estudios internacionales. Es urgente proteger la salud tanto de la población ocupacional como de la general, en especial de los/las niños/as, a través de un mayor control en la venta y el uso de plaguicidas, con sistemas integrales de vigilancia en salud ambiental y acciones educativas en el contexto social y cultural de las comunidades rurales. Resulta prioritario potenciar la investigación sobre daños en salud y restringir legalmente de manera estricta el uso de plaguicidas peligrosos ya prohibidos en países desarrollados por su alto riesgo para la salud de las personas y el medio ambiente.

Abstract Biometrics has had a rapid expansion as a technology, being increasingly accessible to the public, and lending utility to governments and society in the management of citizen security. It is applied either for verification or for identification of an individual's identity and technically constitutes a problem of pattern recognition. In Chile, the existing legal framework regarding the handling of personal data does not include specific biometrics in its regulation. A new bill that considers both biometric data and Biological profiles is in process. In addition, we revised the international reports of the last two decades that analyze the use of biometrics. The primary focus of concern of these documents, from the ethical point of view, is the right to privacy of individuals, giving practical guidance and discussion regarding the elements necessary for the application of these novel technologies in an appropriate ethically manner. Finally, we contextualize from a brief analysis of biopolitics the role of biometrics and the basic ethical requirements for its development in that framework.

Resumen La biometría ha tenido una rápida expansión como tecnología, siendo cada vez más accesible para el público general, prestando utilidad a los gobiernos y a la sociedad en el manejo de la seguridad ciudadana. Se aplica para la verificación o la identificación de la identidad de un individuo y, desde un punto de vista puramente técnico, constituye un problema de reconocimiento de patrones. En Chile, el marco legal acerca del manejo de datos personales no incluye específicamente a la biometría. A la fecha, se encuentra en trámite un nuevo proyecto de ley que considera tanto los datos biométricos como los perfiles biológicos. En otros países, los informes de las últimas dos décadas, que analizan el uso de biometría, plantean como principal foco de preocupación, desde el punto de vista ético, el derecho a la privacidad de los individuos, entregándose orientaciones prácticas acerca de la aplicación apropiada de estas tecnologías. Finalmente, desde un breve análisis de la biopolítica, se contextualiza el papel que cumple la biometría y los requerimientos éticos básicos para su desarrollo en dicho marco.

Resumo A biometria teve uma rápida expansão como tecnologia, sendo cada vez mais acessível para o público geral, sendo de utilidade para os governos e à sociedade no manejo da segurança cidadã. Ela pode ser aplicada para a verificação ou estabelecimento da identidade de um indivíduo e, desde um ponto de vista puramente técnico, constitui um problema de reconhecimento de padrões. No Chile, o contexto legal acerca do manejo de dados pessoais não inclui especificamente a biometria. Atualmente, encontra-se tramitando um novo projeto de lei que considera tanto os dados biométricos como os perfis biológicos. Em outros países, os informes das últimas duas décadas que analisam o uso da biometria, propõem como principal foco de preocupação, do ponto de vista ético, o direito à privacidade dos indivíduos, entregando-se orientações práticas acerca da aplicação apropriada destas tecnologias. Finalmente, desde uma breve análise da bio-política, contextualiza-se o papel que cumpre a biometria e os requerimentos éticos básicos para seu desenvolvimento em tal contexto legal.

ABSTRACT OBJECTIVE: To explore the association of occupational pesticide exposure with acute and mental health symptoms. METHODS: Cross-sectional survey carried out with 78 Brazilian family farmers, who were pesticide applicators and helpers conveniently selected. Symptoms and exposure data were collected by interviews, and mental health outcomes by the Self-Reporting Questionnaire. Blood samples were analyzed to assess cholinesterase levels. Exposure indicators and symptoms were compared between applicators and helpers, and Poisson regression was performed to estimate prevalence ratios. RESULTS: Farmers reported exposure to multiple pesticides from early ages; they worked without safety training, technical support, and full protective equipment, and they had a high prevalence of acute and mental health symptoms (e.g., headache, mucosal irritation, tachycardia, and depressive signs). Applicators had more cholinesterase changes than helpers, but less symptoms. Helpers used less personal protection and had significantly higher prevalence ratio of headache, dyspnea, wheezing, cough, poor digestion, tiredness, and feeling worthless, after adjustment. CONCLUSIONS: Acute and mental health symptoms were observed, both among farmers and helpers. Thus, surveillance actions must be reinforced in Brazil, technical support and safety training improved, focused on applicators and helpers, who are occupationally and environmentally exposed to pesticides. Agricultural practices of these groups with less pesticide use should receive incentive.

ABSTRACT OBJECTIVE: To explore the association of occupational pesticide exposure with acute and mental health symptoms. METHODS: Cross-sectional survey carried out with 78 Brazilian family farmers, who were pesticide applicators and helpers conveniently selected. Symptoms and exposure data were collected by interviews, and mental health outcomes by the Self-Reporting Questionnaire. Blood samples were analyzed to assess cholinesterase levels. Exposure indicators and symptoms were compared between applicators and helpers, and Poisson regression was performed to estimate prevalence ratios. RESULTS: Farmers reported exposure to multiple pesticides from early ages; they worked without safety training, technical support, and full protective equipment, and they had a high prevalence of acute and mental health symptoms (e.g., headache, mucosal irritation, tachycardia, and depressive signs). Applicators had more cholinesterase changes than helpers, but less symptoms. Helpers used less personal protection and had significantly higher prevalence ratio of headache, dyspnea, wheezing, cough, poor digestion, tiredness, and feeling worthless, after adjustment. CONCLUSIONS: Acute and mental health symptoms were observed, both among farmers and helpers. Thus, surveillance actions must be reinforced in Brazil, technical support and safety training improved, focused on applicators and helpers, who are occupationally and environmentally exposed to pesticides. Agricultural practices of these groups with less pesticide use should receive incentive.

Abstract: A series of studies show the health consequences of people exposed to pesticides either because of their work activity or because they live or study near agricultural land. Occupational exposure to a series of insecticides, herbicides and fungicides is mainly associated with cancer, neurocognitive and motor damage, peripheral polyneuropathy, depression and anxiety, malformations in children at birth, endocrine and reproductive system difficulties, kidney damage and genotoxic effects. Through a review of the literature, the objective of the following article was to elucidate the situation of exposure to pesticides in rural school communities, unveil the bioethical dilemmas in which they are located and the need to apply elements of environmental justice to generate a change and actions to improve their quality of life and health, for the right to live free of environmental pollution. Environmental justice seeks much more than equity and fair treatment and quality similar to that of other non-vulnerable communities, aims to make the same communities demand the need for a more egalitarian society that ensures the right to live in an environment cleansed.

Resumen: Una serie de estudios evidencian las consecuencias en la salud de las personas expuestas a plaguicidas, ya sea por la actividad laboral como por vivir o estudiar cerca de predios agrícolas. La exposición ocupacional a una serie de insecticidas, herbicidas y fungicidas está asociada principalmente a cáncer, daño neurocognitivo y motor, polineuropatía periférica, depresión y ansiedad, malformaciones en niños al nacer, dificultades endocrinas y en el sistema reproductivo, daño renal y genotóxicos. A través de una revisión de la literatura, el objetivo del siguiente artículo consistió en dilucidar la situación de exposición a plaguicidas en comunidades escolares rurales y aplicar elementos de la bioética y justicia ambiental para proponer un cambio y acciones que permitan mejorar su calidad de vida y salud, por el derecho a vivir libres de contaminación ambiental. La justicia ambiental busca mucho más que la equidad y el tratamiento justo y de calidad similar al de otras comunidades no vulnerables, apunta a hacer que las mismas comunidades exijan la necesidad de una sociedad más igualitaria que vele por el derecho a vivir en un medio ambiente limpio.

Resumo: Uma série de estudos evidenciam as conseqüências na saúde das pessoas expostas a pesticidas, seja por atividade de trabalho como por viver ou estudar perdo de prédiso agrícolas. A exposição ocupacional a uma série de inseticidas, herbicidas e fungicidas está associada principalmente a câncer, dano neurocognitivo e motor, polineuropatia periférica, depressão e ansiedade, mal formações em crianças ao nascer, dificuldade endócrinas e no sistema reprodutivo, dano renal e genotóxicos. Através de uma revisão da literatura, o objetivo do artigo seguinte consistiu em elucidar a situação de exposição a pesticidas em comunidades escolares rurais e aplicar elementos de bioética e justiça ambiental para propor uma mudança e ações que permitam melhorar sua qualidade de vida e saúde, pelo direito a viver livre de contaminação ambiental. A justiça ambiental busca muito mais que a equidade e o tratamento justo e de qualidade similar ao de outras comunidades não vulneráveis, tenta fazer que as mesmas comunidades exijam a necessidade de uma sociedade mais igualitária que vele pelo direito a viver em um meio ambiente limpo.

There is little evidence on the quality of life and emotional overload of caregivers of students with intellectual disabilities. Research of recent years address this problem from the adult with severe disability, whether physical or neurological, therefore there is a need to identify the quality of life and overburden level of the caregiver in charge of a student with intellectual disability or multiple challenges. The objective was to evaluate the overload and quality of life of caregivers of students with intellectual and multiple disabilities of Curicó, Chile. We did across-sectional design, with a sample of 137 caregivers of school children with mild, moderate intellectual disability and multiple disabilities of municipal schools, we applied the Zarit Burden Interview scale for caregivers and the SF36 Health Survey. The average age of caregivers of people with disabilities (n = 140) was 40 years(SD = 12), with a minimum age of 18 and a maximum of 66 years. Regarding the marital status of the caregivers (Table 1), 48.6% corresponded to married, 23.6% single, 13.6% cohabiting, 4.3% widowed and 10% separated. With regard to kinship, 73.6% corresponds to the mother of the scholar with a disability. A greater percentage of the caregivers attended the complete secondary education (32.1%), followed by the basic complete with 20.0%, and without studies with 1.4%. The majority of the respondents were primary caregivers of children in the first cycle of education (56.0%) and 72.0% reported living with 4 or more people in the home. The results showed that the highest number of school children was found at the level of mild intellectual disability with 62.9% following multiple challenges (19.3%) and moderate disability with 17.9%. The 48.1% of the total caregivers of children with multiple challenges presented an intense level of overload. This relationship is statistically significant (χ²= 12.4, p = .015) which indicates that caregivers of students with multiple disabilities present a greater burden. Caregivers of children with multiple disabilities presented a higher level of emotional overload and lower quality of life in the body pain function. The final model of multiple linear regression for the dependent variable overload of the caregiver that presents the best goodness of fit presented an association between multiple challenges and greater overload of the caregiver adjusted by the kinship of the caregiver with the scholar. The data indicate that there is a difference of up to 5.8 points in the overload among caregivers of students with mild, moderate intellectual disability and multiple challenges. We concluded that it is necessary to develop proposals in both health and education that integrates the family in the training process and that ensures the quality of life of the main caregivers of students with disabilities, in order to strengthen the processes of social and educational inclusion of the schoolchildren. At the same time, the results obtained provide key background for future research, in terms of support and information that is required to improve the quality of life of caregivers of students with disabilities, while allowing optimal development for children and thus reduce the level of stress and overload of the family. In the same way, it addresses a paradigm of school inclusion that goes beyond curricular adaptations, allows to propose a comprehensive view among all involved, recognizing that the higher the level of disability, the greater the perception of emotional overload and physical discomfort, being necessary incorporate other support networks for caregivers and their family in general, however, it is considered key that the financing of these activities and intervention be intersectoral, involving entities inthe area of health, education, social-community and work among the most important.

Existe escasa evidencia sobre calidad de vida y sobrecarga emocional de cuidadores de estudiantes con discapacidad intelectual. Las investigaciones de los últimos años abordan esta problemática desde la persona adulta con discapacidad grave, ya sea física y neurológica, por ende existe la necesidad de identificar la calidad de vida y nivel de sobrecarga del cuidador a cargo de un estudiante con discapacidad intelectual o retos múltiples. El objetivo de este estudio consistió en evaluar la sobrecarga y calidad de vida de cuidadores de escolares con discapacidad intelectual y retos múltiples de Curicó, Chile. Se realizó un diseño transversal, con una muestra de 137 cuidadores de escolares con discapacidad intelectual leve, moderada y discapacidades múltiples de escuelas municipales, y se aplicaron el Cuestionario de Sobrecarga del Cuidador de Zarit y el Cuestionario de Salud de Calidad de Vida SF36. Los resultados mostraron que el mayor número de escolares se encontró en el nivel de discapacidad intelectual leve con un 62.9%, luego un 19.3% para retos múltiples y un 17.9% para discapacidad moderada. Los cuidadores de niños con discapacidades múltiples presentaron un mayor nivel de sobrecarga emocional y menor calidad de vida en la función, dolor corporal y salud general. Se concluye que es necesario el desarrollo de propuestas, tanto en el ámbito de salud como de educación, que integre a la familia en el proceso formativo y que vele por la calidad de vida de los cuidadores principales de estudiantes con discapacidades, con el fin de fortalecer los procesos de inclusión social y educativa de los escolares.

ABSTRACT Background. Organophosphate pesticides (OP) are used massively for their low cost, low environmental persistence and high effectiveness in insect pest control, however, agricultural workers, when exposed to OP, have negative consequences on their health mainly neurological. For the first time, a research is reported in a Latin American population that studied the association between labor exposure to OP and the presence of peripheral polyneuropathy in agricultural workers. The aim of the study was to estimate the relationship between occupational exposure to organophosphate pesticides (OP) and presence of peripheral polyneuropathy in workers in the Maule Region, Chile. Method. We conducted a cross-sectional study with 55 agricultural workers exposed to OP and 58 non-agricultural workers not exposed. It was applied a test for the detection of peripheral polyneuropathy through pallesthetic threshold assessment by on-off method. To estimate the relationship between exposure to OP pesticides and peripheral polyneuropathy, we used a multiple logistic regression model (95% confidence interval). Results. 26% of the total sample had polyneuropathy, with 38% positive cases for the exposed group and 14% for the non-exposed group. The risk of developing peripheral polyneuropathy was 3.6 times higher in workers exposed to OP than in non-exposed workers. Conclusions. There is a positive association between the presence of peripheral polyneuropathy and chronic occupational exposure to OP, adjusting for age and sex.

RESUMEN Fundamentos. Los plaguicidas organofosforados (OP) se usan de manera masiva, por su bajo costo y por su baja persistencia, en el medio ambiente y su alta efectividad en el control de plagas de insectos, sin embargo, los trabajadores agrícolas, cuando se exponen a OP, presentan consecuencias negativas en su salud, principalmente de caracter neurológico. Por primera vez se reporta una investigación en población latinoamericana que estudió la asociación entre exposición laboral a OP y presencia de polineuropatía periférica en trabajadores agrícolas. El objetivo del estudio fue estimar la relación entre exposición laboral a plaguicidas organofosforados (OP) y presencia de polineuropatía periférica en trabajadores de la Región del Maule, Chile. Método. Se realizó un estudio transversal analítico con 55 trabajadores agrícolas expuestos a OP y 58 trabajadores no agrícolas no expuestos. Se aplicó una prueba para la detección de polineuropatía periférica a través de la evaluación del umbral palestésico por método on-off. Para estimar la relación entre exposición a plaguicidas OP y polineuropatía periférica se realizó un modelo de regresión logística múltiple (intervalo de confianza del 95%). Resultados. Un 26% del total de la muestra padecía de polineuropatía, con un 38% de casos positivos para el grupo expuesto y un 14% para el grupo no expuesto. El riesgo de desarrollar polineuropatía periférica fue 3,6 veces mayor en los trabajadores expuestos a OP que en los trabajadores no expuestos. Conclusiones. Existe una asociación positiva entre la presencia de polineuropatía periférica y la exposición laboral crónica a OP, ajustando por edad y sexo.

ABSTRACT Background. Organophosphate pesticides (OP) are used massively for their low cost, low environmental persistence and high effectiveness in insect pest control, however, agricultural workers, when exposed to OP, have negative consequences on their health mainly neurological. For the first time, a research is reported in a Latin American population that studied the association between labor exposure to OP and the presence of peripheral polyneuropathy in agricultural workers. The aim of the study was to estimate the relationship between occupational exposure to organophosphate pesticides (OP) and presence of peripheral polyneuropathy in workers in the Maule Region, Chile. Method. We conducted a cross-sectional study with 55 agricultural workers exposed to OP and 58 non-agricultural workers not exposed. It was applied a test for the detection of peripheral polyneuropathy through pallesthetic threshold assessment by on-off method. To estimate the relationship between exposure to OP pesticides and peripheral polyneuropathy, we used a multiple logistic regression model (95% confidence interval). Results. 26% of the total sample had polyneuropathy, with 38% positive cases for the exposed group and 14% for the non-exposed group. The risk of developing peripheral polyneuropathy was 3.6 times higher in workers exposed to OP than in non-exposed workers. Conclusions. There is a positive association between the presence of peripheral polyneuropathy and chronic occupational exposure to OP, adjusting for age and sex.

RESUMEN Fundamentos. Los plaguicidas organofosforados (OP) se usan de manera masiva, por su bajo costo y por su baja persistencia, en el medio ambiente y su alta efectividad en el control de plagas de insectos, sin embargo, los trabajadores agrícolas, cuando se exponen a OP, presentan consecuencias negativas en su salud, principalmente de caracter neurológico. Por primera vez se reporta una investigación en población latinoamericana que estudió la asociación entre exposición laboral a OP y presencia de polineuropatía periférica en trabajadores agrícolas. El objetivo del estudio fue estimar la relación entre exposición laboral a plaguicidas organofosforados (OP) y presencia de polineuropatía periférica en trabajadores de la Región del Maule, Chile. Método. Se realizó un estudio transversal analítico con 55 trabajadores agrícolas expuestos a OP y 58 trabajadores no agrícolas no expuestos. Se aplicó una prueba para la detección de polineuropatía periférica a través de la evaluación del umbral palestésico por método on-off. Para estimar la relación entre exposición a plaguicidas OP y polineuropatía periférica se realizó un modelo de regresión logística múltiple (intervalo de confianza del 95%). Resultados. Un 26% del total de la muestra padecía de polineuropatía, con un 38% de casos positivos para el grupo expuesto y un 14% para el grupo no expuesto. El riesgo de desarrollar polineuropatía periférica fue 3,6 veces mayor en los trabajadores expuestos a OP que en los trabajadores no expuestos. Conclusiones. Existe una asociación positiva entre la presencia de polineuropatía periférica y la exposición laboral crónica a OP, ajustando por edad y sexo.

El diagnóstico de la capacidad intelectual de estudiantes con más de una discapacidad, es compleja. El objetivo del estudio consistió en evaluar los procedimientos e instrumentos para el diagnóstico de discapacidad intelectual en estudiantes con retos múltiples de una escuela especial. A través de un estudio de caso con 44 niños con retos múltiples, se evaluaron los procedimientos usados por tres psicólogos para el diagnóstico de discapacidad intelectual. Los resultados indican que ningún escolar pudo ser medido con una prueba de inteligencia de Wechsler completa, a 11,4% se les aplicó solamente la escala verbal y 18,2% la escala de ejecución, 18,2% fueron evaluados con la prueba Raven y 22,7% con el Test de Goodenough. En todos los casos se utilizó juicio clínico, entrevistas, observación y una escala de conducta adaptativa. Se concluye que se requiere establecer procedimientos concordantes con criterios diagnósticos actualizados en la evaluación de estudiantes con discapacidades múltiples.

O diagnóstico da capacidade intelectual dos estudantes com mais do que uma deficiência é complexo. O objetivo do estudo foi avaliar os procedimentos e instrumentos para diagnosticar deficiência intelectual em alunos com deficiências múltiplas em uma escola especial. Através de um estudo de caso de 44 crianças com múltiplos desafíos. Nós avaliamos os procedimentos utilizados por três psicólogos para diagnosticar deficiências intelectual. Os resultados indicam que uma escola pode ser medido por um teste de inteligência Wechsler completa, 11,4% só foi avaliada escala de inteligência verbal e 18,2% com escala de inteligência Manual. 18,2% com a prova de Raven e 22,7% com Goodenough. O julgamento clínico, entrevistas, observação e escala comportamento adaptativo foi utilizado em todos os casos. Concluímos que é necessário estabelecer procedimentos consistentes com critérios diagnósticos atuais para avaliar alunos com deficiências múltiplas.

The aim of the study was to evaluate the procedures and instruments for the diagnosis of intellectual disability in students with multiple challenges in a special school. Through a case study of cross-sectional design with 44 children with multiple challenges, we evaluate the procedures used by three psychologists on the diagnosis of intellectual disability. The results noted that none of the school-children could be assessed with the Wechsler full scale, 11.4% children were tested only with the verbal scale and 18.2% only with the perfomance scale. 18.2% children were assessed with the Raven test and 22.7% with the Goodenough test. In all cases, the psychologists used clinical judgment, interviews, observation, and administered a scale of adaptive behavior. In conclusion, it is necessary to establish procedures consistent with current diagnostic criteria in the assessment of students with multiple disabilities.

Objective: To evaluate organophosphate pesticide exposure and neuropsychological and motor performance in agricultural and non-agricultural workers in the Maule Region in Chile. Method: Analytic cross-sectional study in 93 exposed farm workers and 84 unexposed non-agricultural workers. A battery of four neuropsychological tests was administered together with a neuro-motor physical examination. Results: On the Weschler adult intelligence scale (WAIS-IV), exposed agricultural workers exhibited poorer performance than non-agricultural workers in verbal comprehension (Β = -3.2; p = 0.034) and processing speed (Β = -4.4; p = 0.036) and in the full scale (Β = -4; p = 0.016), as well as in discrimination sensitivity (Β = 1, p = 0,009), adjusted by years of schooling and/or age. Conclusions: We suggest the development of policies and regulations for the control, sale and use of organophosphate pesticides and intervention strategies on safety measures aimed at the exposed population.

Objetivo: Evaluar la exposición a plaguicidas organofosforados y el desempeño neuropsicológico y motor de trabajadores/as agrícolas y no agrícolas de la Región del Maule, Chile. Método: Estudio transversal analítico con 93 trabajadores/as agrícolas expuestos/as a plaguicidas organofosforados y 84 trabajadores/as no agrícolas no expuestos/as. Se administró una batería de cuatro pruebas neuropsicológicas junto con un examen físico neuromotor. Resultados: Los/las trabajadores/as agrícolas expuestos/as tuvieron un menor desempeño en la escala de inteligencia de Wechsler para Adultos (WAIS-IV) en comprensión verbal (Β = -3,2; p = 0,034), en velocidad de procesamiento (Β = -4,4; p = 0,036) y en la escala total (Β = -4; p = 0,016); sensibilidad discriminativa (Β = 1, p = 0,009) ajustada por años de educación o edad en comparación con los controles. Conclusiones: Se sugiere el desarrollo de políticas en materia de control, venta y uso de plaguicidas organofosforados, y de intervenciones con la población expuesta respecto a medidas de seguridad.

Objective: To evaluate organophosphate pesticide exposure and neuropsychological and motor performance in agricultural and non-agricultural workers in the Maule Region in Chile. Method: Analytic cross-sectional study in 93 exposed farm workers and 84 unexposed non-agricultural workers. A battery of four neuropsychological tests was administered together with a neuro-motor physical examination. Results: On the Weschler adult intelligence scale (WAIS-IV), exposed agricultural workers exhibited poorer performance than non-agricultural workers in verbal comprehension (Β = -3.2; p = 0.034) and processing speed (Β = -4.4; p = 0.036) and in the full scale (Β = -4; p = 0.016), as well as in discrimination sensitivity (Β = 1, p = 0,009), adjusted by years of schooling and/or age. Conclusions: We suggest the development of policies and regulations for the control, sale and use of organophosphate pesticides and intervention strategies on safety measures aimed at the exposed population.

Objetivo: Evaluar la exposición a plaguicidas organofosforados y el desempeño neuropsicológico y motor de trabajadores/as agrícolas y no agrícolas de la Región del Maule, Chile. Método: Estudio transversal analítico con 93 trabajadores/as agrícolas expuestos/as a plaguicidas organofosforados y 84 trabajadores/as no agrícolas no expuestos/as. Se administró una batería de cuatro pruebas neuropsicológicas junto con un examen físico neuromotor. Resultados: Los/las trabajadores/as agrícolas expuestos/as tuvieron un menor desempeño en la escala de inteligencia de Wechsler para Adultos (WAIS-IV) en comprensión verbal (Β = -3,2; p = 0,034), en velocidad de procesamiento (Β = -4,4; p = 0,036) y en la escala total (Β = -4; p = 0,016); sensibilidad discriminativa (Β = 1, p = 0,009) ajustada por años de educación o edad en comparación con los controles. Conclusiones: Se sugiere el desarrollo de políticas en materia de control, venta y uso de plaguicidas organofosforados, y de intervenciones con la población expuesta respecto a medidas de seguridad.

Este estudo avaliou a confiabilidade na codificação das causas de óbitos cardiovasculares entre um codificador no Chile e outro nos Estados Unidos, em uma amostra aleatória estratificada de declarações de óbito de pessoas ≥ 60 anos, emitidas em 2008 nas regiões de Valparaíso e Metropolitana do Chile. Todas as causas da morte foram convertidas em códigos CID-10 em paralelo por ambos os codificadores. A confiabilidade foi avaliada de acordo com o intercodificador e o coeficiente kappa de Cohen, segundo o nível de especificação do código CID-10 para a codificação de causa básica e para todas as causas de óbito. A concordância intercodificador foi de 76,4% para todas as causas de morte e 80,6% para a causa básica (acordo no nível de quatro dígitos), com diferenças por nível de especificação do código CID-10, linha da declaração de óbito, e por número de causas de morte por declaração de óbito. O coeficiente kappa foi 0,76 (IC95%: 0,68-0,84) para a causa básica e 0,75 (IC95%: 0,74-0,77) para todas as causas de óbito. Em conclusão, a codificação das causas de morte cardiovasculares e acordo intercodificador em duas regiões do Chile são comparáveis a uma referência externa e com os relatórios de outros países.

This study evaluates the agreement of nosologic coding of cardiovascular causes of death between a Chilean coder and one in the United States, in a stratified random sample of death certificates of persons aged ≥ 60, issued in 2008 in the Valparaíso and Metropolitan regions, Chile. All causes of death were converted to ICD-10 codes in parallel by both coders. Concordance was analyzed with inter-coder agreement and Cohen’s kappa coefficient by level of specification ICD-10 code for the underlying cause and the total causes of death coding. Inter-coder agreement was 76.4% for all causes of death and 80.6% for the underlying cause (agreement at the four-digit level), with differences by the level of specification of the ICD-10 code, by line of the death certificate, and by number of causes of death per certificate. Cohen's kappa coefficient was 0.76 (95%CI: 0.68-0.84) for the underlying cause and 0.75 (95%CI: 0.74-0.77) for the total causes of death. In conclusion, causes of death coding and inter-coder agreement for cardiovascular diseases in two regions of Chile are comparable to an external benchmark and with reports from other countries.

Este estudio evalúa la concordancia en la codificación de causas de muerte cardiovasculares entre un codificador en Chile y otro en EEUU en una muestra aleatoria estratificada de certificados de defunción de personas ≥ 60 años, emitidos el 2008 en las Regiones de Valparaíso y Metropolitana de Chile. Todas las causas de muerte fueron convertidas a códigos CIE-10 en paralelo por ambas codificadoras. La concordancia se analizó con el acuerdo inter-codificador y el coeficiente kappa de Cohen, según nivel de especificación del código CIE-10 para la codificación de la causa básica y para el total de causas de muerte. El acuerdo inter-codificador fue 76,4% para el total de causas de muerte y 80,6% para la causa básica (acuerdo a nivel de cuatro dígitos), con diferencias según nivel de especificación del código CIE, línea del certificado y número de causas de muerte por certificado. El coeficiente kappa de Cohen fue 0,76 (IC95%: 0,68-0,84) para la causa básica y 0.75 (IC95%: 0.74-0.77) para el total de causas de muerte. En conclusión, la codificación de causas de muerte cardiovasculares y el acuerdo inter-codificador en dos regiones de Chile son comparables a una referencia externa y a informes internacionales.