Background Cirrhosis is a serious public health problem worldwide. There are geographical, socioeconomic and demographic differences in mortality due to the disease. Aim To establish an association between mortality from cirrhosis and other chronic liver diseases and socioeconomic and demographic indicators in communes of the two largest regions of Chile, the Metropolitan Region (RM) and Bíobío. Material and Methods Analysis of the mortality data from the Chilean Ministry of Health. Multiple regression models of smoothed standardized mortality ratios at the community level between 2001 and 2008, were carried out for men and women in relation to socioeconomic and demographic indicators. Results Quite dissimilar phenomena were observed in these two regions. In RM, the risk of death is associated with urban communes of lower educational level (R2 = 53.6% in men, R2 = 62.3% in women). In men of the Bíobío Region, the risk decreases along with the percentage of population belonging to originary populations (R2 = 9.1%). In women, the model also includes a variable that represents the service sector (R2 = 15.0%), that represents a greater risk. Conclusions The association of mortality due to liver disease with other variables, changes according to the territory in which it is studied. Therefore, specific local studies are required to address this problem in depth. These studies will contribute to the design of locally relevant public policies, aimed at addressing health inequities and the prevention of liver diseases.

Background: Years of potential life lost (YPLL) is a parameter that allows to analyze premature deaths. Aim: To study the causes, differences by gender, geographic variations and the trend of premature deaths in the last decade in Chile. Material and Methods: Using death databases published by the Ministry of Health, YPLL were calculated for the decade 2001-2010, using the method proposed by the Organization for Economic Cooperation and Development. Results: The standardized annual average YPLL rate in Chile in the study period was 4.703 per 100,000 inhabitants. Trauma, cancer and cardiovascular diseases accounted for 68% of YPLL. The male/female YPLL ratio was 2.07; for trauma and mental disorders, the male/female ratio for YPLL was over 5; for cardiovascular and respiratory diseases the male/female ratio was over two. Regions with a higher proportion of rural areas had higher YPLL rates. Conclusions: The main causes of YPLL are potentially preventable. Further studies should be carried out to identify risk factors for premature death.

Background: Among women, breast cancer is the leading cause of death due to cancer worldwide. Aim: To describe the epidemiology of breast cancer mortality in Chilean women by age, time trend and explore its ecological association with socio-demographic variables. Material and Methods: Descriptive study of age specific death rates (2009-2013), and time trend analysis of crude mortality rates (1995-2013) using RiskDiff analysis. Additionally, time trend analysis of age specific death rates was done using Jointpoint regression. The relationship between county mortality risk and socio-demographic variables in the period 2001-2008 was done through an ecological analysis. Socio-demographic variables were: education, income, occupation, housing and living in rural areas. Results: Breast cancer mortality in Chilean women increases with age, with a sharp increase from 80 years old on. In the 1995-2013 period the increase in the crude death rate was 21.8%, this increment was due to changes in demographic structure (43.4%) and decrease in risk (21.7%). The county relative risk of breast cancer mortality is positively associated with education level and negatively associated with living in rural areas. Conclusions: The risk of dying from breast cancer in women has decreased in the period 1995-2013. Nonetheless, the crude death rate has increased in the same period. At an ecological level (counties), breast cancer mortality in Chile is associated with a higher socioeconomic status, measured by educational level and living in rural areas.

O objetivo foi analisar a tendência da taxa de mortalidade por câncer de pulmão no Chile, durante 1990-2009 e projetar estas taxas em seis anos. As informações sobre a mortalidade foram obtidas no Ministério da Saúde do Chile. Para calcular as taxas foram utilizadas projeções da população de acordo com o Censo de 2002. As taxas foram padronizadas utilizando-se a população mundial como referência. Modelos lineares dinâmicos bayesianos foram ajustados para estimar a tendência entre 1990-2009 e projetar o período 2010-2015. Durante o período, observa-se uma redução da taxa de mortalidade de 19,9% nos homens, entretanto nas mulheres a tendência é de crescimento, com o aumento de 28,4%. O modelo de segunda ordem deu um melhor ajuste para os homens e mulheres de primeira ordem. Entre 2010 e 2015, a tendência descendente é mantida entre os homens, no entanto, projetando uma tendência de estabilização da mortalidade por câncer de pulmão em mulheres no Chile. Este tipo de análise pode ser útil para implementar sistemas de vigilância epidemiológica e avaliar estratégias.

The objectives were to analyze lung cancer mortality trends in Chile from 1990 to 2009, and to project the rates six years forward. Lung cancer mortality data were obtained from the Chilean Ministry of Health. To obtain mortality rates, population projections were used, based on the 2002 National Census. Rates were adjusted using the world standard population as reference. Bayesian dynamic linear models were fitted to estimate trends from 1990 to 2009 and to obtain projections for 2010-2015. During the period under study, there was a 19.9% reduction in the lung cancer mortality rate in men. In women, there was increase of 28.4%. The second-order model showed a better fit for men, and the first-order model a better fit for women. Between 2010 and 2015 the downward trend continued in men, while a trend to stabilization was projected for lung cancer mortality in women in Chile. This analytical approach could be useful implement surveillance systems for chronic non-communicable disease and to evaluate preventive strategies.

El objetivo fue analizar la tendencia de la tasa de mortalidad por cáncer de pulmón en Chile, durante el periodo 1990-2009 y proyectar estas tasas a seis años. La información de mortalidad fue obtenida del Ministerio de Salud de Chile. Para calcular las tasas se utilizaron las proyecciones de población según el Censo de 2002. Las tasas se estandarizaron usando la población mundial como referencia. Se ajustaron modelos lineales dinámicos bayesianos para estimar la tendencia entre 1990-2009 y proyectar el periodo 2010-2015. Durante el periodo se observa una reducción del 19,9% de la tasa de mortalidad en hombres, mientras que en mujeres, la tendencia es creciente con aumento de 28,4%. El modelo de segundo orden entregó un mejor ajuste en hombres y el de primer orden en mujeres. Entre 2010 y 2015, se mantiene la tendencia decreciente en hombres, en cambio se proyecta una estabilización en la tendencia de mortalidad por cáncer pulmonar en mujeres en Chile. Este tipo de análisis es útil para implementar sistemas de vigilancia epidemiológica y evaluar estrategias.

O objetivo foi analisar a tendência da taxa de mortalidade por câncer de pulmão no Chile, durante 1990-2009 e projetar estas taxas em seis anos. As informações sobre a mortalidade foram obtidas no Ministério da Saúde do Chile. Para calcular as taxas foram utilizadas projeções da população de acordo com o Censo de 2002. As taxas foram padronizadas utilizando-se a população mundial como referência. Modelos lineares dinâmicos bayesianos foram ajustados para estimar a tendência entre 1990-2009 e projetar o período 2010-2015. Durante o período, observa-se uma redução da taxa de mortalidade de 19,9% nos homens, entretanto nas mulheres a tendência é de crescimento, com o aumento de 28,4%. O modelo de segunda ordem deu um melhor ajuste para os homens e mulheres de primeira ordem. Entre 2010 e 2015, a tendência descendente é mantida entre os homens, no entanto, projetando uma tendência de estabilização da mortalidade por câncer de pulmão em mulheres no Chile. Este tipo de análise pode ser útil para implementar sistemas de vigilância epidemiológica e avaliar estratégias.

The objectives were to analyze lung cancer mortality trends in Chile from 1990 to 2009, and to project the rates six years forward. Lung cancer mortality data were obtained from the Chilean Ministry of Health. To obtain mortality rates, population projections were used, based on the 2002 National Census. Rates were adjusted using the world standard population as reference. Bayesian dynamic linear models were fitted to estimate trends from 1990 to 2009 and to obtain projections for 2010-2015. During the period under study, there was a 19.9% reduction in the lung cancer mortality rate in men. In women, there was increase of 28.4%. The second-order model showed a better fit for men, and the first-order model a better fit for women. Between 2010 and 2015 the downward trend continued in men, while a trend to stabilization was projected for lung cancer mortality in women in Chile. This analytical approach could be useful implement surveillance systems for chronic non-communicable disease and to evaluate preventive strategies.

El objetivo fue analizar la tendencia de la tasa de mortalidad por cáncer de pulmón en Chile, durante el periodo 1990-2009 y proyectar estas tasas a seis años. La información de mortalidad fue obtenida del Ministerio de Salud de Chile. Para calcular las tasas se utilizaron las proyecciones de población según el Censo de 2002. Las tasas se estandarizaron usando la población mundial como referencia. Se ajustaron modelos lineales dinámicos bayesianos para estimar la tendencia entre 1990-2009 y proyectar el periodo 2010-2015. Durante el periodo se observa una reducción del 19,9% de la tasa de mortalidad en hombres, mientras que en mujeres, la tendencia es creciente con aumento de 28,4%. El modelo de segundo orden entregó un mejor ajuste en hombres y el de primer orden en mujeres. Entre 2010 y 2015, se mantiene la tendencia decreciente en hombres, en cambio se proyecta una estabilización en la tendencia de mortalidad por cáncer pulmonar en mujeres en Chile. Este tipo de análisis es útil para implementar sistemas de vigilancia epidemiológica y evaluar estrategias.

Objective: To identify the factors that influence the use of dental services in 4-7-year-olds and in 10-13-year-olds resident in the cities of Talca (Chile) and Montreal (Canada). Methods: A nonprobabilistic cross-sectional study was carried out in 147 boys and girls in Talca and in 94 boys and girls in Montreal between 2009 and 2011. Sociodemographic variables were recorded in parents and children, including age and sex. Data were also gathered on parental education, family composition, and proximity to health centers within neighborhoods. The data were analyzed with Fisher's exact test and the robust Cox regression model (with constant time) with a significance level of 0,05. Results: In Talca, parental education was significantly associated with dental care visits at least twice a year. The children of parents with university education were 2.20 times more likely to consult a dentist (95% CI: 1.30-3.73). Children whose parents perceived their children's health positively were 53% (OR = 0,47; 95% CI: 0,28-0,77) less likely to consult a dentist. In Montreal, the children of parents with university education were 2.10 times more likely to consult a dentist (95%CI: 1.17-3.76), while older children (10-13 years) were 2.11 (95% CI: 1.15-3.88) times more likely to consult a dentist. Conclusions: In both cities, parental education level was associated with the use of dental services.

Objetivo: Determinar los factores que influyen en la consulta al odontólogo de los/las niños/as de 4 a 7 años y los/las jóvenes de 10-13 años de edad residentes de la ciudad de Talca (Chile) y los/las niños/as y los/las jóvenes inmigrantes chilenos residentes en la ciudad de Montreal (Canadá). Métodos: Estudio transversal no probabilístico, con 147 niños/as en Talca y 94 en Montreal. Entre 2009 y 2011 se midieron variables sociodemográficas, nivel de estudios, percepción de la salud de los/las hijos/as, sexo y edad de los/las niños/as, composición familiar y cercanía al centro de salud. Se hizo análisis exploratorio bivariado con test exacto de Fisher. Para buscar las variables asociadas a la consulta odontológica se utilizó la regresión de Cox robusta con tiempo constante con nivel de significación de 0,05. Resultados: En Talca las variables asociadas a la consulta odontológica de dos o más veces al año fueron el nivel de estudios del/de la tutor/a y su percepción sobre la salud del/de la hijo/a, teniendo los/las niños/as con tutores/as con estudios universitarios 2,20 (intervalo de confianza del 95% [IC95%]: 1,30-3,73) veces más posibilidades de consultar al dentista y los/las tutores/as con percepción positiva consultan 53% menos al dentista (odds ratio: 0,47; IC95%: 0,28-0,77). En Montreal, los/las niños/as con tutores/as con estudios universitarios tenían 2,10 veces más posibilidades (IC95%: 1,17-3,76) de consultar al dentista y 2,11 veces más posibilidades de consultar si tenían entre 10 y 13 años de edad (IC95%: 1,15-3,88). Conclusiones: El nivel de estudios del/de la tutor/a se asoció con las visitas al dentista en ambas muestras, siendo los/las niños/as con tutores/as de mayor nivel de estudios quienes más consultan.

Objective: To identify the factors that influence the use of dental services in 4-7-year-olds and in 10-13-year-olds resident in the cities of Talca (Chile) and Montreal (Canada). Methods: A nonprobabilistic cross-sectional study was carried out in 147 boys and girls in Talca and in 94 boys and girls in Montreal between 2009 and 2011. Sociodemographic variables were recorded in parents and children, including age and sex. Data were also gathered on parental education, family composition, and proximity to health centers within neighborhoods. The data were analyzed with Fisher's exact test and the robust Cox regression model (with constant time) with a significance level of 0,05. Results: In Talca, parental education was significantly associated with dental care visits at least twice a year. The children of parents with university education were 2.20 times more likely to consult a dentist (95% CI: 1.30-3.73). Children whose parents perceived their children's health positively were 53% (OR = 0,47; 95% CI: 0,28-0,77) less likely to consult a dentist. In Montreal, the children of parents with university education were 2.10 times more likely to consult a dentist (95%CI: 1.17-3.76), while older children (10-13 years) were 2.11 (95% CI: 1.15-3.88) times more likely to consult a dentist. Conclusions: In both cities, parental education level was associated with the use of dental services.

Objetivo: Determinar los factores que influyen en la consulta al odontólogo de los/las niños/as de 4 a 7 años y los/las jóvenes de 10-13 años de edad residentes de la ciudad de Talca (Chile) y los/las niños/as y los/las jóvenes inmigrantes chilenos residentes en la ciudad de Montreal (Canadá). Métodos: Estudio transversal no probabilístico, con 147 niños/as en Talca y 94 en Montreal. Entre 2009 y 2011 se midieron variables sociodemográficas, nivel de estudios, percepción de la salud de los/las hijos/as, sexo y edad de los/las niños/as, composición familiar y cercanía al centro de salud. Se hizo análisis exploratorio bivariado con test exacto de Fisher. Para buscar las variables asociadas a la consulta odontológica se utilizó la regresión de Cox robusta con tiempo constante con nivel de significación de 0,05. Resultados: En Talca las variables asociadas a la consulta odontológica de dos o más veces al año fueron el nivel de estudios del/de la tutor/a y su percepción sobre la salud del/de la hijo/a, teniendo los/las niños/as con tutores/as con estudios universitarios 2,20 (intervalo de confianza del 95% [IC95%]: 1,30-3,73) veces más posibilidades de consultar al dentista y los/las tutores/as con percepción positiva consultan 53% menos al dentista (odds ratio: 0,47; IC95%: 0,28-0,77). En Montreal, los/las niños/as con tutores/as con estudios universitarios tenían 2,10 veces más posibilidades (IC95%: 1,17-3,76) de consultar al dentista y 2,11 veces más posibilidades de consultar si tenían entre 10 y 13 años de edad (IC95%: 1,15-3,88). Conclusiones: El nivel de estudios del/de la tutor/a se asoció con las visitas al dentista en ambas muestras, siendo los/las niños/as con tutores/as de mayor nivel de estudios quienes más consultan.

Este trabajo aborda las distribuciones obtenidas como mezcla de escala de normales para variables aleatorias correlacionadas, en el contexto de la teoría de los campos markovianos, la cual es aplicada a modelos bayesianos espaciales con efectos aleatorios autoregresivos intrínsecos. Se establecen condiciones para garantizar la existencia de la distribución a posteriori cuando se asume una distribución mezcla de escala de normales para el campo markoviano propuesto. Para ilustrar los métodos propuestos, se estiman los riesgos relativos de cáncer de tráquea, bronquios y pulmón, y tasas de incidencia de diabetes tipo 1 en distritos municipales de Chile. Los resultados son presentados usando mapas temáticos apropiados. Se discute la inferencia sobre los parámetros desconocidos y se proponen algunas extensiones.

This work considers distributions obtained as scale mixture of normal densities for correlated random variables, in the context of the Markov random field theory, which is applied in Bayesian spatial intrinsically autoregressive random effect models. Conditions are established in order to guarantee the posterior distribution existence when the random field is assumed as scale mixture of normal densities. Lung, trachea and bronchi cancer relative risks and childhood diabetes incidence in Chilean municipal districts are estimated to illustrate the proposed methods. Results are presented using appropriate thematic maps. Inference over unknown parameters is discussed and some extensions are proposed.

Un aumento de las enfermedades cardiovasculares (ECV) mundialmente, la existencia de un porcentaje más alto que el promedio nacional de éstas para la región de Maule (Chile), y una atención incrementada en el análisis de factores psicológicos, motivan el análisis del Patrón de Comportamiento Tipo A (PCTA) y la ira respecto de las ECV. Se trabajó con 1007 participantes de 18 a 74 años (ciudadanos de Talca, Chile), mayoritariamente mujeres, quienes respondieron un cuestionario (información socio demográfica, hábitos alimentarios y de estilo de vida), la Escala Retiro de Patrón de Conducta tipo A (ERCTAa), y el Inventario de Ira de Novaco. Se les midió peso, masa corporal, presión arterial y sangre, como factores de riesgo cardiovascular. Los participantes son altamente sedentarios (79.9%), tabáquicos (53.6%), hipercolesterolémicos (44.5%), con sobrepeso (40.7%) y obesidad (32.6%), un cuarto de los cuales presenta hiperglicemia e hipertensión y con PCTA equirepartido según sexo. Es la ausencia de PCTA (ó presencia de PCTB) la que aparece asociada a factores tradicionales de riesgo cardiovascular (FRCV). La ira alta se presenta más en mujeres que en hombres (2.1% vs. 0.3%; c²(3) = 27.99, p<.0001), disminuyendo para ambos sexos con la edad, pero los infartos acaecen igualmente según sexo.

A worldwide raise in the number of cardiovascular disease (CVD) and the existence of a higher percentage in Maule (Chile) than the national media, and increased attention in the analysis of psychological factors motivate to analyze the Type A Behavior Pattern (TABP) and anger in relation to CVD. The sample was 1007 adults between 18 and 74 years old (citizens of Talca, Chile), mostly women. They provided information about their demographic details, eating habits and lifestyle, answered the Novaco's Anger Inventory and the Retiro Scale of Type A Behavior (RSTAB), and also were taken measurements like weight, body mass index and blood pressure and blood tests related to risk factors to traditional cardiovascular diseases. The results show Overall, that the participants appear highly sedentary (79.9%) with relatively high levels of tabaquism (53.6%), and hypercholesterolemia (44.5%), overweight (40.7%) and obesity (32.6%). A quarter of the sample also presents hyperglycemic indexes, hypertension and TABP unequally distributed by sex. The absence of PCTA (or PCTB presence) appeared mostly associated with traditional cardiovascular risk factors (CRF). Regarding anger, women present more high than men (2.1% against 0.3%; c²(3) = 27.99, p<.0001), decreasing for both sexes with age, while also befall stroke by sex.

Background: Maps have played a critical role in public health since 1855, when John Snow associated a cholera outbreak with contaminated water source in London. After cardiovascular diseases, cancer is the second leading cause of death in Chile. Cancer was responsible for 22.7% of all deaths in 1997-2004 period. Aim To describe the geographical distribution of stomach, trachea, bronchi and lung cancer mortality. Material and methods: Mortality statistics for the years 1997-2004, published by the National Statistics Institute and Chilean Ministry of Health, were used. The standardized mortality ratio (SMR) for sex and age quinquennium was calculated for 341 counties in the country. A hierarchical Bayesian analysis of Poisson regression models for SMR was performed. The maps were developed using adjusted SMR (or smoothed) by the Poisson model. Results: There is an excess mortality caused by stomach cancer in south central Chile, from Teno to Valdivia. There is an excess mortality caused by trachea, bronchi and lung cancer in northern Chile, from Copiapó to Iquique. Conclusions: The geographical analysis of mortality caused by cancer shows cluster of counties with an excess risk. These areas should be considered for health care decision making and resource allocation

Background: Cardiovascular disease (CVD) has several traditional risk factors (RF), and some of them are potentially modifiable. Aim: To determine the prevalence of most common risk factors in adult population in Talca in Central Chile. Subjects and methods: We studied 1007 subjects aged 18 to 74 years (66% women), living in Talca, selected by a probability sampling. They answered a questionnaire and anthropometry, blood pressure, lipid profile and blood glucose were measured. Results: Thirty seven percent of subjects smoked, 70.1% had a body mass index over 25 kg/m² and 41% had an abnormally high circumference. High blood pressure was found in 37% (36% of these subjects were unaware of this condition), 44.5% had hypercholesterolemia, 21.5% had low HDL cholesterol, 40.1% had hypertriglyceridemia and 26.3% had high blood glucose levels. Conclusions: There is a high prevalence of risk factors for CVD in adult population from Talca. The prevalence of risk factors is higher than that reported by the 2003 National Health Survery

Background: Death certification is the basis for the study of mortality patterns and the identification of leading causes of death. These data are used for planning health policies and prevention programs. Aim: To evaluate the quality of mortality statistics in Chile from 1997 and 2003. Material and methods: Mortality data from 1997 to 2003 available at the Chilean Ministry of Health was used. Quality of information was evaluated using the percentage of certifications done by physicians and ill-defined causes of death according to rural or urban residence, medical services, age and gender. Results: Death certification done by physicians increased from 97.6% to 99.0% in the studied period. The greatest increase was observed in rural areas, from 89.9% to 94,8%. There was a steady reduction in the percentage of ill-defined causes of deaths, from 4.7% in 1997 to 2.8% in 2003. The percentage of ill-defined causes had a great variation among the different medical services. The variation went from 1.5% in Magallanes to 13.7% in Araucania Sur. There was an inverse linear correlation between death certification by physicians and ill-defined conditions. Conclusions: Quality of Chilean mortality statistics has improved over time. Nevertheless, there is still space for enhancement for the appropriate use of this information

Background: The analysis of infant mortality from congenital malformations, which at present is the main group of causes of this mortality in Chile, suggests that it could be decreased with a good knowledge of its conditioning factors. Aim: To study infant mortality differentials from congenital malformations with linked records, in the 1993 to 1995 Chilean birth cohorts. Material and methods: Analysis of mortality differentials in 1993,1994 and 1995 birth cohorts. Multivariate logistic regression of mortality from congenital diseases. Results: Univariate analysis showed that mortality is highest in the Southern regions of the country (VII to XII) and in rural areas. It is also higher in children from older and from very young mothers, it increases along with the birth order of the child and decreases with increasing educational level of the mother. Multiple logistic regression analysis, confirmed the higher mortality in the Southern regions, aged mothers, high birth order of the child and low educational level of the mother. However no significant influence of rurality nor greater mortality in children of very young mothers was found. Conclusions: These results can be attributed to the fact that this type of analysis permits the control with other variables. Although the mortality data showed interesting relationships with the independent variables, a registry of all live births and stillbirths with congenital anomalies, that would provide greater numbers and data on non fatal anomalies, would be desirable to better study their causal factors. (Rev Méd Chile 2001; 129: 405-12)

Skinfold anthropometry (SKF) has been used to estimate body composition for many years but it has several limitations. Bioelectrical impedance (BIA) is a new method recently recommended to be used in adults. Aim: To determine the level of agreement for body fat mass (BF) measurement by BIA and SKF. Subjects and methods: BF was calculated using the following algorithms: Slaughter for SKF, Deurenberg, Houtkooper, Schafer and Cordain for BIA in 50 girls aged between 9 and 11,6 years. Results: Level of agreement determined using Bland and Altman method was poor, with an average difference (SKF-BIA) of 5% ± 2 DS (-5.5 to 15.5). Conclusions: Measurements of BF determined by BIA gave poor agreement with SKF, thus the use of BIA is not recommended in pediatrics clinical practice

La estimación de los pliegues subcutáneos (PS) para evaluar composición corporal ha sido utilizada durante años, sin embargo, su uso tiene limitaciones. La impedanciometría bioeléctrica (BIA) es un nuevo método cuyo uso ha sido recomendado en adultos. Objetivos: evaluar si la BIA para estimar grasa corporal (GC) tiene una precisión comparable a la obtenida usando PS en pediatría. Material y métodos: Se determinó % GC usando las ecuaciones de Slaughter para PS y Deurenberg, Houtkooper, Schaefer y Cordain para BIA en 50 niñas, entre 9 y 11,6 años. Resultados: El nivel de concordancia, evaluado por el método de Bland y Altman, entre % GC derivado de las ecuaciones de BIA y PS, fue pobre, con una diferencia promedio de 5% ± 2DE (-5,5 a 15,5). Conclusiones: En la determinación de GC la BIA no arroja cifras concordantes con las obtenidas por PS, por lo cual no es adecuado recomendar su uso en pediatría