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BACKGROUND: Some nutritional interventions have shown their efficacy in reducing gestational weight gain (GWG); however, their applicability in routine care is limited. OBJECTIVE: We assessed the effectiveness of a low-intensity and high-coverage nutritional intervention on maternal and offspring outcomes; the intervention enhanced existing nutritional health care standards and practices at the primary health care level in Chile. METHODS: This study was a cluster-randomized controlled trial of 12 primary health care centers (PHCCs) from Santiago, Chile. PHCCs were randomly allocated to either nutritional intervention [intervention group (IG), n = 5] or routine care [control group (CG), n = 7]. A total of 4631 pregnant women were recruited (IG, n = 2565; and CG, n = 2066). Primary outcomes were adequate GWG and glycemic control in mothers and birth weight, birth length, macrosomia, and large for gestational age in neonates. The intervention consisted of 4 key actions: training of health care professionals on nutritional recommendations, counseling of pregnant women on diet and physical activity recommendations, offering a physical activity program implemented in the participating PHCCs, and adequate referral to dietitians. Women randomly assigned to the CG received routine antenatal care. RESULTS: At baseline, the mean age was 26.1 y; 45% of women were primipara and 24% were obese. No differences were found in the percentage of women achieving adequate GWG (IG: 30.3%, compared with CG: 31.3%; OR: 0.94; 95% CI: 0.81, 1.09), but women in the IG had lower GWG than those in the CG (11.3 compared with 11.9 kg; mean difference: -0.63 kg; 95% CI: -1.19, -0.08). Effects of the intervention were significantly higher in women with obesity at the begining of pregnancy (mean difference: -1.24 kg; 95% CI: -2.18, -0.30; P for interaction < 0.05). No differences were found between groups regarding maternal glycemic control or neonatal outcomes. CONCLUSIONS: Our findings demonstrate that a low-intensity, high-coverage intervention delivered through the Chilean public health care system under standard operating conditions reduces GWG and has the potential for successful scale-up. This trial was registered at clinicaltrials.gov as NCT01916603.
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Peso al Nacer , Ganancia de Peso Gestacional , Fenómenos Fisiologicos Nutricionales Maternos , Atención Prenatal , Adolescente , Adulto , Glucemia/análisis , Femenino , Humanos , Recién Nacido , Estado Nutricional , Embarazo , Adulto JovenRESUMEN
OBJECTIVES: One of every four pregnant women in Chile is obese. Gestational obesity is associated with maternal metabolic complications in pregnancy (e.g., gestational diabetes, preeclampsia), but to our knowledge, there is little evidence on relationships with future metabolic risk. The aim of this study was to evaluate the association between prepregnancy obesity (prepregnancy body mass index ≥30 kg/m2) or excessive gestational weight gain (GWG; according to the 2009 recommendations from the Institute of Medicine), and maternal metabolic complications 10 y postpartum in premenopausal Chilean women. METHODS: A prospective study was conducted. In 2006, 1067 Chilean mothers of children born in 2002-participants of the GOCS (Growth and Obesity Cohort Study)-were recruited. Mothers completed a questionnaire concerning sociodemographic, anthropometric, and pregnancy characteristics. Of the sample, 402 women were randomly selected to participate in a study related to the determinants of breast cancer risk in 2012. At follow-up, anthropometry, blood pressure, and fasting labs were measured. Complete data was available for 366 women. RESULTS: Thirty-two percent of mothers had prepregnancy overweight/obesity and 39.1% had excessive GWG. In adjusted models, prepregnancy obesity was positively associated with increased insulin resistance (odds ratio [OR], 18; 95% confidence interval [CI], 5.2-62.7), metabolic syndrome (OR, 3.3; 95% CI, 1.3-8.3), and hyperglycemia (OR, 3; 95% CI, 1.1-8.6). Prepregnancy overweight/obesity was associated with increased risk for insulin resistance, metabolic syndrome, abdominal obesity, low high-density lipoprotein cholesterol, and hypertriglyceridemia (P < 0.05). Excessive GWG was not associated with metabolic risk in the main model but was found to be positively associated in models with correction of weight by possible recall bias. CONCLUSIONS: Gestational obesity was associated with maternal metabolic alterations 10 y postpartum. Prevention strategies for chronic diseases should consider prepregnancy obesity as a modifiable risk factor for future metabolic health.
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Hiperglucemia/epidemiología , Síndrome Metabólico/epidemiología , Obesidad/epidemiología , Complicaciones del Embarazo/epidemiología , Premenopausia , Adolescente , Adulto , Chile , Estudios de Cohortes , Comorbilidad , Femenino , Humanos , Resistencia a la Insulina , Embarazo , Estudios Prospectivos , Factores de Riesgo , Aumento de Peso , Adulto JovenRESUMEN
Operations management tools are critical in the process of evaluating and implementing action towards a low carbon production. Currently, a sustainable production implies both an efficient resource use and the obligation to meet targets for reducing greenhouse gas (GHG) emissions. The carbon footprint (CF) tool allows estimating the overall amount of GHG emissions associated with a product or activity throughout its life cycle. In this paper, we propose a four-step method for a joint use of CF assessment and Data Envelopment Analysis (DEA). Following the eco-efficiency definition, which is the delivery of goods using fewer resources and with decreasing environmental impact, we use an output oriented DEA model to maximize production and reduce CF, taking into account simultaneously the economic and ecological perspectives. In another step, we stablish targets for the contributing CF factors in order to achieve CF reduction. The proposed method was applied to assess the eco-efficiency of five organic blueberry orchards throughout three growing seasons. The results show that this method is a practical tool for determining eco-efficiency and reducing GHG emissions.
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BACKGROUND: Maternal obesity before and during pregnancy predicts maternal and infant risks of obesity and its associated metabolic conditions. Dietary and physical activity recommendations during pregnancy as well as weight monitoring are currently available in the Chilean primary health care system. However some of these recommendations are not updated and most of them are poorly implemented. We seek to assess the effectiveness of an intervention that enhances the implementation of updated nutrition health care standards (diet, physical activity, and breastfeeding promotion) during pregnancy on maternal weight gain and infant growth. DESIGN & SETTING: Cluster randomized controlled trial. The cluster units will be 12 primary health care centers from two counties (La Florida and Puente Alto) from the South-East Area of Santiago randomly allocated to: 1) enhanced nutrition health care standards (intervention group) or 2) routine care (control group). PARTICIPANTS: Women seeking prenatal care before 15 weeks of gestation, residing within a catchment area of selected health centers, and who express that they are not planning to change residence will be invited to participate in the study. Pregnant women classified as high risk according to the Chilean norms (i.e age <16 or >40 years, multiple gestation, pre-gestational medical conditions, previous pregnancy-related issues) and/or underweight will be excluded. INTERVENTION: Pregnant women who attend intervened health care centers starting at their first prenatal visit will receive advice regarding optimal weight gain during pregnancy and diet and physical activity counseling-support. Pregnant women who attend control health clinics will receive routine antenatal care according to national guidelines. We plan to recruit 200 women in each health center. Assuming a 20% loss to follow up, we expect to include 960 women per arm. MAIN OUTCOME MEASURES: 1) Achievement of adequate weight gain based on IOM 2009 recommendations and adequate glycaemic control at 24-28 weeks of pregnancy according to ADA 2011, and 2) healthy infant growth during the first year of age based on WHO standards. DISCUSSION: We expect that the intervention will benefit the participants in achieving adequate weight gain & metabolic control during pregnancy as well as adequate infant growth as a result of an increased impact of standard nutrition and health care practices. Gathered information should contribute to a better understanding of how to develop effective interventions to halt the maternal obesity epidemic and its associated co-morbidities in the Chilean population. TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT01916603.
Asunto(s)
Lactancia Materna , Desarrollo Infantil , Dieta , Actividad Motora , Obesidad/terapia , Atención Posnatal/métodos , Complicaciones del Embarazo/terapia , Atención Prenatal/métodos , Adolescente , Adulto , Chile , Estudios de Cohortes , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Fenómenos Fisiologicos Nutricionales Maternos , Estado Nutricional , Sobrepeso/terapia , Embarazo , Evaluación de Programas y Proyectos de Salud , Aumento de Peso , Adulto JovenRESUMEN
El objetivo del trabajo realizado fue evaluar la utilidad del Cuestionario de Salud del Paciente como posible instrumento de tamizaje para Trastornos por somatización. La metodología consistió en la validación de lenguaje del instrumento, mediante su traducción doble ciego. Posteriormente se realizó su validación de contenido con un panel de expertos. El cuestionario fue aplicado en una muestra aleatoria de100 personas en la atención primaria de salud del Hospital El Pino. Se aplicó de forma anónima y se excluyeron los síntomas de los pacientes producidos por enfermedades médicas ya diagnosticadas previamente. Al analizar los resultados se constató una sospecha de un 34,15 por ciento para trastornos por somatización según el cuestionario de salud del paciente, la cual sería 12 veces mayor a la indicada con los criterios del CIE-10 y casi 4 veces mayor que la indicada por los criterios de Escobar. Esto podría explicarse porque los síntomas pesquisados por el cuestionario se deban a otras enfermedades orgánicas o psiquiátricas, que no se discriminan bien por esta herramienta, o a errores en su aplicación.
The objective of the work performed was to evaluate the usefulness of the Patient Health Questionnaire as a possible somatization disorders screening tool. The methodology consisted in validating the language of the instrument, using a double blind translation. Then the questionnaire was presented to health professionals who gave us their impressions. The questionnaire was applied to a random sample of 100 people at the primary attention health service of Hospital El Pino. It was applied anonymously, and the symptoms of patients caused by medical diseases previously diagnosed were excluded. When the results were analyzed , a suspicion of 34.15 percent in somatization disorders was found according to the patient health questionnaire, which would be 12 times greater than that indicated in the criteria of the CIE-10, and almost 4 times greater than the one indicated by the criteria of Escobar. This could be explained if the symptoms investigated were caused by other organic or psychiatric diseases, that had not been discriminated by this tool or errors in its application.
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Humanos , Encuestas y Cuestionarios , Tamizaje Masivo/instrumentación , Trastornos Somatomorfos/diagnóstico , Chile , Reproducibilidad de los Resultados , TraducciónRESUMEN
In the recent past, the Sepetiba Bay watershed, located in the Rio de Janeiro State, Brazil has experienced rapid industrial development and population growth, as well as an increase in water pollution and environmental degradation. To analyze the complex interrelationships among the agents affecting the Sepetibza Bay environment, a system dynamics model was developed. The model builds on extensive studies conducted for the watershed, and simulates different hypotheses of economic growth and of demographic expansion. Thus, it can be used as a decision support tool for the identification of investment priorities and policy analyses under various scenarios. In order to provide a comprehensive approach to the environmental management of the Sepetiba Bay watershed, the model had to consider only the most relevant aspects of the behavior and the key interactions among agents operating in the watershed. In this article, the model's structure is presented together with some of its main results.