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BACKGROUND: The high prevalence of obesity, smoking, and physical inactivity in Chile despite government-sponsored measures and campaigns, along with others in the last 30 years, suggests additional reinforcement of these efforts at the primary care level. OBJECTIVES: To determine if lifestyles and modifiable health risk factors in first-year students from the University of Chile Faculties of Medicine and Dentistry, potential future promoters of healthy lifestyles, show changes throughout their first academic year. METHODS: In a randomized stratified sample of 388 students according to sex and chosen career weight, height, waist circumference, waist circumference-weight ratio, food consumption, smoking prevalence and dependence, alcohol use, perceived stress level, and physical activity were measured at the first week, 3 and 6 months after their admission. The Cochrane test assessed dichotomic variables, and the Friedman test was used for nonparametric values. RESULTS: 253 students (186 women) completed the follow-up. A significant worsening of obesity (general and abdominal) and physical inactivity, persistent moderate and high-stress perception, and smoking prevalence were documented throughout the study period. CONCLUSIONS: The progressive obesity and physical inactivity, high-stress perception, and persistent smoking prevalence in the first year of academic life suggest considering measures in the curricular academic structure that facilitate adjustments in the student's lifestyles. Future follow-up of this cohort, increasing participants, and assessing students' mental health are planned.
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Humanos , Masculino , Femenino , Adolescente , Adulto , Adulto Joven , Estrés Psicológico/epidemiología , Estudiantes de Odontología/psicología , Estudiantes de Odontología/estadística & datos numéricos , Estudiantes de Medicina/psicología , Estudiantes de Medicina/estadística & datos numéricos , Conducta Sedentaria , Obesidad/epidemiología , Fumar/epidemiología , Chile/epidemiología , Prevalencia , Factores de RiesgoRESUMEN
BACKGROUND: The high prevalence of obesity, smoking, and physical inactivity in Chile despite government-sponsored measures and campaigns, along with others in the last 30 years, suggests additional reinforcement of these efforts at the primary care level. OBJECTIVES: To determine if lifestyles and modifiable health risk factors in first-year students from the University of Chile Faculties of Medicine and Dentistry, potential future promoters of healthy lifestyles, show changes throughout their first academic year. METHODS: In a randomized stratified sample of 388 students according to sex and chosen career weight, height, waist circumference, waist circumference-weight ratio, food consumption, smoking prevalence and dependence, alcohol use, perceived stress level, and physical activity were measured at the first week, 3 and 6 months after their admission. The Cochrane test assessed dichotomic variables, and the Friedman test was used for nonparametric values. RESULTS: 253 students (186 women) completed the follow-up. A significant worsening of obesity (general and abdominal) and physical inactivity, persistent moderate and high-stress perception, and smoking prevalence were documented throughout the study period. CONCLUSIONS: The progressive obesity and physical inactivity, high-stress perception, and persistent smoking prevalence in the first year of academic life suggest considering measures in the curricular academic structure that facilitate adjustments in the student's lifestyles. Future follow-up of this cohort, increasing participants, and assessing students' mental health are planned.
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Obesidad , Conducta Sedentaria , Estrés Psicológico , Estudiantes de Odontología , Estudiantes de Medicina , Humanos , Chile/epidemiología , Femenino , Masculino , Estudiantes de Medicina/estadística & datos numéricos , Estudiantes de Medicina/psicología , Obesidad/epidemiología , Estrés Psicológico/epidemiología , Estudiantes de Odontología/estadística & datos numéricos , Estudiantes de Odontología/psicología , Adulto Joven , Factores de Riesgo , Fumar/epidemiología , Prevalencia , Adulto , AdolescenteRESUMEN
Objetivo: Describir las fallas en diferentes sistemas de implantes al ser sometidos a fuerzas de torsión creciente, de- terminar el torque en el cual aparece un daño medible en el implante o alguno de sus componentes y especificar la falla más frecuente. Materiales y métodos: Se realizó un estudio experi- mental in vitro. Se utilizaron 88 implantes agrupados según diseño y marca comercial (Federa, Rosterdent, Biomet 3i, Tree-Oss, B&W, ML) en 11 grupos de 8 implantes cada uno. Éstos fueron inmovilizados en acrílico y fijados en una pren- sa. Se aplicó una fuerza de torsión creciente con torquímetro de precisión digital hasta la aparición de alguna falla en el implante o sus componentes. Se registró el torque en el que se produjo la falla. Se realizó estadística descriptiva para el análisis de datos. Resultados: El 100% de los implantes o alguno de sus componentes mostraron una falla detectable al ser sometidos a fuerzas de torsión creciente (rango de torque: 83,5 Ncm im- plante con conexión cono morse 8 grados a 384 Ncm implan- te de conexión interna sin montar). El torque promedio más bajo en el que aparecieron los daños fue 103,75 (±8,08) Ncm para implantes de conexión interna tipo cono morse, mientras que el más alto fue 279,87 (±89,73) Ncm para implantes de conexión interna sin montar. La falla más frecuente (28,4%) fue la fractura del tornillo del portaimplante y falseo del hexá- gono externo simultáneamente. Conclusión: Las fallas detectables a fuerzas de torsión creciente ocurrieron entre 83,5 Ncm y 384 Ncm. La falla rei-terada fue la fractura del tornillo del portaimplante y falseo del hexágono simultáneamente (AU)
Aim: To describe the failures in different implant sys- tems when subjected to increasing torsional forces, deter- mine the torque at which measurable damage occurs to the implant or one of its components, and determine the most frequent failure. Materials and methods: This was an experimental in vitro study. A total 88 implants were used, grouped accord- ing to design and trademark (Federa, Rosterdent, Biomet 3i, Tree-Oss, B&W, ML) into 11 groups of 8 implants each. The implants were immobilized in Duralay acrylic and fixed in a vice. Increasing torsional force was applied with a digital pre- cision torque wrench until the occurrence of any failure in the implants or their components. The torque at which the failure occurred was recorded. Descriptive statistics were performed for data analysis. Results: 100% of the implants or any of their compo- nents showed a detectable failure when subjected to increas- ing torsional forces (force range: 83.5 Ncm in an implant with 8-degree Morse taper connection to 384 Ncm in an implant with unmounted internal connection). The lowest average torque at which damage occurred was 103.75 (±8.08) Ncm for conical implants with Morse internal connection, while the highest was 279.87 (±89.73) Ncm for implant with unmounted internal connection. The most frequent failure (28.4%) was fracture of the implant retaining screw and distortion of the external hexagon simultaneously (AU)
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Resistencia a la Tracción , Implantes Dentales , Torsión Mecánica , Técnicas In Vitro , Fracaso de la Restauración Dental , TorqueRESUMEN
The introduction of digital technology in Medicine has brought enormous diagnostic and therapeutic advances but also has impacted the practitioner's welfare and important aspects of practice such as patient-physician relations. It has been alarming the increasing reports of physicians and nurse's burnout and associated mental disturbances such as depression and suicidal ideation. Increasing administrative burden brought to the practitioners by the need to document by digital technology patients' encounters has reduced the time of patient-physician relation and substituted by a longer time spend by the provider interacting with a computer. This represents probably one of the major causes of frustration and burnout consequences among health providers, as reported by a recent National Academy of Medicine review, a Mayo Clinic Proceedings study published in 2019, several recent Medscapes physicians surveys and by a panel discussion in the 2018 European Congress of Cardiology among many other publications. Many factors are indeed at play in this complex scenario such as government, payers, hospital facilities rules and regulations, and the way to modify them to create a more provider friendly environment may be long and difficult. Nevertheless, a first step to be considered is to reduce the administrative burden of the providers to free more time for them with their patients The future role of using diagnostic and therapeutic algorithms, some of them already available, to develop platforms of patient management with a reduced or minimal medical provider force is still uncertain and likely subject to controversial value and ethical considerations.
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Humanos , Médicos/psicología , Salud Mental , Medicina/tendencias , Agotamiento Profesional , Cardiólogos/psicología , Agotamiento PsicológicoRESUMEN
BACKGROUND: Limited information exists on blood pressure (BP) control factors and adherence to antihypertensive drug therapy (Rx) in developing countries. METHODS: Cross-sectional study in randomly selected 992 hypertensive patients under a Chilean national comprehensive Cardiovascular Health Program (CVHP). Association of education, income, diabetes, obesity, physical activity, psychosocial characteristics, smoking, and alcohol abuse with BP control and adherence were evaluated by multivariate logistic regression. RESULTS: BP control (<140/90 mmHg) was achieved in 63.1% of patients, with 38.4% adherent to Rx. Uncontrolled BP significantly associated with male sex (OR: 1.73 [95% CI 1.35-2.22]), low family income, high emotional-stress-depression score, body mass index, no adherence (OR: 1.83 [95% CI 1.44 - 2.32]), multiple Rx, baseline systolic BP value, and sedentary life style. Males (OR: 1.54 [95% CI 1.23 - 1.93]), low family income, high emotional stress-depression score (OR: 2.15 [95% CI 1.68 - 2.76]), low social support, and uncontrolled BP (OR: 1.52 [95% CI 1.22-1.90]) associated with no adherence. CONCLUSIONS: Comparable BP control (63.1%) to higher-income societies was observed. Uncontrolled BP associated significantly to no adherence and both to male sex, socioeconomic, and psychosocial factors. Global low adherence (38.4%) and improved BP control and adherence in diabetics were noted.
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Antecedentes: Inadecuado control de presión arterial (PA) y baja adherencia a tratamiento farmacológico (Rx) en hipertensos son problemas persistentes globales y en Chile. Factores socioeconómicos y psicosociales han sido frecuentemente mencionados, pero escasamente en Chile. Objetivo: Evaluar control de la PA y adherencia a Rx en hipertensos seguidos en el Programa de Salud Cardiovascular (PSCV) y su asociación con factores clínicos, socioeconómicos y psicosociales. Métodos: Muestra randomizada de 1.794 hipertensos seguidos por 1 año en PSCV en Región Metropolitana. Se evaluó la asociación de edad, sexo, educación, ingreso familiar, Rx, diabetes, obesidad, tabaquismo, consumo problemático de alcohol y actividad física con el control de la PA (<140/90 mmHg) y adherencia. Además, en 600 pacientes, se evaluó la asociación con estrés emocional/depre-sión, relación médico-paciente y apoyo social. Se obtuvieron Odds Ratio (OR) mediante análisis de regresión logística multivariante. Resultados: PA controlada se comprobó en 56,5% y adherencia en 37,3% sin documentarse asociación entre ambas (OR 1,01 [IC 95% 0,78 - 1,32]). Factores asociados a PA no controlada y no adherencia fueron: edad, bajo ingreso familiar, inadecuada relación medico-paciente y alto nivel de estrés emocio-nal/depresión. Rx múltiple y obesidad se asociaron a PA no controlada; sexo masculino y baja educación a no adherencia. Conclusiones: El control de la PA (56,5%) fue similar a resultados de países desarrollados y supera ampliamente cifras de la Encuesta Nacional de Salud 2010 (16,9%). Estos resultados y la falta de asociación entre el control de la PA y la adherencia, sugieren la favorable influencia de otros factores posiblemente relacionados al PSCV.
Background: Unsatisfactory blood pressure (BP) control and low adherence to antihypertensive pharmacotherapy (Rx) in hypertensive populations are persistent problems worldwide and also in Chile. Socioeconomic and psychosocial factors have been frequently mentioned, but with limited contributions from Chile. Objective: The assessment of BP control and adherence to Rx in hypertensive patients followed in the Cardiovascular Health Program (CVHP) and to determine their association with clinical, socioeconomic and psychosocial characteristics. Methods: A randomized sample of 1,794 hypertensive patients followed for 1 year under the CVHP in Metropolitan Region. Association of BP control (<140/90 mmHg) and adherence with age, gender, education, income, Rx, diabetes, obesity, smoking, alcohol use problem and physical activity were analyzed. In a subgroup of 600 patients additional analysis included the association with emotional stress and depression, patient-physician relation and social support. Odds Ratio (OR) were obtained by multivariate logistic regression. Results: BP control was achieved in 56.5% and adherence in 37.3%. No association was found between them (OR 1.01 [CI 95% 0.78-1.32]). Uncontrolled BP and no adherence were associated to advanced age, low income, poor patient-physician relation and high stress-depression. Obesity and multiple Rx were associated to uncontrolled BP. Male gender and low education, were associated to no adherence. Conclusions: BP control (56.5%) was similar to results obtained in developed countries and is strikingly higher than the results reported in the 2010 Chilean National Health Survey (16.9%). These results and the lack of association between BP control and adherence suggest the favorable influence of unaccounted factors, possibly related to the CVHP.
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Atención Primaria de Salud , Cooperación del Paciente , Presión Arterial/efectos de los fármacos , Hipertensión/tratamiento farmacológico , Relaciones Médico-Paciente , Factores Socioeconómicos , Modelos Logísticos , Análisis Multivariante , Encuestas y Cuestionarios , Cumplimiento de la Medicación , Estilo de Vida , Antihipertensivos/uso terapéuticoRESUMEN
Background: Inadequate blood pressure control in hypertensive patients remains a persistent health problem in Chile and worldwide. Poor adherence to antihypertensive drug therapy is one of the frequently cited factors. Objectives: To determine the influence of psychosocial factors in the adherence to drug therapy in hypertensive patients followed through a Cardiovascular Health Program (CHP) that provides free access to primary care centers located in the Metropolitan Region of Santiago, Chile. Methods: Cross sectional study. A randomized sample of 513 hypertensive patients (30 to 68 years) was obtained from a universe of 1.484 patients. Adherence to treatment was determined by the Morisky-Green-Levine test. Demographic, socioeconomic and average values of blood pressure were recorded. Validated questionnaires were utilized to assess the patient-physician relationship, awareness of being hypertensive, patient perception of social support, family cohesion, patient self-health assessment and symptoms of emotional stress and depression. Results: The drug therapy adherence was 36.6%, higher in women (38.4% vs 28.9%; p < 0.001). After multivariate analysis, absence of adherence was associated with male gender (OR: 1.76 [95% CI 1.21-2.56]), low education (OR: 1.72 [95% CI 1.18 to 2.53]), inadequate patient-physician relationship (OR: 1.56 [95% CI 1.13 to 2.27]), and high level of emotional stress and depression (OR: 1.93 [95% CI 1.27 to 2.94]). Conclusions: Our study highlights the influence of inadequate patient-physician relation, high level of emotional stress and depression, low education level and income and male gender in the lack of adherence to antihypertensive drug therapy in hypertensive patients followed throughout the CHP.
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Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Hipertensión/tratamiento farmacológico , Cumplimiento de la Medicación/psicología , Antihipertensivos/uso terapéutico , Chile , Estudios de Cohortes , Hipertensión/psicología , Cumplimiento de la Medicación/estadística & datos numéricos , Encuestas y Cuestionarios , Factores de Riesgo , Factores Socioeconómicos , Población UrbanaRESUMEN
BACKGROUND: Inadequate blood pressure control in hypertensive patients remains a persistent health problem in Chile and worldwide. Poor adherence to antihypertensive drug therapy is one of the frequently cited factors. OBJECTIVES: To determine the influence of psychosocial factors in the adherence to drug therapy in hypertensive patients followed through a Cardiovascular Health Program (CHP) that provides free access to primary care centers located in the Metropolitan Region of Santiago, Chile. METHODS: Cross sectional study. A randomized sample of 513 hypertensive patients (30 to 68 years) was obtained from a universe of 1.484 patients. Adherence to treatment was determined by the Morisky-Green-Levine test. Demographic, socioeconomic and average values of blood pressure were recorded. Validated questionnaires were utilized to assess the patient-physician relationship, awareness of being hypertensive, patient perception of social support, family cohesion, patient self-health assessment and symptoms of emotional stress and depression. RESULTS: The drug therapy adherence was 36.6%, higher in women (38.4% vs 28.9%; p < 0.001). After multivariate analysis, absence of adherence was associated with male gender (OR: 1.76 [95% CI 1.21-2.56]), low education (OR: 1.72 [95% CI 1.18 to 2.53]), inadequate patient-physician relationship (OR: 1.56 [95% CI 1.13 to 2.27]), and high level of emotional stress and depression (OR: 1.93 [95% CI 1.27 to 2.94]). CONCLUSIONS: Our study highlights the influence of inadequate patient-physician relation, high level of emotional stress and depression, low education level and income and male gender in the lack of adherence to antihypertensive drug therapy in hypertensive patients followed throughout the CHP.
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Hipertensión/tratamiento farmacológico , Cumplimiento de la Medicación/psicología , Adulto , Anciano , Antihipertensivos/uso terapéutico , Chile , Estudios de Cohortes , Femenino , Humanos , Hipertensión/psicología , Masculino , Cumplimiento de la Medicación/estadística & datos numéricos , Persona de Mediana Edad , Factores de Riesgo , Factores Socioeconómicos , Encuestas y Cuestionarios , Población UrbanaRESUMEN
Antecedentes: El control de la presión arterial (PA) es fundamental en reducir la morbi-mor-talidad en hipertensos, pero con resultados hasta la fecha insatisfactorios en Chile y en países de alto desarrollo socioeconómico. En Chile se inició en 2002 el Programa de Salud Cardiovascular (PSCV) intentando mejorar el manejo de estos pacientes. Objetivos: Evaluar características sociodemográ-ficas, clínicas, antropométricas, psicosociales y de estilos de vida de un grupo de pacientes participantes en el PSCV, y la influencia de estos factores en el control de la PA. Métodos: Se obtuvo una muestra aleatoria de 525 pacientes (380 mujeres) de un universo de 1.533 hipertensos entre 30 y 68 años bajo seguimiento en el PSCV. Se registraron datos sociodemográficos, clínicos, antropométricos, psicosociales y de estilos de vida a través de evaluación clínica y cuestionarios validados. La PA fue medida utilizando un protocolo estándar por personal entrenado. El análisis estadístico incluyó la predicción del riesgo (Odds RATIO) de PA no controlada por las diversas características estudiadas. Resultados: El 47 por ciento de los pacientes logró una PA controlada (<140/90 mmHg). La presencia de diabetes mellitus (DM) fue documentada en el 38,5 por ciento. Factores predictores significativos de PA no controlada fueron DM, baja educación, inadecuada relación médico paciente y alto nivel de estrés emocional/depresión. Conclusiones: El PSCV ha logrado un avance importante en el control de la PA resaltando la influencia significativa de factores psicosociales. Sin embargo es preocupante la alta proporción de hipertensos diabéticos, su inferior control de PA, y la limitada captación de hombres al programa.
Background: Blood pressure (BP) control is a necessary requirement to reduce cardiovascular events and mortality in hypertensive patients, but so far results have been disappointing in Chile and also in countries with advanced socioeconomic development. Since 2002 a Cardiovascular Health Program (CHP) was launched in Chile attempting to improve the outcomes in these patients. Objectives: To assess the influence of sociodemo-graphic, clinical, anthropometric, psychosocial, lifestyle habits characteristics upon BP control (<140/90 mmHg) in a group of hypertensive patients referred to the CHP. Methods: A cross sectional study of a random sample of 525 hypertensive patients (380 women) obtained from a universe of 1,533 patients with ages ranging from 30 to 68 years was performed. Socio-demographic, clinical, anthropometric, psychosocial and lifestyle habits data were collected through clinical evaluation and validated questionnaires. Trai-ned personnel using standard protocols recorded BP. Adjusted ODDS RATIOS were used to assess theinfluence of different population characteristics upon blood pressure control . Results: A controlled BP (<140/90 mmHg) was achieved in 47 percent of patients, and 38.5 percent presented diabetes mellitus (DM). Significant predictors of uncontrolled BP (>140/90 mmHg) were DM, low education, unsatisfactory patient-physician relation, and high score of emotional stress /depression. Conclusions: In Chile the CHP has achieved an important progress in BP control in hypertensive patients. Psychosocial factors influenced significantly these results. It is concern the high proportion of diabetics in this hypertensive population and their unsatisfactory BP control. The lower proportion of men enrolled in the CHP needs additional analysis and corrective actions.
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Presión Arterial , Hipertensión/prevención & control , Atención Primaria de Salud/métodosRESUMEN
Objective. To assess the blood pressure control and cardiovascular risk factors (CVRFs) in a population of hypertensive patients with access to care under a government-financed program, the Cardiovascular Health Program (CHP). Design. A cross-sectional and multicenter study. Setting. 52 primary care centers, metropolitan area of Santiago, Chile. Participants. 1,194 patients were selected by a systematic random sampling from a universe of 316,654 hypertensive patients. Key Measurements. Demographic information, blood pressure (BP) measurements, and CVRF were extracted from medical records of patients followed for a 12-month period. Results. 59.7% of patients reached target BP <140/90 mmHg. More women were captured in the sampling (2.1 : 1), achieving better BP control than men. Diabetic patients (26.4%) had worse BP control than nondiabetics. Antihypertensive medications were used in 91.5%, with multidrug therapy more frequent in patients with higher BP and more difficult control. Conclusions. The success in improving the BP control to values <140/90 mmHg from 45.3% to 59.7% underscores the contribution of this program in the Chilean primary care cardiovascular preventive strategies. However, fewer hypertensive men than women were captured by this program, and it is of concern the underperforming of BP control observed in diabetics.
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OBJECTIVES: To test whether foreign-born status confers a protective effect against low birth weight (LBW) outcomes among Mexican-origin women in Colorado. METHODS: Retrospective cohort study utilizing Colorado birth records from 1989-2004 for multivariate logistic regression analysis. The study population was 66,422 U.S.-born women of Mexican origin (USB) and 85,000 Mexican-born (MB) women with singleton births. RESULTS: Mexican-born women had 24.9% lower odds of LBW (OR 0.751 95% CI 0.782) than USB women. Mexican-born women had a higher prevalence of risk factors for LBW than their USB counterparts (anemia, cardiac disease, hypertension, inadequate prenatal care, less than high school education). After adjusting for these risk factors, MB women had 22.5% lower odds of having LBW infants than USB women (OR 0.775, 95% CI 0.73-0.81). CONCLUSIONS: This study supports the epidemiologic paradox of LBW; despite higher prevalence of risk factors, foreign-born status confers an overall protective effect against low birth weight outcomes.
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Causalidad , Recién Nacido de Bajo Peso/fisiología , Americanos Mexicanos , Adolescente , Adulto , Colorado/epidemiología , Emigrantes e Inmigrantes , Femenino , Disparidades en el Estado de Salud , Humanos , Recién Nacido , Modelos Logísticos , Embarazo , Complicaciones del Embarazo/epidemiología , Sistema de Registros , Estudios Retrospectivos , Factores de Riesgo , Adulto JovenRESUMEN
Antecedentes: Una relación inversa entre estatura y riesgo de mortalidad ha sido establecida en estudios prospectivos de países desarrollados. Sin embargo, dicha asociación prácticamente permanece inexplorada en sociedades latinoamericanas en rápida transición económica y epidemiológica. Diseño: De un universo de 11.600 adultos viviendo en el centro urbano de Mostazal, Chile, se realizó un estudio de cohorte prospectivo de una muestra aleatoria ponderada de 795 sujetos seguidos durante 8 años. Método: Desde 1997 a 1999 se evaluó la estatura (percentiles 50 y 75 por sexo), hipertensión, diabetes, dislipidemia, obesidad, tabaquismo, consumo de alcohol y antecedentes hereditarios de enfermedad cardiovascular. El riesgo relativo de mortalidad por cualquier causa fue estimado a través de modelos de regresión de Cox ajustando por edad, sexo, factores de riesgo, educación e ingreso. Resultados: Se observó una relación inversa entre la estatura adulta y los factores de riesgo cardiovascular. En el modelo completamente ajustado el riesgo de mortalidad por cualquier causa asociado a la estatura fue 0,75 (IC 95 por ciento 0,66 - 0,85; p tendencia <0,001). Los factores de riesgo cardiovascular tradicionales solo explicaron 22 por ciento de la asociación inversa establecida entre estatura y mortalidad. Conclusión: En sociedades en transición económica como Chile, la estatura aparece como un factor de riesgo independiente de mortalidad. En esta cohorte de adultos chilenos, los factores de riesgo cardiovascular tradicionales solo explicaron parcialmente la relación inversa entre estatura y mortalidad.
Background: The inverse relationship between height and mortality risk has been well established in developed countries, but remains practically unexplored in Latin American societies. Setting: Chile, 11,600 adults living in the urban centre of Mostazal. Design: Prospective cohort study of a weighted random sample of 795 subjects followed during 8 years. Methods: Height (percentiles 50 and 75 by sex) along hypertension, diabetes, dyslipidemia, obesity, smoking, alcohol consumption and hereditary cardiovascular disease were assessed at baseline. Relative risks of all-cause mortality with 95% confidence intervals were computed in Cox regression models adjusting for age, gender, cardiovascular risk factors and joint-effects of other socioeconomic measures. Results: A significant inverse relationship between cardiovascular risk factors and height was observed. The risk of all cause mortality was 0.75 (95 percent CI 0.66 - 0.85; p-for trend <0.001) after full adjustments. Traditional cardiovascular risk factors explained only 22 percent of the association for height with mortality risk. Conclusions: In this adult cohort, traditional cardiovascular risk factors only explained partially the inverse relationship between height and all-cause mortality. Similar to developed countries, in economic transitioning societies such as Chile, height is an independent risk factor, likely reflecting different early exposure patterns that influence the health status during the life course.
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Estatura , Enfermedades Cardiovasculares/mortalidad , Análisis de Varianza , Chile , Estudios de Cohortes , Países en Desarrollo , Enfermedades Cardiovasculares/epidemiología , Estudios de Seguimiento , Medición de Riesgo , Factores de Riesgo , Factores Socioeconómicos , Análisis de SupervivenciaRESUMEN
PURPOSE: The inverse relationship between early life and adult socioeconomic measures and mortality risk has been well established in developed countries, but remains practically unexplored in Latin American societies. The setting was Chile; the study included 11,600 adults living in the urban center of San Francisco de Mostazal. This was a prospective cohort study of a weighted random sample of 795 subjects followed up during 8 years. METHODS: Education (elementary, high school and college), height (percentiles 50 and 75), and income (population quartiles) were assessed at baseline. Relative risks of all-cause mortality were computed in Cox regression models adjusting for age, gender, body mass index, smoking status, and joint effects of the socioeconomic measures. RESULTS: A graded inverse relationship with all-cause mortality was observed for education (risk: 1.0, 0.67, and 0.30, p for trend < 0.01) and height (risk: 1.0, 0.75, and 0.56, p for trend < 0.01), but not for income (p for trend = 0.94). CONCLUSIONS: These findings suggest a 'pauper rich' paradox in transitioning Latin American economies. Income level does not seem sufficient to improve survival in cohorts exposed to adverse early life influences reflected by education and height.