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Monitoring gestational weight gain (GWG) throughout pregnancy among adolescents is important for detecting individuals at risk and timely intervention. However, there are no specific tools or guidelines for GWG monitoring of this group. We aimed to construct GWG charts for pregnant adolescents (10-19 years old) according to pre-pregnancy body mass index (BMI) using a pooled dataset from nine Latin American countries. Datasets from Argentina, Brazil, Chile, Colombia, Mexico, Panama, Paraguay, Peru, and Uruguay collected between 2003 and 2021 were combined after data cleaning and harmonization. Adolescents free of diseases that could affect GWG and who gave birth to newborns weighing between 2,500-4,000 g and free of congenital malformations were included. Multiple imputation techniques were applied to increase the sample size available for underweight and obesity categories. Generalized Additive Models for Location, Scale, and Shape were used to construct the charts of GWG according to gestational age. Internal and external validation procedures were performed to ensure that models were not over-adjusted to the data. The cohort included 6,414 individuals and 29,414 measurements to construct the charts and 1,684 individuals and 8,879 measurements for external validation. The medians (and interquartile ranges) for GWG at 40 weeks according to pre-pregnancy BMI were: underweight, 14.9 (11.9-18.6); normal weight, 14.0 (10.6-17.7); overweight, 11.6 (7.7-15.6); obesity, 10.6 kg (6.7-14.3). Internal and external validation showed that the percentages above/below selected percentiles were close to those expected, except for underweight adolescents. These charts describe the GWG throughout pregnancy among Latin American adolescents and represent a significant contribution to the prenatal care of this group. GWG cut-offs based on values associated with lower risks of unfavorable outcomes for the mother-child binomial should be determined before implementing the charts in clinical practice.

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[This corrects the article DOI: 10.1371/journal.pgph.0000763.].

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El país se ha visto enfrentado a la pandemia por Sars-Cov-2, que coexiste con problemas alimentario-nutricionales relacionados con enfermedades no trasmisibles (ENT). En esta situación, las personas con ENT han tenido menos probabilidades de recibir atención de salud debido a la reestructuración del sistema de salud. En este contexto se desarrolló un proyecto que tuvo como objetivo general evaluar la autogestión del cuidado y acceso a prestaciones de salud en personas con factores de riesgo cardiovascular pertenecientes al Programa de Salud Cardiovascular (PSCV) de la Atención Primaria de Salud (APS) de la Región Metropolitana, en condiciones de pandemia por COVID-19. El objetivo del presente trabajo fue describir estrategias que integren aspectos individuales, comunitarios y estructurales para mejorar el automanejo en personas con ENT con el fin de afrontar interrupciones de las prestaciones en salud y para mejorar el control en condiciones normales y en futuras crisis. Las estrategias propuestas se originaron a partir del análisis de convergencia y complementariedad de los resultados cuantitativos y cualitativos del estudio y de un seminario con actores clave de la APS. Las propuestas fueron organizadas en tres niveles 1) rediseño del programa de salud cardiovascular; 2) respuesta a la discontinuidad de la atención en salud y 3) medidas estructurales. Conclusión: Es necesario reevaluar las políticas de atención primaria a la luz de estas estrategias propuestas, con el fin de que la salud sea una responsabilidad compartida y a la vez empoderar a los usuarios-as sobre sus propias habilidades.

BACKGROUND: Chile faced the Sars-Cov-2 pandemic, which coexisted with food-nutritional problems related to non-communicable diseases (NCDs). Due to this context, individuals with chronic conditions had less chance to receive medical attention due to the restructuring of the public health system. OBJECTIVE: The present study aimed to identify strategies that integrate the individual, community, and structural levels to improve health control in habitual and critical situations. METHODS: The study included individuals attending the Cardiovascular Health Program (Programa de Salud Cardiovascular) at the primary care level in the capital city of Santiago during the COVID-19 pandemic. Nine hundred forty individuals attending the Cardiovascular Health Program answered a 40-question telephonic interview. With the results of the analysis (convergence analyses, the complement of quantitative and qualitative results), we performed a seminar with key stakeholders from the Ministry of Health and the primary care level. RESULTS: Our study describes integrative strategies that include the individual level, the community level, and structural aspects. These strategies may improve healthcare management among people with NCDs and could be helpful to face interruptions of health benefits and improve health control in everyday and critical situations. The strategies include three levels: 1) Cardiovascular Health Program redesign; 2) facing health attendance discontinuities, and 3) structural measures. Conclusion: It is necessary to re-evaluate primary care policies in light of these proposed strategies for sharing responsibility and empowering users about their abilities.

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BACKGROUND: Chile faced the Sars-Cov-2 pandemic, which coexisted with food-nutritional problems related to non-communicable diseases (NCDs). Due to this context, individuals with chronic conditions had less chance to receive medical attention due to the restructuring of the public health system. OBJECTIVE: The present study aimed to identify strategies that integrate the individual, community, and structural levels to improve health control in habitual and critical situations. METHODS: The study included individuals attending the Cardiovascular Health Program (Programa de Salud Cardiovascular) at the primary care level in the capital city of Santiago during the COVID-19 pandemic. Nine hundred forty individuals attending the Cardiovascular Health Program answered a 40-question telephonic interview. With the results of the analysis (convergence analyses, the complement of quantitative and qualitative results), we performed a seminar with key stakeholders from the Ministry of Health and the primary care level. RESULTS: Our study describes integrative strategies that include the individual level, the community level, and structural aspects. These strategies may improve healthcare management among people with NCDs and could be helpful to face interruptions of health benefits and improve health control in everyday and critical situations. The strategies include three levels: 1) Cardiovascular Health Program redesign; 2) facing health attendance discontinuities, and 3) structural measures. CONCLUSION: It is necessary to re-evaluate primary care policies in light of these proposed strategies for sharing responsibility and empowering users about their abilities.

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BACKGROUND: The Human Right to Food is not incorporated in the Chilean Constitution. Aim: To identify the legal, social, and nutritional elements for its incorporation into the new Constitution, and to draft a text proposal for the constituent discussion. MATERIAL AND METHODS: Descriptive and qualitative study on the perceptions of experts and key actors of the food chain in Chile. The sample was for convenience and included civil society, academia, international organizations, parliamentarians, food traders and producers, and national and local authorities (n = 26). The research team, previously trained and standardized, applied semi-structured online surveys, which were recorded and transcribed. Through an inductive approach, a thematic analysis was carried out using the Atlas.ti 9.0 software. RESULTS: Eighty-one percent of the interviewees were in favor of the Constitutional incorporation of the Right to Food. According to interviews, a constitutional text was proposed considering the characteristics of adequate, healthy, safe, and nutritious foods. Also, the food items must be available, physically and economically accessible, and culturally relevant. A guaranteed citizen participation, food sovereignty, food security, and environmental sustainability must be considered. Conclusions: The high prevalence of malnutrition due to excess, poor diet, and food insecurity during the COVID-19 pandemic, and a current Constitution that does not explicitly guarantee physical and economic access to food, establish a factual and normative background that justifies the incorporation of this right in a new Constitution.

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BACKGROUND: The Human Right to Food is not incorporated in the Chilean Constitution. AIM: To identify the legal, social, and nutritional elements for its incorporation into the new Constitution, and to draft a text proposal for the constituent discussion. MATERIAL AND METHODS: Descriptive and qualitative study on the perceptions of experts and key actors of the food chain in Chile. The sample was for convenience and included civil society, academia, international organizations, parliamentarians, food traders and producers, and national and local authorities (n = 26). The research team, previously trained and standardized, applied semi-structured online surveys, which were recorded and transcribed. Through an inductive approach, a thematic analysis was carried out using the Atlas.ti 9.0 software. RESULTS: Eighty-one percent of the interviewees were in favor of the Constitutional incorporation of the Right to Food. According to interviews, a constitutional text was proposed considering the characteristics of adequate, healthy, safe, and nutritious foods. Also, the food items must be available, physically and economically accessible, and culturally relevant. A guaranteed citizen participation, food sovereignty, food security, and environmental sustainability must be considered. CONCLUSIONS: The high prevalence of malnutrition due to excess, poor diet, and food insecurity during the COVID-19 pandemic, and a current Constitution that does not explicitly guarantee physical and economic access to food, establish a factual and normative background that justifies the incorporation of this right in a new Constitution.

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Individuals with non-communicable diseases (NCDs) are potentially at increased vulnerability during the Covid-19 pandemic and require additional help to reduce risk. Self-management is one effective strategy and this study investigated the effect of sociodemographic and health factors on the self-management of some non-communicable diseases, namely hypertension, type 2 diabetes mellitus and dyslipidemia, among Chilean adults during the Covid-19 pandemic. A cross-sectional telephone survey was carried out on 910 participants with NCDs, from Santiago, Chile. An adapted and validated version of the "Partners in Health" scale was used to measure self-management. Exploratory Factor analysis yielded five dimensions of this scale: Disease Knowledge, Healthcare Team Relationship, General Self-Management and Daily Routines, Drug Access and Intake, and Monitoring and Decision-Making. The average of these dimensions was calculated to create a new variable Self-Management Mean, which was used as a dependent variable together with the five separate dimensions. Independent variables included age, gender, years of schooling, number of diseases, the percentage of Multidimensional Poverty Index in the commune of residence, and self-rated health status. Beta regressions and ANOVA for the Beta regression residuals were utilized for analyses. Beta regression model explained 8.1% of the variance in Self-Management Mean. Age, years of schooling, number of diseases and self-rated health status were statistically associated with Self-Management Mean and dimensions related to daily routines and health decision making, such as Disease Knowledge, General Self-Management and Daily Routines, and Monitoring and Decision-Making. Gender and the percentage of Multidimensional Poverty Index in the commune of residence were insignificant. Strategies for self-management of NCDs during a crisis should consider age, years of schooling, number of diseases, and self-rated health status in their design.

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RESUMEN La pandemia por COVID-19 y las medidas sanitarias para su control han afectado la alimentación de las personas, lo que probablemente lleve a cifras elevadas de malnutrición en todas sus formas. El objetivo de este estudio fue describir las percepciones de un grupo de actores clave sobre el aseguramiento del derecho a la alimentación en contexto de pandemia en Chile. El presente es un estudio cualitativo realizado en Chile. Los/as entrevistados fueron seleccionados/as por conveniencia y con una visión transdisciplinaria. Se realizaron 26 entrevistas semiestructuradas online, durante septiembre y octubre de 2020. El análisis de los datos se realizó utilizando un enfoque inductivo y un análisis temático, organizando la información en el software Atlas.ti 9.0. Los discursos de las y los participantes permitieron obtener 4 temas: 1. Seguridad alimentaria en tiempos de pandemia, 2. Apreciación de las estrategias alimentarias gubernamentales, 3. Respuesta comunitaria a la pandemia y 4. Otras miradas para el enfrentamiento de la pandemia. Se concluye que el acceso a los alimentos es la dimensión del derecho a la alimentación más afectada en el país en pandemia. Se reconocen estrategias estatales para mantener la alimentación de la población, sin embargo, estas se perciben como insuficientes. Por otro lado, se destaca la relevancia de la organización comunitaria. Se hace necesario realizar un seguimiento sobre las acciones tomadas para garantizar el derecho a la alimentación en el país y conocer la experiencia de otros países de América Latina y el Caribe para prepararse para futuras crisis.

ABSTRACT The COVID-19 pandemic and the sanitary measures to control it have affected people's diets, which is likely to lead to high rates of malnutrition in all its forms. The objective of this study was to describe the perceptions of a group of key actors on the assurance of the right to food in the context of a pandemic. This was a qualitative study conducted in Chile. The interviewees were selected by convenience with a transdisciplinary approach. We conducted 26 semi-structured interviews online, during September and October 2020. Data analysis was carried out using an inductive approach and a thematic analysis. We organized information using Atlas.ti 9.0 software. From the participants' narratives, we obtained 4 themes: 1. Food security in times of pandemic, 2. Appreciation of government food strategies, 3. Community response to the pandemic and 4. Other perspectives for facing the pandemic. We concluded that access to food is the dimension of the right to food most affected during the pandemic. State strategies are recognized as maintaining the population's nutrition; however, these are perceived as insufficient. On the other hand, the relevance of community organization stands out. It is necessary to monitor the actions taken to guarantee the right to food in the country and learn about the experience of other Latin American and Caribbean countries to prepare for future crises.

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OBJECTIVE: To evaluate whether pregestational obesity is associated with the risk of caesarean section in pregnant women living in a country in an advanced stage of the obstetric transition. METHODS: Retrospective cohort study. Data were collected from prenatal and hospital records. Pregestational obesity was defined as: body mass index, [weight(k)/height (m2)] ≥30, and caesarean sections were categorized as elective, emergency, or non-emergency/medically necessary. Biodemographic and sociodemographic characteristics, obstetric and perinatal pathologies, and maternal anthropometric variables were assessed. Chi-square and t-tests were used to compare qualitative and quantitative variables, respectively. Simple and adjusted generalized linear models were used to evaluate the association between pregestational obesity and caesarean delivery. Finally, population attributable risk was calculated. Data analysis was performed using STATA.v.14.0. PARTICIPANTS: 2309 pregnant women with a singleton pregnancy who gave birth at a public hospital in the Metropolitan Region of Santiago, Chile in 2015. RESULTS: The prevalence of pregestational obesity was 21.4%, and the incidence of caesarean deliveries was 34.8% (33% of which corresponded to elective, 46% to emergency, and 21% to non-emergency/medically necessary caesarean deliveries). Pregestational obesity increased the risk of caesarean delivery (aRR = 1.46; 95%CI. [1.19-1.79] as well as the risk of elective (aRR = 1.74; 95%CI. [1.23-2.45]) and emergency caesarean delivery (aRR = 1.44; 95%CI. [1.03-2.00]). The population attributable risk of pregestational obesity for caesarean section was 32%. CONCLUSION: Given the significant association between pregestational obesity and caesarean delivery, it is necessary to develop strategies to decrease obesity among women of childbearing age in order to decrease obstetric intervention.

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