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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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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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BACKGROUND/OBJECTIVES: To examine how much of the variation in weight-for-height (WHZ) z-scores were associated with age at which breastfeeding ceased and provision of fortified cow's milk (Leche Purita Fortificada, LPF) commenced in a cohort of children studied from birth to 3 years of age. SUBJECTS/METHODS: Longitudinal data were obtained from routine medical check-ups on 8373 children from nine Chilean counties through convenience sampling. WHZ z-scores were generated at six-monthly intervals using WHO 2006 standards from birth to 3 years old (seven measurements). Age of cessation of breastfeeding and age of commencement of LPF were the independent variables. Repeated-measures ANOVA were used to analyse the changes in WHZ over the seven measurements. Binomial generalised estimating equations (GEE) were used to analyse the effect of each independent variable on the change from normal to overweight, and normal to obese over the seven measurements. RESULTS: ANOVA indicated that children given LPF milk before 3 months of age had, on average, higher mean WHZ of about 0.11 SD from 18 months of age onwards (p < 0.001). GEE analyses showed that children given LPF before 3 months of age were significantly more likely to be overweight or obese (OR = 1) compared with children given LPF later (overweight OR: 0.809-0.970, p = 0.009, obese (OR: 0.666-0.901, p = 0.001). CONCLUSIONS: Early intake of LPF increases WHZ and is a risk factor for overweight and obesity in young children, while prolonged breastfeeding acts as protective factor against obesity.

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OBJECTIVE: To examine the changes in children's weight-for-height at six monthly intervals between birth and three years old (3yo) from different counties across Chile and to determine if children had overweight or obesity, and if so, whether it was a transient or persistent change. SUBJECTS AND METHODS: Longitudinal data were obtained from routine medical check-ups and 8,373 children were selected from nine counties in Chile through a non-randomised sample design. Weight-for-height z-scores (WHZ) were generated and categorized as wasted, normal, overweight, and obese using WHO standards. Repeated-measures ANOVA were used to analyse the changes in WHZ over the seven measurements as well as based on having normal, overweight, or obese WHZ at 3yo. The number of times having overweight or obesity was counted (from 0 to 7 times). The timing of having overweight and obesity was computed as well as all combinations of the patterns. RESULTS: Mean WHZ significantly increased up to 18months of age and declined thereafter (p<<0.001). Overall mean WHZ was 0.743, prevalence of overweight 31.2% and prevalence of obesity 10.0%. Children categorised with overweight or obesity at 3yo showed significantly higher and sustained pattern of weight gain compared with children with normal WHZ. Once a child had overweight or obesity they tended to remain with it and did not return to a weight-for-height in the normal range. CONCLUSION: The increasing prevalence of overweight and obesity in Chilean children is of concern. There is a need for greater healthcare promotion and prevention of this disease from infancy.

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OBJECTIVE: The objectives of the study were to see how much of the variation in weight-for-height z-scores (WHZ) and surface area/body mass ratio (SA/mass) were associated with regional (county) differences including mean temperature. SUBJECTS AND METHODS: Longitudinal data were obtained from routine medical check-ups on 8,373 children from nine counties across Chile. WHZ and SA/mass were calculated from weight and height from birth to 3-years old at 6 monthly intervals. County of birth was used as an independent variable after controlling for sociodemographic factors. Sequential repeated-measures ANOVAs were used to analyze the changes in WHZ and SA/mass over the seven measurements from birth to 3 years of age. Simple and partial Pearson correlations were calculated between WHZ and annual mean temperature and between SA/mass and annual mean temperature after controlling for socioeconomic factors. RESULTS: County of birth was significantly (p < 0.001) associated with both WHZ and SA/mass. There was a progressive decrease in WHZ means and a progressive increase in SA/mass means from colder to warmer counties. Significant negative correlation in WHZ (r < -0.864) and significant positive correlations in SA/mass (r > 0.821) were found with the annual mean temperature from 18 months of age onwards and in the overall mean age. CONCLUSION: This study suggests that WHZ and SA/mass variation may be influenced by ecogeographical factors in this Chilean sample.

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Se ha identificado una sobrecarga laboral en mujeres durante el embarazo. Suelen presentar una alta prevalencia de trastornos mús culo-esqueléticos, no obstante existe poca evidencia sobre su progresión en los trimestres y asociación con carga de trabajo. OBJETIVO: Describir la carga de trabajo, factor físico biomecánico y percepción de molestias músculo-esqueléticas (PMME) en trabajadoras embara zadas. MATERIAL Y MÉTODO: Estudio de diseño observacional, descriptivo y transversal. Muestreo por conveniencia de 80 mujeres emba razadas de la Unidad de Medicina Materno Fetal del Hospital Clínico de la Universidad de Chile. Se describe la muestra a través de la evaluación de carga de trabajo, factores físicos biomecánicos, dificultades percibidas al realizar su tarea mediante una hoja de recolección de información diseñada específicamente para la investigación, usan do metodología en ergonomía. RESULTADOS: Las PMME presentan una prevalencia de un 90%, destacando la zona de la espalda baja y cadera/nalgas/muslos. Las posturas mantenidas o forzadas fueron el factor más prevalente. Una de cada 6 embarazadas refirieron continuar realizando manejo manual de carga. La mayoría de las trabaja doras presentaron un alto riesgo en su carga de trabajo. CONCLUSIONES PRINCIPALES: Las embarazadas están expuestas a altos niveles de carga de trabajo determinado por exigencia mental.

It have been detected overload work among women during preg nancy. Often they present a high prevalence on HYPERLINK “https://www.google.cl/search?q=work+related+musculoskeletal+disorder&spell=1&sa=X&ved=0ahUKEwiw2IS2gePTAhWDD5AKHbK5DcoQvwUIIigA” work related musculoskeletal disorder; however there is little evidence about their progression during the pregnancy's trimester and the association with work load. OBJECTIVE: Describe work load, physical and biomechanical factors, perception of musculoskeletal discomfort (PMSD) in pregnant women. MATERIALS AND METHODS: Observational, descriptive and cross-sectional study. Sampling by convenience of 80 pregnant women of the Maternal-fetal care unit of the Clinical Hospital of the University of Chile. The sample is described trough the evaluation of workload, physical and biome chanical factors, trouble performing tasks by means of a sheet of collection of information created for this investigation, using ergo nomics methodology. RESULTS: The PMSD present a prevalence of 90%, stands out the lower back and hips/buttocks/thigh areas. The forced or maintained postures ware the most prevalent factor. One in six pregnant women referred continuing performing weight manual handling tasks. Most of the women presents high workload. MAIN CONCLUSION: Pregnant women are exposed to high levels of workload determined by mental exigence.

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The aim of this study was to test the reliability of Osborne et al. (2004) [8] age estimation based on the iliac auricular surface of the ilium. We selected 172 skeletons with documented sex and age-at-death and established six uniformly distributed age intervals for analysis. ANOVA was employed to assess the association of the documented age with sex and the auricular surface classification. We employed Bonferroni post-hoc tests to find any statistical differences across documented ages within each phase of Osborne's criteria. While the ANOVA showed a significant association between the documented age and the auricular surface classification, post-hoc tests found that phases 2 and 3 were the only consecutive phases with significant differences. We argue that a lack of statistical significance between consecutive phases undermines the reliability of this method for forensic purposes especially in middle adults. It may be possible that the collapse of intermediate phases would increase the accuracy of this method.

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OBJECTIVE: The goal of this research is to understand the relevance of diet diversity during the transition to agriculture, in ancient populations from northern Chile, especially considering the significance of marine resources and crops in a lesser degree. METHODS: A total of 14 human individuals were sampled from the Tarapacá 40 cemetery. Both bone and tooth samples were collected. Samples were studied from bone/dentine collagen for carbon and nitrogen isotopic analysis; and bone/enamel apatite for carbon isotope analysis. Inferential statistical analyses were performed in order to compare Tarapacá 40 stable carbon and nitrogen isotope values with other Formative and Late Intermediate Period groups. A nonparametrical hypothesis Kruskal-Wallis test was used. RESULTS: The results show that the individuals from Tarapacá 40 are intermediate to the values observed for terrestrial and marine fauna as well as C3 and C4 plants. CONCLUSIONS: A gradual transition to crop consumption, especially maize, is suggested. This complemented the earlier hunter-gatherer tradition of marine resources and wild fruit consumption. Contrarily to the predictions made by some archaeologists, the results obtained for northern Chile contrast with the classical perspective of a "Neolithic Revolution" in which transition to agriculture occurred more abruptly and linearly.

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