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Background: The study aimed to explore the psychometric properties of two versions of the Patient Health Questionnaires (PHQ-9 and PHQ-2) on screening for Major Depressive Disorder (MDD) among Spanish-speaking Latin American adult immigrants in Santiago, and to explore factors associated with a higher risk of occurrence of MDD among them. Methods: A representative sample of 897 Spanish-speaking immigrants completed the PHQ-9. The Composite International Diagnostic Interview (CIDI) was employed to evaluate MDD. Internal consistency and structural validity were evaluated using Cronbach’s α coefficient and confirmatory factor analysis (CFA). Convergent validity with the 7-item General Anxiety Disorder Scale (GAD-7) was assessed using Spearman’s correlations. Sensitivity, specificity, positive predictive values, and area under the receiver operating characteristic (ROC) curve were calculated for different cut-off points. Logistic regression analysis was used to identify factors associated with the risk of MDD. Results: Cronbach’s α coefficient of the PHQ-9 was 0.90; item-total correlation coefficients ranged from 0.61 to 0.76 and correlation with the GAD-7 was moderate (r = 0.625; p < 0.001). CFA on three alternative models suggests a plausible fit in the overall sample and among two of the subsamples: Peruvians and Venezuelans. Taking the results of CIDI as the gold standard for MDD, the area under the ROC curve was 0.91 (95% confidence interval (CI): 0.83~1.0). When the cut-off score was equal to 5, values of sensitivity, specificity, and Youden’s index were 0.85, 0.90, and 0.75, respectively. Multivariate logistic regression analyses showed that the influence of having three or more children (OR = 3.91, 95% CI: 1.20~12.81; p < 0.05), residency in Chile of up to three years (OR = 1.79, 95% CI: 1.07~3.00; p < 0.05), active debt (OR = 2.74, 95% CI: 1.60~4.70; p < 0.001), a one (OR = 2.01, 95% CI: 1.03~3.94; p < 0.05) and two or more events of adversity during childhood (OR = 5.25, 95% CI: 1.93~14.3; p < 0.01) on the occurrence of MDD was statistically significant. Reliability (α = 0.62), convergent (r = 0.534; p < 0.01) and criterion (AUC = 0.85, 95% CI: 0.67~1.00) validity coefficients of the PHQ-2 were weaker than for the PHQ-9. Conclusions: The PHQ-2 and the PHQ-9 are reliable and valid instruments for use as screeners for MDD among Spanish-speaking populations of Latin America.

Objective:To analyse serum folate levels in women of childbearing age in the Metropolitan Region (MR) of Chile.Design:Cross-sectional design as part of the 2016–2017 National Health Survey (Encuesta Nacional de Salud, ENS 2016–2017), using a household-based multistage stratified random sample. Serum folate levels measured by electrochemiluminescence immunoassay in fasting venous blood samples were classified as deficient (20 ng/ml).Setting:The MR of Chile.Participants:Women of reproductive age (15–49 years, n 222) from the MR participated in the ENS 2016–2017.Results:The mean, median and range of serum folate were 14·2 (se 0·4), 13·9 and 2·1–32·2 ng/ml, respectively. Folate deficiency was detected in 0·9 % of women, while 7·0 % had supraphysiological levels of the vitamin. No significant effects of age, educational level, marital status, parity, smoking status or nutritional status on serum folate levels were detected by univariate or multivariate analyses. Intake of folic acid supplements showed a significant association with serum folate levels, but only 1·2 % of women used supplements.Conclusions:Folate deficiency in women of reproductive age living in the MR of Chile is almost inexistent according to the ENS 2016–2017, suggesting that the current population-wide mandatory folic acid fortification of flour is an effective and equitable measure to prevent folate deficiency. These results support the option of maintaining current folic acid fortification in Chile, particularly based on the low adherence to supplementation regimes evidenced in other populations.

Background Trend data on hypertension prevalence and attainment indicators at each step of the care cascade (awareness, treatment, control) are required in Chile. This study aims to quantify trends (2003–2017) in prevalence and in the proportion of individuals with hypertension attaining each step of the care cascade among adults aged 17 years or older, and to assess the impact of lowering the blood pressure (BP) thresholds used to define elevated BP on these indicators. Methods We used data from 2003, 2010, and 2017 Chilean national health surveys. Each year we assessed levels of (1) mean systolic (SBP) and diastolic (DBP) blood pressure, (2) hypertension prevalence (BP ≥ 140/90 mmHg or use of antihypertensive treatment), and (3) awareness, treatment, and control. Logistic regression on pooled data was used to assess trends in binary outcomes; linear regression was used to assess trends in continuous SBP and DBP. We compared levels of hypertension prevalence using two sources to ascertain antihypertensive treatment (self-reported versus medicine inventory). The 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines were used to re-define hypertension using lower thresholds (BP ≥ 130/80 mmHg). Results Hypertension prevalence was 34.0, 32.0 and 30.8% in 2003, 2010 and 2017, respectively. Levels of treated- and controlled-hypertension were significantly higher in 2017 than in 2003 (65% versus 41% for treatment, P P P = 0.130). Awareness, treatment, and control levels were higher among females in 2003, 2010, and 2017 (P Conclusions Chile has experienced a positive population-wide lowering in blood pressure distribution which may be explained partly by a significant rise in levels of treated- and controlled-hypertension since 2003. Lowering the thresholds used to define elevated BP would substantially increase the financial public health challenge of further improving attainment levels at each step of the care cascade. Innovative and collaborative strategies are needed to improve hypertension management, especially among males.

Objective.Genetic and environmental backgrounds influence the development of rheumatoid arthritis (RA). In Latin America, epidemiologic data are scarce. We aimed to determine the prevalence of RA in Chile in a population-based study.Methods.The National Health Survey was a cross-sectional household survey with a stratified multistage probability sample of 6233 participants performed between August 2016 and March 2017. A screening instrument for RA was applied to a random sample of 3847 subjects > 30 years old. Positive screening was defined by at least 1 of the following: 2 swollen joints for at least 4 consecutive weeks (past/present), and/or a diagnosis of arthritis in the past. Individuals with positive screening had rheumatoid factor, anticitrullinated protein antibodies, and C-reactive protein measured, as well as clinical examination performed by a rheumatologist. Self-report of doctor-diagnosed RA was also performed.Results.The screening questionnaire was applied to 2998 subjects. A positive screening was found for 783 (22.1%). Among subjects with positive screening, 493 (66%) had a clinical evaluation performed by a rheumatologist. Using the American College of Rheumatology/European League Against Rheumatism 2010 classification criteria, prevalence was 0.6% (95% CI 0.3–1.2). Prevalence was higher in women, and 3.3% of subjects self-reported having RA.Conclusion.According to this national population-based study, RA prevalence in Chile is 0.6% (0.3–1.2), a value similar to what has been found in developed countries and slightly lower than some Latin American countries. Self-reporting leads to overestimating RA.

Background Place-based characteristics have been implicated as determinants of socioeconomic inequalities in cardiovascular-related health risk factors (such as hypertension) and in use of healthcare services. In Chile, one-third of adults are hypertensive. Chilean evidence has documented inequalities in hypertension by various measures of individual socioeconomic position (SEP). However, more research is needed to assess the contribution of area-level contextual factors such as income inequality on hypertension management inequalities. Methods Data came from the Chilean Health Surveys (2003, 2010, 2017: N=13,605 participants aged 17 years and older). Our outcomes were hypertension and management indicators (e.g. treatment among hypertensives). Hypertension was defined as SBP/DBP of at least 140/90 mmHg or use of antihypertensive medication. Years of formal education was our chosen measure of individual SEP; at the county-level, the Gini coefficient was used as an index of income inequality. Our models, adjusted for the complex survey design, were age (categorized as 17–64 or 65+ years) -and gender-specific. We compared two models. First, a fixed model assessed inequalities using individual-level SEP. Secondly, multilevel analyses assessed inequalities using individual-level SEP after adjustment for the Gini coefficient. Inequalities were summarised using the Slope and Relative Indices of Inequality (SII and RII, respectively). For brevity, we report only the RII (values above 1 indicate higher outcomes amongst those with lower education). Results Hypertension prevalence was 34.0% (95% CI: 31.6–36.4), 32.0% (29.9–34.2) and 30.8% (28.7–32.9) in 2003, 2010 and 2017, respectively. Levels of treatment among hypertensives was 38.5% (34.9–42.3), 56.5% (52.3–60.6) and 65.2% (61.2–68.9) in 2003, 2010 and 2017, respectively. Inequalities in hypertension were higher in 2017 after adjustment for the Gini coefficient. For example, in the fixed-effects model, the RII for hypertension among persons aged below 65 years was 2.9 (95% CI: 1.6–5.2) and 5.8 (2.5–9.7) for males and females, respectively. After adjustment for the Gini coefficient, the RII increased to 4.2 (2.6–6.6) and 6.3 (3.9–10.1) for males and females, respectively. Inequalities in treatment among older hypertensive females were similar in magnitude before and after adjustment for the Gini coefficient, with an estimated RII of 0.6 (0.5–0.8) and 0.7 (0.5–0.8) respectively. Conclusion Multilevel analyses are required to better estimate inequalities. Chile currently needs interventions to improve the management of hypertension and simultaneously, decrease inequalities, first, in hypertension prevalence among younger males and females and, secondly, in its management among older hypertensive females. The Chilean National Health Surveys 2003–2010–2017 were funded by the Chilean Ministry of Health. This study is part of Alvaro Passi-Solar’s PhD research, funded by the Chilean Ministry of Education (ANID-Conicyt).

Background: Data on trends in hypertension prevalence and indicators of attainment at each step of the care cascade are required in Chile. Aim : To quantify trends (2003-2017) in prevalence and in the proportion of individuals with hypertension attaining each step of the care cascade (awareness, treatment and control) among adults aged ≥17 years, and to assess the impact of lowering the blood pressure (BP) threshold on these indicators. Methods: We used data from three Chilean national health surveys (ENS 2003; 2010; 2017). Mean systolic (SBP) and diastolic (DBP) levels, hypertension prevalence (BP≥140/90 mmHg or use of antihypertensive treatment), and levels of awareness, treatment and control were assessed in each year. Logistic regression on pooled data was used to assess trends in hypertension prevalence and in its care cascade; linear regression was used to assess trends in SBP and DBP. We compared levels of hypertension prevalence using two sources to ascertain use of antihypertensive treatment (ATC codes from a detailed medicine inventory and self-reported use). The 2017 ACC/AHA guidelines were used to re-define hypertension using lower thresholds (BP≥130/80 mmHg or use of treatment). Results : Hypertension prevalence was 34.0%, 32.0% and 30.8% in 2003, 2010 and 2017, respectively. Mean SBP and DBP decreased over the 15-year period, except for SBP among females on treatment. Adopting the 2017 ACC/AHA guidelines would increase hypertension prevalence by 17% and 55% in absolute and relative terms, respectively. Levels of treated- and controlled-hypertension were significantly higher in 2017 than in 2003 (65% vs 41% for treatment; 34% vs 14% for control), while levels of awareness were stable (66% vs 59%). Gender disparities were evident, with higher awareness, treatment and control levels among females in 2003, 2010 and 2017. Conclusions: The introduction of universal access to care for hypertension in Chile in 2005 accounted partly for the rise in levels of treated- and controlled-hypertension since 2003. Lowering the BP threshold would substantially increase the financial public health challenge of further improving levels of attainment at each step of the care cascade. Innovative and collaborative strategies are needed to improve the management of hypertension, especially among males.

Introducción: Las enfermedades crónicas no transmisibles del adulto son el principal desafío de los sistemas de salud en el mundo. Se requiere información local para planificación sanitaria.Objetivos: Estimar la magnitud y distribución de problemas de salud crónicos prioritarios y sus determinantes en una muestra nacional representativa de la población general chilena.Métodos: ENS 2016-2017 es un estudio transversal con muestra de hogares aleatoria, estratificada, multietápica y por conglomerados representativa del nivel nacional, regional, urbano rural de 6233 personas de 15 y más años. Personal capacitado (encuestadores y enfermeras) en sucesivas visitas al hogar, administraron cuestionarios, examen dental, presión arterial, antropometría, recolectaron muestras de sangre en ayunas y orina. Se estimó la magnitud de 72 problemas de salud.Resultados: Se observa un elevado nivel absoluto de morbilidad por enfermedades crónicas y sus factores de riesgo. Se estima una magnitud de al menos 11 millones de personas con multimorbilidad que requieren atención médica y control crónico anual de por vida. Algunos ejemplos de altas prevalencias son: hipertensión (27,6%), dislipidemia HDL (46%), obesidad (34,4%), caries cavitadas (55%), diabetes (12,3%), tabaquismo actual (33,4%), problemas asociados al consumo de alcohol (12%), síntomas depresivos (15,8%), consumo excesivo de sal (98%), bajo consumo de frutas y verduras (85%), sedentarismo de tiempo libre (87%). Las mayores diferencias entre hombres y mujeres se observan en el uso riesgoso de alcohol y los síntomas depresivos.Conclusiones: la magnitud de población que requiere atención médica y cuidados crónicos supera la capacidad de respuesta del sistema de salud. Urgen fuertes estrategias preventivas de tipo poblacional (medidas regulatorias masivas) complementadas con una priorización de las estrategias de alto riesgo individual más costo efectivas. ENS aporta a la evaluación y vigilancia de ambas estrategias.

Background: Genetic and environmental backgrounds influence the development of rheumatoid arthritis (RA) and its frequency has regional variations. In Latin America epidemiologic data are scarce. Objectives: We aimed to determine the prevalence of RA in Chile as part of the National Health Survey (ENS, Encuesta Nacional de Salud). Methods: ENS was a cross-sectional household survey with a stratified multistage probability sample of 6,233 participants performed between August 2016 and March 2017. A screening instrument for RA was applied to a random sample of 3,700 subjects >30 years old.1, 2 Positive screening was defined by at least one of the following: (i) 2 swollen joints for at least 4 consecutive weeks (past or present) and/or (ii) a diagnosis of arthritis in the past. Individuals with positive screening had Rheumatoid Factor, Anti-citrullinated protein antibodies, and C-reactive protein measured and clinical examination was performed by a rheumatologist. Self-report of doctor-diagnosed RA was also performed. Results: The screening questionnaire was applied to 2,998 subjects. Seven hundred and thirty-eight (22.1%) had a positive screening. Among the subjects with a positive screening 493 (66%) had consulted a rheumatologist. Thirty-one subjects had RA according to the ACR/EULAR 2010 classification criteria, which corresponds to 0.6% (95%CI 0.3, 1.2). Three point three per cent reported having RA. Prevalence was higher in women and in high SES. Conclusion: According to this national population-based study RA prevalence in Chile is 0.6% (0.3, 1.2). This is similar to the prevalence previously reported in developed countries, which is noteworthy given the differences in sociodemographic characteristics which exist compared to Chile. Self-reporting leads to an important overestimation of RA. Our study suggests there is a higher risk of RA in subjects with high SES in this region. References [1] MacGregor AJ, Riste LK, Hazes JMW, Silman AJ. Low prevalence of rheumatoid arthritis in Black Caribbeans compared with Whites in inner city Manchester. Ann Rheum Dis 1994;53:293–7 [2] Carmona L, et al. The prevalence of rheumatoid arthritis in the general population of Spain. Rheumatology (Oxford). 2002;41(1):88-95. Disclosure of Interests: josefina duran: None declared, loreto massardo Speakers bureau: Werfen, carolina llanos: None declared, sergio iacobelli: None declared, Paula Burgos: None declared, Raquel Aguilera: None declared, maria eugenia martinez: None declared, marcela cisternas: None declared, macarena armstrong: None declared, mirentxu iruretagoyena: None declared, francisco radrigan: None declared, alvaro passi: None declared, pablo riedemann: None declared, camila cifuentes: None declared, lucero hagedorn: None declared, natalia crisostomo: None declared, alvaro cisternas: None declared, paula margozzini: None declared

Background Physical inactivity is one of the main risk factors for death worldwide. There is a paucity of studies about the association between transport and objective health measures using nationally representative samples worldwide, especially from Latin American countries. The aim of this research is to explore the relationship between active transportation and objective health measures in Chile. Methods We analysed the Chilean National Health Survey (ENS) 2016–2017, based on a nationally representative sample of non-institutionalised adults aged ≥15 years (n = 6,113). ENS included anthropometric measures (weight, height, waist circumference), a specific question about the main mode of transportation and several metabolic markers. Results 41%, 38% and 21% of participants used public transport, motor vehicles and active (cycling and walking) transport respectively. Higher levels of active transport were observed in males, younger groups, less educated and rural populations. Both active and public transport were associated with multiple nutritional and metabolic benefits such as lower BMI, lower waist circumference, less obesity, higher vitamin D, lower cholesterol and lower hepatic inflammation. Associations persisted after adjusting for other healthy lifestyles. Stronger benefits were observed in males than in females. Conclusions Promoting active transportation in urban planning policies may help Chile tackle the growing burden of chronic diseases.

Background: Inappropriate medication use in older people is an important source of adverse events and complications. Aim: To determine the frequency of inappropriate medication use in the general population. Material and methods: As part of the 2010 Chilean National Health Survey, 1048 persons aged 65 years or more were interviewed about medication use. The information obtained was analyzed using standardized Beer’s criteria, adapted for the Chilean population, to define inappropriate medication use. A logistic regression model was performed to define risk factors for inappropriate medication use. Results: Ten percent of subjects had a high risk of inappropriate medication use. The most common medications used were chlorphenamine, amitriptyline, diazepam, chlorpromazine, chlordiazepoxide and piroxicam. The risk factors detected were female gender, polypharmacy and a bad health self-perception. Conclusions: Inappropriate medication use is common among Chilean older people and should be discouraged.

Background Maule Cohort (MAUCO), a Chilean cohort study, seeks to analyze the natural history of chronic diseases in the agricultural county of Molina (40,000 inhabitants) in the Maule Region, Chile. Molina´s population is of particular interest because in the last few decades it changed from being undernourished to suffering excess caloric intake, and it currently has the highest national rates of cardiovascular diseases, stomach cancer and gallbladder cancer. Between 2009 and 2011 Molina´s poverty rate dropped from 24.1 % to 13.5 % (national average 20.4 %); in this period the county went from insufficient to almost complete basic sanitation. Despite these advances, chemical pollutants in the food and air are increasing. Thus, in Molina risk factors typical of both under-developed and developed countries coexist, generating a unique profile associated with inflammation, oxidative stress and chronic diseases. Methods/Design MAUCO is the core project of the recently established Advanced Center for Chronic Diseases (ACCDiS), Universidad de Chile & Pontificia Universidad Católica de Chile. In this study, we are enrolling and following 10,000 adults aged 38 to 74 years over 10 years. All eligible Molina residents will be enrolled. Participants were identified through a household census. Consenting individuals answer an epidemiological survey exploring risk factors (psycho-social, pesticides, diet, alcohol, and physical activity), medical history and physical and cognitive conditions; provide fasting blood, urine, and saliva samples; receive an electrocardiogram, abdominal ultrasound and bio-impedance test; and take a hand-grip strength test. These subjects will be re-interviewed after 2, 5 and 7 years. Active surveillance of health events is in place throughout the regional healthcare system. The MAUCO Bio-Bank will store 30 to 50 aliquots per subject using an NIH/NCI biorepository system for secure and anonymous linkage of samples with data. Discussion MAUCO´s results will help design public health interventions tailored to agricultural populations in Latin America.

Inappropriate medication use in older people is an important source of adverse events and complications.To determine the frequency of inappropriate medication use in the general population.As part of the 2010 Chilean National Health Survey, 1,048 persons aged 65 years or more were interviewed about medication use. The information obtained was analyzed using standardized Beer’s criteria, adapted for the Chilean population, to define inappropriate medication use. A logistic regression model was performed to define risk factors for inappropriate medication use.Ten percent of subjects had a high risk of inappropriate medication use. The most common medications used were chlorphenamine, amitriptyline, diazepam, chlorpromazine, chlordiazepoxide and piroxicam. The risk factors detected were female gender, polypharmacy and a bad health self-perception.Inappropriate medication use is common among Chilean older people and should be discouraged.