Using evidence-informed policies to tackle overweight and obesity in Chile

Overweight and obesity are a global epidemic with rates having risen to alarming levels in both developed and developing countries. Chile has been no exemption, with sharp increases in obesity prevalence, especially among school-age children. This paper describes the policy actions and strategies implemented to tackle this major public health concern in Chile over the last 10 years, and highlights the main challenges and nuances of the process. Chile has taken policy action that includes front-of-package labelling, advertising regulations, and school-food restrictions. New policies focus on the social determinants of health as they relate to food environments and people's behavior. These actions are not only suitable to the current context in Chile, but are also supported by the best available scientific evidence. Moreover, the implementation of these policies has produced a broad debate involving public institutions and the food industry, with discussions issues ranging from property rights to trade barriers. Despite some differences among stakeholders, a valuable political consensus has been achieved, and several international organizations are eager to evaluate the impact of these pioneer initiatives in Latin America.

Desempeño hospitalario en un sistema de salud segmentado y desigual: Chile 2001-2010 / Hospital performance in a segmented and unequal health system: Chile 2001-2010

Resumen: Objetivo: Analizar las diferencias en los resultados en salud según condiciones observadas de los hospitales, en particular su tipo de propiedad: hospitales públicos, privados sin fines de lucro (PSL) y privados con fines de lucro (PCL). Material y métodos: Se utilizó información de egresos hospitalarios en Chile entre 2001 y 2010 con un total de 16 205 314 altas de 20 hospitales públicos, 6 de PSL y 15 de PCL. Se seleccionó una muestra de pacientes con infarto al miocardio (IAM) y accidente cerebrovascular (ACV). Se estimó una regresión probit utilizando como variable dependiente la mortalidad intrahospitalaria y controlando por variables como estado de salud, nivel socioeconómico y características del hospital. Resultados: Los hospitales privados tienen menor riesgo de mortalidad intrahospitalaria: 1.3% en PSL y 0.7% en PCL, mientras que en los hospitales públicos el riesgo llega a 3.5%. Conclusiones: Este análisis muestra las inequidades que el sector público tiene respecto de los demás sectores.

Abstract: Objective: To analyze the differences in health outcomes by hospital characteristics, focusing on ownership: public, private not-for-profit (PNFP) and private for-profit (PFP). Materials and methods: We used a discharged patient dataset of Chilean hospitals for the period 2001-2010 with a total of 16 205 314 discharges in 20 public, six PNFP and 15 PFP hospitals.We selected a subsample of two medical conditions: myocardial infarction and stroke.We used probit regression analyses with mortality rates as dependent variable, ownership status as the key explanatory variable, and control variables which included patients' health status and socioeconomic level, and hospital characteristics. Results: Private hospitals showed lower risk of death relative to public hospitals: 1.3% in PNFP, 0.7% in PFP and 3.5% in public hospitals. Conclusions: The analysis shows the inequities that exist between public hospitals and the private sector.

Identificación de las necesidades de capacitación docente de los jefes de programa de especialización médica / Identifying the main training needs of postgraduate medical program managers

Training of postgraduate medical specialty program managers (PMSPM) is essential for the proper development of their programs. Aim: To identify the main training needs of PMSPM at a medical school. Material and Methods: A mixed-methodology approach was implemented including focus group/interviews and the administration of the Program Managers Training Needs Assessment Questionnaire (PROMANAQ) developed by an expert panel with 59 items (with two sections: relevance/performance-self-perception). Higher priority was assigned to items with high relevance and low performance. Results: Forty five PMSPM completed the PROMANAQ (81.8% response rate). Both sections of PROMANAQ were highly reliable (Cronbach alpha of 0.95/0.97 for relevance/performance-self-perception, respectively). The items with higher priority value were evaluation of clinical educators, evaluation of teaching programs and accreditation of programs. Ten PMSPM were included in the focus group (18.2% of the universe). The findings of the qualitative component were concordant with the areas explored in the questionnaire. Conclusions: The PROMANAQ is valid and reliable to identify the training needs of PMSPM. The views of PMSPM must be taken into account for faculty development planning.

Evaluación del ambiente educacional en programas de especialización médica / Evaluation of the educational environment in medical specialty programs

Background: The Postgraduate Hospital Education Environment Measure (PHEEM) questionnaire, is a valid and reliable instrument to measure the educational environment (EE) in postgraduate medical education. Aim: To evaluate the EE perceived by the residents of a postgraduate training program using the PHEEM. Material and Methods: The PHEEM was applied in 2010-2011 in 35 specialty programs. We calculated their individual results and compared means of both global and individual domain scores of the PHEEM, by gender, university of origin and nationality. Cronbach's alpha coefficients and D study (Generalizability theory) were performed for reliability. Results: Three hundred eighteen residents were surveyed (75.7% of the total universe). The mean score of the PHEEM was 105.09 ± 22.46 (65.7% of the maximal score) which is considered a positive EE. The instrument is highly reliable (Cronbach's alpha = 0.934). The D study found that 15 subjects are required to obtain reliable results (G coefficient = 0.813). There were no significant differences between gender and university of origin. Foreigners evaluated better the EE than Chileans and racism was not perceived. The programs showed a safe physical environment and teachers with good clinical skills. The negative aspects perceived were a lack of information about working hours, insufficient academic counseling, and scanty time left for extracurricular activities. Conclusions: This questionnaire allowed us to identify positive aspects of the EE, and areas to be improved in the specialty programs. The PHEEM is a useful instrument to evaluate the EE in Spanish-speaking participants of medical specialty programs.