In Chile childhood obesity is a growing public health problem. Intervention programs within schools have shown variable results, with better impacts when multiple aspects are involved and included the entire educational community. The objective of the study was to evaluate the effect on the nutritional status of children in intervention schools within 2 years of duration (Healthy Living Program). The sample included 2,527 students first through fourth grade of 3 counties of Santiago. The students were intervened and followed for a period of two years in their food and nutrition habits, physical activity and self-care practices, by a team of nutritionists and physical education teachers. Weight and height were measured at start of program, end of the first and second years of intervention, under standardized conditions and calculated the Z score of BMI and nutritional status according to the WHO reference 2007. At the end of the second year 1,453 children were reassessed. There was a significant decrease in BMI Z score in obese children (-0.3 SD) and obesity decreased from 21.8% to 18.4% at the end of the intervention. 75% of schoolchildren obese and 60.5% overweight decreased their BMI Z score, reduction that was greater in men and students in the upper grades. 51.9% of normal weight children increased their BMI Z-score age, although most less than 0.5 SD. The intervention in education, nutrition and physical activity among schoolchildren in three communes of Greater Santiago was effective in reducing the prevalence of obesity (-3.4 percentage points). The big challenge is to find mechanisms to give continuity to the program and evaluate long-term effects.

En Chile la obesidad infantil es un creciente problema de salud pública. Los programas de intervención al interior de las escuelas han mostrado resultados variables, con mejores resultados cuando se incluyen diversas variables y a toda la comunidad educativa. El objetivo del estudio fue evaluar el efecto sobre el estado nutricional de un programa realizado al interior de las escuelas, de 2 años de duración (Programa Vive Sano). Se estudiaron 2.527 escolares de primero a cuarto año de educación básica, de 3 comunas de la Región Metropolitana de Chile, que fueron intervenidos en alimentación, nutrición, actividad física y autocuidado de la salud con un equipo de Nutricionistas y Profesores de educación física. Se evaluó peso y talla al ingreso al programa y al final del primer y segundo año de intervención, en condiciones estandarizadas. Se calculó puntaje Z del IMC y estado nutricional según la referencia OMS 2007. Al final del segundo año 1.453 niños fueron reevaluados. Hubo una disminución significativa en puntaje Z del IMC-edad en los escolares obesos (-0,3 DE) y la prevalencia global de obesidad disminuyó de 21,8% a 18,4% al final de la intervención. El 75% de los escolares con obesidad y 60,5% con sobrepeso disminuyó su Z score IMC, siendo mayor la reducción en el sexo masculino y en los cursos superiores. El 51,9% de los estudiantes con peso normal aumentó su puntaje Z de IMC-edad, aunque mayoritariamente menos de 0,5 DE. Se puede concluir que la educación en alimentación y actividad física realizada por profesionales fue efectiva en reducir la prevalencia de obesidad (-3,4 puntos porcentuales). El gran desafío es buscar mecanismos para darle continuidad al programa y evaluar los efectos a largo plazo.

Background: Wireless capsule endoscopy (CE) is a relatively new method to evaluate the small intestine. Aim: To evaluate the indications of CE in our center and assess whether specific indications are associated with best results during CE studies. Material and Methods: Retrospective analysis of 69 patients aged 9 to 85 years (36 males) subjected to a CE at our institution between April 2004 and October 2007. Results: The most common indications for CE were overt gastrointestinal bleeding in 43.5% of patients, iron deficiency anemia in 39.1 %, suspicion of a small bowel tumor in 4.3%, chronic diarrhea in 4.3% and abdominalpain in 2.9%. CE was normal in 23.2% and was able to find lesions in 76.8% of the studies. Gastrointestinal bleeding, followed by iron deficiency anemia were the indications associated with the higher rates of positive findings during CE. Conclusions: Gastrointestinal bleeding and iron deficiency anemia were the indications that obtained the best diagnostic y ield for CE.

In the context of Explicit Health Guarantees Plan (EHGP), in 2005 the Ministry of Health introduced the "Comprehensive Oral Health care for 6 year old children". By MTNSAL's initiative, a study was developed to assess the distribution, use and implementation of this guarantee for every child in the country. Some results of this study are presented. Method: Parents and guardians of 6-year-old children who receive this benefit were surveyed in a random representative sample of urban and rural schools in the country throughout 2007-2008. Results: A large majority (73.9%) of parents are familiar with the National Health Guaranties , among these, 70.3% are familiar with the dental benefit. A small proportion (23.3% in public insurance, 13.2% in private insurance system), found out about this program through the Primary health care services. Discussion: The Dental Guarantee is well known, but underutilized. It is important that physicians, especially pediatricians, collaborate in the promotion of dental health and the utilization of this benefit, which is the right of every Chilean child.

Antecedentes: El Ministerio de Salud incorporó el programa "Salud Oral Integral para niños (as) de 6 años" dentro del régimen de Garantías Explícitas en Salud (GES) en 2005. Por iniciativa de MINSAL, se realizó un estudio para evaluar la difusión, uso e implementación de esta garantía. Objetivo: Presentar algunos resultados de dicho estudio. Metodología: Se encuestaron apoderados de niños (as) de 6 años beneficiarios de la garantía en el 2006 mediante un cuestionario autoaplicado en una muestra representativa de escuelas urbanas y rurales a lo largo del país durante el período 2007-2008. Resultados: El 73,9% de los apoderados conoce el GES en general; y de éstos, 70,3% está informado sobre la garantía de atención dental para niños de 6 años. Pocos padres (23,3% en FONASAy 13,2% en ISAPRES) se informaron del GES dental por medio del Control de Niño Sano. Del total de niños que solicitaron atención (36,5%), 98,5% fue acogida satisfactoriamente. Conclusión: La garantía GES dental para niños de 6 años se está cumpliendo satisfactoriamente, sin embargo, pocos niños la solicitan. Por esto, es necesario que el médico y, especialmente el pediatra, colabore y se haga cargo de la promoción de salud bucal y la difusión de esta garantía, derecho de todo niño chileno.

Background: The National Socioeconomic Characterization Survey (CASEN) was modified in the year 2000, to include an assessment of the inequalities in the access to health services. Aim: To analyze the health issues of year 2000 survey database. Material and methods: During 2000, 38338 urban and 26698 rural dwellings were surveyed, totaling 240000 people analyzing ascription to public or private health services and the need demand and use of these services. Results: A higher risk population (lower income, higher age and women) is ascribed to public health services. Sixty five percent of the population self perceives their health as good, this figure decreases along with age and women have a worse self perception than men. In the 30 days prior to the survey, 13% of the population had a health related event; this figure was higher among women and the lower income quintiles. Expressed health demand was higher among women and lower income quintiles. A multivariate analysis identified an age below 14 years, pertaining to a minority ethnic group, ascription to private health services, residing in rural areas, pertaining to the lower income quintile and male sex, as factors associated to a lack access to health care. In the adjusted model, pertaining to the National Health Fund (a public system) is a protective factor to receive health services. Conclusions: The significant inequalities in the access to health care should be corrected with the new Health Reform. The new module incorporated to the National Socioeconomic Characterization Survey, is usefel to assess the access to health care in Chile (Rev Méd Chile 2004; 132: 750-60)

Background: In the last two decades, Chile has experienced advances in economical development and global health indicators. However, gender inequities persist in particular related to access to health services and financing of health insurance. Aim: To examine gender inequities in the access to health care in Chile. Material and methods: An analysis of data obtained from a serial national survey applied to assess social policies (CASEN) carried out by the Ministry of Planning. During the survey 45,379 and 48,107 dwellings were interviewed in 1994 and in 1998, respectively. Results: Women use health services 1.5 times more often, their salaries are 30% lower in all socioeconomic strata. Besides, in the private health sector, women pay higher insurance premiums than men. Men of less than two years of age have 2.5 times more preventive consultations than girls. This difference, although of lesser magnitude, is also observed in people over 60 years. Women of high income quintiles and users of private health insurance have a better access to preventive consultations but not to specialized care. Conclusions: An improvement in equitable access of women to health care and financing is recommended. Also, monitoring systems to survey these indicators for women should improve their efficiency (Rev Méd Chile 2003; 131: 669-678)

Background: The correlation between income inequality and life expectancy was demonstrated 10 years ago, but later, several studies suggested that the negative impact of a low economic income on the health status was disappearing. Aim: To assess the independent effects of community income inequality on self rated health in Chile. Material and methods: Multilevel analysis of the 2000 National Socio Economic Characterization Survey (CASEN) data from Chile. Individual level information included self rated health, age, sex, ethnicity, marital status, education, income, type of health insurance and residential setting (urban/rural). Community level variables included the Gini coefficient and median income. The main outcome measure was dichotomized self rated health (0 if excellent, very good or good; 1 if fair or poor). Results: 101,374 individuals (at level 1) aged 18 and above, nested within 285 communities (at level 2) and 13 regions (at level 3) were studied. Controlling for a range of individual level predictors, a significant gradient was observed between income and poor self rated health, with very poor most likely to report poor health (10.5%) followed by poor (9.5%) low (9%) middle (7%), high (6%) and very high (4.5%) income earners. Controlling for individual and community effects of income, a significant non linear effect of community income inequality was observed, with the most unequal communities being associated with approximately 5% higher likelihood of reporting poor health compared to the most equal communities. Conclusions: Individual income does not explain any of the between community differences and neither does it wash the significant effects of income inequality on poor self rated health. The contextual effect of inequality is almost as large as the differential observed in poor health comparing the very poor to the very rich individual income categories (Rev Méd Chile 2003; 131: 321-30).

Objective. Previous research has shown that controlling blood glucose improves short-term and long-term outcomes among patients who have either type 1 or type 2 diabetes. The objective of this study was to investigate, in a developing country, the effectiveness of an intervention that included patient education, self-monitoring of blood glucose, and determination of the level of glycosylated hemoglobin (HbA1c). Methods. The patients were grouped into three categories, taking into account such clinical manifestations as the duration of their diabetes, its treatment, and their hospitalization history. After the inclusion and exclusion criteria were applied, the persons were randomly assigned to two groups. One group (210 patients) received the educational intervention, and the control group (206 patients) received customary care. The intervention group received educational information needed for self-monitoring of blood glucose and for the self-evaluation of positive and negative behaviors related to metabolic control of the disease. Results. The two groups were similar with respect to age (mean of 52.3 and 50.5 years) and to the proportion of patients with type 1 diabetes (13.8% and 16.0%). There were no initial differences in the average concentration of HbA1c in the two groups (8.9% ± 0.1% and 8.9% ± 1.4%). A total of 50 persons dropped out of the study, 14.8% of those in the intervention group and 9.2% of those in the control group. In the intervention group, compliance with dietary recommendations increased by 43.5%, from 57.5% at the beginning of the study to 82.5% at the end (P < 0.001); in the control group there was also a change but it was not significant. Although patients with a high initial HbA1c concentration were underrepresented in this study, the average HbA1c concentration declined significantly in the intervention group (-0.4% ± 1.1%, P = 0.001) but not in the control group (-0.1% ± 0.1%). Conclusions. In one developing country, educating patients about diabetes helped improve metabolic control, a fact that can be attributed mainly to the intervention's positive impact on those persons' diet.

Objetivos. Investigaciones anteriores han demostrado que el control de la glucemia mejora los desenlaces a corto y largo plazo de los pacientes con diabetes de tipo 1 y 2. El objetivo de este estudio consistió en investigar en un país en desarrollo la eficacia de una intervención que incluyó la educación del paciente, la automonitorización de la glucemia y la determinación de la hemoglobina glucosilada (HbA1c). Métodos. Los pacientes fueron agrupados en tres categorías, teniendo en cuenta características clínicas tales como la duración de la diabetes, su tratamiento y los antecedentes de hospitalización. Los que cumplieron los criterios de inclusión y exclusión fueron asignados aleatoriamente a un grupo que recibió la intervención educativa (210 pacientes) o a un grupo de control que recibió la asistencia habitual (206 pacientes). El grupo de intervención recibió la información educativa necesaria para la automonitorización de la glucemia y para la autoevaluación de las conductas positivas y negativas relacionadas con el control metabólico de la enfermedad. Resultados. Los dos grupos eran similares con respecto a la edad (media de 52,3 y 50,5 años) y a la proporción de pacientes con diabetes de tipo 1 (13,8% y 16,0%). Inicialmente no había diferencias entre las concentraciones medias de HbA1c de los dos grupos (8,9 ± 0,1 y 8,9 ± 1,4%). Cincuenta pacientes (un 14,8% del grupo de intervención y un 9,2% del grupo de control) abandonaron el estudio de forma prematura. En el grupo de intervención, el cumplimiento de las recomendaciones dietéticas aumentó del 57,5% al principio del estudio al 82,5% al final del mismo, lo cual representa un cambio porcentual del 43,5% (P < 0,001); en el grupo de control el cambio registrado no fue significativo. Aunque los pacientes con concentraciones iniciales elevadas de HbA1c estaban subrepresentados en este estudio, la concentración media de HbA1c disminuyó significativamente en el grupo de intervención (-0,4 ± 1,1%; P = 0,001), pero no en el grupo de control (-0,1 ± 0,1%). Conclusiones. En un país en desarrollo, la educación diabetológica del paciente consiguió mejorar el control metabólico, hecho atribuible principalmente a su impacto positivo sobre la dieta.

Background: In the last decades, chronic non communicable diseases are becoming the main cause of disability and mortality among adults. The risk factor surveillance and management is the most efficient mean of reducing the impact of these diseases. Aim: To report the results of a non communicable disease risk factor surveillance program in Valparaiso, Chile. Material and methods: A random samples of people aged 25 to 64 years old living in Valparaiso, Chile was studied. Subjects were questioned about smoking and physical activity habits. Blood pressure, height and weight were measured using standardized techniques at their homes and blood samples were obtained to measure serum lipid levels and oral glucose tolerance test at the nearest outpatient clinic. Results: Of the initial 3852 homes selected, 752 individuals did no agree to answer the inquiry, therefore 3120 subjects were finally interviewed. Of these, 40.6% were smokers, 15% drank alcohol in two or more occasions per month, 84.6% were physically inactive, 19.7% had a body mass index over 30 kg/m2, 11.1% had high blood pressure, 3.9% were diabetic and 46.9% had high serum cholesterol levels. Conclusions: The basal survey for the CARMEN program shows a high prevalence of cardiovascular risk factors among Chileans.