Suchergebnisse

The UN Millennium Development Goals (MDG) in nutrition are at the core of this book, with special attention to young women and their children. The first part is dedicated to the overall analysis of the world nutrition situation as related to achieving the MDG. The chapters cover the global distribution of malnutrition and micronutrient deficiencies in young women and infants, and the disease burden related to it. The second part reviews the measures taken to achieve the MDG and the potential contributions of nutrition-specific and disease control interventions (particularly with regard to reducing child and maternal mortality), as well as the possible role of sectors other than health. The last part looks into the future, scrutinizing the causes and consequences of non-communicable disease in both the developing and developed world, as well as reviewing the latest scientific evidence for underlying mechanisms and discussing the implications for public health and policy makers.

BACKGROUND: As a consequence of the epidemiological transition in Chile, the nutritional status of the population has changed notoriously. AIM: To study the changes in the nutritional status of six years-old Chilean children from 1987 to 2003. MATERIAL AND METHODS: The computer data base of a government institution in charge of the School Lunch Program (JUNAEB) was used. It contains data on weight, height, sex and date of birth of six years old children, in the years 1987, 1990, 1993, 1996, 2000, 2001, 2002 and 2003. RESULTS: The data of approximately 80,000 children was analyzed. Both weight and height increased over the study years. There was a significant reduction in the number of children with weight deficit but also an increase in the proportion of children with obesity. Stunting was also reduced. The proportion of children with HAZ over 2 SD increased from 0.76 in 1987 to 2.2% in 2003. The prevalence of obesity has not increased since the year 2000. CONCLUSION: The stabilization in the prevalence of obesity is a positive finding, considering its adverse consequences for health.

The UN Millennium Development Goals (MDG) in nutrition are at the core of this book, with special attention to young women and their children. The first part is dedicated to the overall analysis of the world nutrition situation as related to achieving the MDG. The chapters cover the global distribution of malnutrition and micronutrient deficiencies in young women and infants, and the disease burden related to it. The second part reviews the measures taken to achieve the MDG and the potential contributions of nutrition-specific and disease control interventions (particularly with regard to reducing child and maternal mortality), as well as the possible role of sectors other than health. The last part looks into the future, scrutinizing the causes and consequences of non-communicable disease in both the developing and developed world, as well as reviewing the latest scientific evidence for underlying mechanisms and discussing the implications for public health and policy makers.

BACKGROUND: Chile is currently undergoing a period of rapid demographic transition which has led to an increase in the proportion of older people in the population; the proportion aged 60 years and over, for example, increased from 8% of the population in 1980 to 12% in 2005. In an effort to promote healthy ageing and preserve function, the government of Chile has formulated a package of actions into the Programme of Complementary Feeding for the Older Population (PACAM) which has been providing a nutritional supplement to older people since 1998. PACAM distributes micronutrient fortified foods to individuals aged 70 years and over registered at Primary Health Centres and enrolled in the programme. The recommended serving size (50 g/day) of these supplements provides 50% of daily micronutrient requirements and 20% of daily energy requirements of older people. No information is currently available on the cost-effectiveness of the supplementation programme. AIM: The aim of the CENEX cluster randomised controlled trial is to evaluate the cost-effectiveness of an ongoing nutrition supplementation programme, and a specially designed physical exercise intervention for older people of low to medium socio-economic status living in Santiago, Chile. METHODS: The study has been conceptualised as a public health programme effectiveness study and has been designed as a 24-month factorial cluster-randomised controlled trial conducted among 2800 individuals aged 65.0-67.9 years at baseline attending 28 health centres in Santiago. The main outcomes are incidence of pneumonia, walking capacity and change in body mass index over 24 months of intervention. Costing data (user and provider), collected at all levels, will enable the determination of the cost-effectiveness of the two interventions individually and in combination. The study is supported by the Ministry of Health in Chile, which is keen to expand and improve its national programme of nutrition for older people based on sound science-base and evidence for cost-effectiveness. : TRIAL REGISTRATION: ISRCTN48153354.

BACKGROUND: In an effort to promote healthy ageing and preserve health and function, the government of Chile has formulated a package of actions into the Programme for Complementary Food in Older People (Programa de Alimentación Complementaria para el Adulto Mayor - PACAM). The CENEX study was designed to evaluate the impact, cost and cost-effectiveness of the PACAM and a specially designed exercise programme on pneumonia incidence, walking capacity and body mass index in healthy older people living in low- to medium-socio-economic status areas of Santiago. The purpose of this paper is to describe in detail the methods that will be used to estimate the incremental costs and cost-effectiveness of the interventions. METHODS AND DESIGN: The base-case analysis will adopt a societal perspective, including the direct medical and non-medical costs borne by the government and patients. The cost of the interventions will be calculated by the ingredients approach, in which the total quantities of goods and services actually employed in applying the interventions will be estimated, and multiplied by their respective unit prices. Relevant information on costs of interventions will be obtained mainly from administrative records. The costs borne by patients will be collected via exit and telephone interviews. An annual discount rate of 8% will be used, consistent with the rate recommended by the Government of Chile. All costs will be converted from Chilean Peso to US dollars with the 2007 average period exchange rate of US$1 = 522.37 Chilean Peso. To test the robustness of model results, we will vary the assumptions over a plausible range in sensitivity analyses. DISCUSSION: The protocol described here indicates our intent to conduct an economic evaluation alongside the CENEX study. It provides a detailed and transparent statement of planned data collection methods and analyses. TRIAL REGISTRATION: ISRCTN48153354.