Browsing by Author "Valentino, Giovanna"

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    Analysis of the Chilean health promotion policy "Choose a Healthy Lifestyle"
    (2023) Valentino, Giovanna; Vio, Fernando; Rodriguez-Osiac, Lorena
    Background: Intersectoral health promotion initiatives in Chile to address obesity and non- communicable diseases have had a long history in Chile, but also a high degree of changes in their design, implementation, and financing. Aim: To analyze the "Choose a Healthy Lifestyle" enacted by Law 20,670 under Sabatier's "Advocacy Coalition Framework" (ACF), addressing the political discussion and its execution in the subsequent governing coalitions (2011-2022). Material and Methods: The ACF components are the following: external events, coalitions, policy subsystem (health promotion), and policy brokers. Policy change and learning occurs when a certain level of conflict exists between coalitions. We carried out a bibliographic and literature review, including history of the Law and notes in the media. Results: We identified two coalitions. The first is pro-individual freedom and aims to solve the problem with education and health promotion. The second one defines the problem as structural and related to social determinants and health inequity. The first coalition launched the "Choose Healthy Liferstyle" program in 2011 when they were in executive power. After criticism from the opposition and the participation of policy brokers, the Program was institutionalized with an intersectoral vision. The lack of permanent financing affected the continuity of the policy, especially after a change in the governing coalition. Conclusions: Law 20,670 falls within the ACF. However, policy learning slowed down because the problem involved social aspects, conflict between deep beliefs of both coalitions, and lack of permanent funding, thus affecting the continuity of the policy.
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    Cardiorespiratory fitness improves prediction of mortality of standard cardiovascular risk scores in a Latino population
    (2020) Acevedo, Monica; Valentino, Giovanna; Jose Bustamante, Maria; Orellana, Lorena; Adasme, Marcela; Baraona, Fernando; Corbalan, Ramon; Navarrete, Carlos
    Background Cardiorespiratory fitness (CRF) is a powerful predictor of mortality. This study evaluated the predictive value of CRF for mortality in Chilean subjects without atherosclerotic disease compared with the Framingham, European Systematic Coronary Risk Evaluation (SCORE), and 2013 ACC/AHA risk scores and determined the incremental predictive value of CRF when added to these scores. Hypothesis CRF improves prediction of all-cause and cardiovascular disease (CVD)-related mortality of the standard international risk scores. Methods Cross-sectional study, which evaluated 4064 subjects between 2002 and 2016. Cardiovascular (CV) risk factors, anthropometric and biochemical parameters, and blood pressure were measured. CRF was determined by metabolic equivalents during maximum stress test. The Framingham, SCORE, and ACC/AHA risk scores were calculated for all subjects. After a median follow-up of 9 years, all-cause and CVD-related mortality were assessed. Receiver operating curves were built to determine mortality prediction for CRF, the risk scores, and CRF added to the scores. Results As of August 2016, 99 deaths were reported, 33 of which were CVD-related. All risk scores and CRF predicted CVD-related mortality, with CRF identified as the best predictor: CRF: C = 0.88 (95% CI: 0.82-0.93) vs Framingham: C = 0.68 (95% CI: 0.60-0.76), SCORE: C = 0.76 (95% CI: 0.70-0.83), and ACC/AHA: C = 0.79 (95% CI: 0.73-0.85). Predictive power of the three scores improved when CRF was added to the model, but this was only significant for the Framingham score. Conclusions CRF is a good predictor of both, all-cause and CV mortality and a better predictor of CVD-related deaths than standard risk scores in this population.
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    Comparison of Lipoprotein-Associated Phospholipase A2 and High Sensitive C-Reactive Protein as Determinants of Metabolic Syndrome in Subjects without Coronary Heart Disease: In Search of the Best Predictor
    (HINDAWI LTD, 2015) Acevedo, Monica; Varleta, Paola; Kramer, Veronica; Valentino, Giovanna; Quiroga, Teresa; Prieto, Carolina; Parada, Jacqueline; Adasme, Marcela; Briones, Luisa; Navarrete, Carlos
    High sensitivity C-reactive protein (hsCRP) is a marker of metabolic syndrome (MS) and cardiovascular (CV) disease. Lipoproteinassociated phospholipase A2 (Lp-PLA2) also predicts CV disease. There are no reports comparing these markers as predictors of MS. Methods. Cross-sectional study comparing Lp-PLA2 and hsCRP as predictors of MS in asymptomatic subjects was carried out; 152 subjects without known atherosclerosis participated. Data were collected on demographics, cardiovascular risk factors, anthropometric and biochemical measurements, and hsCRP and Lp-PLA2 activity levels. A logistic regression analysis was performed with each biomarker and receiver operating characteristic (ROC) curves were constructed for MS. Results. Mean age was 46 +/- 11 years, and 38% of the subjects had MS. Mean Lp-PLA2 activity was 185 +/- 48 nmol/mL/min, and mean hsCRP was 2.1 +/- 2.2mg/L. Subjects with MS had significantly higher levels of Lp-PLA2 (P = 0.03) and hsCRP (P < 0.0001) than those without MS. ROC curves showed that both markers predictedMS. Conclusion. Lp-PLA2 and hsCRP are elevated in subjects withMS. Both biomarkers were independent and significant predictors for MS, emphasizing the role of inflammation in MS. Further research is necessary to determine if inflammation predicts a higher risk for CV events in MS subjects.
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    Smoking Ban Law in Chile: Impact in Newborns' Birth Weight by Women's Age Groups and by City Population Density
    (2022) Valentino, Giovanna; Ortigoza, Ana; Rodriguez Osiac, Lorena; Doberti, Tamara; Mullachery, Pricila; Nazzal, Carolina
    Objectives: We examined the short-term impact of the Smoking Ban Law (SBL) enacted in Chile in 2013 on low birth weight (LBW) rates in cities and its differential effects by different maternal age groups and city density.Methods: We included 885,880 live births from 21 Chilean cities of >= 100,000 inhabitants. We examined the smoking and LBW prevalence distribution before and after the SBL. Through Poisson mixed effect models, we determined whether a meaningful change in LBW rate occurred after SBL implementation in the whole sample and stratified by city population density and maternal age group.Results: LBW prevalence remained stable before and after the SBL implementation (6.1% and 6.3%, respectively), while women's smoking prevalence had a relative reduction of 25.9% (p < 0.00001). No significant changes in LBW rate occurred after the implementation of SBL in the total sample or stratified by city density tertiles or maternal age groups.Conclusion: SBL implementation did not show short-term impact on LBW rate in Chile. Further studies need to examine long-term impact of SBL on low birthweight.