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Association between a lifestyle score and all-cause mortality: a prospective analysis of the Chilean National Health Survey 2009–2010
- Fanny Petermann-Rocha, Felipe Diaz-Toro, Claudia Troncoso-Pantoja, María Adela Martínez-Sanguinetti, Ana María Leiva-Ordoñez, Gabriela Nazar, Yeny Concha-Cisternas, Ximena Díaz Martínez, Fabian Lanuza, Fernanda Carrasco-Marín, Miquel Martorell, Karina Ramírez-Alarcón, Ana María Labraña, Solange Parra-Soto, Marcelo Villagran, Nicole Lasserre-Laso, Igor Cigarroa, Lorena Mardones, Jaime Vásquez-Gómez, Carlos A Celis-Morales
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- Journal:
- Public Health Nutrition / Volume 27 / Issue 1 / 2024
- Published online by Cambridge University Press:
- 06 December 2023, e9
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- Article
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- You have access Access
- Open access
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Objective:
To investigate the association between a lifestyle score and all-cause mortality in the Chilean population.
Design:Prospective study.
Settings:The score was based on seven modifiable behaviours: salt intake, fruit and vegetable intake, alcohol consumption, sleep duration, smoking, physical activity and sedentary behaviours. 1-point was assigned for each healthy recommendation. Points were summed to create an unweighted score from 0 (less healthy) to 7 (healthiest). According to their score, participants were then classified into: less healthy (0–2 points), moderately healthy (3–4 points) and the healthiest (5–7 points). Associations between the categories of lifestyle score and all-cause mortality were investigated using Cox proportional hazard models adjusted for confounders. Nonlinear associations were also investigated.
Participants:2706 participants from the Chilean National Health Survey 2009–2010.
Results:After a median follow-up of 10·9 years, 286 (10·6 %) participants died. In the maximally adjusted model, and compared with the healthiest participants, those less healthy had 2·55 (95 % CI 1·75, 3·71) times higher mortality risk due to any cause. Similar trends were identified for the moderately healthy group. Moreover, there was a significant trend towards increasing the mortality risk when increasing unhealthy behaviours (hazard ratio model 3: 1·61 (95 % CI 1·34, 1·94)). There was no evidence of nonlinearity between the lifestyle score and all-cause mortality.
Conclusion:Individuals in the less healthy lifestyle category had higher mortality risk than the healthiest group. Therefore, public health strategies should be implemented to promote adherence to a healthy lifestyle across the Chilean population.
Three - Policy Analysis, Bureaucratic Capacity and Public Administration Reforms in Colombia
- Edited by Pablo Sanabria-Pulido, Nadia Rubaii
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- Book:
- Policy Analysis in Colombia
- Published by:
- Bristol University Press
- Published online:
- 10 March 2021
- Print publication:
- 30 September 2020, pp 47-62
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Summary
Introduction
The Colombian government has undertaken numerous reforms in its public administration with the aim of enhancing bureaucratic capacity, effectiveness and efficiency (Younes, 2004; Restrepo, 2011). These reforms have taken place hand in hand with successive international public administration approaches, from the traditional Weberian approach to NPM, to the New Public Governance (as developed in Osborne, 2010). This chapter undertakes a policy analysis of administrative policies in Colombia in terms of both the design and characteristics of public administration reforms and the conditions for their implementation, in particular, the bureaucratic capacity of public organizations.
The design of administrative policies in Colombia historically has been based on the global North's approaches to public administration. Weberian approaches were influential in the 19th and 20th centuries, but NPM can be considered the main current approach in Colombian public administration. Some elements of New Public Governance can also be detected. The characteristics of these policies are identified in a timeline starting with the Constitution of 1991 and finishing in 2018.
On a second level of policy analysis, the implementation of these administrative policies has not been as expected. The chapter argues that one of the foremost conditions for implementation is bureaucratic capacity. It is still perceived that implementation of the administrative reforms has not been satisfactory, and that the bureaucratic capacity of public organizations tends to be low (Echebarría, 2006). Organizations with a high bureaucratic capacity constitute islands of excellence in Colombian public administration and have implemented the reforms in a more consistent and successful way, leading to better performance as measured in national indicators. Considering this, the purpose of this chapter is to analyze the different processes of administrative reform occurring in Colombia from 1991 to 2018, including implementation problems and main areas of progress, with an emphasis on the factors that determine high bureaucratic capacity in islands of excellence.
Thus, the chapter is divided into three sections. The first section presents a description of the public administration reforms implemented in Colombia since the 1990s. The second section is centered on the review of some of the difficulties in the implementation of such reforms, mainly related to bureaucratic capacity.