Equity and Prevention of Cardiovascular Diseases in Latin America and the Caribbean.

Non-communicable diseases, particularly cardiovascular diseases, are the leading cause of decreased life expectancy and death in Latin America and the Caribbean. Although a lifestyle, which includes no tobacco use, good nutrition, and regular physical activity is touted as key to health, the environmental, racial, social and economic conditions, which underpin lifestyle are often ignored or considered only secondarily. Placing the main responsibility on a patient to change their lifestyle or to simply comply with pharmacological treatment ignores the specific conditions in which the individual lives. Furthermore, there are major disparities in access to both healthy living conditions as well as access to medical care. There is sufficient evidence to support advocating for policies that support healthy living, particularly healthy food choices. Progress is being made to improve the food environment with enactment of front of package nutritional labels. However, policies were enacted only after intense regional research and advocacy supporting their implementation. Government officials must rise above the pressures of commercial interests and support health-promoting policies or be exposed as self-interest groups themselves. Strong advocacy is required to persuade officials that all policies should take health into consideration both to improve lives and economies.

Bridging the gap between science and public health: taking advantage of tobacco control experience in Brazil to inform policies to counter risk factors for non-communicable diseases.

AIMS AND DESIGN: The historical and economic involvement of Brazil with tobacco, as a major producer and exporter, was considered an insurmountable obstacle to controlling the consumption of this product. Nevertheless, the country was able to achieve significant progress in implementing public policies and to take an international leadership position, meeting its constitutional commitment to protect public health. In this paper we provide a brief historical overview of tobacco control (TC) in Brazil, and analyse the factors that contributed to the major decline in tobacco consumption in the country over the last 20 years, as well as identify the challenges that had to be overcome and those still at play. FINDINGS: The Brazilian case demonstrates how cross-sectorial collaborations among health-related groups that capitalize on their respective strengths and capacities can help to influence public policy and overcome industry and population resistance to change. Although Brazil still lags behind some leading TC nations, the country has an extensive collaborative TC network that was built over time and continues to focus upon this issue. CONCLUSIONS: The tobacco experience can serve as an example for other fields, such as alcoholic beverages, of how networks can be formed to influence the legislative process and the development of public policies. Brazilian statistics show that problems related to non-communicable diseases are a pressing public health issue, and advocacy groups, policy-makers and government departments can benefit from tobacco control history to fashion their own strategies.

Fatores psicolócos na insuficiência coronariana / Psychological factors in coronary diseases

Este trabalho tem como objetivo básico abordar a problemática de ordem psicológica vivenciada pelo pacientes portador de Insuficiência Coronariana. Ressalta os fatores psicossociais que ocupam importante papel seja no desencadeamento como também na reaçäo a doença isquêmica, de acordo com análise de questionários e teste projetivo de personalidade aplicado em 101 pacientes no pós-operatório imediato de revascularizaçäo miocárdica

Morte e prática médica: ensaio reflexivo sobre o discurso de cardiologistas / Death and medical practice: reflexive essay about speeches made by cardiologists

Analisa a vivência de situaçöes de morte por médicos em seu cotidiano profissional, as representaçöes de morte emergentes através de seu discurso, constituindo-se em estudo que possibilita a realizaçäo de reflexöes acerca da maneira como se insere e se lida com a morte atualmente na prática médica. Considera-se uma temática de grande valia e abrangência, uma vez que está associada a significativos elementos sócio-culturais, ideológicos e psicológicos. Realiza entrevistas näo diretivas com pré-estruturaçäo mínima junto a Médicos Cardiologistas da Irmandade Santa Casa de Misericórdia de Säo Paulo, sendo a análise do material do tipo qualitativa e baseada em conceitos de referencial teórico psicanalítico e análise de enunciaçäo. Säo destacados e desenvolvidos núcleos temáticos apreendidos no discurso dos entrevistados e constata intensa mobilizaçäo diante do tema; caracteriza-se como fator ansiogênico e conflitante no exercício profissional, o que indica a necessidade de adoçäo de medidas profiláticas e terapêuticas junto à formaçäo e prática médica