Wakabayashi & Daimon cardiometabolic index as an indicator to assess risk in adults. A systematic review.

OBJECTIVE: To analyze the Wakabayashi & Daimon (2015) equation, as a predictive indicator of cardiometabolic diseases and its comparison with other indices. DESIGN: A systematic review was carried out between January and March 2023, according to the PRISMA statement. DATA SOURCE: Scopus, Web of Science, and PubMed databases were reviewed using "cardiometabolic index" (CMI) as the search term. STUDY SELECTION: The following inclusion criteria were determined: studies in adults with cardiometabolic diseases using the Wakabayashi & Daimon (2015) CMI formula in different populations; studies that validate or compare the equation or that demonstrate the effects of the intervention. DATA EXTRACTION: Of the 11 selected articles, the characteristics of the population, type of study, indicators for the validation of the CMI, the reported statistics and the conclusions that were recorded in a comparative table were obtained. RESULTS AND CONCLUSIONS: Odds ratio, hazard ratio, sensitivity, and specificity were used to assess associations, risk, effectiveness, and validity of the tests, indicating favorable relationships between the factors analyzed and the results obtained. Validation and probabilistic analysis of the CMI were performed against diverse diseases such as obesity [Man >60y=AUC=0.90 (0.75-1.00) (p=0.01), Se=100, Sp=81.8, YI=0.82 and OR 4.66 and Women >60y=AUC=0.95 (0.88-1.00), p=0.001, Se=90.0, Sp=100, YI=0.90 and OR=36.27]; cardiovascular diseases [AUC=0.617, Se=0.675, Sp=0.509; HR=1.48 (1.33, 1.65), p=<0.001], among others. In conclusion CMI is a new utility index that broadly identifies the presence of risk that leads to cardiometabolic diseases in adults.

[Impact of diabetes on cardiovascular risk in patients with dyslipidemia]. / Impacto de la diabetes en el riesgo cardiovascular en pacientes con dislipidemia.

Objective: To determine the impact of diabetes on cardiovascular risk in patients with dyslipidemia. Method: Observational, cross-sectional and comparative study in which cardiovascular risk was determined at 10 years in 100 patients with dyslipidemia, of these, 50 non-diabetic patients and 50 diabetic patients. Results: Both groups had similar characteristics in terms of age, blood pressure figures, average body mass index, and HDL and LDL levels. It was observed that the diabetic group has almost double the risk compared to the dyslipidemia group, 13.7 vs. 7.9 (p = 0.014), and the calculated heart age is also higher in patients with diabetes, 80 vs. 66 years (p = 0.003). Even in patients with diabetes there is a greater difference between the real age and the age of the heart, 24 years vs. 15 years of patients without diabetes (p = 0.000). Conclusion: Having diabetes and dyslipidemia doubles the cardiovascular risk of patients. Little metabolic control was found in the population studied, which significantly increases complications at an early age and the economic burden on the health system and the families of patients, so it is necessary to rethink treatment strategies to improve metabolic control and with it the prognosis for the patient in the long term.

Objetivo: Determinar el impacto de la diabetes en el riesgo cardiovascular en pacientes con dislipidemia. Método: Estudio observacional, transversal y comparativo, en el que se determinó el riesgo cardiovascular en 100 pacientes con dislipidemia, de los cuales 50 eran diabéticos, sin complicaciones crónicas. Resultados: Ambos grupos tenían características similares en cuanto a edad, presión arterial, índice de masa corporal, niveles de c-HDL y c-LDL. Sin embargo, al comparar el porcentaje de riesgo cardiovascular, observamos que el grupo de diabéticos tenía casi el doble de riesgo cardiovascular, 13.7 contra 7.9 (p = 0.014), y la edad del corazón calculada también fue mayor en los pacientes con diabetes, 80 contra 66 años (p = 0.003). Incluso, en los pacientes diabéticos la diferencia entre la edad real y la edad del corazón fue mayor, 24 años contra 15 años (p = 0.000). Conclusión: Padecer diabetes y dislipidemia duplica el riesgo cardiovascular. En la población estudiada se encontró poco control metabólico, lo que aumenta significativamente las complicaciones en edades tempranas y la carga económica al sistema de salud y a las familias de los pacientes; por tanto, es necesario replantear las estrategias de tratamiento para mejorar el control metabólico y el pronóstico del paciente a largo plazo.

[Impact of the COVID-19 pandemic on cardiovascular disease mortality trends in Mexico, 2000-2022]. / Impacto de la pandemia de COVID-19 en las tendencias de mortalidad por enfermedades cardiovasculares en México, 2000-2022.

OBJECTIVE: To estimate the impact of the COVID-19 pandemic on cardiovascular disease (CVD) mortality trends in Mexico. METHODS: An ecological study was conducted where deaths from CVD reported in Mexico under the ICD-10 classification with codes I10 to I99 for the period 2000-2022 were analyzed. Age-standardized mortality rates were calculated at the national and state levels, then the annual percentage variation was estimated using joinpoint analysis to know the changes in the mortality trend in the period studied. RESULTS: There was an increase of 27.96 deaths per 100,000 inhabitants from 2000 to 2022 in Mexico. The joinpoint analysis shows in the period 2019-2021 an annual percentage change at the national level of 17,398 and subsequently a negative trend is presented between the years 2021-2022. The states of Guanajuato, Tlaxcala and Querétaro showed the largest increases in CVD mortality trends during the COVID-19 pandemic. CONCLUSIONS: The trend in CVD mortality in Mexico increased significantly during the COVID-19 pandemic.

Temporal variability of Lp(a) in clinically stable patients: Implications for cardiovascular risk assessment.

OBJECTIVES: Lipoprotein(a) [Lp(a)] is a significant risk factor for cardiovascular disease, yet it is often overlooked in routine clinical assessments. As a primarily genetically determined risk factor, the traditional recommendation is to assess its level once in a lifetime, as the variability of Lp(a) over time is considered to be minimal. This study aims to evaluate the potential variability of Lp(a) in clinically stable patients and investigate factors contributing to the lack of stable levels. METHODS: A retrospective analysis was conducted on a sample of adult patients attending a lipid clinic. Participants with at least two Lp(a) measurements taken with a minimum interval of four months were included. Lp(a) measurements were performed using the immunoturbidimetric assay. Variability in Lp(a) values was calculated as a percentage change from baseline, with participants exceeding a 25% change classified as having hypervariable Lp(a) levels. Additional clinical and biochemical variables were assessed. RESULTS: 61 participants with 171 Lp(a) determinations were included. Thirty-four percent exhibited a variability of 25% or higher (hypervariable). Men showed slightly greater variability than women. Changes in Lp(a) categories were observed among hypervariable patients, with some participants experiencing an increase while others showed a decrease. Menopause was present in all the women with hypervariable levels. CONCLUSION: Our study suggests reconsidering the reliance on a single Lp(a) measurement for assessing cardiovascular risk. Repeat measurements, particularly in borderline cases, may be beneficial.

[Usefulness of e-consultation in cardiology]. / Utilidad de la teleconsulta en cardiología.

INTRODUCTION AND OBJECTIVES: The development of IT tools and interlevel relationships in the management of the most prevalent processes has led to a semi-presential assessment approach. In cardiology, this form of assessment is possible through a close collaboration with primary care. The aim of this study is to analyze the results of our e-consultation program and to establish the effectiveness of this new form of assistance. METHODS: Single-center study that included e-consultations referred from 15 September 2021 to 30 September 2022. Subsequently, we analyzed the events in which patients were discharged directly during the e-consultation with no need for an on-site visit. RESULTS: We included 3,155 e-consultations. The mean age of the patients was 57±17.6 years. Of the consultations, 75% were answered within 48h (62% within 24h). A total of 1,988 patients completed one year of follow-up in e-consultation. Out of these, 1,278 patients (64.2%) were discharged from the e-consultation with no need for an on-site visit: 685 patients (53.5%) during the first consultation, and 593 (46.5%) upon request of a complementary test. After one year of follow-up, 13 patients (0.006%) were admitted due to cardiological pathology, and 16 patients (0.008%) died, only one due to cardiovascular causes. The mean age of the deceased was 80.5 years. CONCLUSIONS: E-consultation as a single referral system from primary care to cardiology improves patient accessibility, speeds up patient assessment and is effective for patients discharged without the need for an on-site consultation.

Impacto de la diabetes en el riesgo cardiovascular en pacientes con dislipidemia / Impact of diabetes on cardiovascular risk in patients with dyslipidemia

Resumen Objetivo: Determinar el impacto de la diabetes en el riesgo cardiovascular en pacientes con dislipidemia. Método: Estudio observacional, transversal y comparativo, en el que se determinó el riesgo cardiovascular en 100 pacientes con dislipidemia, de los cuales 50 eran diabéticos, sin complicaciones crónicas. Resultados: Ambos grupos tenían características similares en cuanto a edad, presión arterial, índice de masa corporal, niveles de c-HDL y c-LDL. Sin embargo, al comparar el porcentaje de riesgo cardiovascular, observamos que el grupo de diabéticos tenía casi el doble de riesgo cardiovascular, 13.7 contra 7.9 (p = 0.014), y la edad del corazón calculada también fue mayor en los pacientes con diabetes, 80 contra 66 años (p = 0.003). Incluso, en los pacientes diabéticos la diferencia entre la edad real y la edad del corazón fue mayor, 24 años contra 15 años (p = 0.000). Conclusión: Padecer diabetes y dislipidemia duplica el riesgo cardiovascular. En la población estudiada se encontró poco control metabólico, lo que aumenta significativamente las complicaciones en edades tempranas y la carga económica al sistema de salud y a las familias de los pacientes; por tanto, es necesario replantear las estrategias de tratamiento para mejorar el control metabólico y el pronóstico del paciente a largo plazo.

Abstract Objective: To determine the impact of diabetes on cardiovascular risk in patients with dyslipidemia. Method: Observational, cross-sectional and comparative study in which cardiovascular risk was determined at 10 years in 100 patients with dyslipidemia, of these, 50 non-diabetic patients and 50 diabetic patients. Results: Both groups had similar characteristics in terms of age, blood pressure figures, average body mass index, and HDL and LDL levels. It was observed that the diabetic group has almost double the risk compared to the dyslipidemia group, 13.7 vs. 7.9 (p = 0.014), and the calculated heart age is also higher in patients with diabetes, 80 vs. 66 years (p = 0.003). Even in patients with diabetes there is a greater difference between the real age and the age of the heart, 24 years vs. 15 years of patients without diabetes (p = 0.000). Conclusion: Having diabetes and dyslipidemia doubles the cardiovascular risk of patients. Little metabolic control was found in the population studied, which significantly increases complications at an early age and the economic burden on the health system and the families of patients, so it is necessary to rethink treatment strategies to improve metabolic control and with it the prognosis for the patient in the long term.

Asociación entre los marcadores lipídicos en la infancia/ adolescencia y los eventos cardiovasculares en la adultez: una revisión sistemática / Association between lipid markers in childhood/ adolescence and cardiovascular events in adulthood: A systematic review

Introducción. La asociación entre los marcadores lipídicos en la infancia/adolescencia y la incidencia de eventos clínicos cardiovasculares en la adultez está poco explorada en la literatura. El objetivo de esta revisión sistemática fue analizar la evidencia disponible sobre este tema. Población y métodos. Esta revisión sistemática se realizó de acuerdo con las guías PRISMA. Se realizó una búsqueda bibliográfica para detectar los estudios que evaluaron la asociación entre los niveles lipídicos en la edad pediátrica y la incidencia de eventos cardiovasculares en la edad adulta. No hubo restricciones idiomáticas ni geográficas en la búsqueda. Resultados. En total, cinco estudios observacionales (todas cohortes prospectivas) que incluyeron 43 540 pacientes fueron identificados y considerados elegibles para este estudio. Cuatro estudios evaluaron el nivel de triglicéridos; todos reportaron una asociación significativa entre este marcador en la edad pediátrica y los eventos cardiovasculares en la adultez. Un estudio reportó la misma asociación con el nivel de colesterol total, mientras que otro evidenció el valor predictivo de la lipoproteína (a) para el mismo desenlace clínico. Un solo estudio evaluó el colesterol asociado a lipoproteínas de alta densidad (C-HDL), sin encontrar una relación con el punto final de interés. El análisis del colesterol asociado a lipoproteínas de baja densidad (C-LDL) arrojó resultados contradictorios, aunque la asociación fue significativa en los estudios con un tamaño muestral más grande y con un mayor número de eventos durante el seguimiento. Conclusión. Los datos de esta revisión sugieren que las alteraciones de los marcadores lipídicos en la infancia y la adolescencia se asocian con un mayor riesgo cardiovascular en la adultez temprana y media.

Introduction. The association between lipid markers in childhood/adolescence and the incidence of clinical cardiovascular events in adulthood has been little explored in the bibliography. The objective of this systematic review was to analyze available evidence on this topic. Population and methods. This systematic review was conducted in accordance with the PRISMA guidelines. A comprehensive bibliographic search was done to find studies assessing the association between lipid levels in childhood and the incidence of cardiovascular events in adulthood. There were no language or geographic restrictions. Results. A total of 5 observational studies (all prospective cohorts) including 43 540 patients were identified and considered eligible for this study. Four studies assessed triglyceride levels; all reported a significant association between this lipid marker in childhood and cardiovascular events in adulthood. A study reported the same association with total cholesterol level, while another showed the predictive value of lipoprotein (a) for the same clinical outcome. Only one study assessed high-density lipoprotein cholesterol (HDL-C), but it did not find an association with the endpoint of interest. The analysis of lowdensity lipoprotein cholesterol (LDL-C) showed contradictory results, although the association was significant in the studies with a larger sample size and a higher number of events during follow-up. Conclusion. According to this review, alterations in lipid markers in childhood and adolescence are associated with a higher cardiovascular risk in early and middle adulthood.

Una experiencia en la evaluación del Programa de Hipertensión Arterial basado en la Iniciativa HEARTS

Fundamento: la hipertensión se ha convertido en una de las condiciones de mayor prevalencia entre los adultos cubanos y en el principal factor de riesgo de morbilidad y de mortalidad por causas cardiovasculares. Objetivo: evaluar el impacto de la implementación del Programa de Hipertensión Arterial basado en la Iniciativa HEARTS en el Policlínico Comunitario Octavio de la Concepción y de la Pedraja en el municipio Cienfuegos. Métodos: se realizó un estudio descriptivo, de corte transversal en sistemas y servicios de salud desde el 2018 hasta el 2022. El universo fue la población mayor de 18 años y la muestra de 4 346 hipertensos. Se estudiaron las variables: sexo, control de hipertensión arterial, estructura tecnológica, índice de desempeño, índice de madurez y comportamiento de la mortalidad por enfermedades cardiovasculares. Resultados: el índice de desempeño de los Equipos Básicos de Salud fue excelente y el índice de madurez tuvo la categoría de avanzado. Se alcanzó el 85,5 % de cobertura diagnóstica y de registro, el 94,7 % de control entre tratados, un 39,5 % de control de los pacientes con alto riesgo cardiovascular y el 60,1 % de control poblacional. La mortalidad por enfermedades cardiovasculares para todas las edades en específico la mortalidad prematura disminuyó, con predominio del sexo masculino. Conclusiones: la implementación del programa de hipertensión arterial consolidó un sistema de trabajo para el perfeccionamiento de actuación en la Atención Primaria de Salud ante el paciente hipertenso. El uso de la política terapéutica estandarizada ha tenido impacto en el control de la presión arterial.

Foundation: hypertension has become one of the most prevalent conditions among Cuban adults and the main risk factor for morbidity and mortality due to cardiovascular causes. Objective: to evaluate the impact of the implementation of the Arterial Hypertension Program Based on the HEARTS Initiative in the Octavio de la Concepción y de la Pedraja Community Polyclinic in the Cienfuegos municipality. Methods: a descriptive, cross-sectional study was carried out in health systems and services from 2018 to 2022. The universe was the population over 18 years of age and the sample of 4,346 hypertensive patients. The variables were studied: sex, control of high blood pressure, technological structure, performance index, maturity index and mortality behavior due to cardiovascular diseases. Results: the performance index of the Basic Health Teams was excellent and the maturity index was in the advanced category. 85.5 % diagnostic and registration coverage were achieved, 94.7 % control among treated patients, 39.5 % control of patients with high cardiovascular risk and 60.1 % population control. Mortality from cardiovascular diseases for all ages, specifically premature mortality, decreased, with a predominance of the male sex. Conclusions: the implementation of the arterial hypertension program consolidated a work system for the improvement of action in Primary Health Care for hypertensive patients. The use of standardized therapeutic policy has had an impact on blood pressure control.

Between health and pleasure: perceptions of patients with cardiovascular disease following a nutritional intervention / Entre a saúde e o prazer: percepções de pacientes com doença cardiovascular acompanhados por um programa de intervenção nutricional / Entre la salud y el placer: percepciones de pacientes con enfermedad cardiovascular seguidos de un programa de intervención nutricional

The Brazilian Cardioprotective Nutritional Program (Balance)(f) consists of a nutritional counseling strategy aiming to prevent new cardiovascular events. This qualitative investigation is a case study of Balance aiming to understand the process of food choices related to the adherence of participants to the nutritional counseling. Semi-structured interviews were conducted with 10 participants and analyzed according to thematic content analysis. Patients reported incorporating nutritional advice and how they negotiate food choices to achieve a healthy diet while maintaining the consumption of pleasurable foods, some of them recommended avoiding. The continuous tensions and conflicts between healthy and pleasurable eating which permeate patients' food choices should be addressed in nutritional counseling, enabling greater and long-lasting adherence to Balance.

O Programa Alimentar Brasileiro Cardioprotetor (Dica Br) consiste em uma estratégia de aconselhamento nutricional com o objetivo de prevenção da incidência de novos eventos cardiovasculares. Esta investigação qualitativa é um estudo de caso do Dica Br e visa compreender o processo de escolhas alimentares relacionadas à adesão dos participantes às estratégias orientadas. Aplicou-se a análise de conteúdo temática para explorar as entrevistas semiestruturadas realizadas com dez participantes. Os pacientes relataram incorporar as orientações nutricionais e como negociam suas escolhas alimentares para alcançar uma alimentação saudável mantendo o consumo de alimentos prazerosos, sendo alguns recomendados a serem evitados pelo Dica Br. As contínuas tensões e conflitos entre comer por saúde e comer por prazer que permeiam as escolhas alimentares dos pacientes devem ser abordados no aconselhamento nutricional, possibilitando maior e duradoura adesão ao Dica Br.

El Programa Alimentario Brasileño Cardioprotector (Dica Br) consiste en una estrategia de prevención de nuevos eventos cardiovasculares. Esta investigación cualitativa es un estudio de caso del Dica Br con el objetivo de comprender el proceso de elección alimentaria relacionada con la adhesión a las estrategias orientadas. Se aplicó el análisis de contenido temático para explorar las entrevistas semiestructuradas realizadas con 10 participantes. Los pacientes informaron incorporar pautas nutricionales y cómo negocian sus elecciones alimentarias para lograr una dieta saludable mientras mantienen el consumo de alimentos placenteros, algunos de los cuales se recomienda evitar. Las tensiones y conflictos continuos entre comer para la salud y comer por placer que impregnan las elecciones alimentarias deben abordarse en el asesoramiento nutricional para una mayor y duradera adherencia al Dica Br.

Evidencias del efecto del grano integral en las enfermedades crónicas no transmisibles

Los cereales integrales son una categoría de alimentos fundamental para la dieta humana y representan una fuente invaluable de carbohidratos, proteínas, fibras, fitoquímicos, minerales y vitaminas. Muchos estudios han demostrado que el consumo de cereales integrales está relacionado con un menor riesgo de enfermedades crónicas no transmisibles. Sin embargo, varios de sus efectos positivos para la salud parecen desaparecer cuando se refinan los cereales. La pregunta de investigación es cuál sería el efecto de los cereales integrales en la prevención de enfermedades crónicas no transmisibles. Este artículo describe los efectos positivos del consumo de cereales integrales en la prevención de estas enfermedades. Para ello, se realiza una descripción narrativa que revisa los antecedentes disponibles sobre: a) situación epidemiológica en Chile y su relación con la alimentación; b) consumo de cereales integrales en el mundo y en Chile; y c) el efecto del consumo de cereales integrales en la reducción del riesgo de enfermedad cardiovascular. obesidad, diabetes tipo 2 y cáncer. Los antecedentes generales son muy alentadores sobre el efecto positivo del consumo de cereales integrales sobre determinadas enfermedades, especialmente las de origen metabólico. Sin embargo, la incertidumbre de algunas asociaciones negativas merece mayor atención.

Whole grains are a fundamental food category for the human diet and represent an invaluable source of carbohydrates, proteins, fibers, phytochemicals, minerals and vitamins. Many studies have shown that consumption of whole grains is linked to a lower risk of chronic non-communicable diseases. However, several of its positive health effects seem to disappear when grains are refined. The research question is what would be the effect of whole grains in the prevention of Chronic Non-Communicable Diseases. This article describes the positive effects of whole grain consumption in these diseases.To this end, a narrative description is made that reviews the available background on: a) epidemiological situation in Chile and its relationship with diet; b) consumption of whole grains in the world and in Chile; and c) the effect of whole grain consumption on reducing the risk of cardiovascular disease. obesity, type 2 diabetes, and cancer. The general background is very encouraging for a positive effect of whole grain consumption on certain diseases, especially those of metabolic origin. However, the uncertainty of some negative associations deserves further attention.

Liporoteínas de baja densidad y grados de riesgo cardiovascular en adultos mayores de 40 años: estudio de casos y controles

Fundamento: Las enfermedades cardiovasculares constituyen la principal causa de muerte y discapacidad en el mundo. Su incidencia y prevalencia ha aumentado durante la última década y representa un tercio de todas las muertes. Objetivo: Determinar la asociación de LDL-C y grados de riesgo cardiovascular en adultos mayores de 40 años en la Unidad de Medicina Familiar # 43 del Instituto Mexicano del Seguro Social. Método: Se realizó una investigación con un diseño de casos y controles durante el 2023, mediante la fórmula de relación caso-control 1:1, (230 sujetos) que reunieron los criterios de selección. La recolección de la información se realizó por medio de una base de datos en Excel, el contraste de variables se realizó con la fórmula de X2. Mediante el programa de SPSS versión 25 de Windows. Resultados: El género femenino fue el de mayor frecuencia, la media de edad fue de 62 años, el colesterol total elevado presentó 109 (94,8) pacientes con alto riesgo cardiovascular, se calculó una RM: 43.279, IC: 95 %, (17.347-107.980), el colesterol LDL presentó un 68 % (59,1) con riesgo cardiovascular y una RM: 1.28, IC: 95% (0.760-2.158), la evaluación de los triglicéridos con cifras elevadas presentó un 50,4 % (58), RM: 0.037, IC 95 % (0.013-0.106). Conclusiones: La edad media de los sujetos fue, 62 años, predominó el sexo femenino, con mayor proporción de casados, el nivel de escolaridad que prevaleció fue la preparatoria, la religión católica tuvo mayor frecuencia y los sujetos de la zona urbana. Las variables de lípidos como el colesterol total y LDL-C presentaron significancia estadística en relación a riesgo cardiovascular.

Foundation: Cardiovascular diseases are the main cause of death and disability in the world. Its incidence and prevalence has increased over the last decade and accounts for a third of all deaths. Objective: Determine the association of LDL-C and degrees of cardiovascular risk in adults over 40 years of age in the Family Medicine Unit # 43 of the Mexican Social Security Institute. Method: An investigation was carried out with a case-control design during 2023, using the 1:1 case-control ratio formula, (230 subjects) who met the selection criteria. Information collection was carried out through an Excel database, the contrast of variables was carried out with the X2 formula. Using the SPSS version 25 Windows program. Results: The female gender was the most frequent, the average age was 62 years, elevated total cholesterol presented 109 (94.8) patients with high cardiovascular risk, an MRI was calculated: 43,279, CI: 95 %, (17,347-107,980), LDL cholesterol presented 68 % (59.1) with cardiovascular risk and an MRI: 1.28, CI: 95 % (0.760-2.158), the evaluation of triglycerides with high figures presented 50.4 % (58), OR: 0.037, 95 % CI (0.013-0.106). Conclusions: The average age of the subjects was 62 years, the female sex predominated, with a greater proportion of married people, the level of schooling that predominated was high school, the catholic religion was more frequent and the subjects were from the urban area. Lipid variables such as total cholesterol and LDL-C presented statistical significance in relation to cardiovascular risk.

Riesgo de enfermedad cardiovascular e indicadores de adiposidad corporal y su relación con el riesgo psicosocial en trabajadores del sector económico de comercio / Indicadores de risco de doenças cardiovasculares e de adiposidade corporal e sua relação com o risco psicossocial em trabalhadores do setor econômico do comércio / Cardiovascular disease risk and body adiposity indicators and their relationship with psychosocial risk in workers of the commerce economic sector

Resumen Introducción Cada año a nivel mundial se presentan millones de muertes y lesiones no mortales por inadecuadas prácticas en salud laboral, muertes por cardiopatías isquémicas y accidente cerebrovascular son causadas por largas jornadas y altas cargas laborales. Objetivo Identificar el grado de correlación del riesgo psicosocial con el riesgo de enfermedad cardiovascular e indicadores de adiposidad corporal: IMC (índice de masa corporal), PA (perímetro abdominal) y BFP (porcentaje de grasa corporal) en trabajadores del sector económico de comercio. Método Estudio de enfoque cuantitativo y alcance correlacional no causal, con una muestra de 118 sujetos (56.7% mujeres y 43.3% hombres). Se evaluó los indicadores de adiposidad mediante el protocolo internacional para la valoración antropométrica ISAK, el riesgo cardiovascular por medio de la escala de Framingham y para evaluar el riesgo psicosocial se aplicó la Batería de Instrumentos para la Evaluación de Factores de Riesgos Psicosociales validada para la población colombiana. Estos datos fueron procesados y analizados estadísticamente mediante SPSS versión 28. Resultados Se destaca una relación significativa (p < .05) entre las variables en diferentes grados, en el caso de la correlación entre enfermedad cardiovascular y el riesgo psicosocial su coeficiente de correlación es de (r = .62), para la correlación entre el IMC y el riesgo psicosocial un coeficiente de (r = .52), en el caso del BFP y el riesgo psicosocial en mujeres fue de (r = .45) y en hombres de (r = .67) y para el PA y el riesgo psicosocial, su coeficiente de correlación fue de (r = .42) y (r = .64) respectivamente. Conclusión Existe una correlación positiva y fuerte entre el riesgo psicosocial y el riesgo de enfermedad cardiovascular, del mismo modo, entre el IMC y el riesgo psicosocial. En el caso del BFP y el riesgo psicosocial, el grado de correlación fue moderado en mujeres y fuerte en hombres al igual que en la correlación entre el PA y el riesgo psicosocial.

Resumo Introdução Todos os anos, em todo o mundo, ocorrem milhões de mortes e lesões não fatais devido a práticas inadequadas de saúde ocupacional, as mortes por doença cardíaca isquêmica e acidente vascular cerebral são causadas por longas jornadas de trabalho e altas cargas de trabalho. Objetivo Identificar o grau de correlação do risco psicossocial com o risco de doenças cardiovasculares e com os indicadores de adiposidade corporal: IMC (índice de massa corporal), PA (circunferência abdominal) e PBC (percentagem de gordura corporal) em trabalhadores do sector econômico do comércio. Método Estudo quantitativo de âmbito correlacional não causal, com uma amostra de 118 indivíduos (56.7% mulheres e 43.3% homens). Os indicadores de adiposidade foram avaliados através do protocolo internacional de avaliação antropométrica ISAK, o risco cardiovascular foi avaliado através da escala de Framingham e o risco psicossocial foi avaliado através da Bateria de Instrumentos para a Avaliação de Factores de Risco Psicossocial validada para a população colombiana. Estes dados foram processados e analisados estatisticamente utilizando o SPSS versão 28. Resultados Existe uma relação significativa (p < .05) entre as variáveis em diferentes graus, no caso da correlação entre doença cardiovascular e risco psicossocial o seu coeficiente de correlação é (r = .62), para a correlação entre IMC e risco psicossocial um coeficiente de (r = .52), para a PAF e risco psicossocial nas mulheres um coeficiente de (r = .52). 62), para a correlação entre o IMC e o risco psicossocial um coeficiente de (r = .52), no caso da PA e do risco psicossocial nas mulheres foi (r = .45) e nos homens (r = .67) e para a PA e o risco psicossocial, o seu coeficiente de correlação foi (r = .42) e (r = .64) respetivamente. Conclusão Existe uma forte correlação positiva entre o risco psicossocial e o risco de doença cardiovascular, bem como entre o IMC e o risco psicossocial. No caso da PAF e do risco psicossocial, o grau de correlação foi moderado nas mulheres e forte nos homens, tal como a correlação entre a PA e o risco psicossocial.

Abstract Introduction Every year worldwide millions of deaths and non-fatal injuries occur due to inadequate occupational health practices, deaths from ischemic heart disease and stroke are caused by long working hours and high workloads. Objective To identify the degree of correlation of psychosocial risk with the risk of cardiovascular disease and body adiposity indicators: BMI (body mass index), AC (abdominal circumference) and BFP (body fat percentage) in workers of the commerce economic sector. Method A study with a quantitative approach and non-causal correlational scope, with a sample of 118 subjects (56.7% women and 43.3% men). Adiposity indicators were evaluated by means of the international protocol for anthropometric assessment ISAK, cardiovascular risk by means of the Framingham scale and to evaluate psychosocial risk, the Battery of Instruments for the Evaluation of Psychosocial Risk Factors validated for the Colombian population was applied. These data were processed and analyzed statistically using SPSS version 28. Results A significant relationship (p < .05) between the variables is highlighted in different degrees, in the case of the correlation between cardiovascular disease and psychosocial risk its correlation coefficient is (r =. 62), for the correlation between BMI and psychosocial risk a coefficient of (r = .52), in the case of BFP and psychosocial risk in women it was (r = .45) and in men (r = .67) and for AC and psychosocial risk, its correlation coefficient was (r = .42) and (r = .64) respectively. Conclusion There was a strong positive correlation between psychosocial risk and cardiovascular disease risk, as well as between BMI and psychosocial risk. In the case of BFP and psychosocial risk, the degree of correlation was moderate in women and strong in men, as was the correlation between AC and psychosocial risk.

HEARTS en las Américas: impulsar el cambio en el sistema de salud para mejorar el control de la hipertensión en la población / HEARTS in the Americas: targeting health system change to improve population hypertension control / HEARTS nas Américas: impulsionar mudanças no sistema de saúde para melhorar o controle da hipertensão arterial na população

RESUMEN Propósito de la revisión. HEARTS en las Américas es la adaptación regional de la iniciativa mundial HEARTS, de la Organización Mundial de la Salud, para la prevención y el control de las enfermedades cardiovasculares (ECV). Su objetivo general es impulsar el cambio de la práctica clínica y de la gestión en los entornos de atención primaria, por parte de los servicios de salud, a fin de mejorar el control de la hipertensión y reducir el riesgo de ECV. En esta revisión se describe la iniciativa HEARTS en las Américas. En primer lugar, se resume la situación epidemiológica regional en cuanto a la mortalidad por ECV y las tendencias en el control de la hipertensión a nivel poblacional; a continuación, se explica la razón de ser de los principales componentes de la intervención: el sistema de manejo orientado a la atención primaria y la vía clínica de HEARTS. Por último, se examinan los factores clave para acelerar la expansión de HEARTS: los medicamentos, la atención basada en el trabajo en equipo y un sistema de monitoreo y evaluación. Resultados recientes. Hasta el momento, 33 países y territorios de América Latina y el Caribe se han comprometido a integrar este programa en toda su red de atención primaria de salud para el 2025. El aumento de la cobertura y del control de la hipertensión en los entornos de atención primaria de salud (en comparación con el modelo tradicional) es prometedor y confirma que las intervenciones que se promueven como parte de HEARTS son factibles y resultan aceptables para las comunidades, los pacientes, los prestadores de servicios de salud, los responsables de la toma de decisiones y los financiadores. En esta revisión se destacan algunos casos de implementación satisfactoria. Conclusiones. Ampliar el uso de un tratamiento eficaz de la hipertensión y optimizar el control del riesgo de ECV es una forma pragmática de acelerar la reducción de la mortalidad por ECV y, al mismo tiempo, de fortalecer los sistemas de atención primaria de salud para responder con calidad y de manera eficaz y equitativa al desafío que entrañan las enfermedades no transmisibles, no solo en los países de ingresos bajos o medianos, sino en todas las comunidades a nivel mundial.

ABSTRACT Purpose of review. HEARTS in the Americas is the regional adaptation of Global Hearts, the World Health Organization initiative for cardiovascular disease (CVD) prevention and control. Its overarching goal is to drive health services to change managerial and clinical practice in primary care settings to improve hypertension control and CVD risk management. This review describes the HEARTS in the Americas initiative. First, the regional epidemiological situation of CVD mortality and population hypertension control trends are summarized; then the rationale for its main intervention components: the primary care-oriented management system and the HEARTS Clinical Pathway are described. Finally, the key factors for accelerating the expansion of HEARTS are examined: medicines, team-based care, and a system for monitoring and evaluation. Recent findings. Thus far, 33 countries in Latin America and the Caribbean have committed to integrating this program across their primary healthcare network by 2025. The increase in hypertension coverage and control in primary health care settings compared with the traditional model is promising and confirms that the interventions under the HEARTS umbrella are feasible and acceptable to communities, patients, providers, decision-makers, and funders. This review highlights some cases of successful implementation. Summary. Scaling up effective treatment for hypertension and optimization of CVD risk management is a pragmatic way to accelerate the reduction of CVD mortality while strengthening primary healthcare systems to respond effectively, with quality, and equitably, to the challenge of non-communicable diseases, not only in low-middle income countries but in all communities globally.

RESUMO Propósito da revisão. HEARTS nas Américas é uma adaptação regional da iniciativa mundial HEARTS, da Organização Mundial da Saúde, voltada para prevenção e controle das doenças cardiovasculares (DCV) na Região das Américas. Seu objetivo geral é promover mudanças na prática clínica e na gestão da atenção primária pelos serviços de saúde a fim de melhorar o controle da hipertensão arterial e reduzir o risco de DCV. Esta revisão descreve a iniciativa HEARTS nas Américas. Primeiro, é apresentado um resumo da situação epidemiológica regional relativa à mortalidade por DCV e das tendências no controle da hipertensão arterial em nível populacional. Em seguida, são explicados os motivos por trás dos principais componentes da intervenção: o sistema de manejo focado na atenção primária e o componente clínico da HEARTS. Por fim, são examinados os principais fatores para acelerar a ampliação da HEARTS: medicamentos, atenção baseada no trabalho em equipe e um sistema de monitoramento e avaliação. Resultados recentes. Até o momento, 33 países e territórios da América Latina e do Caribe se comprometeram a integrar esse programa em toda sua rede de atenção primária à saúde até 2025. Comparado com o modelo tradicional, o aumento da cobertura e do controle da hipertensão arterial nos ambientes de atenção primária à saúde é promissor e confirma que as intervenções promovidas pela HEARTS são exequíveis e aceitas por comunidades, pacientes, prestadores de serviços de saúde, tomadores de decisão e financiadores. Nesta revisão, destacamos alguns casos nos quais a implementação foi satisfatória. Conclusões. Ampliar a aplicação de um tratamento eficaz contra a hipertensão arterial e otimizar o controle do risco de DCV são medidas pragmáticas para acelerar a redução da mortalidade por DCV e, ao mesmo tempo, fortalecer os sistemas de atenção primária à saúde para responder com qualidade, eficácia e equidade ao desafio apresentado pelas doenças não transmissíveis, não apenas nos países de baixa ou média renda, mas no mundo todo.

Psychological stress and cardiovascular risk among women in Brazilian communities: a cross-sectional study / Estresse psicológico e risco cardiovascular de mulheres em comunidades brasileiras: um estudo transversal / Estrés psicológico y riesgo cardiovascular entre mujeres en comunidades brasileñas: un estudio transversal

Abstract: Psychosocial evaluations are rarely conducted with community-dwelling individuals, especially those with higher risk of cardiovascular disease. This study aims to evaluate the perceptual stress and cardiovascular risk among women in a large cross-sectional study performed in Brazilian communities. Subjects aged over 18 years were included out of 500 public basic health units (BHU) in Brazil. All subjects were subjected to a clinical consultation and questionnaires application. Data were used to identify healthy lifestyle, smoking status, and self-perception of psychological stress. The National Health and Nutrition Examination Survey (NHANES) risk score (NRS) was used to estimate cardiovascular risk. Ethnicity information was self-reported, considering white versus non-white (black, brown, and mixed-race) women. A total of 93,605 patients were recruited from a primary care setting, of which 62,200 (66.4%) were women. Intense and severe auto-perception of stress was higher within non-white women at home (p < 0.001), at work (p = 0.008), socially (p < 0.001), and financially (p < 0.001) compared to white women. Therefore, the NRS indicates that non-white women had higher cardiovascular risk, lower physical activity, and lower daily vegetables/fruits consumption compared to white women (p < 0.001). Non-white women in Brazilian communities are susceptible to increased stress and cardiovascular disease risk, which adds up to disparities in access to the public health system.

Resumo: Avaliações psicossociais raramente são realizadas com indivíduos residentes na comunidade, especialmente aqueles com maior risco de doença cardiovascular. Este estudo tem como objetivo avaliar o estresse perceptivo e o risco cardiovascular entre mulheres em um grande estudo transversal realizado em comunidades brasileiras. Foram incluídas mulheres com idade superior a 18 anos de 500 unidades básicas de saúde (UBS) públicas do Brasil. Todas as participantes foram submetidas a consulta clínica e aplicação de questionários. Os dados foram utilizados para identificar estilo de vida saudável, tabagismo e autopercepção de estresse psicológico. O índice de risco (NRS) do National Health and Nutrition Examination Survey (NHANES) foi utilizado para estimar o risco cardiovascular. As informações de etnia foram autorreferidas, considerando mulheres brancas versus não brancas (negras, pardas e pardas). Um total de 93.605 pacientes foram recrutados em um ambiente de atenção primária, dos quais 62.200 (66,4%) eram mulheres. A autopercepção intensa e grave de estresse foi maior em mulheres não brancas em casa (p < 0,001), no trabalho (p = 0,008), socialmente (p < 0,001) e financeiramente (p < 0,001) em comparação com mulheres brancas. Portanto, a NRS indica que as mulheres não brancas apresentaram maior risco cardiovascular, menor atividade física e menor consumo diário de vegetais/frutas em comparação às mulheres brancas (p < 0,001). As mulheres não brancas nas comunidades brasileiras são suscetíveis ao aumento do estresse e do risco de doenças cardiovasculares, o que aumenta as disparidades no acesso ao sistema público de saúde.

Resumen: Raramente se realizan evaluaciones psicosociales con personas que viven en la comunidad, especialmente aquellas con mayor riesgo de enfermedad cardiovascular. Este estudio tiene como objetivo evaluar el estrés perceptivo y el riesgo cardiovascular entre las mujeres en un gran estudio transversal realizado en comunidades brasileñas. Se incluyeron mujeres mayores de 18 años de 500 unidades básicas de salud (UBS) públicas de Brasil. Todas las participantes fueron sometidas a una consulta clínica y aplicación de cuestionarios. Los datos se utilizaron para identificar el estilo de vida saludable, el tabaquismo y la autopercepción del estrés psicológico. Se utilizó la puntuación de riesgo (NRS) de la Encuesta Nacional de Examen de Salud y Nutrición (NHANES) para estimar el riesgo cardiovascular. La información étnica fue autoinformada, considerando mujeres blancas versus no blancas (negras, marrones y mestizas). Se reclutó a un total de 93.605 pacientes en un entorno de atención primaria, de los cuales 62.200 (66,4%) eran mujeres. La autopercepción intensa y severa del estrés fue mayor entre las mujeres no blancas en el hogar (p < 0,001), en el trabajo (p = 0,008), socialmente (p < 0,001) y financieramente (p < 0,001) en comparación con las mujeres blancas. Por lo tanto, el NRS indica que las mujeres no blancas tenían mayor riesgo cardiovascular, menor actividad física y menor consumo diario de verduras y frutas en comparación con las mujeres blancas (p < 0,001). Las mujeres no blancas en las comunidades brasileñas son susceptibles a un mayor estrés y riesgo de enfermedades cardiovasculares, lo que se suma a las disparidades en el acceso al sistema de salud pública.

El desempeño profesional del pediatra en la atención a los factores de riesgo cardiovascular

Introducción: la atención integral a niños y adolescentes con factores de riesgo cardiovascular es un desafío para el desempeño profesional del pediatra en la atención primaria de salud. Objetivo: sistematizar los referentes teóricos que sustentan el desempeño profesional del pediatra de la atención primaria de salud para la atención a los factores de riesgo cardiovascular. Métodos: se realizó una revisión bibliográfica de enero de 2020 a julio de 2022. Se utilizaron las bases de datos Pubmed, SciELO y Google Académico, a través de la combinación de los operadores OR, AND y NOT; las palabras clave utilizadas fueron: enfermedades cardiovasculares, desempeño profesional, factores de riesgo, atención primaria de salud y pediatra. Se evaluaron artículos y páginas web en idioma español e inglés que hicieran referencia al tema de estudio, a través del título. Desarrollo: a partir de la sistematización de varios autores, se adoptaron enfoques teóricos en relación con el desempeño profesional del pediatra de la atención primaria de salud para la atención a los factores de riesgo cardiovascular, se identificaron regularidades en diferentes áreas del conocimiento y se propuso de manera operacional la definición del desempeño profesional del pediatra de la atención primaria de salud para la atención a los factores de riesgo cardiovascular. Conclusiones: la sistematización realizada permitió establecer una aproximación a los referentes teóricos que sustentan el tema y profundizar en el desempeño profesional del pediatra para la prevención de los factores de riesgo cardiovascular en los niños.

Background: comprehensive care for children and adolescents with cardiovascular risk factors is a challenge for the professional performance of pediatricians in primary health care. Objective: to systematize the theoretical references that support the professional performance of pediatricians in primary health care for the care of cardiovascular risk factors. Methods: a literature review was performed from January 2020 to July 2022. Pubmed, SciELO and Google Scholar databases were used, through the combination of OR, AND and NOT operators; the keywords used were cardiovascular diseases, professional performance, risk factors, primary health care and pediatrician. Articles and web pages in Spanish and English referring to the subject of the study were evaluated through the title. Development: based on the systematization of several authors, theoretical approaches were adopted in relation to the professional performance of the pediatrician in primary health care for the attention to cardiovascular risk factors, regularities were identified in different areas of knowledge and the definition of the professional performance of the pediatrician in primary health care for the attention to cardiovascular risk factors was proposed in an operational manner. Conclusions: the systematization made it possible to establish an approach to the theoretical references that support the subject and to deepen in the professional performance of the pediatrician for the prevention of cardiovascular risk factors in children.

Instrumentos de avaliação multidimensional de fragilidade para uso no cuidado de idosos com doença cardiovascular / Multidimensional frailty assessment tools for use in the care of older adults with cardiovascular disease / Instrumentos de evaluación multidimensional de la fragilidad en la atención de adultos mayores con enfermedad cardiovascular

Objetivo: identificar quais os instrumentos disponíveis para avaliação multidimensional da fragilidade em idosos com doença cardiovascular, potencialmente aplicáveis durante a realização do Processo de Enfermagem. Método: revisão sistemática conduzida em oito bases de dados/portais, para identificação de estudos que apresentassem instrumentos multidimensionais de avaliação de fragilidade em idosos com doença cardiovascular e que fossem aplicáveis ao processo de enfermagem. Resultados: foram incluídos 19 instrumentos multidimensionais. O Brief Frailty Index for Coronary Artery Disease foi desenvolvido para uso no cuidado cardiovascular de idosos. O Frailty Index for Adults e o Maastricht Frailty Screening Tool for Hospitalized Patients foram desenvolvidos para uso no Processo de Enfermagem. Conclusão: apesar de apenas um instrumento ter sido desenvolvido para o idosos com doença cardiovascular e apenas dois serem aplicáveis ao processo de enfermagem, a maioria deles tem potencial de adaptação e validação para uso nesta população durante a avaliação de enfermagem.

Objective: to identify which tools are available for multidimensional frailty assessment of older adult with cardiovascular disease and which are potentially applicable during the Nursing Process. Method: a systematic review conducted in eight databases/portals to identify studies that presented multidimensional frailty assessment tools for older adult with cardiovascular disease and that were applicable to the nursing process. Results: a total of 19 multidimensional tools were included. The Brief Frailty Index for Coronary Artery Disease was developed for use in the cardiovascular care of older adult. The Frailty Index for Adults and the Maastricht Frailty Screening Tool for Hospitalized Patients were developed for use in the Nursing Process. Conclusion: although only one tool was developed for older adults with cardiovascular disease and only two are applicable to the nursing process, most of them have the potential to be adapted and validated for use in this population during nursing assessment.

Objetivo: identificar qué instrumentos están disponibles para la evaluación multidimensional de la fragilidad en personas mayores con enfermedad cardiovascular, que se puedan aplicar en el Proceso de Enfermería. Método: revisión sistemática realizada en ocho bases de datos/portales, para identificar estudios que presentaran instrumentos multidimensionales para la evaluación de la fragilidad en adultos mayores con enfermedad cardiovascular y que fueran aplicables al proceso de enfermería. Resultados: se incluyeron 19 instrumentos multidimensionales. El Brief Frailty Index for Coronary Artery Disease se desarrolló para usarlo en el cuidado cardiovascular de las personas mayores. El Frailty Index for Adults y la Maastricht Frailty Screening Tool for Hospitalized Patients se elaboraron para ser usados en el Proceso de Enfermería. Conclusión: aunque sólo se elaboró un instrumento para adultos mayores con enfermedad cardiovascular y sólo dos son aplicables al proceso de enfermería, la mayoría de ellos tienen el potencial para ser adaptados y validados para ser usados en esa población en la evaluación de enfermería.

Mortalidade em domicílio durante pandemia de covid-19 / Home mortality during the COVID-19 pandemic / Muerte en el hogar durante la pandemia de COVID-19

Resumo O estudo investigou a mortalidade em domicílio durante a pandemia de SARS-CoV-2 em Santa Catarina, utilizando dados secundários do Serviço de Atendimento Móvel de Urgência caracterizando óbitos notificados pelas equipes. A análise dos dados, acessados no Portal da Transparência do governo estadual, revelou aumento nos óbitos atendidos pelas equipes de urgência na região. Destacou-se também incremento médio de 2,16/100 mil habitantes na taxa de mortalidade por doenças cardiovasculares inespecíficas entre 2019 e 2022, diferenciando Santa Catarina do restante do Brasil. Essa disparidade pode estar associada à falta de controle dos fatores de risco e comorbidades durante a pandemia. Os achados ressaltam a necessidade de medidas preventivas para mitigar os efeitos adversos sobre a mortalidade domiciliar e melhorar os serviços de saúde, especialmente em relação à equidade na distribuição de recursos escassos durante a pandemia.

Abstract The study investigated home mortality during the SARS-CoV-2 pandemic in Santa Catarina, using secondary data from the Mobile Emergency Care Service characterizing deaths reported by the teams. Analysis of the data, accessed via the state government's Transparency Portal, uncovered a rise in deaths attended to by emergency teams in the area. It also highlighted an average increase of 2.16 per 100,000 residents in the mortality rate attributable to non-specific cardiovascular diseases between 2019 and 2022, distinguishing Santa Catarina from the rest of Brazil. This contrast could be linked to inadequate management of risk factors and comorbidities during the pandemic. The findings underscore the need for preventive measures to alleviate adverse impacts on home mortality and enhance healthcare services, particularly concerning equity in the allocation of limited resources amid the pandemic.

Resumen El estudio investigó la muerte en el hogar durante la pandemia por SARS-CoV-2 en el estado de Santa Catarina, en Brasil, utilizando datos secundarios del Servicio de Atención Móvil de Urgencia que caracterizan las defunciones notificadas por los equipos. El análisis de los datos, a los que se tuvo acceso por medio del Portal de la Transparencia del gobierno estatal, puso de manifiesto un aumento en las muertes atendidas por los equipos de urgencia en la región. También se resaltó un incremento medio de 2,16/100.000 habitantes en la tasa de mortalidad por enfermedades cardiovasculares inespecíficas entre el 2019 y el 2022, lo que diferencia a Santa Catarina del resto de Brasil. Esta disparidad puede estar asociada a la falta de control de los factores de riesgo y comorbilidades durante la pandemia. Los hallazgos resaltan la necesidad de adoptar medidas preventivas para mitigar los efectos adversos sobre la muerte en el hogar y mejorar los servicios de salud, en especial con respecto a la equidad en la distribución de recursos escasos durante la pandemia.

Leptina, obesidad y enfermedades cardiovasculares / Leptin, obesity and cardiovascular diseases

Introducción: la obesidad está asociada con el síndrome metabólico, la hipertensión, la aterosclerosis y las enfermedades del corazón. El tejido adiposo funciona como un órgano endocrino al secretar múltiples proteínas inmunomoduladoras conocidas como adipocinas, que pueden actuar en forma directa sobre órganos cercanos o remotos. Objetivos: la búsqueda de las funciones de las diferentes adipocinas ha permitido establecer la relación entre obesidad y enfermedades cardiovasculares. La primera conduce a mayor expresión de algunas adipocinas proinamatorias y disminución de otras antiinamatorias, dando como resultado el desarrollo de un estado inamatorio crónico de bajo grado. Discusión: algunas adipocinas disminuyen su expresión en sujetos obesos. Sin embargo, la leptina la aumenta en obesidad y promueve complicaciones relacionadas con esta. Conclusiones: estudios clínicos y experimentales indican que la leptina contribuye al desarrollo de cardiopatía isquémica y ejerce acciones perniciosas en las enfermedades cardiovasculares relacionadas con la obesidad.

Introduction: obesity is associated with metabolic syndrome, hypertension, atherosclerosis and heart disease. Adipose tissue functions as an endocrine organ by secreting multiple immune-modulatory proteins known as adipokines, that can directly act on nearby or remote organs. Objetive: research on the various functions of adipokines has shed light on the relationship between obesity and cardiovascular diseases. Obesity leads to increased expression of some pro-inammatory adipokines and diminished expression of other anti-inammatory adipokines, resulting in the development of a chronic low-grade inammatory state. Some adipokines decrease their expression in obese individuals. However, obese subjects have elevated leptin levels which promote obesity-related complications. Conclusions: clinical and experimental studies indicate that leptin contributes to the development of ischemic heart disease and exerts pernicious actions on obesity-linked cardiovascular diseases.

Perfil de riesgo cardiovascular en mujeres de tres entornos de la Provincia de Tucumán - Argentina / Cardiovascular risk profile in women from three different areas of the Province of Tucumán, Argentina

RESUMEN Introducción : El rol del entorno sobre la salud en la población femenina de Tucumán está poco estudiado. El objetivo del presente trabajo fue evaluar el perfil de riesgo cardiovascular de mujeres de los entornos rural, periurbano y urbano de la provincia de Tucumán (Argentina). Material y métodos : Se efectuó un estudio analítico transversal en 3 grupos de mujeres de Tucumán: rural (n=125), periurbano (n= 50) y urbano (n=112). Resultados : La presión arterial (PA) fue menor en el grupo rural; el grupo urbano presentó mayor frecuencia cardíaca y menor circunferencia de cuello. El 29,7% de las mujeres presentaron sobrepeso y el 42,4% obesidad, sin diferencia significativa entre los 3 grupos. La circunferencia de cuello estuvo aumentada en el 62% de las mujeres del grupo rural, 79% del periurbano y 41% del urbano (p<0,001). El grupo urbano presentó más frecuentemente tabaquismo. En los grupos urbano y periurbano fue mayor la proporción de mujeres con estudios superiores (p <0,001). El nivel educativo se correlacionó positivamente con la frecuencia cardíaca. Conclusiones : Independientemente del entorno las mujeres de Tucumán presentan sobrepeso u obesidad asociados a otros factores de riesgo para enfermedad cardiovascular. Ello debe ser tenido en cuenta para la elaboración de políticas y la toma de conductas a fin de mejorar su pronóstico.

ABSTRACT Background : The role of the environment on female population health in Tucumán has been little studied. This study aimed to evaluate the cardiovascular risk profile in women from rural, peri-urban and urban areas in the province of Tucumán (Argentina) and to analyse their differences. Methods : An analytical cross-sectional study was conducted in 3 groups of women from Tucumán: rural (n = 125), peri-urban (n = 50) and urban (n = 112). Results : Blood pressure (BP) was lower in the rural group; the urban group showed higher heart rate and smaller neck cir cumference. Of the studied women, 29.7% were overweight and 42.4% obese, and no significant differences were found in the 3 groups. Increased neck circumference was observed in 62% of women in the rural group, 79% in the peri-urban group and 41% in the urban group (p <0.001). Smoking was more frequent in the urban group. In the urban and peri-urban groups, the proportion of women with higher education level was greater (p <0.001). Education level was positively correlated with heart rate. Conclusion : Regardless of the environment, women from Tucumán are overweight or obese and have other risk factors for cardiovascular disease. This should be considered when planning policies and making decisions in order to improve their prognosis.

Estrategia de apropiación social del conocimiento en la isquemia cardiaca / Strategy for the social appropriation of knowledge in myocardial ischemia

Introducción: La construcción de conocimiento a partir del intercambio de saberes entre pacientes, familias y equipo de salud es una necesidad sentida que puede impactar en la educación en salud y la adherencia a los tratamientos. Objetivo: Desarrollar una estrategia de apropiación social que permita innovar en el cuidado de la salud de las personas con enfermedad isquémica cardiaca y sus familias mediante el uso de la herramienta MHealth. Materiales y Métodos: Estudio exploratorio que permitió el diseño de una estrategia de apropiación social de conocimiento para mejorar la salud cardiovascular de personas que sufren isquemia cardiaca. Participaron 31 personas entre pacientes, familiares, profesionales de la salud. Se desarrollaron dos talleres virtuales en el mes de junio y seguimientos telefónicos entre agosto y septiembre. Las experiencias y saberes de los participantes, permitió la construcción de la herramienta MHealth. Resultados: La reflexión crítica entre los actores facilitó la construcción y desarrollo de la herramienta tipo MHealth (página web/app) titulada "Cuidando tu corazón", que permite el acceso a información relacionada con el cuidado durante la isquemia cardiaca y articula información a partir del diálogo de saberes y la evidencia reportada en la literatura. Discusión: Las estrategias de apropiación social son una herramienta relevante para la generación de conocimiento en el área de la salud. Conclusiones: La estrategia implementada permitió reconocer la importancia de contar con herramientas para el cuidado de la salud cardiovascular elaboradas desde las necesidades, perspectivas y creencias de sus actores para mejorar la educación y el cuidado.

Introduction: The construction of knowledge from the exchange of knowledge between patients, families, and healthcare teams is a felt need that can impact health education and adherence to treatment. Objective: To develop a social appropriation strategy that enables innovation in the health care of people with ischemic heart disease and their families through the use of an MHealth tool. Materials and methods: Exploratory study that allowed the design of a strategy for the social appropriation of knowledge to improve the cardiovascular health of people suffering from myocardial ischemia. Thirty-one people participated, including patients, family members, and health professionals. Two virtual workshops were held in June, and follow-up phone calls were made between August and September. The participant's experiences and knowledge enabled the construction of the MHealth tool. Results: The critical reflection of the stakeholders facilitated the construction and development of the MHealth tool (webpage/app) named "Cuidando tu corazón" (Taking care of your heart). Discussion: Social appropriation strategies are a relevant tool for knowledge creation in health. Conclusions: The strategy implemented made it possible to recognize the importance of developing cardiovascular healthcare tools from stakeholders' needs, perspectives, and beliefs to improve education and care.

Introdução: A construção do conhecimento a partir da troca de conhecimentos entre pacientes, familiares e equipe de saúde é uma necessidade sentida que pode impactar na educação em saúde e na adesão aos tratamentos. Objetivo: Desenvolver uma estratégia de apropriação social que permita inovar na atenção à saúde de pessoas com doença isquêmica do coração e seus familiares por meio do uso da ferramenta MHealth. Materiais e Métodos: Estudo exploratório que permitiu desenhar uma estratégia de apropriação social do conhecimento para melhorar a saúde cardiovascular de pessoas com isquemia cardíaca. Participaram 31 pessoas, entre pacientes, familiares e profissionais de saúde. Foram realizadas dois seminários virtuais em junho e acompanhamentos por telefone entre agosto e setembro. As experiências e conhecimentos dos participantes permitiram a construção da ferramenta MHealth. Resultados: A reflexão crítica entre os atores facilitou a construção e desenvolvimento da ferramenta do tipo MHealth (página web/ aplicativo) intitulada "Cuidando do seu coração", que permite o acesso às informações relacionadas aos cuidados durante a isquemia cardíaca e articula as informações a partir do diálogo de conhecimento e as evidências relatadas na literatura. Discussão: As estratégias de apropriação social são uma ferramenta relevante para a geração de conhecimento na área da saúde. Conclusões: A estratégia implementada possibilitou reconhecer a importância de ter ferramentas para o cuidado à saúde cardiovascular elaboradas a partir das necessidades, perspectivas e crenças de seus atores para melhorar a educação e o cuidado.