Chagas cardiomyopathy in the context of the chronic disease transition.

BACKGROUND: Patients with Chagas disease have migrated to cities, where obesity, hypertension and other cardiac risk factors are common. METHODOLOGY/PRINCIPAL FINDINGS: The study included adult patients evaluated by the cardiology service in a public hospital in Santa Cruz, Bolivia. Data included risk factors for T. cruzi infection, medical history, physical examination, electrocardiogram, echocardiogram, and contact 9 months after initial data collection to ascertain mortality. Serology and PCR for Trypanosoma cruzi were performed. Of 394 participants, 251 (64%) had confirmed T. cruzi infection by serology. Among seropositive participants, 109 (43%) had positive results by conventional PCR; of these, 89 (82%) also had positive results by real time PCR. There was a high prevalence of hypertension (64%) and overweight (body mass index [BMI] >25; 67%), with no difference by T. cruzi infection status. Nearly 60% of symptomatic congestive heart failure was attributed to Chagas cardiomyopathy; mortality was also higher for seropositive than seronegative patients (p = 0.05). In multivariable models, longer residence in an endemic province, residence in a rural area and poor housing conditions were associated with T. cruzi infection. Male sex, increasing age and poor housing were independent predictors of Chagas cardiomyopathy severity. Males and participants with BMI

COPAIA 5. Gestión de políticas públicas mercados saludables: Municipio Santa Cruz de la Sierra-Bolivia

[Introducción] Los mercados en Santa Cruz, se han desarrollado al margen de la planificación, donde la problemática va mas allá de las malas condiciones de venta, higiene y manipulación de alimentos, encierra problemas sociales generados por pobreza, la venta de alimentos, cada vez más creciente, se ha convertido en una actividad de sobrevivencia ante la falta de empleo formal, entorno que dificulta el ordenamiento de los mercados. El Municipio de Santa Cruz de la Sierra (Bolivia) asume el reto e inicia el proceso de mejoramiento de sus mercados, a través del programa Mercados Saludables y Productivos, impulsado por la OPS- OMS, como una alternativa que favorece la salud, la educación, el orden higiénico sanitario del expendio y manejo de alimentos. Se inicia el proceso con muy buenos resultados, especialmente; actualmente se ha institucionalizado el programa y se encuentra en fase consolidación.

[Introduction] The development of markets in Santa Cruz has been unplanned, and the issues that beset them go beyond the deficient environment for the sale of food products and, poor hygiene and food-handling conditions to include social problems generated by poverty. Food vending--which is rapidly growing — has become a subsistence activity given the dearth of formal employment, a situation that makes it difficult to organize the markets. The Municipio of Santa Cruz de la Sierra (Bolivia) is responding the challenge and embarking on an effort to improve its markets through the Healthy and Productive Markets Program, promoted by PAHO/WHO, as an alternative for improving health, education, hygiene and sanitation in food sales and handling. The initial results have been very positive; the program has been given institutional status and is currently in the consolidation phase.