Effectiveness of peer mentoring and self-monitoring to improve blood pressure control in a vulnerable population in Argentina: Pragmatic randomized open-label controlled trial.

OBJECTIVE: To evaluate the effectiveness of blood pressure (BP) self-monitoring and peer mentoring to improve the control of hypertension in clinical practice in primary care centers (PCCs) located in low-resource settings in Argentina. METHODS: An individual randomized controlled trial was carried out to test two different approaches based on behavioral interventions in PCCs in Argentina. Hypertensive adults were randomly assigned to one of three arms: BP self-monitoring, peer mentoring, and usual care. The primary outcome was the change in BP values from baseline to the end of follow-up at 3 months. A qualitative approach of participants' experiences of the peer mentoring arm was also conducted. RESULTS: A total of 442 participants with hypertension were included in the study. Self-monitoring and peer mentoring interventions did not show a significant difference in BP control compared to usual care. However, this trial showed an improvement regarding antihypertensive medication adherence among those assigned to the peer mentoring intervention compared to the control at the end of follow-up (p = 0.031). DISCUSSION: Self-monitoring and peer mentoring interventions did not demonstrate to be effective in BP control compared to usual care. Implementing a peer support strategy was demonstrated to be feasible and effective in improving medication adherence in this population.

Attributes of the food and physical activity built environments from the Southern Cone of Latin America.

Previous studies have shown the influence of the physical and social environments on the development of obesity and non-communicable diseases (NCD). An obesogenic environment promotes higher dietary energy intakes and sedentary behaviors while limiting opportunities or incentives for active living. This paper presents a dataset with key attributes of the food and physical activity built environment, including green spaces, quality of streets and sidewalks, and different types of food retail outlets in four cities of the Southern Cone of Latin America. A total of 139 representative neighborhoods randomly selected from: Marcos Paz and Bariloche (Argentina), Temuco (Chile) and Canelones-Barros Blancos (Uruguay) were evaluated, where standardized community walks were conducted for direct observation of the built environment. This dataset will contribute valuable data to the evaluation of obesogenic environments in the region, and could be linked to additional ecological information about risk factors for NCDs and socio-economic features from other sources. Understanding environmental influences on cardiovascular risk factors and individual habits may help explain NCD outcomes and plan urban policies.

Development of physical activity and food built environment quality indicators for chronic diseases in Argentina.

Although obesity and non-communicable disease (NCD) prevention efforts to-date have focused mainly on individual level factors, the social and physical environments in which people live are now widely recognized as important social determinants of health. Obesogenic environments promote higher dietary energy intakes and sedentary behaviors, thus contributing to the obesity/NCD burden. To develop quality indicators (QIs) for measuring food and physical activity (PA)-built environments in municipalities. A literature review was conducted. Based on the best practices identified from this review, a draft set of candidate QI was retrieved. The initial 67 QIs were then evaluated by a modified Delphi panel of multidisciplinary health professionals (n = 40) to determine their relevance, validity, and feasibility in 3 rounds of voting and threaded discussion using a modified RAND/University of California, Los Angeles Appropriateness Methodology. Response rate for the panel was 89.4%. All final 42 QIs were rated as highly relevant, valid, and feasible (median rating ≥ 7 on a 1-9 scale), with no significant disagreement. The final QI set addresses for the PA domain: (i) promotion of PA; and (ii) improvements in the environment to strengthen the practice of PA; and for Food environment domain: (i) promotion of healthy eating; (ii) access to healthy foods; and (iii) promotion of responsible advertising. We generated a set of indicators to evaluate the PA and food built environment, which can be adapted for use in Latin American and other low- and middle-income countries.

The built environment has a considerable effect on health indicators such as physical activity, eating behavior, and community. There is considerable research evidence demonstrating a direct relationship between our built environments and our health. In Argentina, the Healthy Municipalities and Communities Program focuses in health promotion interventions. It was developed to seek collaboration among community members, local government authorities and other stakeholders in order to improve quality of life. However, up to date, there has not been a homogenous measure to evaluate how well a particular locality or a whole municipality supports the health and wellbeing its residents. The proposed study aims to develop a set of local valid and common measures in order to evaluate what is happening within a particular municipality. A designated group of local experts will select a set of final measures trough out an iterative multistage process in order to combine opinion into group consensus. We will ask the panel to rate, discuss and re-rate the proposed measures (based on the existing evidence). This will study provide an evaluative tool to inform policy making and program implementation, and to guide programs and initiatives aimed at combating obesogenic environments in municipalities and communities.

Cost-Effectiveness of a Comprehensive Approach for Hypertension Control in Low-Income Settings in Argentina: Trial-Based Analysis of the Hypertension Control Program in Argentina.

BACKGROUND: A recent cluster randomized trial evaluating a multicomponent intervention showed significant reductions in blood pressure in low-income hypertensive subjects in Argentina. OBJECTIVES: To assess the cost-effectiveness of this intervention. METHODS: A total of 1432 hypertensive participants were recruited from 18 primary health care centers. The intervention included home visits led by community health workers, physician education, and text messaging. Resource use and quality of life data using the three-level EuroQol five-dimensional questionnaire were prospectively collected. The study perspective was that of the public health care system, and the time horizon was 18 months. Intention-to-treat analysis was used to analyze cost and health outcomes (systolic blood pressure [SBP] change and quality-adjusted life-years [QALYs]). A 1 time gross domestic product per capita per QALY was used as the cost-effectiveness threshold (US $14,062). RESULTS: Baseline characteristics were similar in the two arms. QALYs significantly increased by 0.06 (95% confidence interval [CI] 0.04-0.09) in the intervention group, and SBP net difference favored the intervention group: 5.3 mm Hg (95% CI 0.27-10.34). Mean total costs per participant were higher in the intervention arm: US $304 in the intervention group and US $154 in the control group (adjusted difference of US $140.18; 95% CI US $75.41-US $204.94). The incremental cost-effectiveness ratio was $3299 per QALY (95% credible interval 1635-6099) and US $26 per mm Hg of SBP (95% credible interval 13-46). Subgroup analysis showed that the intervention was cost-effective in all prespecified subgroups (age, sex, cardiovascular risk, and body mass index). CONCLUSIONS: The multicomponent intervention was cost-effective for blood pressure control among low-income hypertensive patients.

Evaluación del impacto sanitario del Programa Estaciones Saludables en la Ciudad Autónoma de Buenos Aires, Argentina

[RESUMEN]. Objetivo. Explorar las motivaciones y expectativas de los usuarios del Programa de Estaciones Saludables en la Ciudad Autónoma de Buenos Aires y evaluar su potencial impacto sanitario. Métodos. Se realizaron entrevistas en profundidad (n = 34) y una encuesta autoadministrada (n = 605) a usuarios del programa. Se desarrolló un modelo epidemiológico para estimar el impacto del programa sobre los eventos cardiovasculares y los años de vida ajustados por discapacidad (AVAD). Resultados. Los principales factores motivadores para el uso de las estaciones saludables fueron la accesibilidad geográfica, económica (servicios gratuitos) y la satisfacción con la atención recibida. El 14,4% (intervalos de confianza del 95% [IC95%] 10,3–18,5%) de los usuarios hipertensos y el 24,8% (IC95% 17,6–32,0%) de los diabéticos informó haberse enterado de sus valores alterados en las estaciones saludables. Más de la mitad de los encuestados reportó alguna mejora de conocimientos sobre los beneficios de realizar actividad física y una alimentación saludable; esto fue más frecuente entre los usuarios más jóvenes, de menor nivel educativo, usuarios del sistema público de salud, usuarios de estaciones saludables de la zona sur y los que tenían algún factor de riesgo cardiometabólico (p<0.05). Se estimó que debido a la existencia de estaciones saludables se evitarían 12,5 eventos cardiovasculares y cerebrovasculares por año en la población asistida (4,75 eventos/100 000 personas) y 47,75 AVAD por estas causas. Conclusiones. Las estaciones saludables resultan un espacio propicio para la implementación de acciones de promoción de la salud y prevención, contribuyendo en la detección y facilitando el monitoreo de los factores de riesgo, con potencialidad para prevenir eventos cardiovasculares y sus consecuencias.

[ABSTRACT]. Objective. To explore the motivations and expectations of the users of the Program for Healthy Centers in the Autonomous City of Buenos Aires and to evaluate its potential health impact. Methods. In-depth interviews were conducted (n = 34) and a self-administered survey was sent to users of the program (n = 605). An epidemiological model was developed to estimate the impact of the program on cardiovascular events (CVE) and disability-adjusted life years (DALYs). Results. The main motivating factors for using the healthy centers were geographic and economic accessibility (free services) and satisfaction with the care received. 14.4% (95% CI, 10.3-18.5%) of hypertensive users and 24.8% (95% CI, 17.6-32.0%) of diabetic users reported having learned of their altered values in the healthy center. More than half of the respondents reported some improvement in their knowledge about the benefits of physical activity and healthy eating; this was more frequent among those who were younger, of lower educational level, users of the public health system, users of a healthy center in the South zone and those who had a cardiometabolic risk factor (p<0.05). It was estimated that the healthy centers would prevent 12.5 cardiovascular and cerebrovascular events per year in the assisted population (4.75 events/100 000) and 47.75 DALYs due to these causes. Conclusions. The healthy centers are a favorable space for the implementation of health promotion and prevention actions, contributing to the detection of and facilitating the monitoring of risk factors, with a potential to prevent cardiovascular events and its consequences.

[RESUMO]. Objetivo. Explorar as motivações e expectativas dos usuários do Programa Estações Saudáveis na Cidade Autônoma de Buenos Aires e avaliar seu impacto potencial na saúde. Métodos. Foram realizadas entrevistas em profundidade (n = 34) e uma pesquisa auto-administrada (n = 605) a usuários do programa. Um modelo epidemiológico foi desenvolvido para estimar o impacto do programa em eventos cardiovasculares e anos de vida ajustados por incapacidade (DALY). Resultados. Os principais fatores motivadores para o uso do estações saudáveis foram a acessibilidade geográfica, econômica (serviços gratuitos) e a satisfação com o atendimento recebido. 14,4% (intervalo de confiança de 95% [IC95%] 10,3-18,5%) de usuários hipertensos e 24,8% (IC95% 17,6-32,0%) dos diabéticos relataram ter aprendido sobre seus valores alterados na estação saudável. Mais da metade dos entrevistados relataram alguma melhora no conhecimento sobre os benefícios da atividade física e da alimentação saudável, com maior freqüência entre os mais jovens, de menor escolaridade, usuários do sistema público de saúde, usuários de estações saudáveis na zona sul e aqueles que apresentaram algum fator de risco cardiometabólico (p<0,05). Estimou-se que, devido à existência de estações saudáveis, 12,5 eventos cardiovasculares e cerebrovasculares por ano seriam evitados na população atendida (4,75 eventos/100 000) e 47,75 DALY por essas causas. Conclusões. As estações saudáveis são um espaço propício para a implementação de ações de promoção e prevenção da saúde, contribuindo para a detecção e facilitação do monitoramento dos fatores de risco, com potencial para prevenir os eventos cardiovasculares e suas consequências.

Geospatial and environmental analysis of road traffic accidents in the city of Resistencia, Argentina. / Análisis espacial y del entorno físico de accidentes de tránsito en la ciudad de Resistencia, Chaco, Argentina.

Traffic accidents are an emerging problem in cities with high mobility and little urban planning. Evidence is lacking in Argentina regarding the relationship between the environment and accident occurrence; we therefore conducted a geospatial analysis and estimated the risk of accidents and their possible association with the characteristics of the physical environment in the city of Resistencia, Argentina occurring in 2012. Kernel density estimates were used for the spatial distribution of accidents and in parallel an observational, analytical study was carried out to analyze the factors associated with accident occurrence. The results show three critical areas (in the northwest, center and south of the city) with greater accident frequency. Environmental factors that were associated with the occurrence of accidents were the presence of street lighting (23% greater), the presence of a tree close to the road (47% greater), the presence of a traffic light (28% greater), and if the road was a major avenue (122% greater) and had curves (129% greater). This study shows the city of Resistencia to be in a situation of urban vulnerability due not only to its socioeconomic status but also to the unequal development compared to neighboring cities, a reality that fosters an unfavorable environment.

Los accidentes de tránsito constituyen un problema emergente en ciudades con alta movilidad y baja planificación urbana. No existe suficiente evidencia en Argentina acerca de la relación entre el entorno y la ocurrencia de accidentes. Por ello, realizamos un análisis espacial de ocurrencia y estimamos el riesgo de ocurrencia de accidentes en el año 2012 y su posible asociación con las características del entorno físico en la ciudad de Resistencia, provincia del Chaco, Argentina. Para el análisis espacial de los accidentes se utilizó la estimación de densidad kernel. Luego, a través de un estudio observacional y analítico se procedió a analizar los factores asociados a la ocurrencia de los accidentes. Los resultados muestran que existen tres zonas críticas (noroeste, centro y sur) con mayor frecuencia de accidentes. Los factores del entorno que estuvieron asociados con la ocurrencia de accidentes fueron la presencia de iluminación vial (23% menor), árbol próximo a la calzada (47% mayor), la presencia de semáforo (28% mayor), avenidas (122% mayor) y disposición curva de la calzada (129% mayor). Este estudio ubica a la ciudad de Resistencia en una situación de vulnerabilidad urbana, no solo por el contexto socioeconómico donde se encuentra sino por el desigual desarrollo territorial que presenta respecto a las ciudades vecinas, que propicia un entorno desfavorable.

Análisis espacial y del entorno físico de accidentes de tránsito en la ciudad de Resistencia, Chaco, Argentina / Geospatial and environmental analysis of road traffic accidents in the city of Resistencia, Argentina

RESUMEN Los accidentes de tránsito constituyen un problema emergente en ciudades con alta movilidad y baja planificación urbana. No existe suficiente evidencia en Argentina acerca de la relación entre el entorno y la ocurrencia de accidentes. Por ello, realizamos un análisis espacial de ocurrencia y estimamos el riesgo de ocurrencia de accidentes en el año 2012 y su posible asociación con las características del entorno físico en la ciudad de Resistencia, provincia del Chaco, Argentina. Para el análisis espacial de los accidentes se utilizó la estimación de densidad kernel. Luego, a través de un estudio observacional y analítico se procedió a analizar los factores asociados a la ocurrencia de los accidentes. Los resultados muestran que existen tres zonas críticas (noroeste, centro y sur) con mayor frecuencia de accidentes. Los factores del entorno que estuvieron asociados con la ocurrencia de accidentes fueron la presencia de iluminación vial (23% menor), árbol próximo a la calzada (47% mayor), la presencia de semáforo (28% mayor), avenidas (122% mayor) y disposición curva de la calzada (129% mayor). Este estudio ubica a la ciudad de Resistencia en una situación de vulnerabilidad urbana, no solo por el contexto socioeconómico donde se encuentra sino por el desigual desarrollo territorial que presenta respecto a las ciudades vecinas, que propicia un entorno desfavorable.

ABSTRACT Traffic accidents are an emerging problem in cities with high mobility and little urban planning. Evidence is lacking in Argentina regarding the relationship between the environment and accident occurrence; we therefore conducted a geospatial analysis and estimated the risk of accidents and their possible association with the characteristics of the physical environment in the city of Resistencia, Argentina occurring in 2012. Kernel density estimates were used for the spatial distribution of accidents and in parallel an observational, analytical study was carried out to analyze the factors associated with accident occurrence. The results show three critical areas (in the northwest, center and south of the city) with greater accident frequency. Environmental factors that were associated with the occurrence of accidents were the presence of street lighting (23% greater), the presence of a tree close to the road (47% greater), the presence of a traffic light (28% greater), and if the road was a major avenue (122% greater) and had curves (129% greater). This study shows the city of Resistencia to be in a situation of urban vulnerability due not only to its socioeconomic status but also to the unequal development compared to neighboring cities, a reality that fosters an unfavorable environment.

[Health impact assessment of the Program Healthy Centers in the Autonomous City of Buenos Aires, ArgentinaAvaliação do impacto na saúde do Programa Estações Saudáveis na Cidade Autônoma de Buenos Aires, Argentina]. / Evaluación del impacto sanitario del Programa Estaciones Saludables en la Ciudad Autónoma de Buenos Aires, Argentina.

OBJECTIVE: To explore the motivations and expectations of the users of the Program for Healthy Centers in the Autonomous City of Buenos Aires and to evaluate its potential health impact. METHODS: In-depth interviews were conducted (n = 34) and a self-administered survey was sent to users of the program (n = 605). An epidemiological model was developed to estimate the impact of the program on cardiovascular events (CVE) and disability-adjusted life years (DALYs). RESULTS: The main motivating factors for using the healthy centers were geographic and economic accessibility (free services) and satisfaction with the care received. 14.4% (95% CI, 10.3-18.5%) of hypertensive users and 24.8% (95% CI, 17.6-32.0%) of diabetic users reported having learned of their altered values in the healthy center. More than half of the respondents reported some improvement in their knowledge about the benefits of physical activity and healthy eating; this was more frequent among those who were younger, of lower educational level, users of the public health system, users of a healthy center in the South zone and those who had a cardiometabolic risk factor (p<0.05). It was estimated that the healthy centers would prevent 12.5 cardiovascular and cerebrovascular events per year in the assisted population (4.75 events/100 000) and 47.75 DALYs due to these causes. CONCLUSIONS: The healthy centers are a favorable space for the implementation of health promotion and prevention actions, contributing to the detection of and facilitating the monitoring of risk factors, with a potential to prevent cardiovascular events and its consequences.

OBJETIVO: Explorar as motivações e expectativas dos usuários do Programa Estações Saudáveis na Cidade Autônoma de Buenos Aires e avaliar seu impacto potencial na saúde. MÉTODOS: Foram realizadas entrevistas em profundidade (n = 34) e uma pesquisa auto-administrada (n = 605) a usuários do programa. Um modelo epidemiológico foi desenvolvido para estimar o impacto do programa em eventos cardiovasculares e anos de vida ajustados por incapacidade (DALY). RESULTADOS: Os principais fatores motivadores para o uso do estações saudáveis foram a acessibilidade geográfica, econômica (serviços gratuitos) e a satisfação com o atendimento recebido. 14,4% (intervalo de confiança de 95% [IC95%] 10,3-18,5%) de usuários hipertensos e 24,8% (IC95% 17,6-32,0%) dos diabéticos relataram ter aprendido sobre seus valores alterados na estação saudável. Mais da metade dos entrevistados relataram alguma melhora no conhecimento sobre os benefícios da atividade física e da alimentação saudável, com maior freqüência entre os mais jovens, de menor escolaridade, usuários do sistema público de saúde, usuários de estações saudáveis na zona sul e aqueles que apresentaram algum fator de risco cardiometabólico (p<0,05). Estimou-se que, devido à existência de estações saudáveis, 12,5 eventos cardiovasculares e cerebrovasculares por ano seriam evitados na população atendida (4,75 eventos/100 000) e 47,75 DALY por essas causas. CONCLUSÕES: As estações saudáveis são um espaço propício para a implementação de ações de promoção e prevenção da saúde, contribuindo para a detecção e facilitação do monitoramento dos fatores de risco, com potencial para prevenir os eventos cardiovasculares e suas consequências.

Evaluación del impacto sanitario del Programa Estaciones Saludables en la Ciudad Autónoma de Buenos Aires, Argentina / Health impact assessment of the Program Healthy Centers in the Autonomous City of Buenos Aires, Argentina / Avaliação do impacto na saúde do Programa Estações Saudáveis na Cidade Autônoma de Buenos Aires, Argentina

RESUMEN Objetivo Explorar las motivaciones y expectativas de los usuarios del Programa de Estaciones Saludables en la Ciudad Autónoma de Buenos Aires y evaluar su potencial impacto sanitario. Métodos Se realizaron entrevistas en profundidad (n = 34) y una encuesta autoadministrada (n = 605) a usuarios del programa. Se desarrolló un modelo epidemiológico para estimar el impacto del programa sobre los eventos cardiovasculares y los años de vida ajustados por discapacidad (AVAD). Resultados Los principales factores motivadores para el uso de las estaciones saludables fueron la accesibilidad geográfica, económica (servicios gratuitos) y la satisfacción con la atención recibida. El 14,4% (intervalos de confianza del 95% [IC95%] 10,3-18,5%) de los usuarios hipertensos y el 24,8% (IC95% 17,6-32,0%) de los diabéticos informó haberse enterado de sus valores alterados en las estaciones saludables. Más de la mitad de los encuestados reportó alguna mejora de conocimientos sobre los beneficios de realizar actividad física y una alimentación saludable; esto fue más frecuente entre los usuarios más jóvenes, de menor nivel educativo, usuarios del sistema público de salud, usuarios de estaciones saludables de la zona sur y los que tenían algún factor de riesgo cardiometabólico (p<0.05). Se estimó que debido a la existencia de estaciones saludables se evitarían 12,5 eventos cardiovasculares y cerebrovasculares por año en la población asistida (4,75 eventos/100 000 personas) y 47,75 AVAD por estas causas. Conclusiones Las estaciones saludables resultan un espacio propicio para la implementación de acciones de promoción de la salud y prevención, contribuyendo en la detección y facilitando el monitoreo de los factores de riesgo, con potencialidad para prevenir eventos cardiovasculares y sus consecuencias.

ABSTRACT Objective To explore the motivations and expectations of the users of the Program for Healthy Centers in the Autonomous City of Buenos Aires and to evaluate its potential health impact. Methods In-depth interviews were conducted (n = 34) and a self-administered survey was sent to users of the program (n = 605). An epidemiological model was developed to estimate the impact of the program on cardiovascular events (CVE) and disability-adjusted life years (DALYs). Results The main motivating factors for using the healthy centers were geographic and economic accessibility (free services) and satisfaction with the care received. 14.4% (95% CI, 10.3-18.5%) of hypertensive users and 24.8% (95% CI, 17.6-32.0%) of diabetic users reported having learned of their altered values in the healthy center. More than half of the respondents reported some improvement in their knowledge about the benefits of physical activity and healthy eating; this was more frequent among those who were younger, of lower educational level, users of the public health system, users of a healthy center in the South zone and those who had a cardiometabolic risk factor (p<0.05). It was estimated that the healthy centers would prevent 12.5 cardiovascular and cerebrovascular events per year in the assisted population (4.75 events/100 000) and 47.75 DALYs due to these causes. Conclusions The healthy centers are a favorable space for the implementation of health promotion and prevention actions, contributing to the detection of and facilitating the monitoring of risk factors, with a potential to prevent cardiovascular events and its consequences.

RESUMO Objetivo Explorar as motivações e expectativas dos usuários do Programa Estações Saudáveis na Cidade Autônoma de Buenos Aires e avaliar seu impacto potencial na saúde. Métodos Foram realizadas entrevistas em profundidade (n = 34) e uma pesquisa auto-administrada (n = 605) a usuários do programa. Um modelo epidemiológico foi desenvolvido para estimar o impacto do programa em eventos cardiovasculares e anos de vida ajustados por incapacidade (DALY). Resultados Os principais fatores motivadores para o uso do estações saudáveis foram a acessibilidade geográfica, econômica (serviços gratuitos) e a satisfação com o atendimento recebido. 14,4% (intervalo de confiança de 95% [IC95%] 10,3-18,5%) de usuários hipertensos e 24,8% (IC95% 17,6-32,0%) dos diabéticos relataram ter aprendido sobre seus valores alterados na estação saudável. Mais da metade dos entrevistados relataram alguma melhora no conhecimento sobre os benefícios da atividade física e da alimentação saudável, com maior freqüência entre os mais jovens, de menor escolaridade, usuários do sistema público de saúde, usuários de estações saudáveis na zona sul e aqueles que apresentaram algum fator de risco cardiometabólico (p<0,05). Estimou-se que, devido à existência de estações saudáveis, 12,5 eventos cardiovasculares e cerebrovasculares por ano seriam evitados na população atendida (4,75 eventos/100 000) e 47,75 DALY por essas causas. Conclusões As estações saudáveis são um espaço propício para a implementação de ações de promoção e prevenção da saúde, contribuindo para a detecção e facilitação do monitoramento dos fatores de risco, com potencial para prevenir os eventos cardiovasculares e suas consequências.

MECA; Salud mental y adulto mayor / MECA: Mental health and the elderly

Hoy en día, por primera vez en la historia, la mayoría de las personas puede aspirar a vivir hasta entrados los 60 años y más. Los adultos mayores pueden padecer alteraciones de su salud mental que es preciso reconocer. Las investigaciones y la información son la base para establecer políticas de salud acertadas. El fortalecimiento de la capacidad de investigación es uno de los medios para la promoción de la salud y control de las enfermedades. Sin embargo, la inversión sigue siendo desproporcionadamente baja en la región en comparación con la carga de enfermedad. Por lo tanto, es importante que la promoción de la investigación y el desarrollo respondan a las necesidades de investigación locales y las prioridades de los actores involucrados para optimizar los beneficios para la salud y conducir a la equidad. El objetivo de este estudio fue identificar brechas de conocimiento y prioridades de investigación en salud mental del adulto mayor en Argentina, con la finalidad de contribuir con información rigurosa a los decisores a cargo de establecer la agenda de investigación y optimizar el uso de los recursos. Se utilizó diseño mixto, cualitativo y cuantitativo, en tres fases o etapas que incluyeron; 1) diagnóstico inicial, 2) recolección y análisis de datos (visualización global de las necesidades) y finalmente 3) un ejercicio de priorización basado en la matriz de estrategias combinadas (MECA). Esta herramienta ha sido validada y adaptada en 2006 para su uso en Argentina, en otras áreas temáticas. RESULTADOS Se identificaron dos grandes áreas temáticas a investigar y al interior temas priorizados. Para el tema "Soledad" se priorizaron; 1. Efecto de los programas; 2. Accesibilidad y equidad; 3. Adaptabilidad; 4. Calidad de servicios. Para el tema "Deterioro cognitivo/demencia" se priorizaron; 1. Impacto cuidadores y entorno; 2. Barreras para la implementación de guías y capacitación; 3. Estudios de costo-efectividad sobre intervenciones y calidad de vida; 4. Epidemiología. DISCUSIÓN Se debe enfatizar la importancia de fortalecer la investigación sobre la implementación y difusión de intervenciones de promoción, prevención y prestación de servicios en la salud mental del adulto mayor. La complejidad de la salud mental y su conceptualización más amplia requiere enfoques de investigación complementarios y colaboración interdisciplinaria para satisfacer mejor las necesidades de la población argentina

Educational intervention to improve effectiveness in treatment and control of patients with high cardiovascular risk in low-resource settings in Argentina: study protocol of a cluster randomised controlled trial.

INTRODUCTION: Hypercholesterolaemia is estimated to cause 2.6 million deaths annually and one-third of the cases of ischaemic heart disease. In Argentina, the prevalence of hypercholesterolaemia increased between 2005 and 2013 from 27.9% to 29.8%. Only one out of four subjects with a self-reported diagnosis of coronary heart disease is taking statins. Since 2014, statins (simvastatin 20 mg) are part of the package of drugs provided free-of-charge for patients according to cardiovascular disease (CVD) risk stratification. The goal of this study is to test whether a complex intervention targeting physicians and pharmacist assistants improves treatment and control of hypercholesterolaemia among patients with moderate-to-high cardiovascular risk in Argentina. METHODS AND ANALYSIS: This is a cluster trial of 350 patients from 10 public primary care centres in Argentina to be randomised to either the intervention or usual care. The study is designed to have 90% statistical power to detect a 0.7 mmol/L reduction in low-density lipoproteins cholesterol from baseline to 12 months. The physician education programme consists of a 2-day initial intensive training and certification workshop followed by educational outreach visits (EOVs) conducted at 3, 6 and 9 months from the outset of the study. An on-site training to pharmacist assistants during the first EOV is performed at each intervention clinic. In addition, two intervention support tools are used: an app installed in physician's smartphones to serve as a decision aid to improve prescription of statins according to patient's CVD risk and a web-based platform tailored to send individualised SMS messages to patients. ETHICS AND DISSEMINATION: Ethical approval was obtained from an independent ethics committee. Results of this study will be presented to the Ministry of Health of Argentina for potential dissemination and scale-up of the intervention programme to the entire national public primary care network in Argentina. TRIAL REGISTRATION NUMBER: NCT02380911.

Carga de enfermedad de la insuficiencia cardiaca en América Latina: revisión sistemática y metanálisis / Burden of heart failure in Latin America: a systematic review and meta-analysis

Introducción y objetivos: La insuficiencia cardiaca es un grave problema de salud pública. El objetivo de la revisión es estimar la carga de insuficiencia cardiaca en Latinoamérica. Métodos: Revisión sistemática y metanálisis, tras búsqueda en MEDLINE, EMBASE, LILACS y CENTRAL desde enero de 1994 a junio de 2014, sin restricción de idioma. Se incluyeron estudios experimentales y observacionales con al menos 50 participantes de edad ≥ 18 años. Resultados: Se incluyeron 143 de las 4.792 referencias recuperadas. La mayoría de los estudios se realizaron en Sudamérica (92%), principalmente en Brasil (64%). La media de edad era 60 ± 9 años y la fracción de eyección media, del 36 ± 9%. La incidencia de insuficiencia cardiaca en el único estudio poblacional identificado fue de 199/100.000 personas-años; la prevalencia, del 1% (intervalo de confianza del 95% [IC95%], 0,1-2,7%); las tasas de rehospitalización, del 33, el 28, el 31 y el 35% a 3, 6, 12 y 24-60 meses de seguimiento respectivamente, y la mediana de estancia hospitalaria, 7,0 días. La tasa de mortalidad al año fue del 24,5% (IC95%, 19,4-30,0%). La mortalidad intrahospitalaria fue del 11,7% (IC95%, 10,4-13,0%), y aumentaba en pacientes con fracción de eyección reducida, cardiopatía isquémica y enfermedad de Chagas. Conclusiones: Pocos estudios han evaluado la incidencia y la prevalencia de insuficiencia cardiaca en Latinoamérica. Se hallaron altas tasas de mortalidad y de hospitalización, y la heterogeneidad es su principal limitación. Este estudio brinda la información epidemiológica disponible para la toma de decisiones sobre esta enfermedad. Se requieren más estudios con metodologías estandarizadas y en poblaciones representativas (AU)

Introduction and objectives: Heart failure is a major public health concern. The aim of this review was to estimate the burden of heart failure in Latin America. Methods: Systematic review and meta-analysis following a search in MEDLINE, EMBASE, LILACS, and CENTRAL for articles published between January 1994 and June 2014, with no language restrictions. We included experimental and observational studies with at least 50 participants aged ≥ 18 years. Results: In total, 143 of the 4792 references retrieved were included in the study. Most studies had been conducted in South America (92%), and mainly in Brazil (64%). The mean age of the patients was 60 ± 9 years, and mean ejection fraction was 36% ± 9%. The incidence of heart failure in the single population study providing this information was 199 cases per 100 000 person-years. The prevalence of heart failure was 1% (95% confidence interval [95%CI], 0.1%-2.7%); hospital readmission rates were 33%, 28%, 31%, and 35% at 3, 6, 12, and 24 to 60 months of follow-up, respectively; and the median duration of hospitalization was 7.0 days. The 1-year mortality rate was 24.5% (95%CI, 19.4%-30.0%). In-hospital mortality was 11.7% (95%CI, 10.4%-13.0%), and the rate was higher in patients with a reduced ejection fraction, ischemic heart disease, or Chagas disease. Conclusions: Few studies have evaluated the incidence and prevalence of heart failure in Latin America. High mortality and hospitalization rates were found, and the main limitation was heterogeneity between studies. The results presented provide useful epidemiologic information for decision-making related to this disease. Further studies with standardized methods and representative populations are needed in this line (AU)

Burden of Heart Failure in Latin America: A Systematic Review and Meta-analysis.

INTRODUCTION AND OBJECTIVES: Heart failure is a major public health concern. The aim of this review was to estimate the burden of heart failure in Latin America. METHODS: Systematic review and meta-analysis following a search in MEDLINE, EMBASE, LILACS, and CENTRAL for articles published between January 1994 and June 2014, with no language restrictions. We included experimental and observational studies with at least 50 participants aged ≥ 18 years. RESULTS: In total, 143 of the 4792 references retrieved were included in the study. Most studies had been conducted in South America (92%), and mainly in Brazil (64%). The mean age of the patients was 60 ± 9 years, and mean ejection fraction was 36% ± 9%. The incidence of heart failure in the single population study providing this information was 199 cases per 100000 person-years. The prevalence of heart failure was 1% (95% confidence interval [95%CI], 0.1%-2.7%); hospital readmission rates were 33%, 28%, 31%, and 35% at 3, 6, 12, and 24 to 60 months of follow-up, respectively; and the median duration of hospitalization was 7.0 days. The 1-year mortality rate was 24.5% (95%CI, 19.4%-30.0%). In-hospital mortality was 11.7% (95%CI, 10.4%-13.0%), and the rate was higher in patients with a reduced ejection fraction, ischemic heart disease, or Chagas disease. CONCLUSIONS: Few studies have evaluated the incidence and prevalence of heart failure in Latin America. High mortality and hospitalization rates were found, and the main limitation was heterogeneity between studies. The results presented provide useful epidemiologic information for decision-making related to this disease. Further studies with standardized methods and representative populations are needed in this line.

Epidemiology of chronic disease related to arsenic in Argentina: A systematic review.

Four million people in Argentina are exposed to arsenic contamination from drinking waters of several center-northern provinces. A systematic review to examine the geographical distribution of arsenic-related diseases in Argentina was conducted, searching electronic databases and gray literature up to November 2013. Key informants were also contacted. Of the 430 references identified, 47 (mostly cross-sectional and ecological designs) referred to arsenic concentration in water and its relationship with the incidence and mortality of cancer, dermatological diseases and genetic disorders. A high percentage of the water samples had arsenic concentrations above the WHO threshold value of 10µg/L, especially in the province of Buenos Aires. The median prevalence of arsenicosis was 2.6% in exposed areas. The proportion of skin cancer in patients with arsenicosis reached 88% in case-series from the Buenos Aires province. We found higher incidence rate ratios per 100µg/L increment in inorganic arsenic concentration for colorectal, lung, breast, prostate and skin cancer, for both genders. Liver and skin cancer mortality risk ratios were higher in regions with medium/high concentrations than in those with low concentrations. The relative risk of mortality by skin cancer associated to arsenic exposure in the province of Buenos Aires ranged from 2.5 to 5.2. In the north of this province, high levels of arsenic in drinking water were reported; however, removal interventions were scarcely documented. Arsenic contamination in Argentina is associated with an increased risk of serious chronic diseases, including cancer, showing the need for adequate and timely actions.