[Implementation of the HEARTS Initiative in Argentina: initial resultsImplementação da Iniciativa HEARTS na Argentina: primeiros resultados]. / Implementación de la Iniciativa HEARTS en Argentina: primeros resultados.

Cardiovascular diseases are the leading cause of mortality and morbidity in the Region of the Americas, and hypertension is one of the main risk factors. In 2018, Argentina began implementing the HEARTS Initiative in five primary health care centers, through the National Plan for the Prevention and Control of Arterial Hypertension. This study presents the impact its implementation has had on the indicators of effective coverage, treatment, combination therapy, and control. The HEARTS Initiative has multiple components; these include training health teams, reassigning tasks based on the transfer of clinical competencies, providing automatic and clinically validated blood pressure measurement devices, and using a single standardized treatment protocol. A longitudinal data model (generalized estimating equation analysis) was used, and the information from the five health centers was grouped using weighted averages according to the size of the population under coverage. Analysis of the results was stratified into two time periods delimited by the imposition of restrictions due to COVID-19. During the first period of 18 months, significant improvement was observed in treatment (5.9%; p<0.01) and combination therapy (13.4%; p<0.01), with no significant change in coverage (8.4%; p=0.87) and with a paradoxical decrease in control (-3.3%; p=0.02). When the period of restrictions was compared to the previous period, a generalized reduction was observed in all indicators, particularly coverage (-23.6%; p<0.01) and control (-12.5%; p<0.01). However, treatment and combination therapy levels remained above baseline values (1.7%; p<0.01 and 5.4%; p<0.01, respectively).

As doenças cardiovasculares são a principal causa de morbimortalidade, e a hipertensão, seu principal fator de risco. Em 2018, a Argentina começou a implementar a Iniciativa HEARTS em 5 centros de atenção primária à saúde por meio do Plano Nacional de Prevenção e Controle da Hipertensão Arterial. Este estudo apresenta o impacto de sua implementação nos indicadores de cobertura efetiva, tratamento, tratamento combinado e controle. A Iniciativa HEARTS inclui vários componentes. Entre eles, se destacam a capacitação das equipes de saúde, a reorganização das tarefas com base na transferência de competências clínicas, a disponibilização de aparelhos automáticos e clinicamente validados para aferição da pressão arterial e a utilização de um único protocolo padronizado de tratamento. Foi utilizado um modelo de equações de estimativas generalizadas para a análise de dados longitudinais, e as informações dos 5 centros de saúde foram agrupadas por meio de médias ponderadas de acordo com o tamanho da população coberta. A análise dos resultados foi estratificada em dois períodos de tempo delimitados pela irrupção das restrições em virtude da COVID-19. Durante os primeiros 18 meses, houve melhora significativa no tratamento (5,9%; p<0,01) e no tratamento combinado (13,4%; p<0,01), sem mudança significativa na cobertura (8,4%; p=0,87) e com uma diminuição paradoxal no controle (−3,3%; p=0,02). Durante as restrições e em relação ao período anterior, verificou-se redução generalizada em todos os indicadores, principalmente na cobertura (−23,6%; p<0,01) e no controle (−12,5%; p<0,01). No entanto, os níveis de tratamento e tratamento combinado persistiram acima dos valores basais (1,7%; p<0,01 e 5,4%; p<0,01, respectivamente).

Implementación de la Iniciativa HEARTS en Argentina: primeros resultados

[RESUMEN]. Las enfermedades cardiovasculares son la principal causa de morbimortalidad, y la hipertensión es su principal factor de riesgo. En 2018, Argentina comenzó a implementar la Iniciativa HEARTS en 5 centros de atención primaria de salud a través del Plan Nacional de Prevención y Control de la Hipertensión Arterial. En este estudio se presenta el impacto de su implementación en los indicadores de cobertura efectiva, tratamiento, tratamiento combinado y control. La Iniciativa HEARTS incluye múltiples componentes; entre ellos se destacan la capacitación de los equipos de salud, la reorganización de las tareas basada en la transferencia de competencias clínicas, la provisión de dispositivos de medición de la presión arterial automáticos y clínicamente validados, y la utilización de un único protocolo de tratamiento estandarizado. Se utilizó un modelo de datos longitudinales del tipo ecuación de estimación generalizada, y se agrupó la información de los 5 centros de salud mediante promedios ponderados según el tamaño de la población bajo cobertura. El análisis de los resultados fue estratificado en dos períodos de tiempo delimitados por la irrupción de las restricciones debidas al COVID-19. Durante el primer período de 18 meses se observó una mejoría significativa en el tratamiento (5,9%; p<0,01) y el tratamiento combinado (13,4%; p<0,01), sin cambios significativos en la cobertura (8,4%; p=0,87) y con un descenso paradojal en el control (−3,3%; p=0,02). Durante las restricciones y respecto del período previo, se constató una reducción generalizada en todos los indicadores, principalmente en la cobertura (−23,6%; p<0,01) y el control (−12,5%; p<0,01). Sin embargo, los niveles de tratamiento y tratamiento combinado persistieron por encima de los valores basales (1,7%; p<0,01 y 5,4%; p<0,01, respectivamente).

[ABSTRACT]. Cardiovascular diseases are the leading cause of mortality and morbidity in the Region of the Americas, and hypertension is one of the main risk factors. In 2018, Argentina began implementing the HEARTS Initiative in five primary health care centers, through the National Plan for the Prevention and Control of Arterial Hypertension. This study presents the impact its implementation has had on the indicators of effective coverage, treatment, combination therapy, and control. The HEARTS Initiative has multiple components; these include training health teams, reassigning tasks based on the transfer of clinical competencies, providing automatic and clinically validated blood pressure measurement devices, and using a single standardized treatment protocol. A longitudinal data model (generalized estimating equation analysis) was used, and the information from the five health centers was grouped using weighted averages according to the size of the population under coverage. Analysis of the results was stratified into two time periods delimited by the imposition of restrictions due to COVID-19. During the first period of 18 months, significant improvement was observed in treatment (5.9%; p<0.01) and combination therapy (13.4%; p<0.01), with no significant change in coverage (8.4%; p=0.87) and with a paradoxical decrease in control (−3.3%; p=0.02). When the period of restrictions was compared to the previous period, a generalized reduction was observed in all indicators, particularly coverage (−23.6%; p<0.01) and control (−12.5%; p<0.01). However, treatment and combination therapy levels remained above baseline values (1.7%; p<0.01 and 5.4%; p<0.01, respectively).

[RESUMO]. As doenças cardiovasculares são a principal causa de morbimortalidade, e a hipertensão, seu principal fator de risco. Em 2018, a Argentina começou a implementar a Iniciativa HEARTS em 5 centros de atenção primária à saúde por meio do Plano Nacional de Prevenção e Controle da Hipertensão Arterial. Este estudo apresenta o impacto de sua implementação nos indicadores de cobertura efetiva, tratamento, tratamento combinado e controle. A Iniciativa HEARTS inclui vários componentes. Entre eles, se destacam a capacitação das equipes de saúde, a reorganização das tarefas com base na transferência de competências clínicas, a disponibilização de aparelhos automáticos e clinicamente validados para aferição da pressão arterial e a utilização de um único protocolo padronizado de tratamento. Foi utilizado um modelo de equações de estimativas generalizadas para a análise de dados longitudinais, e as informações dos 5 centros de saúde foram agrupadas por meio de médias ponderadas de acordo com o tamanho da população coberta. A análise dos resultados foi estratificada em dois períodos de tempo delimitados pela irrupção das restrições em virtude da COVID-19. Durante os primeiros 18 meses, houve melhora significativa no tratamento (5,9%; p<0,01) e no tratamento combinado (13,4%; p<0,01), sem mudança significativa na cobertura (8,4%; p=0,87) e com uma diminuição paradoxal no controle (−3,3%; p=0,02). Durante as restrições e em relação ao período anterior, verificou-se redução generalizada em todos os indicadores, principalmente na cobertura (−23,6%; p<0,01) e no controle (−12,5%; p<0,01). No entanto, os níveis de tratamento e tratamento combinado persistiram acima dos valores basais (1,7%; p<0,01 e 5,4%; p<0,01, respectivamente).

Implementación de la Iniciativa HEARTS en Argentina: primeros resultados / Implementation of the HEARTS Initiative in Argentina: initial results / Implementação da Iniciativa HEARTS na Argentina: primeiros resultados

RESUMEN Las enfermedades cardiovasculares son la principal causa de morbimortalidad, y la hipertensión es su principal factor de riesgo. En 2018, Argentina comenzó a implementar la Iniciativa HEARTS en 5 centros de atención primaria de salud a través del Plan Nacional de Prevención y Control de la Hipertensión Arterial. En este estudio se presenta el impacto de su implementación en los indicadores de cobertura efectiva, tratamiento, tratamiento combinado y control. La Iniciativa HEARTS incluye múltiples componentes; entre ellos se destacan la capacitación de los equipos de salud, la reorganización de las tareas basada en la transferencia de competencias clínicas, la provisión de dispositivos de medición de la presión arterial automáticos y clínicamente validados, y la utilización de un único protocolo de tratamiento estandarizado. Se utilizó un modelo de datos longitudinales del tipo ecuación de estimación generalizada, y se agrupó la información de los 5 centros de salud mediante promedios ponderados según el tamaño de la población bajo cobertura. El análisis de los resultados fue estratificado en dos períodos de tiempo delimitados por la irrupción de las restricciones debidas al COVID-19. Durante el primer período de 18 meses se observó una mejoría significativa en el tratamiento (5,9%; p<0,01) y el tratamiento combinado (13,4%; p<0,01), sin cambios significativos en la cobertura (8,4%; p=0,87) y con un descenso paradojal en el control (−3,3%; p=0,02). Durante las restricciones y respecto del período previo, se constató una reducción generalizada en todos los indicadores, principalmente en la cobertura (−23,6%; p<0,01) y el control (−12,5%; p<0,01). Sin embargo, los niveles de tratamiento y tratamiento combinado persistieron por encima de los valores basales (1,7%; p<0,01 y 5,4%; p<0,01, respectivamente).

ABSTRACT Cardiovascular diseases are the leading cause of mortality and morbidity in the Region of the Americas, and hypertension is one of the main risk factors. In 2018, Argentina began implementing the HEARTS Initiative in five primary health care centers, through the National Plan for the Prevention and Control of Arterial Hypertension. This study presents the impact its implementation has had on the indicators of effective coverage, treatment, combination therapy, and control. The HEARTS Initiative has multiple components; these include training health teams, reassigning tasks based on the transfer of clinical competencies, providing automatic and clinically validated blood pressure measurement devices, and using a single standardized treatment protocol. A longitudinal data model (generalized estimating equation analysis) was used, and the information from the five health centers was grouped using weighted averages according to the size of the population under coverage. Analysis of the results was stratified into two time periods delimited by the imposition of restrictions due to COVID-19. During the first period of 18 months, significant improvement was observed in treatment (5.9%; p<0.01) and combination therapy (13.4%; p<0.01), with no significant change in coverage (8.4%; p=0.87) and with a paradoxical decrease in control (−3.3%; p=0.02). When the period of restrictions was compared to the previous period, a generalized reduction was observed in all indicators, particularly coverage (−23.6%; p<0.01) and control (−12.5%; p<0.01). However, treatment and combination therapy levels remained above baseline values (1.7%; p<0.01 and 5.4%; p<0.01, respectively).

RESUMO As doenças cardiovasculares são a principal causa de morbimortalidade, e a hipertensão, seu principal fator de risco. Em 2018, a Argentina começou a implementar a Iniciativa HEARTS em 5 centros de atenção primária à saúde por meio do Plano Nacional de Prevenção e Controle da Hipertensão Arterial. Este estudo apresenta o impacto de sua implementação nos indicadores de cobertura efetiva, tratamento, tratamento combinado e controle. A Iniciativa HEARTS inclui vários componentes. Entre eles, se destacam a capacitação das equipes de saúde, a reorganização das tarefas com base na transferência de competências clínicas, a disponibilização de aparelhos automáticos e clinicamente validados para aferição da pressão arterial e a utilização de um único protocolo padronizado de tratamento. Foi utilizado um modelo de equações de estimativas generalizadas para a análise de dados longitudinais, e as informações dos 5 centros de saúde foram agrupadas por meio de médias ponderadas de acordo com o tamanho da população coberta. A análise dos resultados foi estratificada em dois períodos de tempo delimitados pela irrupção das restrições em virtude da COVID-19. Durante os primeiros 18 meses, houve melhora significativa no tratamento (5,9%; p<0,01) e no tratamento combinado (13,4%; p<0,01), sem mudança significativa na cobertura (8,4%; p=0,87) e com uma diminuição paradoxal no controle (−3,3%; p=0,02). Durante as restrições e em relação ao período anterior, verificou-se redução generalizada em todos os indicadores, principalmente na cobertura (−23,6%; p<0,01) e no controle (−12,5%; p<0,01). No entanto, os níveis de tratamento e tratamento combinado persistiram acima dos valores basais (1,7%; p<0,01 e 5,4%; p<0,01, respectivamente).

Principales resultados de la tercera encuesta nacional de factores de riesgo de enfermedades no trasmisibles en Argentina / Main results of the third national non-communicable disease risk factor survey in Argentina

INTRODUCCIÓN: la vigilancia de las enfermedades no transmisibles (ENT) y sus factores de riesgo es esencial para diseñar y evaluar políticas efectivas. En 2013 se realizó la tercera EncuestaNacional de Factores de Riesgo de ENT (ENFR). OBJETIVOS: Describir la prevalencia, distribución y evolución de los principales factores de riesgo de las ENT en Argentina. MÉTODOS: Se utilizó un diseño muestral probabilístico, que incluyó una población general de 18años o más en viviendas pertenecientes a ciudades de más de 5 000 habitantes. RESULTADOS: Se encuestó a 32 365 personas (tasa derespuesta: 70,7%). La prevalencia de obesidad (20,8%) y sobrepeso(37,1%) aumentó en comparación con ENFR previas (2005 y 2009). Se mantuvieron estables la hipertensión arterial (34,1%) y el colesterolelevado (29,8%). El consumo de frutas/verduras (media: dosporciones/día) continuó siendo bajo, mientras que el sedentarismo fueelevado (54,7%). El consumo de tabaco (25,1%), la exposición al humode tabaco ajeno en bares/restaurantes (23,5%), trabajo (25%) y hogar(27,6%) y la utilización de sal (17,3%) se redujeron significativamente. El 71,6%, 65,6% y 24,5% de la población diana realizó Papanicolaou, mamografía y pruebas de rastreo de cáncer de colon, respectivamente.La cobertura de salud sólo pública se vio asociada a una menor proporción de prácticas preventivas, y las personas con menor nivel educativo tuvieron peores indicadores. CONCLUSIONES: Aunque hubo una mejora en materia de consumo de tabaco y utilización de sal, es necesario intensificar las políticas para el abordaje de las ENT.

INTRODUCTION: the surveillance of non-comunicable diseases (NCD) and their risk factors is essential to designand evaluate effective interventions. The 3rd National Risk Factor Survey of NCD (NRFS) was conducted in 2013. OBJECTIVES: To describe the prevalence, distribution and evolution of main risk factors of NCD in Argentina. METHODS: A probabilistic sampling design was used, including a general population aged 18 years orolder living in cities with more than 5 000 inhabitants. RESULTS: 32 365 people were interviewed (response rate: 70.7%). The prevalence of obesity (20.8%) and overweight (37.1%) was higher than in previous NRFS (2005-2009). Hypertension (34.1%) and high cholesterol (29.8%) prevalence remained stable. Meanconsumption of fruits and vegetables remained low (two servings/day), while physical inactivity was high (54.7%). Smoking (25.1%) and exposure to secondhand smoke in bars/restaurants (23.5%), at work (25%) and at home (27.6%) as well as the use of salt (17.3%) were reduced significantly. Among the targetpopulation, 71.6%, 65.6% and 24.5% performed Pap tests, mammograms and screening tests for colon cancer, respectively. Preventive health practices were less frequent among those with public health coverage only. People with lower education levelshad worse indicators. CONCLUSIONS: Despite the improvement in terms of smoking and salt consumption, further actions are needed to address NCDs.

Iniciativa menos sal, más vida: estrategia para la reducción de la ingesta de sodio en Argentina / Less salt, more life initiative: strategy to reduce sodium intake in Argentina

La ingesta elevada de sodio se asocia a una mayor incidencia de eventos cardiovasculares y muertes. Lareducción de esa ingesta resulta una intervención sanitaria costo-efectiva para la prevención. A través de un enfoque multisectorial, la iniciativa “Menos Sal, Más Vida” logró disminuir el contenido de sodio de losalimentos más consumidos en Argentina con un beneficio sanitario significativo.

Evidencia generada a partir de las Encuestas Nacionales deFactores de Riesgo de Argentina: revisión de la literatura / Evidence generated from the National Risk Factor Surveys in Argentina: literature review

INTRODUCCION: Las encuestas nacionales de factores de riesgo (ENFR) forman parte del sistema estadístico nacional y se realizan con una periodicidad de cuatro años. OBJETIVOS:Analizar, a través de una revisión sistemática de los estudios publicados, la utilización de los datos de las ENFR. METODOS: Se realizó una búsqueda en PubMed y SciELO, y se sumaronartículos identificados a partir de las citas aportadas por artículos de revisión y recomendaciones de autores. RESULTADOS: Se seleccionaron 17 estudios de investigación publicados, 12 en inglés y 5 en español, entre 2006 y 2014. En ellos se analizaron los siguientes temas: actividad física baja, hipertensión, control de colesterol, diabetes, obesidad, utilización de servicios preventivos, autopercepción de salud, tabaquismo, exposición al humo de tabaco ajeno y disposición a dejar de fumar, alimentación (consumode frutas y/o verduras), utilización de sal y consumo de alcohol de riesgo. CONCLUSIONES: La ENFR no sólo constituye una herramienta fundamental para el monitoreo de la epidemia deenfermedades no transmisibles, sino que también es una fuente de datos útil para profundizar el entendimiento de la epidemia a través de estudios de investigación.

INTRODUCTION: The National Risk Factor Surveys (NRFS) are part of the national statistical system and are conducted every four years. OBJECTIVES: To analyze the use of NRFS data through a systematic review of published studies. METHODS: A search was carried out in PubMed and SciELO, and articles identified from citations from review articles and recommendations of authors were also taken into consideration. RESULTS: A total of 17 research studies published in English (N=12) and Spanish (N=5) were selected, dating from 2006 to 2014. On these studies the following topics were analyzed: low physicalactivity, high blood pressure, cholesterol control, diabetes, obesity, use of preventive services, smoking self-perception, exposure to secondhand smoke and willingness to stop smoking, diet (consumption of fruits and/or vegetables), use of salt and binge drinking. CONCLUSIONS: The NRFSis not only a key tool to monitor the non-communicable disease epidemic, but also a useful source of data to develop research studies which deepen the understanding of the epidemic.

Prevalencia de sobrepeso, obesidad, actividad física y tabaquismo en adolescentes argentinos: Encuestas Mundiales de Salud Escolar y de Tabaco en Jóvenes, 2007-2012 / Prevalence of overweight, obesity, physical activity and tobacco use in Argentine youth: Global School-Based Student Health Survey and Global Youth Tobacco Survey, 2007-2012

Introducción. En 2007 y 2012, se implementaron en nuestro país las Encuestas Mundiales de Salud en Jóvenes (EMSE) y de Tabaco en Jóvenes (EMTJ) para estimar la prevalencia de comportamientos de riesgo y factores de protección entre los adolescentes de 13 a 15 años. Objetivo. Evaluar los cambios de los indicadores de alimentación y peso corporal, tabaco y actividad física en los últimos 5 años. Metodología. Estudio de corte transversal. Se utilizó un muestreo aleatorizado bietápico con selección de 600 escuelas a nivel nacional. Los estudiantes de las divisiones elegidas al azar fueron invitados a responder el cuestionario autoadministrado (de la EMSE o de la EMTJ). Resultados. En 2012, la encuesta fue respondida por 20 697 alumnos de 544 escuelas para la EMSE y 2062 para la EMTJ en 73 escuelas. Entre 2007 y 2012, se incrementó en forma significativa la prevalencia de sobrepeso (24,5% en 2007, 28,6% en 2012) y obesidad (4,4% en 2007, 5,9% en 2012), y se mantuvieron elevados los consumos de bebidas azucaradas y comidas rápidas. Se observó una leve mejora en el nivel de actividad física (12,7% en 2007, 16,7% en 2012) aunque continúa por debajo de lo recomendado. Se redujo la prevalencia de tabaquismo (24,5% en 2007, 19,6% en 2012), pero persiste elevado el acceso a productos del tabaco y la exposición al humo de tabaco ajeno en lugares públicos, incluso la escuela. Conclusiones. La progresión de la epidemia de sobrepeso y obesidad indica una necesidad de profundizar acciones en alimentación saludable y actividad física. A pesar del descenso de la prevalencia de tabaquismo, es necesario seguir fortaleciendo las acciones de control de tabaco.

Introduction. In2007and 2012, the Global School-Based Student Health Survey (GSHS) and the Global Youth Tobacco Survey (GYTS) were implemented to estimate the prevalence of risk behaviors and protection factors among 13 to 15 year-old adolescents. Objective. To assess changes in dietary, body weight, tobacco and physical activity indicators in the past five years. Population and Methos. Cross-sectional study. A randomized, two-stage sampling with 600 schools selected at a national level was used. Students from randomly selected courses were invited to answer a self-administered questionnaire (either the GSHS or the GYTS). Results. In 2012, the GSHS was completed by 20 697 students from 544 schools, while the GYTS was completed by 2062 students from 73 schools. Between 2007 and 2012, overweight and obesity prevalence significantly increased (overweight: 24.5% in2007, 28.6% in2012; obesity 4.4% in2007, 5.9% in 2012), while the consumption of sugar-sweetened beverages and fast food remained high. A slight improvement was observed in the level of physical activity (12.7% in 2007, 16.7% in 2012), although it remains below what is recommended. The prevalence of tobacco use was reduced (24.5% in 2007, 19.6% in 2012), but access to tobacco products and exposure to secondhand smoke remains high in public places, including schools. Conclusions. The spread of the overweight and obesity epidemic calls for a need to consolidate actions tending towards a healthy diet and physical activity. Despite a decrease in the prevalence of tobacco use, it is necessary to continue strengthening tobacco control actions.

Prevalencia de sobrepeso, obesidad, actividad física y tabaquismo en adolescentes argentinos: Encuestas Mundiales de Salud Escolar y de Tabaco en Jóvenes, 2007-2012 / Prevalence of overweight, obesity, physical activity and tobacco use in Argentine youth: Global School-Based Student Health Survey and Global Youth Tobacco Survey, 2007-2012

Introducción. En 2007 y 2012, se implementaron en nuestro país las Encuestas Mundiales de Salud en Jóvenes (EMSE) y de Tabaco en Jóvenes (EMTJ) para estimar la prevalencia de comportamientos de riesgo y factores de protección entre los adolescentes de 13 a 15 años. Objetivo. Evaluar los cambios de los indicadores de alimentación y peso corporal, tabaco y actividad física en los últimos 5 años. Metodología. Estudio de corte transversal. Se utilizó un muestreo aleatorizado bietápico con selección de 600 escuelas a nivel nacional. Los estudiantes de las divisiones elegidas al azar fueron invitados a responder el cuestionario autoadministrado (de la EMSE o de la EMTJ). Resultados. En 2012, la encuesta fue respondida por 20 697 alumnos de 544 escuelas para la EMSE y 2062 para la EMTJ en 73 escuelas. Entre 2007 y 2012, se incrementó en forma significativa la prevalencia de sobrepeso (24,5% en 2007, 28,6% en 2012) y obesidad (4,4% en 2007, 5,9% en 2012), y se mantuvieron elevados los consumos de bebidas azucaradas y comidas rápidas. Se observó una leve mejora en el nivel de actividad física (12,7% en 2007, 16,7% en 2012) aunque continúa por debajo de lo recomendado. Se redujo la prevalencia de tabaquismo (24,5% en 2007, 19,6% en 2012), pero persiste elevado el acceso a productos del tabaco y la exposición al humo de tabaco ajeno en lugares públicos, incluso la escuela. Conclusiones. La progresión de la epidemia de sobrepeso y obesidad indica una necesidad de profundizar acciones en alimentación saludable y actividad física. A pesar del descenso de la prevalencia de tabaquismo, es necesario seguir fortaleciendo las acciones de control de tabaco.(AU)

Introduction. In2007and 2012, the Global School-Based Student Health Survey (GSHS) and the Global Youth Tobacco Survey (GYTS) were implemented to estimate the prevalence of risk behaviors and protection factors among 13 to 15 year-old adolescents. Objective. To assess changes in dietary, body weight, tobacco and physical activity indicators in the past five years. Population and Methos. Cross-sectional study. A randomized, two-stage sampling with 600 schools selected at a national level was used. Students from randomly selected courses were invited to answer a self-administered questionnaire (either the GSHS or the GYTS). Results. In 2012, the GSHS was completed by 20 697 students from 544 schools, while the GYTS was completed by 2062 students from 73 schools. Between 2007 and 2012, overweight and obesity prevalence significantly increased (overweight: 24.5% in2007, 28.6% in2012; obesity 4.4% in2007, 5.9% in 2012), while the consumption of sugar-sweetened beverages and fast food remained high. A slight improvement was observed in the level of physical activity (12.7% in 2007, 16.7% in 2012), although it remains below what is recommended. The prevalence of tobacco use was reduced (24.5% in 2007, 19.6% in 2012), but access to tobacco products and exposure to secondhand smoke remains high in public places, including schools. Conclusions. The spread of the overweight and obesity epidemic calls for a need to consolidate actions tending towards a healthy diet and physical activity. Despite a decrease in the prevalence of tobacco use, it is necessary to continue strengthening tobacco control actions.(AU)

Prevalence of overweight, obesity, physical activity and tobacco use in Argentine youth: Global School-Based Student Health Survey and Global Youth Tobacco Survey, 2007-2012.

INTRODUCTION: In 2007 and 2012, the Global School-Based Student Health Survey (GSHS) and the Global Youth Tobacco Survey (GYTS) were implemented to estimate the prevalence of risk behaviors and protection factors among 13 to 15 year-old adolescents. OBJECTIVE: To assess changes in dietary, body weight, tobacco and physical activity indicators in the past five years. POPULATION AND METHODS: Cross-sectional study. A randomized, two-stage sampling with 600 schools selected at a national level was used. Students from randomly selected courses were invited to answer a self-administered questionnaire (either the GSHS or the GYTS). RESULTS: In 2012, the GSHS was completed by 20 697 students from 544 schools, while the GYTS was completed by 2062 students from 73 schools. Between 2007 and 2012, overweight and obesity prevalence significantly increased (overweight: 24.5% in 2007, 28.6% in 2012; obesity 4.4% in 2007, 5.9% in 2012), while the consumption of sugar-sweetened beverages and fast food remained high. A slight improvement was observed in the level of physical activity (12.7% in 2007, 16.7% in 2012), although it remains below what is recommended. The prevalence of tobacco use was reduced (24.5% in 2007, 19.6% in 2012), but access to tobacco products and exposure to secondhand smoke remains high in public places, including schools. CONCLUSIONS: The spread of the overweight and obesity epidemic calls for a need to consolidate actions tending towards a healthy diet and physical activity. Despite a decrease in the prevalence of tobacco use, it is necessary to continue strengthening tobacco control actions.

Prevalence of overweight, obesity, physical activity and tobacco use in Argentine youth: Global School-Based Student Health Survey and Global Youth Tobacco Survey, 2007-2012. / Prevalence of overweight, obesity, physical activity and tobacco use in Argentine youth: Global School-Based Student Health Survey and Global Youth Tobacco Survey, 2007-2012.

INTRODUCTION: In 2007 and 2012, the Global School-Based Student Health Survey (GSHS) and the Global Youth Tobacco Survey (GYTS) were implemented to estimate the prevalence of risk behaviors and protection factors among 13 to 15 year-old adolescents. OBJECTIVE: To assess changes in dietary, body weight, tobacco and physical activity indicators in the past five years. POPULATION AND METHODS: Cross-sectional study. A randomized, two-stage sampling with 600 schools selected at a national level was used. Students from randomly selected courses were invited to answer a self-administered questionnaire (either the GSHS or the GYTS). RESULTS: In 2012, the GSHS was completed by 20 697 students from 544 schools, while the GYTS was completed by 2062 students from 73 schools. Between 2007 and 2012, overweight and obesity prevalence significantly increased (overweight: 24.5

in 2007, 28.6

in 2012; obesity 4.4

in 2007, 5.9

in 2012), while the consumption of sugar-sweetened beverages and fast food remained high. A slight improvement was observed in the level of physical activity (12.7

in 2007, 16.7

in 2012), although it remains below what is recommended. The prevalence of tobacco use was reduced (24.5

in 2007, 19.6

in 2012), but access to tobacco products and exposure to secondhand smoke remains high in public places, including schools. CONCLUSIONS: The spread of the overweight and obesity epidemic calls for a need to consolidate actions tending towards a healthy diet and physical activity. Despite a decrease in the prevalence of tobacco use, it is necessary to continue strengthening tobacco control actions.

Barriers to prevention of cardiovascular disease in primary care settings in Argentina.

OBJECTIVE: To identify main barriers to preventing cardiovascular disease and implementing clinical practice guidelines in primary care, to pilot implementation of a tailored enactment of the adapted World Health Organization guidelines to prevent cardiovascular disease, and to assess the impact of the intervention in risk stratification. METHODS: A qualitative study was done with decision makers, health professionals, and staff from five primary health care centers, who were interviewed to identify the main barriers. A tailored intervention to apply the guidelines was then designed and implemented. To assess the impact of the intervention on risk factor screening, a before-and-after analysis was performed through a records review of independent samples of patients aged 40 years or older attending each center. RESULTS: The main barriers identified were lack of awareness of guidelines and lack of knowledge about preventing cardiovascular disease, communication problems within health teams, lack of motivation, and organizational problems. Before (n = 226) and after (n = 234) the intervention, screening of the main risk factors increased: blood pressure measurement from 44.3% to 72.6%, cholesterol measurement from 20.7% to 49.7%, smoking status assessment from 20.4% to 56.1%, diabetes status assessment from 25.5% to 93.6%, and previous vascular event status from 33.2% to 74.3%. Global risk stratification was not done at baseline, compared with 45.1% after the intervention. CONCLUSIONS: The main barriers identified were useful in designing a tailored intervention. Although no clinical outcomes were evaluated, this study shows that the implementation is feasible, with increased risk stratification as a first step at better patient management.

Barriers to prevention of cardiovascular disease in primary care settings in Argentina / Obstáculos en la prevención de las enfermedades cardiovasculares en entornos de atención primaria en Argentina

OBJECTIVE: To identify main barriers to preventing cardiovascular disease and implementing clinical practice guidelines in primary care, to pilot implementation of a tailored enactment of the adapted World Health Organization guidelines to prevent cardiovascular disease, and to assess the impact of the intervention in risk stratification. METHODS: A qualitative study was done with decision makers, health professionals, and staff from five primary health care centers, who were interviewed to identify the main barriers. A tailored intervention to apply the guidelines was then designed and implemented. To assess the impact of the intervention on risk factor screening, a before-and-after analysis was performed through a records review of independent samples of patients aged 40 years or older attending each center. RESULTS: The main barriers identified were lack of awareness of guidelines and lack of knowledge about preventing cardiovascular disease, communication problems within health teams, lack of motivation, and organizational problems. Before (n = 226) and after (n = 234) the intervention, screening of the main risk factors increased: blood pressure measurement from 44.3% to 72.6%, cholesterol measurement from 20.7% to 49.7%, smoking status assessment from 20.4% to 56.1%, diabetes status assessment from 25.5% to 93.6%, and previous vascular event status from 33.2% to 74.3%. Global risk stratification was not done at baseline, compared with 45.1% after the intervention. CONCLUSIONS: The main barriers identified were useful in designing a tailored intervention. Although no clinical outcomes were evaluated, this study shows that the implementation is feasible, with increased risk stratification as a first step at better patient management.

OBJETIVO: Determinar las principales barreras en la prevención de las enfermedades cardiovasculares y la aplicación de las directrices de práctica clínica en atención primaria, guiar la adecuada puesta en práctica de las directrices adaptadas de la Organización Mundial de la Salud para prevenir las enfermedades cardiovasculares, y evaluar la repercusión de la intervención en la estratificación del riesgo. MÉTODOS: Se llevó a cabo un estudio cualitativo dirigido a los encargados de adoptar las decisiones, los profesionales de la salud y el personal de cinco centros de atención primaria de salud, que fueron entrevistados con objeto de determinar las principales barreras. Posteriormente se diseñó y ejecutó una intervención adaptada para aplicar las directrices. Con objeto de evaluar la repercusión de la intervención sobre el tamizaje de los factores de riesgo, se llevaron a cabo un análisis anterior y posterior a la intervención mediante un examen de los registros de muestras independientes de pacientes de 40 años o mayores que acudían a cada centro. RESULTADOS: Las principales barreras detectadas fueron el desconocimiento de las directrices y la carencia de información sobre la prevención de las enfermedades cardiovasculares, los problemas de comunicación dentro de los equipos de salud, la falta de motivación y los problemas organizativos. Al comparar los datos previos a la intervención (n = 226) con los posteriores a esta (n = 234), se observó un incremento del tamizaje de los principales factores de riesgo: la medición de la presión arterial de 44,3 a 72,6%, la determinación del colesterol de 20,7 a 49,7%, la evaluación de la presencia de tabaquismo de 20,4 a 56,1%, la evaluación de la presencia de diabetes de 25,5 a 93,6% y la evaluación de la presencia de un episodio vascular anterior de 33,2 a 74,3%. Al inicio del estudio no se llevaba a cabo la estratificación del riesgo global, en comparación con el 45,1% de estratificación realizada posteriormente a la intervención. CONCLUSIONES: La determinación de las principales barreras fue útil para el diseño de una intervención adaptada. Aunque no se evaluaron los resultados clínicos, este estudio revela que la ejecución es factible, y que la mayor estratificación del riesgo constituye un primer paso en la mejora de la atención de los pacientes.

Encuesta nacional de factores de riesgo 2009: evolución de la epidemia de enfermedades crónicas no transmisibles en Argentina: estudio de corte transversal / 2009 National risk factors survey: evolution of the epidemic of chronic non communicable diseases in Argentina: cross sectional study

INTRODUCCIÓN: las enfermedades crónicas no transmisibles (ECNT) en Argentina causan o están relacionadas con aproximadamente el 80% de la mortalidad. La forma más costoefectivapara su vigilancia es a través de encuestas de factores de riesgo. En 2009, se realizó la segunda Encuesta Nacional de Factores de Riesgo (ENFR). OBJETIVOS: monitorear la evolución de los principales factores de riesgo de las ECNT y describir su distribuciónen subgrupos. MÉTODOS: Se realizó un muestreo probabilístico, incluyendo a personas de 18 años y más, no institucionalizadas, de la población general, a partir de un muestreo de viviendas de ciudades de más de 5.000 habitantes de todo el país. Fueron incluidos en el relevamiento los principales factores de riesgo de las ECNT al igual que en la primera ENFR (2005). RESULTADOS: se incluyeron a34.372 encuestados, con una tasa de respuesta de 75%. Los factores de riesgo que presentaron una mejoría respecto a la ENFR 2005 a nivel nacional fueron el tabaquismo, la exposición al humo de tabaco ajeno, la realización de mediciones de presión arterial, colesterol y glucemia, mamografías y Papanicolau. Por el contrario, se incrementaron la obesidad, el sedentarismo, la inactividad física y la alimentación no saludable. Las poblaciones más desfavorecidas (de menores ingresos y menor nivel educativo) presentaron peores indicadores. CONCLUSIONES: las políticas de prevención y control de las ECNT deben continuar intensificándose para revertir esta epidemia. Dadoel impacto de las ECNT en el desarrollo y el costo sanitario y social, su abordaje debe priorizarse aún más en la agenda política y sanitaria nacional e internacional.

INTRODUCTION: In Argentina, non-communicable diseases (NCD) account for about 80% of the mortality. Themost cost-effective way for their surveillance is through risk factor surveys. In 2009 we conducted the second National Risk Factor Survey (NRFS). OBJECTIVES: To monitor the evolution of the main risk factors of chronic diseases and describe thedistribution of major risk factors in subgroups. METHODS: A probabilistic sample was performed, including general urban population (cities with more than 5.000 habitants) aged 18and over across the country. The main risk factors for chronic diseases were included in the survey. RESULTS: We included 34.372 respondents, with a response rate of 75%. The risk factorsat the national level that showed improvement compared with 2005 NRFS were smoking, exposure to second hand smoke, blood pressure measurement, cholesterol measurement, glucosemeasurement, mammography and Papanicolau. However, obesity, physical inactivity and unhealthy diets increased.Disadvantaged populations (with lower incomes and less education) had worse indicators. CONCLUSIONS: Policies forprevention and control of NCDs should continue to intensify to reverse this epidemic. Further actions will be needed both at environmental and individual levels. The NCDs, given theirimpact on development and social and health costs, should be highly prioritized into the political and health agendas inour country and globally.

Encuesta nacional de factores de riesgo 2009: Evolución de la epidemia de enfermedades crónicas no transmisibles en Argentina. Estudio de corte transversal / 2009 National Risk Factors Survey: evolution of the epidemic of chronic non communicable diseases in Argentina. Cross sectional study

INTRODUCCION: las enfermedades crónicas no transmisibles (ECNT) en Argentina causan o están relacionadas con aproximadamente el 80

de la mortalidad. La forma más costoefectivapara su vigilancia es a través de encuestas de factores de riesgo. En 2009, se realizó la segunda Encuesta Nacional de Factores de Riesgo (ENFR). OBJETIVOS: monitorear la evolución de los principales factores de riesgo de las ECNT y describir su distribuciónen subgrupos. METODOS: Se realizó un muestreo probabilístico, incluyendo a personas de 18 años y más, no institucionalizadas, de la población general, a partir de un muestreo de viviendas de ciudades de más de 5.000 habitantes de todo el país. Fueron incluidos en el relevamiento los principales factores de riesgo de las ECNT al igual que en la primera ENFR (2005). RESULTADOS: se incluyeron a34.372 encuestados, con una tasa de respuesta de 75

INTRODUCTION: In Argentina, non-communicable diseases (NCD) account for about 80

of the mortality. Themost cost-effective way for their surveillance is through risk factor surveys. In 2009 we conducted the second National Risk Factor Survey (NRFS). OBJECTIVES: To monitor the evolution of the main risk factors of chronic diseases and describe thedistribution of major risk factors in subgroups. METHODS: A probabilistic sample was performed, including general urban population (cities with more than 5.000 habitants) aged 18and over across the country. The main risk factors for chronic diseases were included in the survey. RESULTS: We included 34.372 respondents, with a response rate of 75

. Los factores de riesgo que presentaron una mejoría respecto a la ENFR 2005 a nivel nacional fueron el tabaquismo, la exposición al humo de tabaco ajeno, la realización de mediciones de presión arterial, colesterol y glucemia, mamografías y Papanicolau. Por el contrario, se incrementaron la obesidad, el sedentarismo, la inactividad física y la alimentación no saludable. Las poblaciones más desfavorecidas (de menores ingresos y menor nivel educativo) presentaron peores indicadores. CONCLUSIONES: las políticas de prevención y control de las ECNT deben continuar intensificándose para revertir esta epidemia. Dadoel impacto de las ECNT en el desarrollo y el costo sanitario y social, su abordaje debe priorizarse aún más en la agenda política y sanitaria nacional e internacional (AU)

. The risk factorsat the national level that showed improvement compared with 2005 NRFS were smoking, exposure to second hand smoke, blood pressure measurement, cholesterol measurement, glucosemeasurement, mammography and Papanicolau. However, obesity, physical inactivity and unhealthy diets increased.Disadvantaged populations (with lower incomes and less education) had worse indicators. CONCLUSIONS: Policies forprevention and control of NCDs should continue to intensify to reverse this epidemic. Further actions will be needed both at environmental and individual levels. The NCDs, given theirimpact on development and social and health costs, should be highly prioritized into the political and health agendas inour country and globally (AU)