A prospective longitudinal approach to examine the association between social position in childhood, adolescence, and adulthood with the control of hypertension during adulthood.

Introduction: Hypertension is one of the main concerns in public health, since it is related with increased morbidity, and potential years of life lost in addition to loss of quality of life. This study aimed to assess: (1) the distribution of indicators of life course SEP in a cohort of Colombian patients with hypertension and (2) to assess the association of life course SEP and control of hypertension among this cohort of patients. Methods: Data were obtained using the baseline survey of 258 patients from the Social Determinants and Inequities in the Control of Blood Hypertension Program (ProDSICHA). Mother occupation and housing conditions were measured with the Event History Calendar. Mother educational level was measured with the questionnaire developed by the Project on Ethnicity and Race in Latin America (PERLA). Socioeconomic position during adulthood was measured using education, occupation, and income level based in the MacArthur Network. Results: The group with a higher lifelong social position and the group of lower lifelong social position showed better control of hypertension (OR = 1.21; p <0.05; OR = 1.33; p < .05, respectively) compared to those whose social position throughout life varied the most. No statistical differences were found in the relations between single lifetime social position variables, and hypertension control in the three time points analyzed. Discussion: These findings warrant further research to deeper our understanding on the role of a multidimensional and cumulative approach of social position in hypertension control.

Cardiovascular disease prevention capacity in Colombian local health departments.

Prevention capacity of local health organisations is associated with the performance and outcomes in public health. In Colombia, where cardiovascular disease is the leading cause of morbidity and mortality, there is limited knowledge about the capacity of local health departments to prevent this condition. Efforts are needed to address problems, potential solutions and expected outcomes regarding cardiovascular disease. In this study, a conceptual model for cardiovascular disease prevention capacity in Colombian local health departments was developed, a questionnaire based on this model was validated, the overall cardiovascular disease prevention capacity in a subsample of these organisations was measured, and the association between cardiovascular disease prevention capacity and political, population, and organisational factors was examined. Once the acceptable performance of the questionnaire was verified, variability in cardiovascular prevention capacity was found among a subsample of local health departments. Furthermore, this study provides primary evidence regarding the association between the size of local health departments and overall cardiovascular disease prevention capacity in Colombia. Future studies should focus on measuring this capacity on a larger scale and developing, implementing, and evaluating interventions aimed at strengthening cardiovascular prevention capacity in Colombian local jurisdictions.

Association of education level with diabetes prevalence in Latin American cities and its modification by city social environment.

BACKGROUND: Diabetes prevalence continues to increase in urban areas of low-income and middle-income countries (LMIC). Evidence from high-income countries suggests an inverse association between educational attainment and diabetes, but research in LMIC is limited. We investigated educational differences in diabetes prevalence across 232 Latin American (LA) cities, and the extent to which these inequities vary across countries/cities and are modified by city socioeconomic factors. METHODS: Using harmonised health survey and census data for 110 498 city dwellers from eight LA countries, we estimated the association between education and diabetes. We considered effect modification by city Social Environment Index (SEI) as a proxy for city-level development using multilevel models, considering heterogeneity by sex and country. RESULTS: In women, there was an inverse dose-response relationship between education and diabetes (OR: 0.80 per level increase in education, 95% CI 0.75 to 0.85), consistent across countries and not modified by SEI. In men, Argentina, Brazil, Colombia, Chile and Mexico showed an inverse association (pooled OR: 0.92; 95% CI 0.86 to 0.99). Peru, Panama and El Salvador showed a positive relationship (pooled OR 1.24; 95% CI 1.04 to 1.49). For men, these associations were further modified by city-SEI: in countries with an inverse association, it became stronger as city-SEI increased. In countries where the association was positive, it became weaker as city-SEI increased. CONCLUSION: Social inequities in diabetes inequalities increase as cities develop. To achieve non-communicable disease-related sustainable development goals in LMIC, there is an urgent need to develop policies aimed at reducing these educational inequities.

Do the determinants of self-rated health vary among older people with disability, chronic diseases or both conditions in urban Colombia?

Our study aimed to identify the main determinants of self-rated health for individuals aged 60 years or older in Bogotá, Colombia, and if those determinants vary between groups. Data was obtained from the Demographic Health Survey 2011 for Bogotá. Logistic regression models were estimated to identify the determinants of excellent/good self-rated health among people aged 60 years or older living in Bogotá. Moreover, a subgroup analysis was conducted seeking to identify if the determinants changed between groups (men, women, persons with disability, with chronic disease(s), and persons with both disability and chronic disease(s)). The likelihood of reporting an excellent/good self-rated health health decreases when the individual has a disability, a chronic disease or reports that their household income is not enough to cover the basic needs. On the other hand, the odds of reporting excellent/good self-rated health increase when the individual is more educated and reports to receive family support. The subgroup analysis showed that although some determinants are only associated with one group (age with chronic diseases), in general, three main determinants stood out: years of education, socioeconomic status variables and receiving family support. The determinants of self-rated health for older adults in Bogotá differ according to the disability and the chronic disease status. Thus, public policies aiming to improve the levels of health and quality must consider the impacts of those characteristics on individuals' perceptions of their own health.

Establishing a local coalition for addressing social determinants of hypertension in Quibdó (Colombia): a description and reflection on the process.

One-fourth of the adult population of Colombia is estimated to have hypertension. However, there has been relatively little attention to participatory approaches that address the social determinants of hypertension at the local level in Colombia. Early stages of a coalition for addressing hypertension in Quibdó (Colombia) included a stakeholder analysis and engagement of local organizations. This was followed by defining mutual goals, agreement of rules for decision making, and refining a shared vision. Based on a unified understanding of factors influencing hypertension risk, 12 organizations joined the local coalition. They developed an action plan for preventing hypertension and eliminating social disparities in its distribution. Lessons learned during this process suggest that, in marginalized urban areas of middle- and low-income countries, particular attention should be paid, at early implementation stages of coalition, to context specific challenges and opportunities, coalition membership and structure, reframing health, and strengthening capacity.

Do the determinants of self-rated health vary among older people with disability, chronic diseases or both conditions in urban Colombia? / ¿Varían los determinantes de la salud autoevaluada entre las personas ancianas con discapacidad, enfermedades crónicas o ambas condiciones en áreas urbanas de Colombia? / Os determinantes da autopercepção da saúde variam entre idosos com deficiência, com doenças crônicas não transmissíveis ou com ambas condições nas áreas urbanas da Colômbia?

Abstract: Our study aimed to identify the main determinants of self-rated health for individuals aged 60 years or older in Bogotá, Colombia, and if those determinants vary between groups. Data was obtained from the Demographic Health Survey 2011 for Bogotá. Logistic regression models were estimated to identify the determinants of excellent/good self-rated health among people aged 60 years or older living in Bogotá. Moreover, a subgroup analysis was conducted seeking to identify if the determinants changed between groups (men, women, persons with disability, with chronic disease(s), and persons with both disability and chronic disease(s)). The likelihood of reporting an excellent/good self-rated health health decreases when the individual has a disability, a chronic disease or reports that their household income is not enough to cover the basic needs. On the other hand, the odds of reporting excellent/good self-rated health increase when the individual is more educated and reports to receive family support. The subgroup analysis showed that although some determinants are only associated with one group (age with chronic diseases), in general, three main determinants stood out: years of education, socioeconomic status variables and receiving family support. The determinants of self-rated health for older adults in Bogotá differ according to the disability and the chronic disease status. Thus, public policies aiming to improve the levels of health and quality must consider the impacts of those characteristics on individuals' perceptions of their own health.

Resumen: El objetivo fue identificar los determinantes principales de salud autoevaluada en individuos con edades comprendidas entre los 60 años o más en Bogotá, Colombia y si esos determinantes varían entre grupos. Los datos se recabaron de la Encuesta Demográfica sobre Salud de 2011 en Bogotá. Los modelos de regresión logística se estimaron para identificar los determinantes de una excelente/buena salud autoevaluada entre personas con 60 años o mayores, viviendo en Bogotá. Asimismo, se realizó un análisis subgrupo, con el fin de identificar si los determinantes cambiaron entre grupos (hombres, mujeres, personas con discapacidad, con enfermedades crónicas, y personas viviendo con discapacidad y enfermedades crónicas. La probabilidad de informar de una excelente/buena salud autoevaluada decrece cuando la persona sufre una discapacidad, una enfermedad crónica o informa que sus ingresos no son suficientes para cubrir las necesidades básicas. En cambio, las probabilidades de informar sobre una excelente/buena salud autoevaluada se incrementan cuando la persona tiene más formación educacional e informa recibir apoyo familiar. El subgrupo de análisis revela que pese a que algunos determinantes están sólo asociados a un grupo (edad con enfermedades crónicas), en general, fueron importantes tres determinantes: años de educación, variables status socieconómico y recibir apoyo familiar. Los determinantes de salud autoevaluada para las personas mayores en Bogotá varían, dependiendo de la discapacidad y estatus de las enfermedades crónicas. Por tanto, las políticas públicas con el fin de mejorar los niveles de salud y calidad deben considerar los efectos de aquellas características sobre las percepciones individuales de su propia salud.

Resumo: O estudo teve como objetivos identificar os principais determinantes da autopercepção da saúde entre indivíduos com 60 anos ou mais em Bogotá, Colômbia, e averiguar se esses determinantes variam entre grupos. A fonte de dados foi a Pesquisa Nacional de Demografia e Saúde de 2011, para a cidade de Bogotá. Foram estimados modelos de regressão logística para identificar os determinantes da autopercepção da saúde excelente/boa entre pessoas com 60 anos de idade ou mais, residindo em Bogotá. Além disso, foi realizada uma análise de subgrupos com o objetivo de identificar se os determinantes mudaram entre os grupos (homens, mulheres, pessoas com deficiência, com doenças crônicas e pessoas vivendo simultaneamente com deficiência e com doenças crônicas). A probabilidade de relatar autopercepção da saúde excelente/boa diminui quando a pessoa é portadora de deficiência ou doença crônica ou quando a renda domiciliar é insuficiente para atender as necessidades básicas. Enquanto isso, as chances de relatar autopercepção da saúde excelente/boa aumentam quando a pessoa tem maior escolaridade e recebe apoio da família. A análise de subgrupos revelou que, embora alguns determinantes só estejam associados a um grupo (idade e doenças crônicas), de maneira geral, três principais determinantes foram importantes: anos de ensino, condição socioeconômica e apoio familiar. Os determinantes da autopercepção da saúde em idosos residentes em Bogotá variam de acordo com a presença ou ausência de deficiência e doenças crônicas. Portanto, as políticas públicas que procuram melhorar os níveis de saúde e qualidade de vida devem considerar os efeitos dessas características sobre a percepção dos indivíduos em relação à própria saúde.

Income inequality and high blood pressure in Colombia: a multilevel analysis.

The objective of this research was to examine the association between income inequality and high blood pressure in Colombia. Using a nationally representative Colombian sample of adults, and data from departments and municipalities, we fit sex-stratified linear and logistic multilevel models with blood pressure as a continuous and binary variable, respectively. In adjusted models, women living in departments with the highest quintile of income inequality in 1997 had higher systolic blood pressure than their counterparts living in the lowest quintile of income inequality (mean difference 4.42mmHg; 95%CI: 1.46, 7.39). Women living in departments that were at the fourth and fifth quintile of income inequality in 1994 were more likely to have hypertension than those living in departments at the first quintile in the same year (OR: 1.56 and 1.48, respectively). For men, no associations of income inequality with either systolic blood pressure or hypertension were observed. Our findings are consistent with the hypothesis that income inequality is associated with increased risk of high blood pressure for women. Future studies to analyze pathways linking income inequality to high blood pressure in Colombia are needed.

Income inequality and high blood pressure in Colombia: a multilevel analysis / Desigualdad de renta e hipertensión arterial en Colombia: un análisis multinivel / Desigualdade de renda e hipertensão arterial na Colômbia: uma análise multinível

The objective of this research was to examine the association between income inequality and high blood pressure in Colombia. Using a nationally representative Colombian sample of adults, and data from departments and municipalities, we fit sex-stratified linear and logistic multilevel models with blood pressure as a continuous and binary variable, respectively. In adjusted models, women living in departments with the highest quintile of income inequality in 1997 had higher systolic blood pressure than their counterparts living in the lowest quintile of income inequality (mean difference 4.42mmHg; 95%CI: 1.46, 7.39). Women living in departments that were at the fourth and fifth quintile of income inequality in 1994 were more likely to have hypertension than those living in departments at the first quintile in the same year (OR: 1.56 and 1.48, respectively). For men, no associations of income inequality with either systolic blood pressure or hypertension were observed. Our findings are consistent with the hypothesis that income inequality is associated with increased risk of high blood pressure for women. Future studies to analyze pathways linking income inequality to high blood pressure in Colombia are needed.

El objetivo de este estudio fue examinar la asociación entre desigualdad de renta e hipertensión arterial en Colombia. Usando una muestra nacional representativa de adultos colombianos, y datos de los departamentos (estados) y municipios, probamos modelos lineales y logísticos multinivel, estratificados para el género, con la presión arterial como variable continua y binaria, respectivamente. En los modelos ajustados, las mujeres que residían en departamentos del país con el quintil más alto de desigualdad de renta en 1997 presentaban presión arterial sistólica más elevada que las mujeres que residían en el quintil más bajo de desigualdad de renta (diferencia media de 4,42mmHg; IC95%: 1,46, 7,39). Las mujeres que residían en departamentos en el cuarto y quinto quintiles de desigualdad de renta en 1994 tenían una mayor probabilidad de presentar hipertensión arterial que aquellas en departamentos en el primer quintil durante el mismo año (OR: 1,56 y 1,48, respectivamente). En los hombres, no se observaron asociaciones entre desigualdad de renta y presión sistólica o hipertensión arterial. Nuestros hallazgos corroboran la hipótesis de la asociación entre desigualdad de renta y aumento de riesgo de hipertensión arterial en mujeres. Se necesitan más estudios para analizar los vínculos entre la desigualdad de renta y la hipertensión arterial en Colombia.

Este estudo teve como objetivo examinar a associação entre desigualdade de renda e hipertensão arterial na Colômbia. Usando uma amostra nacional representativa de adultos colombianos e dados dos departamentos (estados) e municípios, testamos modelos lineares e logísticos multinível, estratificados para gênero, com a pressão arterial como variável contínua e binária, respectivamente. Nos modelos ajustados, as mulheres que residiam em departamentos do país com o quintil mais alto de desigualdade de renda em 1997 apresentavam pressão arterial sistólica mais elevada do que as mulheres que residiam no quintil mais baixo de desigualdade de renda (diferença média de 4,42mmHg; IC95%: 1,46, 7,39). As mulheres que residiam em departamentos no quarto e quinto quintis de desigualdade de renda em 1994 tinham maior probabilidade de apresentar hipertensão arterial do que aquelas em departamentos no primeiro quintil no mesmo ano (OR: 1,56 e 1,48, respectivamente). Nos homens, não foram observadas associações entre desigualdade de renda e pressão sistólica ou hipertensão arterial. Nossos achados corroboram a hipótese da associação entre desigualdade de renda e aumento de risco de hipertensão arterial em mulheres. São necessários mais estudos para analisar os elos entre a desigualdade de renda e a hipertensão arterial na Colômbia.

Social patterning of cardiovascular and metabolic risk in Colombian adults.

OBJECTIVES: To test for differences in cardiovascular and metabolic risk (CMR) by educational attainment and physical capital. To compare CMR among black, indigenous, and mixed populations, accounting for socioeconomic status (SES). DESIGN: We conducted multivariate analyses using cross-sectional data from a national survey of Colombian adults (n = 10,814) to examine the social patterning of CMR. In sex/gender-stratified models, a CMR index was regressed on educational attainment, physical capital, ethnicity/race, and age. RESULTS: Women with a primary education (OR = 1.64, 95% CI: 1.25, 2.15) had higher age- and ethnicity/race-adjusted odds of CMR than women with more than secondary education. Men with a primary education (OR = 0.67, 95% CI: 0.48, 0.92) had significantly lower adjusted odds of CMR than men with more than secondary education; these associations did not remain significant after adjustments for physical capital. Men in the first (OR = 0.45, 95% CI: 0.36, 0.57) and second (OR = 0.72, 95% CI: 0.57, 0.91) physical capital tertiles had significantly lower adjusted odds of CMR than those in the highest tertile. There was not a significant patterning of CMR by ethnicity/race for women or men, or by physical capital for women. CONCLUSIONS: Findings suggest that for Colombian adults CMR is patterned by SES; these associations differ by sex/gender.

Local Actors' Frames of the Role of Living Conditions in Shaping Hypertension Risk and Disparities in a Colombian Municipality.

Conditions in the social and physical environment influence population health and risk for CVD, including hypertension. These environmental conditions are influenced by the decisions of public officials, community leaders, and service providers. Examining the frames that local decision makers bring to understanding hypertension can provide important insights into the decisions that they make about strategies for addressing this problem in their jurisdiction. The goal of this study was to examine the frames that local decision makers in Quibdó, Colombia, bring to understanding hypertension risk, and in particular, whether and how they use frames that encompass associations between living conditions and hypertension risk. Data for this qualitative study were collected using a stratified sampling strategy. Semi-structured interviews were conducted in 2012 with 13 local decision makers and analyzed using a framework approach. Participants linked the structural conditions experienced in Quibdó, including displacement, limited economic opportunities, and the infrastructure of the city, to hypertension risk through multiple pathways, including behavioral risk factors for hypertension and physiologic responses to stress. They described the social patterning of these factors across socioeconomic, racial/ethnic, and gender hierarchies. Although several conditions associated with hypertension risk are widely distributed in the city's population, social processes of marginalization and stratification create additional disadvantages for those on the lower rungs of the social hierarchy.

Social capital, socioeconomic status, and health-related quality of life among older adults in Bogotá (Colombia).

OBJECTIVE: The main goal of this study was to evaluate the relationship between levels of cognitive social capital and health-related quality of life (HRQOL). METHODS: A multilevel, cross-sectional study was conducted in 2007 in Bogotá Colombia. A total of 1,907 older adults completed the Spanish version of the Short Form of Health Survey (SF-8) to assess HRQOL. Cognitive dimension of social capital was assessed. Hierarchical linear regressions were conducted to determine the associations between social capital variables and HRQOL. RESULTS: Only 20% to 25% of the population reported trust in others and shared values. A total of 93% percent reported that people in their neighborhood would try to take advantage of them if given a chance. Higher social capital indicators were positively associated with the mental and physical dimensions of HRQOL. DISCUSSION: Results from this study support evidence on the disintegration of the Colombian society, which may be influenced by high levels of social inequality.

[Socioeconomic status, perception of environment, and their association with self-rated health status among women in Bogotá, Colombia]. / Asociación de la posición socioeconómica y la percepción del ambiente con la autopercepción del estado de salud en mujeres de Bogotá, Colombia.

OBJECTIVE: Evaluate a conceptual model that suggests an association between socioeconomic status (SES), perception of neighborhood environment, physical activity behavior, and self-rated health status (SRHS) among women living in low-resource neighborhoods of Bogotá, Colombia. METHODS: A secondary source analysis of the first measurement of a community cluster trial was used to evaluate a program to encourage a higher consumption of fruits and vegetables and increase physical activity levels among homemakers in Bogotá. Analyses were done using a multivariate multilevel logistic model to identify associations and confirm the mediations proposed in the conceptual model. RESULTS: The adjusted models revealed that individual-level SES and neighborhood perception are inversely and significantly associated with suboptimal SRHS, while the association between physical activity and SRHS was not significant. CONCLUSIONS: The study findings underscore the importance of individual SES in assessment of health status and strengthen the evidence on the independent role of perception of neighborhood environment in the SRHS of women.

Asociación de la posición socioeconómica y la percepción del ambiente con la autopercepción del estado de salud en mujeres de Bogotá, Colombia / Socioeconomic status, perception of environment, and their association with self-rated health status among women in Bogotá, Colombia

OBJETIVO: Evaluar un modelo conceptual que sugiere una asociación entre la posición socioeconómica (PSE), la percepción del entorno del barrio y la realización de actividad física, con la autopercepción del estado de salud (APES) por parte de mujeres residentes en barrios de bajo nivel socioeconómico de Bogotá, Colombia. MÉTODOS: Se describe un análisis de fuente secundaria de la primera medición de un ensayo grupal comunitario que evaluó un programa dirigido a promover el consumo de frutas y verduras y la actividad física en cuidadoras de hogar residentes en Bogotá. Se realizaron análisis multivariados logísticos de multinivel, con el fin de identificar asociaciones y verificar las mediaciones propuestas en el modelo conceptual. RESULTADOS: En los modelos ajustados se encontró que la PSE medida a nivel individual y la percepción del barrio estuvieron inversa y significativamente asociados a una APES no óptima, mientras que la asociación entre la actividad física y la APES no fue significativa. CONCLUSIONES: Los hallazgos del estudio resaltan la importancia de la PSE de las personas en la valoración de su estado de salud, y extienden la evidencia sobre el papel independiente de la percepción del entorno del barrio en la APES en mujeres.

OBJECTIVE: Evaluate a conceptual model that suggests an association between socioeconomic status (SES), perception of neighborhood environment, physical activity behavior, and self-rated health status (SRHS) among women living in low-resource neighborhoods of Bogotá, Colombia. METHODS: A secondary source analysis of the first measurement of a community cluster trial was used to evaluate a program to encourage a higher consumption of fruits and vegetables and increase physical activity levels among homemakers in Bogotá. Analyses were done using a multivariate multilevel logistic model to identify associations and confirm the mediations proposed in the conceptual model. RESULTS: The adjusted models revealed that individual-level SES and neighborhood perception are inversely and significantly associated with suboptimal SRHS, while the association between physical activity and SRHS was not significant. CONCLUSIONS: The study findings underscore the importance of individual SES in assessment of health status and strengthen the evidence on the independent role of perception of neighborhood environment in the SRHS of women.

Niveles de urbanización, uso de televisión y video-juegos en niños colombianos: posibles implicaciones en salud pública / Possible public health implications regarding associations between the degree of urbanisation and electronic media exposure amongst Colombian children

Objetivo Examinar la asociación entre los niveles de urbanización y el uso excesivo de televisión y videojuegos (2 horas o más) en niños colombianos de 5 a 12 años. Métodos Un análisis secundario fue realizado a partir de los datos provenientes de 13.090 niños entre 5 a 12 años de edad que fueron seleccionados en la Encuesta Nacional de la Situación Nutricional en Colombia 2005, a los cuales se les determinó el tiempo dedicado a ver televisión y jugar con video juegos, a través de la información proveniente de uno de los padres o acudientes. Cinco niveles de urbanización fueron determinados mediante una adaptación de las categorías definidas por el Departamento Nacional de Planeación. Un modelo de regresión logística fue llevado a cabo, el cual considero potenciales variables de confusión. Resultados Se observó un incremento gradual de la probabilidad de ver dos o más horas televisión o video juegos a medida que el nivel de urbanización era mayor, la cual fue estadísticamente significativa a partir del nivel de urbanización 3 (nivel 2 OR de prevalencia: 1,33 IC 95 por ciento: 0,89-1,99; nivel 3: 1,35: 1,00-1,80; nivel 4: 1,61: 1,16-2,23 y nivel 5: 1,70: 1,17-2,46). Conclusión Los hallazgos de este estudio muestran como el uso excesivo de televisión y video juegos en niños esta asociado a mayores niveles de urbanización. Debido a las implicaciones que tiene para la salud de los niños la exposición excesiva a la televisión y otras formas de entretenimiento electrónico, es importante monitorear este comportamiento y entender sus determinantes.

Objective Determining the association between the degree of urbanisation and excessive television-viewing and video-game use amongst children aged 5 to 12 years old. Methods Data from the Colombian National Nutritional Survey 2005 was used in the analysis. Television viewing and video-game use was determined through parental reports for 13,090 children and classified as being excessive (e" 2 hours/day) or suitable (<2 hours/day). Five levels of urbanisation were determined using criteria from the National Planning Department and the population size of the rural or urban settings included in the survey. Multiple logistical regression analysis was conducted while taking potential confounders into account. Results There was a gradual increase in the probability of TV or videogames being used for 2 hours or more as the degree of urbanisation increased. This association was statistically significant for urbanisation level 3 and higher (urbanisation level 2, OR=1,33: 0,89-1,99 95 percentCI; urbanisation level 3, 1,35=OR: 1,00-1,80 95 percentCI; urbanisation level 4, 1,61=OR: 1,16-2,23 95 percentCI and urbanisation level 5, 1,7=OR: 1,17-2,46 95 percentCI). Conclusion Colombian children living in areas of high-to-moderate urbanisation and population density are at a higher risk of excessive exposure to electronic media entertainment. Due to its multiple health implications (in particular obesity and cardio-metabolic health), such sedentary behaviour should be monitored and its determinants in the Colombian paediatric population must be understand for making effective public health interventions.

Planeación local para enfrentar el desafío de las enfermedades crónicas en Pasto, Colombia / Local planning to tackle the threat of the chronic diseases in Pasto, Colombia

Las enfermedades crónicas son un creciente problema de salud pública en el mundo. En países como Colombia, estas enfermedades son una causa importante de morbimortalidad y su tendencia es ascendente. Ante esta situación, diversas entidades han recomendado planear y conducir acciones para su prevención; sin embargo, existen pocas iniciativas con este propósito, lo cual refleja una situación que ha sido denominada como "la epidemia negada de las enfermedades crónicas". Este artículo describe la experiencia de formulación y los contenidos de un plan para la prevención de estas enfermedades en la ciudad colombiana de Pasto, en cuyo proceso se utilizó un modelo de planificación propuesto por la Organización Mundial de la Salud. El plan busca disminuir en los próximos diez años la prevalen-cia de los tres principales factores de riesgo para enfermedades crónicas entre 5 y 10 puntos porcentuales, para lo cual se proponen acciones de política pública, en ámbitos de la vida cotidiana, servicios de salud y la generación de evidencia para la toma de decisiones a través de un observatorio de enfermedades crónicas. Esta experiencia destacó la importancia y factibilidad de estos procesos en el contexto local e identificó la articulación con el nivel nacional como uno de los principales desafíos que deberán ser tenidos en cuenta para el desarrollo de este tipo iniciativas.

Chronic diseases are increasing problem of public health in the world. In countries such as Colombia these diseases are an important cause of morbidity and mortality. Taking into account this situation several organizations have recommended planning and conducting actions to prevent chronic diseases, however there are scarce initiatives addressed to this purpose which reflect a reality that has been named as the "neglected epidemic of chronic diseases". This article describes the experience of formulation of a local plan for the prevention of chronic diseases in the Colombian city of Pasto where was used a planning model developed by the World Health Organization. The goal of this plan is reduce in the following ten year the prevalence of the three main risk factors for chronic disease between 5 to 10 percent addressing the actions in public policies, contexts for the daily life, health services and the generation of evidence to make decisions through an observatory in chronic diseases. This experience showed up the importance and feasibility of this process at the local context and identified the coordination with the national level as one of the main challenges to be considered to carry out these initiatives.

[Possible public health implications regarding associations between the degree of urbanisation and electronic media exposure amongst Colombian children]. / Niveles de urbanización, uso de televisión y video-juegos en niños Colombianos: posibles implicaciones en salud pública.

OBJECTIVE: Determining the association between the degree of urbanisation and excessive television-viewing and video-game use amongst children aged 5 to 12 years old. METHODS: Data from the Colombian National Nutritional Survey 2005 was used in the analysis. Television viewing and video-game use was determined through parental reports for 13,090 children and classified as being excessive (e' 2 hours/day) or suitable (<2 hours/day). Five levels of urbanisation were determined using criteria from the National Planning Department and the population size of the rural or urban settings included in the survey. Multiple logistical regression analysis was conducted while taking potential confounders into account. RESULTS: There was a gradual increase in the probability of TV or videogames being used for 2 hours or more as the degree of urbanisation increased. This association was statistically significant for urbanisation level 3 and higher (urbanisation level 2, OR=1,33: 0,89-1,99 95 %CI; urbanisation level 3, 1,35=OR: 1,00-1,80 95 %CI; urbanisation level 4, 1,61=OR: 1,16-2,23 95 %CI and urbanisation level 5, 1,7=OR: 1,17-2,46 95 %CI). CONCLUSION: Colombian children living in areas of high-to-moderate urbanisation and population density are at a higher risk of excessive exposure to electronic media entertainment. Due to its multiple health implications (in particular obesity and cardio-metabolic health), such sedentary behaviour should be monitored and its determinants in the Colombian paediatric population must be understand for making effective public health interventions.

Television viewing and its association with overweight in Colombian children: results from the 2005 National Nutrition Survey: a cross sectional study.

BACKGROUND: There has been an ongoing discussion about the relationship between time spent watching television and childhood obesity. This debate has special relevance in the Latin American region were the globalization process has increased the availability of screen-based entertainment at home. The aim of this study is to examine the association between television viewing and weight status in Colombian children. METHODS: This cross sectional investigation included children aged 5 to12 yrs from the National Nutrition Survey in Colombia (ENSIN 2005). Weight and height were measured in 11,137 children in order to calculate body mass index. Overweight was defined by international standards. Time spent viewing television was determined for these children through parental reports. Multiple logistic regression analyses were conducted for different subgroups and adjusted for potential confounders in order to study the association between television viewing and weight status in this population. RESULTS: Among the surveyed children, 41.5% viewed television less than two hours/day; 36.8% between two and 3.9 hours/day and 21.7% four or more hours/day. The prevalence of overweight (obesity inclusive) in this population was 11.1%. Children who were classified as excessive television viewers (between two and 3.9 hours/day or 4 or more hours/day) were more likely to be overweight (OR: 1.44 95% CI: 1.41-1.47 and OR: 1.32 95% CI: 1.30-1.34, respectively) than children who reported to watch television less than 2 hours/day. Stratified analyses by age, gender and urbanization levels showed similar results. CONCLUSION: Television viewing was positively associated with the presence of overweight in Colombian children. A positive association between urbanization level and television viewing was detected. Considering that the majority of Colombian children lives in densely populated cities and appear to engage in excessive television viewing these findings are of public health relevance for the prevention of childhood obesity.

Community intervention to promote consumption of fruits and vegetables, smoke-free homes, and physical activity among home caregivers in Bogotá, Colombia.

INTRODUCTION: We conducted a pilot study to develop and assess the effectiveness of three interventions to promote consumption of fruits and vegetables, promote physical activity, and negotiate smoke-free homes among home caregivers in Bogotá, Colombia. Colombian home caregivers were defined as women who take care of minors in their local communities regardless of kinship or family ties. METHODS: A nonrandomized community intervention was conducted in low socioeconomic status neighborhoods in Bogotá. Ninety-seven women aged 18 to 60 years participated in one of three groups. In groups A and B, women received the following components: information and communication about healthy behaviors (with group A receiving additional activities); education about developing decision-making skills; and social support from family members and others. In group C, women received only the information and communication component received by group B. The main outcomes (measured at baseline, immediately after the intervention at 5 months, and at 7 months) included self-reported consumption of fruits and vegetables, whether there was an agreement form signed by family members to refrain from smoking inside the home, and self-reported level of physical activity. RESULTS: No differences were found between intervention groups. Regardless of the intervention, there was an increase in the proportion of women who reported consuming juices made from fruit (from 51.5% at baseline to 80.9% at 7 months, P <.001), an increase in the proportion of women who reported daily consumption of vegetables or salad (from 44.1% at baseline to 64.7% at 7 months, P < .001), and an increase in the proportion of homes with an agreement that forbids in-home smoking (from 27.9% at baseline to 44.1% at 7 months, P = .04). There was no significant difference in levels of physical activity from baseline to postintervention. CONCLUSION: Home caregivers may be responsive to community interventions associated with the promotion of healthy diet and agreements with family members who smoke to refrain from smoking in the home.