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1.
Medicina (B Aires) ; 80 Suppl 3: 42-44, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-32658847

RESUMO

CONICET's Translational Health Research Network is coordinating efforts to advance in translational medicine. Health researchers initiate and focus their research with the aim of improving the health and quality of life of the population. An efficient research system should address health problems relevant to the population resulting in interventions and outcomes important for patients and health professionals. Recommendations to achieve this involve large thematic areas like (a) to set research priorities; (b) to improve research methodology; (c) to make research management and regulation transparent; (d) to increase accessibility to all results; and (e) to improve research dissemination. The recent COVID-19 pandemic has been a clear demonstration of how the country's research system has united the most diverse disciplines to jointly provide solutions to address it. An active and transparent mechanism to identify priorities in the country and to unite funding and research efforts to provide solutions to those priorities is proposed. Translational health research means the joint work of the most diverse health research disciplines in order to jointly obtain efficient and effective interventions to improve the health and quality of life of the population.


Assuntos
Infecções por Coronavirus , Coronavirus , Pandemias , Pneumonia Viral , Pesquisa Médica Translacional , Argentina/epidemiologia , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Humanos , Pneumonia Viral/epidemiologia , Qualidade de Vida
2.
Rev. esp. nutr. comunitaria ; 26(2): 0-0, abr.-jun. 2020. ilus, tab
Artigo em Espanhol | IBECS-Express | IBECS | ID: ibc-ET2-6304

RESUMO

FUNDAMENTOS: Hablar de equidad de género requiere de abordar estereotipos perjudiciales, donde a menudo se perpetúan a través de la publicidad. El objetivo del estudio fue explorar la construcción y reproducción de estereotipos de género presentes en la publicidad gráfica a través de folletos promocionales en las principales cadenas de supermercados de la Ciudad Autónoma de Buenos Aires (CABA), Argentina. MÉTODOS: Se desarrolló una metodología cualitativa usando análisis documental y muestreo intencional. Se recolectaron folletos de 8 principales cadenas de supermercados de la CABA durante 3 meses (960 páginas de folletos). RESULTADOS: Los hallazgos indican que existen marcados estereotipos de género en las publicidades impresas donde se representó a las mujeres en roles pasivos y tradicionales como madre-cuidadora y ama de casa; esta tendencia se vio asimismo en publicidades orientadas a la población infantil. La representación de hombres fue con actividades diferenciales y roles activos. Se observaron representaciones vinculadas a la mujer madre, cuidadora y ama de casa y al modelo de familia tradicional en torno a aspectos alimentarios. CONCLUSIONES: Se concluye que en las publicidades gráficas a través de folletos promocionales existen estereotipos de género sexistas, sin observar una evolución positiva hacia otros patrones de género, inclusión y diversidad


BACKGROUND: Talking about gender equity recquires facing stereotypes counterproductive, often perpetuated through publicity. The objective of the study was to explore the construction and reproduction of gender stereotypes present in graphic advertising through promotional brochures in the main supermarket chains in Buenos Aires (CABA), Argentina. METHODS: A qualitative methodology was developed, usingdocumentary analysis and intentional sampling. Promotional brochures were gathered from 8 supermarket chains of the CABA, along three consecutive months (960 pages). RESULTS: The findings of this study indicate that there are noticeable gender stereotypes in print advertisements (brochures), where women were represented in passive and traditional roles as mother-caregiver and housewife, a trend which was also seen in advertisements aimed at children. Representation of men included differential activities and more active roles. Representations related to the woman mother, caregiver and housewife and the traditional family model regarding food aspects were observed. CONCLUSIONS: It is concluded that there are sexist gender stereotypes in graphic advertising through promotional brochures, without any positive evolution towards other gender patterns, inclusion and diversity

3.
Trials ; 21(1): 509, 2020 Jun 09.
Artigo em Inglês | MEDLINE | ID: mdl-32517806

RESUMO

BACKGROUND: Hypertension is a major risk factor for cardiovascular disease (CVD). Despite advances in hypertension prevention and treatment, the proportion of patients who are aware, treated and controlled is low, particularly in low-income and middle-income countries (LMICs). We will evaluate an adapted version of a multilevel and multicomponent hypertension control program in Guatemala, previously proven effective and feasible in Argentina. The program components are: protocol-based hypertension treatment using a standardized algorithm; team-based collaborative care; health provider education; health coaching sessions; home blood pressure monitoring; blood pressure audit; and feedback. METHODS: Using a hybrid type 2 effectiveness-implementation design, we will evaluate clinical and implementation outcomes of the multicomponent program in Guatemala over an 18-month period. Through a cluster randomized trial, we will randomly assign 18 health districts to the intervention arm and 18 to enhanced usual care across five departments, enrolling 44 participants per health district and 1584 participants in total. The clinical outcomes are (1) the difference in the proportion of patients with controlled hypertension (< 130/80 mmHg) between the intervention and control groups at 18 months and (2) the net change in systolic and diastolic blood pressure from baseline to 18 months. The context-enhanced Reach, Efficacy, Adoption, Implementation, Maintenance (RE-AIM)/Practical Robust Implementation and Sustainability Model (PRISM) framework will guide the evaluation of the implementation at the level of the patient, provider, and health system. Using a mixed-methods approach, we will evaluate the following implementation outcomes: acceptability, adoption, feasibility, fidelity, adaptation, reach, sustainability, and cost-effectiveness. DISCUSSION: We will disseminate the study findings, and promote scale up and scale out of the program, if proven effective. This study will generate urgently needed data on effective, adoptable, and sustainable interventions and implementation strategies to improve hypertension control in Guatemala and other LMICs. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03504124. Registered on 20 April 2018.

4.
Lancet ; 396(10244): 97-109, 2020 07 11.
Artigo em Inglês | MEDLINE | ID: mdl-32445693

RESUMO

BACKGROUND: Some studies, mainly from high-income countries (HICs), report that women receive less care (investigations and treatments) for cardiovascular disease than do men and might have a higher risk of death. However, very few studies systematically report risk factors, use of primary or secondary prevention medications, incidence of cardiovascular disease, or death in populations drawn from the community. Given that most cardiovascular disease occurs in low-income and middle-income countries (LMICs), there is a need for comprehensive information comparing treatments and outcomes between women and men in HICs, middle-income countries, and low-income countries from community-based population studies. METHODS: In the Prospective Urban Rural Epidemiological study (PURE), individuals aged 35-70 years from urban and rural communities in 27 countries were considered for inclusion. We recorded information on participants' sociodemographic characteristics, risk factors, medication use, cardiac investigations, and interventions. 168 490 participants who enrolled in the first two of the three phases of PURE were followed up prospectively for incident cardiovascular disease and death. FINDINGS: From Jan 6, 2005 to May 6, 2019, 202 072 individuals were recruited to the study. The mean age of women included in the study was 50·8 (SD 9·9) years compared with 51·7 (10) years for men. Participants were followed up for a median of 9·5 (IQR 8·5-10·9) years. Women had a lower cardiovascular disease risk factor burden using two different risk scores (INTERHEART and Framingham). Primary prevention strategies, such as adoption of several healthy lifestyle behaviours and use of proven medicines, were more frequent in women than men. Incidence of cardiovascular disease (4·1 [95% CI 4·0-4·2] for women vs 6·4 [6·2-6·6] for men per 1000 person-years; adjusted hazard ratio [aHR] 0·75 [95% CI 0·72-0·79]) and all-cause death (4·5 [95% CI 4·4-4·7] for women vs 7·4 [7·2-7·7] for men per 1000 person-years; aHR 0·62 [95% CI 0·60-0·65]) were also lower in women. By contrast, secondary prevention treatments, cardiac investigations, and coronary revascularisation were less frequent in women than men with coronary artery disease in all groups of countries. Despite this, women had lower risk of recurrent cardiovascular disease events (20·0 [95% CI 18·2-21·7] versus 27·7 [95% CI 25·6-29·8] per 1000 person-years in men, adjusted hazard ratio 0·73 [95% CI 0·64-0·83]) and women had lower 30-day mortality after a new cardiovascular disease event compared with men (22% in women versus 28% in men; p<0·0001). Differences between women and men in treatments and outcomes were more marked in LMICs with little differences in HICs in those with or without previous cardiovascular disease. INTERPRETATION: Treatments for cardiovascular disease are more common in women than men in primary prevention, but the reverse is seen in secondary prevention. However, consistently better outcomes are observed in women than in men, both in those with and without previous cardiovascular disease. Improving cardiovascular disease prevention and treatment, especially in LMICs, should be vigorously pursued in both women and men. FUNDING: Full funding sources are listed at the end of the paper (see Acknowledgments).


Assuntos
Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/prevenção & controle , Países em Desenvolvimento/economia , Adulto , Idoso , Doenças Cardiovasculares/tratamento farmacológico , Doenças Cardiovasculares/epidemiologia , Estudos de Casos e Controles , Causas de Morte/tendências , Doença das Coronárias/epidemiologia , Países em Desenvolvimento/estatística & dados numéricos , Estudos Epidemiológicos , Feminino , Estilo de Vida Saudável/fisiologia , Humanos , Incidência , Renda , Masculino , Pessoa de Meia-Idade , Pobreza , Estudos Prospectivos , Fatores de Risco , População Rural , Prevenção Secundária , Fatores Socioeconômicos
5.
Eur J Prev Cardiol ; : 2047487320912376, 2020 Apr 06.
Artigo em Inglês | MEDLINE | ID: mdl-32250171

RESUMO

BACKGROUND: Observational studies have documented lower risks of coronary heart disease and diabetes among moderate alcohol consumers relative to abstainers, but only a randomized clinical trial can provide conclusive evidence for or against these associations. AIM: The purpose of this study was to describe the rationale and design of the Moderate Alcohol and Cardiovascular Health Trial, aimed to assess the cardiometabolic effects of one alcoholic drink daily over an average of six years among adults 50 years or older. METHODS: This multicenter, parallel-arm randomized trial was designed to compare the effects of one standard serving (∼11-15 g) daily of a preferred alcoholic beverage to abstention. The trial aimed to enroll 7800 people at high risk of cardiovascular disease. The primary composite endpoint comprised time to the first occurrence of non-fatal myocardial infarction, non-fatal ischemic stroke, hospitalized angina, coronary/carotid revascularization, or total mortality. The trial was designed to provide >80% power to detect a 15% reduction in the risk of the primary outcome. Secondary outcomes included diabetes. Adverse effects of special interest included injuries, congestive heart failure, alcohol use disorders, and cancer. RESULTS: We describe the design, governance, masking issues, and data handling. In three months of field center activity until termination by the funder, the trial randomized 32 participants, successfully screened another 70, and identified ∼400 additional interested individuals. CONCLUSIONS: We describe a feasible design for a long-term randomized trial of moderate alcohol consumption. Such a study will provide the highest level of evidence for the effects of moderate alcohol consumption on cardiovascular disease and diabetes, and will directly inform clinical and public health guidelines.

6.
J Public Health (Oxf) ; 42(1): 107-117, 2020 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-30649400

RESUMO

BACKGROUND: Using data from general adult population, this study aims to describe epidemiology of alcohol consumption patterns and their association with cardiovascular risk. METHODS: CESCAS I is a population-based study from four mid-sized cities in Argentina, Chile and Uruguay. Associations between diabetes, hypertension, dyslipidemia, cardiovascular disease (CVD) risk and history of CVD and drinking patterns were assessed using crude prevalence odds ratios (ORs) and adjusted OR. RESULTS: A total of 37.2% of the studied population never drank and 18.3% reported to be former drinkers. Among current drinkers, moderate drinking was the most frequent pattern (24.2%). For women with light and moderate consumption, the odds of having >20% CVD risk was ~40% lower than that of never drinkers. The odds of having a history of CVD was 50% lower in those with moderate consumption. For men with heavy consumption, the odds of having >20% CVD risk was about twice as high as for never drinkers. CONCLUSIONS: A harmful association was observed between heavy drinking and having >20% CVD risk for men. However, for women, an apparently protective association was observed between light and moderate drinking and having >20% CVD risk and between moderate drinking and having a history of CVD.

7.
Medicina (B Aires) ; 79(6): 438-444, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31829945

RESUMO

Cardiovascular disease (CVD) is the leading cause of death in Argentina. Computer simulation models allow to extrapolate evidence to broader populations than the originally studied, over longer timeframes, and to compare different subpopulations. The Cardiovascular Disease Policy Model (CVDPM) is a computer simulation state transition model used to represent and project future CVD mortality and morbidity in the population 35 years-old and older. The objective of this study was to update Argentina's version of the CVDPM. For this purpose, information from the 2010 National Census, the 2013 National Risk Factor Survey, CESCAS I study, and PrEViSTA study were used to update the dynamics of population size, demographics, and CVD risk factor distributions over time. Model projections were later calibrated by comparing them to actual data on CVD events and mortality in the year 2010 (baseline year) in Argentina. Country statistics for people 35 years-old and older reported for 2010 a total of 41 219 myocardial infarctions (MIs), 58 658 strokes, and 281 710 total deaths. The CVDPM, in turn, predicted 41 265 MIs (difference: 0.11%), 58 584 strokes (difference: 0.13%), and 280 707 total deaths (difference: 0.36%) in the same population. In all cases, the final version of the model predicted the actual number of events with an accuracy superior to 99.5%, and could be used to forecast the changes in CVD incidence and mortality after the implementation of public policies.


Assuntos
Doenças Cardiovasculares/mortalidade , Simulação por Computador , Mortalidade/tendências , Medição de Risco/métodos , Adulto , Distribuição por Idade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Argentina/epidemiologia , Calibragem , Feminino , Previsões , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Fatores de Risco , Distribuição por Sexo , Fatores Sexuais , Fatores de Tempo
8.
PLoS One ; 14(12): e0226622, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31841570

RESUMO

Prior studies have suggest that religiosity mitigates symptoms of depression. However, population-based data in South America are limited. This study determines the prevalence of religiosity and explores its association with depression in four cities of the Southern cone of Latin-America. In the CESCAS I study 7524 participants aged between 35 and 74 years old were recruited between 2011 and 2012 from randomly selected samples in 4 cities (Bariloche and Marcos Paz, Argentina; Temuco, Chile; and Pando-Barros Blancos, Uruguay). Religiosity was assessed with a questionnaire from the Hispanic Community Health Study/Study of Latinos. Two dimensions were used: 1) recognition as belonging to a religion; and 2) frequency of participation in religious activities. Depression was measured using the PHQ-9. Prevalence of religiosity was described by sociodemographic characteristics. Association between religiosity and depression was examined through logistic regression models controlling for sex, age and other potential confounders. Weekly religious activities were reported by 32.3% (95% CI: 30.1, 33.6) of participants. Prevalence of major depressive episode (MDE) was 14.6% (95% CI: 13.6, 15.6). After controlling for confounders, older women (≥65 years) who reported religious affiliation had 70% lower likelihood of having MDE (OR: 0.3; 95% CI, 0.1, 0.8). Moreover, in this group, women participating in religious activities more than once per week compared with "never" had 50% lower likelihood of having a MDE (OR: 0.5; 95% CI: 0.3, 0.9). No association between religious activities and depression was found in men. Religiosity is highly prevalent among adults in four cities of South America. Our study found an inverse association between religiosity and depression only in women, stronger in olders. Although longitudinal studies are necessary to determine the true nature of these relationships, religiosity may be a relevant factor that health care providers could take into account when exploring depression in their patients.


Assuntos
Depressão/etiologia , Religião , Adulto , Fatores Etários , Idoso , Argentina/epidemiologia , Chile/epidemiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores Sexuais , América do Sul/epidemiologia , Inquéritos e Questionários , Uruguai/epidemiologia
9.
Medicina (B.Aires) ; 79(6): 438-444, dic. 2019. ilus, graf, tab
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1056750

RESUMO

La enfermedad cardiovascular (ECV) es la principal causa de muerte en Argentina. Los modelos de simulació;n por computadora permiten extrapolar evidencia a poblaciones más amplias que las originalmente estudiadas, a lo largo de períodos prolongados, y comparar diferentes subpoblaciones. El Cardiovascular Disease Policy Model (CVDPM, por sus siglas en ingló;©s) es un modelo de simulació;n utilizado para representar y proyectar la mortalidad y morbilidad por ECV en la població;n de 35 o más aó;±os. El objetivo de este trabajo fue actualizar la versió;n argentina del CVDPM. Para esto, se utilizó; informació;n del Censo Nacional 2010, la Encuesta Nacional de Factores de Riesgo 2013, el estudio CESCAS I, y el estudio PrEViSTA, para actualizar la dinámica del tamaó;±o de la població;n, sus características demográficas, y la distribució;n de factores de riesgo cardiovasculares a lo largo del tiempo. Las proyecciones del modelo se calibraron comparándolas con informació;n sobre eventos de ECV y mortalidad en el aó;±o 2010 (aó;±o de referencia) en Argentina. Las estadísticas argentinas informaron que en 2010 la població;n de 35 o más aó;±os sufrió; un total de 41 219 infartos de miocardio (IM), 58 658 accidentes cerebrovasculares y 281 710 muertes totales. El CVDPM predijo 41 265 IM (diferencia: 0.11%), 58 584 accidentes cerebrovasculares (diferencia: 0.13%) y 280 707 muertes totales (diferencia: 0.36%). En todos los casos, la versió;n final del modelo predijo el nó;ºmero real de eventos cardiovasculares con una precisió;n superior al 99.5%, pudiendo ser utilizado para pronosticar cambios en la incidencia y mortalidad de ECV debidos de la implementació;n de políticas pó;ºblicas.


Cardiovascular disease (CVD) is the leading cause of death in Argentina. Computer simulation models allow to extrapolate evidence to broader populations than the originally studied, over longer timeframes, and to compare different subpopulations. The Cardiovascular Disease Policy Model (CVDPM) is a computer simulation state transition model used to represent and project future CVD mortality and morbidity in the population 35 years-old and older. The objective of this study was to update Argentina’s version of the CVDPM. For this purpose, information from the 2010 National Census, the 2013 National Risk Factor Survey, CESCAS I study, and PrEViSTA study were used to update the dynamics of population size, demographics, and CVD risk factor distributions over time. Model projections were later calibrated by comparing them to actual data on CVD events and mortality in the year 2010 (baseline year) in Argentina. Country statistics for people 35 years-old and older reported for 2010 a total of 41 219 myocardial infarctions (MIs), 58 658 strokes, and 281 710 total deaths. The CVDPM, in turn, predicted 41 265 MIs (difference: 0.11%), 58 584 strokes (difference: 0.13%), and 280 707 total deaths (difference: 0.36%) in the same population. In all cases, the final version of the model predicted the actual number of events with an accuracy superior to 99.5%, and could be used to forecast the changes in CVD incidence and mortality after the implementation of public policies.

10.
Medicina (B.Aires) ; 79(6): 0-0, dic. 2019. ilus, graf, tab
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1056751

RESUMO

Cardiovascular disease (CVD) is the leading cause of death in Argentina. Computer simulation models allow to extrapolate evidence to broader populations than the originally studied, over longer timeframes, and to compare different subpopulations. The Cardiovascular Disease Policy Model (CVDPM) is a computer simulation state transition model used to represent and project future CVD mortality and morbidity in the population 35 years-old and older. The objective of this study was to update Argentina’s version of the CVDPM. For this purpose, information from the 2010 National Census, the 2013 National Risk Factor Survey, CESCAS I study, and PrEViSTA study were used to update the dynamics of population size, demographics, and CVD risk factor distributions over time. Model projections were later calibrated by comparing them to actual data on CVD events and mortality in the year 2010 (baseline year) in Argentina. Country statistics for people 35 years-old and older reported for 2010 a total of 41 219 myocardial infarctions (MIs), 58 658 strokes, and 281 710 total deaths. The CVDPM, in turn, predicted 41 265 MIs (difference: 0.11%), 58 584 strokes (difference: 0.13%), and 280 707 total deaths (difference: 0.36%) in the same population. In all cases, the final version of the model predicted the actual number of events with an accuracy superior to 99.5%, and could be used to forecast the changes in CVD incidence and mortality after the implementation of public policies.


La enfermedad cardiovascular (ECV) es la principal causa de muerte en Argentina. Los modelos de simulació;n por computadora permiten extrapolar evidencia a poblaciones más amplias que las originalmente estudiadas, a lo largo de períodos prolongados, y comparar diferentes subpoblaciones. El Cardiovascular Disease Policy Model (CVDPM, por sus siglas en ingló;©s) es un modelo de simulació;n utilizado para representar y proyectar la mortalidad y morbilidad por ECV en la població;n de 35 o más aó;±os. El objetivo de este trabajo fue actualizar la versió;n argentina del CVDPM. Para esto, se utilizó; informació;n del Censo Nacional 2010, la Encuesta Nacional de Factores de Riesgo 2013, el estudio CESCAS I, y el estudio PrEViSTA, para actualizar la dinámica del tamaó;±o de la població;n, sus características demográficas, y la distribució;n de factores de riesgo cardiovasculares a lo largo del tiempo. Las proyecciones del modelo se calibraron comparándolas con informació;n sobre eventos de ECV y mortalidad en el aó;±o 2010 (aó;±o de referencia) en Argentina. Las estadísticas argentinas informaron que en 2010 la població;n de 35 o más aó;±os sufrió; un total de 41 219 infartos de miocardio (IM), 58 658 accidentes cerebrovasculares y 281 710 muertes totales. El CVDPM predijo 41 265 IM (diferencia: 0.11%), 58 584 accidentes cerebrovasculares (diferencia: 0.13%) y 280 707 muertes totales (diferencia: 0.36%). En todos los casos, la versió;n final del modelo predijo el nó;ºmero real de eventos cardiovasculares con una precisió;n superior al 99.5%, pudiendo ser utilizado para pronosticar cambios en la incidencia y mortalidad de ECV debidos de la implementació;n de políticas pó;ºblicas.

12.
Lancet Glob Health ; 7(12): e1644-e1654, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31708145

RESUMO

BACKGROUND: The burden of obesity differs by socioeconomic status. We aimed to characterise the prevalence of obesity among adult men and women in Latin America and the Caribbean by socioeconomic measures and the shifting obesity burden over time. METHODS: We did a cross-sectional series analysis of obesity prevalence by socioeconomic status by use of national health surveys done between 1998 and 2017 in 13 countries in Latin America and the Caribbean. We generated equiplots to display inequalities in, the primary outcome, obesity by wealth, education, and residence area. We measured obesity gaps as the difference in percentage points between the highest and lowest obesity prevalence within each socioeconomic measure, and described trends as well as changing patterns of the obesity burden over time. FINDINGS: 479 809 adult men and women were included in the analysis. Obesity prevalence across countries has increased over time, with distinct patterns emerging by wealth and education indices. In the most recent available surveys, obesity was most prevalent among women in Mexico in 2016, and the least prevalent among women in Haiti in 2016. The largest gap between the highest and lowest obesity estimates by wealth was observed in Honduras among women (21·6 percentage point gap), and in Peru among men (22·4 percentage point gap), compared with a 3·7 percentage point gap among women in Brazil and 3·3 percentage points among men in Argentina. Urban residents consistently had a larger burden than their rural counterparts in most countries, with obesity gaps ranging from 0·1 percentage points among women in Paraguay to 15·8 percentage points among men in Peru. The trend analysis done in five countries suggests a shifting of the obesity burden across socioeconomic groups and different patterns by gender. Obesity gaps by education in Mexico have reduced over time among women, but increased among men, whereas the gap has increased among women but remains relatively constant among men in Argentina. INTERPRETATION: The increase in obesity prevalence in the Latin American and Caribbean region has been paralleled with an unequal distribution and a shifting burden across socioeconomic groups. Anticipation of the establishment of obesity among low socioeconomic groups could provide opportunities for societal gains in primordial prevention. FUNDING: None.

13.
Lung ; 197(6): 793-801, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31583454

RESUMO

CONTEXT: Observational studies investigating household air pollution (HAP) exposure to biomass fuel smoke as a risk factor for pulmonary tuberculosis have reported inconsistent results. OBJECTIVE: To evaluate the association between HAP exposure and the prevalence of self-reported previous pulmonary tuberculosis. DESIGN: We analyzed pooled data including 12,592 individuals from five population-based studies conducted in Latin America, East Africa, and Southeast Asia from 2010 to 2015. We used multivariable logistic regression to model the association between HAP exposure and self-reported previous pulmonary tuberculosis adjusted for age, sex, tobacco smoking, body mass index, secondary education, site and country of residence. RESULTS: Mean age was 54.6 years (range of mean age across settings 43.8-59.6 years) and 48.6% were women (range of % women 38.3-54.5%). The proportion of participants reporting HAP exposure was 38.8% (range in % HAP exposure 0.48-99.4%). Prevalence of previous pulmonary tuberculosis was 2.7% (range of prevalence 0.6-6.9%). While participants with previous pulmonary tuberculosis had a lower pre-bronchodilator FEV1 (mean - 0.7 SDs, 95% CI - 0.92 to - 0.57), FVC (- 0.52 SDs, 95% CI - 0.69 to - 0.33) and FEV1/FVC (- 0.59 SDs, 95% CI - 0.76 to - 0.43) as compared to those who did not, we did not find an association between HAP exposure and previous pulmonary tuberculosis (adjusted odds ratio = 0.86; 95% CI 0.56-1.32). CONCLUSIONS: There was no association between HAP exposure and self-reported previous pulmonary tuberculosis in five population-based studies conducted worldwide.

14.
BMC Psychiatry ; 19(1): 291, 2019 09 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533674

RESUMO

BACKGROUND: The Patient Health Questionnaire-9 (PHQ-9) is a brief tool to assess the presence and severity of depressive symptoms. This study aimed to validate and calibrate the PHQ-9 to determine appropriate cut-off points for different degrees of severity of depression in Argentina. METHODS: We conducted a cross-sectional study on an intentional sample of adult ambulatory care patients with different degrees of severity of depression. All patients who completed the PHQ-9 were further interviewed by a trained clinician with the Mini International Neuropsychiatric Interview (MINI) and the Beck Depression Inventory-II (BDI-II). Reliability and validity tests, including receiver operating curve analysis, were performed. RESULTS: One hundred sixty-nine patients were recruited with a mean age of 47.4 years (SD = 14.8), of whom 102 were females (60.4%). The local PHQ-9 had high internal consistency (Cronbach's alpha = 0.87) and satisfactory convergent validity with the BDI-II scale [Pearson's correlation = 0.88 (p < 0.01)]. For the diagnosis of Major Depressive Episode (MDE) according to the MINI, a PHQ-9 ≥ 8 was the optimal cut-off point found (sensitivity 88.2%, specificity 86.6%, PPV 90.91%). The local version of PHQ-9 showed good ability to discriminate among depression severity categories according to the BDI-II scale. The best cut off points were 6-8 for mild cases, 9-14 for moderate and 15 or more for severe depressive symptoms respectively. CONCLUSIONS: The Argentine version of the PHQ-9 questionnaire has shown acceptable validity and reliability for both screening and severity assessment of depressive symptoms.


Assuntos
Transtorno Depressivo/diagnóstico , Questionário de Saúde do Paciente/normas , Adulto , Argentina , Estudos Transversais , Transtorno Depressivo/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Questionário de Saúde do Paciente/estatística & dados numéricos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Índice de Gravidade de Doença
15.
Am J Prev Med ; 57(4): 438-446, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31473065

RESUMO

INTRODUCTION: Lifestyle modification, such as healthy diet habits, regular physical activity, and maintaining a normal body weight, must be prescribed to all hypertensive individuals. This study aims to test whether a multicomponent intervention is effective in improving lifestyle and body weight among low-income families. STUDY DESIGN: Cluster randomized trial conducted between June 2013 and October 2016. SETTING/PARTICIPANTS: A total of 1,954 uninsured adult patients were recruited in the study within 18 public primary healthcare centers of Argentina. INTERVENTION: Components targeting the healthcare system, providers, and family groups were delivered by community health workers; tailored text messages were sent for 18 months. MAIN OUTCOME MEASURES: Changes in the proportion of behavioral risk factors and body weight from baseline to end of follow-up. Data were analyzed in 2017. RESULTS: Low fruit and vegetable consumption (fewer than 5 servings per day) decreased from 96.4% at baseline to 92.6% at 18 months in the intervention group, whereas in the control group it increased from 97.0% to 99.9% (p=0.0110). The proportion of low physical activity (<600 MET-minutes/week) decreased from 54.3% at baseline to 46.2% at 18 months in the intervention group and kept constant around 52% (p=0.0232) in the control group. The intervention had no effect on alcohol intake (p=0.7807), smoking (p=0.7607), addition of salt while cooking or at the table (p=0.7273), or body weight (p=0.4000). CONCLUSIONS: The multicomponent intervention was effective for increasing fruit and vegetable intake and physical activity with no effect on alcohol consumption, smoking, addition of salt, or body weight among low-income families in Argentina. TRIAL REGISTRATION: This study is registered at www.clinicaltrials.gov NCT01834131.

16.
Acta Cardiol ; : 1-11, 2019 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-31526309

RESUMO

Background: Early repolarization pattern (ERP) is a frequent finding in asymptomatic subjects with controversial implications regarding to its prognosis. This study aims to estimate the prevalence of ERP and its association with sociodemographic characteristics and cardiovascular risk factors among the adult population in the Southern Cone of Latin America. Methods: A sub-sample of 5398 participants of the CESCAS I study was included in the present analysis. ERP was defined as a J peak ≥0.1 mV in two or more contiguous leads with an end-QRS notch or slur on the downslope of a prominent R-wave. Results: The global prevalence of ERP was 8.1%; 11.1% in men and 5.6% in women. The prevalence in women increased with age (odds ratio [OR] 2.5, 95% confidence interval [CI] 1.5-4.2, at >65 years, p < 0.001), current cigarette smoking (OR 1.4, 95%CI 1.0-2.0, p = 0.045) and hypercholesterolaemia (OR 1.4, 95%CI 1.0-2.0, 0 p = 0.036). Conversely, in men, ERP prevalence decreased with age (OR 0.5, 95%CI 0.3-0.9, at >65 years, p = 0.01) and obesity (OR 0.6, 95%CI 0.4-0.8, p = 0.006). We found an increasing ERP prevalence with a higher Sokolow-Lyon index in both sexes (p < 0.001). Inferior location was found in 67.9% of cases, and the most common ERP type was a "slurring" appearance without ST elevation (76.3%). Conclusions: We found an overall prevalence of ERP of 8.1% and a robust association of ERP with normal BMI and higher Sokolow-Lyon index in men and with hypercholesterolaemia, current cigarette smoking and higher Sokolow-Lyon index in women.

17.
Nutrition ; 67-68: 110521, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31446214

RESUMO

OBJECTIVE: We examined whether dietary patterns (DPS) are associated with endothelial dysfunction (ED) markers in an Argentinian population. RESEARCH METHODS & PROCEDURES: The sample in this cross-sectional study was derived from 1,983 subjects from two mid-sized cities in Argentina who were involved in the CESCAS I Study. To define DP, a food-frequency questionnaire was applied. In a subsample randomly selected from the primary cohort, serum concentrations of C-reactive protein (hs-CRP), soluble vascular cell adhesion molecule-1 (sVCAM-1), soluble intercellular adhesion molecule-1 (sICAM-1), and soluble E selectin (sSELE) were determined. Correlations and multiple linear regression models were used to assess the relation between each quartile of DP adherence score and ED markers (Q1 lowest adherence; Q4 highest adherence). RESULTS: Three DPs were identified: Traditional (TDP), Prudent (PDP), and Convenience and processed (CDP). TDP was characterized by higher intake of refined grains, red meat, whole fat dairy products, vegetable oils, and "mate", a traditional South American infused drink; PDP was characterized by higher intake of vegetables, fruit, low-fat dairy products, whole grains, and legumes; and CDP consisted mainly of processed meat, snacks, pizza, and "empanadas", a stuffed bread served baked or fried. Lower scores (Q2, Q3) in TDP were inversely associated with concentrations of sSELE (P < 0.0001 and P < 0.05, respectively). In PDP, higher scores were inversely associated with hs-CRP, whereas lower scores showed a positive relation with sSELE (P < 0.05). Contrariwise, higher scores in CDP were directly associated with sSELE concentrations (P < 0.05). CONCLUSION: Adherence for each DP identified is differentially related to ED markers in the studied population.

18.
Rev Panam Salud Publica ; 43: e68, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31456821

RESUMO

Objective: To identify gaps in postgraduate training and options for building capacity in noncommunicable disease (NCDs) research in Latin America. Methods: This was a scoping review of postgraduate opportunities in NCDs at top universities in Latin America and of training grants awarded by international funding bodies. Three global university rankings were considered-the QS Ranking, the Shanghai Ranking, and the Times Ranking. Latin American universities appearing in at least two of these were selected. University websites were searched for current graduate programs in biostatistics, epidemiology, global health, health economics, and public health. Information was extracted, summarized, and evaluated to identify any programs focused on NCDs. In addition, seven international funding bodies' websites were searched for training grants. Results: In all, 33 universities offering 72 postgraduate programs met the inclusion criteria. One of these programs was exclusively devoted to NCD, and 12 offered NCDs as a dissertation research topic. Only two training grants were awarded to a Latin American institution for NCD capacity building. There are few NCD research training programs in Latin America and only one program exclusively focused on NCDs. Conclusion: There seem to be few NCD-specific research training programs in Latin America. Leveraging existing programs and expanding those with a focus on NCDs could help enhance NCD research capacity in the region. These initiatives should be supported by international funding agencies through more funding opportunities.

19.
Rev Panam Salud Publica ; 43, August 2019
Artigo em Inglês | PAHO-IRIS | ID: phr-51471

RESUMO

[ABSTRACT]. Objective. To identify gaps in postgraduate training and options for building capacity in noncommunicable disease (NCDs) research in Latin America. Methods. This was a scoping review of postgraduate opportunities in NCDs at top universities in Latin America and of training grants awarded by international funding bodies. Three global university rankings were considered—the QS Ranking, the Shanghai Ranking, and the Times Ranking. Latin American universities appearing in at least two of these were selected. University websites were searched for current graduate programs in biostatistics, epidemiology, global health, health economics, and public health. Information was extracted, summarized, and evaluated to identify any programs focused on NCDs. In addition, seven international funding bodies’ websites were searched for training grants. Results. In all, 33 universities offering 72 postgraduate programs met the inclusion criteria. One of these programs was exclusively devoted to NCD, and 12 offered NCDs as a dissertation research topic. Only two training grants were awarded to a Latin American institution for NCD capacity building. There are few NCD research training programs in Latin America and only one program exclusively focused on NCDs. Conclusion. There seem to be few NCD-specific research training programs in Latin America. Leveraging existing programs and expanding those with a focus on NCDs could help enhance NCD research capacity in the region. These initiatives should be supported by international funding agencies through more funding opportunities.


[RESUMEN]. las capacidades de investigación sobre enfermedades no transmisibles (ENT) en América Latina. Métodos. Se realizó una revisión exploratoria de los programas de posgrado sobre las ENT disponibles en las mejores universidades de América Latina y de las becas para investigadores otorgadas por los organismos internacionales de financiamiento. Se consideraron tres listas de clasificación académica de universidades del mundo: QS Ranking, Shanghai Ranking y Times Ranking. Se seleccionaron las universidades de América Latina que figuraban en al menos dos de ellas. Se utilizaron los sitios web de las universidades para buscar los programas de posgrado actuales en las áreas de bioestadística, epidemiología, salud mundial, economía de la salud y salud pública. La información se extrajo, se resumió y se evaluó para encontrar todos los programas centrados en las ENT. Además, se realizó una búsqueda de las becas de formación ofrecidas en los sitios web de siete organismos internacionales de financiamiento. Resultados. En total, 33 universidades que ofrecían 72 programas de posgrado reunieron los criterios de inclusión. Uno de estos programas estaba exclusivamente dedicado a las ENT, y doce incluían las ENT como tema de investigación en tesis de grado. Solo dos becas de formación fueron otorgadas a una institución latinoamericana para fortalecer las capacidades de investigación sobre las ENT. Existen pocos programas para la formación de investigadores sobre las ENT en América Latina y hay un solo programa exclusivamente centrado en las ENT. Conclusiones. Al parecer, hay pocos programas específicos para la formación de investigadores sobre las ENT en América Latina. Aprovechar mejor los programas existentes y ampliar aquellos que se centran en las ENT podría ayudar a aumentar las capacidades de investigación sobre ENT en la región. Estas iniciativas deben contar con el apoyo de los organismos internacionales de financiamiento mediante el aumento de las oportunidades de financiamiento.


[RESUMO]. Objetivo. Identificar lacunas no ensino de pós-graduação e cursos de formação em pesquisa em doenças não transmissíveis na América Latina. Métodos. Trata-se de uma revisão da literatura do tipo scoping review das oportunidades de pós-graduação em doenças não transmissíveis nas principais universidades da América Latina e das bolsas de estudo oferecidas por organismos internacionais de financiamento. O estudo se baseou em três rankings mundiais de universidades – QS Ranking, Ranking de Xangai e The Times Higher Education World University Ranking – e as universidades latino-americanas que figuravam em pelo menos dois destes rankings foram incluídas na análise. Nos sites das universidades, foi feito um levantamento dos cursos atuais de pós-graduação em bioestatística, epidemiologia, saúde global, economia da saúde e saúde pública. As informações obtidas foram sumarizadas e avaliadas para identificar os cursos em doenças não transmissíveis. Além disso, nos sites de sete organismos internacionais de financiamento, foi feita uma pesquisa das bolsas de estudo oferecidas. Resultados. Ao todo, 33 universidades com 72 cursos de pós-graduação atenderam os critérios de inclusão no estudo. Verificou-se que um curso tinha foco exclusivo no estudo de doenças não transmissíveis e 12 cursos tinham doenças não transmissíveis como tópico de pesquisa de dissertação. Foram concedidas somente duas bolsas de estudo em doenças não transmissíveis a uma instituição latino-americana. Observou-se um pequeno número de programas de formação em pesquisa de doenças não transmissíveis na América Latina, com apenas um programa com foco exclusivo nestas doenças. Conclusões. Existem poucos programas de formação em pesquisa especificamente dedicados ao estudo de doenças não transmissíveis na América Latina. Faz-se necessário tirar proveito dos programas existentes e ampliar os programas com foco em doenças não transmissíveis para melhorar a capacidade de pesquisa em doenças não transmissíveis na Região. Essas iniciativas devem receber o apoio de organismos internacionais com maior oferta de bolsas de estudo.


Assuntos
Doenças não Transmissíveis , Pesquisa , Educação , Pesquisadores , América Latina , Doenças não Transmissíveis , Pesquisa , Educação , Pesquisadores , América Latina , Pesquisa , Pesquisadores , Doenças não Transmissíveis , Educação
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