Prevention and control : the official journal of the World Heart Federation最新文献

Latin American countries are experiencing an increasing burden of tobacco-related diseases. Smoke free policies are cost-effective interventions to control both exposure of non-smokers to the toxic chemicals in secondhand tobacco smoke and to reduce the prevalence of smoking and its consequent morbidity and mortality. The World Health Organization Framework Convention on Tobacco Control has created momentum in Latin America to implement meaningful tobacco control policies. As of August 2007, Uruguay, two provinces and three cities in Argentina, and one state in Venezuela, had passed, regulated, and enforced 100% smoke free legislation. The tobacco industry, working through local subsidiaries, has been the strongest obstacle in achieving this goal and has prevented progress elsewhere in the region. During the 1990s, transnational tobacco companies Philip Morris International and British American Tobacco developed voluntary initiatives (“Courtesy of Choice” and “Environmental Tobacco Smoke Consultancy” programs) to prevent effective smoke free policies. Another important barrier in the region has often been a weak and fragmented local civil society. Opportunities in the region that should be taken into account are a high public support for smoke free environments and increasing capacity building available from international collaboration on tobacco control. Policymakers and tobacco control advocates should prioritize the implementation of smoke free policies in Latin America to protect non-smokers, reduce smoking prevalence with its economic and disease burden in the region.

Background

In Guatemala, cardiovascular diseases are becoming the leading cause of mortality and disability. The rising burden of these diseases makes it imperative to formulate effective community-based interventions. The success of these interventions will depend on the felt needs of the community. Therefore, in this study we assessed perceptions, knowledge and beliefs about cardiovascular diseases in community members, health workers and policy makers from Villa Nueva, a community selected by the Ministry of Health of Guatemala as a site to develop a cardiovascular disease prevention programme. This study provides baseline information for designing and implementing the demonstration programme.

Methods

Qualitative methods (focus group discussions and in-depth interviews) were used to elicit the views of community members, health workers, and policy makers on the magnitude, impact, risk factors and prevention of cardiovascular diseases and infrastructure in Villa Nueva.

Results

Community members perceive cardiovascular diseases as a serious health problem that has increased in recent years. They consider cardiovascular diseases to be acute dramatic events of sudden onset. According to health professionals and policy makers, the adoption of Western lifestyles by the population is the most important contributor to the increase of cardiovascular diseases in Guatemala. They indicated that prevention requires education of the population, together with adequate health policies. According to most participants, the infrastructure for the management of cardiovascular diseases at the primary health care level is inadequate.

Conclusion

Findings from this study suggest strategies for context-specific formulation of the cardiovascular prevention programme.

Background

The significance of anthropometric measures of obesity that determine coronary-heart-disease (CHD) risk varies among populations. This study compares waist circumference (WC) and body mass index (BMI) in identifying the “obesity-related-CHD risk” among Sri Lankan adults.

Methods

A population-based cross-section of 515 adults aged 20–64 years, residing in the district of Colombo in 2004 was selected by a multi-stage, stratified, probability sampling method. WC, height and weight were measured. Demographic, socio-economic and lifestyle characteristics, smoking and obesity-related-CHD risk factors (hypertension, dyslipidaemia, diabetes) were assessed by questionnaires, physical measurements and biochemical assessments. “Obesity-related CHD risk” was defined by the presence of ⩾1 obesity-related-CHD risk factors.

Results

Compared to BMI, WC was a stronger correlate of systolic and diastolic blood pressure, triglycerides among both sexes and of plasma glucose among males. It was also an independent predictor of obesity-related-CHD risk in both males (beta co-efficient = 0.046; standard error = 0.013) and females (0.024; 0.012) in contrast to BMI, which was significant only among males (0.138; 0.037) in the logistic regression models adjusted for confounders. At the same level of obesity-related-CHD risk corresponding with BMI of 25 kg/m² (OR = 1.7) and 30 kg/m² (OR = 3.5), the corresponding WC values were 90.5 cm and 105.5 cm for males and 100 cm and 129 cm for females. The derived optimal risk thresholds of WC for identifying obesity-related-CHD risk was 88.5 cm for males and 82 cm for females.

Conclusions

WC with its sex-specific cutoff values can serve as a better screening tool than BMI in identifying individuals at risk of obesity-related CHD in low-resource settings.