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

Background

Demographic and socioeconomic factors associated with smoking behavior were evaluated in a nationwide household survey in Argentina to describe the status of the tobacco epidemic.

Methods

Face-to-face interviews with adults, age 20 and older, assessed smoking status, frequency, and age of initiation. Multivariate logistic regression was used to compare social and demographic characteristics.

Results

Of the 43,863 participants, 38% of men and 24% of women were current smokers, and 20% of current smokers smoked occasionally. For older men and women, smoking was less prevalent and their probability of quitting higher. Men with more than high school education were less likely to be current smokers. Rates for women did not differ by education.

Conclusions

The lower smoking rates among men with more education suggest that Argentina has begun to transition to the next stage of the tobacco epidemic. Tobacco control policy must direct efforts to change smoking behavior.

Introduction

The Latin America and Caribbean (LAC) regions are undergoing a transition from infectious to chronic non-communicable disease, together with and linked to a rapid aging of the population. Although cardiovascular disease is a principal cause of ill-health and death, few data are available among the elderly.

Materials and methods

We evaluated people aged 60 and over, living in seven urban centers in LAC: Buenos Aires, Bridgetown, Havana, Mexico City, Montevideo, Santiago, and Sao Paulo, who participated in the ‘Salud, Bienestar, y Envejecimiento’ study (SABE), conducted in 1999 and 2000. We calculated the prevalence of self-reported cardiovascular disease (CVD), and examined its association with established risk factors, using odds ratios (ORs) and their population attributable risks (PARs).

Results

The overall prevalence of CVD was 20.3% (95% CI 18.9–21.6). Rates varied across the region: lowest in Mexico City (10.0%) and Bridgetown (11.1%), intermediate in Buenos Aires (19.6%), Sao Paulo (19.8%), Montevideo (23.8%) and Havana (24.1%), and highest in Santiago (32.2%). CVD prevalence increased by 11% with every additional five-years of age, and was higher in women than men (21.2% vs. 18.9%).

Factors related to higher CVD prevalence included hypertension (odds ratio = 2.67), diabetes (OR = 1.42), obesity (OR = 1.19), and smoking (OR = 1.31), while regular exercise (OR = 0.66), adequate nutrition (OR = 0.70), and regular alcohol consumption (OR = 0.79) were related to lower CVD prevalence (p = 0.01 for BMI, p = 0.02 for alcohol consumption, and p < 0.001 for all other risk factors). Collectively, these seven modifiable risk factors accounted for 69.7% of the PAR.

Discussion

Established and modifiable risk factors underpin CVD prevalence in LAC. Public health programmes, including reliable measures of their effectiveness are needed to reduce the burden of CVD in the region.

Background

Cardiovascular diseases are the leading cause of death in Lebanon. This study set out to assess the knowledge and practices of the Lebanese regarding atherothrombosis and its risk factors.

Methods

A total of 2010 interviews were conducted with adults aged 30 years and older throughout Lebanon between December 2003 and February 2004.

Results

The responses revealed that 88.9% were aware of atherothrombosis however, only 23.6% correctly defined it. The main determinants of appropriate knowledge were regional distribution, and educational level. The respondents identified the majority of atherothrombosis risk factors and consequences however only half of the respondents mentioned alcohol and diabetes as risk factors and few mentioned peripheral arterial disease as a consequence. The television was the source of health information for 75.6% of the study population. However, only 27% considered they had enough knowledge about atherothrombosis. The health seeking behavior was satisfactory nevertheless there was a lack of a healthy lifestyle. Almost 70% of the respondents did not exercise and 58.5% were overweight and obese. Among the respondents 6.8% reported a previous atherothrombotic episode, and only 86.8% of them were on medications. The costs of the medications were the main reason for discontinuing medication use.

Conclusion

There is a need for a national television campaign targeting lifestyle modification and risk factor knowledge on the one hand. On the other hand, target-specific campaigns are needed in underprivileged areas of Lebanon with high rates of illiteracy and poverty. In addition, policy makers need to address and improve socio-economic characteristics as these play an important role in disease prevention.

Background

Reduction of tobacco use in the general population is preceded by a reduction in tobacco use among health professionals. There are very few data on tobacco use among health professionals in Nepal and no data on their role in cessation.

Methods

We conducted a cross-sectional study among 377 health professionals (men 59%) in two of the 75 districts of Nepal to understand their tobacco use, factors associated with tobacco use and their role in tobacco cessation. Information on tobacco use, alcohol use, friends’ use of tobacco, knowledge on harmful effects of tobacco use and health professionals’ self-reported tobacco intervention was collected using a pre-tested and structured questionnaire. Multiple logistic regression analysis was conducted to identify the important predictor variables of tobacco use.

Results

Overall prevalence of current tobacco use was 20.4% (95% CI 16.5–24.9); men 32.4%, women 3.2%. Multiple logistic regression analysis showed that men (OR 6.87; 95% CI 2.41–19.53), alcohol users (OR 3.91; CI 2.08–7.36) and those whose friends used tobacco (OR 3.40; CI 1.79–6.45) were more likely to be current tobacco users compared to their counterparts. Current users were less likely to always ask (p < 0.001) and advise (p < 0.001) on tobacco use compared to nonusers.

Conclusion

More than 20% of health professionals in our study currently used tobacco. Efforts should be made to control tobacco use among health professionals focusing on men and alcohol users. Strategies to resist peer pressure and making health institutions tobacco free are likely to reduce tobacco use among health professionals.

In Latin America and the Caribbean, cardiovascular diseases (CVD) are already the leading cause of death and disability. Predictions for the next two decades include a near tripling of ischemic heart disease and stroke mortality in Latin American countries (LAC).

The present review has compiled information from the Pan American Health Organization and taking into consideration relevant information on risk factors and has gleaned from recognized studies, published in peer reviewed journals.

In general, epidemiological data are scarce and have been collected without standardized methodologies, especially on cardiovascular risk factors. The largest and most populated LAC have more complete mortality data and epidemiological studies have been performed by scientific societies and by health authorities. An analysis of mortality indicates that the recent declines in CVD seen in developed countries are not as favorable in LAC, nonetheless, there is considerable variability between countries and by age group. Some of the countries of the region are still in the epidemiological transition where both chronic and infectious diseases have a high prevalence. As the countries of the Region continue their rapid economic and demographic transition, CVD continue to grow in importance.

Several cardiovascular risk factors have a great health impact in the region. Tobacco, hypertension, diabetes, obesity and physical inactivity rank among the five most important causes of ill health and premature death in the Americas.

The resources available to implement prevention and control programs, in most countries, are still very limited. Reversing current trends will require a wide range of strategies, some beyond the traditional realm of public health. Sustainable programs targeting both individuals at high risk and entire communities are needed in combination with effective policies to support the adoption of healthy lifestyles.

Background

Cardiovascular disease (CVD) is a major cause of morbidity and mortality worldwide. It has been suggested that cardiovascular disease has not had a prominent place in the public health agenda in Latin America and the Caribbean. Recently there has been momentum toward formation of partnerships between public and private sectors to develop an improved capacity for CVD research. Notwithstanding these efforts, cardiovascular clinical research output in Latin America and the Caribbean has not kept pace with the need to overcome the burden of CVD.

Methods

Bibliometric data for clinical medicine publications and cardiovascular specialties in the region were assessed from 2000 to 2005. Data were compared with previous bibliometric studies.

Results

Scientific output from Latin America and the Caribbean has not increased. In addition, our findings also suggest that Latin American and Caribbean investigators continue to prefer to publish in local and regional journals in languages other than English.

Conclusion

To overcome the expected economic impact of CVD and to diminish the burden of disease in the region it is necessary to raise the priority for funding of CVD research. With support from ethical research foundations, improved quality and quantity of clinical study data with allow for expedited transformation of the productivity of CVD research within Latin America and the Caribbean.