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

Background

As the prevalence of cardiovascular diseases has increased worldwide over the past 30 years, the agricultural sector has undergone marked and important changes. This paper asks whether these changes are linked to the development of dietary patterns associated with cardiovascular and other diet-related chronic diseases.

Methods

Data on agricultural production are collated and presented, and the literature on agricultural policy in Latin America reviewed and synthesized.

Results

Globally, agricultural production has risen for all major food groups in the past 25 years, but the rate of increase has been much faster for foods associated with cardiovascular and other diet-related chronic diseases, both in negative and positive directions. Latin America is a major producer of vegetable oils, meat and fish, and also of sugar and fruit. Agricultural policy in the region underwent a major paradigm shift in the early 1990s, moving from production-led to market-led policies as part of globalization. The food-consuming industries (distributors, manufacturers, processors and retailers) played a key role in this dynamic. Case studies from Brazil, Colombia and Chile show that these agricultural policy changes are linked to changing consumption patterns of soybean oil, chicken and beef, and fruit. Thus by facilitating greater consumption of specific foods, these changes in agricultural production and policy can be linked with the “nutrition transition”. They also reflect a response to changing food demand.

Conclusions

Agricultural policies can affect the relative availability and price of different foods relative to others. Changes in agricultural production and policies can therefore be associated with dietary changes; historically, these have had both positive and negative implications for cardiovascular health. Governments in Latin America could use agricultural and food policies to promote cardiovascular health by creating incentives for the agricultural sector and the food-consuming industries to produce a food supply aligned with dietary guidelines.

Background

Tobacco consumption is one of the most important risk factors for premature death throughout the world. Medical professionals and trainees play a major role in tobacco control; however there is a paucity of information about smoking in this important group in Nigeria. The objective of this study therefore, was to assess the prevalence of smoking among medical students, their perception of risks associated with smoking and their attitudes towards tobacco control policies in Nigeria.

Methods

A cross-sectional survey was conducted among 2nd–6th year medical students of the University of Ibadan using a self-administered questionnaire originally developed by WHO but modified to suit the local setting. The students’ attitudes to tobacco policy were also assessed by using 17 items adapted from the 35-item smoking policy inventory (SPI).

Results

The overall smoking prevalence was 3%. More men smoked than women (p = 0.003). Nonsmokers perceived the risks associated with smoking as higher than did smokers. Furthermore, students in years 4, 5 and 6 (clinical years) perceived the risks associated with smoking as higher than did the students in preclinical years 2 and 3 (p = 0.012). The majority of students strongly support tobacco control measures.

Conclusions

Smoking generally is not common among medical students in Ibadan. Although the clinical students perceived the risks associated with smoking as higher than did the preclinical students, the proportion of smokers among clinical students was higher but the difference was not statistically significant (p = 0.093).

Pakistan is currently implementing a national programme for the prevention and control of non-communicable diseases (NCD) – the NAP-NCD program. As an integrated approach to addressing the multidisciplinary range of issues across the broad range of NCDs, this strategy has been modeled to impact a set of indicators through the combination of a range of actions capitalizing on the strengths of a public-private partnership, which is led by the NGO Heartfile and constituted additionally by the Ministry of Health, Government of Pakistan and WHO. Focused on institutional, community and public policy level change, this strategy factors integration through its Integrated Framework for Action at four levels: grouping NCDs so that they can be targeted through a set of actions, harmonizing actions, integrating actions with existing public health systems and incorporating contemporary evidence-based concepts with this approach. A range of policy and environmental strategies are part of the tobacco control component of the plan. These involve regulating access and limiting demand through restrictions on advertising, marketing, promotion and through price control and taxation; community and school interventions; cessation programmes; mass media counter-marketing campaigns for both prevention and cessation; surveillance and evaluation of efforts and operational research around tobacco and building capacity in the health system in support of tobacco control. NAP-NCD also stresses the need to develop and enforce legislation on smuggling contrabands and counterfeiting along with legislation to subject tobacco to stringent regulations as those governing pharmaceutical products. The adoption of measures to discourage tobacco cultivation and assist with crop diversification; integration of guidance on tobacco use cessation into health services and ensuing the availability and access to nicotine replacement therapy are also part of NAP-NCD.

Background

Isfahan healthy heart program (IHHP), a six year, action-oriented, comprehensive and integrated community-based demonstration study, was launched late in 1999 to address the ongoing epidemic of non-communicable diseases (NCDs) and their major risk factors in Iran. It is a quasi-experimental trial that includes a reference area and several levels of evaluation including process, impact and outcome evaluations.

IHHP involves individual, community and environmental changes to support health behavior modification.

Objectives

To describe the IHHP evaluation design and to assess the extent to which the program has attained its short-term impacts.

Methods

The IHHP evaluation includes four annual independent sample surveys in four specific sub-groups (adults, adolescents, health professionals and individuals at high risk for NCD) in both intervention and reference areas. In addition a six-year cohort study of persons aged ⩾35 years in both areas measures impact on behaviors at the individual level and assesses the risk of myocardial infarction and stroke. The WHO STEPwise risk factor surveillance questionnaires were used to conduct the cross sectional surveys, which evaluate the impacts and outcomes of interventions undertaken concurrently in 10 distinct component projects designed to improve behaviors, risk factors, and NCD-specific morbidity and mortality. Data collection on ischemic heart disease, stroke, and mortality is ongoing. The results of the first year of evaluation are reported here.

Findings

A significant increase in the consumption of oil was observed among males and females in the intervention community compared to the reference area (P < 0.05). While daily smoking decreased and daily exercise increased among males in the intervention community, less favorable changes were observed among women. Daily exercise and oil consumption increased significantly, and attempts to smoke decreased among adolescents in the intervention community (P < 0.05). Knowledge about healthy life style improved significantly in physicians, nurses and health trainees in the intervention compared to reference areas (P < 0.05). Age, sex, level of education and urban or rural place of residence modified the response to intervention activities.

Conclusion

The implementation and evaluation of a comprehensive integrated community-based program for NCD prevention in a developing country is feasible and successful in obtaining short-term improvement in several lifestyle behaviors.

Background

The large scale migration currently taking place from Latin-America to the United States has created a new era in public health. A systematic examination of patterns of cardiovascular mortality (CVD) for the major US Hispanic populations was carried out and a direct comparison to their respective countries/regions of origin was conducted to evaluate possible transitions in health with migration.

Methods

Vital statistics records from the US, Mexico, Cuba and Puerto Rico compiled by governmental agencies in each country during 2000 were used to estimate CVD age-adjusted mortality.

Results

Total age-adjusted CVD mortality for Mexican Americans, Cuban Americans and mainland Puerto Ricans was similar to non-Hispanic whites, and lower than among blacks. CVD rates in Mexico and on the island of Puerto Rico were likewise similar in magnitude, while these mortality rates were 20% higher in Cuba. Death from ischemic heart disease, on the other hand, was higher in non-Hispanic whites than Mexican Americans, Mexicans, Cuban Americans, but lower than Puerto Ricans, Cubans and US blacks. Stroke rates tended to be lower in US whites and all Hispanics and higher in Mexico and Cuba.

Conclusions

These data suggest at most a very modest Hispanic advantage in CVD within the US at the present time and a substantial burden of both heart disease and stroke in the countries from which these individuals have immigrated. Further surveillance efforts will be required to determine whether the long-term trends for these populations are following the downward course observed in the US.

Background

Obesity and its related adverse health effects have become major public health problems in developing countries. It has been increasing more rapidly in low-income and transitional than in industrialized countries. This study aims to provide the first population-based estimates of the prevalence of obesity in Aleppo, Syria, and to examine its association with a number of risk factors in the adult population.

Methods

An interviewer-administered survey of adults 18–65 years of age, residing in Aleppo, Syria was conducted in 2004, involving a representative sample of 2038 participants (54.8% female, mean age 35.3 ± 12.1, age range 18–65 years) with a response rate of 86%. Demographic factors and anthropometric measurements were obtained for all participants. The main outcome was prevalence of obesity which was defined as BMI ⩾ 30 kg/m².

Results

The prevalence of obesity was 38.2%, higher in women than in men (46.4% and 28.8%, respectively). It increased with age being highest in the 46–65 year-old age group. Obesity was highest among Arabs (40.2%),the unemployed (50.3%), illiterate (50.8%), married (44.5%) especially women with multiparity, low socio-economic status (46.3%), and those with a low physical activity score (40.6%). Obesity was seen among 49% of ex-smokers, 39.7% of non-users of alcohol and 58.3% of participants treated for depression. An association was observed between obesity and an increasing frequency intake of certain food items. Among women, an association was observed between obesity and the number of births.

Conclusion

Our data show that obesity is a major health problem in Aleppo, Syria especially among women. It is related to age, marital status, and consumption of certain food items and it shows a significant prevalence among women with repeated pregnancies.