La Revista DESAFÍOS es el medio oficial de divulgación científica de la Facultad de Ciencias de la Salud de la Universidad del Tolima cuyo propósito es presentar trabajos originales, experiencias documentadas, actualizaciones, perspectivas y opiniones expertas sobre investigación básica, clínica, social o epidemiológica; cuidado; ética, educación y políticas en salud. La revista se publica semestralmente en forma impresa y en formato digital de acceso abierto, y recibe artículos inéditos en español, inglés y portugués que son evaluados por pares académicos. Información de la revista ISSN: 2011-3552 ISSN-L:2463-0152 DOI: https://doi.org/10.59514/2011-3552
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A preface to the keynote and accepted abstracts of the Joint 9th World Alliance for Risk Factor Surveillance (WARFS) and 12th Americas' Network for Chronic Disease Surveillance (AMNET) 2015 Conference, November 18th-20th, 2015, St. John's, Antigua
It is a pleasure to introduce the abstracts arising from the Joint World Alliance for Risk Factor Surveillance (WARFS) and Americas' Network for Chronic Disease Surveillance (AMNET) conference held in Antigua during November 18th-20th, 2015. This was a global conference on risk factor surveillance for public health. This conference was particularly notable because it combined three organizations concerned with public health. First, the host of the conference, the American University of Antigua College of Medicine; second, the World Alliance of Risk Factor Surveillance, a group aﬃliated with the Paris-based International Union for Health Promotion and Education (IUHPE); and third, Americas' Network for Chronic Disease Surveillance. Thus it was subtitled the Joint 9th WARFS Global Conference and 12th AMNET Conference 2015. Both surveillance groups WARFS and AMNET had their historical origins at the U.S. Centers for Disease Control and Prevention (CDC). Over the yeas, since the ﬁrst global meeting on behavioral risk-factor surveillance held in the Atlanta, GA USA area, these two institutions have developed and held meetings focusing on issues in risk factor surveillance. Historically there have been keen discussions, keynotes, presentations, and posters on such topics as the theory of surveillance, the incorporation of social factors into the surveillance, the ever arising methodological and technical challenges, and the global importance of good data to inform decision making and policy taking with regard to major public health issues. The Antigua conference touched on all these issues and the abstracts within this volume represent this diversity of topics. Of particular note was the chance for a small Caribbean country to be a part of this global discussion and it illustrates that the importance of risk factor surveillance is not conﬁned just to larger economically highly developed nations. It is also notable because the previous WARFS-IUHPE Conference in 2013 was held in Beijing, China. Nonetheless, despite the obvious diﬀerence in venue and country size, the discussions were just as globally relevant and pertinent to today's global concerns. Therefore, as the editors of this special issue, we are pleased to present the abstracts that represent the 2015 Antigua Conference.
Changing perspectives in physical activity in the 21st century
Costa Rica is located in Central America country, which is world renowned for its health system. The national census in 2011, reported that Costa Rica has a population of 4,301,712 inhabitants. According to Ministry of Health, Health Situation Analysis of Costa Rica (2014), the latest estimate of life expectancy at birth is the year 2012, which it reached 79.0 years overall, in the women was 81.45 years and for men 76.5 years.
¿Is a global surveillance still valid and feasible?
More and more health problem are becoming global. Also with regard to NCDs, the words “global epidemic” (e.g. for obesity, luck of physical activity, etc.) are often used. Recent years have seen also emerging global solutions (interventions, programs, approaches) for these problems. But, quite often, the global approach lacks global information. Certainly to ﬁnd ways of comparison is not an easy task, and the perfect comparable data constitutes in most cases a myth; still, a lot can be done. Investments are needed more on the analysis and data linkage front, more than on that of data collection: new and old sources of data are more available when, instead, quite often we lack resources and capacity to analyze them and to make this information useful for public health action and health promotion.
Chronic Disease Surveillance in the Americas: How academia contributes to the endeavour
The Americas' Network for Chronic Disease Surveillance (AMNET) is a non-for-proﬁt organization which has the mission to promote a dynamic exchange of integrated eﬀorts between individuals, academic institutions and government towards the development and enhancement of surveillance, prevention and control of chronic diseases and their risk factors in the Americas and in the Caribbean.
Development of a rapid Non-communicable Disease and Risk Factor Surveillance System in China
The China Center for Disease Control and Prevention (CDC) over the years has developed a rapid surveillance system that covers chronic non-communicable diseases (NCD), injuries and other areas. The system has expanded to 605 disease surveillance data collection points (locations) throughout China, covering 24.3% of the national population of China. This presentation focuses on the development of the NCD and risk factor component of the surveillance system. This NCD experience will be useful for looking into similar ways for development of a communicable disease surveillance system for other countries.
Building multidisciplinary, interdisciplinary, and transdisciplinary surveillance partnership
A discipline is a branch of knowledge. Examples are biology, chemistry and history. Real world problems are complex problems which do not respect artiﬁcial disciplinary boundaries. Public health surveillance is increasingly facing new challenges that require multiple disciplinary partnership to resolve. Partnership refers to two or more people or organizations that work together. The terms multidisciplinary, interdisciplinary and transdisciplinary are often used interchangeably but they have speciﬁc meanings. The objectives of this keynote presentation are to (1) deﬁne and compare the three multiple disciplinary approaches, using examples of several surveillance networks including the World Alliance for Risk Factor Surveillance (WARFS) and Americas' Network for Chronic Disease Surveillance (AMNET); (2) discuss a number of promotors of teamwork and partnership building; and (3) present a roadmap on where to ﬁnd multiple disciplinary collaboration based on a review of the knowledge universe.
Gender diﬀerences in delay time for acute myocardial infarction in a Hispanic population
Introduction: There are limited published data on minority populations, especially Hispanics, describing the onset of acute myocardial infarction (AMI) symptoms and time to treatment. The aim of this study is to determine if a diﬀerence exists between gender and delay time in Puerto Rican patients hospitalized with an initial acute myocardial infarction.
An overview of the current challenges and opportunities for surveillance
This keynote address opens the Joint 9th WARFS Global Conference and 12th AMNET Conference 2015. Initially a brief history of the WARFS conference, which began in 1999 in Atlanta, is given. Much ground has been covered since that initial conference. There have been many developments and expansion, but at the same time many challenges were unmet and remain as challenges to risk factor surveillance globally. Historically we have focused on the many technical challenges facing surveillance. This presentation will address the structural and theoretical challenges facing risk factor surveillance. The major challenges are: incorporating the social determinants of health perspective into risk factor surveillance; moving away from continuing to collect data on what we already know; and creating the evidence base to evaluate health policies and interventions designed to improve population health. Above all, the underlying assumption of what we do remains important: continuous data collection, analysis and use of surveillance data provides an evidence base for public health interventions.
The association between gender and priority of admission in Florida stroke patients
Introduction/Objective: Stroke is the ﬁfth leading cause of death in the United States and results in signiﬁcant morbidity and mortality annually. Its wide prevalence and critical nature make it essential to recognize and properly triage patients with symptoms of stroke so that appropriate time-sensitive interventions may be delivered. Many studies have delineated gender diﬀerences in risk, diagnosis and treatment of stroke; however, limited information exists on the association between gender and Emergency Department (ED) triage priority. The objective of this study is to determine if there is a gender diﬀerence in the assignation of an emergency priority of admission code among Florida stroke patients. Methods: An observational cross-sectional study was performed through secondary analysis of the Florida Stroke Registry, composed of hospital discharge data collected by the Agency for Healthcare Administration (AHCA) on Florida stroke patients from 2012. A descriptive analysis was utilized to proﬁle the study population, calculating measures of centrality and dispersion of demographic variables. We tested associations of our bivariate analysis using chi-square tests, then performed a multivariate analysis using logistic regression to control for confounders. Odds ratios were used to measure associations. Results: Women were 24% more likely to receive an emergency priority of admission code than men. Following adjustment and stratiﬁcation by primary stroke center designation, it was determined that women remained more likely to receive a priority code of admission than males. This occurred at a higher rate in primary stroke centers (35% more) than in non-certiﬁed hospitals (11% more). Independently, the other factors included in the adjusted analysis (age, race, payer, source of admission, day of the week, and stroke center designation) also held statistically signiﬁcant associations with emergency priority triage. Conclusions: Gender disparity does exist among Florida stroke patient triage and more research should be conducted concerning the factors inﬂuencing the assignation of an emergency priority code. Emergency department care providers may need more gender speciﬁc protocols on stroke triage and additional training in recognizing gender speciﬁc symptoms. Additional studies need to be conducted in order to identify if gender disparities exist in other links of the stroke chain of survival.
Hispanic ethnicity and survival in pediatric acute lymphocytic leukemia (all) patients in Florida
Introduction: Pediatric cancer mortality rates have drastically declined according to analyzed population-based surveillance data; however, incidences of most childhood cancers continue to rise. Recent studies have indicated an association between ethnicity/race and cancer survival. Florida's ethnically/racially diverse population and surging pediatric cancer incidence characterize the state as an ideal setting to study the association between ethnicity/race and pediatric cancer survival. Objective: To determine whether or not an association exists between Hispanic ethnicity and cancer survival in a Floridian population of pediatric patients with Acute Lymphocytic Leukemia (ALL). Methods: We will use data from participants 18 years or younger of Florida Cancer Data System (FCDS). Cox-proportional hazard regression was used to assess independent association between Hispanic ethnicity and time to death (time interval from diagnose of ALL to the last patient contact, as recorded in the database). Survival status (death or alive) was assessed at the date of last contact. Those who are alive at last contact were then censored. Results: In the unadjusted model, ethnicity was not associated with risk of death (HR = 0.87, 95% CI=0.73 - 1.04). After adjustment for sex, race, age at diagnosis, insurance status, geographic area, and immunophenotype) the results showed again no association between Hispanic ethnicity and survival (HR = 1.19, 95% CI=0.82 - 1.72). Conclusions: We found no evidence for diﬀerences in survival based on ethnic status. Potential diﬀerence in racial-survival disparities in pediatric ALL within various geographic regions might depend on Hispanic ancestries or cancer type. Further research on the topic is still deemed necessary as to clarify the nature of the association between ethnicity and cancer survival.
Efectividad de la terapia hiperbárica en el tratamiento de pie diabético
Introducción: En Ecuador la prevalencia de Diabetes Mellitus Tipo2 (DM2) es de 4,1 a 5 %. La incidencia por año es de 115,19 casos por 100.000 habitantes. Aproximadamente el 15 % de los diabéticos se complican con úlceras y lesiones en miembros inferiores. Los tratamientos convencionales son dolorosos, largos y tienen retraso para cicatrizar evolucionando a gangrena, incluso hasta la amputación. Objetivo: Determinar la efectividad de la terapia hiperbárica en el tratamiento del pie diabético. Métodos: Estudio descriptivo, no experimental, observacional y transversal. Se incluyeron 160 pacientes con diagnóstico de DM2 y complicación de pie diabético, previo consentimiento informado. Las terapias son aplicadas cada 10 días durante 2 meses, con una duración de 30´ a 45´ minutos por sesión, luego de lo cual se valora el tratamiento en una ﬁcha de seguimiento. Resultados: La totalidad de pacientes sobrepasan los 40 años y tienen un tiempo mayor a 6 años con diagnóstico de DM2; el 60% son mujeres, el 70 % de las lesiones son de tipo Wagner grado II. Las patologías asociadas que se encuentran son: obesidad 35 %, arterioesclerosis 25 %, insuﬁciencia renal 25%, retinopatias 10 % e hipertiroidismo 5%. Mediante cultivos se establece que los agentes causales de las infecciones son: 40 % Enterococcus, 25 % Estaphyloccocus aereus, 20 % Estreptococos y un 15 % Corynebacterium. Como respuesta al tratamiento se observa eliminación de infección en las lesiones en el 85 % luego de las 3 primeras sesiones, y en el 95 % de los pacientes se empezó a observar la presencia de tejido de epitelización e inicio de la cicatrización luego de las 6 sesiones al culminar el segundo mes de tratamiento. Implicaciones: La terapia hiperbárica incrementa signiﬁcativamente los niveles de oxígeno en los tejidos, este proceso interviene en la resolución de las lesiones del pie diabético, reduciendo el tiempo de tratamiento y cicatrización.
Investigating the association between children who witness domestic volence in their household and being clinically diagnosed with childhood depression
Introduction/Objective: Depression is the most common psychiatric disorder in the general population. In particular, childhood depression is undertreated. Domestic violence aﬀects more than 32 million Americans, and children who witness violence are more likely to display internalizing behaviors. Although the association between childhood abuse and depression in adulthood has been established, the objective of our study was to determine the association between children witnessing violence at home and being diagnosed with childhood depression. Methods: We used the 2011 NSCH database, which randomly surveyed parents in the U.S. Our cross-sectional study sample was limited to children 8-17 years old, and whose parents responded to speciﬁc survey questions. The exposure was children who witnessed domestic violence at home and the outcome was the diagnosis of childhood depression. Data analysis included 1) a descriptive analysis of population baseline characteristics, 2) a bivariate analysis of the baseline characteristics with the exposure and outcome, and 3) a multivariate logistic regression to control for potential confounders. Results: Our sample included 54,268 children. The unadjusted binary logistic regression indicated that children who witnessed domestic violence were 4.5 times more likely (95% CI 3.6- 5.5, p <0.001) to be diagnosed with childhood depression. However, the adjusted analysis did not ﬁnd an association between witnessing domestic violence and childhood depression (OR 1.0, 95% CI 0.6-1.4, p: 0.834). Other variables independently associated with childhood depression include, but are not limited to: children whose school contacted the household about problems more than 10 times (OR 8.4, 95% CI 5.9-12.1, p: <0.001), poor general health of the child (OR 7.7, 95% CI 2.6-22.6, p <0.001), and poor mental health of the mother (OR 7.4, 95% CI 3.0-18.5, p <0.001). Conclusions: Our study found that children witnessing domestic violence do not have an increased risk of childhood depression. We found other factors such as problems at school or instability at home had a signiﬁcant inﬂuence on whether a child was clinically depressed. Further research should be conducted to explore the associations of these other factors with childhood depression.
Causas de terapia de sustitución renal en pacientes atendidos en la unidad de diálisis del Hospital San Vicente de Paúl-Ibarra
Introducción: La Insuﬁciencia renal crónica (IRC), es la pérdida de la función renal, se estima que a nivel mundial el 10% de la población tiene esta patología como consecuencia de Hipertensión arterial, síndrome metabólico y diabetes, declarada también como enfermedad catastróﬁca ya que se requiere de un sinnúmero de recursos económicos, humanos y de insumos, y su mortalidad debido a las características clínicas de los pacientes es alta. El tratamiento de elección para este tipo de pacientes es la hemodiálisis, la cual se la realiza como como terapia de sustitución renal. Objetivo: Determinar las causas de terapia de sustitución renal en pacientes atendidos en la Unidad de Diálisis del Hospital San Vicente de Paúl-Ibarra Metodología: Estudio descriptivo, no experimental y de corte transversal, realizado con información estadística de la unidad de diálisis del Hospital San Vicente de Paúl. Se recopila información en una base de datos para su tabulación y procesamiento. Resultados: El 57% de pacientes son mujeres, edad promedio 51.5 años, 10,3% (15- 20 años); 13,8% (21-40 años), 43,1% (41- 60 años) y 31,8% (> 60 años). En referencia al tiempo de diagnóstico con IRC, 34.5% (< 5 años), 41,4% (5-10 años) y 24,1% (>10 años). En cuanto al tiempo de terapia real sustitutiva 25,9% (< 1 año), 8,6% (2 años), 8,6% (3 años) y 56,9% (4 años) que coincide con el tiempo de funcionamiento de la unidad del diálisis del Hospital San Vicente de Paúl de Ibarra (HSVP-I). Conclusiones: Las causas principales de IRC se relacionan directamente con Diabetes Mellitus tipo 2, HTA, Glomérulo nefritis y uropatias obstructivas. Se deben diseñar estrategias de atención oportuna de pacientes con riesgo de falla renal, referencia inmediata a nefrología para disminuir la velocidad de progresión de la enfermedad y mejorar la calidad y la esperanza de vida.
Diabetes and atypical presentations of patients hospitalized for an acute myocardial infarction in Puerto Rico
Introduction: Diabetes mellitus is one of the fastest growing health issues concerning the world today with an estimated 382 million individuals aﬀected as of 2013 and a projected increase in number to 592 million by 2035. Diabetes mellitus is a condition aﬀecting 12-15% of the population or around 400,000 people in Puerto Rico. The most common presenting complaint of diabetics who are hospitalized for an acute myocardial infarction (AMI) is chest pain. However, the pervasiveness of atypical symptoms in diabetic patients is yet unclear. The aim of this study is to determine if there is an association between diabetes and the presentation of atypical symptoms in the emergency room in those suﬀering from an AMI in Puerto Rico. Methods: We conducted a secondary data analysis of data from participants from the 2007, 2009 and 2011 Puerto Rico Cardiovascular Disease Surveillance system (PRCDS), an observational, non-concurrent, cross-sectional study. The main independent variable was presence of diabetes mellitus (Type I and Type II). The outcome was the presence of atypical symptoms at the time of presentation, deﬁned as the absence of chest pain on admission. The prevalence of atypical symptoms in diabetic patients and non-diabetic patients was compared. Binary logistic regression was used to test for independent association. Statistical signiﬁcance was considered for p-values ≤0.05 for a two-tailed test. Analysis was conducted using SPSS software. Results: We found no association between atypical presentation of an AMI and diabetes, before or after adjustment for age, gender, congestive heart failure, stroke history and BMI. (unadjusted OR= 1.0, 95%CI=0.7-1.4 and adjusted OR=1.0, 95% CI=0.6-1.5). Other independent associations identiﬁed were that patients older than 75 were 3.5 times more likely to present atypically than people younger than 55 (OR= 3.5, 95% CI=1.6-7.6), and those with CHF and stroke were more likely to present with atypical symptoms (OR=3.2, 95% CI=1.7-6.1 and OR=4.2 95% CI=2.1-8.4, respectively). Lastly, overweight patients were 3.3 times more likely to present atypically than healthy weight patients (OR=2.0, 95% CI=0.6-7.0). Conclusion: We found no evidence of an association between diabetes and the presentation of atypical symptoms in patients hospitalized for AMI in Puerto Rico.
Implementación del plan integrado local de acción para la prevención de enfermedades crónicas Pasto Pila 2006-2015
Objetivo: Se formuló a partir de una iniciativa gubernamental por la alta carga de morbimortalidad por Enfermedades Crónicas en el Municipio, se fundamentó en la búsqueda de la satisfacción de las cinco necesidades propuestas por Maslow soporte social, movilidad, alimentación, recreación e información. Métodos: El proceso metodológico inicio tomando como guía el modelo MATCH, como soporte para planear, implementar y evaluar acciones de promoción de la salud, enfocándolo desde cuatro componentes: Políticas y ambientes, Atención sanitaria, Acciones colectivas y Observatorio de Enfermedades Crónicas, evaluados por Indicadores de cada componente según periodos de gobierno, propuestos a corto (2007), mediano (2011) y largo plazo (2015). Resultados: creación de un observatorio, formulación de políticas públicas de movilidad, actividad fisica, control de tabaco, Seguridad Alimentaria y Nutricional y políticas escolares, modelo de atención integral para la prevención de enfermedades crónicas, diseño de un sistema de información, metodología de unidades de análisis, conformación de redes de información, estudios poblacionales, convenios con academia y apoyo ﬁnanciero, programas y planes municipales, que han impactado positivamente indicadores como actividad fisica recreativa que aumentó un 3,6%, moderada 15,5%, uso de aceite vegetal subió 1%, consumo diario de frutas subió 3,1%, consumo activo de tabaco disminuyo un 2,4%. Implicaciones y conclusiones: lograr legitimidad del plan entre gobierno, academia y salud se debe a procesos metodológicos sustentados teóricamente y al arduo trabajo de retroalimentación en calidad, análisis y difusión de la información con todos los actores, la sensibilización de los tomadores de decisiones fue de vital importancia para darle continuidad y sostenibilidad en los periodos gubernamentales y el acompañamiento de la academia es trascendental en la formulación de políticas públicas basadas en evidencia, además contar con una carta de navegación como el PILA fue determinante para no perder el camino inicialmente planeado con el que se logró impactar positivamente factores de riesgo de la población.
Awareness, treatment and control of hypertension: Trend from population-based surveys conducted in a low-middle income country
Aim: To estimate and determine temporal trends for awareness, treatment and control of hypertension in adults from the urban area in Colombia. Methods: We conducted two population-based surveys (years 2010 and 2015) in the Metropolitan Area of Bucaramanga-Santander, Colombia, using the WHO STEPwise approach. Participants were asked to provide demographic, socioeconomic and cardiovascular risk factors data. Blood pressure (BP) was measured twice using an automated device. Hypertension was deﬁned as a systolic BP≥140 mmHg, a diastolic BP≥90 mmHg or self-reported antihypertensive treatment. We estimated age, sex, and socioeconomic status (SES) adjusted prevalence ratios (PR), with 2010 as the reference survey, using poisson regression and correcting standard errors by clustering. Results: We evaluated 1,136 (mean age: 35.7 years; 43% male) and 872 (mean age: 37.7 years; 41% male) adults from the 2010 and 2015 surveys, respectively. There were a larger proportion of individuals sampled from low SES in the 2015 as compared to the 2010 survey (93.6% vs. 70.9%). Overall, prevalence of hypertension was 16.4% (95%CI: 14.8 – 17.9): It increased signiﬁcantly with age (from 2.4% among individuals 15-19 years old to 41.1% among individuals 50 years and older; p-trend<0.001) but did not diﬀered by sex (17.8% in men vs. 15.4% in women) or year (16.1% vs. 16.6% in 2010 and 2015, respectively). Overall, prevalence of awareness, treatment and control of hypertension were 65.0%, 84.1%, and 62.2%, respectively. Although awareness and control increased from 2010 to 2015 (PR=1.05 and PR=1.12, respectively), only the prevalence of treatment showed a statistically signiﬁcant increment of 11% (PR=1.11; 95%IC: 1.01 – 1.24). Implication: The STEPwise is a suitable surveillance strategy to estimate the burden of cardiovascular risk factors in low-middle income countries. Our results are consistent with national data from urban areas and show for the ﬁrst time a short-time improvement in antihypertensive coverage.
In-hospital mortality of non-st segment elevation myocardial infarction in a Puerto Rican population
Introduction: Currently, there is limited published information on in-hospital mortality regarding ST segment elevation and non-ST segment elevation myocardial infarction. This information is even scarcer on the Hispanic population. We aim to study if there is a diﬀerence on in-hospital mortality between ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI) in a mostly Hispanic population. Methods: A secondary data analysis of a non-concurrent prospective study was performed using the Puerto Rican Heart Attack study database. Dependent variable was in-hospital mortality and independent variable was type of myocardial infarction (STEMI or NSTEMI). We conducted, sequentially, a descriptive, bivariate and multivariate analysis. The chi-squared test was used to compare categorical variables and t-test for continuous variables. Finally, a logistic regression model was used to perform the multivariate analysis. Results: From the 838 Puerto Rican patients hospitalized with ST classiﬁcation, 310 (37%) were diagnosed with STEMI. Patients with STEMI were younger (65 years vs 68 years; p=0.008), more likely to receive invasive treatment (47.9% vs 27.5%, p<0.001), and less likely to have a history of hypertension (72.5% vs 79.0%, p=0.033) compared to NSTEMI patients. For every 1- year increase in age, there is a 4% increase in in-hospital mortality. Patients with hyperlipidemia were approximately two times more likely to die in the hospital compared to patients without hyperlipidemia. In the unadjusted analysis, there was no signiﬁcant association between STEMI and NSTEMI patients and in-hospital mortality. After adjusting for confounders, patients with STEMI had twice the risk of dying than those with NSTEMI. Conclusions: Findings from this study suggest that Puerto Ricans with STEMI have double the risk of in-hospital mortality than NSTEMI patients. Our ﬁndings were similar to those reported in the literature. A timely recognition of at-risk patients, especially among STEMI patients, may help reduce short-term morality among patients hospitalized with acute myocardial infarction in Puerto Rico.
Association between gender and receipt of magnetic resonance imaging (MRI) in stroke patients from Puerto Rico
Introduction: Stroke is the ﬁfth principal cause of death in the United States and Puerto Rico and a prime cause of adult disability. Women tend to have worse outcomes post-stroke. Initial diagnoses and management of stroke include the use of computed tomography (CT) and magnetic resonance image (MRI) scans. MRI scans are more sensitive and more speciﬁc than CT scans. Still, CT scans are used more commonly. Whether diﬀerences in the choice of imaging techniques exists for gender and whether that can be a potential reason for gender diﬀerences in post-stroke outcomes it is yet unknown. The study is directed to evaluate the association between gender and receipt of a MRI in stroke patients in the Puerto Rico population. Methods: We did a secondary analysis of data collected from patients who suﬀered from a stroke and who participated in the Puerto Rican Cardiovascular Surveillance System (PRCSS) in 2007, 2009 and 2011. The main independent variable was gender (male and female). The dependent variable will be receipt of a MRI (alone or in combination with any other imaging modality as recorded in the medical charts). Multivariate logistic regression was used to assess for the independent associations. P-value < 0.05 for a two tailed test was considered to be statistically signiﬁcant. SPSS software was used for analysis. Results: A total of 1,950 patients suﬀered from an ischemic stroke and participated at the PRCSS. We excluded 595 patients due to BMI ≥35 (n=135) or no recorded BMI (n=460). MRI was used for 50% of participants. Women were 85% less likely to receive a MRI compared to men in both the unadjusted (OR-0.85, 95% CI=0.11-0.20, p-value <0.001) and after adjusting for BMI, age, marital status, hypertension, and transient ischemic attacks (TIA) (OR=0.15; 95%CI: 0.11-0.20). No other variables assessed had signiﬁcant independent association with the receipt of a MRI. Conclusions: We found evidence of gender disparities in the receipt of MRI during hospitalization for stroke in patients in the Puerto Rico. Women were less likely to receive MRI compared to men. Further research on potential reasons for such dispairites, increasing awareness, and testing intervention as to decrease these potential disparities are needed.
Eﬀect of complete heart block on in-hospital mortality in a Hispanic population presenting with acute myocardial infarction
Introduction/Objective: Complete heart block (CHB) is an important clinical complication in patients hospitalized with acute myocardial infarction (AMI). Yet, limited information is available on the relationship between the two in the Hispanic population. We want to determine whether a diﬀerence exists between in-hospital mortality of patients with and without CHB presenting with AMI in Puerto Rico. Methods: A secondary data analysis was conducted from the Puerto Rican Cardiovascular Surveillance Study in 2007, 2009, and 2011, a non-concurrent prospective study. Our main independent variable was patients with and without CHB and our dependent variable was in- hospital mortality. SPSS V. 20 software was used for data analysis. The in-hospital mortality was examined by using chi-square or Fisher's Exact test for discrete variables and independent t-tests for continuous variables. Age, gender, and diabetes were included as potential confounders in a multivariate analyses using logistic regression. Results: The overall incidence of CHB was low (n=23). Our unadjusted model showed that patients with CHB were 4 times more likely to die compared to those without (OR: 4.1, 95%CI: 1.5-11.1; p=0.014). For every 1- year increase in age, there was a 10% increase on in-hospital mortality risk (OR: 1.1, 95%CI: 1.05-1.07; p<0.001). Women were 50% more likely to die than males (OR: 1.5, 95%CI: 1.2-2.0; p=0.003). In the adjusted model, CHB and age were the only variables signiﬁcantly associated with mortality. The association between CHB and mortality remained strong (OR: 4.7, 95%CI: 1.7-13.5; p=0.003). No collinearity was detected among any of the explanatory variables. Conclusions: CHB increases the risk of in-hospital mortality after AMI by roughly ﬁve times after adjusting for age, gender, and diabetes. As age of the patient increased, so did the mortality. As a result of our study, clinicians may become more aware of the mortality risks associated with a minority population and could tailor their surveillance and treatment plan accordingly.
Poliglobulia como factor de riesgo en hipertensión arterial
La poliglobulia constituye un aumento de todos los elementos de la sangre. Existen dos tipos de poliglobulia: La policitemia Vera cuya causa es desconocida y poco frecuente, y la policitemia secundaria que aparece como respuesta a estimulos conocidos. La hipoxemia que ocurre en las zonas altas es una de las causas más frecuentes. Los habitantes de la alta montaña poseen una mayor amplitud torácica así como su ventilación pulmonar. La difusión alvéolo/capilar y el contenido arterial de oxígeno están aumentados como compensación a la baja concentración de oxígeno. El sedentarismo y el tipo de alimentación que hoy tiene la población, se ha asociado con la hipertensión arterial. Los cambios de la altura y la aparición de la poliglobulia pueden incrementar estos riesgos.
Espinel-Jara Viviana Espinel-Jara Viviana
Countries' capacity to monitor Noncommunicable Diseases and Risk Factors in the Americas
Surveillance is critical to provide the information needed to measure the prevalence and incidence of noncommunicable diseases (NCDs), their risk factors (RFs) and outcomes; to design policies and programs for their prevention and control, and to measure the impact of these policies and programs. Tracking NCDs and RFs remains a challenge because the surveillance systems established in many countries are still oriented towards monitoring transmissible diseases, and lack the capacity to comprehensively gather the information needed to orient policy- making for NCDs and Rfs.
Eﬀect of delay time on in-hospital mortality in a Hispanic Population hospitalized with acute myocardial infarction. The Puerto Rico Cardiovascular Surveillance Study: 2007, 2009 and 2011.
Introduction: In the United States, heart disease is the leading cause of death for both men and women. One of the main categories of heart disease is acute myocardial infarction (AMI), which is responsible for 1.5 million events per year. Data show that longer delay time to treatment limit the beneﬁcial use of thrombolytic therapy with optimal use during the ﬁrst hour after symptom onset. The purpose of this study is identify if an association exists between delay time and in-hospital mortality and to explore which factors impact delay time to treatment in a Hispanic population of Puerto Rico hospitalized with AMI. Methods: Study Design: A non-concurrent prospective design was conducted using a secondary analysis of the Puerto Rico Cardiovascular Surveillance Study. Data were abstracted from the medical charts of 21 health care facilities using International Classiﬁcation of Diseases, 9th Revision (ICD-9) codes 410-41. Each case was validated according to the World Health Organization (WHO) criteria for AMI. Only patients with incidental AMI and adults > 18 years of age were included. Variables: Dependent variable is in-hospital mortality and independent variables are delay time, demographics, transportation mode, teaching hospital, angina, coronary artery bypass grafting, congestive heart failure, diabetes, hyperlipidemia, hypertension, current smoker and stroke. Analysis: Distribution of categorical variables were expressed in frequencies of percent and associations were analyzed via X2 test. Distribution of numerical variables were expressed as the Mean (Standard Deviation) and associations were analyzed via ANOVA and t-test. Binomial logistic regression was used to test for the unadjusted and adjusted association between delay time and mortality. Statistical analysis was conducted utilizing SPSS software, and statistical signiﬁcance was deﬁned as p<0.05.
Cardiovascular risk factor surveillance and physical activity among the Dubai population, UAE
Background: Regular practicing of physical activity is considered to be one of the easiest and cost eﬀective ways of improving and maintaining health, and avoiding diseases like diabetes mellitus, cardiovascular diseases, obesity and others. Purpose: The study aims to determine the prevalence of physical activity among the Dubai population and the eﬀect of associated factors, as well as assess the knowledge, practice and attitudes of the Dubai population.
Non-communicable diseases sustained high call: China's health care model should be transformed as soon as possible
Background: There is suﬃcient evidence that the prevalence of non-communicable diseases (NCDs) in China is increasing rapidly. Results from the Fourth China National Health Services Survey (2008) show that compared to 2003, the prevalence of chronic diseases in China increased by 5%, while results from the Fifth National Health Services Survey (2013) showed an increase of 9% since 2008. As the world's most populous country and in the face of the rapid rise of non-communicable diseases, China lacks eﬀective measures to achieve signiﬁcant results on aspects of tobacco use, unhealthy diet, lack of exercise, harmful alcohol use and other risk factors. Of more concern is that the Chinese health care model is still stuck in the "medical services" stage. The "therapy" of health care models not only cause China to experience high health costs - there is also a steady increase in adverse health outcomes, with a failure to timely and eﬀectively respond to the challenges of NCDs. Purpose: This article aims to analyze health care inputs and outputs since Chinese health care reform, and to provide a useful reference to improve Chinese future health care policies.
Depression and health-adjusted life expectancy in the Canadian adult population: a descriptive study
Background: Few studies have evaluated the overall population health-related impact of depression in terms of losses to both premature mortality and health-related quality of life (HRQL). Purpose: To estimate health-adjusted life expectancy (HALE) for Canadian adults according to depression status.
Unique epidemiological patterns of human infections with H7N9 avian influenza virus discovered by combined risk factor surveillance and epidemiology
Background: An outbreak of a novel human avian inﬂuenza (H7N9) [h-H7N9 AI] took place in China from February 2013 to April 2015, with 628 reported cases. However, there were no exact answers on epidemiological patterns and its origin. Purpose: To examine the epidemiological patterns and its origin compared with other inﬂuenza outbreaks by combined analysis of risk factor surveillance and epidemiological characteristics, and to explore new surveillance methods for tracking infectious disease outbreaks.
A case crossover study on the impact of heat waves on non-accidental deaths in Jinan, China
Background: Heat waves can not only cause direct death from heat stroke but also lead to excess deaths due to other illnesses. Identifying contributing factors of population vulnerability to heat waves is particularly crucial because heat waves will aﬀect the most disadvantaged populations aggravating health disparities. There has been little evidence on the risk of deaths from heat waves and associated contributing factors to the population vulnerability in Jinan. Purpose: To assess the impact of heat waves on non-accidental deaths and identify individual vulnerability factors to heat wave-related deaths in Jinan, China.
¿Does the Kish grid sampling method distort the structure of samples in risk factor surveillance?
Background: The Kish grid is commonly used in risk factor surveillance as a sampling method within households,. However through the risk factor surveillance surveys of Jiangsu Province of China in the years of 2007, 2010 and 2013, in which Kish grid method was used to select one eligible respondent within a household, we observed that the structure of samples was different from the population. Purpose: To determine if the Kish grid method distorts the structure of the sample in risk factor surveillance and to explore possible solution to this problem.
Understanding of the role of surveillance in Health Promotion for NCDs among Georgians
Background: Recognizing the need to build local capacity for non-communicable diseases (NCDs) and having a skilled workforce is an important strategy to implement the policy changes necessary to reduce the burden of NCDs. Indicators of tobacco smoking, alcohol consump on and drug abuse are s ll very high among Georgians. Nine out of ten deaths are a ributed to cardio-vascular diseases (CVD), cancer and injuries, the majority of which are caused by unhealthy behaviors. There is a very unclear understanding of health promo on (HP) approaches as a best opportunity to impact on NCDs and their risk factors even among Georgian professionals and more at the popula on level. The present study is the ﬁrst eﬀort to iden fy gaps, requirements and opportuni es in the health- promo on communica on system in Georgia, in order to iden fy the needs of capacity building for NCDs and their risk factors. Purpose: The Health Promo on Capacity Assessment aimed to evaluate the current health promo on system in Georgia. It covers the following issues: quality of health promo on/communica on and disease preven on services, access to services, resources, health-promo on informa on/ communica on system and health-promo on ﬁnancing. Its speciﬁc aims were (1) To iden fy the shor alls, requirements and opportuni es in health-promo on communica on through quan ta ve and qualita ve research; and (2) To deﬁne and analyze healthcare workers' knowledge, a tude and prac ce (KAP) related to health promo on/communica on aspects, the level of the professional development and requirements for their future training/retraining.
Health Promotion in Singapore : A need to focus on sociocultural and socioeconomic differences
Background: In the last 50 years, Singapore's achievement has been to use multiculturalism to foster social cohesion and build a new nation. With a population of 75% Chinese, 13% Malays, 9% Indians and 3% other nationalities, this heterogeneous population brought with them different cultures and goals. The nation has seen through diverse health promoting interventions with mixed success. Purpose: This paper presents the health behavior trends focusing on sociocultural and socioeconomic differences in the population using data from the on-going Health Behavior Surveillance of Singapore (HBSS). Highest educational qualification is used as a proxy for socioeconomic status.
Measuring subjective wellbeing in a surveillance system: ¿who are these people who are positive?
Background: Promo ng and improving the wellbeing (and happiness) of the general popula on is emerging as a public health priority globally and a key societal aspira on. Countries are including measures on wellbeing to supplement tradi onal measures of economic growth as an indicator of na onal prosperity. Including ques ons on subjec ve individual wellbeing can be useful to measure and can be included in a surveillance system. These ques ons can provide an overall assessment of how people are doing and take into account of what people decide for themselves is important beside health. It can capture the meaning and purpose in life which is not covered in current “nega ve” ques ons such as psychological distress. Purpose: To assess the performance and associa on of subjec ve wellbeing on a range of socio- economic status (SES) and inequali es indicators.
The impact of socioeconomic status on arthritis and osteoporosis
Background: Low socioeconomic status has been shown to be associated with both osteoarthri s and rheumatoid arthri s, impac ng on outcomes and even the development of arthri s. However the associa on with osteoporosis has been less clear. The reasons for the associa on may be linked to socioeconomic status through educa onal aspects, income, employment type and even area of residence. Purpose: The purpose of this study was use a monthly surveillance and monitoring system to examine the prevalence of self-reported osteoarthri s, rheumatoid arthri s and osteoporosis over me and the associa on with measures of socioeconomic status.
Characterising risk clusters in the context of curbing obesity
Background: In the last few years, Canada has been ac vely working on the implementa on of popula on health programs aimed to improving healthy lifestyle behaviors that have poten al to reduce the obesity epidemic. Obesity increases the risk of a number of main chronic diseases and is also associated with an increased risk of premature mortality. Our understanding of the underlying risk factors that contribute to obesity is increasing but there is s ll much more to be done. Increasingly research is showing that the prevalence of risk behaviors is not independent; most individuals have more than one risk behavior. A be er understanding of risk “clusters” or the co-occurrence of unhealthy behaviors will contribute greatly to targeted preven on, health promo on, and policy ac vi es. Purpose: The objec ve of this work is to understand and characterize the clustering of XX risk behaviors contribu ng to the obesity epidemic in Canada. Our hypothesis is that mul ple risk behavior s may occur in single individuals rather with randomly in diﬀerent individuals and that the groups of people with diﬀerent combina ons of risk can be diﬀeren ated using cluster analysis.
Chronic Disease Surveillance in Canada: The Chronic Disease and Injury Indicator Framework
Background: The Public Health Agency of Canada (the Agency) has developed a Chronic Disease and Injury Indicator Framework (the Framework) which is the ﬁrst of its kind in Canada. The Framework provides a snapshot of current data on chronic diseases and associated risk and protec ve factors using a set of core evidence based indicators. Purpose: The Framework is intended to improve access to current chronic disease and risk factor surveillance data in Canada by providing consistent, reliable and ongoing pan-Canadian informa on on chronic disease. The Framework's main target audiences are policy makers and public health professionals. The Framework has broad applicability as a reference tool.
Evaluation of epidemiological surveillance of measles/ rubella in Haiti, 2009-2013
Background: Measles and rubella are two highly contagious and serious viral diseases that affect both developed countries such as underdeveloped countries. In 1980, before the use of the vaccine became widespread, measles caused about 2.6 million deaths a year worldwide. The last cases of measles in Haiti occurred in 2001. Purpose: The last evaluation of the surveillance system (SS) of S/R by the Ministry of Health was in 2003
Monitoring Health Inequalities in Canada: Meeting the challenge through collaboration, communication and innovation
Background: Monitoring of health inequali es demands access to mul ple data sources and surveillance systems that enable disaggrega on by a range of sub-popula on groups. It demands development of innova ve approaches to maximize data use to rou nely provide absolute and rela ve measures of health inequality. These demands challenge the tradi onal epidemiological surveillance systems. Purpose: To describe the process of implemen ng a system to measure and report on health inequali es in Canada while discussing gaps in the current surveillance system speciﬁc to health inequali es. Based on lessons learned to date, we will iden fy key considera ons for undertaking this work.
Some health behaviours of inal year students at the College of Medicine of the University of Lagos (CMUL), Lagos, Nigeria
Background: Health behavior can be described as behaviors expressed by individuals to protect, maintain or promote health status. For example, proper diet and appropriate exercise are ac vi es perceived to inﬂuence health status. High-risk behaviors can signiﬁcantly impact the lives of youth and those around them; hence parents, educators and other concerned adults should be aware of the prevalence of these behaviors, the factors that increase their likelihood, and what can be done to abate or prevent those risks [CDC, 2006; Eaton et al., 2006]. The students at the College of Medicine, University of Lagos (CMUL) are youths and also future health providers that will be involved in health promo on hence the need to determine their risk behavior. Purpose: This study was to assess the health behavior of ﬁnal year students in CMUL.
Assessment of tobacco smoking status and in luence of health care professionals on tobacco cessation among outpatients in diﬀerent clinics of the Department of Medicine of Lagos University Teaching Hospital (LUTH), Idi Araba, Lagos, Nigeria
Background: As a risk factor for six out of the world's eight leading causes of death, tobacco smoking has been dubbed the single most preventable cause of death. Healthcare professionals have a prominent role to play in tobacco control. Studies have shown that even a brief interven on by a health professional signiﬁcantly increases the cessa on rate. Purpose: The objec ves of the study were to assess the smoking status and iden fy the inﬂuence of health professionals on smoking cessa on of outpa ents in diﬀerent clinics at the department of Medicine, Lagos University Teaching Hospital (LUTH), Nigeria.
Big Data Analytics for Risk Factor Surveillance
Background: Risk factor surveillance is a con nuous data collec on, analysis, and dissemina on ac vity. Informa on technology plays an important role in building the surveillance system and a big data approach has become a hot topic. Big data analy cs are the advanced methods to derive insight and knowledge from the big data of high volume, speed and variety, such as text mining, natural language processing, and ar ﬁcial intelligence. They can handle a large amount of untradi onal and unstructured data and thus provide innova ve ways for conduc ng the risk factor surveillance. Purpose: The purpose of this study is to explore the possible applica on of current big data analy cs in the risk factor surveillance.
Health promotion beliefs and involvement among hospital pharmacists in Lagos State
Background: The number of chronically ill pa ents and pa ents with non-communicable diseases are increasing rapidly. This is partly due to unhealthy lifestyle prac ces (Geense et al, 2013). The health promo on services expected from pharmacists include provision of advice on healthy living and self-care and involvement in health promo on campaigns (Eades, Ferguson & O'Carroll, 2011) There is limited data available regarding the ac vi es of hospital pharmacists in health promo on. Purpose: The objec ves of this study were to determine the beliefs and how much importance is a ached to the promo on of certain health-related behaviors and extent of involvement in promo ng it by hospital pharmacists prac cing in Lagos State general hospitals.
What risky behaviour is prevalent among pharmacy students at the University of Lagos
Background: Risky behaviors can take years oﬀ a person's life and endanger those around that person. Eﬀec ve health promo on ac on on healthy ea ng, physical ac vity and tobacco control will make the most important contribu ons to reducing the burden of non-communicable diseases (NCDs) in the global popula on (IUHPE, 2011). A signiﬁcant propor on of heart disease, stroke, type 2 diabetes and cancer would be prevented if the major common risk factors (tobacco, physical inac vity, unhealthy diet) were eliminated. This would save many millions of premature deaths. Pharmacy students are part of the future workforce of health promo on specialists, hence the need to determine their risky behaviors, if any. Purpose: The objec ve of this study was to assess the risky health behavior of pharmacy students of University of Lagos in the area of tobacco, physical ac vity and ea ng habits.
My Health My Community – an intersectoral collaboration for population health improvement
Background: My Health My Community (MHMC) is a collaborative initiative, developed to ﬁll a gap in health and well-being information for Vancouver Coastal Health (VCH) and Fraser Health (FH) regions. MHMC survey sought to capture information within the domains of socio-demographics, health status, lifestyle, access to care, built environment and community resiliency. VCH and FHA engaged their municipal governments and community partners to develop relevant content and recruit participants. Purpose: Understand the burden and determinants of chronic disease at a local level (municipal and neighborhood) that facilitates partnership with local governments and community organizations to create health-promoting environments.