Avances del estudio de evaluación del efecto del consumo de mate para reducir el riesgo cardiometabólico en Argentina

La enfermedad cardiometabólica (ECM) es la principal causa global de muerte y el 80% de estas muertes ocurre en países en desarrollo. Recientemente se han descripto beneficios de la yerba mate relacionados con la prevención de factores de riesgo cardiometabólico y la evidencia en humanos es limitada a estudios realizados en periodos cortos. Desde el 2011, en cuatro ciudades latinoamericanas se está llevando a cabo un estudio de cohorte prospectivo de base poblacional para la detección y el seguimiento de ECM y sus factores de riesgo en adultos de ambos sexos de 35 a 74 años, denominado CESCAS I

Association between drinking patterns and cardiovascular risk: a population-based study in the Southern Cone of Latin America

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.Fil: Gulayin, Pablo Elías. Instituto de Efectividad Clínica y Sanitaria; Argentina. Universidad Nacional de La Plata; ArgentinaFil: Irazola, Vilma. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: Gutierrez, Laura. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Elorriaga, Natalia. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: Lanas, Fernando. Universidad de La Frontera; ChileFil: Mores, Nora Cecilia. Municipalidad de Marcos Paz (buenos Aires).; ArgentinaFil: Ponzo, Jaqueline. Universidad de la Republica. Facultad de Medicina; UruguayFil: Calandrelli, Matías Enrique. Sociedad Rural de San Carlos de Bariloche.; ArgentinaFil: Poggio, Rosana. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: Rubinstein, Adolfo Luis. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: Bardach, Ariel Esteban. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentin

Association between drinking patterns and cardiovascular risk: a population-based study in the Southern Cone of Latin America

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.Facultad de Ciencias Médica

Family History of Breast and Colorectal Cancer in a Population-Based Cohort in two cities of Argentina

INTRODUCCIÓN: Los cánceres de mama (CM) y colorrectal (CCR) presentan una elevada carga de enfermedad en Argentina, por lo que el estudio de la epidemiología de estos tumores constituye una prioridad en salud pública. El objetivo del presente trabajo fue describir la prevalencia de antecedentes familiares de CM y CCR, y estimar la incidencia de los tumores en adultos de 35 a 74 años de dos ciudades de Argentina: Bariloche y Marcos Paz. MÉTODOS: En el marco de la cohorte prospectiva de población general CESCAS I (Estudio de detección y seguimiento de enfermedad cardiovascular y factores de riesgo en el Cono Sur de Latinoamérica), se recolectó información individual sobre antecedentes familiares de CM y CCR en una muestra representativa de las ciudades de Bariloche y Marcos Paz. Los casos de cáncer fueron investigados mediante documentación médica respaldatoria. RESULTADOS: Durante 2016-2017 se obtuvo información de 3245 participantes. El 8,4% de la población reportó antecedente familiar de CCR, y el 15,2% de las mujeres, de CM. La incidencia anual para el período 2011-2017 fue de 55,2/100 000 mujeres de 35 a 74 años (IC95%: 22,8-133,7) para CM y 38,5/100 000 adultos de 35 a 74 años (IC95%: 15,3-96,8) para CCR. CONCLUSIONES: Además de garantizar el acceso universal a los programas de tamizaje, se debe tener en cuenta la importancia de indagar sobre los antecedentes familiares de cáncer para identificar pacientes con riesgo aumentado, que requieren algoritmos particulares de detección temprana y vigilancia.INTRODUCTION: Breast cancer (BC) and colorectal cancer (CRC) both present a high burden of disease in Argentina. Hence, studying the epidemiology of these tumors constitutes a public health priority. The objective of this study was to describe the prevalence of family history of BC and CRC and to estimate the incidence of these tumors in adults aged between 35 and 74 years from two cities in Argentina: Bariloche and Marcos Paz. METHODS: As part of the prospective population-based cohort CESCAS I (Study of detection and monitoring of cardiovascular disease and risk factors in the Southern Cone of Latin America), individual information on family history of BC and CRC was collected from a representative sample of the cities of Bariloche and Marcos Paz. Cancer cases were investigated using supporting medical documentation. RESULTS: During 2016- 2017, information from 3245 participants was obtained. Family history of CRC was reported by 8.4% of the population, and 15.2% of women reported a family history of BC. The annual incidence for the 2011-2017 period was 55.2/100 000 women aged 35 to 74 years (95%CI: 22.8-133.7) for BC and 38.5/100 000 adults aged 35 to 74 years (95%CI: 15.3-96.8) for CRC.CONCLUSIONS: Besides guaranteeing universal access to screening programs, it is important to evaluate family history of cancer to identify patients with increased risk, who require specific early detection and surveillance algorithmsFil: Melendi, Santiago Ezequiel. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Chaparro, Raul Martin. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: González, Lucas Ángel Damián. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Gutiérrez, Laura. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Calandrelli, Matías Enrique. Sanatorio San Carlos, Bariloche; ArgentinaFil: Mores, Nora Cecilia. Municipalidad de Marcos Paz (buenos Aires).; ArgentinaFil: Elorriaga, Natalia. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Poggio, Rosana. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Irazola, Vilma. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Adherence to Drinking Guidelines and Reasons for Alcohol Consumption Cessation in the Southern Cone of Latin America – Findings from the CESCAS Study

Introduction: Alcohol consumption is a risk factor for morbidity and mortality globally. Consumption levels in Southern Latin America are among the highest in the world. Objectives: To describe consumption patterns and adherence to guidelines in the general adult population of Southern Latin America, as well as exploration of reasons for alcohol cessation and the advising role of the health worker in this decision. Methods: In 7,520 participants from the Centro de Excelencia en Salud Cardiovascular para el America del Sur (CESCAS) cohort, consumption patterns were described and the proportion excessive drinkers (i.e. >7 units/week for women and >14 for men or binge drinking: >4 (women) or >5 (men) units at a single occasion) was calculated. Former drinkers were asked if they had quit alcohol consumption on the advice of a health worker and/or because of health reasons. Furthermore, among former drinkers, multivariable logistic regression analysis was performed to assess which participant characteristics were independently associated with the chance of quitting consumption on a health worker’s advice. Results: Mean age was 54.8 years (SD = 10.8), 42% was male. Current drinking was reported by 44.6%, excessive drinking by 8.5% of the population. In former drinkers, 23% had quit alcohol consumption because of health reasons, half of them had additionally quit on the advice of a health worker. The majority of former drinkers however had other, unknown, reasons. When alcohol cessation was based on a health worker’s advice, sex, country of residence, educational status and frequency of visiting a physician were independent predictors. Conclusion: In this Southern American population-based sample, most participants adhered to the alcohol consumption guidelines. The advising role of the health worker in quitting alcohol consumption was only modest and the motivation for the majority of former drinkers remains unknown. A more detailed assessment of actual advice rates and exploration of additional reasons for alcohol cessation might be valuable for alcohol policy making.Facultad de Ciencias Médica

Detection and follow-up of chronic obstructive pulmonary disease (COPD) and risk factors in the Southern Cone of Latin America. the pulmonary risk in South America (PRISA) study

<p>Abstract</p> <p>Background</p> <p>The World Health Organization has estimated that by 2030, chronic obstructive pulmonary disease will be the third leading cause of death worldwide. Most knowledge of chronic obstructive pulmonary disease is based on studies performed in Europe or North America and little is known about the prevalence, patient characteristics and change in lung function over time in patients in developing countries, such as those of Latin America. This lack of knowledge is in sharp contrast to the high levels of tobacco consumption and exposure to biomass fuels exhibited in Latin America, both major risk factors for the development of chronic obstructive pulmonary disease. Studies have also demonstrated that most Latin American physicians frequently do not follow international chronic obstructive pulmonary disease diagnostic and treatment guidelines. The PRISA Study will expand the current knowledge regarding chronic obstructive pulmonary disease and risk factors in Argentina, Chile and Uruguay to inform policy makers and health professionals on the best policies and practices to address this condition.</p> <p>Methods/Design</p> <p>PRISA is an observational, prospective cohort study with at least four years of follow-up. In the first year, PRISA has employed a randomized three-staged stratified cluster sampling strategy to identify 6,000 subjects from Marcos Paz and Bariloche, Argentina, Temuco, Chile, and Canelones, Uruguay. Information, such as comorbidities, socioeconomic status and tobacco and biomass exposure, will be collected and spirometry, anthropometric measurements, blood sampling and electrocardiogram will be performed. In year four, subjects will have repeat measurements taken.</p> <p>Discussion</p> <p>There is no longitudinal data on chronic obstructive pulmonary disease incidence and risk factors in the southern cone of Latin America, therefore this population-based prospective cohort study will fill knowledge gaps in the prevalence and incidence of chronic obstructive pulmonary disease, patient characteristics and changes in lung function over time as well as quality of life and health care resource utilization. Information gathered during the PRISA Study will inform public health interventions and prevention practices to reduce risk of COPD in the region.</p

Ensayo psicológico sobre la locura : Tesis para optar al grado de doctor en medicina

A la cabeza de portada: Universidad de la Capital. Facultad de Ciencias Médicas. - Incluye nómina de Catedráticos y Asignatura

Survey on Cardiovascular Risk Factors in Bariloche

Background The development and evaluation of health policies and program planning requires timely and accurate information about risk factors, the presence of chronic diseases, their distribution and trends. The self-reported prevalence of cardiovascular risk factors in a population, together with anthropometric measurements and blood tests are necessary, according to the Pan American Health Organization, to know the real prevalence of these factors.ObjectivesTo determine the prevalence, knowledge, treatment and control of cardiovascular risk factors (CRFs) in a  epresentative sample of the population of San Carlos de Bariloche; to compare the outcomes obtained with those of the 2005 National Survey of Risk Factors and to estimate the overall cardiovascular risk.Material and MethodsWe conducted a cross-sectional study, using a two-stage probability and stratified sampling (census block, household). In each household, subjects aged 18 years and older were surveyed after signing informed consent form. The instrument used was the National Survey of Risk Factors together with a translated adaptation of the psychosocial stress score of the INTERHEART study. Anthropometric measurements were performed and total cholesterol, HDL-cholesterol, blood sugar and creatinine levels were measured. The following conditions were defined: hypertension (HT) ≥ 140/90 mm Hg or under treatment; hypercholesterolemia (HC): ≥ 240 mg/dl or under treatment; low HDL: <40 mg/dl, and diabetes mellitus (DM): ≥ 126 mg/dl or under treatment.ResultsA total of 902 surveys were conducted, with a response survey rate of 87.4%. Average age was 43.2 years (range 18-88) and 52% were women.Introducción La información oportuna y precisa sobre los factores de riesgo, la aparición de las enfermedades crónicas, su distribución y sus tendencias es esencial para la formulación de políticas de salud, la planificación de los programas y su evaluación. Para conocer la prevalencia de los principales factores de riesgo de enfermedades cardiovasculares en una población, la Organización Panamericana de la Salud recomienda, además de la autorreferencia, complementar los cuestionarios con mediciones físicas y de laboratorio.ObjetivosDeterminar la prevalencia, el conocimiento, el tratamiento y el control de los factores de riesgo cardiovascular (FRC) en una muestra representativa de la población de San Carlos de Bariloche, comparar los resultados obtenidos con la Encuesta Nacional de Factores de Riesgo 2005 (ENFR) y estimar el riesgo cardiovascular global.Material y métodosEl presente es un estudio de corte transversal. El muestreo fue probabilístico, estratificado y de dos etapas (radio censal, vivienda). En cada hogar se entrevistaron todos los individuos de 18 años o más que firmaron consentimiento. El instrumento utilizado fue la Encuesta Nacional de Factores de Riesgo, a la que se le agregó una adaptación traducida del puntaje de estrés psicosocial del estudio INTERHEART. Se realizaron mediciones antropométricas y dosajes de colesterol total, C-HDL, glucemia y creatinina. Se definieron hipertensión arterial (HTA): ≥ 140/90 mm Hg o tratados; hipercolesterolemia (HC): ≥ 240 mg/dl o tratados; HDL bajo: < 40 mg/dl y diabetes (DM): ≥ 126 mg/dl o tratados.  (continúa en pdf

Survey on the Management of ST-Segment Elevation Myocardial Infarction in Hospitals from Rural Areas of Rio Negro, Argentina

Introduction: information on the management of AMI with a ST-segment elevation (IAMCEST) in rural areas of our countryis scarce.Objective: To know about the availability and use of diagnostic and therapeutic resources in the care of IAMCEST in ruralmedical centers in Río Negro provinceMethods: A structured, open-response, telephone survey was conducted, to on-call doctors from 8 hospitals of the South Line,all between 2 and 4 level (without intensive areas).Results: The IAMCEST patients are attended by generalists, who in half of the cases have no one to consult the ECG. Broadlythey do not have systematic systems or referral networks. Although 75% of the centers have more than 2 hours of derivation,most do not have streptokinase. Half of the referrals are cities that do not have hemodynamics for cases without coverage.Conclusion: The organization and availability of resources in IAMCEST care in rural areas of the province of Río Negro is scarce.Introducción: Es escasa la información del manejo del infarto agudo de miocardio con supradesnivel del segmento ST (IAMCEST)en zonas rurales de nuestro país.Objetivo: Conocer la disponibilidad y utilización de recursos diagnósticos y terapéuticos en la atención del infarto agudo demiocardio con supradesnivel del segmento ST en centros médicos rurales de la provincia de Río Negro.Material y métodos: Se realizó una encuesta telefónica, estructurada, de respuesta abierta, a médicos de guardia de los 8hospitales de la Línea Sur, todos de nivel entre 2 y 4 (sin áreas intensivas).Resultados: Los casos con infarto agudo de miocardio con supradesnivel del segmento ST son atendidos por generalistas, queen la mitad de los casos no tienen con quién consultar los electrocardiogramas. En general, no cuentan con sistemáticas niredes de derivación. A pesar de que el 75% de los centros tienen más de 2 horas de derivación, la mayoría no disponen deestreptoquinasa. La mitad de las derivaciones son a ciudades que no disponen de hemodinamia para casos sin cobertura.Conclusión: Es escasa la organización y la disponibilidad de recursos en la atención del infarto agudo de miocardio con supradesniveldel segmento ST en zonas rurales de la provincia de Río Negro