Factores de riesgo para las enfermedades no transmisibles: metodología y resultados globales de la encuesta de base del programa CARMEN: conjunto de acciones para la reducción multifactorial de las enfermedades no transmisibles / Risk factors for chronic non communicable diseases: methods and results of CARMEN program basal survey

Background: In the last decades, chronic non communicable diseases are becoming the main cause of disability and mortality among adults. The risk factor surveillance and management is the most efficient mean of reducing the impact of these diseases. Aim: To report the results of a non communicable disease risk factor surveillance program in Valparaiso, Chile. Material and methods: a random samples of people aged 25 to 64 years old living in Valparaiso, Chile was studied. Subjects were questioned about smoking and physical activity habits. Blood pressure, height and weight were measured using standardized techniques at their homes and blood samples were obtained to measure serum lipid levels and oral glucose tolerance test at the nearest outpatient clinic. Results: Of the initial 3852 homes selected, 752 individuals did no agree to answer the inquiry, therefore 3120 subjects were finally interviewed. Of these, 40.6 percent were smokers, 15 percent drank alcohol in two or more occasions per month, 84.6 percent were physically inactive, 19.7 percent had a body mass index over 30 kg/m2, 11.1 percent had high blood pressure, 3.9 percent were diabetic and 46.9 percent had high serum cholesterol levels. Conclusions: The basal survey for the CARMEN program shows a high prevalence of cardiovascular risk factors among chileans

Prevalencia de hipertensión arterial en Valparaíso: resultados de la encuesta de base el programa CARMEN: conjunto de acciones para la reducción multifactorial de las enfermedades no transmisibles / Prevalence of hypertension in Valparaíso: results of the base survey of CARMEN program

Background: There is little information about the real prevalence of hypertension in Chile. Aim: To assess the adjusted prevalence of hypertension and its main therapeutic measures among adults living in Valparaiso, Chile. Material and methods: A random sample of dwellings in Valparaiso was chosen. Among these, an individual of 25 to 64 years old was randomly surveyed for risk factors for chronic diseases and sociodemographic parameters. Blood pressure, weight, height, oral glucose tolerance test, fasting cholesterol and triglycerides were also measured. Prevalence was pondered according to age, sex, and probability of selection in the dwelling interior. Results: Three thousand one hundred twelve individuals were studied. The adjusted prevalence of hypertension was 11.4 percent (11.6 percent among females and 10.6 percent among men). The prevalence increased along with age from 3 and 1.9 percent in men and women of 25 to 34 years old respectively, to 18.2 and 27.4 percent among men and women of 55 to 64 years old (p< 0.01). People of low socioeconomic level had a higher prevalence of hypertension than those of high socioeconomic level (14.2 and 9.3 percent respectively, p < 0.05). Diabetes, obesity and hypercholesterolemia were significantly more frequent in subjects with hypertension than in the general population. Forty four percent of diagnosed hypertensives were receiving medications (angiotensin converting enzyme inhibitors 40 percent, calcium antagonists 34 percent, beta blockers 22 percent). Twenty five percent of patients were treated with a combination of medications. Of those treated, only 22 percent had normal blood pressure levels at the moment of examination. Conclusions: High blood pressure is an important public health problem that requires more efficient detection and treatment programs

Equidad en salud / Equity in health

Diferencias crecientes en la salud entre y dentro de los países están relacionadas con las diferencias de ingreso y status que persisten y se acentúan a pesar del crecimiento económico. Se define inequidad como toda diferencia evitable en el nivel de salud que es considerada como injusta. Se distingue la equidad en la atención de salud de la equidad en el nivel de salud de la población. En la primera preocupa que la distribución de los recursos asignados a la atención médica sea orientada según necesidades de la población, localizando según vulnerabilidad y capacidad de pago. La máxima es ofrecer igual acceso e igual tratamiento a igual necesidad. Se discuten herramientas técnicas para lograrlo. Equidad en la atención en salud no permite alcanzar equidad en el nivel de salud. Tampoco la superación de la pobreza o la modificación de estilos de vida. Menores tasas de mortalidad de distintos grupos sociales no se relacionan con la riqueza total sino con una mejor distribución del ingreso al interior de la sociedad. A mayor distancia entre los grupos sociales, menor inversión en capital social, lo cual a su vez determinaría una menor cohesión social, factor determinante en el progreso de las naciones