Electrocardiographic Findings in Brazilian Adults without Heart Disease: ELSA-Brasil / Medidas Eletrocardiográficas de Adultos Brasileiros sem Cardiopatia Estabelecida: ELSA-Brasil

Abstract Background: The electrocardiogram (ECG) is widely used in population-based studies. However, there are few studies on electrocardiographic findings in Latin America and in Brazil. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) comprised 15,105 participants (35-74 years) from six Brazilian capitals. Objectives: To describe electrocardiographic findings in Brazilian adults without heart disease, stratified by sex, age and race/skin color. Methods: Cross-sectional study with baseline data of 11,094 adults (44.5% men) without heart disease from ELSA-Brasil. The ECGs were recorded with the Burdick Atria 6100 machine and stored at the Pyramis System. ECG analysis was automatically performed using the Glasgow University software. A descriptive analysis of heart rate (HR), P, QRS and T waves' duration, PR and QT intervals, and P, R and T axes was performed. After stratification by sex, race/color and age, the groups were compared by the Wilcoxon and Kruskal-Wallis test at a significance level of 5%. Linear regression models were used to evaluate the behavior of electrocardiographic parameters over age. Major electrocardiographic abnormalities defined by the Minnesota code were manually revised. Results: Medians values of the electrocardiographic parameters were different between men and women: HR 63 vs. 66 bpm, PR 164 vs.158 ms, QT corrected 410 vs. 421 ms, QRS duration 92 vs. 86 ms, P-wave duration 112 vs. 108 ms, P-wave axis 54 vs. 57 degrees, R-wave axis 35 vs. 39 degrees, T-wave axis 39 vs. 45 degrees (p < 0.001 for all). The 2nd and the 98th percentiles of each variable were also obtained, and graphs were constructed to illustrate the behavior of the electrocardiographic findings over age of participants stratified by sex and race/skin color. Conclusions: The values for the electrocardiographic measurements herein described can be used as reference for Brazilian adults free of heart disease, stratified by sex. Our results suggest that self-reported race/skin color have no significant influence on electrocardiographic parameters.

Resumo Fundamento: O eletrocardiograma (ECG) é amplamente utilizado em estudos de base populacional. Porém, poucos desses estudos descrevem achados eletrocardiográficos na América Latina e particularmente no Brasil. O Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil) incluiu 15105 participantes (35-74 anos) de seis capitais brasileiras. Objetivos: Descrever as medidas eletrocardiográficas em adultos brasileiros não cardiopatas, estratificados por sexo, raça/cor e idade. Métodos: Estudo transversal com dados da linha de base do ELSA-Brasil (n=11094, 44,5% homens) de participantes sem doença cardiopatia prevalente. Os ECGs foram obtidos no aparelho Burdick Atria 6100 e armazenados pelo Sistema Pyramis. A análise dos ECGs foi realizada automaticamente utilizando-se o software da Universidade de Glasgow. Realizou-se análise descritiva da frequência cardíaca, da duração das ondas P, QRS e T, dos intervalos (i) PR e QT, e dos eixos de P, R e T. A comparação dos grupos estratificados por sexo, raça/cor e idade, foi feita pelos testes de Wilcoxon e Kruskal-Wallis com nível de significância definido em 5%. O comportamento das medidas eletrocardiográficas ao longo da idade foi avaliado por modelos de regressão linear. Alterações eletrocardiográficas definidas como maiores pelo código de Minnesota foram revisadas manualmente. Resultados: As medianas das mensurações foram diferentes entre homens e mulheres: FC 63 vs 66 bpm, iPR 164 vs 158 ms, iQT corrigido 410 vs. 421 ms, QRS 92 vs 86 ms, onda P 112 vs 108 ms, eixo da onda P 54 vs 58, eixo da onda R 35 vs 39 e eixo da onda T 39 vs 45 (p < 0,001 para todas). Os percentis 02 e 98 foram obtidos para cada variável analisada, assim como gráficos demonstrando o comportamento dos parâmetros eletrocardiográficos ao longo da idade dos participantes estratificados por sexo e raça/cor. Conclusões: Os valores descritos para as medidas eletrocardiográficas analisadas poderão ser utilizados como referência para adultos brasileiros sem cardiopatia prevalente, estratificados por sexo. Os resultados sugerem que não existe grande influência da raça/cor autodeclarada nas mensurações eletrocardiográficas realizadas.

Beating Obesity: Factors Associated with Interest in Workplace Weight Management Assistance in the Mining Industry

BACKGROUND: Rates of overweight and obese Australians are high and continue to rise, putting a large proportion of the population at risk of chronic illness. Examining characteristics associated with preference for a work-based weight-loss program will enable employers to better target programs to increase enrolment and benefit employees' health and fitness for work. METHODS: A cross-sectional survey was undertaken at two Australian mining sites. The survey collected information on employee demographics, health characteristics, work characteristics, stages of behavior change, and preference for workplace assistance with reaching a healthy weight. RESULTS: A total of 897 employees participated; 73.7% were male, and 68% had a body mass index in the overweight or obese range. Employees at risk of developing obesity-related chronic illnesses (based on high body mass index) were more likely to report preference for weight management assistance than lower risk employees. This indicates that, even in the absence of workplace promotion for weight management, some at risk employees want workplace assistance. Employees who were not aware of a need to change their current nutrition or physical activity behaviors were less likely to seek assistance. This indicates that practitioners need to communicate the negative effects of excess weight and promote the benefits of a healthy lifestyle to increase the likelihood of weight management. CONCLUSION: Weight management programs should provide information, motivation. and trouble-shooting assistance to meet the needs of at-risk mining employees, including those who are attempting to change and maintain behaviors to achieve a healthy weight and be suitably fit for work.

Sedentarismo, deporte y la presión biopolítica de vivir saludable: análisis del discurso del sistema elige vivir sano en Chile / Sedentary lifestyle, sports and biopolitical pressure for healthy living: discourse analysis on the “choose to live healthy” system in Chile / Sedentarismo, esporte e a pressão biopolítica por uma vida saudável: análise do discurso do programa “escolha uma vida saudável”, do Chile

En la actualidad es cada vez más común escuchar a autoridades gubernamentales comentando acerca de cuál es la forma adecuada de “vivir bien” o de cómo se puede “vivir sano”. En Chile, en el año 2013 se creó la Ley Elige Vivir Sano (EVS), la cual propone generar un cambio cultural de la población, promoviendo el deporte y la actividad física como promotores de salud. Bajo un marco de referencia de la biopolítica y de la gubernamentalidad, en esta investigación se realiza un análisis de discurso a diversos documentos oficiales que construyen el discurso de EVS. Los resultados muestran que la construcción discursiva de EVS promueve una individualización del cuidado de la salud junto con la promoción del deporte y la actividad física acordes a la ideología neoliberal. Asimismo se discute respecto al tiempo libre y a las condiciones materiales que permiten o no llevar una vida sana.

It is increasingly common to hear governmental authorities commenting on the proper way to “live well” or how to “live healthy”. The so-called Choose to Live Healthy Law (Elige Vivir Sano, EVS) was created in Chile in 2013. It proposes cultural change for the population by advancing sport and physical activity as health promoters. Under a biopolitics and governmentality framework, this study uses discourse analysis to understand several official documents that build the EVS discourse. The results show that the EVS discursive construction promotes individualization of health care while advancing sport and physical activity in line with neoliberal ideology. It also discusses spare time and material conditions may allow a healthy life or not.

Na atualidade, é cada vez mais comum ouvir autoridades governamentais opinando sobre qual seria a maneira correta de se “viver bem” ou como se pode levar uma “vida saudável”. No Chile, em 2013 foi criada a Lei “Escolha uma Vida Saudável” (EVS), que propõe uma mudança cultural à população, estimulando o esporte e a atividade física como promotores de saúde. A partir de um quadro de referências relativas à biopolítica e à governamentalidade, esta pesquisa realiza uma análise do discurso de vários documentos oficiais que constroem o discurso de EVS. Os resultados mostram que a construção discursiva de EVS promove uma individualização dos cuidados de saúde, juntamente com uma promoção do esporte e da atividade física em conformidade com a ideologia neoliberal. O trabalho também discute o tempo livre e as condições materiais que permitem ou não levar-se uma vida saudável.

A cross-sectional survey on the efficacy of ‘China Healthy Lifestyle for All' in 2012 / 中华流行病学杂志

Objective To study the efficacy of ‘China Healthy Lifestyle for All' (CHLA).Methods Under similar GDP status,two counties (one with CHLA and one without) were randomly selected from each province of China.Cluster randomized sampling method was performed to select 500 over 18-year-olds from each county.Face-to-face questionnaire interview was used to collect data related to knowledge,awareness and behavior on healthy lifestyle.Generalized Estimated Equation was fitted for the multi-factor analysis.Results A total of 31 396 subjects were surveyed,with 11 871 urban and 6312 rural residents from counties that had under gone the CHLA.Another 3934 urban and 9279 rural subjects were from those counties that had not carried out the CHLA (as control group).In both urban and rural areas,the CHLA group seemed more likely to be aware of the Campaign itself and the knowledge on healthy lifestyle,than the control group as well as consciously limiting the salt and oil intake,after adjusting other factors such as county,gender,age and education.In the urban area,rates of awareness on the Campaign in both the CHLA and control groups were 57.1％ and 31.7％ (OR=3.33,95％CI:1.63-6.80,P=0.001) respectively.And in the rural area,the rates of consciously limiting the salt intake in the CHLA group and in the control group were 51.5％ and 38.8％ (OR=l.70,95％CI:1.13-2.56,P=0.011) respectively.In the urban area,subjects from the CHLA group were more likely to use the healthy supportive tools than the control group.Rates of using salt measuring spoons in both the CHLA group and control groups were 49.2％ and 29.5％ (OR=2.46,95％ CI:1.45-4.17,P=0.001) respectively.In the rural area,statistically significant difference was only found in the rate of using scaled oil pots (OR=2.11,95％CI:1.09-4.09,P=0.028) between the CHLA group and the control group.In the rural area,the CHLA group was more likely to engage in more physical activities than the control group.No differences on the rates related to physical activities were found in the urban area.Some behavioral indicators such as the rates of consciously maintaining the body weight,daily intake of vegetables and fruits showed no statistically significant differences between the CHLA group and the control group either in the urban or in the rural areas.Conclusion The ‘China Healthy Lifestyle for All' seemed to have improved the knowledge on awareness and conciousness of healthy lifestyle.However,the effect of CHLA on the healthy behavior needs to be further evaluated.

Gestión de gobiernos locales en la calidad de la atención de la salud para niños / Local government management regarding the quality of children's healthcare

Objetivo Evaluar el componente de calidad de los programas de atención en salud dirigidos a niños, niñas y adolescentes establecidos por los gobiernos locales de Colombia en cumplimiento de las normas legales. Métodos Estudio descriptivo en el que se evaluó la evidencia de rectoría de los sistemas de calidad y del cumplimiento de los atributos de accesibilidad, oportunidad, seguridad, continuidad y pertinencia como indicadores de la calidad en la prestación de servicios. Resultado No se encontró evidencia que demuestre que los gobiernos locales examinados desarrollen programas de salud orientados a la niñez que sean específicos a su realidad epidemiológica. Las actividades que se ejecutan corresponden al mínimo legal y no son evaluados en su componente de calidad, por tanto no hay un enfoque de mejoramiento en los mismos. Conclusión Se proponen estos resultados como línea base y dado que la función de los gobiernos locales, en materia de calidad en salud, va desde la planeación, pasando por la rectoría y el control de la calidad de los prestadores, se hace inaplazable la implementación de programas de gestión de la calidad antes que nuevos programas de atención.

Objective Assessing the quality of healthcare programs aimed at children and adolescents set by Colombian local governments in compliance with current legal standards. Methods This was a descriptive study which evaluated the evidence regarding surveillance of quality systems and compliance with accessibility, opportunity, safety, continuity and relevance as indicators of quality concerning service delivery. Results No evidence was found showing that the local governments so examined were developing child-orientated health programs specifically addressing epidemiological reality. Ongoing activities complied with minimum legal requirements and were not being evaluated regarding their quality, meaning that an approach aimed at improvement was not being adopted. Conclusion The above results are thus proposed as a working baseline and, given that the role of local government in terms of healthcare quality ranges from planning, to surveillance and quality control concerning providers, quality management programs must be implemented before new healthcare programs are introduced.

Health status of southern Arizona border counties: a Healthy Border 2010 midterm review / Situación de salud de los condados de la frontera sur de Arizona: examen a mitad de período del programa "Frontera saludable 2010"

OBJECTIVE: The region on the United States (US) side of the US-Mexico border consists of 44 counties in four states; populations on both sides of the border have similar health problems. Healthy Border 2010: An Agenda for Improving Health on the US-Mexico Border (HB 2010) is a binational agenda of health promotion and disease prevention for individuals in the region. This study reports on the health status of the four southern Arizona border counties. METHODS: Data on health indicators for Cochise, Pima, Santa Cruz, and Yuma Counties were collected from the Arizona Department of Health Services Vital Records and Statistics. Progress was calculated as a percentage made toward or away from the 2010 target. Comparisons were made between the border counties and Arizona. RESULTS: Progress toward the HB 2010 targets varied among the border counties. All border counties made progress toward the targets with the cervical cancer, hepatitis A, and teenage birthrate objectives. Most border counties moved toward the goals for breast cancer, diabetes mortality, tuberculosis, motor vehicle crashes, infant mortality from congenital abnormalities, and prenatal care. Border counties moved away from the target with the human immunodeficiency virus and infant mortality objectives. CONCLUSIONS: Assessment of the HB 2010 objectives provided a comprehensive description of the health status of the population. Although the southern Arizona border counties have shown improvement in some areas, monitoring is still needed to identify the disparities that remain.

OBJETIVO: La región estadounidense de la frontera entre México y los Estados Unidos consta de 48 condados distribuidos en cuatro estados, y las poblaciones que viven a uno y otro lado de la frontera tienen problemas de salud similares. El programa binacional "Frontera saludable 2010" está destinado a las poblaciones de la región y se propone mejorar la situación sanitaria en la frontera entre México y los Estados Unidos mediante actividades de promoción de la salud y prevención de enfermedades. Este estudio es un informe sobre la situación sanitaria de los cuatro condados de la frontera sur de Arizona. MÉTODOS. Los datos acerca de los indicadores de salud de los condados de Cochise, Pima, Santa Cruz y Yuma se obtuvieron del registro civil y estadísticas del Departamento de Servicios de Salud de Arizona. Se calculó el progreso mediante un porcentaje que refleja la cercanía o la lejanía del objetivo propuesto para el año 2010. Se compararon los datos correspondientes a los condados fronterizos con los del estado de Arizona. RESULTADOS: El progreso hacia los objetivos del programa "Frontera saludable 2010" no fue uniforme en los distintos condados fronterizos. Los cuatro condados lograron avances hacia los objetivos propuestos en materia de cáncer cervicouterino, hepatitis A y tasa de natalidad entre las adolescentes. La mayoría de los condados fronterizos están más próximos a cumplir con los objetivos en materia de cáncer de mama, mortalidad por diabetes, tuberculosis, colisiones de vehículos automotores, mortalidad infantil por anomalías congénitas y atención prenatal. Sin embargo, ninguno de los cuatro condados se está acercando al objetivo propuesto en cuanto al virus de la inmunodeficiencia humana y la mortalidad infantil. CONCLUSIONES: La evaluación de los objetivos del programa "Frontera saludable 2010" brindó una descripción integral de la situación de salud de la población. Aunque los condados de la frontera sur de Arizona han logrado avances en algunos aspectos, sigue siendo necesario mantener la vigilancia con el fin de detectar las disparidades aún presentes.