Beneficios que reciben los pacientes asmáticos tras la aplicación de un tratamiento fisioterapéutico y rehabilitador

El asma bronquial sigue siendo la enfermedad crónica más frecuente en la infancia. Su prevalencia continúa aumentando a pesar de que en la actualidad se disponen de eficaces manuales terapéuticos para el correcto manejo de los principales síntomas de la enfermedad. El tratamiento no farmacológico de este padecimiento se fundamenta en tres pilares esenciales: la educación sobre la enfermedad, las guías para profesionales y pacientes y la fisioterapia respiratoria. Los pacientes que tienen un tratamiento fisioterapéutico y rehabilitador de manera habitual, tienen una mejoría significativa en el control del asma, especialmente si estos se practican bajo la supervisión de un fisioterapeuta. Los beneficios que los pacientes asmáticos logran con la fisioterapia y la rehabilitación son numerosos y uno de los efectos más importante es el impacto positivo sobre la calidad de vida.

Bronchial asthma continues to be the most common chronic disease in childhood. Its prevalence continues to increase despite the fact that effective therapeutic manuals are currently available for the correct management of the main symptoms of the disease. The non-pharmacological treatment of this condition is based on three pillars: education about the disease, guides for professionals and patients, and respiratory physiotherapy. Patients who have regular physiotherapy and rehabilitation treatment have a significant improvement in asthma control, especially if these are practiced under the supervision of a physiotherapist. The benefits that asthmatic patients achieve with physiotherapy and rehabilitation are numerous and one of the most important effects is the positive impact on quality of life.

Prevalence of Hypertension Among Tribal Population in India: A Systematic Review and Meta-Analysis

Hypertension is an important worldwide public-health challenge and it is accountable for 7% of Disability Ad-justed Life Years (DALY) loss, and by the end of 2025 about 29% of world’s population is likely to suffer from hypertension. Tribal population constitute about 8% of the total population in India. Among tribal population, study on hypertension will provide an interesting outcome because studies across the world have shown a lower prevalence. The objective of the study was to estimate the pooled prevalence of hypertension among adult tribal populations in India and also to analyse the possible sources of heterogeneity in the estimate. A systematic search was performed in PubMed, Google scholar, Scopus, Embase MEDLINE, and journals for arti-cles published between 2001 and 2020. This is a systematic review and meta-analysis done on hypertension among tribal populations of India. Three authors independently reviewed the articles, performed quality as-sessment and data was extracted. Pooled estimate of hypertension was calculated. Subgroup analyses was performed. A total of 26 articles with a total number of subjects of 75,543 were included in the study. The pooled estimate of hypertension prevalence was 25.1% (95% CI: 24.7, 25.4). There was significant heteroge-neity among the studies (I2 = 98.2 and Q = 1289.37). It is essential to conduct larger cohort studies and ran-domised controlled trials to determine the causes of the increased prevalence of hypertension among the tribal population. The prevalence of hypertension among tribal population are essential as a source of prima-ry information and for rational planning of health services and will help public-health policy-makers to assign sufficient priority and resources for its management and prevention.

The burden of physical inactivity for the public health care system in Brazil

ABSTRACT OBJECTIVE To update the estimated cost of physical inactivity for the Brazilian Unified Health System (SUS). METHODS The hospitalization costs were accessed via a database of the Ministry of Health - Informatics Department of the Brazilian SUS. Physical inactivity for the year 2017 was accessed via the Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (Vigitel - Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey). Seven chronic non-communicable diseases (NCD) were selected via the international classification of disease (ICD-10). The population fraction attributable to physical inactivity was calculated based on relative risk reported in previous studies and the prevalence of physical inactivity. RESULTS In 2017, the seven NCD considered in the analysis were responsible for 154,017 hospital admissions in adults older than 40 years old, residing in the state capitals and the Federal District, which corresponded to 6.5% of hospitalizations and 10.6% of SUS costs at an estimated US$ 112,524,914.47. Considering the group of individuals with insufficient physical activity in their leisure time, the percentage cost attributed to physical inactivity reached 17.4% of the estimated costs with NCD. At a national level, NCD were responsible for approximately 740 thousand hospitalizations, costing US$ 482 million, from which 17.4%, US$ 83 million were attributed to physical inactivity. CONCLUSION This study provides evidence to conclude that physical inactivity exerts an economic impact on the SUS due to NCD hospitalization. Physical inactivity is a modifiable lifestyle and compelling evidence, including that of this article, supports the promotion of a more active community as one of the major targets of public health care policies.

The epidemiological burden of reducing salt intake in Paraguay: A modeling study / A carga epidemiológica da redução do sal no Paraguai: um estudo de modelagem

ABSTRACT Objective This study aims to estimate the epidemiological burden of excessive salt intake reduction and achieve the World Health Organization salt reduction target for 2025 in Paraguay, in 2019. Methods We used the Preventable Risk Integrated Model, a comparative risk assessment macro-simulation model, to estimate the averted deaths, disease incidence, and disability-adjusted life years from cardiovascular disease attributable to salt intake in the population of Paraguay for different salt reduction policy scenarios. Results As a result, in Paraguay, excessive salt intake (over 5 g/day) is responsible for approximately 2,656 cardiovascular disease deaths (95% Uncertainty Interval: 1,250-3,765), 4,816 cardiovascular disease cases (95% UI: 2,251-6,947), and 60,529 disability-adjusted life years (95% UI: 27,828-86,258) per year. By reducing salt consumption by 30%, as recommended by the World Health Organization until 2025, approximately 1,188 deaths (95% UI: 520 to 1,820), 2,100 incident cases (95% UI: 923-3,234), and 27,272 disability-adjusted life years (95% UI: 11,999-41,675) from cardiovascular disease could be averted every year. Conclusion In conclusion, the burden of cardiovascular disease attributable to excessive salt intake is significant and salt reduction policies must become a priority in Paraguay.

RESUMO Objetivo Este estudo visa estimar a carga epidemiológica do consumo excessivo de sal e o alcance da meta da Organização Mundial de Saúde para 2025 no Paraguai, em 2019. Métodos Foi usado um modelo de avaliação comparativa de risco (Preventable Risk Integrated Model) para análise comparativa de risco para estimar mortes, casos incidentes e anos de vida ajustados por incapacidade (DALYs) por doenças cardiovasculares atribuíveis ao consumo excessivo de sal na população paraguaia em diferentes cenários. Resultados No Paraguai, o consumo excessivo de sal é responsável por aproximadamente 2.656 mortes (Intervalo de Incerteza 95%: 1.250-3.765), 4.816 casos incidentes (95% II: 2.251-6.947) e 60.529 DALYs (95% II: 27.828-86.258) por doenças cardiovasculares por ano. Com uma redução de 30% no consumo de sal, como recomendado pela Organização Mundial de Saúde até 2025, aproximadamente 1.188 mortes (95% II: 520-1.820), 2.100 casos incidentes (95% II: 923-3.234) e 27.272 DALYs (95% II: 11.999-41.675) por doenças cardiovasculares poderiam ser prevenidos ou adiados por ano. Conclusão Concluiu-se que a carga de doenças cardiovasculares atribuível ao consumo excessivo de sal no Paraguai é significante e políticas de redução deveriam ser priorizadas no país.

Correlation between chronic non-communicable disease and falls incidence among the elderly in urban and rural areas in Chongqing / 公共卫生与预防医学

Objective To analyze the correlation between the prevalence of chronic non-communicable diseases (NCDs) and fall incidence among the elderly in urban and rural areas in Chongqing, and to provide evidence for targeted intervention. Methods In 2019, a questionnaire survey was conducted among the elderly aged 65 and over in four districts and counties using multistage stratified cluster random sampling. The difference of NCDs prevalence and fall incidence was compared by Chi-square test. The correlation between NCDs and fall incidence was analyzed by multivariate logistic regression. Results A total of 806 and 801 elderly people aged 65 and above in urban and rural areas，respectively, were investigated The fall incidence among the elderly in rural areas (12.98%) was higher than that in urban areas (7.94%) (χ2=10.916, P=0.001). The multivariable logistic regression analysis showed that the prevalence of heart disease (OR=2.988, 95%CI:1.544-5.785), osteoporosis (OR=2.696, 95%CI:1.527-4.760) and vestibular dysfunction or deafness (OR=3.180, 95%CI:1.142-8.861) was associated with fall incidence among urban elderly people. Factors including need for care (OR=2.315，95%CI：1.130-4.744), diabetes (OR=3.067，95%CI:1.634-5.756), osteoporosis (OR=1.972, 95%CI:1.210-3.214), and arthritis (OR=2.975, 95%CI:1.901-4.657) were associated with fall incidence among rural elderly people. Conclusion The fall incidence among the elderly in rural areas is higher than that in urban areas in Chongqing. The prevalence of NCD is high among the elderly. Timely treatment of NCDs should be provided to reduce fall incidence among the elderly.

Estimates of major non-communicable disease risk factors for India, 2010 & 2015: A summary of evidence

Background & objectives: The National Monitoring Framework for the prevention and control of NCDs in India has set targets for reduction of risk factors relative to the measure recorded in 2010. Estimates for 2010 and 2015 were established using meta-analyses in the absence of a national risk factor survey till 2017. Methods: We searched national survey reports and also articles published in English from India between 2008 and 2017 in PubMed, Google Scholar and Cochrane review databases for specific risk factors among 18-69 yr Indians. Quality of studies was evaluated using Joanna-Briggs tool, but all studies were included in analyses. Estimates for each of the eight strata by age, gender and place of residence, respectively, were generated. MetaXL was used to calculate the pooled estimate for 2010 and 2015 using a random effects model. Strata-specific estimates were combined to arrive at national estimate using population weight of each stratum. The credibility of the estimates was determined using four parameters - average Briggs score; representativeness of the contributing studies and precision and stability of the estimates. Results: The estimates [95% confidence interval (CI)] for 2010 for different risk factors were as follows: current alcohol use, 15.7 per cent (13.2-18.2); current tobacco use, 27 per cent (21.4-32.6); household solid fuel use, 61.5 per cent (50.2-72.5); physical inactivity, 44.2 per cent (37.8-50.6); obesity, seven per cent (3.8-10.2) and raised blood pressure, 20.2 per cent (18.4-22.1). In 2015, compared to 2010, tobacco use showed a relative decline of 18 per cent, household solid fuel use of nine per cent and physical inactivity of 15 per cent. The estimates were stable for alcohol use, raised blood pressure and obesity between 2010 and 2015. All estimates varied between moderate and high degrees of credibility. Interpretation & conclusions: The estimates are consistent with other available estimates and with current national-level initiatives focused on tobacco control and improving access to clean fuel. These estimates can be used to monitor progress on non-communicable disease risk factor targets for India

Demographic, Clinical, Laboratory and Management Profile in Patients of Amoebic Liver Abscess from Northern India

Background: Amoebic liver abscess (ALA) is a serious extra-intestinal manifestation of amoebiasis and a major problem in developing countries. Due to rapid urbanization, improved sanitation and hygiene in India, there has been a shift in disease epidemiology towards non-communicable disease, but recent changes in epidemiological and clinical pattern in ALA are not well studied. Aim: To evaluate recent demographic, clinical, laboratory and management profile in patient with ALA. Methods: It is a prospective observational study conducted in the Department of Gastroenterology, SMS medical college, Jaipur, Rajasthan from June 2018 to December 2020. A predesigned semi structured questionnaire consisting of socio-demographic factors, risk factors, clinical, laboratory and management profile was used to collect data. Result: A total 508 patients of amoebic liver abscess were analysed. Median age of presentation was 40 years, majority were males (90.4%) with chronic alcoholism (44.1%) and belonging to lower socio-economic class. Abdominal pain, fever and anorexia were the most common symptoms. A majority had right lobe involvement (77.6%) and solitary abscess in 67.5%. Most of the small liver abscesses (68%) were managed by medical treatment alone. Percutaneous needle aspiration was done in 62.6% patients, mostly for abscess size 5-10 cm (93%) with 90% success. A total of 24.6% patients underwent percutaneous catheter drainage, all successfully done. Intraperitoneal rupture was seen in 10% patient. Mortality was 1.5%. Conclusion: This is one of the largest cohorts of ALA which shows that a majority of cases are males from lower socioeconomic status with history of significant alcohol intake. Early initiation of a combined therapeutic approach leads to early symptomatic improvement, fewer complications and better outcomes.

Contextual factors in premature non-communicable disease mortality in selected African countries within the sustainable development goals framework: the implication of voice and accountability

Sustainable Development Goal number 3, target 4 (SDG 3.4), seeks a 30% reduction in premature Non-Communicable Diseases (NCDs) mortality from 2015 levels by 2030. Africa United Nations (UN) Member States continue to experience increasing NCD mortality significantly, with the highest proportion of diabetes mortality among the working-age group. Past efforts to address this burden have been centered primarily on individual risk modifications evident by the NCDs Cluster Program at the World Health Organization (WHO) Africa Regional Office. To achieve a progressive reduction, a comprehensive premature NCD reduction approach which includes a consideration of contexts within which premature NCD, such diabetes mortality arises is necessary. The aim was to examine the relationship between contextual factors and diabetes-related deaths as premature NCD mortality and to enable an improved contextualized evidence-based approach to premature NCD mortality reduction. Country-level data was retrieved for post SDG initiative years (2016-2019) from multiple publicly available data sources for 32 selected Africa UN Member States in the International Diabetes Federation (IDF) East and West Africa Region. Multiple linear regression was employed to examine the relationship between diabetes-related deaths in individuals 20-79 years and contextual factors identified within the SDG framework. Weighted data analysis showed that voice and accountability as a contextual factor explained approximately 47% variability in diabetes-related deaths across the selected Africa UN Member Sates in IDF East and West Region (n=32). Civil society engagement is vital to develop effective premature NCD mortality reduction policies, and strategies and stakeholders' accountabilities are necessary to ensure adherence to obligations.

Relación entre la obesidad y la COVID-19 / Relationship between obesity and COVID - 19

Existen evidencias crecientes que indican que la obesidad actúa como factor de riesgo independiente para padecer la COVID-19, los pacientes obesos tienen mayor incidencia de complicaciones, tiempo de hospitalización y riesgo de muerte. El objetivo de este trabajo es exponer la relación entre la obesidad y las formas graves de COVID-19, así como exponer los posibles mecanismos implicados. Se realiza una revisión de la literatura mundial y de las publicaciones nacionales referidas a la obesidad y la COVID-19. Se identifican las características que hacen a los obesos más susceptibles a infectarse por SARS-CoV-2 y a tener peor pronóstico. Se concluye que la obesidad constituye un desafío permanente en nuestro medio, que su prevención, tratamiento temprano y oportuno, permitirían reducir los tiempos de hospitalización, evolución desfavorable y mortalidad por COVID-19 grave(AU)

There is growing evidence that obesity acts as an independent risk factor for Covid-19. Obese patients have higher incidence of complications, hospitalization time and risk of death. The objective of this paper is to describe the relationship between obesity and severe forms of COVID 19, as well as to expose the possible mechanisms involved. A review of the world literature and national publications referring to obesity and COVID-19 is carried out. The characteristics that make obese people more susceptible to being infected by SARS-COV-2 and having a worse prognosis are identified. It is concluded that obesity constitutes a permanent challenge in our environment. Early and timely prevention would allow reducing hospitalization times, unfavorable evolution and mortality due to severe Covid-19(AU)

A Scoping Review on Salt Reduction Intervention

@#Excessive salt intake has been linked to the development of hypertension and non-communicable diseases. This study aims to explore the different types of salt reduction intervention implemented among adults aged ≥18 years and to identify the suitable settings, duration and tools used for effective salt reduction interventions. This review adapted the established structured scoping review framework by Arksey and O’Malley. Related articles from the year 2008 to 2018 were retrieved based on the study objectives using keywords in electronic databases and through a bibliographic search of books, reports, conference proceedings, posters and summaries. Out of 130 potentially relevant full-text articles assessed, 14 articles were included in the review. Suitable salt reduction initiatives for the community who regularly consume home-cooked food are through cooking and usage of a tool such as a salt-restriction spoon, together with awareness on the benefits of salt reduction in their daily diet. Healthy catering initiative should be implemented in the workplace or institution-based settings. Policy development targeting the source of salts such as mandatory usage of salt-substitutes or Front-of-Pack labelling of salt content in all food products suitable for population-level intervention.

Determinants of alcohol consumption and marijuana use among young adults in the Republic of Palau

BACKGROUND@#This study aimed to describe the status of alcohol consumption and drug use among young adults as well as their determinants.@*METHODS@#We conducted a cross-sectional study of 356 young adults (aged 18 to 24 years) living in Palau in 2013. The prevalence of self-reported alcohol and marijuana usage were compared within and between sexes, age groups, ethnicities, and education levels.@*RESULTS@#The proportion of current drinking was higher in people aged 21-24 than in those aged 18-20 (73.2% vs. 60.9%, p = 0.09 in men and 48.3% vs. 30.0%, p = 0.02 in women), while that of marijuana use did not differ between the age groups. The proportions of current drinking and marijuana use were higher in Palauan than in other ethnicities (current drinking: 70.6% vs. 40.6%, p = 0.005 in men and 38.8% vs. 16.6%, p = 0.04 in women; lifetime marijuana use: 80.0% vs. 52.9%, p = 0.02 in men and 56.1% vs. 30.6%, p = 0.09 in women). The proportion of frequent (3 times or more) marijuana users was higher for the lower educated than for the higher educated (62.5% vs. 32.1%, p < 0.001 in men and 33.9% vs. 24.4%, p = 0.12 in women).@*CONCLUSIONS@#Sex, age, ethnicity, and education were significant determinants of alcohol and marijuana use.

Obesidade e sobrepeso em colaboradores de um Centro Universitário em Fortaleza ­ Ceará - Brasil: há diferença entre os sexos? / Obesity and overweight in collaborators of a University Center in Fortaleza ­ Ceará ­ Brazil: is there a difference between the sexes?

Objetivo: avaliar a prevalência de sobrepeso e obesidade de acordo com o sexo entre os colaboradores de um centro universitário. Métodos: trata-se de um estudo transversal realizado com funcionários de um centro universitário particular, localizado na cidade de Fortaleza ­ Ceará ­ Brasil. Foram coletados, em entrevista presencial, os seguintes dados: pessoais, socioeconômicos e demográficos, além de ter sido realizadas por equipe treinada, medidas antropométricas, tais como, peso, altura, circunferência do pescoço (CP) e circunferência da cintura (CC). Resultados: foram entrevistados 80 funcionários, a maioria do sexo feminino 65% e 40% na faixa etária entre 20 a 29 anos, 40,0% com ensino médio incompleto e 31,3% com renda de até um salário-mínimo mensal. De acordo com a classificação do estado nutricional segundo valores de Índice de Massa Corporal (IMC), 68,7% dos participantes apresentavam excesso de peso, considerando os colaboradores com sobrepeso e obesidade e 78,8% das mulheres apresentaram CC de risco moderado e alto para o desenvolvimento de doenças cardiovasculares (DCV). Os dados de CP mostraram que há uma prevalência elevada 77,5% de sobrepeso e obesidade em ambos os sexos. Do total, 75% das mulheres apresentaram risco nutricional antropométrico para desenvolver DCV, enquanto 60,7 % dos homens apresentaram parâmetros de risco, sem diferença estatística (p = 0,184). Conclusão: foi possível identificar que a maioria da população estudada apresenta excesso de peso segundo o IMC e CP, além de apresentar risco para o desenvolvimento de DCV analisados por meio da CC e RCE, sem diferença significativa entre os sexos. Ressalta, assim, a importância do atendimento nutricional para o diagnóstico precoce de sobrepeso/obesidade, com a finalidade de reduzir a prevalência de excesso de peso no ambiente de trabalho e no setor produtivo, com a realização de ações de conscientização da importância da alimentação e hábitos saudáveis na promoção da saúde e na prevenção de doenças crônicas não transmissíveis, como a obesidade

Objective: To assess the prevalence of overweight and obesity according to sex among employees of a university center. Methods: This is a cross-sectional study carried out with employees of a private university center located in the city of Fortaleza ­ Ceará ­ Brazil. Personal, socioeconomic, and demographic data were collected in a face-to-face interview, in addition to anthropometric measurements such as weight, height, neck circumference (NC), and waist circumference (WC) by a trained team. Results: 80 employees were interviewed, most of them 65% female and 40% aged between 20 and 29 years, 40.0% with incomplete high school education, and 31.3% with an income of up to one minimum monthly wage. According to the classification of nutritional status according to Body Mass Index (BMI) values, 68.7% of the participants were overweight, considering the overweight and obese employees, and 78.8% of the women had moderate-risk WC and high for the development of cardiovascular disease (CVD). The PC data showed that there is a high 77.5% prevalence of overweight and obesity in both sexes. Of the total, 75% of women had an anthropometric nutritional risk for developing CVD, while 60.7% of men had risk parameters, with no statistical difference (p = 0.184). Conclusion: It was possible to identify that the majority of the studied population is overweight according to BMI and LC, in addition to being at risk for the development of CVD analyzed through WC and WHtR, with no significant difference between genders. Thus, it emphasizes the importance of nutritional care for the early diagnosis of overweight/obesity to reduce the prevalence of excess weight in the work environment and the productive sector by carrying out actions to raise awareness of the importance of food and healthy habits in promoting health and preventing chronic non-communicable diseases such as obesity.

Desigualdades étnicas y de género en la prevalencia de presión arterial elevada en población general de Cochabamba: un análisis interseccional de inequidades en salud / Ethnic and gender inequalities in the prevalence of elevated blood pressure in the general population of Cochabamba: an intersectional analysis of health inequities

Las desigualdades en salud comúnmente son evaluadas en una sola dimensión de análisis y poco se conoce sobre el efecto sumativo o multiplicativo cuando se combinan 2 o más dimensiones sociales; representando un desafío para la prevención y control de la Presión Arterial Elevada (PAE). OBJETIVO: analizar los factores involucrados en las desigualdades poblacionales de la prevalencia de PAE en el espacio inter seccional de los procesos de ventaja y desventaja social por referencia étnica y de género. MÉTODOS: estudio observacional, de corte transversal con enfoque interseccional. Participaron sujetos mayores de 18 años con residencia permanente en Cochabamba (n=10595), seleccionados mediante muestreo aleatorio trietápico. Se utilizó la encuesta WHO-STEPS para recopilar información sobre PAE y factores de riesgo asociados. Se construyeron cuatro posiciones interseccionales por la combinación de género y etnicidad. La descomposición de Oaxaca-Blinder se aplicó para estimar las contribuciones de los factores explicativos de las desigualdades. RESULTADOS: la prevalencia de PAE fue mayor en los hombres-mestizos (10,76%); la disparidad por referencia de género fue más importante entre mestizos (3,74%) e indígenas (3,11%); la disparidad interseccional entre grupos extremos (3,53%) fue mayor a la disparidad entre grupos medios (3,32%). La edad, el tipo de trabajo y estilos de vida, contribuyeron más para explicar estas diferencias. CONCLUSIONES: la PAE no se distribuye según los patrones esperados de desventaja social en el espacio interseccional de etnicidad y género. Una alta ventaja social se relacionó con prevalencias más altas de PAE, así como los factores de riesgo de comportamiento asociados.

Health inequalities are commonly evaluated in a single dimension of analysis and little is known about the summative or multiplicative effect when 2 or more social dimensions are combined; representing a challenge for the prevention and control of High Blood Pressure (HBP). OBJECTIVE: analyze the factors involved in the inequalities of the prevalence of HBP in the inter-sectional space of the processes of social advantage and disadvantage by ethnic and gender reference. METHODS: observational, cross-sectional study with an intersectional approach. Subjects over 18 years of age with permanent residence in Cochabamba (n = 10,595), selected by means of three-stage random sampling, participated. The WHO-STEPS survey was used to collect information on HBP and the risk factors associated. Four intersectional positions were constructed by the combination of gender and ethnicity. The Oaxaca-Blinder decomposition was applied to estimate the contributions of the explanatory factors of the inequalities. RESULTS: the prevalence of HBP was higher in mestizos men (10.76%); the disparity by gender reference was more important between mestizos (3.74%) and indigenous people (3.11%); the intersectional disparity between extreme groups (3.53%) was greater than the disparity between middle groups (3.32%). Age, type of work, and lifestyles contributed more to explain these differences. CONCLUSIONS: the HBP is not distributed according to the expected patterns of social disadvantage in the intersectional space of ethnicity and gender. A high social advantage was related to higher prevalence of HBP, as well as associated behavioral risk factors.

Impacto dos exercícios de estabilização no equilíbrio e na distribuição da pressão plantar em crianças com excesso de peso: um protocolo de estudo randomizado controlado / Core stabilization exercises impact on balance and foot pressure distribution in overweight children: A randomized controlled trial protocol

O excesso de pesso em crianças tem sido associado com perda na função neuromuscular e desequilíbrio postural. Exercícios de estabilização têm demonstrado sucesso no tratamento de crianças com paralisia cerebral e com síndrome de Down. No entanto, sua eficácia não foi testada com crianças com excesso de peso. OBJETIVO: Medir a eficácia de exercícios de estabilização postural no equilíbrio estático e dinâmico e na distribuição da pressão plantar em crianças com excesso de peso. MATERIAL E MÉTODOS: Protocolo de um ensaio clínico randomizado paralelo não cego comparando pré e pós-teste. Serão recrutados 52 (26 em cada grupo) participantes com idade de 8 a 16 anos, meninos e meninas com índice de massa corpórea (IMC) entre os percentis de crescimento de 85 e 95 de acordo com a idade. As variáveis serão a distribuição da pressão plantar com duplo apoio, aopio unipodal, teste de alcance e a projeção do centro de força. O protocolo de exercícios de estabilização será oferecido ao grupo experimental 3 vezes por semana durante 6 semanas. Estatística descritiva e inferencial serão aplicadas após a realização de testes de normalidade da distribuição (teste T ou Wilcoxon ou Mann-Whitney) considerando significâncai de 0,05. RESULTADOS ESPERADOS: Os resultados do presente estudo oferecerá a primeira evidência sobre a eficácia de exercícios de estabilização em crianças com excesso de peso. Espera-se uma maior compreensão clínica dos exercícios de estabilização em crianças com excesso de peso. Geração de dados para a incorporação de atividades da vida diária qie favoreçam o desenvolvimento global e crescimento.

Overweight children are associated with low neuromuscular function and postural imbalance. Core stabilization exercises have shown success in the cerebral palsy and Down syndrome children. However, its efficacy in overweight children is not known till date. OBJECTIVES: To measure the postural stability (static and dynamic) and foot pressure distribution in overweight children. To determine the efficacy of core stability training on postural stability (static and dynamic) in overweight children. To determine the efficacy of core stability training on foot pressure distribution in overweight children. MATERIALS AND METHODS: This is parallel design, non ­ blinded, two ­ group, pretest - posttest randomized controlled trial. The study will recruit 52 (26 in each group) aged 8- 16 years old both boys and girls with BMI-for-age percentile growth between 85th to less than 95th percentile. The outcomes are foot pressure distribution, single limb stance, Y-Reach test and core strength respectively. The core stabilization exercises will be provided in the experimental group and no exercises will be given in the control group, 3 times a week for 6 weeks. PREDICTED RESULTS: The predicted results from this study will provide the first evidence of the effectiveness of core stabilization exercises in overweight children. A greater clinical understanding of core strength and balance in this age group may be helpful for incorporating activities in their daily life in order for the better overall development and growth. Kolmnogorov Smirnov test will be used for checking the normal distribution of the data. Descriptive statistics will be expressed either as mean±standard deviation or median and inter- quartile range, based on the data distribution. Paired t-tests or Wilcoxon signed- rank test will be used to conduct within group analyses and Independent t- tests or Mann- Whitney U- test will be used for between group analyses. For all the analyses the level of significance will be set at 0.05.

Características clínicas, epidemiológicas y terapéuticas de los pacientes que ingresan por crisis de asma bronquial / Clinical, Epidemiological and Therapeutic Characteristics of Patients Admitted for a Bronchial Asthma Attack

RESUMEN Fundamento: el asma bronquial es una de las enfermedades crónicas no transmisibles más prevalentes en la infancia, en su evolución presenta crisis desencadenadas por múltiples factores, relacionados al huésped y a factores ambientales. Objetivo: describir las características clínicas, epidemiológicas y terapéuticas de las crisis de asma bronquial en el Hospital Pediátrico Universitario Paquito González Cueto de Cienfuegos, durante los años 2015 y 2016. Método: se realizó un estudio descriptivo y correlacional sobre una serie de casos en el Hospital Pediátrico Universitario Paquito González Cueto de Cienfuegos en el periodo comprendido desde el 1ero de enero 2015 hasta el 31 diciembre del 2016 en el que fueron incluidos los pacientes que egresaron con el diagnóstico de crisis de asma bronquial. Los datos fueron obtenidos de la historia clínica de los pacientes. Se analizaron las variables: edad, sexo, color de la piel, clasificación de la enfermedad asmática, severidad de la crisis en el ingreso y forma de distribución del medicamento. Se aplicaron los procedimientos de la estadística descriptiva como son la determinación de la frecuencia de ocurrencia y los porcientos. Resultados: el grupo etáreo más afectado fue el menor de 3 años (35,8 %), con ligero predominio del sexo masculino (55 %) y el color de piel blanca (57 %), el mayor número de ingreso correspondió a los meses de alza epidémica, predominó la forma leve persistente (53,6 %) y las crisis moderadas (94,6 %), 64,4 % no tenía tratamiento de control. Conclusiones: la mayor parte de los pacientes recibieron un tratamiento inadecuado para la crisis en cuerpo de guardia y la sala, además el tratamiento de control fue inadecuado en casi la mitad de los pacientes o inexistente.

ABSTRACT Background: bronchial asthma is the prevalent chronic non-communicable disease in childhood, in its evolution it presents crises triggered by multiple factors, related to the host and the environment. Objective: to describe the clinical, epidemiological and therapeutic characteristics of bronchial asthma crises at the Paquito González Cueto University Pediatric Hospital in Cienfuegos, during 2015 and 2016. Method: a descriptive, and correlational study was carried out on a series of cases at the Paquito González Cueto University Pediatric Hospital in Cienfuegos in the period from January 1st, 2015 to December 31st 2016, in which were included the patients who leave with the diagnosis of a bronchial asthma crisis. The data were obtained from the clinical history of the patients. The variables were analyzed: age, sex, skin color, classification of the asthmatic disease, severity of the crisis on admission, and form of drug distribution. Descriptive statistics procedures were applied, such as the determination of the frequency of occurrence and the percentages. Results: the most affected age group was under 3 years old (35.8 %), with a slight predominance of males (55 %) and white skin color (57 %), the highest number of admission corresponded to the months of epidemic rise, the minor persistent form (53.6 %) and the moderate seizures (94.6 %) predominated, the 64.4 % had no control treatment. Conclusions: most of the patients received inadequate treatment for the crisis in the emergency room and the ward; in addition, the control treatment was inadequate or non-existent in almost half of the patients.

Prevalence of Hypertension in Children 10-18 Years of Age in Private Schools of Delhi and Their Associated Risk Factors.

Prevalence of non-communicable diseases were considered to be rare in children. But they have increased recently in developing countries, with increase in the prevalence of paediatric overweight and obesity. Body Mass Index (BMI) is commonly used to define overweight and obesity. Positive associations have been repeatedly reported between BMI and Hypertension.METHODSWe have conducted an observational cross sectional study of hypertension in 1250 students in the age group of 10-18 years studying in class 6 to 12 during school hours from July 2013 to June 2014. The values were recorded in multiples of 2 mmHg and levels greater than 95th percentile of age and gender were considered using the definition of the fourth report of NHBPEP. The association of risk factors were also evaluated.RESULTSOut of a total 1250 children, 239 (19.1%) had systolic hypertension, and 216 (17.3%) has diastolic hypertension. Prevalence of overweight and obesity were 11.8% and 7.5% respectively. Highly significant statistical association was found between body mass index (BMI) and both systolic and diastolic hypertension (p value 0.001).CONCLUSIONSPrevalence of both systolic and diastolic hypertensions were significantly high in overweight and obese children in comparison to normal weight children. Strong positive association was found between body mass index (BMI) and both systolic and diastolic hypertension. Association of other risk factors such as sex, family history, dietary habits like junk food intake and extra salt intake, were also observed

Awareness level and associated factors for non-communicable disease screening among adults in rural Puducherry, India

Background: Non-communicable diseases have emerged as a health problem of global priority in recent times. Screening and early diagnosis is important to plan appropriate interventions. Objectives: The objectives of the study were as follows: (1) To study the awareness of screening for hypertension (HTN), diabetes, cancer cervix, and cancer breast, (2) to study the status of screening for HTN, diabetes, cancer cervix, and cancer breast, and (3) to study the factors associated with not aware of screening for above non-communicable diseases. Materials and Methods: A community-based cross-sectional study was conducted in service practice area of a tertiary care, Puducherry. Adults aged more than 30 years were included by simple random sampling technique. The required sample size was 400. Face-to-face interview was done using semi-structured questionnaire. Basic sociodemographic details, awareness, and status of screening were collected. Data were entered in EpiData Version 3.1 and analyzed in IBM SPSS 17. Results: Of 398 study participants, majority (43.2%) belongs to 30–45 age groups. The mean age of the study participants was 49 ± 13 years. The prevalence of self-reported HTN and diabetes in the present study was 24% and 19.8%, respectively. Nearly three-fourth of the study population had awareness of screening for HTN and diabetes. Awareness of cancer cervix screening was very low (35%) when compared to cancer breast (45%). Unmarried and below primary level of education were independently associated with unawareness of screening for non-communicable disease. Conclusion: Around 15% and 30% of the study population were never screened for HTN and diabetes, respectively, though the awareness was high, whereas more than three-fourth of the female participants were never screened for cancer breast and cancer cervix though the awareness was <50%. Non-communicable disease screening needs to be targeted more toward young females, those with below primary level of education with low socioeconomic background and elderly people.

Predictor Risk of Diabetes Mellitus in Indonesia, based on National Health Survey

@# Diabetes mellitus which is estimated to continue to increase over time becomes a problem that needs to be immediately addressed by various related stakeholders. Knowing the risk factors associated with diabetes mellitus is considered the right way to minimize the number of diabetes in the world, especially Indonesia. Analysis of secondary data on the Indonesian Family Life Survey is expected to be the basis for taking appropriate policies in Diabetes Mellitus intervention in Indonesia. Methods: Cross sectional design based on secondary data from the Indonesian Family Life Survey V was conducted in this study to find the most influential risk for diabetic mellitus in Indonesia. Binary logistic regression analysis was used to simplify analyzing information from 30133 respondents aged > 18 years spread across 13 Provinces in Indonesia. The selection of respondents was based on the completeness of the information in the dataset provided by RAND as the dataset provider. The variables were analyzed in this study, included diabetes mellitus, cholesterol levels, gender, hypertension, overweight and age. Results: High cholesterol, hypertension and overweight were risks associated with diabetes mellitus in Indonesia. Of the three risks, overweight was the most significant risk (p = 0,000; OR 2,200; 95% CI 1,655 – 2,295). Conclusion: Striving for healthy living behaviours and periodic screening programs can reduce overweight rates because they can be detected quickly.

Custos atribuíveis a obesidade, hipertensão e diabetes no Sistema Único de Saúde, Brasil, 2018 / Costs attributable to obesity, hypertension, and diabetes in the Unified Health System, Brazil, 2018 / Costos atribuibles a la obesidad, la hipertensión y la diabetes en el Sistema Único de Salud de Brasil, 2018

RESUMO Objetivo. Estimar os custos atribuíveis a hipertensão arterial, diabetes e obesidade no Sistema Único de Saúde (SUS) no Brasil em 2018. Métodos. Realizou-se uma estimativa dos custos atribuíveis a doenças crônicas não transmissíveis a partir dos riscos relativos e das prevalências populacionais de hipertensão, diabetes e obesidade, considerando custos de hospitalizações, procedimentos ambulatoriais e medicamentos distribuídos pelo SUS para tratamento dessas doenças. As informações de custo foram obtidas nos sistemas de informação em saúde disponíveis no SUS. A análise explorou os custos das doenças segundo sexo e idade na população adulta. Resultados. Os custos totais de hipertensão, diabetes e obesidade no SUS alcançaram 3,45 bilhões de reais (R$) (IC95%: 3,15 a 3,75) em 2018, ou seja, mais de 890 milhões de dólares (US$). Desses custos, 59% foram referentes ao tratamento da hipertensão, 30% ao do diabetes e 11% ao da obesidade. No total, 72% dos custos foram com indivíduos de 30 a 69 anos de idade e 56%, com mulheres. Considerando separadamente a obesidade como fator de risco para hipertensão e diabetes, os custos atribuíveis a essa doença chegaram a R$ 1,42 bilhão (IC95%: 0,98 a 1,87), ou seja, 41% dos custos totais. Conclusões. As estimativas dos custos atribuíveis às principais doenças crônicas associadas à alimentação inadequada evidenciam a grande carga econômica dessas doenças para o SUS. Os dados mostram a necessidade de priorizar políticas integradas e intersetoriais para a prevenção e o controle da hipertensão, do diabetes e da obesidade e podem apoiar a defesa de intervenções como medidas fiscais e regulatórias para alcançar os objetivos da Década de Ação das Nações Unidas sobre Nutrição.(AU)

ABSTRACT Objective. To estimate the cost attributable to arterial hypertension, diabetes and obesity in the Unified Health System of Brazil in 2018. Method. The study estimated the cost attributable to non-communicable chronic diseases based on relative risk and population prevalence of hypertension, diabetes, and obesity, considering the cost of hospitalizations, outpatient procedures, and medications distributed by the SUS to treat these diseases. Cost data were obtained from SUS information systems. The analysis explored the cost of disease according to sex and age in the adult population. Results. The total cost of hypertension, diabetes, and obesity in the SUS reached R$ 3.45 billion (95%CI: 3.15-3.75) in 2018, that is, more than US$ 890 million. Of this amount, 59% referred to the treatment of hypertension, 30% to diabetes, and 11% to obesity. The age group from 30 to 69 years accounted for 72% of the total costs, and women accounted for 56%. When obesity was considered separately as a risk factor for hypertension and diabetes, the cost attributable to this diseases reached R$ 1.42 billion (95%CI: 0.98-1.87), i.e., 41% of the total cost. Conclusions. The estimates of costs attributable to the main chronic diseases associated with inadequate diet revealed a heavy economic burden of these disorders for the SUS. The data show the need to prioritize integrated and intersectoral policies for the prevention and control of hypertension, diabetes, and obesity, and may support the advocacy for interventions such as fiscal and regulatory measures to ensure that the objectives of the United Nations Decade of Action on Nutrition are met.(AU)

RESUMEN Objetivo. Estimar los costos atribuibles a la hipertensión arterial, la diabetes y la obesidad en el Sistema Único de Salud (SUS) de Brasil en el 2018. Métodos. Se estimaron los costos atribuibles a las enfermedades crónicas no transmisibles a partir de los riesgos relativos y de las tasas de prevalencia poblacional de hipertensión, diabetes y obesidad, teniendo en cuenta los costos de hospitalización, los procedimientos ambulatorios y los medicamentos distribuidos por el SUS para el tratamiento de esas enfermedades. Los datos de costos se obtuvieron en los sistemas de información de salud disponibles en el SUS. En el análisis se exploraron los costos de las enfermedades según el sexo y la edad de la población adulta. Resultados. Los costos totales atribuibles a la hipertensión, la diabetes y la obesidad en el SUS alcanzaron R$ 3,450 milliones (IC 95%: de 3,15 a 3,75) en el 2018, o sea, más de US$ 890 millones. De esos costos, 59% correspondió al tratamiento de la hipertensión, 30% al de la diabetes y 11% al de la obesidad. En total, 72% de los costos correspondieron a personas de 30 a 69 años y 56%, a mujeres. Al considerarse por separado la obesidad como factor de riesgo de hipertensión y diabetes, los costos atribuibles a esa enfermedad alcanzaron R$ 1.420 millones (IC 95%: de 0,98 a 1,87), o sea, 41% del total. Conclusiones. Las estimaciones de los costos atribuibles a las principales enfermedades crónicas relacionadas con la alimentación inadecuada ponen de manifiesto la pesada carga económica de esas enfermedades para el SUS. Los datos muestran la necesidad de priorizar políticas integradas e intersectoriales para la prevención y el control de la hipertensión, la diabetes y la obesidad, y permiten apoyar la defensa de intervenciones como medidas fiscales y regulatorias para alcanzar los objetivos del Decenio de las Naciones Unidas de Acción sobre la Nutrición.(AU)