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Introducción: La Organización Mundial de la Salud diseñó un instrumento para la vigilancia de los factores de riesgo asociados con las enfermedades crónicas, este abarca tres pasos que incluyen los datos personales y comportamentales, antropométricos y bioquímicos. Objetivo: Describir las aplicaciones del Instrumento STEPS (paso 1) para la identificación de factores de riesgo comportamentales asociados a enfermedades no transmisibles en adultos trabajadores, según país y año de publicación. Metodología: Revisión narrativa de estudios originales que utilizaron el STEPS, publicados entre 2015 y 2019 en español, inglés y portugués en las bases de datos PubMed, SciELO y el motor de búsqueda Google Scholar. Resultados: Se revisaron 20 documentos de los cuales 6 fueron de Asia y África, y el año de mayor publicación fue 2017. El consumo nocivo del alcohol, tabaquismo, inactividad física y alimentación no saludable son los riesgos más estudiados. Conclusiones: La utilización del instrumento STEPS en publicaciones es más frecuente en países de África y Asia. Se requiere que su implementación sea sistemática y difundida en otros países, con la finalidad de diseñar e implementar estrategias de salud pública para la prevención, mitigación y tratamiento oportuno de las enfermedades no transmisibles.
Introduction: The World Health Organization designed an instrument for the surveillance of risk factors associated with chronic diseases, it has three steps that include personal and behavioral, anthropometric, and biochemical data. Objective: To describe the applications of the STEPS Instrument (step 1) to identify behavioral risk factors associated with noncommunicable diseases in working adults, according to country and year of publication. Methodology: Narrative review of original studies that used STEPS, published between 2015 and 2019 in Spanish, English and Portuguese in the databases PubMed, SciELO, and the search engine Google Scholar. Results: A total of 20 studies were reviewed, of which 6 were from Asia and Africa, and the year of most significant publication was 2017. The most studied risks are harmful alcohol consumption, smoking, physical inactivity, and unhealthy eating. Conclusions: the use of the STEPS instrument in publications is more frequent in countries of Africa and Asia. Its implementation must be systematic and disseminated in other countries to design and implement public health strategies for the prevention, mitigation, and timely treatment of noncommunicable diseases.
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Objective@#This study aims to determine the prevalence of risk factors of non-communicable diseases (NCDs) in 16 barangays of the AMIGA municipalities of Cavite. @*Methods@#The research is a cross-sectional study. Randomly chosen participants were interviewed using a translated version of the WHO Steps questionnaire. Interviewees were then invited to participate in another session where their anthropometric measurements were taken and their fasting blood sugar and cholesterol levels were determined.@*Results@#The research was done in 12 out of the 16 targeted barangays. A total of 1,527 participants were interviewed and 1,123 of them completed the study. The most significant findings in all 12 barangays were a very high rate of passive smoking (range of 60-80%); a relatively high proportion of respondents with obesity by all 3 parameters (BMI 29-52%; waist circumference 42-78%; and waist-to-hip ratio 41-78%) despite sufficient intake of fruits and vegetables and more than adequate physical activity; and a high proportion of participants with hypertension (more than 30% in 8 out of 12 barangays) and diabetes mellitus (more than 8% in 7 out of 12 barangays). @* Conclusion@#A high prevalence of risk factors of NCDs, particularly obesity, hypertension, and diabetes was found in the 12 barangays of AMIGA that participated in the study. Results of this study should provide the baseline data against which the success of an ongoing program in the area can be measured.
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Cidades , Doenças não Transmissíveis , Organização Mundial da Saúde , Inquéritos e Questionários , Fatores de RiscoRESUMO
Background Isolated diastolic hypertension (IDH) has been actively discussed for the last two decades because of its prevalence in a younger population and its association with cardiovascular disease. Furthermore, the association of IDH is significant in South Asian Countries such as India because relatively younger populations are known to have a higher risk of cardiovascular events. Objective The objective of this study is to find prevalence of IDH and its risk correlates in a semiurban population of South Indian state of Andhra Pradesh. Methods Data were collected using the modified World Health Organization - STEPwise approach to Surveillance (WHO STEPS) questionnaire for 16,636 individuals from a group of villages under Thavanampalle Mandal. Collated data were analyzed for prevalence and risk factors of IDH. Results Prevalence of IDH was found to be 4.0% with mean age of 46.0 (±SD 13.6) years and a relatively higher prevalence in men (5.3%) as compared with women (3.2%). The prevalence of IDH peaked in the fifth decade of life (40–49 years of age) and declined thereafter. Among various risk factors that were analyzed for their association with IDH, only age, body weight, and body mass index retained their significance in multivariate binary logistic regression analysis. Conclusion There is a significant prevalence of IDH below 50 years of age in the semiurban population of South India. As IDH in young and middle age is known to be associated with increased risk of cardiovascular events and end organ involvement, it highlights need for study and development of effective IDH management strategies to reduce associated morbidity and mortality.
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La evaluación del perfil epidemiológico del Síndrome Metabólico en población general usando la metodología WHO-STEPS de la Organización Mundial de la Salud es incipiente o nula en muchos países Latino Americanos. OBJETIVO: caracterizar el perfil epidemiológico del Síndrome Metabólico y sus factores de riesgo asociados en población general mayor de 18 años en la ciudad de Cochabamba, Bolivia, durante la gestión II-2016. MÉTODOS: se realizó un estudio observacional, analítico de corte transversal, en población general de 18 o más años, con una muestra de n=186 sujetos ajustados por grupo etario y sexo en base a la pirámide poblacional de Cochabamba-Bolivia. Se aplicó la metodología STEPS (pasos) de la OPS/OMS para la recolección de la información centrada en datos sociodemográficos, hábitos de vida, evaluación física y laboratorial. Se calcularon proporciones e intervalos de confianza al 95% conforme lo establecido en el manual de implementación de la metodología STEP; y regresión logística multivariada para la obtención del OR ajustado para el nivel de riesgo asociados al Síndrome Metabólico. RESULTADOS: la prevalencia global de Síndrome metabólico fue de 44,1%; la prevalencia de sus factores de riesgo asociados fue: STEP-1, Tabaquismo 11,29%; consumo actual de alcohol 63,44%; bajo consumo de frutas y vegetales 76,88%; sedentarismo o bajo nivel de actividad física 75,81%. STEP-2: sobrepeso 44,62%; obesidad 24,73%; obesidad abdominal 38,7% y presión arterial elevada en 35,14%. STEP3: Glicemia alterada en ayunas 36,02%; Insulina basal alterada 36,56%; colesterol total elevado 36,02%; Triglicéridos elevados 46,77% y HDL-colesterol reducido en el 66,67%. Los niveles de OR ajustado fueron >1 y estadísticamente significativas para las medidas físicas y laboratoriales. CONCLUSIÓN: el síndrome metabólico en altamente prevalente en la población general de la ciudad de Cochabamba y se asocia a niveles elevados de IMC, presión arterial elevada y perfil laboratorial alterado.
The epidemiological profile evaluation of Metabolic Syndrome in the general population using the WHO-STEPS approach of the World Health Organization is incipient or null in many Latin American countries. OBJECTIVE: to characterize the epidemiological profile of Metabolic Syndrome and risk factors associated in the general population over 18 years of age in Cercado-Cochabamba city, from Bolivia, during the second semester of 2016. METHODS: an observational, analytical, cross-sectional study was conducted in the general population of 18 years of age or older, with a sample of n = 186 subjects adjusted by age group and sex based on the population pyramid of Cochabamba-Bolivia. WHO-STEPS approach was applied for the collection of information focused on sociodemographic data, life habits, physical and laboratory evaluation. Proportions and 95% confidence intervals were calculated as established in the STEP Ì implementation manual, and multivariate logistic regression was calculated to obtain adjusted OR for the level of risk associated with Metabolic Syndrome. RESULTS: the overall prevalence of metabolic syndrome was 44.1%; the prevalence of risk factors associated were: STEP-1, Smoking 11.29%; current alcohol consumption 63.44%; low consumption of fruits and vegetables 76.88%; sedentary lifestyle or low level of physical activity 75.81%. STEP-2: overweight 44.62%; obesity 24.73%; abdominal obesity 38.7% and high blood pressure 35.14%. STEP3: Hyperglycemia in 36.02%; basal insulin elevated 36.56%; total cholesterol 36.02%; Triglycerides elevated 46.77% and HDL-cholesterol reduced in 66.67%. CONCLUSION: metabolic syndrome is highly prevalent in the general population in Cochabamba City and is associated with high levels of BMI, high blood pressure high values of the laboratorial profile.
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Síndrome Metabólica , Índice de Massa CorporalRESUMO
Background & objectives: A comprehensive risk factor profile of non-communicable diseases (NCDs) as suggested by the World Health Organization (WHO) has not been reported from tribal population in India. This survey was carried out to assess the prevalence of NCD risk factors among Mishing tribes in Assam using the WHO STEPs approach. Methods: A total of 332 individuals of the Mishing tribe (men 54%) aged 25-64 yr were selected from Tinsukia district by multistage cluster sampling. Using the WHO STEPs approach information was collected on demographics, STEP 1 variables (tobacco, alcohol, physical activity, diet) and measured STEP 2 variables (weight, height, waist circumference and blood pressure). Multivariate analysis was used to find the relation between STEP 1 and STEP 2 variables. Results: Overall, tobacco use was 84 per cent (men 94%; women 73%, p<0.001) and alcohol use was 67 per cent (men 82%; women 50%, p<0.05); 86 per cent reported vigorous physical activity, (men 91%, women 82%; p < 0.05). Sixty eight per cent reported to consume unhealthy diet (less than five servings of fruits and vegetables/day), 11 per cent had abdominal obesity, 16 per cent were overweight and 26 per cent had hypertension. Non users of tobacco and those who consumed more fruits and vegetables had higher prevalence of overweight (p<0.05). Among the hypertensives, 24 per cent were aware, 17 per cent treated and 2.4 per cent controlled their hypertension. Older individuals had higher hypertension prevalence (p<0.05) compared to younger individuals. Interpretation & conclusions: Tobacco use, alcohol use and unhealthy diet habits were high among men and women in this population and were major NCD risk factors. An integrated approach of culturally appropriate population level and high risk strategies are warranted to reduce these risk factors and to enhance adequate control of hypertension.
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The study attempted to identify the prevalence and distribution of risk factors of non-communicable diseases among urban and rural population in Gujarat, India. Using the WHO stepwise approach, a crosssectional study was carried out among 1,805 urban and 1,684 rural people of 15-64 years age-group. Information on behavioural and physiological risk factors of non-communicable diseases was obtained through standardized protocol. High prevalence of smoking (22.8%) and the use of smokeless tobacco (43.4%) were observed among rural men compared to urban men (smoking-12.8% and smokeless tobacco consumption-23.1%). There was a significant difference in the average consumption of fruits and vegetables between urban (2.18±1.59 servings) and rural (1.78±1.48 servings) area. Prevalence of overweight and obesity was observed to be high among urban men and women in all age-groups compared to rural men and women. Prevalence of behavioural risk factors, overweight, and obesity increased with age in both the areas. Twenty-nine percent of the urban residents and 15.4% of the rural residents were found to have raised blood pressure, and the difference was found to be statistically significant (p<0.01). For both men and women, the prevalence of overweight and obesity, hypertension, and lack of physical activities were significantly higher in the urban population while smoking, smokeless tobacco consumption, poor consumption of fruits and vegetables were more prevalent in the rural population. The results highlight the need for interventions and approaches for the prevention of risk factors of non-communicable diseases in rural and urban areas.
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Background & objectives: Kerala State is a harbinger of what will happen in future to the rest of India in chronic non-communicable diseases (NCD). We assessed: (i) the burden of NCD risk factors; (ii) estimated the relations of behavioural risk factors to socio-demographic correlates, anthropometric risk factors with behavioural risk factors; (iii) evaluated if socio-demographic, behavioural and anthropometric risk factors predicted biochemical risk factors; and (iv) estimated awareness, treatment and adequacy of control of hypertension and diabetes, in Kerala state. Methods: A total of 7449 individuals (51% women) stratified by age group, sex and place of residence were selected and information on behavioural risk factors; tobacco use, diet, physical activity, alcohol use, measured anthropometry, blood pressure was collected. Fasting blood samples were analysed for blood glucose, total cholesterol, high density lipoprotein cholesterol and triglycerides in a sample subset. Using multiple logistic regression models the associations between socio-demographic and anthropometric variables with biochemical risk factors were estimated. Results: The burden of NCD risk factors was high in our sample. Prevalence of behavioural and each of the biochemical risk factors increased with age, adjusting for other factors including sex and the place of residence. The odds ratios relating anthropometric variables to biochemical variables were modest, suggesting that anthropometric variables may not be useful surrogates for biochemical risk factors for population screening purposes. Interpretation & conclusions: In this large study of community-based sample in Kerala, high burden of NCD risk factors was observed, comparable to that in the United States. These data may serve to propel multisectoral efforts to lower the community burden of NCD risk factors in India in general, and in Kerala, in particular.
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Adolescente , Adulto , Doença Crônica/epidemiologia , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Adulto JovemRESUMO
A doença cerebrovascular é a maior causa de morte e uma grande causa de incapacidades no Brasil. A taxa de mortalidade no Brasil é uma das mais altas do mundo, principalmente entre os indivíduos com menor condição socioeconômica. A coleta de dados confiáveis e com qualidade sobre as características do acidente vascular cerebral (AVC) é essencial para sua prevenção. Entretanto, existem poucos estudos brasileiros sobre a prevalência da doença. A Organização Mundial de Saúde propõe uma estratégia de vigilância para o acidente vascular cerebral (The WHO STEPwise Approach to Stroke Surveillance) em 3 etapas. A etapa 1 analisa os eventos hospitalizados, a etapa 2, os eventos fatais na comunidade e a etapa 3, os casos de AVC na comunidade que não foram admitidos em hospitais. Por meio de padronização de instrumentos para coleta de dados nas três etapas, esta estratégia permite a comparação de dados sobre a epidemiologia do AVC ao longo do tempo e entre países. Este estudo transversal tem como objetivo avaliar a prevalência de acidente vascular cerebral na área de abrangência do Programa Saúde da Família no Jardim São Jorge, zona oeste do município de São Paulo, por meio da implantação do terceiro passo do WHO STEPS Stroke. Validou-se questionário sobre sintomas de AVC (fraqueza de membros em um dos lados do corpo, paralisia facial, problemas na articulação da fala, alterações de sensibilidade em um dos lados do corpo e alterações visuais) e história prévia da doença. O padrão-ouro utilizado para validação do instrumento foi avaliação por neurologista e revisão de prontuário. Após validação, foram considerados casos de AVC indivíduos com duas ou mais respostas positivas ao questionário com procura a serviços de saúde ou mais de 3, mesmo sem procura a serviços de saúde. Utilizando-se os critérios de positividade acima expostos, a sensibilidade do questionário comparada ao padrão-ouro foi de 72,2%, a especificidade 94,4%, a razão de verossimilhança...
Stroke is the leading cause of death and a major cause of disability in Brazil. Mortality rates are higher compared to other countries mainly among individuals with lower socio-economic status. The search of reliable and good quality data on characteristics of stroke -is essential for stroke prevention. However, there are few Brazilian studies about the prevalence of stroke. The World Health Organization proposes a surveillance strategy to stroke (The WHO STEP wise approach to stroke surveillance). Using standardized questionnaires, it is possible to collect data and compare them over time and among countries. Step 1 aims to collect information on stroke patients admitted to hospitals, Step 2 identifies fatal stroke events in the community and Step 3 estimates community based non fatal stroke events. This crosssectional study aims to evaluate the prevalence of stroke in a poor neighborhood "Jardim São Jorge" assisted by the Family Health Program. A validated questionnaire about stroke symptoms (limb weakness, facial weakness, speech articulation problems, sensibility disturbances and impaired vision) and past diagnosis of stroke were applied to all residents older than 35 years in the area. The gold-standard method was a neurological evaluation and a review of patient medical records. After validation, questionnaire were considered positive when a participant answered positive to two or more questions about stroke symptoms and/or the presence of stroke being confirmed by a physician, or at least three positive questions not confirmed by a physician. The questionnaire presented a sensitivity of 72.2%, a specificity of 94.4%, a positive likelihood ratio of 12.9 and a negative likelihood ratio of 0.29. Of 4,496 individuals with 35 years or more, 3,661 people were screened (81.4%) by the community health workers in their monthly visits to the residences and 577 (15.8%) presented a positive screening and underwent more detailed interview for confirmation of stroke...
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Acidente Vascular Cerebral/epidemiologia , Prevalência , BrasilRESUMO
Background & objectives: Stroke is a leading cause of deaths, and disabilities in India. Reliable and good quality data on epidemiological characteristics of stroke are essential to plan, implement and evaluate stroke prevention and control programmes. A feasibility study was undertaken in Bangalore to examine the possibility of establishing stroke surveillance and to develop methodology for a larger programme. Methods: The study adapted WHO STEPs-STROKE methodology to collect data on hospitalized stroke events and fatal stroke events in the city of Bangalore. In STEP I, Information was collected from 1,174 stroke patients in three large hospitals and were followed till discharge and 28 days; outcome was measured as death or disability. Stroke cases fulfilling diagnostic criteria, evaluated by neurologists and CT/MRI confirmed cases were included. Brief information on major risk factors was collected from all stroke patients / family members and from medical records by trained research officers. In STEP II, death records of Bangalore Mahanagara Palike for 2004 (n=23,312) were analyzed to identify stroke related deaths. Results: Using WHO-STEPs approach, a methodology was developed for stroke surveillance in a geographically defined population. By STEP 1 method - 7 per cent of medical and 45 per cent of neurological admissions were due to stroke with a fatality rate of 9 per cent at hospital discharge and 20 per cent at 28 days. With a mean age of 54.5 (± 17.0) yr and male preponderance, nearly half had one or more risk factors. Weakness or paresis (92%) was the commonest presentation and ischaemic stroke was most frequent (73.8%). One third of total stroke patients were dependent at both discharge and 28 day follow up. By STEP II method the proportional mortality rate for Bangalore city was observed to be 6 per cent and more than 50 per cent of total stroke deaths had occurred in 10 major hospitals. Interpretation & conclusions: The present study has shown that stroke surveillance is possible and feasible. Institution based (hospitals and vital registry data) stroke surveillance supplemented with periodical population based information can provide comprehensive information on vital aspects of stroke like mortality, risk factors, disability and outcome. There is a need to develop stroke surveillance in a phased manner along with mechanisms to apply data for prevention and control programmes.