Capacidade institucional para o cuidado às pessoas com doenças crônicas na atenção primária à saúde / Institutional capacity for the care of people with chronic diseases in primary health care

Objetivo: investigar a capacidade institucional para o cuidado às pessoas com doenças crônicas não transmissíveis na atenção primária à saúde. Método: estudo transversal, quantitativo e exploratório. A coleta de dados utilizou o questionário, traduzido e adaptado para o Brasil, Assessment of Chronic Illness Care. A coleta de dados aconteceu entre dezembro de 2017 a junho de 2018. O instrumento foi respondido por 159 profissionais que atuavam em 49 unidades de atenção primária à saúde. Resultados: a capacidade para o cuidado às pessoas com doenças crônicas foi classificada como básica. Os componentes com melhor e pior nota atribuída foram, desenho do sistema de prestação de serviços e suporte à decisão clínica, respectivamente. Conclusão: os resultados deste estudo apontaram que é necessário investir, prioritariamente, em: feedback do especialista na contrarreferência, parcerias com a comunidade, especialmente nas unidades que atuam no modelo tradicional e capacitação dos profissionais para apoio ao autocuidado.

Objective: to investigate the institutional capacity for the care of people with chronic non-communicable diseases in primary health care. Method: cross-sectional, quantitative and exploratory study. Data collection used the questionnaire, translated and adapted for Brazil, Assessment of Chronic Illness Care. Data collection took place between December 2017 and June 2018. 159 professionals working in 49 primary health care units responded to the instrument. Results: the ability to care for people with chronic diseases was classified as basic. The components with the best and worst scores were the design of the service delivery system and clinical decision support, respectively. Conclusion: the results of this study showed that it is necessary to invest primarily in expert feedback on counter-reference, partnerships with the community, especially in units that work in the traditional model, and training of professionals to support self-care.

The role of education on Cancer amenable mortality among non-Hispanic blacks & non-Hispanic whites in the United States (1989-2018).

BACKGROUND: Cancer mortality in the U.S. has fallen in recent decades; however, individuals with lower levels of education experienced a smaller decline than more highly educated individuals. This analysis aimed to measure the influence of education lower than a high school diploma, on cancer amenable mortality among Non-Hispanic Whites (NHW) and Non-Hispanic Blacks (NHB) in the U.S. from 1989 to 2018. METHODS: We analyzed data from 8.2 million death certificates of men and women who died from cancer between 1989 and 2018. We examined 5-year and calendar period intervals, as well as annual percent changes (APC). APC was adjusted for each combination of sex, educational level, and race categories (8 models) to separate the general trend from the effects of age. RESULTS: Our study demonstrated an increasing mortality gap between the least and the most educated NHW and NHB males and females who died from all cancers combined and for most other cancer types included in this study. The gap between the least and the most educated was broader among NHW males and females than among NHB males and females, respectively, for most malignancies. CONCLUSIONS: In summary, we reported an increasing gap in the age-adjusted cancer mortality among the most and the least educated NHW and NHB between 25 and 74 years of age. We demonstrated that although NHB exhibited the greatest age-adjusted mortality rates for most cancer locations, the gap between the most and the least educated was shown for NHW.

Análise da estrutura de serviços de saúde para o cuidado às pessoas com diabetes / Análisis de estructura de los servicios de salud para el cuidado de personas con diabetes / Analysis of the health service structures for the care of people with diabetes

Objetivo: Analisar a estrutura de unidades básicas de saúde para o cuidado às pessoas com diabetes na perspectiva do modelo de atenção às condições crônicas. Métodos: Estudo transversal e exploratório, realizado em 49 serviços de saúde. Aplicado instrumento baseado em cinco componentes do modelo de cuidados crônicos. Realizada análise descritiva dos resultados. A interpretação foi feita por faixas de pontuação entre 0 e 100% e quartis de classificações que variaram entre limitada, básica, razoável e ótima. Resultados: A estrutura para o cuidado foi classificada como básica. Os componentes com melhor e pior nota atribuída foram sistema de prestação de serviços e apoio à decisão, respectivamente. Observaram-se menor disponibilidade de recursos em unidades que atuavam no modelo tradicional. Conclusões: Os achados apontam para a necessidade de otimização dos recursos disponíveis para a melhoria dos processos de trabalho e investimento em metas organizacionais, parcerias com a comunidade, feedback do especialista e capacitação(AU)

Objective: To analyze the structure of basic health units for care of people with diabetes in the perspective of the chronicle conditions model. Methods: Transversal and exploratory study, conducted in 49 health services. An instrument based on the chronicle care model was applied. Descriptive analysis was performed. The interpretation was made by grades ranging from 0 to 100% and classification tracks that ranged from limited, basic, fair, and great. Results: The care structure was classified as basic. The components with the best and worst attributed grades were the service delivery system and decision support, respectively. It was observed a smaller availability of resources in units which act in the traditional model. Conclusions: Findings point to the need of optimizing the available resources for the improvement of work processes and invest in organizational goals, partnerships with the community, expert feedback, and training(AU)

Objetivo: Analizar la estructura de las unidades básicas de salud para el cuidado de personas con diabetes desde la perspectiva del modelo de cuidado crónico. Métodos: Estudio transversal y exploratorio, realizado en 49 servicios de salud. Se aplicó un instrumento basado en cinco componentes del modelo de cuidados crónicos. Se realizó un análisis descriptivo de los resultados. La interpretación se realizó utilizando rangos de puntuación entre 0 y 100% y cuartiles de puntuación que van desde limitado, básico, regular y excelente. Resultados: La estructura para el cuidado se clasificó como básica. Los componentes con mejores y las peores calificaciones fueron: sistema de prestación de servicios y apoyo a toma de decisiones, respectivamente. Hubo menor disponibilidad de recursos en unidades que operan en modelo tradicional. Conclusiones: Resultados apuntan a necesidad de optimizar recursos disponibles para mejorar procesos de trabajo e invertir en objetivos organizacionales, asociaciones comunitarias, retroalimentación de expertos y capacitación.(AU)

A review of the quality of current diabetes clinical practice guidelines / Examen de la calidad de las directrices actuales de práctica clínica sobre la diabetes / Uma revisão da qualidade das diretrizes atuais para a prática clínica em casos de diabetes

Objective. To obtain an evaluation of current type 2 diabetes mellitus (T2DM) clinical practice guidelines. Methods. Relevant guidelines were identified through a systematic search of MEDLINE/ PubMed. Pan American Health Organization (PAHO) country offices were also contacted to obtain national diabetes guidelines in use but not published/available online. Overall, 770 records were identified on MEDLINE/PubMed for citations published from 2008 to 2013. After an initial screening of these records, 146 were found to be guidelines related to diabetes. Inclusion and exclusion criteria were used to further refine the search and obtain a feasible number of guidelines for appraisal. Guideline evaluation was conducted by health professionals using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, which was developed to address the issue of variability in guideline quality and assesses the methodological rigor and transparency in which a guideline is developed. A total of 17 guidelines were selected and evaluated. Results. Ten guidelines scored ≥ 70% and seven guidelines scored ≥ 80%. The range was 21%–100%. The mean scores for Latin America and the Caribbean (LAC) country guidelines (n = 6) were compared to the mean scores for non-LAC country guidelines (n = 11). International guidelines consistently scored notably higher in all domains and overall quality than LAC guidelines. Conclusions. Based on this study’s findings, it is clear that T2DM clinical practice guideline development requires further improvements, particularly with regard to the involvement of stakeholders and editorial independence. This issue is most apparent for LAC country guidelines, as their quality requires major improvement in almost all aspects of the AGREE II criteria. Continued efforts should be made to generate and update high-quality guidelines to improve the management of increasingly prevalent noncommunicable diseases, such as T2DM.

Objetivo. Evaluar las directrices de práctica clínica sobre la diabetes mellitus de tipo 2 que se utilizan en la actualidad. Métodos. Se realizó una búsqueda sistemática en MEDLINE/PubMed con el fin de localizar las directrices pertinentes. Asimismo, se solicitó a las oficinas de la Organización Panamericana de la Salud (OPS) en los países que facilitaran las directrices nacionales sobre la diabetes utilizadas en cada país que no estuvieran accesibles ni publicadas en línea. Se obtuvieron 770 registros de trabajos publicados del 2008 al 2013 en MEDLINE/PubMed. Tras un tamizaje inicial, se localizaron 146 directrices relacionadas con la diabetes. Se aplicaron criterios de inclusión y exclusión para perfeccionar aún más la búsqueda y obtener un número viable de directrices para realizar la evaluación. La evaluación estuvo a cargo de profesionales de la salud, quienes utilizaron el instrumento AGREE II (Appraisal of Guidelines for Research and Evaluation), creado para abordar el problema de la variabilidad en cuanto a la calidad de las directrices, que evalúa el rigor metodológico y la transparencia del proceso de formulación. Se seleccionaron y evaluaron 17 directrices. Resultados. Diez directrices recibieron una puntuación ≥ 70% y siete directrices, ≥ 80%. El margen de las puntuaciones asignadas fue de 21-100 %. Se comparó la media de las puntuaciones asignadas a las directrices provenientes de países de América Latina y el Caribe (n = 6) con la media de aquellas provenientes de otros países (n = 11). Las directrices internacionales recibieron una puntuación notablemente mayor que las de América Latina y el Caribe en todos los criterios evaluados y en la calidad general. Conclusiones. Dados los resultados de este estudio, está claro que es preciso mejorar la formulación de directrices de práctica clínica sobre la diabetes mellitus de tipo 2, en particular con respecto a la participación de los interesados directos y la independencia editorial. Esta cuestión es sumamente evidente en las directrices de los países de América Latina y el Caribe, puesto que son necesarias mejoras considerables de la calidad en casi todos los aspectos de los criterios evaluados con el instrumento AGREE II. Es fundamental continuar con los esfuerzos destinados a formular directrices de excelente calidad y actualizarlas para mejorar el diagnóstico y el tratamiento de las enfermedades no transmisibles que son cada vez más prevalentes, como es el caso de la diabetes mellitus de tipo 2.

Objetivo. Avaliar as diretrizes atuais para a prática clínica em casos de diabetes mellitus do tipo 2 (DMT2). Métodos. Identificamos diretrizes relevantes por meio de uma pesquisa sistemática na base de dados MEDLINE/PubMed. As representações da Organização Pan- Americana da Saúde (OPAS) nos países também foram contatadas para que pudéssemos obter diretrizes para diabetes utilizadas nos países, mas não publicadas/disponíveis on-line. Ao todo, foram encontrados 770 resultados na MEDLINE/PubMed para citações publicadas entre 2008 e 2013. Depois de uma triagem inicial destes resultados, constatou-se que 146 eram diretrizes relacionadas ao diabetes. Utilizamos critérios de inclusão e exclusão para refinar ainda mais a pesquisa e obter um número viável de diretrizes a serem avaliadas. A avaliação das diretrizes foi feita por profissionais da saúde usando o instrumento AGREE II (Avaliação de Diretrizes para Pesquisa e Avaliação), desenvolvido para abordar a questão da variabilidade na qualidade de diretrizes e avaliar o rigor metodológico e a transparência no desenvolvimento de uma diretriz. No total, foram selecionadas e avaliadas17 diretrizes. Resultados. Dez diretrizes tiveram pontuação ≥70%, e sete diretrizes tiveram pontuação ≥80%. A variação foi de 21% a 100%. As pontuações médias das diretrizes de países da América Latina e Caribe (ALC) (n=6) foram comparadas às de países não pertencentes a esta região (n=11). As diretrizes internacionais tiveram pontuações consistentemente mais altas em todos os domínios e uma qualidade global mais elevada que as diretrizes da ALC. Conclusões. Com base nos resultados deste estudo, está claro que o desenvolvimento de diretrizes para a prática clínica em casos de DMT2 precisa ser aperfeiçoado, especialmente no que diz respeito à participação dos interessados diretos e à independência editorial. Este problema fica muito evidente no caso das diretrizes de países da ALC, cuja qualidade precisa melhorar muito em quase todos os aspectos dos critérios AGREE II. É preciso fazer esforços contínuos para desenvolver e atualizar diretrizes de alta qualidade a fim de melhorar a gestão de doenças não transmissíveis cada vez mais prevalentes, como o DMT2.

Carga de enfermedad tuberculosa atribuible a la diabetes en población adulta de las Américas / Burden of tuberculosis attributable to diabetes in the adult population of the Americas / Carga de tuberculose atribuível à diabetes em população adulta nas Américas

RESUMEN Se realizó un estudio ecológico para estimar la carga de enfermedad tuberculosa incidente atribuible a la diabetes en la Región de las Américas. El tamaño poblacional, la prevalencia de diabetes y la incidencia de tuberculosis (TB) en la población adulta de cada país de 2013 se emplearon para estimar el riesgo atribuible poblacional porcentual, que ascendió a 16,8% (IC95%: 10,8%- 23,8%), lo que corresponde a 25 045 (16 050-35 741) casos incidentes de TB/año. La diabetes es un importante determinante de la incidencia de tuberculosis en los países de la Región de las Américas y puede dar cuenta de hasta 1 de cada 4 casos incidentes de TB. La intersección de ambas epidemias plantea a los países el doble desafío de la atención y el control integrados de la comorbilidad y de sus determinantes sociales estructurales.(AU)

ABSTRACT An ecological study was conducted to estimate the burden of incident tuberculosis attributable to diabetes in the Region of the Americas. Population size, the prevalence of diabetes, and the incidence of tuberculosis (TB) in the adult population of each country in 2013 were used to estimate the percent population attributable risk. The estimated population attributable risk was 16.8% (CI 95%: 10.8-23.8%), which corresponds to 25,045 (16,050-35,741) incident cases of TB per year. Diabetes is an important determinant of the incidence of tuberculosis in the countries of the Region of the Americas and may account for up to 1 in 4 incident TB cases. For countries, the intersection of both epidemics poses the dual challenge of providing integrated are and control of comorbidity and its structural social determinants.(AU)

RESUMO Estudo ecológico conduzido para estimar a carga de tuberculose incidente atribuível à diabetes na Região das Américas. O tamanho populacional, a prevalência da diabetes e a incidência de tuberculose na população adulta de cada país em 2013 foram usados para estimar o risco atribuível populacional proporcional. Estimou-se um risco atribuível populacional de 16,8% (IC95% 10,8%-23,8%), correspondente a 25.045 (16.050-35.741) casos incidentes de tuberculose ao ano. A diabetes é um importante determinante da incidência de tuberculose nos países da Região das Américas e pode estar associada a até 1 em 4 casos incidentes de tuberculose. A intersecção de ambas as epidemias faz com que os países tenham de enfrentar o duplo desafio da atenção e controle integrados da comorbidade e de seus determinantes sociais estruturais..(AU)

A review of the quality of current diabetes clinical practice guidelines / Examen de la calidad de las directrices actuales de práctica clínica sobre la diabetes / Uma revisão da qualidade das diretrizes atuais para a prática clínica em casos de diabetes

Objective To obtain an evaluation of current type 2 diabetes mellitus (T2DM) clinical practice guidelines. Methods Relevant guidelines were identified through a systematic search of MEDLINE/PubMed. Pan American Health Organization (PAHO) country offices were also contacted to obtain national diabetes guidelines in use but not published/available online. Overall, 770 records were identified on MEDLINE/PubMed for citations published from 2008 to 2013. After an initial screening of these records, 146 were found to be guidelines related to diabetes. Inclusion and exclusion criteria were used to further refine the search and obtain a feasible number of guidelines for appraisal. Guideline evaluation was conducted by health professionals using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, which was developed to address the issue of variability in guideline quality and assesses the methodological rigor and transparency in which a guideline is developed. A total of 17 guidelines were selected and evaluated. Results Ten guidelines scored ≥ 70% and seven guidelines scored ≥ 80%. The range was 21%-100%. The mean scores for Latin America and the Caribbean (LAC) country guidelines (n = 6) were compared to the mean scores for non-LAC country guidelines (n = 11). International guidelines consistently scored notably higher in all domains and overall quality than LAC guidelines. Conclusions Based on this study's findings, it is clear that T2DM clinical practice guideline development requires further improvements, particularly with regard to the involvement of stakeholders and editorial independence. This issue is most apparent for LAC country guidelines, as their quality requires major improvement in almost all aspects of the AGREE II criteria. Continued efforts should be made to generate and update high-quality guidelines to improve the management of increasingly prevalent noncommunicable diseases, such as T2DM.

RESUMEN Objetivo Evaluar las directrices de práctica clínica sobre la diabetes mellitus de tipo 2 que se utilizan en la actualidad. Métodos Se realizó una búsqueda sistemática en MEDLINE/PubMed con el fin de localizar las directrices pertinentes. Asimismo, se solicitó a las oficinas de la Organización Panamericana de la Salud (OPS) en los países que facilitaran las directrices nacionales sobre la diabetes utilizadas en cada país que no estuvieran accesibles ni publicadas en línea. Se obtuvieron 770 registros de trabajos publicados del 2008 al 2013 en MEDLINE/PubMed. Tras un tamizaje inicial, se localizaron 146 directrices relacionadas con la diabetes. Se aplicaron criterios de inclusión y exclusión para perfeccionar aún más la búsqueda y obtener un número viable de directrices para realizar la evaluación. La evaluación estuvo a cargo de profesionales de la salud, quienes utilizaron el instrumento AGREE II (Appraisal of Guidelines for Research and Evaluation), creado para abordar el problema de la variabilidad en cuanto a la calidad de las directrices, que evalúa el rigor metodológico y la transparencia del proceso de formulación. Se seleccionaron y evaluaron 17 directrices. Resultados Diez directrices recibieron una puntuación  70% y siete directrices,  80%. El margen de las puntuaciones asignadas fue de 21-100 %. Se comparó la media de las puntuaciones asignadas a las directrices provenientes de países de América Latina y el Caribe (n = 6) con la media de aquellas provenientes de otros países (n = 11). Las directrices internacionales recibieron una puntuación notablemente mayor que las de América Latina y el Caribe en todos los criterios evaluados y en la calidad general. Conclusiones Dados los resultados de este estudio, está claro que es preciso mejorar la formulación de directrices de práctica clínica sobre la diabetes mellitus de tipo 2, en particular con respecto a la participación de los interesados directos y la independencia editorial. Esta cuestión es sumamente evidente en las directrices de los países de América Latina y el Caribe, puesto que son necesarias mejoras considerables de la calidad en casi todos los aspectos de los criterios evaluados con el instrumento AGREE II. Es fundamental continuar con los esfuerzos destinados a formular directrices de excelente calidad y actualizarlas para mejorar el diagnóstico y el tratamiento de las enfermedades no transmisibles que son cada vez más prevalentes, como es el caso de la diabetes mellitus de tipo 2.

RESUMO Objetivo Avaliar as diretrizes atuais para a prática clínica em casos de diabetes mellitus do tipo 2 (DMT2). Métodos Identificamos diretrizes relevantes por meio de uma pesquisa sistemática na base de dados MEDLINE/PubMed. As representações da Organização Pan-Americana da Saúde (OPAS) nos países também foram contatadas para que pudéssemos obter diretrizes para diabetes utilizadas nos países, mas não publicadas/disponíveis on-line. Ao todo, foram encontrados 770 resultados na MEDLINE/PubMed para citações publicadas entre 2008 e 2013. Depois de uma triagem inicial destes resultados, constatou-se que 146 eram diretrizes relacionadas ao diabetes. Utilizamos critérios de inclusão e exclusão para refinar ainda mais a pesquisa e obter um número viável de diretrizes a serem avaliadas. A avaliação das diretrizes foi feita por profissionais da saúde usando o instrumento AGREE II (Avaliação de Diretrizes para Pesquisa e Avaliação), desenvolvido para abordar a questão da variabilidade na qualidade de diretrizes e avaliar o rigor metodológico e a transparência no desenvolvimento de uma diretriz. No total, foram selecionadas e avaliadas17 diretrizes. Resultados Dez diretrizes tiveram pontuação 70%, e sete diretrizes tiveram pontuação 80%. A variação foi de 21% a 100%. As pontuações médias das diretrizes de países da América Latina e Caribe (ALC) (n=6) foram comparadas às de países não pertencentes a esta região (n=11). As diretrizes internacionais tiveram pontuações consistentemente mais altas em todos os domínios e uma qualidade global mais elevada que as diretrizes da ALC. Conclusões Com base nos resultados deste estudo, está claro que o desenvolvimento de diretrizes para a prática clínica em casos de DMT2 precisa ser aperfeiçoado, especialmente no que diz respeito à participação dos interessados diretos e à independência editorial. Este problema fica muito evidente no caso das diretrizes de países da ALC, cuja qualidade precisa melhorar muito em quase todos os aspectos dos critérios AGREE II. É preciso fazer esforços contínuos para desenvolver e atualizar diretrizes de alta qualidade a fim de melhorar a gestão de doenças não transmissíveis cada vez mais prevalentes, como o DMT2.

Prevalence of diabetes and impaired fasting glucose in Costa Rica: Costa Rican National Cardiovascular Risk Factors Survey, 2010.

BACKGROUND: The projected rising prevalence of diabetes and impaired fasting glucose (IFG) in developing countries warrants careful monitoring. The aim of this study was to present the results of the Costa Rican National Cardiovascular Risk Factors Surveillance System, which provides the first national estimates of diabetes and IFG prevalence among adults in Costa Rica. METHODS: A cross-sectional survey of 3653 non-institutionalized adults aged ≥20 years (87.8% response rate) following the World Health Organization STEPwise approach was built on a probabilistic sample of the non-institutionalized population during 2010. Known diabetes was defined as self-reported diagnosis, the use of insulin, or hypoglycemic oral treatment as consequence of diabetes during at least the previous 2 weeks before the survey. Unknown diabetes was defined no self-reported diabetes but with venous blood concentrations of fasting glucose >125 mg/dL determined by laboratory testing. Impaired fasting glucose was defined as fasting glucose between 100 and 125 mg/dL among those without diabetes. The prevalence of diabetes and IFG prevalence was estimated according gender, body mass index (BMI), waist circumference (WC), educational level, and physical activity level. RESULTS: Overall diabetes prevalence was 10.8% (9.5% known and 1.3% unknown diabetes) and IFG prevalence was 16.5%. The prevalence of known diabetes was higher among women >65 years compared with men of the same age group. Both known and unknown diabetes were significantly associated with higher BMI, increased WC, and low education level (P = 0.01). CONCLUSIONS: The prevalence of diabetes and IFG in Costa Rica is comparable to that in developed countries and indicates an urgent need for effective preventive interventions.

Prevalence of metabolic syndrome in Central America: a cross-sectional population-based study / Prevalencia del síndrome metabólico en Centroamérica: un estudio transversal basado en la población

OBJECTIVE: To report the prevalence of metabolic syndrome (MetS) as found by the Central American Diabetes Initiative (CAMDI) study for five major Central American populations: Belize (national); Costa Rica (San José); Guatemala (Guatemala City); Honduras (Tegucigalpa); and Nicaragua (Managua). METHODS: Study data on 6 185 adults aged 20 years or older with anthropometric and laboratory determination of MetS from population-based surveys were analyzed. Overall, the survey response rate was 82.0%. MetS prevalence was determined according to criteria from the Adult Treatment Panel III of the National Cholesterol Education Program. The study's protocol was reviewed and approved by the bioethical committee of each country studied. RESULTS: The overall standardized prevalence of MetS in the Central American region was 30.3% (95% confidence interval (CI): 27.1-33.4). There was wide variability by gender and work conditions, with higher prevalence among females and unpaid workers. The standardized percentage of the population free of any component of MetS was lowest in Costa Rica (9.0%; CI: 6.5-11.4) and highest in Honduras (21.1%; CI: 16.4-25.9). CONCLUSIONS: Overall prevalence of MetS in Central America is high. Strengthening surveillance of chronic diseases and establishing effective programs for preventing cardiovascular diseases might reduce the risk of MetS in Central America.

OBJETIVO: Notificar la prevalencia del síndrome metabólico (SMet) observada en el estudio de la Iniciativa Centroamericana de Diabetes (CAMDI) llevado a cabo en cinco importantes poblaciones centroamericanas: Belice (nacional); Costa Rica (San José); Guatemala (Ciudad de Guatemala); Honduras (Tegucigalpa); y Nicaragua (Managua). MÉTODOS: Se analizaron los datos de estudio obtenidos de las encuestas poblacionales dirigidas a 6 185 adultos de 20 años de edad o mayores con determinaciones antropométricas y de laboratorio relativas al SMet. En términos generales, la tasa de respuesta a las encuestas fue de 82,0%. Se determinó la prevalencia del SMet según los criterios del tercer informe del Grupo de Expertos en el Tratamiento de Adultos (Adult Treatment Panel III) del Programa Nacional de Educación sobre el Colesterol. El protocolo del estudio fue examinado y aprobado por el comité de bioética de cada uno de los países incluidos en el estudio. RESULTADOS: La prevalencia general estandarizada del SMet en Centroamérica fue de 30,3% (Intervalo de confianza de 95% (IC): 27,1-33,4). Se observó una amplia variabilidad según el sexo y las condiciones laborales, con mayor prevalencia en mujeres y trabajadores no retribuidos. El menor porcentaje estandarizado de población libre de cualquier componente del SMet se observó en Costa Rica (9,0%; IC: 6,5-11,4) y el mayor en Honduras (21,1%; IC: 16,4-25,9). CONCLUSIONES: La prevalencia general de SMet en Centroamérica es alta. Se podría reducir el riesgo de SMet en Centroamérica mediante el fortalecimiento de la vigilancia de las enfermedades crónicas y el establecimiento de programas eficaces de prevención de las enfermedades cardiovasculares.

Prevalence of metabolic syndrome in Central America: a cross-sectional population-based study / Prevalencia del síndrome metabólico en Centroamérica: un estudio transversal basado en la población

Objective. To report the prevalence of metabolic syndrome (MetS) as found by the Central American Diabetes Initiative (CAMDI) study for five major Central American populations: Belize (national); Costa Rica (San José); Guatemala (Guatemala City); Honduras (Tegucigalpa); and Nicaragua (Managua). Methods. Study data on 6 185 adults aged 20 years or older with anthropometric and laboratory determination of MetS from population-based surveys were analyzed. Overall, the survey response rate was 82.0%. MetS prevalence was determined according to criteria from the Adult Treatment Panel III of the National Cholesterol Education Program. The study’s protocol was reviewed and approved by the bioethical committee of each country studied. Results. The overall standardized prevalence of MetS in the Central American region was 30.3% (95% confidence interval (CI): 27.1–33.4). There was wide variability by gender and work conditions, with higher prevalence among females and unpaid workers. The standardized percentage of the population free of any component of MetS was lowest in Costa Rica (9.0%; CI: 6.5–11.4) and highest in Honduras (21.1%; CI: 16.4–25.9). Conclusions. Overall prevalence of MetS in Central America is high. Strengthening surveillance of chronic diseases and establishing effective programs for preventing cardiovascular diseases might reduce the risk of MetS in Central America.

Objetivo. Notificar la prevalencia del síndrome metabólico (SMet) observada en el estudio de la Iniciativa Centroamericana de Diabetes (CAMDI) llevado a cabo en cinco importantes poblaciones centroamericanas: Belice (nacional); Costa Rica (San José); Guatemala (Ciudad de Guatemala); Honduras (Tegucigalpa); y Nicaragua (Managua). Métodos. Se analizaron los datos de estudio obtenidos de las encuestas poblacionales dirigidas a 6 185 adultos de 20 años de edad o mayores con determinaciones antropométricas y de laboratorio relativas al SMet. En términos generales, la tasa de respuesta a las encuestas fue de 82,0%. Se determinó la prevalencia del SMet según los criterios del tercer informe del Grupo de Expertos en el Tratamiento de Adultos (Adult Treatment Panel III) del Programa Nacional de Educación sobre el Colesterol. El protocolo del estudio fue examinado y aprobado por el comité de bioética de cada uno de los países incluidos en el estudio. Resultados. La prevalencia general estandarizada del SMet en Centroamérica fue de 30,3% (Intervalo de confianza de 95% (IC): 27,1–33,4). Se observó una amplia variabilidad según el sexo y las condiciones laborales, con mayor prevalencia en mujeres y trabajadores no retribuidos. El menor porcentaje estandarizado de población libre de cualquier componente del SMet se observó en Costa Rica (9,0%; IC: 6,5–11,4) y el mayor en Honduras (21,1%; IC: 16,4–25,9). Conclusiones. La prevalencia general de SMet en Centroamérica es alta. Se podría reducir el riesgo de SMet en Centroamérica mediante el fortalecimiento de la vigilancia de las enfermedades crónicas y el establecimiento de programas eficaces de prevención de las enfermedades cardiovasculares.

A comparative assessment of avoidable blindness and visual impairment in seven Latin American countries: prevalence, coverage, and inequality.

OBJECTIVE: To conduct a comparative analysis of social inequalities in eye health and eye health care and generate baseline evidence for seven Latin American countries as a benchmarking exercise for monitoring progress toward three goals of the regional Plan of Action for the Prevention of Blindness and Visual Impairment: increasing eye health service coverage, minimizing barriers, and reducing eye health-related disease burden. METHODS: Results from cross-sectional eye health surveys conducted in six Latin American countries (Argentina, El Salvador, Honduras, Panama, Peru, and Uruguay) from 2011 to 2013 and recently published national surveys in Paraguay were analyzed. The magnitude of absolute and relative inequalities between countries in five dimensions of eye health across the population gradient defined by three equity stratifiers (educational attainment, literacy, and wealth) were explored using standard exploratory data analysis techniques. RESULTS: Overall prevalence of blindness in people 50 years old and older varied from 0.7% (95% CI: 0.4-1.0) in Argentina to 3.0% (95% CI: 2.3-3.6) in Panama. Overall prevalence of visual impairment (severe plus moderate) varied from 8.0% (95% CI: 6.5-11.0) in Uruguay to 14.3% (95% CI: 13.9-14.7) in El Salvador. The main reported cause of blindness was unoperated cataract and most cases of visual impairment were caused by uncorrected refractive error. Three countries had cataract surgical coverage of more than 90% for blind persons, and two-thirds of cataract-operated patients had good visual acuity. CONCLUSIONS: Blindness and moderate visual impairment prevalence were concentrated among the most socially disadvantaged, and cataract surgical coverage and cataract surgery optimal outcome were concentrated among the wealthiest. There is a need for policy action to increase services coverage and quality to achieve universality.

A comparative assessment of avoidable blindness and visual impairment in seven Latin American countries: prevalence, coverage, and inequality / Una evaluación comparativa de la ceguera y la deficiencia visual evitables en siete países latinoamericanos: prevalencia, cobertura y desigualdades

Objective. To conduct a comparative analysis of social inequalities in eye health and eye health care and generate baseline evidence for seven Latin American countries as a benchmarking exercise for monitoring progress toward three goals of the regional Plan of Action for the Prevention of Blindness and Visual Impairment: increasing eye health service coverage, minimizing barriers, and reducing eye health-related disease burden. Methods. Results from cross-sectional eye health surveys conducted in six Latin American countries (Argentina, El Salvador, Honduras, Panama, Peru, and Uruguay) from 2011 to 2013 and recently published national surveys in Paraguay were analyzed. The magnitude of absolute and relative inequalities between countries in five dimensions of eye health across the population gradient defined by three equity stratifiers (educational attainment, literacy, and wealth) were explored using standard exploratory data analysis techniques. Results. Overall prevalence of blindness in people 50 years old and older varied from 0.7% (95% CI: 0.4-1.0) in Argentina to 3.0% (95% CI: 2.3-3.6) in Panama. Overall prevalence of visual impairment (severe plus moderate) varied from 8.0% (95% CI: 6.5-11.0) in Uruguay to 14.3% (95% CI: 13.9-14.7) in El Salvador. The main reported cause of blindness was unoperated cataract and most cases of visual impairment were caused by uncorrected refractive error. Three countries had cataract surgical coverage of more than 90% for blind persons, and two-thirds of cataract-operated patients had good visual acuity. Conclusions. Blindness and moderate visual impairment prevalence were concentrated among the most socially disadvantaged, and cataract surgical coverage and cataract surgery optimal outcome were concentrated among the wealthiest. There is a need for policy action to increase services coverage and quality to achieve universality.

Objetivo. Realizar un análisis comparativo de las desigualdades sociales en materia de salud ocular y atención oftálmica, y generar datos probatorios de referencia de siete países latinoamericanos como un ejercicio de evaluación comparativa para vigilar el progreso hacia tres metas del Plan de Acción para la Prevención de la Ceguera y la Deficiencia Visual Evitables: el aumento de la cobertura de los servicios de salud ocular, la reducción al mínimo de las barreras y la disminución de la carga de morbilidad relacionada con la salud ocular. Métodos. Se analizaron los resultados de las encuestas transversales de salud ocular realizadas en seis países latinoamericanos (Argentina, El Salvador, Honduras, Panamá, Perú y Uruguay) desde el 2011 al 2013, y las encuestas nacionales del Paraguay recientemente publicadas. Mediante el empleo de técnicas ordinarias de análisis exploratorio de datos, se investigó la magnitud de las desigualdades absolutas y relativas entre países en cinco dimensiones de la salud ocular a través del gradiente poblacional definido por tres variables de estratificación de equidad (logro educativo, alfabetización y riqueza). Resultados. La prevalencia general de la ceguera en personas de 50 años de edad o mayores varió de 0,7% (intervalo de confianza (IC) de 95%: 0,4-1,0) en Argentina a 3,0% (IC95%: 2,3-3,6) en Panamá. La prevalencia general de la deficiencia visual (grave y moderada) varió de 8,0% (IC95%: 6,5-11,0) en Uruguay a 14,3% (IC95%: 13,9-14,7) en El Salvador. La principal causa notificada de ceguera fue la catarata no operada, mientras que la mayor parte de los casos de deficiencia visual fueron causados por un error de refracción no corregido. Tres países tenían una cobertura quirúrgica de la catarata de más de 90% para las personas ciegas, mientras que dos terceras partes de los pacientes operados de cataratas mostraban una buena agudeza visual. Conclusiones. Las prevalencias de la ceguera y la deficiencia visual moderada se concentraban en las personas más desfavorecidas socialmente, mientras que la cobertura quirúrgica de la catarata así como los resultados óptimos de esta intervención se concentraban en los más adinerados. Son necesarias acciones políticas para aumentar la cobertura y la calidad de los servicios con objeto de alcanzar la universalidad.

Prevalence of metabolic syndrome in Central America: a cross-sectional population-based study.

OBJECTIVE: To report the prevalence of metabolic syndrome (MetS) as found by the Central American Diabetes Initiative (CAMDI) study for five major Central American populations: Belize (national); Costa Rica (San José); Guatemala (Guatemala City); Honduras (Tegucigalpa); and Nicaragua (Managua). METHODS: Study data on 6 185 adults aged 20 years or older with anthropometric and laboratory determination of MetS from population-based surveys were analyzed. Overall, the survey response rate was 82.0%. MetS prevalence was determined according to criteria from the Adult Treatment Panel III of the National Cholesterol Education Program. The study's protocol was reviewed and approved by the bioethical committee of each country studied. RESULTS: The overall standardized prevalence of MetS in the Central American region was 30.3% (95% confidence interval (CI): 27.1-33.4). There was wide variability by gender and work conditions, with higher prevalence among females and unpaid workers. The standardized percentage of the population free of any component of MetS was lowest in Costa Rica (9.0%; CI: 6.5-11.4) and highest in Honduras (21.1%; CI: 16.4-25.9). CONCLUSIONS: Overall prevalence of MetS in Central America is high. Strengthening surveillance of chronic diseases and establishing effective programs for preventing cardiovascular diseases might reduce the risk of MetS in Central America.

Prevalence of diabetes and intermediate hyperglycemia among adults from the first multinational study of noncommunicable diseases in six Central American countries: the Central America Diabetes Initiative (CAMDI).

OBJECTIVE: The increasing burdens of obesity and diabetes are two of the most prominent threats to the health of populations of developed and developing countries alike. The Central America Diabetes Initiative (CAMDI) is the first study to examine the prevalence of diabetes in Central America. RESEARCH DESIGN AND METHODS: The CAMDI survey was a cross-sectional survey based on a probabilistic sample of the noninstitutionalized population of five Central American populations conducted between 2003 and 2006. The total sample population was 10,822, of whom 7,234 (67%) underwent anthropometry measurement and a fasting blood glucose or 2-h oral glucose tolerance test. RESULTS: The total prevalence of diabetes was 8.5%, but was higher in Belize (12.9%) and lower in Honduras (5.4%). Of the screened population, 18.6% had impaired glucose tolerance/impaired fasting glucose. CONCLUSIONS: As this population ages, the prevalence of diabetes is likely to continue to rise in a dramatic and devastating manner. Preventive strategies must be quickly introduced.

Using collaborative learning to improve diabetes care and outcomes: the VIDA project.

UNLABELLED: The prevalence of diabetes in Mexico among those 20-64 years of age has increased from 7.2% in 1993 to 10.7% in 2000. National population-based surveys in Mexico demonstrated that 50% of the total population with diabetes had blood glucose levels of 200mg/dl or higher. Thus, diabetes care has become one of the most important public health challenges in this country. The aim of the study was to improve the quality of diabetes care in primary health care centers using the chronic care model and the breakthrough series (BTS) collaborative methodology. METHODS: Ten public health centers in the cities of Xalapa and Veracruz were randomly selected to participate in the project. Five of the health centers were randomly assigned to receive the intervention (intervention group) and the other five followed usual care (usual care group). The intervention was evaluated by A1c test before and after the intervention in both groups of patients. Patients were followed for 18 months from November 2002 to May 2004. Results were adjusted for the clustering of patients within practices and baseline measure. RESULTS: The proportion of people with good glycemic control (A1c<7%) among those in the intervention group increased from 28% before the intervention to 39% after the intervention. The proportion of patients achieving three or more quality improvement goals increased from 16.6% to 69.7% (p<0.001) among the intervention group while the usual care group experienced a non-significant decrease from 12.4% to 5.9% (p=0.118). The focus on the primary care team and the participation of people with diabetes were strategic elements incorporated into the methodology, expected to ensure sustainability of continued improvement of health outcomes. CONCLUSIONS: The intervention introduced modifications to solve problems identified by health teams in their practice and improved process and outcome measures of quality diabetes care. Most of the actions were directed at four components of the chronic care model: self-management support, decision support, delivery system design, and clinical information systems.

Risk factors associated with uncontrolled hypertension: findings from the baseline CARMEN survey in Cienfuegos, Cuba.

OBJECTIVES: Identifying methods to improve pharmacologic control of elevated blood pressure remains the most urgent challenge in clinical research on hypertension. The probability of having inadequate control varies widely in the population and better understanding of the factors responsible could help to focus treatment strategies. METHODS: A population-based community survey of 1475 persons aged 25-74 years, in Cienfuegos, Cuba, was used to identify these factors in a low-resource setting. RESULTS: While half of women with hypertension were controlled, only one-third of men were receiving successful treatment. Gender differences were not seen, however, among those currently taking medications. The largest burden of hypertension in absolute terms was concentrated in the age range 45-64, emphasizing the heavy burden of uncontrolled high blood pressure that falls on middle-aged men. Race-ethnicity was not a determinant of treatment and control status, nor was inability to obtain medication. CONCLUSIONS: These findings largely confirm the pattern observed in industrialized countries and demonstrate the near-universal challenge confronting primary-care systems in physician-based control of cardiovascular risk factors.