Survey on Chronic Noncommunicable Diseases in Universidad Nacional de La Matanza, Argentina. Year 2019 / Encuesta de factores de riesgo de enfermedades crónicas no transmisibles en la Universidad Nacional de La Matanza, Argentina. Año 2019.

Introduction: Chronic noncommunicable diseases (NCDs) account for leading causes of death in Argentina and early identification of their risk factors (RF) is key to prevention.Objective: The objective of this study was to describe the frequency of RF for NCDs among students from Universidad Nacional de la Matanza. Methods: A cross-sectional study was performed, using a self-reported survey adapted from the "National survey of risk factors", to describe risk factors and their association with sociodemographic characteristics. Results: A total of 130 students participated; 6.9% identified their health as "fair" and 48.5% referred some degree of anxiety or depression, 26.2% reported a low level of physical activity and almost all respondents ate less than 5 fruits or vegetables per day, 6.2% were smokers and 38.5% were exposed to tobacco smoke. The prevalence of overweight and obesity was 23.2% and 6.4% respectively. Occasional high cholesterol and blood pressure were reported by 20.4% and 16.8% of respondents, respectively. Conclusion: The university is an ideal setting for activities aimed at the promotion and prevention of these RF.

INTRODUCCIÓN: Las Enfermedades Crónicas No Transmisibles (ECNT) representan las principales causas de muerte en Argentina y la identificación temprana de sus factores de riesgo (FR) es clave para su prevención. El objetivo de este estudio fue describir la frecuencia de FR y ECNT en estudiantes de la Universidad Nacional de La Matanza. MÉTODOS: Se realizó un estudio de corte transversal, utilizando un cuestionario adaptado de la Encuesta Nacional de Factores de Riesgo por autorreporte, para describir los FR y su asociación con características sociodemográficas. RESULTADOS: Se encuestaron 130 estudiantes de ambos sexos. El 6,9% identificó su salud como "regular" y un 48,5% algún grado de ansiedad o depresión. El 26,2% reportó bajo nivel de actividad física y casi todos los encuestados consumieron menos de 5 porciones de frutas y verduras al día. Un 6,2% reportó ser fumador y un 38,5% estar expuesto al humo del tabaco. La prevalencia de sobrepeso fue de 23,2% y de obesidad de 6,4%. El 20,4% y el 16,8% de los estudiantes informaron respectivamente colesterol y presión arterial elevados "alguna vez". CONCLUSIÓN: El ámbito universitario es un espacio ideal para el abordaje de actividades de promoción y prevención de estos FR.

[Health promotion initiatives aimed at young adults. Qualitative study]. / Iniciativas de promoción de la salud destinadas a adultos jóvenes. Estudio cualitativo.

Introduction: Introduction. Health promotion initiatives, even more those promoted by the State, play a fundamental and strategic role in the construction of healthy lifestyles. The objective was to explore from the perspective of a group of young adults from the Autonomous City of Buenos Aires, dimensions and qualitative categories related to health promotion community initiatives with a focus on healthy diet, physical activity, and smoking cessation. Methods: A qualitative phenomenological study were conducted, including sixteen in-depth interviews with people under 40 years of age. Results: Were found and explored that interventions through websites, email, social networks, application- Mobile App (App), calls, text messages (SMS), printed material, or brief advice. The most acceptable interventions were: website, social networks, and the App. The potential use of these interventions would be related by the inclusion of audiovisual elements and personalized messages. Conclusion: The findings indicate that interventions that include social networks, App and web would have greater potential among young adults to promote healthy lifestyles.

Introducción: Las iniciativas de promoción de salud, más aún las impulsadas desde el Estado, juegan un papel fundamental y estratégico en torno a la construcción de estilos de vida saludables. El objetivo fue explorar desde la perspectiva de un grupo de adultos jóvenes de la Ciudad Autónoma de Buenos Aires dimensiones y categorías cualitativas relacionadas a iniciativas comunitarias de promoción de la salud con foco en alimentación saludable, actividad física y cesación tabáquica. Métodos: Se realizó un estudio cualitativo de carácter fenomenológico incluyendo 16 entrevistas en profundidad a personas menores de 40 años. Resultados: Se identificaron y exploraron intervenciones a través de sitios web, correo electrónico, redes sociales, aplicativo-App móvil (App), llamadas, mensajes de texto-SMS, material impreso o asesoría breve. Las intervenciones de mayor aceptabilidad fueron: sitio web, redes sociales y App. El uso potencial de las intervenciones estaría relacionado con la inclusión de elementos audiovisuales y los mensajes personalizados. Conclusión: Nuestros hallazgos indican que las intervenciones que incluyan redes sociales, App y web tendrían mayor potencial para promover estilos de vida saludables entre los adultos jóvenes.

Prevalencia de lactancia materna en el sector público de salud de Argentina, según la Encuesta Nacional de Lactancia Materna, 2017 / Prevalence of breastfeeding in the public health sector of Argentina according to the National Survey on Breastfeeding of 2017

Introducción. La lactancia materna (LM) reduce el riesgo de morbimortalidad en niños, además, provee ventajas medioambientales y económicas. El monitoreo de su práctica es indispensable para las políticas públicas. Objetivos. Los objetivos de este trabajo fueron estimar la prevalencia de LM en la población que demanda al sector público, comparar la prevalencia con datos del 2015 y evaluar variables de interés asociadas. Población y métodos. Estudio transversal observacional. Mediante un cuestionario estructurado, se relevó información de ingestión y datos sociodemográficos de lactantes <6 meses (n = 15 322) y de entre 12 y 15 meses (n = 3243) que concurrieron en forma espontánea a efectores del sector público entre agosto y septiembre de 2017. Resultados. La prevalencia de LM exclusiva (LME) en <6 meses fue del 53,5 % (intervalo de confianza del 95 % [IC95%]: 52,7-54,3); al cuarto y sexto mes, del 51,5 % (IC95%: 49,7-53,4) y del 41,7 % (IC95%: 39,8-43,5) respectivamente. La prevalencia de LME al cuarto y al sexto mes aumentaron en relación con el 2015 (p <0,001). La prevalencia de LM en niños de 12 a 15 meses fue del 77,8 % (IC95%: 76,4-79,3). Las siguientes variables se asociaron en forma independiente con menor frecuencia de LME (en <6 meses) y LM: mayor edad del niño, menor nivel educativo materno, parto por cesárea, bajo peso al nacer, puesta al pecho después de la primera hora y separación de la díada madre-hijo/a ≥4 horas diarias. Conclusiones. La LME al sexto mes y la LM continuada muestran cierta mejora, pero aún la proporción de lactantes amamantados no logra alcanzar niveles deseables.

Introduction. Breastfeeding reduces the risk for morbidity and mortality in children and also provides environmental and financial advantages. Breastfeeding monitoring is critical for public policies. Objectives. The objectives of this study were to estimate the prevalence of breastfeeding in the population seeking care in the public sector, compare this prevalence to data from 2015, and assess associated outcome measures. Population and methods. Cross-sectional, observational study. A structured questionnaire was used to collect intake and sociodemographic data from infants aged < 6 months (n = 15 322) and 12-15 months (n = 3243) who sought care from public sector health care providers spontaneously between August and September 2017. Results. The prevalence of exclusive breastfeeding among infants < 6 months was 53.5% (95% confidence interval [CI]: 52.7-54.3); and at 4 and 6 months, 51.5% (95% CI: 49.7-53.4) and 41.7% (95% CI: 39.8-43.5), respectively. The prevalence of exclusive breastfeeding at 4 and 6 months increased compared to 2015 (p < 0.001). The prevalence of breastfeeding among infants aged 12-15 months was 77.8% (95% CI: 76.4-79.3). The following variables were independently associated with a lower frequency of exclusive breastfeeding (< 6 months old) and breastfeeding: older age, lower level of maternal education, delivery via C-section, low birth weight, initial breastfeeding after the first hour, and separation of the mother-child dyad ≥ 4 hours a day. Conclusions. Exclusive breastfeeding at 6 months and continued breastfeeding showed certain improvement, but the rate of breastfed infants is still below desirable levels.

Prevalence of breastfeeding in the public health sector of Argentina according to the National Survey on Breastfeeding of 2017. / Prevalencia de lactancia materna en el sector público de salud de Argentina, según la Encuesta Nacional de Lactancia Materna, 2017.

INTRODUCTION: Breastfeeding reduces the risk for morbidity and mortality in children and also provides environmental and financial advantages. Breastfeeding monitoring is critical for public policies. OBJECTIVES: The objectives of this study were to estimate the prevalence of breastfeeding in the population seeking care in the public sector, compare this prevalence to data from 2015, and assess associated outcome measures. POPULATION AND METHODS: Cross-sectional, observational study. A structured questionnaire was used to collect intake and sociodemographic data from infants aged < 6 months (n = 15 322) and 12-15 months (n = 3243) who sought care from public sector health care providers spontaneously between August and September 2017. RESULTS: The prevalence of exclusive breastfeeding among infants < 6 months was 53.5% (95% confidence interval [CI]: 52.7-54.3); and at 4 and 6 months, 51.5% (95% CI: 49.7-53.4) and 41.7% (95% CI: 39.8-43.5), respectively. The prevalence of exclusive breastfeeding at 4 and 6 months increased compared to 2015 (p < 0.001). The prevalence of breastfeeding among infants aged 12-15 months was 77.8% (95% CI: 76.4-79.3). The following variables were independently associated with a lower frequency of exclusive breastfeeding (< 6 months old) and breastfeeding: older age, lower level of maternal education, delivery via C-section, low birth weight, initial breastfeeding after the first hour, and separation of the mother-child dyad ≥ 4 hours a day. CONCLUSIONS: Exclusive breastfeeding at 6 months and continued breastfeeding showed certain improvement, but the rate of breastfed infants is still below desirable levels.

Introducción. La lactancia materna (LM) reduce el riesgo de morbimortalidad en niños, además, provee ventajas medioambientales y económicas. El monitoreo de su práctica es indispensable para las políticas públicas. OBJETIVOS: Los objetivos de este trabajo fueron estimar la prevalencia de LM en la población que demanda al sector público, comparar la prevalencia con datos del 2015 y evaluar variables de interés asociadas. Población y métodos. Estudio transversal observacional. Mediante un cuestionario estructurado, se relevó información de ingestión y datos sociodemográficos de lactantes <6 meses (n = 15 322) y de entre 12 y 15 meses (n = 3243) que concurrieron en forma espontánea a efectores del sector público entre agosto y septiembre de 2017. RESULTADOS: La prevalencia de LM exclusiva (LME) en <6 meses fue del 53,5 % (intervalo de confianza del 95 % [IC95%]: 52,7-54,3); al cuarto y sexto mes, del 51,5 % (IC95%: 49,7-53,4) y del 41,7 % (IC95%: 39,8-43,5) respectivamente. La prevalencia de LME al cuarto y al sexto mes aumentaron en relación con el 2015 (p <0,001). La prevalencia de LM en niños de 12 a 15 meses fue del 77,8 % (IC95%: 76,4-79,3). Las siguientes variables se asociaron en forma independiente con menor frecuencia de LME (en <6 meses) y LM: mayor edad del niño, menor nivel educativo materno, parto por cesárea, bajo peso al nacer, puesta al pecho después de la primera hora y separación de la díada madre-hijo/a ≥4 horas diarias. CONCLUSIONES: La LME al sexto mes y la LM continuada muestran cierta mejora, pero aún la proporción de lactantes amamantados no logra alcanzar niveles deseables.

Attributes of the food and physical activity built environments from the Southern Cone of Latin America.

Previous studies have shown the influence of the physical and social environments on the development of obesity and non-communicable diseases (NCD). An obesogenic environment promotes higher dietary energy intakes and sedentary behaviors while limiting opportunities or incentives for active living. This paper presents a dataset with key attributes of the food and physical activity built environment, including green spaces, quality of streets and sidewalks, and different types of food retail outlets in four cities of the Southern Cone of Latin America. A total of 139 representative neighborhoods randomly selected from: Marcos Paz and Bariloche (Argentina), Temuco (Chile) and Canelones-Barros Blancos (Uruguay) were evaluated, where standardized community walks were conducted for direct observation of the built environment. This dataset will contribute valuable data to the evaluation of obesogenic environments in the region, and could be linked to additional ecological information about risk factors for NCDs and socio-economic features from other sources. Understanding environmental influences on cardiovascular risk factors and individual habits may help explain NCD outcomes and plan urban policies.

Dietary patterns and blood pressure in Southern Cone of Latin America.

BACKGROUND AND AIMS: in the Southern Cone of Latin America, previous studies have shown that blood hypertension is one of the most significant risk factor for cardiovascular disease, and diet plays a fundamental role. We analyzed the cross-sectional relationship between dietary patterns (DP) and blood pressure values in people involved in the CESCAS I Study. METHODS AND RESULTS: the participants (n = 4626) were derived from randomly selected samples in 4 cities (Bariloche and Marcos Paz, Argentina; Temuco, Chile; and Pando-Barros Blancos, Uruguay). To define DP, a food-frequency questionnaire was applied and principal component analysis was performed. Blood pressure was determined according to standardized guidelines. A multivariate regression model was developed to determine the association between each DP and blood pressure values, according to the quartile (Q) of adherence to DP. Two predominant DP were detected, Prudent (PDP, higher consumption of fruits, vegetables, legumes, whole grains, fish, seafood and nuts) and Western (WDP, higher consumption of red and processed meats, dressings, sweets, snacks and refined grains). A significant inverse association was found between adherence to PDP and systolic and diastolic blood pressure (-1.85 and -1.29 mmHg for Q4 vs Q1, respectively). Adherence to WDP was positively associated with systolic blood pressure (2.09 mmHg for Q4 vs Q1). CONCLUSION: the WDP detected in the studied population is positively associated with higher levels of blood pressure, while greater adherence to healthy DP has a positive impact on blood pressure.

Adaptación y confiabilidad inter-observador de un protocolo para evaluar la disponibilidad de alimentos en supermercados en Buenos Aires, Argentina.

Introducción: La Red Internacional para la Investigación, Monitoreo y Apoyo a la Acción para la Alimentación, Obesidad y Enfermedades No Transmisibles (INFORMAS por su sigla en inglés) ha desarrollado el Protocolo para evaluar la Disponibilidad de Alimentos en Supermercados. Objetivos: Describir el proceso de adaptación del protocolo para utilizarlo en la Ciudad de Buenos Aires (BA) y evaluar la variabilidad inter-observador al aplicarlo en supermercados de la ciudad. Metodología: El principal indicador del protocolo es la disponibilidad relativa de alimentos saludables (AS) vs. no saludables (ANS), calculado como el cociente entre la longitud (m) de estantes asignados a AS y ANS (longitudAS/ANS). Se adaptó la selección de alimentos a incluir en el indicador para utilizarlo en BA. Para explorar el funcionamiento del indicador se construyó una referencia, midiendo todos los alimentos y bebidas ofrecidos en 5 supermercados, que se clasificaron en AS y ANS según las guías alimentarias argentinas. El indicador se comparó con la disponibilidad relativa calculada a partir de la referencia. Para evaluar la confiabilidad inter-observador dos observadores realizaron mediciones en tres supermercados y se calculó el coeficiente de correlación intra-clase (CCI). Resultados: Según la referencia, el cociente longitudAS/ANS varió entre 0,16 y 0,61, con una media de 0,34 (DE 0,18). El indicador adaptado produjo resultados similares con una diferencia media de -0,05 (DE 0,04). El CCI entre la mediciones de ambos observadores resultó 0,92 (IC95% 0,86-0,98). Conclusión: Se adaptó el protocolo para aplicarlo en BA, con modificaciones en los alimentos a evaluar y una adecuada confiabilidad inter-observador.

Development of physical activity and food built environment quality indicators for chronic diseases in Argentina.

Although obesity and non-communicable disease (NCD) prevention efforts to-date have focused mainly on individual level factors, the social and physical environments in which people live are now widely recognized as important social determinants of health. Obesogenic environments promote higher dietary energy intakes and sedentary behaviors, thus contributing to the obesity/NCD burden. To develop quality indicators (QIs) for measuring food and physical activity (PA)-built environments in municipalities. A literature review was conducted. Based on the best practices identified from this review, a draft set of candidate QI was retrieved. The initial 67 QIs were then evaluated by a modified Delphi panel of multidisciplinary health professionals (n = 40) to determine their relevance, validity, and feasibility in 3 rounds of voting and threaded discussion using a modified RAND/University of California, Los Angeles Appropriateness Methodology. Response rate for the panel was 89.4%. All final 42 QIs were rated as highly relevant, valid, and feasible (median rating ≥ 7 on a 1-9 scale), with no significant disagreement. The final QI set addresses for the PA domain: (i) promotion of PA; and (ii) improvements in the environment to strengthen the practice of PA; and for Food environment domain: (i) promotion of healthy eating; (ii) access to healthy foods; and (iii) promotion of responsible advertising. We generated a set of indicators to evaluate the PA and food built environment, which can be adapted for use in Latin American and other low- and middle-income countries.

The built environment has a considerable effect on health indicators such as physical activity, eating behavior, and community. There is considerable research evidence demonstrating a direct relationship between our built environments and our health. In Argentina, the Healthy Municipalities and Communities Program focuses in health promotion interventions. It was developed to seek collaboration among community members, local government authorities and other stakeholders in order to improve quality of life. However, up to date, there has not been a homogenous measure to evaluate how well a particular locality or a whole municipality supports the health and wellbeing its residents. The proposed study aims to develop a set of local valid and common measures in order to evaluate what is happening within a particular municipality. A designated group of local experts will select a set of final measures trough out an iterative multistage process in order to combine opinion into group consensus. We will ask the panel to rate, discuss and re-rate the proposed measures (based on the existing evidence). This will study provide an evaluative tool to inform policy making and program implementation, and to guide programs and initiatives aimed at combating obesogenic environments in municipalities and communities.

Urban Retail Food Environments: Relative Availability and Prominence of Exhibition of Healthy vs. Unhealthy Foods at Supermarkets in Buenos Aires, Argentina.

There is growing evidence that the food environment can influence diets. The present study aimed to assess the relative availability and prominence of healthy foods (HF) versus unhealthy products (UP) in supermarkets in Buenos Aires, Argentina and to explore differences by retail characteristics and neighborhood income level. We conducted store audits in 32 randomly selected food retails. Food availability (presence/absence, ratio of cumulative linear shelf length for HF vs. UP) and prominence inside the store (location visibility) were measured based on the International Network for Food and Obesity/NCDs Research, Monitoring and Action Support (INFORMAS) protocol. On average, for every 1 m of shelf length for UP, there was about 25 cm of shelf length for HF (HF/UP ratio: 0.255, SD 0.130). UP were more frequently available in high-prominence store areas (31/32 retails) than HF (9/32 retails). Shelf length ratio differed across commercial chains (p = 0.0268), but not by store size or type. Retails in the lower-income neighborhoods had a lower HF/UP ratio than those in the higher-income neighborhoods (p = 0.0329). Availability of the selected HF was overcome largely by the UP, particularly in high prominence areas, and in neighborhoods with lower income level, which may pose an opportunity for public health interventions.

Estereotipos de género en la publicidad gráfica a través de folletos promocionales de las grandes cadenas de supermercados de Argentina / Gender stereotypes in graphic advertising through promotional brochures in the main supermarket chains in Argentina

FUNDAMENTOS: Hablar de equidad de género requiere de abordar estereotipos perjudiciales, donde a menudo se perpetúan a través de la publicidad. El objetivo del estudio fue explorar la construcción y reproducción de estereotipos de género presentes en la publicidad gráfica a través de folletos promocionales en las principales cadenas de supermercados de la Ciudad Autónoma de Buenos Aires (CABA), Argentina. MÉTODOS: Se desarrolló una metodología cualitativa usando análisis documental y muestreo intencional. Se recolectaron folletos de 8 principales cadenas de supermercados de la CABA durante 3 meses (960 páginas de folletos). RESULTADOS: Los hallazgos indican que existen marcados estereotipos de género en las publicidades impresas donde se representó a las mujeres en roles pasivos y tradicionales como madre-cuidadora y ama de casa; esta tendencia se vio asimismo en publicidades orientadas a la población infantil. La representación de hombres fue con actividades diferenciales y roles activos. Se observaron representaciones vinculadas a la mujer madre, cuidadora y ama de casa y al modelo de familia tradicional en torno a aspectos alimentarios. CONCLUSIONES: Se concluye que en las publicidades gráficas a través de folletos promocionales existen estereotipos de género sexistas, sin observar una evolución positiva hacia otros patrones de género, inclusión y diversidad

BACKGROUND: Talking about gender equity recquires facing stereotypes counterproductive, often perpetuated through publicity. The objective of the study was to explore the construction and reproduction of gender stereotypes present in graphic advertising through promotional brochures in the main supermarket chains in Buenos Aires (CABA), Argentina. METHODS: A qualitative methodology was developed, usingdocumentary analysis and intentional sampling. Promotional brochures were gathered from 8 supermarket chains of the CABA, along three consecutive months (960 pages). RESULTS: The findings of this study indicate that there are noticeable gender stereotypes in print advertisements (brochures), where women were represented in passive and traditional roles as mother-caregiver and housewife, a trend which was also seen in advertisements aimed at children. Representation of men included differential activities and more active roles. Representations related to the woman mother, caregiver and housewife and the traditional family model regarding food aspects were observed. CONCLUSIONS: It is concluded that there are sexist gender stereotypes in graphic advertising through promotional brochures, without any positive evolution towards other gender patterns, inclusion and diversity

Association between drinking patterns and cardiovascular risk: a population-based study in the Southern Cone of Latin America.

BACKGROUND: Using data from general adult population, this study aims to describe epidemiology of alcohol consumption patterns and their association with cardiovascular risk. METHODS: CESCAS I is a population-based study from four mid-sized cities in Argentina, Chile and Uruguay. Associations between diabetes, hypertension, dyslipidemia, cardiovascular disease (CVD) risk and history of CVD and drinking patterns were assessed using crude prevalence odds ratios (ORs) and adjusted OR. RESULTS: A total of 37.2% of the studied population never drank and 18.3% reported to be former drinkers. Among current drinkers, moderate drinking was the most frequent pattern (24.2%). For women with light and moderate consumption, the odds of having >20% CVD risk was ~40% lower than that of never drinkers. The odds of having a history of CVD was 50% lower in those with moderate consumption. For men with heavy consumption, the odds of having >20% CVD risk was about twice as high as for never drinkers. CONCLUSIONS: A harmful association was observed between heavy drinking and having >20% CVD risk for men. However, for women, an apparently protective association was observed between light and moderate drinking and having >20% CVD risk and between moderate drinking and having a history of CVD.

A review of assessment indicators used by Healthy Municipalities and Communities Program in Latin America and the Caribbean region.

The Healthy Municipalities and Communities Strategy (HMCS) was developed by the Pan American Health Organization in 1990. Evaluation and monitoring are fundamental components of health promotion policies. The aim of this study is to explore the indicators used in Latin America and the Caribbean (LAC) countries to assess the performance of HMCS. We searched MEDLINE, EMBASE, LILACS, BVSDE and Google Advanced Search for documents published between January 2000 and April 2016. We included only documents with assessment indicators of the strategy. All articles were independently assessed for eligibility by pairs of reviewers. We classified the indicators with a supporting framework proposed by O'Neill and Simard (Choosing indicators to evaluate Healthy Cities projects: a political task? Health Promot Int 2006, 21, 145-152.). Local level indicators figured far more prominently among countries and were distributed both in projects and specific activities. Regarding the evolution of the HMCS, indicators were reported in the five levels of analysis (local projects and activities, provincial, national and international networks). Empowerment was represented through the presence of active community organizations and different methods of community participation (forums, open hearing and participation maps). Public policies (such as for tobacco cessation) and bylaws adherence and changes in school's curricula regarding healthy eating were frequently mentioned. However, this review demonstrated that impact indicators related to lifestyle changes or built environment are not clearly defined and there is a lack of indicators to measure progress in achieving change in long-term outcomes in LAC. We highlight the importance of designing validated indicators for measuring the impact of health promotion policies in partnership with each country involved.

Associations between major dietary patterns and biomarkers of endothelial dysfunction in two urban midsized cities in Argentina.

OBJECTIVE: We examined whether dietary patterns (DPS) are associated with endothelial dysfunction (ED) markers in an Argentinian population. RESEARCH METHODS & PROCEDURES: The sample in this cross-sectional study was derived from 1,983 subjects from two mid-sized cities in Argentina who were involved in the CESCAS I Study. To define DP, a food-frequency questionnaire was applied. In a subsample randomly selected from the primary cohort, serum concentrations of C-reactive protein (hs-CRP), soluble vascular cell adhesion molecule-1 (sVCAM-1), soluble intercellular adhesion molecule-1 (sICAM-1), and soluble E selectin (sSELE) were determined. Correlations and multiple linear regression models were used to assess the relation between each quartile of DP adherence score and ED markers (Q1 lowest adherence; Q4 highest adherence). RESULTS: Three DPs were identified: Traditional (TDP), Prudent (PDP), and Convenience and processed (CDP). TDP was characterized by higher intake of refined grains, red meat, whole fat dairy products, vegetable oils, and "mate", a traditional South American infused drink; PDP was characterized by higher intake of vegetables, fruit, low-fat dairy products, whole grains, and legumes; and CDP consisted mainly of processed meat, snacks, pizza, and "empanadas", a stuffed bread served baked or fried. Lower scores (Q2, Q3) in TDP were inversely associated with concentrations of sSELE (P < 0.0001 and P < 0.05, respectively). In PDP, higher scores were inversely associated with hs-CRP, whereas lower scores showed a positive relation with sSELE (P < 0.05). Contrariwise, higher scores in CDP were directly associated with sSELE concentrations (P < 0.05). CONCLUSION: Adherence for each DP identified is differentially related to ED markers in the studied population.

Antecedentes familiares de cáncer de mama y colorrectal en una cohorte de población general en dos ciudades de Argentina / Family History of Breast and Colorectal Cancer in a Population-Based Cohort in two cities of Argentina

INTRODUCCIÓN: Los cánceres de mama (CM) y colorrectal (CCR) presentan una elevada carga de enfermedad en Argentina, por lo que el estudio de la epidemiología de estos tumores constituye una prioridad en salud pública. El objetivo del presente trabajo fue describir la prevalencia de antecedentes familiares de CM y CCR, y estimar la incidencia de los tumores en adultos de 35 a 74 años de dos ciudades de Argentina: Bariloche y Marcos Paz. MÉTODOS: En el marco de la cohorte prospectiva de población general CESCAS I (Estudio de detección y seguimiento de enfermedad cardiovascular y factores de riesgo en el Cono Sur de Latinoamérica), se recolectó información individual sobre antecedentes familiares de CM y CCR en una muestra representativa de las ciudades de Bariloche y Marcos Paz. Los casos de cáncer fueron investigados mediante documentación médica respaldatoria. RESULTADOS: Durante 2016-2017 se obtuvo información de 3245 participantes. El 8,4% de la población reportó antecedente familiar de CCR, y el 15,2% de las mujeres, de CM. La incidencia anual para el período 2011-2017 fue de 55,2/100 000 mujeres de 35 a 74 años (IC95%: 22,8-133,7) para CM y 8,5/100 000 adultos de 35 a 74 años (IC95%: 15,3-96,8) para CCR. CONCLUSIONES: Además de garantizar el acceso universal a los programas de tamizaje, se debe tener en cuenta la importancia de indagar sobre los antecedentes familiares de cáncer para identificar pacientes con riesgo aumentado, que requieren algoritmos particulares de detección temprana y vigilancia.

INTRODUCTION: Breast cancer (BC) and colorectal cancer (CRC) both present a high burden of disease in Argentina. Hence, studying the epidemiology of these tumors constitutes a public health priority. The objective of this study was to describe the prevalence of family history of BC and CRC and to estimate the incidence of these tumors in adults aged between 35 and 74 years from two cities in Argentina: Bariloche and Marcos Paz. METHODS: As part of the prospective population-based cohort CESCAS I (Study of detection and monitoring of cardiovascular disease and risk factors in the Southern Cone of Latin America), individual information on family history of BC and CRC was collected from a representative sample of the cities of Bariloche and Marcos Paz. Cancer cases were investigated using supporting medical documentation. RESULTS: During 2016-2017, information from 3245 participants was obtained. Family history of CRC was reported by 8.4% of the population, and 15.2% of women reported a family history of BC. The annual incidence for the 2011-2017 period was 55.2/100 000 women aged 35 to 74 years (95%CI: 22.8-133.7) for BC and 38.5/100 000 adults aged 35 to 74 years (95%CI: 15.3-96.8) for CRC.CONCLUSIONS: Besides guaranteeing universal access to screening programs, it is important to evaluate family history of cancer to identify patients with increased risk, who require specific early detection and surveillance algorithms.

Barriers and Facilitators for the Implementation and Evaluation of Community-Based Interventions to Promote Physical Activity and Healthy Diet: A Mixed Methods Study in Argentina.

Background: Obesogenic environments promote sedentary behavior and high dietary energy intake. The objective of the study was to identify barriers and facilitators to the implementation and impact evaluation of projects oriented to promote physical activity and healthy diet at community level. We analyzed experiences of the projects implemented within the Healthy Municipalities and Communities Program (HMCP) in Argentina. Methods: A mixed methods approach included (1) in-depth semi-structured interviews, with 44 stakeholders; and (2) electronic survey completed by 206 individuals from 96 municipalities across the country. Results: The most important barriers included the lack of: adequate funding (43%); skilled personnel (42%); equipment and material resources (31%); technical support for data management and analysis (20%); training on project designs (12%); political support from local authorities (17%) and acceptance of the proposed intervention by the local community (9%). Facilitators included motivated local leaders, inter-sectorial participation and seizing local resources. Project evaluation was mostly based on process rather than outcome indicators. Conclusions: This study contributes to a better understanding of the difficulties in the implementation of community-based intervention projects. Findings may guide stakeholders on how to facilitate local initiatives. There is a need to improve project evaluation strategies by incorporating process, outcome and context specific indicators.

Evaluación del impacto sanitario del Programa Estaciones Saludables en la Ciudad Autónoma de Buenos Aires, Argentina

[RESUMEN]. Objetivo. Explorar las motivaciones y expectativas de los usuarios del Programa de Estaciones Saludables en la Ciudad Autónoma de Buenos Aires y evaluar su potencial impacto sanitario. Métodos. Se realizaron entrevistas en profundidad (n = 34) y una encuesta autoadministrada (n = 605) a usuarios del programa. Se desarrolló un modelo epidemiológico para estimar el impacto del programa sobre los eventos cardiovasculares y los años de vida ajustados por discapacidad (AVAD). Resultados. Los principales factores motivadores para el uso de las estaciones saludables fueron la accesibilidad geográfica, económica (servicios gratuitos) y la satisfacción con la atención recibida. El 14,4% (intervalos de confianza del 95% [IC95%] 10,3–18,5%) de los usuarios hipertensos y el 24,8% (IC95% 17,6–32,0%) de los diabéticos informó haberse enterado de sus valores alterados en las estaciones saludables. Más de la mitad de los encuestados reportó alguna mejora de conocimientos sobre los beneficios de realizar actividad física y una alimentación saludable; esto fue más frecuente entre los usuarios más jóvenes, de menor nivel educativo, usuarios del sistema público de salud, usuarios de estaciones saludables de la zona sur y los que tenían algún factor de riesgo cardiometabólico (p<0.05). Se estimó que debido a la existencia de estaciones saludables se evitarían 12,5 eventos cardiovasculares y cerebrovasculares por año en la población asistida (4,75 eventos/100 000 personas) y 47,75 AVAD por estas causas. Conclusiones. Las estaciones saludables resultan un espacio propicio para la implementación de acciones de promoción de la salud y prevención, contribuyendo en la detección y facilitando el monitoreo de los factores de riesgo, con potencialidad para prevenir eventos cardiovasculares y sus consecuencias.

[ABSTRACT]. Objective. To explore the motivations and expectations of the users of the Program for Healthy Centers in the Autonomous City of Buenos Aires and to evaluate its potential health impact. Methods. In-depth interviews were conducted (n = 34) and a self-administered survey was sent to users of the program (n = 605). An epidemiological model was developed to estimate the impact of the program on cardiovascular events (CVE) and disability-adjusted life years (DALYs). Results. The main motivating factors for using the healthy centers were geographic and economic accessibility (free services) and satisfaction with the care received. 14.4% (95% CI, 10.3-18.5%) of hypertensive users and 24.8% (95% CI, 17.6-32.0%) of diabetic users reported having learned of their altered values in the healthy center. More than half of the respondents reported some improvement in their knowledge about the benefits of physical activity and healthy eating; this was more frequent among those who were younger, of lower educational level, users of the public health system, users of a healthy center in the South zone and those who had a cardiometabolic risk factor (p<0.05). It was estimated that the healthy centers would prevent 12.5 cardiovascular and cerebrovascular events per year in the assisted population (4.75 events/100 000) and 47.75 DALYs due to these causes. Conclusions. The healthy centers are a favorable space for the implementation of health promotion and prevention actions, contributing to the detection of and facilitating the monitoring of risk factors, with a potential to prevent cardiovascular events and its consequences.

[RESUMO]. Objetivo. Explorar as motivações e expectativas dos usuários do Programa Estações Saudáveis na Cidade Autônoma de Buenos Aires e avaliar seu impacto potencial na saúde. Métodos. Foram realizadas entrevistas em profundidade (n = 34) e uma pesquisa auto-administrada (n = 605) a usuários do programa. Um modelo epidemiológico foi desenvolvido para estimar o impacto do programa em eventos cardiovasculares e anos de vida ajustados por incapacidade (DALY). Resultados. Os principais fatores motivadores para o uso do estações saudáveis foram a acessibilidade geográfica, econômica (serviços gratuitos) e a satisfação com o atendimento recebido. 14,4% (intervalo de confiança de 95% [IC95%] 10,3-18,5%) de usuários hipertensos e 24,8% (IC95% 17,6-32,0%) dos diabéticos relataram ter aprendido sobre seus valores alterados na estação saudável. Mais da metade dos entrevistados relataram alguma melhora no conhecimento sobre os benefícios da atividade física e da alimentação saudável, com maior freqüência entre os mais jovens, de menor escolaridade, usuários do sistema público de saúde, usuários de estações saudáveis na zona sul e aqueles que apresentaram algum fator de risco cardiometabólico (p<0,05). Estimou-se que, devido à existência de estações saudáveis, 12,5 eventos cardiovasculares e cerebrovasculares por ano seriam evitados na população atendida (4,75 eventos/100 000) e 47,75 DALY por essas causas. Conclusões. As estações saudáveis são um espaço propício para a implementação de ações de promoção e prevenção da saúde, contribuindo para a detecção e facilitação do monitoramento dos fatores de risco, com potencial para prevenir os eventos cardiovasculares e suas consequências.

Occupational Physical Activity and Cardiovascular Risk Factors Profile in the Adult Population of the Southern Cone of Latin America: Results From the CESCAS I Study.

OBJECTIVE: We explore the association between occupational physical activity (OPA) and cardiovascular risk factors in four cities of the Southern Cone. METHODS: Robust multivariable linear regression models were used to examine the associations. RESULTS: The working population was constituted by 1868 men and 1672 women. Men performing high levels of OPA showed higher levels of high-density lipoprotein (HDL; mean adj. diff. = 2.24 mg/dL; P = 0.004), lower levels of triglycerides (-24.59 mg/dL; P = 0.006), and total cholesterol (TC)/HDL ratio values (-0.21; P = 0.015) than reference. Women in the highest category of OPA had higher levels of HDL (2.85 mg/dL; P = 0.006), lower TC/HDL (0.27; P = 0.001), and low-density lipoprotein/HDL ratios (-0.18; P = 0.003) than sedentary activities. CONCLUSION: Individuals who performed high levels of OPA did not exhibit a worse cardiovascular risk profile and an improvement on selected biomarkers was observed when compared with those performing sedentary activities.

Community-based cardiovascular health promotion in Argentina. A systematic review.

In Argentina, cardiovascular disease (CVD) accounts for 30% of deaths and more than 600 000 disability-adjusted life years. However, no reviews describing local studies on interventions to address CVD risk factors have been identified. The purpose of this study is to characterize those population-based interventions and public policies implemented in Argentina to reduce the burden of cardiovascular disease with an adequate evaluation of their impact on population health. We conducted a systematic review of studies that assessed interventions in health promotion and/or primary prevention conducted in adult populations of Argentina, addressing specific CVD factors, from 1999 to 2016. We searched major bibliographic databases, grey literature, ministries and secretariats of health, and academic national libraries. Key informants, non-governmental organizations, universities, hospitals and experts were also contacted. We applied specific inclusion criteria. We assessed the methodological quality of the studies and reported the effectiveness and impact of population interventions and policies, as well as process evaluations' characteristics. After removing duplicates we identified 1686 references from databases. After reviewing title and abstracts 18 studies were selected, five of them corresponded to evaluations of public policies-all addressing tobacco smoking. We presented a structured review of each experience. Most of the studies were deemed to entail moderate or high risk of bias. We summarized the findings and characteristics of these studies, including implementation strategies, process and impact evaluation. This is the first systematic review of interventions focused on primary prevention and health promotion to counter CVD and diabetes in Argentina.

[Health impact assessment of the Program Healthy Centers in the Autonomous City of Buenos Aires, ArgentinaAvaliação do impacto na saúde do Programa Estações Saudáveis na Cidade Autônoma de Buenos Aires, Argentina]. / Evaluación del impacto sanitario del Programa Estaciones Saludables en la Ciudad Autónoma de Buenos Aires, Argentina.

OBJECTIVE: To explore the motivations and expectations of the users of the Program for Healthy Centers in the Autonomous City of Buenos Aires and to evaluate its potential health impact. METHODS: In-depth interviews were conducted (n = 34) and a self-administered survey was sent to users of the program (n = 605). An epidemiological model was developed to estimate the impact of the program on cardiovascular events (CVE) and disability-adjusted life years (DALYs). RESULTS: The main motivating factors for using the healthy centers were geographic and economic accessibility (free services) and satisfaction with the care received. 14.4% (95% CI, 10.3-18.5%) of hypertensive users and 24.8% (95% CI, 17.6-32.0%) of diabetic users reported having learned of their altered values in the healthy center. More than half of the respondents reported some improvement in their knowledge about the benefits of physical activity and healthy eating; this was more frequent among those who were younger, of lower educational level, users of the public health system, users of a healthy center in the South zone and those who had a cardiometabolic risk factor (p<0.05). It was estimated that the healthy centers would prevent 12.5 cardiovascular and cerebrovascular events per year in the assisted population (4.75 events/100 000) and 47.75 DALYs due to these causes. CONCLUSIONS: The healthy centers are a favorable space for the implementation of health promotion and prevention actions, contributing to the detection of and facilitating the monitoring of risk factors, with a potential to prevent cardiovascular events and its consequences.

OBJETIVO: Explorar as motivações e expectativas dos usuários do Programa Estações Saudáveis na Cidade Autônoma de Buenos Aires e avaliar seu impacto potencial na saúde. MÉTODOS: Foram realizadas entrevistas em profundidade (n = 34) e uma pesquisa auto-administrada (n = 605) a usuários do programa. Um modelo epidemiológico foi desenvolvido para estimar o impacto do programa em eventos cardiovasculares e anos de vida ajustados por incapacidade (DALY). RESULTADOS: Os principais fatores motivadores para o uso do estações saudáveis foram a acessibilidade geográfica, econômica (serviços gratuitos) e a satisfação com o atendimento recebido. 14,4% (intervalo de confiança de 95% [IC95%] 10,3-18,5%) de usuários hipertensos e 24,8% (IC95% 17,6-32,0%) dos diabéticos relataram ter aprendido sobre seus valores alterados na estação saudável. Mais da metade dos entrevistados relataram alguma melhora no conhecimento sobre os benefícios da atividade física e da alimentação saudável, com maior freqüência entre os mais jovens, de menor escolaridade, usuários do sistema público de saúde, usuários de estações saudáveis na zona sul e aqueles que apresentaram algum fator de risco cardiometabólico (p<0,05). Estimou-se que, devido à existência de estações saudáveis, 12,5 eventos cardiovasculares e cerebrovasculares por ano seriam evitados na população atendida (4,75 eventos/100 000) e 47,75 DALY por essas causas. CONCLUSÕES: As estações saudáveis são um espaço propício para a implementação de ações de promoção e prevenção da saúde, contribuindo para a detecção e facilitação do monitoramento dos fatores de risco, com potencial para prevenir os eventos cardiovasculares e suas consequências.