Vol.48 - Número 4, Octubre/Diciembre 2019 Imprimir sólo la columna central

Differences in risk factors and self-care measures among Cardiology residents at
Public and Private Hospitals: Analysis of the FRiCCAr survey.


BRAIAN CARDINALI RÉ; MATÍAS GÓMEZ; JUAN PABLO CATTANEO; ROMANO TRIONFI;
MACARENA COUSIRAT LIENDRO; PAULA BERLIER; ALAN SIGAL; EMMANUEL SCATULARO;
SEBASTIÁN GARCÍA ZAMORA.
* En representación de CONAREC (Consejo Argentino de Residentes de Cardiología)
(1900). La Plata, Buenos Aires, Argentina.
E-mail
Recibido 27-ENE-2019 ACEPTADO después de revisión el 21-MARZO-2019.
There are no conflicts of interest to disclose.

 

ABSTRACT

Physicians, especially cardiologists, struggle daily with cardiovascular risk factors that cause our patients to suffer diseases that condition their quality of life; but in that fight we forget that we are people immersed within the same society, harassed by the same "ghosts" that haunt our patients, and often we put aside our personal care.
Although from the FRICCAR survey developed in 2017 at country level, there has been progress in the knowledge of cardiovascular risk factors in cardiologists in Argentina, there is still uncertainty about its distribution in the public and private sector.
That is why as a goal we propose to determine if there are differences in cardiovascular risk factors and self-care measures among Cardiology residents in the public sector and those in the private sector in our country.
Conclusion: There was a high rate of overweight and obesity, sedentary lifestyle, smoking and dyslipidemia in residents of Cardiology, taking into account the average age of this population. There were no differences in them between the private and public areas, except in the sedentary lifestyle and benzodiazepine consumption that were greater in the group of public residencies. Strategies should be implemented to promote the practice of healthy lifestyles among health professionals in all areas.
Key words: Risk factors. Cardiology residents. Public health sector. Private health sector.

 

INTRODUCTION
Noncommunicable chronic diseases represent the greatest load of health care in developed countries and are a rapidly growing problem in underdeveloped countries, as our own country. In most of the world, three every four deaths are due to cardiovascular diseases, cancer and other diseases such as diabetes, hypertension, chronic respiratory disease, all of them having as cornerstone, cardiovascular risk factors originating them; risk factors such as smoking, obesity and excessive consumption of salt, among others [1].

A cardiovascular risk factor (CVRF) is a biological trait or a habit or lifestyle aspect that increases the chance of suffering or dying by a cardiovascular disease (CVD) in individuals that present them.

The main risk factors could be nonmodifiable (age, gender, genetic factors/family history) or modifiable, precisely the most interesting ones, as we can act on them preventively: hypertension (HTN), smoking, hypercholesterolemia, diabetes mellitus (DM) and overweight/obesity (particularly abdominal or visceral obesity), frequently coupled with physical inactivity.

These are the so-called major and independent risk factors, and are those that have a stronger association with CVD, being frequent in the population [2,3].

We, physicians and particularly cardiologists, fight daily against cardiovascular risk factors that make our patients suffer diseases that condition their quality of life; but in such struggle, we forget we are people immersed within the same society, suffering the same “ghosts” that haunt our patients, and in our eagerness to provide care, we leave aside our own care [4].

Although from the FRICCAR [5] survey, we have advanced in the knowledge of cardiovascular risk factors (CVRF) in cardiologists in Argentina, there is still uncertainty as to its distribution in the public and private sectors.


Aims
To determine whether there are differences in CVRF and self-care measures between Cardiology residents from the public sector and the private sector in our country.

 

MATERIAL AND METHODS

Inclusion criteria:

  • Cardiology residents belonging to the cardiology residencies throughout the country, regardless of whether they are associated or not to CONAREC.

Exclusion criteria:

  • Physicians who are specialists in cardiology.
  • Physicians who are performing a specialty other than cardiology or a subspecialty of it.
  • Also, physicians will be excluded who, having completed a cardiology residency, are working on a specialty other than this.
  • Similarly, professionals who are retired from all their tasks will be excluded.

 

METHOD
An analysis was made on the social, demographic and clinical characteristics of residents in public and private institutions, included in the FRICCAR (Cardiovascular Risk Factors in Argentine Cardiologists and Cardiology Residents) survey, which was closed and preset, voluntary and anonymous, with convenience nonprobability sampling, developed in year 2017 in centers belonging to the CONAREC (Consejo Argentino de Residentes de Cardiología [Argentine Council of Cardiology Residents]). A statistical difference with a value of P<0.05 was considered significant.

Data collection: It was conducted during the months of August, September, October and November 2017, including participants by personal interview or performance of a self-administered survey (see Appendix I).

Data uploading will be made online, through the Web page of the Council (www.conarec.org), through an electronic case report form – eCRF; especially designed with exclusive access through an individual password. Automatically and immediately, the data will be added to the central database, from where the subanalysis presented here comes from.

 

RESULTS
The social, demographic and clinical characteristics of 278 residents belonging to 22 residencies in the private sector (n=174) and 18 residencies in the public sector (n=104) were analyzed. Table 1.

Table 1. Characteristics of the population studied
  Characteristics of the population Residents in public hospitals (n=104) Residents in private hospitals (n=174)
    Male gender
Age (mean ± 2SD)
Hypertension
Smoking
Dyslipidemia
Diabetes
Abdominal perimeter >88 cm in women
Abdominal perimeter >102 cm in men
Absence of health controls
Practice of physical activity
Benzodiazepines consumption
Antidepressants consumption
57 (54.8%)
29.24 ± 5.04
3 (2.88%)
20 (19.2)
12 (11.5%)
-
2 (2%)
11 (10.6%)
55 (53%)
54 (52%)
5 (5%)
2 (2%)
97 (55.74%)
28.87 ± 4.96
3 (1.7%)
31 (18%)
13 (7.5%)
1 (0.5%)
8 (4.6%)
8 (4.6%)
78 (45%)
118 (68%)
-
-

 

Between the residents in the private and public sectors respectively, we found a prevalence of hypertension in 2% and 3% (P=0.82); dyslipidemia in 8% and 12% (p=0.35); active smoking in 18% and 19% (p=0.98); salt addition in food in 41% in both groups, and a single case of diabetes mellitus. There were no differences in the rate of waist perimeter greater than 88 cm in women (5% and 2%) and 102 cm in men (5% and 11%) respectively (p=0.83).

Between the self-care measures, physical activity is significantly less practiced between residents from public hospitals: 52% versus 68% (OR: 0.51; 95% CI: 0.31-0.84; p=0.01). On the other hand, the performance of periodical medical checks was similar in both groups: 55% in the private sector and 47% in the public sector (p=0.29).

As to medications consumption, the most used ones were antacids, equally in both populations, and a higher tendency to more consumption of benzodiazepines in the public sector residents: 5% vs 0.1% (p=0.05).

 

CONCLUSIONS
A high rate of overweight and obesity, sedentarism, smoking and dyslipidemia was evident in Cardiology residents, taking into account the average age of this population. There were no differences in these parameters between the private and public sectors, except in sedentarism and benzodiazepines consumption, which were higher in the group with public residencies.

Consequently, we should implement strategies to favor the practice of healthy lifestyles between health care professionals in all sectors.

 

Figure 1.

 


BIBLIOGRAPHY

  1. Organización Panamericana de la Salud. Enfermedades Transmisibles y Análisis de Salud/Información y Análisis de Salud. Situación de la salud en las Américas: indicadores básicos 2016. Washington, D.C.: OPS; 2016.
    https://www.paho.org/salud-en-las-americas-2017/wp content/uploads/2017/09/Print-Version-Spanish.pdf

  2. OMS. Informe sobre la situación mundial de las enfermedades no transmisibles. Ginebra: OMS; 2014. https://apps.who.int/iris/bitstream/handle/10665/149296/WHO_NMH_NVI_15.1_spa.pdf;jsessionid=
    18D186D8E94FC559DC05382DDE40B215?sequence=1

  3. Guijarro C, Brotons C, Camarelles F, et al. Primera conferencia de prevención y promoción de la salud en la práctica clínica en España: Prevención cardiovascular. Aten Primaria 2008; 40: 473-74.
  4. Lobos Bejarano JM, Royo-Bordonada MA, Brotons C, et al. Guía europea de prevención cardiovascular en la práctica clínica. Adaptación española del CEIPC 2008. Aten Primaria 2009; 41: 463.e1-463.e24.
  5. Pulenta H, Burgos LM, Cigalini I, et al. Factores de riesgo cardiovascular en residentes y cardiólogos argentinos. “Cómo se cuidan los que cuidan”. Encuesta FRICCAR, CONAREC. Revista del Consejo Argentino de Residentes de Cardiología 2018; 147: 0308-0312.

Publication: December 2019



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