"Mírame! To be a healthy adult in the 2000", a strategy to prevent cardiovascular diseases in a developing country<

Berríos Ximena, Guzmán Beatriz, Cifuentes Mónica, Nissinen Aulikki
Departament of Public Health, School of Medicine, Catholic University. Santiago de Chile. Chile
Departament of Public Health. University of Kuopio. Finland

Introduction: Cardiovascular diseases (CVD) are the main health problem in Chile. Risk factors have been assessed in adult population showing high prevalence rates, mainly physical inactivity, smoking, alcohol consumption in both sexes, plus obesity in women, all of them in the rise at this moment.
Objectives: To face this situation in future generations a demonstration program to prove intervention strategies in school population have been organized.
Material and methods: For evaluation purposes a quasi-experiment was designed selecting intervention (IP) and reference population (RP). 5th and 6th grades are the target population, both sexes. A baseline prevalence survey and an interim survey after two years of intervention were planned. Behavioral RF (BRF) as smoking (SMK), alcohol intake (OHI), marijuana use and physiologic RF (PRF) as obesity (OB) hypertension (HBP), alteration of lipid profile and knowledge, attitudes, perceptions as well were assessed as indicators of effect of intervention. Based on Social Learning Theory, intervention strategies were curricular insertions teaching skills to resist peer pressure. The first evaluation was two years after intervention. The family was an important component of the strategy.
Results: 2686 children both sexes are in both study population. Mean age 11.4 years, range 9-16. 40% of the population are in middle and low-middle social class. Teachers and parents are very keen to the program. OHI is the main BRF and HBP and OB in PRF. P of RF increased with age. Evaluation showed and effect in SMK of 8% and OHI of 10%.
Conclusions: An intervention model to promote healthy lifestyles has been proved in an urban community in a developing country. Preliminary evaluation is encouraging mainly for its effect.

Rheumatic disease at the Southeast Health District. A 10 years-old follow-up. 1976-1985<

Berríos Ximena, Gómez M. Inés, Guzmán Beatriz
Departament of Public Health, School of Medicine, Catholic University. Santiago de Chile. Chile

Introduction: Rheumatic Disease (RD) remains as an important cause of morbility in some countries.
Objectives: To characterize acute episodes in a 10 years-old period.
Material and methods: This survey was conducted in the Southeast Health District in the Metropolitan Region, where live mostly people in low-middle and low social class. The study population was inpatient between January 1976 and December 1985 at Sótero del Río Hospital. All patients were assessed by: 1: history; 2: physical examination; 3: general laboratory; 4: laboratory to detect previous streptococal infection (SI): pharyngeal sample and antistreptococcus antibodies.
Results: 319 episodes of RD. Patients were mostly female, young aged (0: 15.6 years-old) and living in low social class in the urban area. RD had highest rate of prevalence in the autumn and in spring. Carditis was severe in 25.2%, milded in 42.2% and light in 32.6%. 27% were relapse, only 23.8% had RD antecedent. Evidence of previous RD was founded only in 0.9% (scarlet fever). If the study is divided in five-year period: carditis decreased as in frecuency (45% to 35%) as in risk (17.6 to 6.5 per 100.000 inhabitants). Infections were less inmunogenic in the second period: antibodies titers decreased from 72.4% to 57%.
Conclusions: RD decrease in the entire period and it tends to be less severe in the second one. These changes are most similar to ones showed in developed countries.

Rheumatic fever at the Southeast Health District. 12-years-old surveillance study<

Berríos Ximena, Gómez M. Inés, del Campo Emilio, Guzmán Beatriz, Rodríguez Cecilia, Quesney Francisco
Departament of Public Health, School of Medicine, Catholic University. Santiago de Chile. Chile

Introduction: In 1976 was started at the Southeast Health District (SSMSO) a prospective study to characterize the active rheumatic disease (ARD) which represented an important cause of hospitalization in that period.
Objectives: To characterize the active rheumatic disease (ARD).
Material and methods: All inpatient with ARD diagnosed according to Jones´s criteria were included between January 1976 and December 1987 at Pediatrics and Internal Medicine Service in the Sótero del Río Hospital. Patients were assessed with: 1: clinical-epidemiological data; 2: general laboratory; 3: laboratory to found previous streptococal infection (SI): pharyngeal sample and antistreptococcus antibodies. Serologic evidence of ARD was assessed measuring: 1: high antistreptolisin-O (ASO) titers (_ 333 U) and 2: two-titers difference between two samples at the same time.
Results: 401 ARD episodes were founded. The distribution was characterized as a first period or epidemic period (EP) between 1976-1977, an endemic period (ENP) between 1978-1985 and an outbreak (O) in 1986-1987. The highest prevalence of ARD was founded in female and adolescents in low social class. Arthritis, carditis and corea were the most common clinical manifestations. SI was founded only in 14.3% (1976-77). Serologic confirmation had its highest frecuency at the same period: 82.5%, decreasing to 64% and 59.8%, respectively. The Jones´s criteria were fulfilled in 85.8% in 1976-77, 96.4% in 1978-85, and 97.6% in 1986-87, respectively. Most of episodes founded were first outbreak. Relapse was founded in the ENP: 35.9%.
Conclusions: Characteristics of the population with ARD are similar to reported by international surveys. Arthritis, carditis and corea were the most common clinical manifestations. Serological response decrease during the period. This data could be useful in countries where the ARD prevalence remains high.

Rheumatic reactivation induced darditis (RRC) as an intraoperative finding during valve surgery<

Banerjee A, Mathew S, Panwar S, Akhter M, Gupta V, Shinde M
Department of Cardiothoracic Surgery, Govin Ballabh Pant Hospital. New Delhi. India

Rheumatic fever remains the most important cause of valvular heart disease in the developing world. Poor socioeconomic status renders rheumatic prophylaxis erratic and inefficient. Because of its endemicity, a large number of patients present with severe valvular ailments requiring surgery. Many of these patients have ongoing subclinical rheumatic activity or recurrent carditis. The surgeon may encounter RRC with operative findings like haemorrhagic pericardial effusion, intractable myocardial irritability, epimyocardial plaques, mushy and friable cardiac tissues or severe, dense pericardial adhesions. The objectives of this study are (a). to ascertain the role of RRC as a determinant of morbidity and mortality; (b). to evaluate the predictive utility of diagnostic tests; and (c). to disprove the existence of any age-barrier for RRC. Between June 1989 and May 1999, 2,889 patients underwent surgery for valvular heart disease. The operative expenses including cost of prosthetic valves, were borne by the state. All patients underwent clinical evaluation and appropriate laboratory tests, viz., ESR,anti-streptolysin O, C-reactive protein and throat swab culture. RRC, whenever suspected, was treated with aspirin or steroids and surgery usually deferred for 6-8 weeks. A similar regime was started and continued if RRC was discovered at surgery. We found RRC in 896 (31%) cases. Amongst them, 402 (44.9%) were diagnosed preoperatively but had no corroborative operative findings. In 233 (26%) cases, surgical confirmation was available and in 261 (29.1%) surgical findings of RRC came as a surprise. Thus 494 (17.1%) had operative evidence of RRC. 56 (11.3%) of them were above 40 years of age accounting for 18.5% of all patients above forty. The seniormost patient with such findings was 56-years-old. Our study suggests that sustained/ recurring rheumatic activity is quite frequent amongst patients suffering from valvular heart disease in a developing country. Vulnerability to this condition transgresses all age-barriers.


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Publicación: Diciembre 2000

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