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First Virtual Meeting on Cardiovascular
Prevention in Young People

Debate Subject:
A Challenge: Is it possible for us to get integrated
to develop this task? How?

Coordinator:
Bernardo Igolnikof M.D., Argentina
Committee for Cardiovascular Prevention in Young People
of the Inter-American Heart Foundation

Panelists:

Ximena Berrios (XB) M.D., Universidad Católica de Chile
Diana Molina (DM) M.D., Fundacor, Venezuela
Cándida Linares (LC) BS and Eng. Marielba Cordido (MC), Fundación Venezolana del Corazón
Gustavo Anzola (GA) M.D., Fundación Precardio Nuevas Esparta, Venezuela
Diego C. Garófalo (DG) M.D., Fundación FAC, Argentina
Nery Suarez Lugo (NS) M.D., Escuela Nacional de Educación Pública, Cuba
Eduardo Bianco (EB) M.D., Uruguay
Yvonne García Richaud (YG) M.D., AMPAC, México

Only guest experts on the topic from different Latin-American countries took part in this Debate, proposed by the Coordinator of the First Virtual Meeting on Cardiovascular Prevention in Young People, Dr. Bernardo Igolnikoff.-
We consider that the Debate was completely successful, and the results obtained will represent undoubtedly, a significant contribution to the operation of the Committee for Cardiovascular Prevention in Young People and the Inter-American Heart Foundation.-
We want to emphasize this unprecedented, successful pilot experience, developed in this Congress.-
We will repeat in the future the use of this methodology, which is quick, simple and economic, since as it has been proved, it is feasible to gather groups of experts from anywhere in the world to discuss on a given topic without time, cost or distance limitations.

Dr. Florencio Garófalo
Dr. Raul Bretal
President of the SVCC
President of the Scientific Committee of the SVCC

 

QUESTION 1
Do you think it is important to develop a joint and organized task in America about
prevention of cardiovascular diseases in young people, addressed to the community?

Panelists' Comment
Coordinator's Comment

QUESTION 2
Do you think that is feasible to carry out a task with these characteristics?
Please, state three reasons that you consider fundamental to answer positively or negatively.

Panelists' Comment
Coordinator's Comment

QUESTION 3
Which do you think must be the 5 most important objectives that this task should meet,
and the 5 initial requirements that it must have to begin developing it?

Panelists' Comment
Coordinator's Comment

QUESTION 4
Why do you think that if this task is feasible, it hasn't been developed until now?
Please, state the two reasons you regard as the most important ones.

Panelists' Comment
Coordinator's Comment

QUESTION 5
Within what framework this task should be developed?
Do you wish to participate?

Panelists' Comment
Coordinator's Comment

CONCLUSIONS

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REPLIES QUESTIONS 1

DG
   I think it is very important to develop a joint and organized task in America about prevention of cardiovascular diseases in young people since this would allow us to unify criteria, to share regional difficulties in the application of preventive programs, and it could generate a higher degree of awareness regarding the problem in the authorities of each Nation.

   I believe that having a unified Program, adapted to each region, would be very valuable, as well as sharing the results from its application.

GA
   Definitely, YES. A common population strategy in America regarding Prevention of Cardiovascular Diseases in young people would hugely help to improve the negative statistics that exist in our countries regarding such pathology.
What is important here ("a titanic work"), is to convince our governments that different ministries should get involved: Health, Education, and Communications, as well as commitment by private companies in a united fight with approaches more or less similar, so that the results would be comparable in some way.

CL
   Yes, I think that it is important to develop a joint population strategy at continental level.

XB
1.- First, I would like to be precise about a term in the question.
   I mean that when we mention the Region of America, the two sub-groups that make up this Continent must be separated, since there is no similarity at all, for instance, between the South Cone countries and Canada or USA.
For operative purposes, such as community interventions, we must think of Latin-America and the Caribbean, as a group of countries with similarities. This doesn't mean that we will exclude USA and CANADA from the discussion. On the contrary, they can assist us with technical and financial help due to their years working on this, and their experience in the topic of Prevention at Early Ages, and because of their better economies when compared to our Latin-American and Caribbean countries.
2.- Now that this point is clear, I think that making alliances between the different countries in our region is very important; e.g. SOUTH CONE, CARIBBEAN, ANDEAN COUNTRIES, and so on; which have similar cultural patterns and economies.
3.- The rationale of these alliances is based in different facts:
-One of them is that to develop any initiative, we will need resources. The international agencies capable of helping with financial contributions through Research Grants, provide an opportunity to the regional and multicenter proposals, rather than isolated small countries.
-Secondly, we ignore more than we know about how to face this new kind of health problems that have already invaded us, and by developing joint and collaborative works, in which each group contributes with their talents that can be supplementary to each other, we can strengthen the possibilities of doing something efficiently and successfully.
-We know that there are already some Centers in the Region that have been developing strategies for some time, with a community or population approach, with different degrees of success, which could work as support for those countries or communities that have not started yet this type of initiatives.

   In brief, when facing an emerging enemy for some, and already installed for others, RESOURCES must not be lost, and least of all we must not waste time trying again what has already been tried; among them, strategies that can be applied to the whole Latin-American Community.

   I will wait for the following questions to comment on: WHAT TO DO??

MC
   I think it is important to develop tasks that would allow making of prevention for Cardiovascular Diseases in young people a daily, continuing task; integrated to education. Based on common points, these actions or tasks must be simple, easy to adopt in each age, and adjusted to the reality of each country.

NS
   The community is a scenario very appropriate to educate and modify attitudes and behaviors related to health, since they are behaviors basically learnt, and the social environment makes this easier or not.

   About this I think it is important to take into account the following aspects:   
1.- When we are considering the behaviors that are risk factors in cardiovascular disease, i.e. smoking, diet, physical exercise among others, we should analyze with more details on which of them we can act from the community and on which not.
2.- Evidently, we can work on the community from different points of view, depending on the socio-economical strata or groups, since in places that gather families with lower incomes, community work generally is more effective.
3.- One last point that I would like to comment, is that when we mention the community, we do not have to limit ourselves to think of educational elements, since by themselves these are not capable of achieving the appropriate behaviors for health, but we should consider all those that are related to the environment, and that can act to make it easier or act as obstacles.
4.- To develop a joint and organized task in America makes work easier, because Guidelines are offered to work, which each country and territory adapt to their particular conditions, and besides it favors the work of Public Policies.

EB
   I think it is very important to develop a joint and organized task at the level of America, so as to achieve the highest impact possible on the behavior of our teenagers.

   Evidently, there are regional differences that we must take into account. But the joint effort will provide us with more information, and will collect valuable experiences that we will be able to share, making our task easier, and strengthening our achievements.

   A very important element to take into account, is that it is not easy to influence on the behavior of teenagers, so we have to sharpen our ingenuity and capability to develop tools that will allow them to acquire skills and habits that will lead them to life styles oriented to health and to fully enjoy life.

   The challenge is very important, and I am very happy to participate with you in this exchanging experience that will be fruitful for everyone.

Coordinator's Comment
   YES, IT IS IMPORTANT.

   ALL PARTICIPANTS AGREE IN THE IMPORTANCE OF DEVELOPING A WORK FOR CARDIOVASCULAR PREVENTION IN YOUNG PEOPLE IN AMERICA.

   The importance of considering the different regional, national and local realities is stressed, as well as exploiting existing resources, experience and knowledge for their implementation.

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REPLIES QUESTION 2

NS
  YES, THE REASONS ARE THE FOLLOWING:
  The problem is common, so it involves us all.

   There is an organization that allows to center efforts, share experiences and prepare strategies. There are human resources trained to face it.

MC
   Yes, I think it is possible to do it, since we have a net of organizations that allows us to transmit information, first, and this is one of the main assets that we obtain by being members of a continental organization.

   Secondly, at national level we make up a net of organizations that also works this way, which provides a certain weight to the actions taken at national level about it. And in the case of those countries that don't do it, the strategic alliances that the organizations establish with educational and governmental institutions in those countries, would allow us the dissemination of these tasks.

   Thirdly, I think that this is one of the main tasks that our organizations devoted to prevention have, to influence on our population's education, especially in young people so that they would become healthy adults. This is why it is important to take a determined and global action in educational programs delivered in America.

EB
   Yes, I think it is feasible to carry out this work at continental level, although I admit that it won't be easy, and that it will take some time.
   The reasons for my positive answer are:

1) There are important international organizations, such as the World Health Organization and the Pan-American Health Organization, which are already working and supporting studies on knowledge, attitudes and beliefs in teenagers that encourage the adoption of behaviors with a high risk of producing cardiovascular diseases, such as smoking. At the same time work is being done regarding opportunities and ways for intervention, not specifically addressed to diminish the possibilities of young people smoking, but to the acquisition of proper information, the development of social skills that would tend to a higher self-esteem, and therefore, to a choice in healthier life habits.
2) The health in children and teenagers is a sensitive topic for our populations. If we can make them aware about the importance for children to learn habits for a healthy life, maybe we can influence on politicians and rulers, who in general "count the votes" before making up their minds to support a strategy or not. Personally, I think we can do it.
3) We have in our countries, prestigious health institutions that are convinced of the importance of prevention; they only need motivation and to join them with a common, well-defined goal, such as the topic of teenagers and prevention of cardiovascular risk and quality of life.

CL
   Yes, I think about the possibility of making this. It is a task for the different organizations devoted to preventing diseases, and to supporting especially children and teenagers through the education in our population, for them to become healthy adults.

GA
   Yes, I think that a task with these characteristics is feasible.

   Main reasons for this statement:
A) The importance of CV diseases as a cause for death and disability in men and women in most American countries (SHARED PROBLEM).
B) The existence of Foundations and Cardiological Societies gathered in Associations (Latin-American, Inter-American and so on) that are aware of the problem, and are listened to and respected internationally.
C) The interest for Education governments claim to have, on which we must work to show that Prevention is a synonym for Education of the general population (Dr. Edgardo Escobar) and if we begin in preschool and basic education, better results will be achieved.

DG
-I think that its feasibility depends mostly on the commitment by the different agents involved, that is to say: medical doctors, not-for-profit institutions (regional Foundations and IAHF), official health and educational organizations, mass media, educational media, etc.
-I think that a unified implementation program is indispensable, which would give School a predominant role in its initial cycles in its development.

- I do not think that the economic aspect is an obstacle to carry it out.
- There are no communication barriers (and this Congress proves it) to interact internationally in creating a Program with this purpose and in the assessment of its results.

XB
   My AFFIRMATIVE reply is the following:
REASON 1.- A problem common to all Latin American and Caribbean countries with a different level of magnitude, but already existing.
REASON 2.- There is awareness about the existence of the problem, although with different levels of clarity regarding its perception.
REASON 3.- There is a capability installed and already working and with experience, in some countries of the Region, which could be exploited at a national level in these countries, and which could be exploited too, by introducing small modifications in form to be useful in other countries of the Region. This would allow to take advantage of the already existing experience, and thus to save resources and most of all time, both currently at a critical level.

   My reply with NEGATIVE CONNOTATIONS is the following:
REASON 1.- Although there is awareness of the problem at regional level (I mean the problem of CVDs), there are countries where there is no clarity about its extent, neither is sufficiently characterized so as to initiate subsequent actions.
REASON 2.- Although there are international organizations such as PAHO, WHO, WORLD BANK, others that could be a great foundation for a Net of "integrated actions to develop the task of cardiovascular prevention in young people" as the title of this "virtual meeting", this has not always been thus translated in practice. The reason is well known by everyone, and this is that all "organizations" like these ones, are subject only to agreements with each country's Governments and their structures, thus leaving aside non-governmental organizations and institutions, such as Universities, NGOs, Foundations, Scientific Societies, and so on, which for different reasons are not considered in some countries in spite of having a lot to contribute in this topic.
    I'd like to draw attention on the significant role of not-for-profit International Foundations, with altruistic objectives, such as the IAHF, which are not "bound" to governments or specific institutions to help revert this negative situation.
REASON 3.- There is a lack of political will to act and lack of commitment to help in preventive actions from some sectors in our countries, included sectors of the medical and educational communities, mass media, pharmacological industry, organized community, political class, etc., and finally there is a lack of vision in some governmental sectors to take advantage of the existing options, which translates into lost opportunities to initiate actions scientifically proven to be efficient and feasible for preventing CVDs in childhood and adolescence.

Coordinator's Comment
   YES, IT IS FEASIBLE

   THERE IS TOTAL AGREEMENT ABOUT THE FEASIBILITY OF DEVELOPING THIS TASK, BASED MOSTLY IN THE EXISTENCE OF ORGANIZATIONS (FOUNDATIONS AND SOCIETIES) IN AMERICA WITH CAPACITY TO DEVELOP IT. THE POINT OF VIEW ABOUT THE LACK OF EXPECTATIONS FOR SUPPORT, IN GENERAL, FROM GOVERNMENTS AND INTERNATIONAL ORGANIZATIONS IS ALSO CLEAR.

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REPLIES QUESTION 3

MC
   Objectives:
1- To identify in each country, the life style of young people: diet, physical activity, habits.
2- To disseminate the information in all the countries of America.
3- Basing ourselves in this information, we should define general guidelines about how to carry out cardiovascular prevention in young people, which could be applied in educational curricula that would respond to the reality of each country.
4- To get young people to know how to prevent cardiovascular diseases.
5- To get young people to become multipliers of prevention for cardiovascular diseases toward the community.

   Initial Requirements
1- To make up a multidisciplinary team: medical doctors, educators, young people, all from the different countries, committed to collect the necessary information to develop the proposed activity.
2- To establish the governmental and non-governmental alliances necessary to obtain the information required.
3- To begin.

DG
   Objectives

1- To make a population survey on risk factors and cardiovascular diseases in America.
2- To raise awareness in the population about the possibility of preventing the occurrence of cardiovascular events.
3- To identify habits and life styles that would favor the development of these risk factors, getting to identify risk families through the children so as to act on them.
4- To revert this behaviors since childhood.
5- To diminish the prevalence of cardiovascular diseases in America.

    Requirements

1- A "unified" program for preventing cardiovascular diseases since childhood all over America.
2- Fundamental role of the School to achieve that such program would get a place in the "obligatory" curricula in the initial stages of learning.
3- To encourage teachers during their training about prevention of cardiovascular diseases, providing them with working materials for the classroom (manuals, leaflets, related games, prizes for contests, and so on).
4- Support by the resolution or declaration of "national interest" for the Program in each country, supported by health international organizations (IAHF, WHO, PAHO, and so on).
5- Active participation of the media in the dissemination of the Program (e.g. American networks for children).

NS
   Main Objectives:

1. To optimize human and material resources.
2. To share and assess experiences.
3. To reduce threats and difficulties.
4. To maximize assets.
5. To identify opportunities.

   Initial Requirements:

1. Political Will to tackle the task.
2. To work with material resources that would make its realization possible.
3. To identify people and entities with experience.
4. To create a Multidisciplinary Team.
5. To assign a Reference Center.

EB
   The most important objectives would be:

   Primary Objective: Decrease of Prevalence of Cardiovascular Diseases in America, promoting healthy life habits in our youth.

   Intermediate Objectives:
1. What can we change? To define which are the modifiable behaviors or those to be encouraged between young people so as to reach the greatest impact on Cardiovascular Disease Prevention. The way I see it, there are three that would get that goal:
a) To avoid tobacco consumption and to Promote an early quitting of it.
b) An appropriate nutrition.
c) Regular physical activity.
Thus, we are acting on the main modifiable vascular risk factors (Smoking, Obesity, Dislipaemia, High Blood Pressure, Stress, Sedentarism).

2. How are we going to make young people adopt these behaviors? To define which are the tools or strategies to achieve such behavioral change. To be able to answer this question, we must understand first why young people perform improper behaviors, opposed to the ones we propose, and although all of them have common points, they also have their peculiarities.
---Is it due to ignorance? It doesn't seem to be the fundamental element, because there is a lot of information and it could be reached by everyone. Anyway, the basis for any process of change in behavior begins at a cognitive level, and the educational factors are fundamental to achieve it.
---Is it because of social models? (Parents, friends, study mates, and so on). This would be important regarding smoking, and probably also for obesity, and the tendency to make physical exercise.
---Is it due to the pressure by mass media? This is important in the case of smoking and of bad nutrition (junk food) through publicity.
---Is it an improper safety valve to handle stress? Smoking, eating in excess, and not making exercise can be the expression of a low self-esteem and depression.

3. Who will be the agents that will produce change? To define who will be the main actors that will carry out change. And among them, we find firstly adolescents themselves (by modeling leaders that would comply with these behaviors and achieve social success), and participating as other important agents: educators, health professionals and media.

4. Who will the organizers be? To define who will be the International and National Organizations that will be responsible of carrying out the project.

   The initial requirements to begin developing the proposed task would be:
1) To appoint an International Steering Committee and National Delegates that would organize the local level.
2) To send the proposal to International Organizations to obtain support and backing.
3) To define backing and support at local level.
4) To design and execute a pilot survey in each country (if it hasn't been done yet) to define: knowledge, beliefs and attitudes in teenagers regarding behaviors to be modified.
4) To define a program and a action plan.

CL
Objectives:

· To improve habits related to all the population's health.
· To preserve health in children and teenagers.
· To decrease morbi-mortality due to cardiovascular disease in young people
· To reduce to a minimum the early appearance of cardiovascular diseases in children and teenagers.
· To stimulate in young people positive attitudes about prevention of cardiovascular diseases in the community.

Requirements

· To achieve an agreement with the Governmental Organizations for supporting the program.
· To get the Educational and Health Institutions to join to perform activities for preventing Cardiovascular Diseases.
· To maintain a continuing program for preventing cardiovascular diseases in Educational Institutions.
· To achieve through Educational Institutions the incorporation of the community in prevention programs.

XB
OBJECTIVES.
General:
1.- To improve the population's health and well-being through the decrease in the magnitude of Cardiovascular Diseases (CVD) and other Non-Transmissible Chronic Diseases in Adults (NTCDA) that share risk factors (RF) and common non-healthy life styles (LS).
2.- To intervene known RF and LS, which are associated epidemiologically to CVD, which can be modified with strategies based on evidence.
3.- To evaluate the effect of the intervention, monitoring the trend of RF in the intervened population.
Specific:
4.- To promote healthy life styles in the population of children and teenagers, applying Health Promotion strategies tested in Latin-American and Caribbean communities.
5.- To educate in health:

5.1.- To the general population with maintained programs, with contents relevant to each local situation, and
5.2.- To the health care staff at all levels and from other related sectors, such as social sciences, mass media, educational sector, and so on.

REQUIREMENTS.
1.- At national level, to establish multidisciplinary and inter-sectorial work teams to define actions, with the participation of governmental and non-governmental sectors.
2.- At the Latin American and Caribbean regional level, to establish the corresponding alliances between the countries participating in these common task, and to implement a common protocol.
3.- To work initially with a defined population as demonstration area, to know the profile of risk factors, population's life style, and psycho-social determinants by a previous epidemiological and community diagnosis, collecting the data with a standardized instrument for possible comparisons according to what is established in the protocol.
4.- To develop a community intervention strategy adjusted to the diagnostic result made according to 3.-, considering the intervention of behavior determinants as a priority due to being more efficient because these are the common denominators of the whole spectrum of habits and risk behavior that we want to prevent, and considering the SCHOOL as a basic or focal center for activities regarding primary prevention on students, including the participation by teachers, parents and representatives, in activities integrated with the primary care level.
5.- To consider the primary and primordial prevention activities as supplementary and not excluding of secondary prevention actions, mostly developed in the primary care level.
6.- The following components must be present in intervention programs with a community approach: health, education, mass media, family, and surrounding community and organized community, sports and recreation, food industry.
7.- To consider integrated actions due to the high prevalence in our communities of superimposition and coexistence of risk factors.

Coordinator's Comment

OBJECTIVES:

1) TO IMPROVE GENERAL HEALTH,
2) TO DECREASE PREVALENCE OF CARDIOVASCULAR DISEASES,
3) EPIDEMIOLOGICAL EVALUATION
4) INTERVENTION ON CARDIOVASCULAR RISK FACTORS
5) TO OPTIMIZE EXISTING RESOURCES
6) TO SHARE THE EXISTING EXPERIENCE
7) TO EDUCATE IN CARDIOVASCULAR HEALTH
8) TO STIMULATE THE MULTIPLYING CAPACITY OF YOUNG PEOPLE

REQUIREMENTS:

1) TO MAKE UP MULTIDISCIPLINARY TEAMS AT NATIONAL, REGIONAL AND INTER-AMERICAN LEVEL
2) TO ESTABLISH REGIONAL ALLIANCES
3) POLITICAL WILL
4) ALLIANCES BETWEEN GOVERNMENTAL AND NON-GOVERNMENTAL AREAS
5) ALLIANCE BETWEEN EDUCATION AND HEALTH SECTORS WITH THE REST OF THE COMMUNITY
6) TO DEFINE A ACTION PLAN

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REPLIES QUESTION 4

NS
   1.- The needed social availability to achieve behavior and life styles changes doesn't exist.

   To develop a task that requires changes in behavior regarding consumption habits and life styles, constitutes a premise for a society that must be available to accept change, a premise that hasn't been achieved in the Region, among others, because of economic interests that exist around current behaviors. An example of this is the role played by transnational corporations regarding tobacco, just to quote an important risk factor for cardiovascular diseases due to a high incidence and prevalence of smoking in young people in Latin-America.

   2.- The healing approach still prevails over the preventive one. A change in paradigms is a slow process, since it also requires changes at individual, social and institutional levels. Although the preventive and health promotion approach is present in the speech and in the current, essential functions of Public Health, in fact budgets are addressed to heal and not to prevent, and health professional education also points to the same direction.

EB
   The reasons why it hasn't been realized yet are:

1) Because no institution had the vision to plan it in a formal way, as it is happening in this event.
2) Because in Latin-America, Prevention is not a priority as health strategy.

GA
   I think that undoubtedly, this Task is feasible, and that great deeds, and this is one of them, require time.

   Reasons that have made difficult its realization:
1- Lack of interest or promotion of it, by Preventive Cardiology until a decade ago.

2- Lack of a continental leadership, that would take into account the information by regional organizations with their peculiarities, and would foster different governments to take into account cardiovascular health policies relatively homogeneous.

DG
1- I think that during the last two decades, we have been looking mostly in the direction of technological advancements in diagnosis, and pharmacological advancements in therapeutics of cardiovascular diseases that entailed a significant increase in health costs. This increase in costs lead recently in the last few years, to turn our eyes to preventive medicine backed by the publication of multi-center studies regarding primary and secondary prevention, with a great population impact.

2- The effort implied in applying local prevention programs makes us see a continental program as a utopia. This symposium is proving that it is possible.

CL
1- The lack of interest by Governmental and non-Governmental Organizations to support prevention programs for cardiovascular diseases.

2- In Venezuela, specifically in the State of Lara, to go on developing this program we need:

- Financial support.
- That the Ministry of Education, Culture and Sports would include it in the curricula to be developed in Educational Units.

MC
   Things happen when there are wills in agreement. Basically, this is the main reason why this task hasn't been developed.

   There must be a will both from governmental and non-governmental organizations that are involved in these tasks so that they can be realized.

XB
REASON 1.- AT COUNTRY LEVEL:
   Although there is awareness about the problem at the level of countries in the Latin-American and Caribbean Region (I mean the problem of CVDs), in some of these countries there is no clarity about its extent, partly because it hasn't been properly or sufficiently measured or characterized (this corresponds to the Situation Diagnosis) so as to motivate making the decisions that this diagnosis would indicate.

   If this diagnosis exists, and there is clarity about the extent and characteristics of the problem as the case in other countries, there is a lack of political decision by governmental authority to act, and a lack of commitment with people's problems by not allowing or considering alliances potentially efficient with other non-governmental sectors (universities, NGOs, and so on) that display experience and technical capacity that has been proven, to contribute to face the problem together, with efficient programs to PREVENT CVD IN CHILDHOOD AND ADOLESCENCE. This is translated in lost opportunities for the common good. In this point, it is also included the lack of real and effective commitment by other sectors of society that should be sensitive before the urgent need to PREVENT THE DISEASE AND PROMOTE PEOPLE'S HEALTH, especially for people in the sectors with lower incomes, and to collaborate in this common task. This is what I mean: medical community, educational community, mass media, pharmacological industry, private companies, political class, etc.

REASON 2.- AT THE LATIN-AMERICAN AND CARIBBEAN REGIONAL LEVEL.-
   The lack of consensual agreements between countries about what to do and how to do what needs to be done, with Common Work Protocols in the Nuclear level, what becomes difficult if there are no international organizations that would coordinate these actions.

   There are international organizations that could play that role at the Regional level, such as the PAHO, the WHO, the WORLD BANK, and others that could be a great foundation for a Net of "integrated actions to develop the task of cardiovascular prevention in young people" in the interior of countries and at international level, just as the title of this "virtual meeting". However, their collaboration and help policies for countries are little efficient for the reasons known by everyone, and that is that these "organizations" are subject only to official agreements with each country's Government, which leave aside of their help sphere non-governmental organizations and institutions, while some of them have a lot to contribute about the topic in some countries, and which for "reasons not always technical" are not considered by the governments of the moment. Thus, a valuable opportunity gets lost, which would contribute to make feasible the desire of the NET to integrate the countries of the Region to develop this specific task.

Coordinator's Comment
  It is feasible because: there is a formal institutional proposal to do it, AND APPROPRIATE ORGANIZATIONS

  It hasn't been developed because of:

The current approach to the problem, and its solution that is more technological and healing than preventive.
Lack of financial support.
Opposed economical interests.
Lack of an institutional proposal regarding a formal work up to date.

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REPLIES QUESTION 5

EB
1) About the framework within which this task should be developed, I think that the International Framework must be given by solid Institutions, such as the Inter-American Heart Foundation, and if possible with the backing and support by the Pan-American Health Organization.

   Regarding the Framework at local level, Institutions with a great local prestige must be involved, such as Medical Societies, mostly Cardiology Societies and Heart Foundations, which will have to be responsible for the coordination of a task that will necessarily be multidisciplinary, and will involve diverse actors, particularly from the educational sector.

2) Personally, we are taking part from the "Sindicato Medico del Uruguay" (Uruguayan Medical Syndicate) and the "Alianza Nacional para el Control del Tabaquismo del Uruguay" (National Alliance for Smoking Control in Uruguay), together with the Public Health Ministry in Development of Programs for children and teenagers to prevent smoking, which could be integrated, and even be the basis for a more extensive program for cardiovascular disease prevention in Young People.

   I offer myself to participate in the task, and to involve in it the Sindicato Medico del Uruguay, the "Sociedad de Cardiología" (Society of Cardiology), the "Comisión Honoraria para la Salud Cardiovascular" (Honorary Committee for Cardiovascular Health) and the "Sociedad Uruguaya de Análisis y Modificación de la Conducta" (Uruguayan Society for Behavior Analysis and Modification).

GA
   In a multiple framework: Preferably with a common leadership.
a) Continental
b) Regional
c) National
d) Local
with permanent interactive dynamics, respecting each other and considering regional, national and local features.

   I would be honored and committed to participate in a task with such significance.

DG
   I think that we should arrange a meeting with predetermined tasks, in order to be able to develop a consensus to plan a continental program under the support of the IAHF. I think the division in task groups for the different areas would be convenient. The latter are:
- Dissemination: in charge of contacting the media for its dissemination.
- Teachers' training: multidisciplinary group to unify subjects and methodology for implementation.
- Sponsorships: addressed to study the way of getting international sponsorships (WHO - UNICEF - PAHO, and so on) that would "compel" States to implement this program in the initial stages of education.
- Finance: its objective would be to get economic support by interested companies (food, prepaid health insurances, etc.), to create aid events, and so on.
- Others.

   Of course, the FAC (Federación Argentina de Cardiología - Argentine Federation of Cardiology) Foundation is willing to take part in attempting this task.

CL
   I think that these prevention programs must develop in Educational Institutions, from preschool to diversified education, even maternal education. In this activity, the family sphere must also get involved (parents, representatives, brothers and friends).

  I'd love to be part of this program.

MC
   I think that we should begin with multidisciplinary, working groups: medical doctors, educators, sociologists, representatives of NGOs and GOs, of scientific societies, of the community, and so on, who are working in the area to make proposals that will later get richer locally, regionally and nationally. An ideal framework is to create a rotation meeting space in the participant countries, sponsored by the governmental and non-governmental entities involved.

XB
PART I OF THE QUESTION
   The framework for acting regarding a complex activity such as "creating a net of integrated actions to develop the task of cardiovascular prevention in young people", as the title of this virtual proposal, must consider two development fields:
I.- At national level, according to each one's political and administrative structure, whether municipal, provincial, regional or national.
II.- At the Latin American and Caribbean Regional level, with the countries that make up the NET.

   In both fields, the NET must work with the proper activities, previously defined for each level. Many of the features that this ACTION FRAMEWORK should have, are answered and implicit in the replies to the previous questions, however, the relevant ones will be repeated here.

I.- At national level, the ACTION FRAMEWORK should consider:

* To create a coordinating entity at national level with the participation of governmental and non-governmental sectors, which would prepare an action program with clear objectives and goals, which should also be flexible, realistic and assessable, and that would outline a plan to collect resources.
* To create working teams, interdisciplinary and inter-sectorial.
* To work with a population defined in a first instance, as a demonstration area that will have national representation, to know the risk situation and to evaluate the process and feasibility before increasing coverage.
* In diagnosis, to consider the profile of "risk behavior determinants", for being the most sensitive phase to effective intervention.
* To focus activities in schools or centers of basic education, at a community level, taking the Municipal or Local Government according to each country, as a reference for action, which coordinates the educational sector, health sector (Primary Care Level) and organized local Community.
* To supplement activities of Primary Prevention at Municipal or Population level (schools) with Secondary Prevention that is developed in the Medical Office.
* To work with the family with a systemic approach.
* To work with the concept of "useful coverage" and "population exposed to risk", increasing the coverage by stages, after the demonstration or pilot phase.
II.- At Latin-American and Caribbean Regional level
* To create a "coalition of countries" interested in Cardiovascular Prevention in Young People, developing a consensual Work Protocol, with central contents, valid for all the countries of the NET, providing the freedom for each country to add contents of their own interest.
* To create a Coordination Committee for the Region with the participation by governmental and non-governmental areas.

PART II OF THE QUESTION:
   YES, I want to take part and provide my experience and that of my work team.

NS
   I think that the Inter-American Heart Foundation is an International entity with the summoning power to join both international organizations that must get involved, such as the PAHO/WHO, and UNICEF, and governmental and non-governmental organizations at local level. It has the proper human resources, and the experience to lead the task and the prestige to do it.

Would you like to participate?
   I would be pleased to. I offer for this my knowledge and experience, and the possibilities that might derive from this, in the academic order from the "Escuela Nacional de Salud Pública" (National School of Public Health).

Coordinator's Comment

   Local, National, Regional, and International Framework

   International: Inter-American Heart Foundation (in alliance with other international Institutions, such as the PAHO, the WHO, UNICEF).
Regional, National, Local: Cardiological Foundations and Societies in alliance with local organizations that would support them.

   Participation: YES
Through an interactive work, with a common leadership and considering local, regional, national and international opinions, realities, possibilities and needs.

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CONCLUSIONS
To work in cardiovascular prevention in young people in America is necessary and feasible.

In spite of the huge difficulties to organize and implement this task, there are individuals and organizations in America with capability, which are willing to do it.

The challenge to change the serious projections regarding cardiovascular disease in developing countries for the next years, depends to a large extent on the success of this task.

Final Reflections
I am very proud for taking part in this debate, in which each one of the participants displayed their experience in the topic, their point of view about how to approach this, and their willingness to work to change this hard reality and the future outlook if it isn't carried out.

The conclusions of this meeting will be sent to the Executive Committee of the Inter-American Heart Foundation, with a request for them to be taken into account as a basis for a work on cardiovascular prevention in young people in America.

Acknowledgement
I would like to thank the organizers of the II Virtual Congress of Cardiology by the Federación Argentina de Cardiología (Argentine Federation of Cardiology) for their invitation to participate and for their continuing support regarding the result of this meeting and debate, as well as all the participants for their excellent contributions and commitment.


Bernardo D. Igolnikof M.D.
Head of the Committee for Cardiovascular Prevention in Young People
Inter-American Heart Foundation

 

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2nd Virtual Congress of Cardiology

Dr. Florencio Garófalo
Steering Committee
President
Dr. Raúl Bretal
Scientific Committee
President
Dr. Armando Pacher
Technical Committee - CETIFAC
President
fgaro@fac.org.ar
fgaro@satlink.com
rbretal@fac.org.ar
rbretal@netverk.com.ar
apacher@fac.org.ar
apacher@satlink.com

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