Jorge Bacallao

La obesidad y sus tendencias en la Región

En la Region de las Americas ha habido, en las ultimas decadas, un notableincremento de las enfermedades cronicas no trasmisibles (ECNT) asocia-das a estilos de vida no saludables. Estas enfermedades y trastornos enconjunto, entre los que se encuentran la hipertension arterial, la diabetesmellitus tipo 2, la enfermedad coronaria, los accidentes cerebrovasculares,la obesidad y algunos tipos de cancer, son las principales causas de muerte,morbilidad, discapacidad y deterioro de la calidad de vida.Otro aspecto critico de esta epidemia de ECNT es el alto costo querepresentan para los servicios de salud el tratamiento y la rehabilitacion depacientes con estas afecciones, factores que acentuan las inequidades exis-tentes.Entre las ECNT, la obesidad merece especial atencion, ya que es ensi misma una enfermedad cronica y a la vez un reconocido factor de riesgode muchas otras. El estudio y abordaje de la obesidad no pueden desli-garse de los de otras ECNT por diversas razones: 1) porque compartenalgunos factores causales y subyacentes comunes, como la alimentacioninapropiada y el sedentarismo; 2) porque al identificar a los sujetos obesosse esta identificando a una alta proporcion de los sujetos en riesgo de pade-cer otras ECNT; 3) porque al prevenir la obesidad —mediante la promo-cion de estilos de vida saludables— se previenen la mayoria de las ECNT;y, por ultimo, 4) porque al tratar al obeso se disminuye el riesgo de quesufra complicaciones y tambien se reduce el efecto mediador que tiene laobesidad en relacion con otros factores de riesgo.El cuadro 1 muestra la prevalencia del exceso de peso (25 - 29,9kg/m

Métodos de medición de las desigualdades de salud

RESUMEN La medicion de las desigualdades en el campo de la salud es una condicion indispensable para avanzar en la mejoria de la situacion de salud de la Region, donde el analisis de los valores medios ha dejado de ser suficiente. Este tipo de analisis es una herramienta fundamental para la accion en busca de una mayor equidad en salud. Existen diferentes metodos de medicion y niveles de complejidad cuya eleccion depende del objetivo del estudio. Este articulo tiene como objetivo familiarizar a los profesionales de la salud y a las instancias decisorias con los aspectos metodologicos de la medicion y el analisis simple de las desigualdades en el campo de la salud, utilizando datos basicos registrados con regularidad y agregados por unidades geopoliticas. Se presenta la forma de calcular los siguientes indicadores y se comentan sus ventajas y desventajas: la razon y la diferencia de tasas, el indice de efecto, el riesgo atribuible poblacional, el indice de disimilitud, el indice de desigualdad de la pendiente y el indice relativo de desigualdad, el coeficiente de Gini y el indice de concentracion. Los metodos presentados son aplicables a la medicion de las desigualdades de diferentes tipos y a distintos niveles de analisis.Measuring health inequalities is indispensable for progress in improving the health situation in the Region of the Americas, where the analysis of average values is no longer sufficient. Analyzing health inequalities is a fundamental tool for action that seeks greater equity in health. There are various measurement methods, with differing levels of complexity, and choosing one rather than another depends on the objective of the study. The purpose of this article is to familiarize health professionals and decision-making institutions with methodological aspects of the measurement and simple analysis of health inequalities, utilizing basic data that are regularly reported by geopolitical unit. The calculation method and the advantages and disadvantages of the following indicators are presented: the rate ratio and the rate difference, the effect index, the population attributable risk, the index of dissimilarity, the slope index of inequality and the relative index of inequality, the Gini coefficient, and the concentration index. The methods presented are applicable to measuring various types of inequalities and at different levels of analysis.

Leptospirosis Outbreaks in Nicaragua: Identifying Critical Areas and Exploring Drivers for Evidence-Based Planning

Leptospirosis is an epidemic-prone zoonotic disease that occurs worldwide. In Central America, leptospirosis outbreaks have been reported in almost all countries; Nicaragua in particular has faced several outbreaks. The objective of this study was to stratify the risk and identify “critical areas” for leptospirosis outbreaks in Nicaragua, and to perform an exploratory analysis of potential “drivers”. This ecological study includes the entire country (153 municipalities). Cases from 2004 to 2010 were obtained from the country’s health information system, demographic and socioeconomic variables from its Census, and environmental data from external sources. Criteria for risk stratification of leptospirosis were defined. Nicaragua reported 1,980 cases of leptospirosis during this period, with the highest percentage of cases (26.36%) in León, followed by Chinandega (15.35%). Among the 153 municipalities, 48 were considered critical areas, 85 were endemic and 20 silent. Using spatial and statistical analysis, the variable presenting the most evident pattern of association with critical areas defined by top quintile of incidence rate is the percentage of municipal surface occupied by the soil combination of cambisol (over pyroclastic and lava bedrock) and andosol (over a volcanic ashes foundation). Precipitation and percentage of rural population are also associated with critical areas. This methodology and findings could be used for Nicaragua’s Leptospirosis Intersectoral Plan, and to identify possible risk areas in other countries with similar drivers.

Fiber and exercise in the treatment of obese adolescents

The changes in body weight, body fat, lean body mass, and the efficiency index were studied in a sample of 80 obese males and females undergoing four different treatments, using two treatment components: an increase in dietary fiber, and energy expenditure through exercise. In both sexes there was a significant effect of exercise upon body weight and an improvement in the efficiency index. There was also a significant interaction between fiber and exercise in girls, but not in boys. This suggests that the eventual effect of dietary fiber is heightened by exercise, as corroborated by significant differences in some of the groups.

Methods for measuring inequalities in health

RESUMEN La medicion de las desigualdades en el campo de la salud es una condicion indispensable para avanzar en la mejoria de la situacion de salud de la Region, donde el analisis de los valores medios ha dejado de ser suficiente. Este tipo de analisis es una herramienta fundamental para la accion en busca de una mayor equidad en salud. Existen diferentes metodos de medicion y niveles de complejidad cuya eleccion depende del objetivo del estudio. Este articulo tiene como objetivo familiarizar a los profesionales de la salud y a las instancias decisorias con los aspectos metodologicos de la medicion y el analisis simple de las desigualdades en el campo de la salud, utilizando datos basicos registrados con regularidad y agregados por unidades geopoliticas. Se presenta la forma de calcular los siguientes indicadores y se comentan sus ventajas y desventajas: la razon y la diferencia de tasas, el indice de efecto, el riesgo atribuible poblacional, el indice de disimilitud, el indice de desigualdad de la pendiente y el indice relativo de desigualdad, el coeficiente de Gini y el indice de concentracion. Los metodos presentados son aplicables a la medicion de las desigualdades de diferentes tipos y a distintos niveles de analisis.Measuring health inequalities is indispensable for progress in improving the health situation in the Region of the Americas, where the analysis of average values is no longer sufficient. Analyzing health inequalities is a fundamental tool for action that seeks greater equity in health. There are various measurement methods, with differing levels of complexity, and choosing one rather than another depends on the objective of the study. The purpose of this article is to familiarize health professionals and decision-making institutions with methodological aspects of the measurement and simple analysis of health inequalities, utilizing basic data that are regularly reported by geopolitical unit. The calculation method and the advantages and disadvantages of the following indicators are presented: the rate ratio and the rate difference, the effect index, the population attributable risk, the index of dissimilarity, the slope index of inequality and the relative index of inequality, the Gini coefficient, and the concentration index. The methods presented are applicable to measuring various types of inequalities and at different levels of analysis.

Índices para medir las desigualdades de salud de carácter social basados en la noción de entropía

Los indices descritos en la literatura para medir las desigualdades de salud de caracter social tienen facetas positivas pero tambien algunas insuficiencias, segun las circunstancias de su aplicacion. El objetivo de este articulo es proponer y demostrar, en los planos teorico y practico, las ventajas de las mediciones de la desigualdad basadas en la nocion de entropia, conocida ampliamente en la fisica y la teoria de la informacion. Se definen y exponen las principales propiedades de los indices basados en las nociones de entropia y redundancia. Se ilustra su aplicacion en dos conjuntos de datos ficticios y en datos reales, derivados de los indicadores basicos de salud para las Americas, de la Organizacion Panamericana de la Salud. Los indices basados en la nocion de entropia poseen, entre otras, las siguientes propiedades: a) no varian con los cambios de escala; b) son simetricos; c) incorporan la dimension social, y d) son faciles de interpretar gracias a la condicion de equivalencia entre la entropia y un sistema con dos clases.

The relationship of birthweight with height at 14 and with the growing process.

The association of birthweight with length at 12 mo and with height at different ages was assessed in a sample of 260 healthy adolescents (130 boys and 130 girls). The longitudinal study included measures on body weight and height at 4, 6, 12, and 14 yr of age. Birthweight is highly correlated with stature at 14 years, particularly in male adolescents. Longitudinal principal components analysis (LPCA) showed that it is also correlated with the growing process. There is also strong evidence that birthweight can be a good predictor of the onset of the pubertal maturation process.

Métodos de mensuração das desigualdades em saúde

RESUMEN La medicion de las desigualdades en el campo de la salud es una condicion indispensable para avanzar en la mejoria de la situacion de salud de la Region, donde el analisis de los valores medios ha dejado de ser suficiente. Este tipo de analisis es una herramienta fundamental para la accion en busca de una mayor equidad en salud. Existen diferentes metodos de medicion y niveles de complejidad cuya eleccion depende del objetivo del estudio. Este articulo tiene como objetivo familiarizar a los profesionales de la salud y a las instancias decisorias con los aspectos metodologicos de la medicion y el analisis simple de las desigualdades en el campo de la salud, utilizando datos basicos registrados con regularidad y agregados por unidades geopoliticas. Se presenta la forma de calcular los siguientes indicadores y se comentan sus ventajas y desventajas: la razon y la diferencia de tasas, el indice de efecto, el riesgo atribuible poblacional, el indice de disimilitud, el indice de desigualdad de la pendiente y el indice relativo de desigualdad, el coeficiente de Gini y el indice de concentracion. Los metodos presentados son aplicables a la medicion de las desigualdades de diferentes tipos y a distintos niveles de analisis.Measuring health inequalities is indispensable for progress in improving the health situation in the Region of the Americas, where the analysis of average values is no longer sufficient. Analyzing health inequalities is a fundamental tool for action that seeks greater equity in health. There are various measurement methods, with differing levels of complexity, and choosing one rather than another depends on the objective of the study. The purpose of this article is to familiarize health professionals and decision-making institutions with methodological aspects of the measurement and simple analysis of health inequalities, utilizing basic data that are regularly reported by geopolitical unit. The calculation method and the advantages and disadvantages of the following indicators are presented: the rate ratio and the rate difference, the effect index, the population attributable risk, the index of dissimilarity, the slope index of inequality and the relative index of inequality, the Gini coefficient, and the concentration index. The methods presented are applicable to measuring various types of inequalities and at different levels of analysis.

Socioeconomic Factors and Vulnerability to Outbreaks of Leptospirosis in Nicaragua

Leptospirosis is an epidemic-prone zoonotic disease that occurs worldwide, with more than 500,000 human cases reported annually. It is influenced by environmental and socioeconomic factors that affect the occurrence of outbreaks and the incidence of the disease. Critical areas and potential drivers for leptospirosis outbreaks have been identified in Nicaragua, where several conditions converge and create an appropriate scenario for the development of leptospirosis. The objectives of this study were to explore possible socioeconomic variables related to leptospirosis critical areas and to construct and validate a vulnerability index based on municipal socioeconomic indicators. Municipalities with lower socioeconomic status (greater unsatisfied basic needs for quality of the household and for sanitary services, and higher extreme poverty and illiteracy rates) were identified with the highest leptospirosis rates. The municipalities with highest local vulnerability index should be the priority for intervention. A distinction between risk given by environmental factors and vulnerability to risk given by socioeconomic conditions was shown as important, which also applies to the “causes of outbreaks” and “causes of cases”.

Subpoblaciones con perfiles epidemiológicos y de riesgo singulares en La Habana, Cuba: diabetes, hipertensión y tabaquismo

OBJECTIVE: Identify and describe population groups with greater risk and morbidity profiles for type II diabetes, hypertension, and tobacco-related illnesses. METHODS: A cross-sectional study was carried out of 840 families under the care of 12 family doctors and nurses in Havana, Cuba. A model-based cluster analysis was used to identify subpopulations with specific morbidity and risk profiles. Key indicators of the subpopulations were compared. RESULTS: A subpopulation with a high disease burden and a particular risk profile was identified and described. The determining factor in defining this group is the subjective perception of their economic situation. The families in this group have the highest household density of diabetes, hypertension, and tobacco-related illnesses and are distributed among all the facilities visited. On average, the subpopulation consisted of smaller families and have between two and three years less schooling, a more negative perception of their economic situation, and an older average age, when compared to the study group as a whole. CONCLUSIONS: Subpopulations were identified with higher proportions of the disease burden and with particular risk profiles. These subpopulations exhibit certain features consistent with trends in the social structure of Cuban families that have been evolving over the past two decades.