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.

Objectives To determine the optimal anthropometric cut-off points for predicting the likelihood ratios of hypertension and diabetes in the Peruvian population. Design A cross-sectional study was performed to establish cut-off values for body mass index (BMI) and waist circumference [WC], waist-height ratio [WHtR], and Conicity index [C-index]) associated with increased risk of hypertension and diabetes. Youden’s index (YIndex), area under the curve (AUC), sensitivity and specificity were considered. Settings Peruvian households. Participants Peruvian population over the age of 18 years. Results 31,553 subjects were included; 57% being women. Among the women, 53.06% belonged to the 25 to 44-year-old age group [mean age: 41.66 in men and 40.02 in women]. The mean BMI, WHtR and C-index values were higher in women 27.49, 0.61, 1.30 respectively; while the mean WC value was higher in men 92.12 cm (SD±11.28). The best predictors of hypertension in men were the WHtR (AUC=0.64) and the C-index (AUC=0.64) with an optimal cut-off point of 0.57 (YIndex=0.284) and 1.301 (YIndex=0.284), respectively. Women showed an AUC of 0.63 and 0.61 in the WHtR and C-index, respectively, with an optimal cut-off of 0.61 (YIndex=0.236) and 1.323 (YIndex=0.225). The best predictor for diabetes was the C-index: with an AUC=0.67 and an optimal cut-off of 1.337 (YIndex=0.346) for men, and an AUC=0.66 and optimal cut-off of 1.313 (YIndex=0.319) for women. Conclusions Our findings show that in Peruvian adults, the WHtR and the C-index have the strongest association with hypertension in both sexes. Likewise, the C-index had the strongest association with diabetes.

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.

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Background The northeastern region of Argentina has the highest age-adjusted cervical cancer mortality rates. Given the strong link between HPV infections and cervical cancer, one of the main interventions is the population-based use of HPV vaccines. However, the acceptability is not very clear in low-and middle-income countries. The purpose of this study was to estimate the level of HPV vaccine acceptance and associated determinants among caregivers of girls in a northeastern city of Argentina. Methods A school-based survey was conducted in 2015 using a multistage sampling method. The primary sample unit were schools stratified by socioeconomic status selected at random, and caregivers of school girls were interviewed. The acceptability was determined using the adapted Theory of Planned Behavior. We performed logistic regression models to assess associated determinants. Results The study included 347 caregivers. The intention to vaccinate was 59.88%. A positive attitude of caregivers (aOR 4.67; 3.11-7.03) and positive influence of social norms (aOR 1.95; 1.03-3.70) were the main predictors independently associated to the intention to vaccinate against HPV. In contrast, practicing a Christian non-Catholic religion decreased the intention to vaccinate against HPV (OR 0.59; 0.36-0.95). All other factors evaluated were not significantly associated with intention to vaccinate against HPV.

<p>Introducción. En la localidad de Avia Terai, Noreste de Argentina, se desarrolló un programa local de Prevención y Control de la enfermedad de Chagas orientado en los principios de la Atención Primaria de la Salud. El objetivo general de este trabajo fue evaluar el cambio en los conocimientos respecto a la enfermedad de Chagas luego de la implementación de la estrategia del componente de información, educación y comunicación social del programa local en la zona urbana de la localidad de Avia Terai en el año 2012. Métodos. Se empleó un diseño de corte transversal en dos momentos. Se realizó un muestreo polietápico por conglomerados. La unidad de análisis correspondió a jefes y jefas de hogar de la vivienda sorteada. Se utilizó el cuestionario adaptado de Sanmartino y Crocco, el cual incluye 3 dimensiones y 15 conocimientos básicos, referidos a la enfermedad de Chagas. Resultados. En cuanto al nivel de conocimientos básicos sobre la enfermedad de Chagas, en el nivel III se observó un aumento en el año 2012 respecto del año anterior, de 56,6% al 66,2% (p&gt;0,0001). Mientras que en cuanto a la forma de transmisión congénita, se observó una disminución de la proporción de respuestas correctas respecto al año anterior. Conclusión.  Luego de la implementación de un programa local de información, educación y comunicación social, se observó un aumento en los conocimientos básicos sobre la enfermedad de Chagas.</p>

The aim of this study was to geospatially explore the occurrence rates of car accidents involving pedestrians in Cercado de Lima (Lima District), Peru. Car accidents involving pedestrians recorded in the 2015 National Police Station Census of the National Statistics and Information Institute were described and georeferenced. Subsequently, a Kernel Density analysis was carried out to locate areas with high, medium, and low density events. Records of 171 car accidents involving pedestrians were studied: the types of vehicles involved were automobiles (56.7%) and smaller vehicles (22.8%). The highest percentage of car accidents involving pedestrians (38.6%) took place between 12:00 p.m. and 5:00 p.m. There were two densely populated areas and two areas with intermediate density for car accidents involving pedestrians, locations that were previously reported as critical due to their deficiencies and high probability of traffic accidents. The use of geographic information systems offers a quick overview of the occurrence rates of car accidents involving pedestrians to make comparisons and enable the local implementation of strategies.

Introducción. Luego de la transmisión vectorial, la congénita, es la forma más importante para mantener la endemia. La probabilidad de transmisión congénita puede depender de factores que varían entre los diferentes países y áreas geográficas. Se realizó este trabajo con el objetivo de estimar la proporción de transmisión congénita y explorar factores maternos asociados a la  enfermedad de Chagas en niños al nacer y sus respectivos hermanos en cuatro hospitales de la Provincia del Chaco. Métodos. Estudio transversal. Se realizó una visita al domicilio de niños de 10 meses de edad o mayores,  nacidos durante el año 2011, hijos de mujeres con infección por T cruzi. Se extrajeron muestras sanguíneas tanto de los niños al nacer como de sus hermanos y se procesaron para diagnóstico de infección por T cruzi con HAI y ELISA. Resultados. Se localizaron a 247 madres infectadas con T. cruzi, y se obtuvieron muestras de sangre de 246 niños al nacer y de 556 de sus hermanos. Del total de nacidos en el año 2011, el 6,1% (IC 95%= 3,6-9,6) resultaron con serología positiva,  así como 7,7%; de sus  hermanos (IC 95%= 5,7-10,1) y el control de salud de ambos niños en el centro de atención primaria  se asoció con una menor probabilidad de transmisión congénita (OR=0,21 y 0,36 respectivamente).Conclusión. La tasa de transmisión es consistente con los valores reportados en el país y solo la multiparidad fue un factor asociado a la mayor  probabilidad de transmisión congénita.