BackgroundViolence by young people is one of the most visible forms of violence and contributes greatly to the global burden of premature death, injury and disability.MethodsThe Global School-based Student Health Survey (GSHS), State of Lara, Venezuela (GSHS-Lara) is a school-based surveillance system. It comprises a repeated, cross-sectional, self-administered survey drawn from a representative sample of 7th to 9th grade students, performed in the school years 2003-2004 (GSHS-Lara 2004) and 2007-2008 (GSHS-Lara 2008). It explores, among other things, a general violence indicator such as school absenteeism due to feeling unsafe at school or on the way to or from school for any reason; and more specific indicators of violence such as robbery, bullying, physical fights and use of weapons, as well as exposure to lectures on how to prevent violence. Results are given in terms of prevalence percentage.ResultsAbsenteeism doubled between the two study periods (10.8% to 20.8%). The number of students that were a victim of robbery remained high and without change both outside (14.2% and 14.8%) and inside school (21.7% and 22.0%). The number of victims of bullying was high and increasing (33.4% and 43.6%). Bullying associated with being physically attacked decreased (18.5% to 14.3%). Physical attacks without active participation and not associated with bullying were frequent (21.5%). Physical fighting with active participation prevalence remained high and without change (27.5% and 28.2%). Carrying a weapon almost doubled (4.3% to 7.1%). Less than 65% reported classes for violence prevention.ConclusionsThe GSHS-Lara shows that violence is an important public health problem that needs to be addressed by the community and its authorities.

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Building a basis for action using the seven themes articulated, especially by incorporating innovative ideas, we presented here, can help enhance global capacity in chronic disease surveillance, prevention and control. Informed initiatives can help achieve the new World Health Organization global goal of reducing chronic disease death rates by 2% annually, generate new ideas for effective interventions and ultimately bring global chronic diseases under greater control.

This study reports on deaths due to acute rheumatic fever (ARF) and chronic rheumatic heart disease (CRHD) in Venezuela from 1955 to 1994. Census publications and other official sources provide the population data. Yearly age -and sex- specific mortality rates per 100,000 inhabitants were calculated and adjusted by the direct method to the WHO's standard population. The RF-adjusted mortality rate (AMR) declined: total from 7.68 to 1.08 (-85.9%); male from 7.53 to 0.84 (-88.8%); and female from 7.83 to 1.33 (-83.0%). In all cases female RF-AMRs were higher than male. There was a reduction of 88.5% in the ratio of RF deaths to cardiovascular deaths (ICD-6330-334,400-447; ICD-7330-334,400-447; ICD-8 390-438; ICD-9 390-438). ARF-AMR declined (-93.5%) as did CRHD-AMR (-85.1%). Proportional death by ARF and CRHD in patients 45 years old and younger increased. Venezuela experienced a continuous decline in RF-AMR from 1955 to the l980s, followed by a period of stabilization lasting until l994. The reduction could be the consequence of improvement in socioeconomic status and of RF prevention with penicillin, a standard practice in the health care system. The 1980s and 1990s RF-AMR stabilization could be associated with economic setbacks in Venezuela and changes in the agent's virulence patterns.

The Global Youth Tobacco Survey (GYTS) is a school-based surveillance system. In Lara State, Venezuela, it was conducted by a coalition of organizations. The instrument includes: attitudes, knowledge, behaviors, exposure to environmental tobacco smoke, mass media, and marketing. Participation was 85.7% in 2000 and 79.3% in 2003. Comparing prevalence (%) from 2000 to 2003: "first contact": unchanged (22.8%); "males having first cigarette before the age of 10": decreased (21.5% to 16.7%); "current cigarette smoker": unchanged (8.4% to 8.3%); "male smokers wanted to quit": increased (62.6% to 84.7%); "exposure to environmental tobacco smoke": increased (43.9% a 50.7%), "support ban on smoking in public places": unchanged (> 80%), "received free promotional cigarettes": increased (9.5% a 13.4%), and "no problem buying cigarettes": decreased in males (97% to 74.3%) and in females (95.9% to 90.3%). Tobacco use has remained unchanged, a situation attributed in part to marketing, including free cigarettes, and lack of law enforcement. GYTS provides evidence to support the design, implementation, and monitoring of policies and programs aimed at the prevention and control of tobacco use among adolescents.

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Death rates due to Ischemic Heart Disease (IHD) are widely used to assess regional and national cardiovascular health status. However, their validity is questionable, essentially because they are based on death certificates (DCs). The present study was conducted in the Greater Metropolitan Area of Barquisimeto (Lara State, Venezuela), from June 1991 to July 1992. The purpose was to establish the validity of the diagnosis of myocardial infarction in DCs of intrahospital deaths. Efforts were made to locate all clinical charts and any other relevant information. To validate the diagnosis of MI in the DC we used the MONICA project criteria. During the study period a total of 247 eligible DCs were recorded. Sufficient clinical information was located for 136 cases (55%). The results were as follows: definite MI - 62 cases (45.6%); probable MI - 31 cases (22.8%); and non MI - 43 cases (31.6%). These results may indicate an overestimation of MI death rates of about 32% [95% Confidence Interval = 23.8% - 39.4%]. Since these data are from a region with an organized cardiovascular health system, it is expected that the overestimation for the rest of the country may be even higher. Thus, in order to enhance quality and accuracy of DCs, it is necessary to develop a system to improve adherence to existing norms for filling out and processing such forms.

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