Justificación y objetivo: La enfermedad isquémica cardiovascular es definida por la Organización Mundial de la Salud como la incapacidad cardiaca aguda y crónica, resultante de la reducción o suspensión del flujo sanguíneo del miocardio, asociado con procesos patológicos en el sistema arterial coronario. Es una de las principales causas de muerte entre los individuos adultos de Costa Rica y el mundo. El presente trabajo describe los factores de riesgo de enfermedad cardiovascular hallados en un grupo de mujeres con sobrepeso y obesidad residentes del área de atracción de salud del programa de Atención Integral en Salud (PAIS), correspondientes a los distritos de La Unión, Curridabat y Montes de Oca.Métodos: Se estudiaron un total de 90 mujeres diagnosticadas con sobrepeso u obesidad, con edades comprendidas entre los 18-49 años, 30 de cada uno de los distritos que conforman el área de cobertura PAIS (Curridabat, La Unión y Montes de Oca) durante 2007. Se evaluaron los factores de riesgo cardiovascular recomendados por el ATPIII establecidos por la Asociación Americana del Corazón.Resultados: Un 75% de las mujeres del estudio mostraron niveles de LDL colesterol fuera del rango aceptable, el 50% presentó niveles no deseables del colesterol total y el 51.3% presentó hipertensión. Los factores de riesgo predisponentes más prevalentes fueron la obesidad (64%) y el 61% gastó menos de 2000 Kcal por semana en actividad física que las clasifica como sedentarias. El único factor de riesgo condicionante que se evaluó fue la hipertrigliceridemia, presentada en el 25.3% de las mujeres.Conclusión: Las mujeres en estudio presentaron al menos dos factores de riesgo cardiovascular; son un grupo de especial atención, de manera que sean sujeto de intervenciones de tipo integral que aborden la promoción de la salud, tanto en las mujeres como en sus familias y comunidades.
Objectives This study aimed to develop, implement, and evaluate an intervention to simultaneously reduce food insecurity and body weight. We hypothesized that, when compared with the non-intensive arm, women in the intensive intervention arm would reduce food insecurity and body weight and improve social support for healthy eating, psychological and economic empowerment, and food and physical activity behaviors. Methods We conducted a cluster-randomized controlled trial in the Central Canton of the Province of Alajuela. Randomization was at the level of the catchment area of the first level of health care in Costa Rica. This 6-month study compared two arms. The intensive arm consisted of activities at the individual (12 two-hour sessions, three follow-up monthly sessions, and one closing session), household (one workshop with the participants’ household and community members, and homework with family participation), and community (two brochures and one workshop) levels. The non-intensive arm was comprised of three one-hour sessions about healthy lifestyles. Results A total of 171 participants were enrolled (83 in intensive and 88 in non-intensive arm). At 6 months the intensive arm had significantly greater decreases from baseline in food insecurity (P = 0.004), body mass index (P = 0.010), and waist circumference (P = 0.001) compared with the non-intensive arm. The intensive arm also had also significantly greater increases in psychological (P = 0.014) and economic empowerment, including a greater increase in the contribution to household support (P = 0.030) and more women that found a job (P = 0.018), compared with the non-intensive arm. Women in the intervention arm had significantly greater changes from baseline in the expected direction in food consumption of fried foods (P = 0.029), sausages (P = 0.038), sugar drinks (P = 0.032), salads (P = 0.032), and beans (P = 0.004) compared to women in the non-intensive arm. We did not find any significant differences between the arms in social support, exercise, and consumption of fruits, vegetables and fast foods. Conclusions This intervention demonstrates that it is possible to simultaneously reduce food insecurity and reduce, rather than exacerbate, excess weight gain. Funding Sources Office of International Affairs, University of Costa Rica.
Objectives This intervention targeted change in gender norms and behaviors regarding co-responsibility in the household and self-care among food-insecure women with excess weight. The objectives of this study were to determine what and how changes occurred in perceived gender norms, attitudes, intentions, and behaviors of women and their family and community members regarding co-responsibility and self-care. Methods We conducted a two-arm, 6-month cluster-randomized controlled trial in Alajuela. This qualitative study included 62 women, 34 family members, and 9 community members in the intensive arm. This arm consisted of activities at the individual (12 two-hour sessions, 3 follow-up monthly sessions, and one closing session), household (one workshop with household and community members, and homework with family participation), and community (two brochures and one workshop) levels. Data used were from observations and content analysis of participant comments during the workshops (n = 83), pre- and post-semi-structured interviews (n = 35), and focus groups with participating women (n = 49). Results Women and family members changed attitudes, intentions, gender norms, and behaviors related to co-responsibility and self-care. Concerning co-responsibility, at baseline all women reported doing most of the domestic work. Most women perceived working outside home as favorable, but those with children worried about childcare. At end-line, women reached more equitable distributions of the domestic work. Many women either obtained a job or began a small business at home and found solutions to balance their job with childcare. Women explained that these changes occurred because they had increased psychological empowerment which allowed them to ask for help at home, search for a job, or accept jobs rejected before. Concerning self-care, women and family members changed self-care behaviors and improved relationships because 1) women understood that self-care first allowed them to care for others and 2) women changed first so their family members followed. Conclusions The intervention changed attitudes, intentions, gender norms, and behaviors related to co-responsibility and self-care, which supported improved food security and weight in women. Funding Sources Office of International Affairs, University of Costa Rica.
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