ASIGNACIÓN DE RESPONSABLES DURANTE EL CICLO DE VIDA

Recently, there has been increasing awareness, attention and effort to primary prevention of CHD. This change in attitude has increased the demand for dealing with CHD determinants. This includes the early detection o f population at risk and further development of intervention techniques to reduce the morbidity of CHD indicators. Epidemiological studies have resulted in the recognition of both inherent (genetic) and environmental (behaviour, lifestyle) parameters. These parameters are hypercholesterolemia, hypertension, percentage of body fat, inactivity and smoking (Kemper et al, 1990).

Tamir et al (1990) stated that the cardiovascular disease and cancer are the leading cause of death and disability in the industrialized nations today and are becoming an increasing problem in developing countries as well. Among very young children, as previously discussed, risk factors for coronary heart disease, such as hypertension, obesity, smoking, hyperlipidemia and lack of physical fitness can be identified and are causally related to cardiovascular disease. Reducing cardiovascular risk factors may decrease the morbidity and mortality rates o f these serious diseases. Mostly, risk factors for cardiovascular disease are related to lifestyle behaviors such as a diet rich in cholesterol, saturated fats, sugar and salt, as welll as smoking and lack of physical activity. Therefore intervention program for prevention must be started in childhood.

Dietary guidelines issued by expert committees now advocate the adoption o f health promoting dietary patterns during childhood. These dietary recommendations are intended for all healthy children over the age o f 2 years and are generally addressed to moderating dietary intakes of fats and cholesterol. They also, emphasized the importance of overall nutritional adequacy.(Kimm etal, 1990)

Alexandrove et al, (1992) stated that primary prevention of coronary heart disease and arterial hypertension, as opposed to secondary prevention, has advantages. It prevents the development of disease and limits the cost of treatment. The start of prevention early in childhood, rather than later, would seen

to be more effective because lifestyle responsible for high risk later in life was actually present in their formative stage.

Beaglehole,et al (1993) enumerated four levels of protection that could be applied, corresponding to different phases in the development o f disease :

Primordial Primary Secondary Tertiary

All are important and complementary, although primordial prevention and primary prevention make the most contributions to the health and well- being o f the whole population.

Primordial prevention : is the most recent level of prevention to have been recognized. It is known that CHD occurs on a large scale only if the basic underlying cause is present e.g. a diet high in saturated animal fat. So, it is concluded that the aim of primordial prevention is to avoid the emergence and establishment of social, economic and cultural patterns of living that are known to contribute to an elevated risk of disease. Consequently, non communicable conditions, especially CHD, take on greater relative importance on that level of prevention. Primordial prevention for coronary heart disease should include : national policies and programmes on nutrition, the food industry, the food import/export sector, comprehensive policies to discourage smoking, programmes for the prevention of hypertension and programmes to promote regular physical activity.

Intervention studies :

Several preventive trials among adults have been started to test the hypothesis that the risk factors reduction in the population will lead to reduction in morbidity and mortality form cardiovascular disease. Data from the North Karelia project in Finland illustrated that an innovative community based program can lead to a general reduction of risk factor levels in the community and this development consequently was associated with reduction in cardiovascular disease

activity, reduction or prevention of overweight and introduction of dietary changes that favourably influence serum cholesterol and blood pressure. These dietary changes may be in the form of reduction in saturated fat, partial substitution of saturated fat by polyunsaturated fats, increase in vegetable consumption, and reduction in sodium intake (Puska, 1985).

An intervention study was carried out by Tamir et al, (1990) on 829 school children aged 7-9 years in Jerusalem. The intervention comprised, school health education and promotion program which was carried out on test and control groups. Educational curriculum consisted of 15-20 teaching hours per year, generally taught by the regular classroom teacher over a period 2-3 months. Curriculum materials included student workbooks, teacher materials, parent material and posters. Pre and post intervention assessment was carried out, by using health knowledge questionnaire including the student's dietary habits, anthropometric measurements, blood pressure and blood lipid profile. The results revealed that a significant increase in serum high density lipoprotein (HDL) among tested group than control group. The mean HDL in the tested group was higher by 3.42 mg/dl than the control group. Moreover, a decrease in serum total cholesterol and body mass index (BMI) among the tested group was observed. The mean total cholesterol in the tested group was lower by 11.96 mg/dl than that of control group. The mean of BMI among tested group was significantly lower than the control group (P<0.01). So, the investigators concluded that changes in cardiovascular disease risk factors such as total cholesterol, high density lipoprotein and body mass index were possible after introducing a health education program.

Alexandrove et al, (1992) in Moscow conducted an intervention study, which comprised two groups: the intervention group which comprised 477 children whose mean age was 11.6+0.11 years, while the reference group comprised 528 children whose mean age was 11.9+0.12 years, aiming to declare the epidemiological background of risk factors associated with atherosclerosis and coronary heart disease among school children. All subjects were examined for

Moreover anthropometric measurements were done. Children with hyperlipidemia or elevated blood pressure levels or who were obese were invited with their parents for a single individual counseling session. The children were advised to maintain a regular dietary regimen and to consume a greater amount o f vegetables and fruit. Also, the children were encouraged to use vegetable oil and to restrict their consumption of fatty meat and fish. Polyvitamins and fruit juices were recommended. The results revealed that after one year, the children o f intervention group had attained a greater reduction in their levels of the total cholesterol, triglycerides, and systolic blood pressure than those of the reference group. High density lipoprotein cholesterol levels decreased equally in both groups. Post intervention assessment after three years showed that the effect was retained for cholesterol and systolic blood pressure. The level of high density lipoprotein cholesterol showed a greater reduction in the reference group. After one year the increase in the Quetelet index (weight kg./height^) among the intervention sample became less. After three years of intervention the smoking accretion rate had decreased in the intervention group than reference group. So, the investigators concluded that the marked prevalence of risk factors among children and teenagers indicated the need for carty corrective measures. So, a successful solution to the problem through early primary prevention, may be of great value in reduction o f morbidity and mortality from cardiovascular disease among adult populations.