Vilma Irazola

• Institute for Clinical Effectiveness and Health Policy

Background Globally, poor sleep is a significant public health problem. Healthy sleep is important for physical and mental well-being, particularly for individuals who work in environments with shift schedules. However, this issue has not been adequately addressed, especially in low-and-middle-income settings. This study examined sleep apnea and ex...

Background HEARTS in the Americas is the regional adaptation of the WHO Global HEARTS Initiative, aimed at helping countries enhance hypertension and cardiovascular disease (CVD) risk management in primary care settings. Its core implementation tool, the HEARTS Clinical Pathway, has been adopted by 28 countries. To improve the care of hypertension,...

HEARTS Pharmacy, a project within the HEARTS in the Americas Initiative, provides a framework to integrate pharmacists into primary health care. Pharmacists are highly respected in health care but face challenges, such as limited scope of practice, regulatory barriers, and insufficient recognition, compounded by social norms that hinder their full...

Background: The "Color of Drinking" is a study conducted at the University of Wisconsin-Madison. It examines the secondhand harms of high-risk drinking on college students of color and explores the connection between alcohol use and the campus racial climate. Since its findings were released in 2018, this study has received significant attention fr...

Background: The World Health Organization HEARTS Technical Package is a widely implemented global initiative to improve the primary care management of cardiovascular disease risk factors. The study’s objective is to report outcomes from a pilot implementation trial of integrated hypertension and diabetes management based on the HEARTS model in Guat...

Objective In low- and middle-income countries, heart failure (HF) is the leading cause of death and disability. Materials and methods A feasibility study was conducted to assess the fidelity, reach, and adoption of an educational program led by non-medical staff to improve outpatient care for patients hospitalized with HF in the local public healt...

Background Exposure to second hand smoke (SHS) is a cause for heart disease and lung cancer among non- smokers. This cluster randomized control trial will evaluate the effectiveness of a tobacco smoke free home intervention in reducing exposure to second hand smoke. Protocol The intervention will be conducted among 30 clusters in urban and peri-ur...

Background: The World Health Organization HEARTS Technical Package is a widely implemented global initiative to improve the primary care management of cardiovascular disease risk factors. The study's objective is to report outcomes from a pilot implementation trial of integrated hypertension and diabetes management based on the HEARTS model in Guat...

Cardiovascular disease (CVD) represents the largest burden of disease globally and despite the availability of strong evidence supporting cost-effective treatments for people with CVD, the implementation of these treatments remains low, especially in low-income settings. Shortages in workforce have led to focus on how to increase clinical capacity....

Background: Uncontrolled hypertension is a major public health challenge in low- and middle-income countries. The Hypertension Control Program in Argentina (HCPIA) showed that a community health worker-led multicomponent intervention was effective for blood pressure (BP) reduction in resource-limited settings, but whether the intervention was equa...

In Latin America and the Caribbean (LAC), sociodemographic context, socioeconomic disparities and the high level of urbanization provide a unique entry point to reflect on the burden of cardiometabolic disease in the region. Cardiovascular diseases are the main cause of death in LAC, precipitated by population growth and ageing together with a rapi...

BACKGROUND The “Color of Drinking” is an influential study in the alcohol consumption field that looks at secondhand harms of high-risk drinking on college students of color (microaggressions, fear of safety, harms in the classroom, and decreased belonging), and studies the connection between alcohol use and the campus racial climate. Since the rel...

Background The “Color of Drinking” is a study conducted at the University of Wisconsin-Madison. It examines the secondhand harms of high-risk drinking on college students of color and explores the connection between alcohol use and the campus racial climate. Since its findings were released in 2018, this study has received significant attention fro...

Non-adherence to medication severely affects chronic disease control. To assess whether a multi-component intervention implemented at the public primary care level in Argentina improves adherence to antihypertensive medication and helps to reduce blood pressure (BP) levels in uncontrolled hypertensive patients. A before-and-after study was conducte...

Introduction: Current recommendations for cardiovascular disease (CVD) prevention are guided CVD risk classification. This study aims to analyze the level of compliance with pharmacological and non-pharmacological recommendations outlined in the World Health Organization (WHO) CVD prevention clinical practice guideline within the general population...

Resumen En este estudio se llevó a cabo una revisión de la literatura, de tipo descriptivo y exploratorio con el objetivo de describir cómo la disponibilidad, el acceso y el consumo de alimentos se ven atravesados y vinculados al género. A partir de la búsqueda en bases de datos y de la búsqueda manual, se recuperaron 833 resúmenes, de los cuales f...

Resumo Este estudo realizou uma revisão descritiva e exploratória da literatura com o objetivo de descrever como a disponibilidade, o acesso e o consumo de alimentos são permeados e relacionados a questões de gênero. A partir de uma pesquisa em bases de dados e de busca manual, foram encontrados 833 resumos, dos quais foram selecionados 37 textos c...

Introduction: The food environment, encompassing factors such as food availability, advertising, and promotions, can significantly impact dietary choices. The main objective of this study was to characterize the profile of the advertised products in relation to the food groups defined by the Dietary Guidelines for the Argentine Population (GAPA), t...

Background Five modifiable risk factors are associated with cardiovascular disease (CVD) and all-cause mortality. The regional and sex-specific prevalence of these modifiable risk factors and their impact on CVD and all-cause mortality have not been evaluated using individual-level data. Methods The Global Cardiovascular Risk Consortium harmonized...

Objective: To evaluate the effectiveness of blood pressure (BP) self-monitoring and peer mentoring to improve the control of hypertension in clinical practice in primary care centers (PCCs) located in low-resource settings in Argentina. Methods: An individual randomized controlled trial was carried out to test two different approaches based on b...

Background Approximately 81% of deaths in Argentina are from chronic non-communicable diseases and 21% caused by cancer. Colorectal cancer (CRC) is the second most frequent cancer in Argentina. Even though CRC screening has been recommended for adults from 50 to 75 years old by using a faecal immunochemical test (FIT) annually, screening rates rema...

Guidance on contextually tailored implementation strategies for the prevention, treatment, and control of hypertension is limited in lower-middle income countries (Lower-MIC). To address this limitation, we compiled implementation strategies and accompanying outcomes of evidence-based hypertension interventions currently being implemented in five L...

Introduction: One of the self-report adherence scales most widely used is the 8-item Morisky Medication Adherence Scale (MMAS-8). Aim: To evaluate construct validity and reliability of the MMAS-8 in hypertensive adults from low-resource settings within the public primary care level in Argentina. Methods: Prospective data from hypertensive adul...

Background: Presence of multiple risk factors (RF) increases the risk for cardiovascular morbidity and mortality, and this is especially important in patients with coronary heart disease (CHD). The current study investigates sex differences in the presence of multiple cardiovascular RF in subjects with established CHD in the southern Cone of Latin...

Background Uncontrolled hypertension is a major public health burden and the most common preventable risk factor for cardiovascular diseases in Guatemala and other low- and middle-income countries. Prior to an initial trial that evaluated a hypertension intervention in rural Guatemala, we collected qualitative information on the needs and knowledge...

Background: The COVID-19 pandemic necessitated rapid changes in the delivery of care across public primary care settings in rural Guatemala in 2020. In response, a hypertension program implemented within the public primary care system required multiple adaptations, providing an illustrative example of dynamic implementation amidst changing context...

Background Elevated Lipoprotein(a) [Lp(a)] is independently associated with increased cardiovascular disease (CVD) risk. There are discrepancies regarding its epidemiology due to great variability in different populations. This study aimed to evaluate the prevalence of elevated Lp(a) in people with moderate CVD risk and increased LDL-c and to deter...

RESUMEN Las enfermedades cardiovasculares son la principal causa de morbimortalidad, y la hipertensión es su principal factor de riesgo. En 2018, Argentina comenzó a implementar la Iniciativa HEARTS en 5 centros de atención primaria de salud a través del Plan Nacional de Prevención y Control de la Hipertensión Arterial. En este estudio se presenta...

Objective: To describe the design, delivery and evaluation of the 3rd Global Alliance for Chronic Diseases (GACD) Implementation Science School (ISS), delivered virtually in 2020 for the first time. Methods: Since 2014, GACD has supported the delivery of more than ten Implementation Science Workshops for more than 500 international participants. It...

Introducción el envejecimiento poblacional es un fenómeno mundial. Los problemas de salud mental, altamente prevalentes en este grupo, impactan en la vida de los individuos, sus familias y la sociedad en su conjunto. Objetivo identificar brechas de conocimiento y prioridades de investigación en salud mental del adulto mayor en Argentina. Material...

Introduction: Introduction. Health promotion initiatives, even more those promoted by the State, play a fundamental and strategic role in the construction of healthy lifestyles. The objective was to explore from the perspective of a group of young adults from the Autonomous City of Buenos Aires, dimensions and qualitative categories related to hea...

Funding Acknowledgements Type of funding sources: None. Introduction Coronary heart disease (CHD) is the most common cause of death globally, and clinical guidelines recommend cardioprotective medications for patients with established CHD. Suboptimal use of these medications has been reported, but an overview from the South American region is lack...

Background: The COVID-19 pandemic and the confinement that was implemented in Argentina generated a need to implement innovative tools for the strengthening of diabetes care. Diabetes self-management education is a core element of diabetes care; however, because of COVID-19 restrictions, in-person diabetes educational activities were suspended. So...

In Argentina, cardiovascular disease (CVD) represents the first cause of mortality, but effective coverage for CVD prevention is low. Strategies based on behavioral economics are emerging worldwide as key pieces to increase the effectiveness of CVD prevention approaches. The aim of this study was to evaluate whether the implementation of two strate...

Background Risk factors for COPD in high-income settings are well understood; however, less attention has been paid to contributors of COPD in low-income and middle-income countries (LMICs) such as pulmonary tuberculosis. We sought to study the association between previous tuberculosis disease and COPD by using pooled population-based cross-section...

Background: The COVID-19 pandemic presents a challenge to health care for patients with chronic diseases, especially hypertension, because of the important association and increased risk of these patients with a severe presentation of COVID-19 disease. The Guatemalan Ministry of Health has been implementing a multi-component program aimed at impro...

Previous studies have shown the influence of the physical and social environments on the development of obesity and non-communicable diseases (NCD). An obesogenic environment promotes higher dietary energy intakes and sedentary behaviors while limiting opportunities or incentives for active living. This paper presents a dataset with key attributes...

Background Estimates of the burden of cardio-metabolic risk factors in Latin America and the Caribbean (LAC) rely on relative risks (RRs) from non-LAC countries. Whether these RRs apply to LAC remains unknown. Methods We pooled LAC cohorts. We estimated RRs per unit of exposure to body mass index (BMI), systolic blood pressure (SBP), fasting plasm...

Importance Hypertension is highly prevalent in low- and middle-income countries, and it is an important preventable risk factor for cardiovascular diseases (CVDs). Understanding the economic benefits of a hypertension control program is valuable to decision-makers. Objective To evaluate the long-term cost-effectiveness of a multicomponent hyperten...

Background Uncontrolled hypertension represents a substantial and growing burden in Guatemala and other low and middle-income countries. As a part of the formative phase of an implementation research study, we conducted a needs assessment to define short- and long-term needs and opportunities for hypertension services within the public health syste...

Resumen Introducción: La Red Internacional para la Investigación, Monitoreo y Apoyo a la Acción para la Alimentación, Obesidad y Enfermedades No Transmisibles (INFORMAS por su sigla en inglés) ha desarrollado el Protocolo para evaluar la Disponibilidad de Alimentos en Supermercados. Objetivos: Describir el proceso de adaptación del protocolo para...

Purpose Little is known on the association of health care access and health-related quality of life (HRQoL) in people with diabetes in the Southern Cone of Latin America (SCLA). Methods We analyzed data of 1025 participants of CESCAS I. To determine HRQoL, we used the SF-12 physical (PCS-12) and mental component summary (MCS-12). We compared four...

Abstract Background The effective management of cardiovascular (CVD) prevention among the population with exclusive public health coverage in Argentina is low since less than 30% of the individuals with predicted 10-year CVD risk ≥10% attend a clinical visit for CVD risk factors control in the primary care clinics (PCCs). Methods We conducted a non...

Although obesity and non-communicable disease (NCD) prevention efforts to-date have focused mainly on individual level factors, the social and physical environments in which people live are now widely recognized as important social determinants of health. Obesogenic environments promote higher dietary energy intakes and sedentary behaviors, thus co...

Este informe es parte de un proyecto de investigación financiado por la agencia canadiense International Development Research Center (IDRC) a través del proyecto colaborativo IDRC 108643-001. Este informe resume los métodos y resultados de la siguiente publicación científica: Elorriaga N, Moyano DL, López MV, Cavallo AS, Gutierrez L, Panaggio CB, I...

There is growing evidence that the food environment can influence diets. The present study aimed to assess the relative availability and prominence of healthy foods (HF) versus unhealthy products (UP) in supermarkets in Buenos Aires, Argentina and to explore differences by retail characteristics and neighborhood income level. We conducted store aud...

Abstract Introduction: Alcohol consumption is a risk factor for morbidity and mortality globally. Consumption levels in Southern Latin America are among the highest in the world. Objectives: To describe consumption patterns and adherence to guidelines in the general adult population of Southern Latin America, as well as exploration of reasons for...

Background The effective management of cardiovascular (CVD) prevention among the uninsured population in Argentina is low since less than 30% of the individuals with predicted 10-year CVD risk ≥10% attend a clinical visit for CVD risk factors control in the primary care clinics (PCCs). Methods We conducted a non-controlled feasibility study using a...

Non-communicable disease (NCD) prevention efforts have traditionally targeted high-risk and high-burden populations. We propose an alteration in prevention efforts to also include emphasis and focus on low-risk populations, predominantly younger individuals and low-prevalence populations. We refer to this approach as “proactive prevention.” This em...

Issue Guatemala is a culturally and linguistically diverse country. Mayan languages are primarily spoken languages; few people know their written form. Health features and outcomes are difficult to assess due to the lack of validated instruments in these languages. Description of the Problem A cluster randomized trial to improve hypertension contr...

CONICET's Translational Health Research Network is coordinating efforts to advance in translational medicine. Health researchers initiate and focus their research with the aim of improving the health and quality of life of the population. An efficient research system should address health problems relevant to the population resulting in interventio...

Background: Hypertension is a major risk factor for cardiovascular disease (CVD). Despite advances in hypertension prevention and treatment, the proportion of patients who are aware, treated and controlled is low, particularly in low-income and middle-income countries (LMICs). We will evaluate an adapted version of a multilevel and multicomponent...

Fundamentos: Hablar de equidad de género requiere de abordar estereotipos perjudiciales, donde a menudo se perpetúan a través de la publicidad. El objetivo del estudio fue explorar la construcción y reproducción de estereotipos de género presentes en la publicidad gráfica a través de folletos promocionales en las principales cadenas de supermercado...

Background Some studies, mainly from high-income countries (HICs), report that women receive less care (investigations and treatments) for cardiovascular disease than do men and might have a higher risk of death. However, very few studies systematically report risk factors, use of primary or secondary prevention medications, incidence of cardiovasc...

Background: Observational studies have documented lower risks of coronary heart disease and diabetes among moderate alcohol consumers relative to abstainers, but only a randomized clinical trial can provide conclusive evidence for or against these associations. Aim: The purpose of this study was to describe the rationale and design of the Modera...

Prior studies have suggest that religiosity mitigates symptoms of depression. However, population-based data in South America are limited. This study determines the prevalence of religiosity and explores its association with depression in four cities of the Southern cone of Latin-America. In the CESCAS I study 7524 participants aged between 35 and...

Context Observational studies investigating household air pollution (HAP) exposure to biomass fuel smoke as a risk factor for pulmonary tuberculosis have reported inconsistent results. Objective To evaluate the association between HAP exposure and the prevalence of self-reported previous pulmonary tuberculosis. Design We analyzed pooled data incl...

Background The burden of obesity differs by socioeconomic status. We aimed to characterise the prevalence of obesity among adult men and women in Latin America and the Caribbean by socioeconomic measures and the shifting obesity burden over time. Methods We did a cross-sectional series analysis of obesity prevalence by socioeconomic status by use o...

Cardiovascular disease (CVD) is the leading cause of death in Argentina. Computer simulation models allow to extrapolate evidence to broader populations than the originally studied, over longer timeframes, and to compare different subpopulations. The Cardiovascular Disease Policy Model (CVDPM) is a computer simulation state transition model used to...

Background The Patient Health Questionnaire-9 (PHQ-9) is a brief tool to assess the presence and severity of depressive symptoms. This study aimed to validate and calibrate the PHQ-9 to determine appropriate cut-off points for different degrees of severity of depression in Argentina. Methods We conducted a cross-sectional study on an intentional s...

Background: Early repolarization pattern (ERP) is a frequent finding in asymptomatic subjects with controversial implications regarding to its prognosis. This study aims to estimate the prevalence of ERP and its association with sociodemographic characteristics and cardiovascular risk factors among the adult population in the Southern Cone of Latin...

Introduction: Lifestyle modification, such as healthy diet habits, regular physical activity, and maintaining a normal body weight, must be prescribed to all hypertensive individuals. This study aims to test whether a multicomponent intervention is effective in improving lifestyle and body weight among low-income families. Study design: Cluster...

Background Process evaluation is increasingly recognized as an important component of effective implementation research and yet, there has been surprisingly little work to understand what constitutes best practice. Researchers use different methodologies describing causal pathways and understanding barriers and facilitators to implementation of int...

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...

Background Understanding patterns of socio-economic inequalities in tobacco consumption is key to design targeted public health policies for tobacco control. This study examines socio-economic inequalities in smoking and involuntary exposure to tobacco smoke between 2005 and 2013. Methods Data were derived from the Argentine National Risk Factors...

Background: The purpose of this review is to examine the effect of Omega-3 Fatty acids on mortality, morbidity, and adverse events in patients with acute myocardial infarction (AMI). Methods: Data Sources: MEDLINE, EMBASE, and the Cochrane Library through May 2018. Study selection: Randomized Controlled trials (RCT). Certainty of evidence was...

Objective: To examine whether dietary patterns (DP) are associated with endothelial dysfunction (ED) markers in an Argentinian population. Research methods & procedures: Cross-sectional study. The sample belonged to 1,983 subjects from two mid-sized cities of Argentina, involved in CESCAS I Study. To define DP, a food-frequency questionnaire was...

Background: There is an urgent need to define appropriate intervention strategies to control blood pressure in low- and middle-income countries. In 2018, a program proven effective in Argentina was translated to Guatemala's public primary health care system in rural and primarily indigenous communities. Objectives: This paper describes the stake...

Introduction: Statins are essential drugs for high cardiovascular disease (CVD) risk management; however, there is still low adherence to good clinical practice guidelines for statin use at the primary care level in low- and middle-income countries. This study aimed to test whether a complex intervention targeting physicians improves treatment and...

Background Control of cardiovascular disease (CVD) risk factors is suboptimal in Argentina, despite the government's provision of free blood pressure and cholesterol‐lowering medications for people without private insurance. We assessed whether community health workers’ use of an integrated mHealth tool encourages patients to attend visits at prima...

Despite efforts to improve detection and treatment of adults with hypertension and diabetes in Argentina, many public healthcare system users remain undiagnosed or face barriers in managing these diseases. The purpose of this study is to identify health system, provider, and user-related factors that may hinder detection and treatment of hypertensi...

Table S1. List of Chronic Medications Used for Medical Record Review Figure S1. mHealth tools screenshots for CVD risk calculation and appointment scheduling. Figure S2. WHO/ISH risk prediction chart for AMR B. 10‐year risk of a fatal or non‐fatal cardiovascular event by sex, age, systolic blood pressure, smoking status and presence or absence of...

Objectives: The objective is to describe hypertension (HTN) prevalence, awareness, treatment and control in urban and rural communities in Latin America to inform public and policy-makers. Methods: Cross-sectional analysis from urban (n = 111) and rural (n = 93) communities including 33 276 participants from six Latin American countries (Argenti...

Introduction: The Hypertension Control Program in Argentina (HCPIA), a cluster-randomized trial of a community health worker-led multicomponent intervention on blood pressure (BP) control in low-income patients in Argentina, previously reported a significant reduction in systolic BP in the intervention compared to the control group over 18 months (...

Background: Cardiovascular prognostic models guide treatment allocation and support clinical decisions. Whether there are valid models for Latin American and Caribbean (LAC) populations is unknown. Objective: This study sought to identify and critically appraise cardiovascular prognostic models developed, tested, or recalibrated in LAC populatio...

INTRODUCTION: Breast cancer (BC) and colorectal cancer (CRC) both present a high burden of disease in Argentina. Hence, studying the epidemiology of these tumors constitutes a public health priority. The objective of this study was to describe the prevalence of family history of BC and CRC and to estimate the incidence of these tumors in adults age...

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 wit...

Introduction: To examine the relationship between suicidal ideation (SI) and cardiovascular disease (CVD) in the general adult population of four cities in the Southern Cone of Latin America (Argentina, Uruguay, Chile) and the role that depression, stressful life events (SLEs) and physical functional impairment may play in this association. Methods...

Background: Asthma-COPD Overlap (ACO) represents the confluence of bronchial airway hyper reactivity and chronic airflow limitation and has been described as leading to worse lung function and quality of life than found with either singular disease process. Objective: We aimed to describe the prevalence and risk factors for ACO among adults acro...

RESUMEN Objetivo Explorar las motivaciones y expectativas de los usuarios del Programa de Estaciones Saludables en la Ciudad Autónoma de Buenos Aires y evaluar su potencial impacto sanitario. Métodos Se realizaron entrevistas en profundidad (n = 34) y una encuesta autoadministrada (n = 605) a usuarios del programa. Se desarrolló un modelo epidemi...

Aim: To evaluate the one-year post effect of the implementation of a diabetes program that includes mHealth interventions on the quality of diabetic care in public primary care centers. Method: It is a quasi-experimental study with outcome measurements at baseline, 6 and 12months. The program includes primary care team training, a diabetes regis...

Background: A recent cluster randomized trial evaluating a multicomponent intervention showed significant reductions in blood pressure in low-income hypertensive subjects in Argentina. Objectives: To assess the cost effectiveness of this intervention. Methods: A total of 1432 hypertensive participants were recruited from 18 primary health care cent...

Objective: We explore the association between occupational physical activity (OPA) and cardiovascular risk factors in 4 cities of the Southern Cone. Methods: Robust multivariable linear regression models were used to examine the associations RESULTS:: The working population was constituted by 1,868 men and 1,672 women. Men performing high levels...

Introduction Cardiovascular disease (CVD) accounts for approximately one-third of Argentina’s deaths. Despite government provision of free primary care health services to the uninsured population, with a focus on non-communicable diseases, screening and management of those with high CVD risk at primary care clinics (PCCs) remain low. Methods and a...

Background The uptake of an intervention aimed at improving health-related lifestyles may be influenced by the participant’s stage of readiness to change behaviors. Objective We conducted secondary analysis of the Grupo de Investigación en Salud Móvil en América Latina (GISMAL) trial according to levels of uptake of intervention (dose-response) to...