DECRETO 3039 PLAN NACIONAL SALUD PUBLICA PDF

Luis F. Objective : To contribute to the knowledge of some aspects of the Healthy Life Style by studying the effects of including legumes in the diet and exercise at two intensity levels, along with the lipid profile of young sedentary women living at meters above sea level. In each group, 20 to 23 sedentary women were included. The intervention was carried out for four weeks, three days a week.

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Luis F. Objective : To contribute to the knowledge of some aspects of the Healthy Life Style by studying the effects of including legumes in the diet and exercise at two intensity levels, along with the lipid profile of young sedentary women living at meters above sea level.

In each group, 20 to 23 sedentary women were included. The intervention was carried out for four weeks, three days a week.

The outcome variables were total serum cholesterol, LDL cholesterol, HDL cholesterol, and triacylglycerols measured at baseline and after two and four weeks of intervention. No significant changes in serum levels were documented for participants in the group with only dietary modifications.

Conclusions : The results suggest that different interventions that meet some of the criteria for healthy eating and life style show different effects with regards to the level of change in the lipid profile components. The World Health Organization WHO holds that a healthy diet and adequate physical activity are main factors in the promotion and maintenance of good health throughout the whole life cycle 1.

In Colombia, this recommendation is adopted by the National Plan for Public Health, which among its central issues includes improving the health status of the population and avoiding the progress and occurrence of adverse outcomes in the population on the risk of becoming ill 2. In spite of the urgency expressed by the organizations mentioned, the operational definitions that may lead to the quick adoption of a healthy diet and adequate physical exercise practiced regularly are scarce. With respect to physical activity, it is recommended that people keep physically active during their whole lives with at least 30 minutes of moderate intensity regular activity on an almost daily basis 4.

There are many combinations of dietary intervention, different from the restrictive ones, related to achieving healthy eating. Likewise, aerobic exercise is one of the therapeutic focuses related to life style and it is recommended to improve lipid and lipoprotein levels in all individuals, including those with cardiovascular problems. However, except for the general recommendation of almost daily engaging in moderate intensity exercise lasting at least 30 minutes, there is no specification of what is the desirable level of intervention in public health.

There is information available on the positive effect of the intake of legumes and dry whole grains on the lipid profile and glycemia levels, both in healthy and ill individuals There is also evidence of the beneficial effect of exercise, although random tests have yielded conflictive results, perhaps due to differences at the base line, characteristics of the exercise program, and duration of the intervention 11, With the purpose of contributing to the knowledge of some practical aspects to engaging in healthy eating and life style, we present the results of the effects on the lipid profile by including legumes beans, lentils, and chick peas in the diet of healthy but sedentary women at the beginning of the study, accompanied by exercise at two intensity levels: moderate and high.

The participants live at meters above sea level masl. Assignment of participants to a particular group was not done randomly.

Group 4: Food intervention for 4 weeks, but without exercise intervention. Through announcements on the Universidad Javeriana web page, female students were summoned to express their interest in participating in a clinical research related with food intake and physical activity.

Four calls were made during four different weeks, corresponding to each phase of the research. Between 30 and 40 students expressed interest during each invitation. Assignment of the subjects to each intervention group was not random and it was done sequentially.

Of these, 23 were included in the study and 2 remained on standby. The participants were informed on the nature of the study and accepted to participate, signing an informed consent according to guidelines by the Research Committee at Pontificia Universidad Javeriana. All the subjects were in good health and presented no contraindication for exercise and ingestion of prescribed foods according to the medical exam performed on each subject.

Food-Intake Intervention. This lunch was offered between 12 noon and 1 pm, 3 days per week during the 4 weeks of the intervention for groups 1, 2, and 4.

For the dietary prescription, we kept in mind the usual values of energy ingestion and other nutrients, along with the feeding characteristics of each individual, obtained through a detailed dietary assessment. The lunch offered included the following foods: red beans, lentils, or chick peas g , cooked white rice 70 g , fruit 80 g , raw or cooked vegetable 75 g and an unsweetened beverage or natural lemonade ml.

The subjects were instructed to always consume the amount of legumes offered and the other foods making up the lunch ad libitum.

During each of the days of intervention three days per week for 4 weeks each subject recorded the weight of the food portions consumed during the day. To comply with this activity, they were furnished a weighing scale and a measuring cup. Exercise intervention. Rest for 3 minutes on the bike to stabilize the parameters measured before starting the ergospirometry; Warm up by pedaling for 3 minutes at minimum power 15 watts ; during this stage, each subject had to pedal at a constant rhythm between 60 and 70 revolutions per minute rpm ; the test included power increases of 15 watts every 3 minutes until reaching a respiratory coefficient of 1.

In both situations, the participants were accompanied by a trained physical therapist. The subjects were free to do the exercise at their convenience between 9 am and 3 pm. The study also stored the average cardiac frequency obtained over the time each exercise session was developed. Ideally, the time in zone and the average cardiac frequency during the activity should coincide with the time prescribed and the target cardiac frequency prescribed.

During the programmed exercise sessions, the subjects were also asked for their perception of effort by using the Borg scale. Determination of lipoproteins. Blood samples were taken from the antecubital vein during the early morning hours after hour fasting.

Total cholesterol and triglyceride concentrations were analyzed via colorimetric enzyme assays Serapak-Bayer. Statistical analysis. The statistical analysis was aimed at determining the differences in serum biochemical parameter measurements prior to intervention and after two and four weeks of intervention for the 4 groups intervened.

The Stata IC version 10 statistical package was used. The study included 81 women Table 1 , ranging in age between 18 and 29 years; with an average age of Note that the food intake was not stimulated by the researchers, but was rather spontaneously given Table 2. Lipid profile measurements were done prior to starting the intervention, at two weeks of intervention and after four weeks of intervention.

Base line measurements were taken from 88 subjects, at two weeks in 87 individuals and after 4 weeks in 82 individuals. We also studied the difference of the serum values at the base line and after four weeks of intervention and were compared through a Student t test.

Total cholesterol. We have no definite explanation for these differences and they could be attributed to bias in the selection of the participants in this group, which should be kept in mind in the discussion and conclusions because reductions are more difficult when starting with low TC values.

LDL cholesterol. The change in lipid profile was evaluated as an indication of the beneficial effect of four weeks of intervention with actions that could become part of a healthy life style. The results shown in Tables 4 and 5 refer to the differences in the magnitude of change obtained through the interventions.

We obtained an average reduction in TC of The values were: a reduction of 7. Strategies by the WHO to prevent chronic illnesses 1 contemplate efforts to have people consume healthy diets and perform moderate physical activity; however, other authors 15 alert on the difficulties of carrying out these interventions.

Our results indicate that the combination legume intake healthy diet and high-intensity exercise is better than any of the other interventions; furthermore, there is a relationship between exercise intensity and the resulting changes in lipid profile. The current study was conducted at an altitude of 2, masl, and the effect of altitude on the physiology of exercise 16 has been well established. Although with the information available, we cannot confirm or deny the influence of this parameter on the results, we do want to wish to direct attention on this fact given the important number of people living in the Andean high plains.

Several studies have shown the relationship between exercise intensity and the effects on lipid profile 11,17 ; however, few studies report altitude over the sea level where the exercise is done. According to the results of this study, it would seem that to achieve changes in TC, LDL, and TAG parameters, some combination form of legume intake and exercise is needed.

In the group of only dietary intervention, we did not observe the changes associated to the consumption of legumes as reported by other authors An explanation of this result may be the type of legumes used, given that in our case we used canned beans, lentils, and chick peas and in several of the articles cited only beans are consumed; however, the WHO recommends legumes in general.

Similarly, it must be kept in mind that the current study was of short duration and the consumption of whole grains and legumes associated to fruits and vegetables for longer periods may be beneficial, as noted with the Mediterranean diet These results agree with the literature, both in the level of increase as in the association between magnitude of change and exercise intensity As reported by other studies, TAG levels diminish with exercise and in our study we obtained a reduction of Hence, it would be the most desirable combination among those studied.

Although the effects of moderate- or low-intensity exercise upon lipid profile is still a motive for discussion 19 , the effects of the altitude where the study was conducted are still an issue of study. In conclusion, different interventions compatible with healthy dietary intake and life style behave differently as far as their effect on the change in the levels of the fractions of the lipid profile studied, and, consequently, the manner of implementing the recommendation to adopt a healthy diet and life style can bear implications on the final outcome.

Conflict of interest. None of the authors has conflicts of interest related to this study.

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DECRETO 3039 de 2007 PLAN NACIONAL DE SALUD PUBLICA

The Colombian healthcare system: 20 years of achievements and problems. El avance del SGSSS es positivo pero no ha logrado alcanzar la universalidad y se ha estancado en acceso a los servicios y equidad. An overview of some of the key processes and results of Colombia's National Health System is presented. A systematic review of the literature evaluating the quality of the evidence published in indexed journals and literature not published in journals was made. The Mandatory Health Plan, defining the benefits to which one has access, has been broadly maintained but has been hampered by mechanisms for making legal complaints, thereby leading to financial deficits. The health system has contributed towards improving the poorest sector's income, but inequalities persist due to the lack of universal coverage, differences in health plans and the system's expenditure according to the population's income.

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