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Funcionalidad familiar y factores de riesgo modificables para hipertension arterial.

Family Functionality and Modifiable Risk Factors for Arterial Hypertension

Introduction

Family health problems influence the individual health, since the latter is determined by healthy or pathogenic practices followed by the family group. A healthy family lifestyle promotes the health of its members, whereas an unhealthy family lifestyle can make the family members sick (1).

It is considered that the relationship between individual and family health is a two-way issue, that is, the influence is reciprocal. Individual health develops in the context of a family, with the formation of habits, lifestyles, value systems, norms, attitudes and behaviors towards health (1,2).

On the other hand, hypertension is a highly prevalent process in all countries, whether developed or not, and affects almost 40% of adults; it is also the main cause of death and disability worldwide through its cardiovascular complications. In the genesis of this high prevalence and incidence, multiple authors point to the change in lifestyle as a generator --at least partial--of this very negative evolution (3,4,5).

The scarce physical activity and sedentary behaviors are associated with dysfunctional aspects of family dynamics (6). The prevalence of a sedentary lifestyle is greater in women, increases as their age increases and has been related to the enlargement of the waist circumference; furthermore, it has been described that sedentary people have an increase in their heart rate that could be related as a sign of cardiovascular system involvement (7).

Individuals who live in family dysfunction develop bad eating habits (8), that is, a dysfunctional family environment and a single parent structure are risk factors for overweight and obesity (9).

The determination of anthropometric indices are tools for predicting hypertension, due to their strong association (10,11). The presence of conflict between parents is associated with a more deteriorated bond between parents and children and greater consumption of alcohol and other drugs (12).

In the province of Loja there is a high prevalence of risk factors for arterial hypertension, among which are overweight and obesity, with 63.9%; alcohol consumption, with 40.6%; tobacco consumption, with 42.3%; physical inactivity, with 55.8%, and prehypertension, with 34.8% (13). Hence, lifestyle not only influences the onset and development of arterial hypertension, but also its control (14,15).

Treating high blood pressure and its complications requires costly interventions that deplete governmental and individual budgets, so that lifestyle changes, through early detection and control of risk factors, generate both health and economic benefits (16,17,18,19,20).

Changes in lifestyles such as smoking cessation, reduction of excess weight, moderation of alcohol consumption, physical activity, reduction of salt intake, increase of fruit and vegetable intake, together with reduction of the consumption of saturated fats, can contribute to lower blood pressure rates (21).

The objective of this research was to determine the relationship between family functionality and modifiable risk factors for arterial hypertension in adults from 20 to 64 years of age from the city of Loja, Ecuador.

There are few studies on the influence of the family on health risk behaviors, so the relationship between family functionality and the modifiable risk factors for arterial hypertension is unknown.

Materials and Methods

Type of Study

A cross-sectional, correlational, analytical study was conducted during November 2015 and October 2016, in a random sample of individuals between 20 and 64 years of age.

Design of the Research

In the development of the present project, field research was used, based on information from surveys and direct observation of the participants.

Calculation of the Sample Size

The data from the Ecuador Population and Housing Census 2010 was taken as a basis, considering the age group between 20 and 64 years of the urban parishes of the city of Loja (97,223 adults). The number of surveys was determined applying the Pita Fernandez formula with an expected proportion of 5%, a confidence level of 95% and an accuracy of 5%.

To determine the number of surveys that were to be carried out in each of the four urban parishes of the city of Loja, a classification performed in subgroups or strata with similar environmental (altitude and latitude) and demographic (population density in adults from 20 to 64 years of age) characteristics. The number of surveys in each parish was divided by the number of neighborhoods and the blocks in which the instrument was applied were randomly drawn using Excel(r). The work was carried out with a minimum desired power of 80%, and its verification was carried out using the G*Power(r) software, with which a total number of 414 people was obtained.

The inclusion criteria were: men and women from 20 to 64 years of age who agreed to be part of this study. The exclusion criteria were: refusal to participate in the study, pregnant women, people with intellectual or physical disabilities that made it difficult to take anthropometric measurements, body mass index less than 18.5 kg/[m.sup.2], patients diagnosed with or under treatment for arterial hypertension. Once the stratification and randomization was done, the roadmap was developed to apply the instrument in the field and collect the information.

Techniques Used to Collect the Information

The secondary information was collected with the help of documents and information about the work context. The primary information was obtained by applying a survey addressed to the participants who were asked to answer objectively and concretely the items proposed.

Ethics

There was an informed consent, which let the participants know about the purpose of the study, its importance, the procedures that were to be carried out, as well as that their participation is voluntary and that they can change their mind later and stop participating, although they had accepted before.

Procedure to Collect the Data

Family functionality. It was determined applying the Family Function Perception Test, which assesses the cohesion, harmony, communication, permeability, affectivity, roles and adaptability of the family. A pilot test was carried out on 30 individuals with similar characteristics and a Cronbach's alpha of 0.768 was obtained, with an acceptable internal consistency.

Degree of tobacco consumption. It was determined according to the parameters and stratification of the World Health Organization (WHO). Likewise, a pilot test was applied on 30 individuals with similar characteristics and a Cronbach's alpha of 0.803 was obtained, with a good internal consistency.

Degree of alcohol consumption. It was established according to the parameters of the Alcohol Use Disorder Identification Test (AUDIT). For the local validation of the AUDIT, a pilot test was carried out on 30 individuals with similar characteristics and a Cronbach's alpha of 0.873 was obtained, with a good internal consistency.

Physical activity. It was determined through the International Physical Activity Questionnaire. This is a short, self-administered format of the last 7 days. After a pilot test on 30 individuals with similar characteristics, a Cronbach's alpha of 0.727 was obtained, with an acceptable internal consistency.

Body Mass Index (BMI). It was established using a weight/height scale previously calibrated to meet the international standards and scales in kilograms and in linear meters. The nutritional status was classified based on the WHO stratification, according to the body mass index (Weight [kg]/height [[m.sup.2]]).

Blood pressure. It was determined by the auscultatory method with a calibrated and properly validated tensiometer. The patients remained seated and still in a chair for at least 5 minutes, with the feet on the floor and the arm at the height of the heart with an adequate size of bracelet (that surpasses at least 80% the arm). The systolic blood pressure was taken as the point at which the first of two or more sounds is heard (phase 1), and the diastolic blood pressure, as the point after which the sound disappears. The blood pressure indices were classified based on the parameters of the Spanish Society of Cardiology.

Method and Model of Analysis. Once the collection instrument was applied, the data was systematized and tabulated with the SPSS program (version 16.0). The relationship of variables was analyzed applying the Pearson's chi-square statistical test. To measure the association between the variables studied, it was necessary to calculate the Cramer V coefficient. Regarding the odds ratio (OR), to determine protective or risk factors, we worked on dichotomous tables and confidence limits with an interval of 95%.

Results

The sample consisted of 414 participants (132 men and 282 women), with an average age of 38.41 years, of which 68.1% were female. The prevalence of family dysfunction was 52.17%; low level of physical activity, 74.88%; tobacco consumption, 26.09%; overweight-obesity, 73.91%; altered blood pressure (normal high), 21.01%, and risky alcohol consumption, 35.75% (see annexes).

Family dysfunction was a risk factor for: low level of physical activity, since a [[chi square].sub.c] value of 11.97 was found (p<0.05 [0.007]; OR: 1.61; 95% CI: 1.03-2.52); tobacco consumption, with a [[chi square].sub.c] of 10.53 (p<0.05 [0.015]; OR: 1.63; 95% CI: 1.04-2.55); overweight-obesity, with a [[chi square].sub.c] of 10.49 (p<0.05 [0.015]; OR: 1.77; 95% CI: 1.13-2.76); altered blood pressure, with a [[chi square].sub.c] of 21.37 (p<0.05 [0.000]; OR: 2.00; 95% CI: 1.22-3.28); risky alcohol consumption, with a [[chi square].sub.c] of 62.91 (p<0.05 [0.000]; OR: 5.69; 95% CI: 3.59-9.01).

Discussion

The results of the study show a statistically significant association between family functionality and risk factors for hypertension, such as low physical activity, tobacco consumption, overweight-obesity, normal high blood pressure and risky alcohol consumption; however, the magnitude of this association, determined by the Cramer's V coefficient, ranges from 0.17 to 0.39, which establishes a low to moderate degree of association, and this relationship should, therefore, be investigated further.

In the nutritional diagnosis of the population studied, classified according to the BMI, overweight-obesity was prevalent, with 73.91%, similar to what occurred in the study by Freire et al. (13), where an overweight-obesity prevalence of 62.8% was observed.

Family dysfunction is a risk factor for the development of scarce physical activity. The correlation between family dysfunction and tobacco consumption contrasts with the results of the study by Santander et al. (22), where participants belonging to households perceived as dysfunctional had a significantly higher risk of tobacco use (OR: 1.46; 95% CI: 1.02-2.07; p<0.03).

Family dysfunction constituted a risk for the development of overweight-obesity, results similar to those obtained in the study by Gonzalez-Rico et al. (23), in which there was an association between family dysfunction and obesity (OR: 1.63; 95% CI: 1.08-2.46; p<0.01).

Participants with family dysfunction presented altered blood pressure, results that could be compared with the study by Gonzalez et al. (24), where it was shown that 84.13% of dysfunctional families showed lack of control of blood pressure levels ([chi square]: 54.6, p = 0.0000, Cramer V: 0.4223).

The association between family dysfunction and alcohol consumption determined in this study is comparable with the results of the study by Musitu et al. (25), which shows a positive and significant relationship between a negative family functionality and substance use ([beta] = 0.15, p<0.01), among these alcohol.

Conclusions

There is a statistically significant relationship between family function and risk factors for arterial hypertension. The data support the hypothesis that family dysfunction constitutes a predisposing factor for the development of risk factors for arterial hypertension.

The analysis of this relationship contributes to the advancement of knowledge and is very useful as a basis for delineating family and community preventive strategies.

Conflicts of interest

The authors declared no conflicts of interest.

Acknowledgements

We thank the study participants for their collaboration in obtaining the data.

Sponsored by the Post-graduate Program in Family and Community Medicine of the National University of Loja, Ecuador, in collaboration with the Ministry of Public Health of Ecuador and financed by the International Development Bank. Reviewed by Dr. Angelica Gordillo. Specialist in Internal Medicine, treating doctor at the Isidro Ayora Hospital of Loja. Professor of the Human Health Area at the National University of Loja.

References

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(14.) Cordoba R, Cabezas C, Camarelles F, Gomez J, Diaz D, Lopez A, et al. Recomendaciones sobre el estilo de vida. Atencion Primaria. 2012;44(1):16-22.

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Annex 1.
Relationship between family dysfunction and risk factors for
arterial hypertension

Crossing       Trouble             1           P      Cramer     OR
Variable       Variable       [chi square]               V

Family         Low level
Dysfunction    of physical       11.976      0.007    0.170    1.513
               activity

Family         Tobacco           10.534      0.015     0.15    1.634
Dysfunction    consumption

Family         Overweight-       10.490      0.015    0.159    1.773
Dysfunction    Obesity
               Altered
Family         blood
Dysfunction    pressure          21.373      0.000    0.337    3.00S
               (normal
               high)

Family         Risky
Dysfunction    Alcohol           62.914      0.000    0.390    5.693
               Consumption

Crossing       Confidence Interval 95%
Variable        LCI      LCS

Family
Dysfunction    1.031    3.534

Family         1.045    3.556
Dysfunction

Family         1.137    3.765
Dysfunction

Family
Dysfunction    1.337    3.3S5

Family
Dysfunction    3.596    90.014

Source: Direct research 2016. Database of the research project
Family factors and their relationship with modifiable risk factors
for hypertension in adults from 20 to 64 years of age Loja 2016.
UNL-ASH. Prepared by: MD Jorge Poma.

Annex 2. Distribution of Adults by Age and Gender

Variable        Frequency                Confidence
                 (n=414)    %            Interval 95%
                                         LCI          LCS
Age
Young Adult     344         58.94        57.73        60.15
Adult           170         41.06        39.85        42.28

Gender

Male            132         31.88        30.67        33.10
Female          383         68.13        66.9         69.33

Annex 3. Prevalence of Family Dysfunction

                                                      Confidence
Family                      Total                     Interval
Function                    adults per   Prevalence   95%
                Frequency   function     (%)          LCI      LCS

Dysfunctional   216         414          53.17        51.88    53.47
Functional      198         414          47.83        47.53    48.13

Source: Direct research 2016. Database of the research project
Family factors and their relationship with modifiable risk factors
for hypertension in adults from 20 to 64 years of age Loja 2016.
UNL-ASH. Prepared by: MD Jorge Poma.

Annex 4. Prevalence of Scarce Physical Activity

Gender                                                Confidence
                            Total                     Interval
                            adults per   Prevalence   95%
                Frequency   function     (%)          LCI      LCS

Male            93          132          70.45        69.94    70.97
Female          217         282          76.95        76.44    77.46
Total           310         414          74.88        74.37    75.39

Source: Direct research 2016. Database of the research project
Family factors and their relationship with modifiable risk factors
for hypertension in adults from 20 to 64 years of age Loja 2016.
UNL-ASH. Prepared by: MD Jorge Poma.

Annex 5. Prevalence of Tobacco Consumption

                                                      Confidence
Gender                      Total                     Interval
                            adults per   Prevalence   95%
                Frequency   function     (%)          LCI      LCS

Male            65          133          49.34        44.71    53.78
Female          43          3S3          15.35        10.73    19.78
Total           108         414          26.09        31.55    30.63

Source: Direct research 2016. Database of the research project
Family factors and their relationship with modifiable risk factors
for hypertension in adults from 20 to 64 years of age Loja 2016.
UNL-ASH. Prepared by: MD Jorge Poma.

Annex 6. Prevalence of Overweight-Obesity
                                                      Confidence
Gender                      Total                     Interval
                            adults per   Prevalence   95%
                Frequency   function     (%)          LCI      LCS

Male            96          132          72.73        72.59    72.S7
Female          210         282          74.47        74.33    74.131
Total           30(5        414          73.91        73.78    74.05

Source: Direct research 2016. Database of the research project
Family factors and their relationship with modifiable risk factors
for hypertension in adults from 20 to 64 years of age Loja 2016.
UNL-ASH. Prepared by: MD Jorge Poma.

Annex 7. Prevalence of normal high blood pressure
                                                      Confidence
Gender                      Total                     Interval
                            adults per   Prevalence   95%
                Frequency   function     (%)          LCI      LCS

Male            34          132          25.73        24.72    26.79
Female          53          2S2          18.79        17.76    19.83
Total           S7          414          21.01        19.98    22.05

Source: Direct research 2016. Database of the research project
Family factors and their relationship with modifiable risk factors
for hypertension in adults from 20 to 64 years of age Loja 2016.
UNL-ASH. Prepared by: MD Jorge Poma.

Annex 8. Prevalence of Risky Alcohol Consumption

                                                      Confidence
Gender                      Total                     Interval
                            adults per   Prevalence   95%
                Frequency   function     (%)          LCI      LCS

Male            78          132          59.09        55.19    62.99
Female          70          282          24.82        20.92    28.73
Total           148         414          35.75        31.85    39.65

Source: Direct research 2016. Database of the research project
Family factors and their relationship with modifiable risk factors
for hypertension in adults from 20 to 64 years of age Loja 2016.
UNL-ASH. Prepared by: MD Jorge Poma.


Authors notes

(a) Corresponding author. E-mail: jorgeluispomamingaok@gmail.com

Additional information

Jorge Poma a jorgeluispomamingaok@gmail.com

National University of Loja, Ecuador

Lucia Carrillo

National University of Loja, Ecuador

Jose Gonzalez

National University of Loja, Ecuado

Received: 29/12/2016

Accepted: 27/06/2017

DOI: https://doi.org/10.11144/Javeriana.umed59-1.ffha

Redalyc: http://www.redalyc.org/articulo.oa?id=231054404002

Funding

Funding source: Post-graduate Program in Family and Community Medicine of the National University of Loja, Ecuador Funding source: Ministry of Public Health of Ecuador Funding source: International Development Bank CC BY
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Title Annotation:Articulos originales
Author:Poma, Jorge; Carrillo, Lucia; Gonzalez, Jose
Publication:Revista Universitas Medica
Date:Jan 1, 2018
Words:3739
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