Scielo RSS <![CDATA[Revista Panamericana de Salud Pública]]> http://www.scielosp.org/rss.php?pid=1020-498920140001&lang=pt vol. 35 num. 1 lang. pt <![CDATA[SciELO Logo]]> http://www.scielosp.org/img/en/fbpelogp.gif http://www.scielosp.org <![CDATA[<b>Health expenditures, income inequality, and the marginalization index in Mexico’s health system</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892014000100001&lng=pt&nrm=iso&tlng=pt OBJETIVO: Se evalúa el efecto de la relación entre el gasto público en salud, la desigualdad en el ingreso y el índice de marginación sobre la mortalidad materna e infantil en México, con el propósito de determinar el efecto de estos factores sobre el desempeño del sistema de salud, desde una perspectiva de eficiencia técnica. MÉTODOS: Se realizó un estudio ecológico de 32 entidades federativas mexicanas. Se estimaron las correlaciones entre la mortalidad materna y la mortalidad infantil, y el gasto público en salud per cápita total, per cápita federal y per cápita estatal correspondientes a los años 2000, 2005 y 2010 (coeficiente de Gini e índice de marginación). Se utilizaron regresiones lineales para explorar la asociación de dichas variables con los indicadores de salud en los sistemas de los estados. RESULTADOS: Se observaron correlaciones negativas para el índice de marginación y el coeficiente de Gini en relación a la esperanza de vida al nacer (-0,62 y -0,28 respectivamente). Asimismo, se registró una correlación positiva de 0,59 entre el índice de marginación y mortalidad infantil (P < 0,05). Los modelos de regresión lineal múltiple revelan un efecto negativo del índice de marginación y el coeficiente de Gini sobre los resultados en salud. El financiamiento por parte del ente federal tuvo un efecto positivo en el desempeño del sistema en términos de indicadores de salud. CONCLUSIONES: El proceso de reforma del sistema de salud de México ha tenido un impacto positivo en los indicadores sanitarios del país; la inversión financiera por parte del ente federal pareciera ser efectiva en este aspecto. Los determinantes sociales tienen un efecto importante sobre el desempeño de los sistemas de salud, y su abordaje requiere de análisis con enfoques multisectoriales y multidisciplinares.<hr/>OBJECTIVE: Evaluate the effect of the relationship among public health expenditures, income inequality, and the marginalization index on maternal and child mortality in Mexico, to determine the effect of these factors on health system performance from a technical efficiency perspective. METHODS: An ecological study of 32 Mexican states. Correlations were estimated between maternal and infant mortality and public health expenditures in total per capita, federal per capita, and state per capita for the years 2000, 2005, and 2010 (Gini coefficient and marginalization index). Linear regressions were used to explore the association of these variables with health indicators in the state systems. RESULTS: Negative correlations were observed for the marginalization index and Gini coefficient with regard to life expectancy at birth (-0.62 and -0.28 respectively). Furthermore, there was a positive correlation of 0.59 between the marginalization index and infant mortality (P <0.05). Multiple linear regression models revealed a negative effect of the marginalization index and Gini coefficient on health out-comes. Federal funding had a positive effect on system performance in terms of health indicators. CONCLUSIONS: Health system reform in Mexico has had a positive impact on the country’s health indicators; federal financial investment seems to be effective in this regard. Social determinants have an important effect on health system performance, and analysis using multisectoral and multidisciplinary approaches are needed in addressing them. <![CDATA[<b>Functioning outcomes for abused immigrant women and their children 4 months after initiating intervention</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892014000100002&lng=pt&nrm=iso&tlng=pt OBJECTIVE: To measure the impact of shelter intervention and protection orders on the mental health functioning, resiliency, and further abuse of documented and undocumented immigrant women and their children in Houston, Texas, United States. METHODS: A prospective cohort study initiated in 2011 examined a subsample of 106 immigrant mothers, primarily from Mexico and Central America, and evaluated their functioning with a battery of 13 well-established instruments as they accessed either shelter or justice services; followed-up was conducted 4 months later to measure improvement. Data were analyzed with a series of repeated measures 2 x 2 x 2 factorial analysis of variance tests. RESULTS: Large effect size improvements were observed in abused immigrant women’s mental health, resiliency, and safety, regardless of whether the intervention accessed was safe shelter or justice services, and regardless of duration of shelter stay and whether or not a protection order was issued. Similarly, large effect size improvements were observed in child functioning, independent of which type of intervention, the duration of shelter stay, or the issuance of a protection order. CONCLUSIONS: Accessing protective services has the potential to improve the health of immigrant women and their children, regardless of documentation status. Global policy for improved access and acceptability of shelter and justice services is essential to promote immigrant women’s safety and to maximize functioning of women and children.<hr/>OBJETIVO: Determinar la repercusión de la intervención de albergue y las órdenes de protección sobre el desempeño en cuanto a la salud mental, la resiliencia y el maltrato adicional de mujeres inmigrantes, documentadas e indocumentadas, y sus hijos, en Houston, Texas, Estados Unidos. MÉTODOS: En un estudio prospectivo de cohortes iniciado en el 2011, se examinó una submuestra de 106 madres inmigrantes, procedentes principalmente de México y Centroamérica, y se evaluó su desempeño mediante una serie de 13 instrumentos bien establecidos cuando accedían a los servicios de albergue o de justicia; cuatro meses después, se llevó a cabo su seguimiento con objeto de medir el grado de mejora. Los datos fueron analizados mediante pruebas de análisis de la varianza, con una serie de mediciones repetidas, según un diseño factorial 2 x 2 x 2. RESULTADOS: Se observaron mejoras de gran magnitud de efecto sobre la salud mental, la resiliencia y la seguridad de las mujeres inmigrantes maltratadas, independientemente de si la intervención correspondía a un albergue seguro o a servicios de justicia, e independientemente del tiempo de permanencia en el albergue y de la expedición de una orden de protección. De manera análoga, se observaron mejoras de gran magnitud de efecto sobre el desempeño de los niños, independiente del tipo de intervención, el tiempo de permanencia en el albergue o la expedición de una orden de protección. CONCLUSIONES: El acceso a los servicios de protección puede mejorar la salud de las mujeres inmigrantes y sus hijos, independientemente de su situación en cuanto a documentación. Resulta esencial el establecimiento de una política mundial dirigida a mejorar el acceso y la aceptabilidad de los servicios de albergue y de justicia para promover la seguridad de las mujeres inmigrantes y potenciar al máximo su desempeño y el de sus hijos. <![CDATA[<b>Characteristics of hospital care and its relationship to severe maternal morbidity in Medellín, Colombia</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892014000100003&lng=pt&nrm=iso&tlng=pt OBJETIVO: El objetivo de este estudio es establecer si la morbilidad materna extrema (MME) se asocia con algunas características del acceso y la utilización de los servicios obstétricos de las gestantes participantes. MÉTODOS: Se realizó un estudio de casos y controles con 600 pacientes en embarazo, en parto o el puerperio atendidas entre 2011 y 2012 en servicios de obstetricia de Medellín (Colombia). Se consideraron casos (n = 150) las pacientes obstétricas que durante el ingreso cumplían los criterios de MME establecidos por el sistema de vigilancia que se aplica en la ciudad. Los controles (n = 450) se obtuvieron aleatoriamente de las mismas instituciones que los casos. La información se recabó mediante entrevista personalizada, revisión de la historia clínica y calificación del cuidado médico, realizada por el personal del programa de vigilancia. El análisis se realizó sobre la base del modelo Camino para la supervivencia a la muerte materna de la OPS/OMS, CDC, FNUAP-LAC y Mother Care. RESULTADOS: El porcentaje de embarazo no planificado en las mujeres estudiadas fue 57,6% y el retraso en la decisión de buscar atención, 32,0%. La etnia (OR = 1,8; IC95%: 1,0-2,9) y el retraso por deficiencias en la calidad de la atención prestada (OR = 8,3; IC95%: 5,0-13,7) fueron las variables que se encontraron asociadas con la MME. CONCLUSIONES: Los hallazgos sugieren que mejorar la efectividad y calidad de los programas de planificación familiar, control prenatal y atención obstétrica hospitalaria pudiera contribuir a reducir los casos evitables de MME.<hr/>OBJECTIVE: The objective of this study was to determine whether there is an association between severe maternal mortality (SMM) and the characteristics of access to and use of obstetric services by the participating women. METHODS: A study of cases and controls was conducted in a group of 600 women who were attended during pregnancy or the puerperium between 2011 and 2012 by obstetric services located in Medellín, Colombia. The study considered cases (n = 150) in obstetric patients who met the criteria for SMM established by the surveillance system being used in Medellín at the time of their admission. The controls (n = 450) were randomly selected in the same institutions where the patients were being treated. The information was obtained through an in-person interview, review of the patient’s clinical history, and rating of the medical care provided by surveillance program personnel. The analysis was based on the model Road Map for Preventing Maternal Death developed jointly by Pan American Health Organization/World Health Organization, Centers for Disease Control, United Nations Population Fund for Latin America and the Caribbean, and Mothercare UK. RESULTS: The proportion of unplanned pregnancies in the women studied was 57.6%, while the proportion of delay in the decision to seek care was 32.0%. Two variables were found to be associated with SMM: ethnicity (OR = 1.79) and delays due to deficiencies in the quality of care provided (OR = 8.54). CONCLUSIONS: The findings suggest that improving the effectiveness and quality of family planning, prenatal check-up, and hospital obstetric care programs could help to reduce avoidable cases of SMM. <![CDATA[<b>Prevalência da cárie radicular na população adulta e idosa da região Sudeste do Brasil</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892014000100004&lng=pt&nrm=iso&tlng=pt OBJETIVO: Avaliar a prevalência da cárie radicular em adultos e idosos da região Sudeste do Brasil. MÉTODOS: O estudo avaliou dados da Pesquisa Nacional de Saúde Bucal (SB Brasil 2010) disponibilizados pelo Ministério da Saúde. Na SB Brasil 2010, 1 586 adultos e 1 277 idosos foram examinados por meio de uma amostra probabilística domiciliar nas quatro capitais e em 30 municípios da região Sudeste. A cárie radicular (CR), desfecho do estudo, foi avaliada segundo os critérios da Organização Mundial da Saúde, por meio do índice de cárie radicular (ICR) e do índice de raízes cariadas e obturadas (CO-R). Os voluntários responderam a um questionário para obtenção de dados sociodemográficos. Aplicou-se o teste do qui-quadrado para verificar se houve associação entre a prevalência de CR e gênero, renda, escolaridade e local de residência (capital ou interior). RESULTADOS: A média do CO-R foi de 0,36 nos adultos, sendo que 15,2% apresentaram CO-R >0. O ICR foi 6,1%. Para os idosos, a média do CO-R foi 0,17. No grupo de idosos dentados, a média foi de 0,37. A prevalência de CO-R >0 foi 12,4% e 27,2%, respectivamente. O ICR para o total de idosos foi 10%. Em ambos os grupos a CR não tratada foi a mais prevalente. Foram associadas à CR em adultos a renda, a escolaridade e a cidade; em idosos, apenas o sexo foi associado à prevalência de cárie radicular. CONCLUSÕES: A prevalência da CR revela a necessidade de maior atenção para essa condição de saúde bucal, que não foi tratada na maior parte da amostra estudada. Sugere-se que futuros estudos avaliem estratégias de cuidado e prevenção relacionadas à cárie radicular.<hr/>OBJECTIVE: To assess the prevalence and factors associated with root caries (RC) among adults and the elderly in the Southeast of Brazil. METHODS: This study used secondary data from the Health Ministry’s 2010 National Oral Health Survey. In the Southeast, a household probability sample of 1 586 adults and 1 277 elderly was evaluated in four capitals and 30 municipalities. The RC outcome was evaluated according to World Health Organization criteria for oral health surveys, based on the root caries index (RCI) and root, decayed, filled (RDF) surface index. Participants answered a sociodemographic questionnaire. The chi-square test was used to determine the association between prevalence of RC and gender, income, educational attainment, and place of residence (capitals or noncapital municipality). RESULTS: The mean RDF index in adults was 0.36, and the RCI was 6.1%. In 15.2% of adults, the RDF index was > 0. The mean RDF index was 0.17 in the elderly and 0.37 in dentate individuals. Prevalence of RDF > 0 was 12.4% and 27.2%, respectively, and the RCI was 10% among the elderly. In both groups, untreated RC was the most prevalent. RC in adults was associated with income, educational attainment, and residence location. In the elderly, it was associated only with gender. CONCLUSIONS: Prevalence of RC indicates that further attention should be paid to this oral condition, especially as RC was untreated in most subjects. We suggest that future studies evaluate new strategies for the care and prevention of RC. <![CDATA[<b>Cohort study of smoke-free homes in economically disadvantaged communities in the Dominican Republic</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892014000100005&lng=pt&nrm=iso&tlng=pt OBJECTIVE: To analyze household smoking-ban prevalence over time and predictors among communities in the Dominican Republic, historically a significant tobacco-growing country with few tobacco control regulations. METHODS: Baseline (2004) and follow-up surveillance surveys (2006, 2007) (each n > 1 000 randomly selected households) conducted in six economically disadvantaged communities (three tobacco-growing and two each urban, peri-urban, and rural) assessed household members’ demographics, health status, and household characteristics, including smoking restrictions. RESULTS: Between 2004 and 2007, household smoking-ban prevalence increased in all communities, with overall rates increasing from 23.9% (2004) to 45.3% (2007). Households with smokers adopted smoking bans at lower rates (6%-17%) versus those without smokers (which had an adoption rate of 35%-58%). Logistic regression models demonstrated that the associations between allowing smoking in households with no members who smoked and being located in a tobacco-growing community, being a Catholic household, and having a member with a cardiovascular problem were statistically significant. The association between having a child under age 5 or a member with a respiratory condition and prohibiting smoking in the home was not statistically significant. CONCLUSIONS: Prevalence of households banning smoking increased in all communities but remained well below rates in industrialized countries. For low- and middle-income countries or those in early stages of tobacco control, basic awareness-raising measures (including surveillance activities) may lead to statistically significant increases in household smoking-ban adoption, particularly among households with no smokers. An increase in household smoking-ban prevalence may result in changes in community norms that can lead to a further increase in the adoption of smoking bans. Having household members who smoke and being in a tobacco-growing community may mitigate the establishment of household bans. Increasing individuals’ knowledge about the far-reaching health effects of secondhand smoke exposure on children and nonsmoking adults (healthy or unhealthy) may help overcome these obstacles.<hr/>OBJETIVO: Analizar la evolución de las prohibiciones de fumar en los hogares con el transcurso del tiempo, y los factores predictivos de estas prohibiciones en las comunidades de la República Dominicana, un país que históricamente ha sido un importante productor de tabaco con pocas regulaciones en cuanto a su control. MÉTODOS: Se llevaron a cabo un estudio inicial (2004) y estudios de vigilancia posterior (2006 y 2007) (cada uno de ellos con un tamaño de muestra n superior a 1 000 hogares seleccionados aleatoriamente) en seis comunidades económicamente desfavorecidas (tres productoras de tabaco, y dos de cada uno de los entornos urbano, periurbano y rural), y se evaluaron los datos demográficos de los miembros de los hogares, su estado de salud y las características de los hogares, incluidas las restricciones al consumo de tabaco. RESULTADOS: Entre el 2004 y el 2007, la prevalencia de la prohibición de fumar en los hogares aumentó en todas la comunidades, con un incremento general de las tasas de 23,9 (2004) a 45,3% (2007). Las tasas de adopción de prohibiciones de fumar en los hogares con fumadores fueron inferiores (de 6 a 17%) a las de los hogares sin fumadores (de 35 a 58%). Los modelos de regresión logística demostraron una asociación estadísticamente significativa entre la permisividad con el tabaco en los hogares sin miembros fumadores y la pertenencia a una comunidad productora de tabaco, profesar la religión católica y la presencia de un miembro afectado por una enfermedad cardiovascular. La asociación entre la presencia de un niño menor de cinco años o de un miembro afectado por una enfermedad respiratoria y la prohibición de fumar en el hogar no fue estadísticamente significativa. CONCLUSIONES: La prevalencia de hogares en los que se prohibía fumar aumentó en todas las comunidades pero se mantuvo bastante por debajo de las tasas de los países industrializados. En los países con ingresos bajos y medianos, o que se encuentran en fases iniciales del control del tabaco, las medidas básicas de sensibilización (incluidas las actividades de vigilancia) pueden conducir a incrementos estadísticamente significativos de la adopción de la prohibición de fumar, en particular en los hogares sin fumadores. Un aumento de la prevalencia de hogares en los que se prohíba fumar puede dar lugar a cambios en las normas de la comunidad que a su vez comporten un aumento adicional de la adopción de prohibiciones de fumar. La presencia en el hogar de miembros fumadores y la pertenencia a una comunidad productora de tabaco pueden mitigar el establecimiento de prohibiciones en los hogares. El incremento de la información proporcionada a las personas sobre los importantes efectos sobre la salud de la exposición pasiva al humo de tabaco de los niños y los adultos no fumadores (sanos o enfermos) puede ayudar a superar estos obstáculos. <![CDATA[<b>Contribuição do turno escolar estendido para o perfil alimentar e de atividade física entre escolares</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892014000100006&lng=pt&nrm=iso&tlng=pt OBJETIVO: Avaliar a influência do tempo de permanência na escola no consumo alimentar, estado nutricional e perfil de atividade física. MÉTODOS: Neste estudo transversal, foram comparados dados dos alunos de dois programas em uma escola municipal de Belo Horizonte: escola integrada (EI), que amplia a jornada educativa, e programa escola tradicional (ET), pela qual os alunos permanecem na escola durante somente um turno. Foram estudados os alunos do 1° ao 6° ano no primeiro semestre de 2010. Realizou-se avaliação demográfica, socioeconômica, de atividade física, antropométrica e de consumo alimentar. RESULTADOS: Participaram do estudo 294 alunos, 53,0% da EI. O excesso de peso foi observado em 14,5% e 17,6% dos estudantes da EI e ET, respectivamente (P = 0,781). Na EI, foi identificada maior mediana de frequência de atividade física [4,5 (2,0-7,0) horas/semana vs. 2,0 (2,0-5,2) na ET; P = 0,004] e maior adequação de carboidratos (82,9% vs. 76,1% na ET; P = 0,01). Os alunos da EI também tiveram maior adequação para o grupo alimentar das frutas (81,8% vs. 18,2% na ET; P = 0,004) e para o número de refeições diárias (67,6% vs. 32,4% na ET; P = 0,002). CONCLUSÃO: A maior permanência no ambiente escolar proporcionou melhores parâmetros dietéticos e favoreceu a prática de atividade física entre os escolares. Tais achados poderão oportunizar mudanças no perfil antropométrico que deverão ser investigadas em longo prazo.<hr/>OBJECTIVE: To evaluate the influence of the amount of time spent in school on food intake, nutritional status, and physical activity profile. METHODS: In this cross-sectional study, student data from two programs were compared in a city school in Belo Horizonte: integrated school (EI), in which students spend longer hours in school, and traditional school (ET), where students stay in school one shift only. First to 6th year students were studied in the first half of 2010. Demographic, socioeconomic, and physical data, as well as anthropometric activity and food intake were assessed. RESULTS: Two hundred and ninety-four students participated in the study, 53.0% from the EI program. Overweight was observed in 14.5% and 17.6% of EI and ET students, respectively (P = 0.781). A higher median frequency of physical activity was identified in EI (4.5 [2.0-7.0] hours/week vs. 2.0 [2.0-5.2] in ET; P = 0.004). EI students also had more adequate intake of carbohydrates (82.9% vs. 76.1% in ET; P = 0.01) and fruit (81.8% vs. 18.2% in ET; P = 0.004), and more adequate number of daily meals (67.6% vs. 32.4% in ET; P = 0.002). CONCLUSIONS: Longer hours school provided better dietary parameters and favored physical activity among students. Such findings may be useful to foster change in anthropometric parameters to be investigated in the long term. <![CDATA[<b>Health-related quality of life in Latin American adolescents</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892014000100007&lng=pt&nrm=iso&tlng=pt OBJETIVO: El objetivo del presente trabajo es determinar diferencias en relación con el sexo, la edad y el país de origen, en los componentes de la calidad de vida relacionada con la salud (CVRS), en una muestra de adolescentes de tres ciudades localizadas en Argentina, Brasil y Chile, utilizando datos recogidos mediante un cuestionario validado y reconocido internacionalmente: el KIDSCREEN-52. MÉTODOS: Se aplicó el cuestionario KIDSCREEN-52 a 1 357 adolescentes con edades comprendidas entre 12 y 17 años (48,6% varones) en muestras seleccionadas en los tres países. Se utilizó el análisis de varianza univariada (ANCOVA) y se identificaron diferencias entre países de los adolescentes, sexo y edad en cada componente de CVRS. RESULTADOS: Los datos indican diferencias significativas en componentes específicos de CVRS entre los tres países. Los varones consiguieron puntuaciones significativamente más elevadas que las mujeres en los componentes Bienestar físico (P < 0,001), Bienestar psicológico (P = 0,019), Estado de ánimo y emociones (P < 0,001), Autopercepción (P = 0,001), Autonomía (P < 0,001) y Relación con los padres y vida familiar (P = 0,008). Las puntuaciones medias atribuidas a los componentes Bienestar físico (P = 0,001), Bienestar psicológico (P = 0,001), Autopercepción (P = 0,038), Autonomía (P = 0,001), Relación con los padres y vida familiar (P = 0,001), Entorno escolar (P = 0,001) y Recursos económicos (P = 0,022) muestran un descenso significativo con el avance de la edad; en cuanto al componente Rechazo (social/bullying), los puntajes medios encontrados aumentaron significativamente con la edad (P < 0,001). CONCLUSIONES: Las evidencias encontradas sugieren que las intervenciones en prevención y promoción de la salud deberían ser concebidas para llegar a los grupos-objetivo específicos y tendrían que contemplar acciones de acuerdo con el sexo y la edad de los adolescentes.<hr/>OBJECTIVE: The objective of the present study was to find out if there are differences in terms of sex, age, or country of origin for the components of health-related quality of life (HRQL) in samples of adolescents from three cities-in Argentina, Brazil, and Chile, respectively-using data collected through an internationally recognized and validated survey questionnaire, KIDSCREEN-52. METHODS: The KIDSCREEN-52 questionnaire was administered to 1 357 adolescents between 12 and 17 years of age (48.6% of them male) in selected samples in the three countries. Univariate analysis of variation (ANCOVA) was used. Not only sex and age differences, but also differences for each component of HRQL, were found between the three country groups. RESULTS: The data showed significant differences between the three countries for each of the specific components of HRQL. Males scored significantly higher than females in the following components: Physical Well-being (P < 0.001), Psychological Well-being (P = 0.019), Moods and Emotions (P < 0.001), Self-perception (P = 0.001), Autonomy (P < 0.001), and Parent Relations and Home Life (P = 0.008). Furthermore, the average scores for Physical Well-being (P = 0.001), Psychological Well-being (P = 0.001), Self-Perception (P = 0.038), Autonomy (P = 0.001), Parent Relations and Home Life (P = 0.001), School Environment (P = 0.001), and Financial Resources (P = 0.022) showed a significantly declining trend with each advancing year, while average scores for the component Social Acceptance (Bullying) increased significantly with age (P < 0.001). CONCLUSIONS: The evidence suggests that interventions in disease prevention and health promotion should be developed for specific target groups, using appropriate actions depending on the sex and age of the adolescents. <![CDATA[<b>Factors associated with hepatitis C seropositivity in people living with HIV</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892014000100008&lng=pt&nrm=iso&tlng=pt OBJECTIVE: To identify risk factors associated with hepatitis C virus (HCV) seropositivity in human immunodeficiency virus (HIV)-infected patients. METHODS: A paired case-control study adjusted by age and gender was conducted. It included adults coinfected with HIV and HCV (cases) and HIV mono-infected subjects (controls) using non-probability sampling. Data were collected through interviews and review of medical records. The chi-square test was used for comparing categorical variables and the Student’s t-test or Wilcoxon (Mann-Whitney U) test for continuous variables. Confidence intervals (95%) were estimated along with crude and adjusted odds ratios using conditional logistic regression. RESULTS: A total of 165 patients were surveyed, including 55 cases and 110 controls. The mean age was 43.6 ± 8.4 years, ranging from 19 to 64 years; 70.9% were male. Independent risk factors for HIV/HCV coinfection were education (up to eight years of schooling); age at first intercourse < 15 years; having undergone tattooing; blood transfusion; and use of injecting drugs. CONCLUSIONS: Low level of education, early age at first sexual intercourse, tattooing, blood transfusions, and sharing needles and other drug injection equipment were factors that increased the risk of HIV/HCV coinfection. The results from this research can be compared with similar data from other regions to help direct preventive and educational efforts targeting people living with HIV.<hr/>OBJETIVO: Determinar los factores de riesgo asociados con la seropositividad al virus de la hepatitis C (VHC) en pacientes infectados por el virus de la inmunodeficiencia humana (VIH) MÉTODOS: Se llevó a cabo un estudio de casos y testigos apareados, ajustados por edad y sexo. Este estudio, realizado mediante muestreo no probabilístico, incluyó a adultos coinfectados por el VIH y el VHC (casos) y a otros infectados únicamente por el VIH (testigos). Se recopilaron datos mediante entrevistas y revisiones de expedientes médicos. Se utilizó la prueba de ji al cuadrado para comparar las variables categóricas, y la prueba t de Student o la prueba de Wilcoxon (U de Mann-Whitney) para las variables continuas. Se calcularon los intervalos de confianza (95%) junto con las razones de posibilidades brutas y ajustadas mediante el empleo de un modelo de regresión logística condicional. RESULTADOS: Fueron estudiados 165 pacientes (55 casos y 110 testigos). La media de edad fue de 43,6 ± 8,4 años, con edades comprendidas entre los 19 y los 64 años; 70,9% eran hombres. Los factores de riesgo independientes de coinfección por el VIH y el VHC fueron la educación (hasta ocho años de escolarización); la primera relación sexual a una edad inferior a los 15 años; los tatuajes; la transfusión de sangre; y el consumo de drogas inyectables. CONCLUSIONES: El escaso nivel de formación, la primera relación sexual a una edad temprana, los tatuajes, las transfusiones de sangre y el compartir agujas y otros materiales de inyección de drogas fueron factores que aumentaron el riesgo de coinfección por el VIH y el VHC. Se pueden comparar los resultados de esta investigación con datos similares de otras regiones para orientar las iniciativas preventivas y educativas dirigidas a las personas infectadas por el VIH. <![CDATA[<b>Structural social determinants and catastrophic illnesses in municipalities in the Colombian department of Valle del Cauca</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892014000100009&lng=pt&nrm=iso&tlng=pt OBJECTIVE: To explore possible associations between self-reported prevalence of catastrophic illnesses such as chronic renal failure, HIV/AIDS and cancer and a set of structural social determinants. METHODS: Ecological study using data from the 2005 Population Census conducted by the National Administrative Department of Statistics (DANE), focusing on municipalities in the Colombian department of Valle del Cauca that experienced the highest prevalence rates for catastrophic illnesses during 2000-2005. Associations were measured with Pearson’s chi-squared statistic and Fisher’s Exact Test. Prevalence ratios were calculated, with 95% confidence intervals. RESULTS: Statistically significant associations were observed between catastrophic illnesses and social structural determinants in the form of illiteracy, deficient sanitary infrastructure, quality of housing units and access to health services. CONCLUSIONS: A role was observed for social determination of catastrophic illnesses in this context. However, additional analyses are required that recognize the complexity of health-determining processes and that explore the interrelationships among social, structural, behavioral and psychosocial determinants in depth.<hr/>OBJETIVO: Explorar las posibles asociaciones entre la prevalencia autonotificada de enfermedades catastróficas, tales como la insuficiencia renal crónica, la infección por el VIH/sida y el cáncer, y un conjunto de determinantes sociales estructurales. MÉTODOS: Se llevó a cabo un estudio ecológico mediante el empleo de datos del Censo de Población del 2005, realizado por el Departamento Administrativo Nacional de Estadística (DANE) y centrado en los municipios del departamento colombiano del Valle del Cauca que experimentaron las tasas más altas de prevalencia de enfermedades catastróficas durante el período del 2000 al 2005. Se midieron las asociaciones mediante la prueba estadística de ji al cuadrado de Pearson y la prueba exacta de Fisher. Se calcularon las razones de prevalencia con intervalos de confianza de 95%. RESULTADOS: Se observaron asociaciones estadísticamente significativas entre las enfermedades catastróficas y los determinantes sociales estructurales en forma de analfabetismo, infraestructura sanitaria deficiente, calidad de las viviendas y acceso a los servicios de salud. CONCLUSIONES: En este contexto, se observó una función de determinación social de las enfermedades catastróficas. Sin embargo, se requieren nuevos estudios que comprueben la complejidad de los procesos determinantes de la salud y exploren a fondo las interrelaciones entre los determinantes sociales, estructurales, conductuales y psicosociales. <![CDATA[<b>Fatores associados a cárie dental e doença periodontal em indígenas na América Latina</b>: <b>revisão sistemática</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892014000100010&lng=pt&nrm=iso&tlng=pt OBJETIVO: Identificar fatores associados à cárie e às doenças periodontais em populações indígenas na América Latina. MÉTODOS: A pesquisa, realizada em janeiro e fevereiro de 2012, incluiu as seguintes bases eletrônicas de dados bibliográficos: MEDLINE/PubMed; Scopus; SciELO; LILACS. Além disso, foram consultadas as listas das referências bibliográficas dos artigos selecionados. A busca inicial identificou 74 artigos indexados, sendo que 33 foram selecionados conforme os critérios de inclusão e exclusão. A qualidade metodológica dos estudos selecionados foi avaliada conforme as recomendações da iniciativa STROBE (Strengthening the Reporting of Observational Studies in Epidemiology). RESULTADOS: As etnias indígenas mais pesquisadas foram as do Brasil, com maior percentual de estudos sobre comunidades indígenas do Xingu e Xavante (31,6%). A maioria das pesquisas foi de natureza transversal. Um dos estudos evidenciou a associação positiva entre perda dental e aumento da idade entre índios Guarani, no Brasil, com maior proporção de sangramento gengival entre adolescentes do sexo masculino e mulheres apresentando maior número de sextantes excluídos por perda dental. Dois estudos longitudinais com índios Xavante, no Brasil, apontaram diferenças significativas na incidência de cárie entre idades e entre sexos. CONCLUSÕES: Pela análise dos artigos considerados adequados, é possível concluir que o aumento da idade e diferenças entre sexos são possíveis fatores associados ao aumento da cárie dentária e doenças periodontais nas etnias Guarani e Xavante, localizadas no Brasil. A insuficiência de estudos com metodologia apropriada confere aos povos indígenas da América Latina uma invisibilidade epidemiológica que prejudica a produção de conhecimento sobre as condições de saúde bucal e a elaboração de estratégias de prevenção de doenças orais e promoção da saúde nessas populações.<hr/>OBJECTIVE: To identify the factors associated with dental caries and periodontal diseases in indigenous populations in Latin America. METHODS: The search was conducted between January and February 2012 in the following databases: MEDLINE/PubMed, SCOPUS, SciELO, and LILACS. The references of the identified articles were also searched. The initial search retrieved 74 articles, 33 of which were selected according to inclusion and exclusion criteria. The methodological quality of the studies was evaluated according to STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) recommendations. RESULTS: Most of the populations studied were Brazilian, with the highest percentage of studies focusing on the Xingu and Xavante communities (31.6%). Most studies were cross-sectional. One of the studies showed a positive association between tooth loss and increasing age among the Guaraní population in Brazil, with the largest proportion of gingival bleeding among adolescent males and females showing a higher number of sextants excluded for tooth loss. Two Brazilian longitudinal studies with Xavante communities showed significant differences in the incidence of caries for age and sex. CONCLUSIONS: Increasing age and differences between sexes are possible factors associated with an increase in dental caries and periodontal diseases in the Guaraní and Xavante people in Brazil. The lack of studies with an appropriate methodology renders Latin American indigenous peoples epidemiologically invisible, hindering the production of knowledge on oral health status and on the development of strategies for oral disease prevention and health promotion in these populations. <![CDATA[<b>Acerca de las desigualdades socioeconómicas en la atención odontológica en Chile</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892014000100011&lng=pt&nrm=iso&tlng=pt OBJETIVO: Identificar fatores associados à cárie e às doenças periodontais em populações indígenas na América Latina. MÉTODOS: A pesquisa, realizada em janeiro e fevereiro de 2012, incluiu as seguintes bases eletrônicas de dados bibliográficos: MEDLINE/PubMed; Scopus; SciELO; LILACS. Além disso, foram consultadas as listas das referências bibliográficas dos artigos selecionados. A busca inicial identificou 74 artigos indexados, sendo que 33 foram selecionados conforme os critérios de inclusão e exclusão. A qualidade metodológica dos estudos selecionados foi avaliada conforme as recomendações da iniciativa STROBE (Strengthening the Reporting of Observational Studies in Epidemiology). RESULTADOS: As etnias indígenas mais pesquisadas foram as do Brasil, com maior percentual de estudos sobre comunidades indígenas do Xingu e Xavante (31,6%). A maioria das pesquisas foi de natureza transversal. Um dos estudos evidenciou a associação positiva entre perda dental e aumento da idade entre índios Guarani, no Brasil, com maior proporção de sangramento gengival entre adolescentes do sexo masculino e mulheres apresentando maior número de sextantes excluídos por perda dental. Dois estudos longitudinais com índios Xavante, no Brasil, apontaram diferenças significativas na incidência de cárie entre idades e entre sexos. CONCLUSÕES: Pela análise dos artigos considerados adequados, é possível concluir que o aumento da idade e diferenças entre sexos são possíveis fatores associados ao aumento da cárie dentária e doenças periodontais nas etnias Guarani e Xavante, localizadas no Brasil. A insuficiência de estudos com metodologia apropriada confere aos povos indígenas da América Latina uma invisibilidade epidemiológica que prejudica a produção de conhecimento sobre as condições de saúde bucal e a elaboração de estratégias de prevenção de doenças orais e promoção da saúde nessas populações.<hr/>OBJECTIVE: To identify the factors associated with dental caries and periodontal diseases in indigenous populations in Latin America. METHODS: The search was conducted between January and February 2012 in the following databases: MEDLINE/PubMed, SCOPUS, SciELO, and LILACS. The references of the identified articles were also searched. The initial search retrieved 74 articles, 33 of which were selected according to inclusion and exclusion criteria. The methodological quality of the studies was evaluated according to STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) recommendations. RESULTS: Most of the populations studied were Brazilian, with the highest percentage of studies focusing on the Xingu and Xavante communities (31.6%). Most studies were cross-sectional. One of the studies showed a positive association between tooth loss and increasing age among the Guaraní population in Brazil, with the largest proportion of gingival bleeding among adolescent males and females showing a higher number of sextants excluded for tooth loss. Two Brazilian longitudinal studies with Xavante communities showed significant differences in the incidence of caries for age and sex. CONCLUSIONS: Increasing age and differences between sexes are possible factors associated with an increase in dental caries and periodontal diseases in the Guaraní and Xavante people in Brazil. The lack of studies with an appropriate methodology renders Latin American indigenous peoples epidemiologically invisible, hindering the production of knowledge on oral health status and on the development of strategies for oral disease prevention and health promotion in these populations. <![CDATA[<b><i>Respuesta a la carta de Cornejo-Ovalle</i></b>: <b>acerca de las desigualdades socioeconómicas en la atención odontológica en Chile</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892014000100012&lng=pt&nrm=iso&tlng=pt OBJETIVO: Identificar fatores associados à cárie e às doenças periodontais em populações indígenas na América Latina. MÉTODOS: A pesquisa, realizada em janeiro e fevereiro de 2012, incluiu as seguintes bases eletrônicas de dados bibliográficos: MEDLINE/PubMed; Scopus; SciELO; LILACS. Além disso, foram consultadas as listas das referências bibliográficas dos artigos selecionados. A busca inicial identificou 74 artigos indexados, sendo que 33 foram selecionados conforme os critérios de inclusão e exclusão. A qualidade metodológica dos estudos selecionados foi avaliada conforme as recomendações da iniciativa STROBE (Strengthening the Reporting of Observational Studies in Epidemiology). RESULTADOS: As etnias indígenas mais pesquisadas foram as do Brasil, com maior percentual de estudos sobre comunidades indígenas do Xingu e Xavante (31,6%). A maioria das pesquisas foi de natureza transversal. Um dos estudos evidenciou a associação positiva entre perda dental e aumento da idade entre índios Guarani, no Brasil, com maior proporção de sangramento gengival entre adolescentes do sexo masculino e mulheres apresentando maior número de sextantes excluídos por perda dental. Dois estudos longitudinais com índios Xavante, no Brasil, apontaram diferenças significativas na incidência de cárie entre idades e entre sexos. CONCLUSÕES: Pela análise dos artigos considerados adequados, é possível concluir que o aumento da idade e diferenças entre sexos são possíveis fatores associados ao aumento da cárie dentária e doenças periodontais nas etnias Guarani e Xavante, localizadas no Brasil. A insuficiência de estudos com metodologia apropriada confere aos povos indígenas da América Latina uma invisibilidade epidemiológica que prejudica a produção de conhecimento sobre as condições de saúde bucal e a elaboração de estratégias de prevenção de doenças orais e promoção da saúde nessas populações.<hr/>OBJECTIVE: To identify the factors associated with dental caries and periodontal diseases in indigenous populations in Latin America. METHODS: The search was conducted between January and February 2012 in the following databases: MEDLINE/PubMed, SCOPUS, SciELO, and LILACS. The references of the identified articles were also searched. The initial search retrieved 74 articles, 33 of which were selected according to inclusion and exclusion criteria. The methodological quality of the studies was evaluated according to STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) recommendations. RESULTS: Most of the populations studied were Brazilian, with the highest percentage of studies focusing on the Xingu and Xavante communities (31.6%). Most studies were cross-sectional. One of the studies showed a positive association between tooth loss and increasing age among the Guaraní population in Brazil, with the largest proportion of gingival bleeding among adolescent males and females showing a higher number of sextants excluded for tooth loss. Two Brazilian longitudinal studies with Xavante communities showed significant differences in the incidence of caries for age and sex. CONCLUSIONS: Increasing age and differences between sexes are possible factors associated with an increase in dental caries and periodontal diseases in the Guaraní and Xavante people in Brazil. The lack of studies with an appropriate methodology renders Latin American indigenous peoples epidemiologically invisible, hindering the production of knowledge on oral health status and on the development of strategies for oral disease prevention and health promotion in these populations.