Scielo RSS <![CDATA[Revista Panamericana de Salud Pública]]> http://www.scielosp.org/rss.php?pid=1020-498919980008&lang=en vol. 4 num. 2 lang. en <![CDATA[SciELO Logo]]> http://www.scielosp.org/img/en/fbpelogp.gif http://www.scielosp.org <![CDATA[<b>Feces, flies, and fetor</b>: <b>findings from a Peruvian shantytown</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49891998000800001&lng=en&nrm=iso&tlng=en Sanitary disposal of feces is vital to combat childhood diarrhea, and its promotion is key to improving health in developing countries. Knowledge of prevailing feces disposal practices is a prerequisite to formulation of effective intervention strategies. Two studies were conducted in a shantytown area of Lima, Peru. First, information was gathered through in-depth interviews with mothers and structured observations (4 hours) of young children and their caretakers. Data on beliefs and practices related to feces disposal behaviors were obtained. Excreta were deposited by animals or humans in or near the house in 82% of households observed. Beliefs about feces depended on their source and were reflected in how likely the feces were to be cleared. While 22% of children aged > or = 18 months were observed to use a potty for defecation, 48% defecated on the ground where the stools often remained. Although almost all children were cleaned after defecation, 30% retained some fecal matter on their body or clothes. Handwashing after the child's defecation was extremely rare for both children (5%) and caretakers (20%). The hygienic disposal of feces poses problems in this type of community. Nevertheless existing practices were found that show promise for promotion on a wider scale, including greater use of potties.<hr/>La disposición sanitaria de las heces es indispensable para poder combatir la diarrea de la infancia y su promoción es esencial para mejorar la salud en países en desarrollo. Es necesario conocer las prácticas actuales de disposición de excretas a fin de formular estrategias de intervención eficaces. Dos estudios se llevaron a cabo en un barrio pobre de Lima, Perú. En el primero se recolectó información por medio de entrevistas minuciosas a madres y observaciones estructuradas (4 horas) de niños pequeños y sus responsables. Se obtuvieron datos sobre las creencias y prácticas vigentes con respecto a la disposición de excretas. En 82% de los domicilios observados, se encontraron excretas depositadas por animales o seres humanos dentro o en el exterior. Las creencias en torno a las heces dependieron de su origen y se vieron reflejadas en las posibilidades de que las heces fueran recogidas. Aunque se observó que 22% de los niños de 18 meses o más defecaban en un recipiente, 48% defecaban en el suelo, donde las heces a menudo se quedaban. Pese a que a casi todos los niños los limpiaron después de defecar, 30% siguieron teniendo materia fecal en el cuerpo o en la ropa. Los niños (5%) o sus responsables (20%) raras veces se lavaron las manos después de la defecación del niño. En este tipo de comunidad, la disposición sanitaria de las heces plantea un problema. No obstante, se observaron algunas prácticas que apuntan a que en un futuro su promoción, incluido el uso de un recipiente, será más amplia. <![CDATA[<B>Risk factors in maternal and child health among Colombian teenage mothers</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49891998000800002&lng=en&nrm=iso&tlng=en Se ha documentado que las madres adolescentes presentan peores indicadores de salud maternoinfantil que las de mayor edad. Por ello, el propósito de esta investigación fue estudiar para Colombia algunas características maternas (biológicas y conductuales) que pudieran afectar a la salud de sus hijos. Con información proveniente de la Encuesta de Prevalencia, Demografía y Salud de 1990, se estudió a la totalidad de niños menores de 5 años (n = 4971) y a sus respectivas madres. Las variables independientes fueron edad (en el momento de la encuesta), estado civil, residencia urbana o rural, nivel socioeconómico y paridad; las variables dependientes fueron bajo peso al nacer, atención prenatal, atención prenatal oportuna y tenencia de la tarjeta de vacunación. Se encontró que en Colombia la mayoría de las mujeres embarazadas o bien recibían atención prenatal de un médico o no recibían atención alguna; muy pocas acudieron con una partera, enfermera u otro personal de salud. En las adolescentes embarazadas la posibilidad de tener un hijo con bajo peso al nacer fue más alta que en las mujeres de 20 a 24 años. Sin embargo, estos dos grupos de mujeres tuvieron resultados similares en las variables del comportamiento (atención prenatal, atención prenatal oportuna y tenencia de la tarjeta de vacunación), a excepción de que hubo más adolescentes que no tenían la tarjeta de vacunación. Por otra parte, estos indicadores fueron mejores en las madres casadas en comparación con las mujeres solteras, viudas, separadas, en unión consensual o divorciadas. En conclusión, el embarazo de una adolescente debe considerarse de alto riesgo, no solo por la falta de desarrollo de su sistema reproductivo sino también por sus características de comportamiento. El riesgo es aun mayor cuando la futura madre no se encuentra legalmente casada, tiene dos o más hijos, no vive en una zona urbana, es de bajos ingresos y tiene poca educación formal.<hr/>It is a documented fact that teenage mothers have worse maternal and child health indicators than older ones. Thus, the purpose of this paper was to investigate some maternal characteristics (biological and behavioral) that could affect their childrens' health. With information derived from the 1990 Prevalence, Demographic, and Health Survey, we studied all children under 5 (n = 4 971) and their respective mothers. Independent variables were age (at the time of the survey), marital status, urban or rural residence, socioeconomic bracket, and parity; dependent variables were low birth weight, prenatal care, early prenatal care, and having a vaccination card. We found that in Colombia most pregnant women were receiving prenatal care from a physician or no prenatal care; very few were under care by a traditional birth attendant, nurse, or other type of health worker. The odds of having a low birth weight infant were higher among pregnant teenagers than among women between the ages of 20 and 24 years. Notwithstanding, these two groups of women showed similar results in terms of behavioral variables (prenatal care, early prenatal care, and having a vaccination card). On the other hand, these indicators were better among married mothers as opposed to those who were unwed, widowed, separated, living with a partner out of wedlock, or divorced. In short, teenage pregnancy should be viewed as high risk not only because of the poor development of the reproductive organs, but also because of behavioral considerations. The risk is even higher when the future mother is legally married, has two or more children, does not live in an urban environment, has a low income, and has little formal education. <![CDATA[<b>Ecuadorian adolescents and cigarette smoking</b>: <b>a cross-sectional survey</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49891998000800003&lng=en&nrm=iso&tlng=en This study investigates adolescents' attitudes and behaviors toward cigarette smoking in Ecuador. Using social cognitive theory as a basis, the cross-sectional survey focuses attention on such social influences as the smoking habits of family members and peers, as well as on the role of cigarette advertisements. Data on prevalence of actual use, access to cigarettes, and knowledge and attitudes about smoking are also obtained. The survey was conducted during the summer of 1994 in both urban and rural areas. Fifty schools in 40 different communities participated, resulting in a sample of 2625 adolescents aged 9 to 15 years who completed the self-administered questionnaire. This study was conducted in collaboration with Amigos de las Américas (AMIGOS), an international health organization. Staff and volunteers who participated in projects conducted by AMIGOS in Ecuador worked with local health and education officials to implement the survey. Nearly 9% of students identified themselves as current smokers, 24.5% had experimented with smoking, and 61.1% had never smoked. The results varied significantly by age and gender, with older students and boys smoking at the highest rate. The smoking status of family members and peers also significantly predicted student smoking status. The results from this sample replicate findings from North American samples. Although Ecuadorian students smoke somewhat less than their American counterparts, cigarette smoking in Ecuador is a significant public health problem and clearly warrants a coordinated response. The present study points to several strategies for preventing smoking among youth.<hr/>En el presente estudio se investigan las actitudes y conductas en torno al tabaquismo de los adolescentes en Ecuador. Basándose en teorías tomadas de la sociología cognoscitiva, la encuesta transversal enfoca la atención en influencias sociales tales como los hábitos de tabaquismo de los miembros de la familia y de los pares o semejantes, así como en el papel que desempeña la propaganda de los cigarrillos. También se obtienen datos sobre la prevalencia de tabaquismo, el acceso a los cigarrillos y los conocimientos y actitudes en torno al hábito de fumar. La encuesta se llevó a cabo en el verano de 1994 en zonas urbanas y rurales. Participaron en ella 50 escuelas situadas en 40 comunidades distintas, y de ese modo se obtuvo una muestra de 2625 adolescentes entre las edades de 9 y 15 años que completaron el cuestionario autoadministrado. El estudio se efectuó en colaboración con los Amigos de las Américas (AMIGOS), organismo internacional dedicado a la salud. Los miembros del personal de planta y los voluntarios que participaron en los proyectos dirigidos por AMIGOS en el Ecuador trabajaron con los funcionarios de salud y educación de cada localidad para realizar la encuesta. Casi 9% de los estudiantes se describieron a sí mismos como fumadores activos, 24,5% habían fumado en ocasiones y 6,1% no habían fumado nunca. Los resultados mostraron grandes diferencias cuando se desglosaron por edad y sexo, ya que los estudiantes mayores de sexo masculino tuvieron las cifras más altas de tabaquismo. La situación de los miembros de la familia y de los semejantes con respecto al tabaquismo también fue un factor que permitió predecir la situación de cada estudiante con respecto al tabaquismo. Los resultados obtenidos con esta muestra son similares a los obtenidos con muestras norteamericanas. Pese a que los estudiantes ecuatorianos fuman un poco menos que sus semejantes estadounidenses, el consumo de cigarrillos en el Ecuador es un problema de salud pública importante y claramente exige una respuesta coordinada. El presente estudio apunta hacia diversas estrategias para prevenir el tabaquismo entre la gente joven. <![CDATA[<B>Risk of <I>Trypanosoma cruzi </I>transmission by blood transfusion in Mexico</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49891998000800004&lng=en&nrm=iso&tlng=en Datos de finales de los años ochenta indican que 1,6% de la población mexicana estaba infectada por la enfermedad de Chagas y que la transmisión de Trypanosoma cruzi por transfusión de sangre ocurría en casi todos los estados, si bien en zonas de diversa extensión. El riesgo de transmisión por esa vía está poco documentado en México, por lo que en 1994 se realizó una encuesta centinela de 18 bancos de sangre de la Secretaría de Salud, situados en sendos estados. El estudio tuvo como objeto conocer el riesgo de transmisión por transfusión de sangre y estimar la prevalencia nacional de infección en los candidatos a donantes, para disponer de indicadores generales de la situación actual de la enfermedad y de la relevancia de ese tipo de transmisión. La selección de participantes se basó en criterios operativos: todos los centros estatales de transfusión que contaban con la capacidad para tamizar a los donantes de sangre por lo menos durante un año y los candidatos a donar (n = 64969) que cumplían con los requisitos exigidos por la Norma Oficial Mexicana para la disposición de sangre humana y derivados con fines terapéuticos. Para el análisis de los resultados, los centros se agruparon según el flujo migratorio para detectar cualquier posible relación entre este y la transmisión de la enfermedad de Chagas en el país. Como prueba de tamizaje se usó la hemaglutinación indirecta con reactivo producido por el Instituto Nacional de Diagnóstico y Referencia Epidemiológicos y donado a los bancos de sangre. Los casos positivos se confirmaron mediante la inmunofluorescencia indirecta. Se detectaron 996 personas con resultados positivos, que representan una prevalencia de 1,5% (IC95%: 1,44 a 1,63). La concordancia de los resultados finales entre los laboratorios locales y el laboratorio central presentó un índice kappa de 0,87 (IC95%: 0,862 a 0,877). En las ciudades con los índices más altos de emigración el riesgo de transmisión fue tres veces mayor que en las ciudades receptoras de inmigrantes (razón de posibilidades = 2,82; IC95%: 2,18 a 3,65). Se recomienda ampliar el tamizaje serológico obligatorio en todo México, ya que debido al fenómeno de las migraciones, la definición de área endémica es inestable.<hr/>Data from the late eighties indicate that 1.6% of the Mexican population was infected with Chagas' disease and that transmission by way of blood transfusion was taking place in nearly every state, in areas of different sizes. The risk of transmission via that route has seldom been documented in Mexico, and for this reason a sentinel survey was conducted in 1994 in 18 blood banks belonging to the Ministry of Health and located in various states. The purpose of the study was to determine the risk of transmission via blood transfusion and to calculate the national prevalence of infection among potential donors, so as to have a set of general indicators of the prevailing disease burden and of the importance of this transmission route. Participants were selected on the basis of operating criteria: all government-run transfusion centers with the capacity to screen blood donors for at least one year and persons seeking to donate blood (n = 64969) who satisfied the Official Mexican Standards (Norma Oficial Mexicana) for the therapeutic use of human blood and blood products. For the analysis of the results the centers were grouped according to migration flow in order to detect any possible influence the latter may have had on Chagas' disease transmission within the country. Screening was done with indirect hemagglutination using a reagent produced by the Instituto Nacional de Diagnóstico y Referencia Epidemiológicos and donated to the blood banks. Positive cases were confirmed by indirect immunofluorescence. Positive results were detected in 996 persons, for a prevalence of 1.5% (95%CI: 1.44 to 1.63). Concordance between the final results obtained by local labs and by the central lab was given by a kappa index of 0.87 (95%CI: 0,862 to 0.877). Cities having the highest emigration rates had three times the risk of transmission as compared to cities that drew immigrants (odds ratio = 2.82; 95%CI: 2.18 to 3.65). We recommend that mandatory serologic screening be enforced throughout Mexico, since migration makes it difficult to determine which areas are endemic. <![CDATA[<B>Climate change, human health, and sustainable development</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49891998000800005&lng=en&nrm=iso&tlng=en El cambio climático debido a actividades humanas pone en peligro los ecosistemas y la salud humana a escala mundial. Con el fin de hacer frente a las amenazas que se ciernen sobre los ecosistemas en todo el mundo, en el decenio de 1980 se introdujo el concepto del desarrollo sostenible. Desde entonces, ese concepto se ha aplicado ampliamente para guiar y enfocar la formulación de políticas. En el presente artículo se examinan las consecuencias sanitarias que tiene el cambio climático debido a actividades humanas para el desarrollo sostenible, en particular su posible efecto en el abastecimiento de alimentos, los desastres naturales, las enfermedades infecciosas, los ecosistemas y la elevación del nivel del mar. Se discute un modelo integrado que contiene los principales indicadores del desarrollo sostenible. También se examina la importancia que tienen el cambio climático, la salud humana y el desarrollo sostenible para las políticas internacionales pertinentes.<hr/>Human-induced climate change threatens ecosystems and human health on a global scale. In order to withstand the worldwide threats to ecosystems, the concept of sustainable development was introduced during the 1980s. Since then, this concept has been widely applied to guide and focus policy-making. The present article reviews the health consequences of human-induced climate change on sustainable development, particularly the potential impact of such change on food supply, natural disasters, infectious diseases, ecosystems, and sea level rise. Discussed is an integrated model containing the key indicators of sustainable development. The relevance of climate change, human health, and sustainable development for international climate change policy is also examined. <![CDATA[<B>Nursing programs in the state of São Paulo, Brazil, during the 1980s</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49891998000800006&lng=en&nrm=iso&tlng=en O objetivo do presente estudo foi identificar a situação da oferta e procura por cursos de enfermagem no estado de São Paulo, Brasil, durante a década de 80. Para isso, um questionário foi enviado aos 28 cursos de enfermagem (públicos e privados) existentes em São Paulo em 1991. As 24 instituições que participaram da pesquisa responderam perguntas sobre o ano de instalação do curso de enfermagem e de seu reconhecimento pelo Ministério da Educação e Cultura; o ano da realização do primeiro vestibular para enfermagem; a fonte financiadora (pública ou privada); e o número de vagas por período (diurno ou noturno) oferecidas pela instituição nos anos de 1980 a 1991. Os dados identificaram uma progressiva diminuição da ocupação das vagas em enfermagem oferecidas pelas instituições de ensino superior. O ano de 1986 foi o que apresentou a menor taxa de ocupação, com uma ociosidade de 34% das vagas. A situação identificada pelo presente estudo aponta para a possibilidade de um comprometimento, a médio e longo prazos, do potencial de trabalho de enfermagem.<hr/>The present study aimed at identifying supply and demand of university-level nursing programs in São Paulo, Brazil, during the 1980s. A questionnaire was sent to the 28 nursing programs (public and private) existing in São Paulo in 1991. The 24 institutions that responded to our survey provided information on: year when the program was established, year when program was officially recognized by the Ministry of Education and Culture; year when entrance examinations began to be required for the nursing program; sources (public or private) of financial support received; and number of students accepted for each term (day or night) in 1980 and 1991. The data collected revealed that every year fewer students applied to nursing programs in São Paulo. In 1986, 34% of the vacancies remained unfilled; this was the lowest occupancy rate registered during the period studied. The situation outlined by our study suggests that in the medium and long run nursing work potential in Brazil could be compromised. <![CDATA[<b>Remuneration and productivity</b>: <b>the case of the Minas Gerais State Hospital Foundation, Brazil, 1992­1995</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49891998000800007&lng=en&nrm=iso&tlng=en En este artículo se analiza el caso de la Fundación Hospitalaria del Estado de Minas Gerais, Brasil, a raíz de haberse introducido en sus unidades de servicios de salud a principios de 1993 un nuevo sistema de recompensas, complementarias a la remuneración salarial, por el buen desempeño y la productividad de los funcionarios. El análisis se basó en un estudio transversal de la evolución de una serie de indicadores de producción y productividad en la Fundación durante el período de 1992 a 1995. Se utilizaron como fuentes de información los formularios de autorización para internación hospitalaria (AIH), las guías de autorización de pagos (GAP) y los boletines de la Administración de Recursos Humanos. Con la estrategia de remuneración y de incentivo condicional adoptada se procuraba no solo mejorar la producción y la productividad, sino también aumentar el compromiso de los empleados con la institución. El análisis de los valores de los indicadores seleccionados parece confirmar que los resultados de este estudio coinciden con los de otros estudios similares en el sentido de que la remuneración basada en los resultados (o incentivo condicional) conduce a un cambio positivo en el nivel de producción de servicios y productividad aunque no se sostenga a lo largo del tiempo. Corrobora asimismo la idea de que esas alternativas pueden utilizarse deliberadamente como parte de una estrategia más general de desarrollo organizacional a largo alcance, y no solamente como un elemento aislado dirigido a lograr mejorías puntuales y temporales en la productividad.<hr/>This article presents an analysis of the Minas Gerais State Hospital Foundation immediately after the introduction in its health services units in early 1993 of a new system of rewards for good performance and productivity, as a complement to salaried remuneration. Analysis was based on a cross-sectional study of changes in indicators of production and productivity in the Foundation during the 1992­1995 period. Data were obtained from hospitalization authorization forms, payment authorization guides, and bulletins from the Human Resource Administration. The strategy of conditional remuneration and incentives was adopted not only to step up production and productivity, but also to increase the employees' commitment to the institution. Analysis of the selected indicators appears to confirm other study results in that remuneration based on results (conditional incentives) leads to a positive change in the production level of services and productivity, even if it does not last for the long term. Study results also support the notion that such alternatives may be deliberately used as part of a more general strategy of organizational development and not only as an isolated element for concrete improvements in productivity. <![CDATA[<B>Rural internship in dentistry in Rio de Janeiro, Brazil</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49891998000800008&lng=en&nrm=iso&tlng=en Este trabalho descreve a experiência da Faculdade de Odontologia da Universidade do Estado do Rio de Janeiro com o internato rural, no período de 1988 a 1993, como parte do processo de sensibilização social do aluno de graduação. As atividades extramurais foram realizadas por meio de estágios supervisionados de 3 meses consecutivos nos serviços odontológicos de unidades de saúde da rede pública, em municípios do interior do estado do Rio de Janeiro. Além de executarem atendimento clínico, os estudantes participaram de atividades cujos temas se relacionavam a: situação de saúde bucal da comunidade; estrutura organizacional e programática das secretarias de saúde; e prioridades, tecnologia apropriada, educação e prevenção em saúde bucal. A modalidade de educação apresentada resultou integradora da reflexão crítica de docentes, alunos, associações de classe e entidades prestadoras de serviços acerca da adequação do profissional formado nos cursos de graduação em odontologia no Rio de Janeiro à realidade do estado.<hr/>This paper describes a rural internship experience developed between 1988 and 1993 by the School of Dentistry, Rio de Janeiro State University. The objective of this program was to raise the social consciousness of undergraduate students. Extramural activities were carried out in the form of supervised 3-month internships in the dentistry services offered by public health units at several locations in the state of Rio de Janeiro. Besides working in the clinics, students took part in activities aimed at assessing oral health in the community, organizational and programmatic structures of the health services, and priorities, appropriate technology, education, and prevention in oral health. These internships integrated the critical thinking of professors, students, class associations, and service-providing institutions regarding the adequacy of education received by future dentists in addressing the true situation of oral health in the state of Rio de Janeiro. <![CDATA[<B>La tuberculosis</B>: <B>principal asesina de mujeres jóvenes</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49891998000800009&lng=en&nrm=iso&tlng=en Este trabalho descreve a experiência da Faculdade de Odontologia da Universidade do Estado do Rio de Janeiro com o internato rural, no período de 1988 a 1993, como parte do processo de sensibilização social do aluno de graduação. As atividades extramurais foram realizadas por meio de estágios supervisionados de 3 meses consecutivos nos serviços odontológicos de unidades de saúde da rede pública, em municípios do interior do estado do Rio de Janeiro. Além de executarem atendimento clínico, os estudantes participaram de atividades cujos temas se relacionavam a: situação de saúde bucal da comunidade; estrutura organizacional e programática das secretarias de saúde; e prioridades, tecnologia apropriada, educação e prevenção em saúde bucal. A modalidade de educação apresentada resultou integradora da reflexão crítica de docentes, alunos, associações de classe e entidades prestadoras de serviços acerca da adequação do profissional formado nos cursos de graduação em odontologia no Rio de Janeiro à realidade do estado.<hr/>This paper describes a rural internship experience developed between 1988 and 1993 by the School of Dentistry, Rio de Janeiro State University. The objective of this program was to raise the social consciousness of undergraduate students. Extramural activities were carried out in the form of supervised 3-month internships in the dentistry services offered by public health units at several locations in the state of Rio de Janeiro. Besides working in the clinics, students took part in activities aimed at assessing oral health in the community, organizational and programmatic structures of the health services, and priorities, appropriate technology, education, and prevention in oral health. These internships integrated the critical thinking of professors, students, class associations, and service-providing institutions regarding the adequacy of education received by future dentists in addressing the true situation of oral health in the state of Rio de Janeiro. <![CDATA[<B>Deben revisarse las indicaciones sobre vitamina D</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49891998000800010&lng=en&nrm=iso&tlng=en Este trabalho descreve a experiência da Faculdade de Odontologia da Universidade do Estado do Rio de Janeiro com o internato rural, no período de 1988 a 1993, como parte do processo de sensibilização social do aluno de graduação. As atividades extramurais foram realizadas por meio de estágios supervisionados de 3 meses consecutivos nos serviços odontológicos de unidades de saúde da rede pública, em municípios do interior do estado do Rio de Janeiro. Além de executarem atendimento clínico, os estudantes participaram de atividades cujos temas se relacionavam a: situação de saúde bucal da comunidade; estrutura organizacional e programática das secretarias de saúde; e prioridades, tecnologia apropriada, educação e prevenção em saúde bucal. A modalidade de educação apresentada resultou integradora da reflexão crítica de docentes, alunos, associações de classe e entidades prestadoras de serviços acerca da adequação do profissional formado nos cursos de graduação em odontologia no Rio de Janeiro à realidade do estado.<hr/>This paper describes a rural internship experience developed between 1988 and 1993 by the School of Dentistry, Rio de Janeiro State University. The objective of this program was to raise the social consciousness of undergraduate students. Extramural activities were carried out in the form of supervised 3-month internships in the dentistry services offered by public health units at several locations in the state of Rio de Janeiro. Besides working in the clinics, students took part in activities aimed at assessing oral health in the community, organizational and programmatic structures of the health services, and priorities, appropriate technology, education, and prevention in oral health. These internships integrated the critical thinking of professors, students, class associations, and service-providing institutions regarding the adequacy of education received by future dentists in addressing the true situation of oral health in the state of Rio de Janeiro. <![CDATA[<B>Inestabilidad mutacional en la mitosis de células cancerosas</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49891998000800011&lng=en&nrm=iso&tlng=en Este trabalho descreve a experiência da Faculdade de Odontologia da Universidade do Estado do Rio de Janeiro com o internato rural, no período de 1988 a 1993, como parte do processo de sensibilização social do aluno de graduação. As atividades extramurais foram realizadas por meio de estágios supervisionados de 3 meses consecutivos nos serviços odontológicos de unidades de saúde da rede pública, em municípios do interior do estado do Rio de Janeiro. Além de executarem atendimento clínico, os estudantes participaram de atividades cujos temas se relacionavam a: situação de saúde bucal da comunidade; estrutura organizacional e programática das secretarias de saúde; e prioridades, tecnologia apropriada, educação e prevenção em saúde bucal. A modalidade de educação apresentada resultou integradora da reflexão crítica de docentes, alunos, associações de classe e entidades prestadoras de serviços acerca da adequação do profissional formado nos cursos de graduação em odontologia no Rio de Janeiro à realidade do estado.<hr/>This paper describes a rural internship experience developed between 1988 and 1993 by the School of Dentistry, Rio de Janeiro State University. The objective of this program was to raise the social consciousness of undergraduate students. Extramural activities were carried out in the form of supervised 3-month internships in the dentistry services offered by public health units at several locations in the state of Rio de Janeiro. Besides working in the clinics, students took part in activities aimed at assessing oral health in the community, organizational and programmatic structures of the health services, and priorities, appropriate technology, education, and prevention in oral health. These internships integrated the critical thinking of professors, students, class associations, and service-providing institutions regarding the adequacy of education received by future dentists in addressing the true situation of oral health in the state of Rio de Janeiro. <![CDATA[<B>¿Son mejores las médicas que los médicos en obstetricia y ginecología?</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49891998000800012&lng=en&nrm=iso&tlng=en Este trabalho descreve a experiência da Faculdade de Odontologia da Universidade do Estado do Rio de Janeiro com o internato rural, no período de 1988 a 1993, como parte do processo de sensibilização social do aluno de graduação. As atividades extramurais foram realizadas por meio de estágios supervisionados de 3 meses consecutivos nos serviços odontológicos de unidades de saúde da rede pública, em municípios do interior do estado do Rio de Janeiro. Além de executarem atendimento clínico, os estudantes participaram de atividades cujos temas se relacionavam a: situação de saúde bucal da comunidade; estrutura organizacional e programática das secretarias de saúde; e prioridades, tecnologia apropriada, educação e prevenção em saúde bucal. A modalidade de educação apresentada resultou integradora da reflexão crítica de docentes, alunos, associações de classe e entidades prestadoras de serviços acerca da adequação do profissional formado nos cursos de graduação em odontologia no Rio de Janeiro à realidade do estado.<hr/>This paper describes a rural internship experience developed between 1988 and 1993 by the School of Dentistry, Rio de Janeiro State University. The objective of this program was to raise the social consciousness of undergraduate students. Extramural activities were carried out in the form of supervised 3-month internships in the dentistry services offered by public health units at several locations in the state of Rio de Janeiro. Besides working in the clinics, students took part in activities aimed at assessing oral health in the community, organizational and programmatic structures of the health services, and priorities, appropriate technology, education, and prevention in oral health. These internships integrated the critical thinking of professors, students, class associations, and service-providing institutions regarding the adequacy of education received by future dentists in addressing the true situation of oral health in the state of Rio de Janeiro. <![CDATA[<B>Factibilidad de una vacuna comestible</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49891998000800013&lng=en&nrm=iso&tlng=en Este trabalho descreve a experiência da Faculdade de Odontologia da Universidade do Estado do Rio de Janeiro com o internato rural, no período de 1988 a 1993, como parte do processo de sensibilização social do aluno de graduação. As atividades extramurais foram realizadas por meio de estágios supervisionados de 3 meses consecutivos nos serviços odontológicos de unidades de saúde da rede pública, em municípios do interior do estado do Rio de Janeiro. Além de executarem atendimento clínico, os estudantes participaram de atividades cujos temas se relacionavam a: situação de saúde bucal da comunidade; estrutura organizacional e programática das secretarias de saúde; e prioridades, tecnologia apropriada, educação e prevenção em saúde bucal. A modalidade de educação apresentada resultou integradora da reflexão crítica de docentes, alunos, associações de classe e entidades prestadoras de serviços acerca da adequação do profissional formado nos cursos de graduação em odontologia no Rio de Janeiro à realidade do estado.<hr/>This paper describes a rural internship experience developed between 1988 and 1993 by the School of Dentistry, Rio de Janeiro State University. The objective of this program was to raise the social consciousness of undergraduate students. Extramural activities were carried out in the form of supervised 3-month internships in the dentistry services offered by public health units at several locations in the state of Rio de Janeiro. Besides working in the clinics, students took part in activities aimed at assessing oral health in the community, organizational and programmatic structures of the health services, and priorities, appropriate technology, education, and prevention in oral health. These internships integrated the critical thinking of professors, students, class associations, and service-providing institutions regarding the adequacy of education received by future dentists in addressing the true situation of oral health in the state of Rio de Janeiro. <![CDATA[<B>¿Afecta el amamantamiento a la capacidad de respuesta inmunitaria del lactante?</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49891998000800014&lng=en&nrm=iso&tlng=en Este trabalho descreve a experiência da Faculdade de Odontologia da Universidade do Estado do Rio de Janeiro com o internato rural, no período de 1988 a 1993, como parte do processo de sensibilização social do aluno de graduação. As atividades extramurais foram realizadas por meio de estágios supervisionados de 3 meses consecutivos nos serviços odontológicos de unidades de saúde da rede pública, em municípios do interior do estado do Rio de Janeiro. Além de executarem atendimento clínico, os estudantes participaram de atividades cujos temas se relacionavam a: situação de saúde bucal da comunidade; estrutura organizacional e programática das secretarias de saúde; e prioridades, tecnologia apropriada, educação e prevenção em saúde bucal. A modalidade de educação apresentada resultou integradora da reflexão crítica de docentes, alunos, associações de classe e entidades prestadoras de serviços acerca da adequação do profissional formado nos cursos de graduação em odontologia no Rio de Janeiro à realidade do estado.<hr/>This paper describes a rural internship experience developed between 1988 and 1993 by the School of Dentistry, Rio de Janeiro State University. The objective of this program was to raise the social consciousness of undergraduate students. Extramural activities were carried out in the form of supervised 3-month internships in the dentistry services offered by public health units at several locations in the state of Rio de Janeiro. Besides working in the clinics, students took part in activities aimed at assessing oral health in the community, organizational and programmatic structures of the health services, and priorities, appropriate technology, education, and prevention in oral health. These internships integrated the critical thinking of professors, students, class associations, and service-providing institutions regarding the adequacy of education received by future dentists in addressing the true situation of oral health in the state of Rio de Janeiro. <![CDATA[<B>Regeneración de músculos atrofiados mediante trasplantes de médula ósea</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49891998000800015&lng=en&nrm=iso&tlng=en Este trabalho descreve a experiência da Faculdade de Odontologia da Universidade do Estado do Rio de Janeiro com o internato rural, no período de 1988 a 1993, como parte do processo de sensibilização social do aluno de graduação. As atividades extramurais foram realizadas por meio de estágios supervisionados de 3 meses consecutivos nos serviços odontológicos de unidades de saúde da rede pública, em municípios do interior do estado do Rio de Janeiro. Além de executarem atendimento clínico, os estudantes participaram de atividades cujos temas se relacionavam a: situação de saúde bucal da comunidade; estrutura organizacional e programática das secretarias de saúde; e prioridades, tecnologia apropriada, educação e prevenção em saúde bucal. A modalidade de educação apresentada resultou integradora da reflexão crítica de docentes, alunos, associações de classe e entidades prestadoras de serviços acerca da adequação do profissional formado nos cursos de graduação em odontologia no Rio de Janeiro à realidade do estado.<hr/>This paper describes a rural internship experience developed between 1988 and 1993 by the School of Dentistry, Rio de Janeiro State University. The objective of this program was to raise the social consciousness of undergraduate students. Extramural activities were carried out in the form of supervised 3-month internships in the dentistry services offered by public health units at several locations in the state of Rio de Janeiro. Besides working in the clinics, students took part in activities aimed at assessing oral health in the community, organizational and programmatic structures of the health services, and priorities, appropriate technology, education, and prevention in oral health. These internships integrated the critical thinking of professors, students, class associations, and service-providing institutions regarding the adequacy of education received by future dentists in addressing the true situation of oral health in the state of Rio de Janeiro. <![CDATA[<B>Health for all in the twenty-first century</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49891998000800016&lng=en&nrm=iso&tlng=en Salud para todos en el siglo XXI renueva el compromiso con el concepto y la visión de salud para todos, tal como se definió en 1977, cuando la 30a Asamblea Mundial de la Salud resolvió que el principal objetivo social de los gobiernos y de la OMS en los decenios venideros debería ser "alcanzar para todos los ciudadanos del mundo en el año 2000 un grado de salud que les permita llevar una vida social y económicamente productiva". Este proceso, que se interpreta de forma diferente según las características sociales, económicas y de salud de cada país, ha contribuido a la mejora paulatina del acceso a la atención primaria de salud, a la disminución mundial de la morbilidad y la mortalidad infantiles y a un aumento considerable de la esperanza de vida. Aun así, todavía hay muchos problemas que resolver. Desde 1990, el sistema de las Naciones Unidas ha convocado nueve conferencias mundiales en las que se han acordado por consenso universal las prioridades de un programa de trabajo para el futuro, incluido el apoyo pleno del logro de salud para todos. Los nuevos enfoques giran en torno al desarrollo centrado en el ser humano, lo cual comprende erradicar la pobreza, satisfacer las necesidades básicas y proteger los derechos humanos, incluido el de la salud. <![CDATA[<B>Theories and methods of the social sciences as applied to health promotion</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49891998000800017&lng=en&nrm=iso&tlng=en We briefly describe herein those social science theories and methods that have slowly been incorporated into health promotion and disease prevention programs. They include the various stages of behavior change, social learning, community organization, spread of innovations, social marketing, and others. Such theories can be very useful for planning and implementing community programs as long as these are low in cost, have enough flexibility to satisfy the needs of target groups, respond to new information and to the suggestions of community members, show sensitivity to the local culture, and involve representatives from the community in all of their activities.