Scielo RSS <![CDATA[Revista Panamericana de Salud Pública]]> http://www.scielosp.org/rss.php?pid=1020-498920080008&lang=en vol. 24 num. 2 lang. en <![CDATA[SciELO Logo]]> http://www.scielosp.org/img/en/fbpelogp.gif http://www.scielosp.org <![CDATA[<b>Utilization of maternal health care services in the department of Matagalpa, Nicaragua</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892008000800001&lng=en&nrm=iso&tlng=en OBJECTIVES: To better understand the individual and community factors and perceptions that influence women's health care-seeking behaviors during pregnancy in order to increase women's utilization of maternal health services. METHODS: This study investigates the logistical and sociocultural barriers influencing women's utilization of maternal health services through 37 semi-structured in-depth interviews with women from the department of Matagalpa, Nicaragua. RESULTS: Results reveal that delays in seeking health care during pregnancy are influenced not only by poor access to care and economic barriers but also by individual and community knowledge and acceptance of maternal health services. Partner support, previous maternal health care experiences, and the degree of communication with other women and health workers affect women's decisions to seek care. CONLUSIONS: Evidence suggests that in order to improve maternal health outcomes in this region, interventions must be targeted at a hierarchy of levels: individual, household, and community.<hr/>OBJETIVOS: Mejorar el conocimiento sobre las percepciones y los factores personales y comunitarios que influyen en la búsqueda de atención médica durante el embarazo, con vistas a aumentar la utilización de los servicios de salud materna. MÉTODOS: Mediante 37 entrevistas semiestructuradas en profundidad aplicadas a mujeres del departamento de Matagalpa, Nicaragua, se investigaron las barreras logísticas y socioculturales que influyen en la utilización de los servicios de salud materna. RESULTADOS: Los resultados muestran que sobre la demora en la búsqueda de atención sanitaria durante el embarazo influyeron no solo el escaso acceso y las barreas económicas, sino también el conocimiento individual y comunitario sobre los servicios de salud materna y su grado de aceptación. El apoyo de la pareja, el haber recibido atención médica durante embarazos previos y el grado de comunicación con otras mujeres y trabajadores sanitarios influyeron en la decisión de las embarazadas de buscar atención. CONCLUSIONES: Los datos indican que para mejorar la salud materna en esta región, las intervenciones se deben dirigir a diversos niveles: el individuo, el hogar y la comunidad. <![CDATA[<b>Institutional ethics committees in Mexico</b>: <b>the ambiguous boundary between health care ethics and research ethics</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892008000800002&lng=en&nrm=iso&tlng=en OBJETIVO: Identificar los comités de ética de la práctica clínica en México y establecer las posibles implicaciones derivadas de su composición y funcionamiento. MÉTODOS: Estudio transversal descriptivo realizado entre enero y diciembre de 2005. Se envió por correo electrónico una encuesta a todos los hospitales y unidades de medicina familiar del Instituto Mexicano del Seguro Social (n = 437) y del Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (n = 167) que contaran con más de 10 consultorios, y a los establecimientos asistenciales más importantes de la Secretaría de Salud de México (n = 15). Los elementos analizados fueron: nombre del comité, fecha en la que fue constituido, estado actual de actividad, composición, funciones y facultades. RESULTADOS: Se identificaron 116 comités con muy diversos nombres, de ellos 101 (87,1%) estaban activos. Estos comités se crearon entre 1985 y 2006, con un pico entre los años 2004 y 2005. De los comités activos, 59 (58,4%) se encargaban tanto de los problemas/dilemas éticos relacionados con la práctica clínica como de los proyectos de investigación. De los integrantes, 357 (59,0%) tenían puestos directivos en el establecimiento al que pertenecía el comité del que eran miembros; predominó la profesión médica (71,5%), seguida de personal de enfermería (11,9%). De los integrantes de los comités activos, 77,9% no había recibido entrenamiento en el campo de la ética. CONCLUSIONES: Puede esperarse que surjan conflictos legales, principalmente en los establecimientos cuyos comités se confieren la autoridad de dictaminar el curso apropiado de una acción. Se requiere un plan integral para estandarizar la composición y los procedimientos de los comités de ética clínica en México y mejorar la preparación de sus miembros.<hr/>OBJECTIVE: To identify ethics committees in medical practice in Mexico and possible implications stemming from their composition and functions. METHODS: A cross-sectional descriptive study was conducted from January-December 2005. A survey was sent by e-mail to the hospitals and family medicine centers with at 10 practices within the Mexican Institute for Social Security (Instituto Mexicano del Seguro Social) (n = 437) and the Institute for Security and Social Services for State Employees (Seguridad y Servicios Sociales de los Trabajadores del Estado) (n = 167) and to the Mexican Ministry of Health's most important health care centers (n= 15). The following items were analyzed: name of the committee, date of formation, current status, composition, functions, and level of authority. RESULTS: In all, 116 committees were identified, with various names. Of these, 101 (87.1%) were active. The committees were formed from 1985-2006, with a spike occurring in 2004-2005. Of the active committees, 59 (58.4%) were charged with ethical problems/dilemmas related to clinical practice as well as those related to research projects. Of the committee members, 357 (59.0%) held managing positions in the establishment to which the committee pertained; most were medical professionals (71.5%), followed by nursing staff (11.9%). Among the members of the active committees, 77.9% had not received training in ethics. CONCLUSIONS: Legal conflicts can be expected, mainly within the organizations whose committees have the authority to determine a course of action. An integrated plan is needed that will set standards for the composition and proceedings of Mexico's ethics committees and the improved training of committee members. <![CDATA[<b>Providing quality pharmaceutical services in Brazil</b>: <b>items pending on the Unified Health System's agenda</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892008000800003&lng=en&nrm=iso&tlng=en OBJETIVOS: Apontar aspectos inconclusos da agenda do Sistema Único de Saúde (SUS) para a qualificação dos serviços farmacêuticos no Brasil. MÉTODOS: Os dados foram coletados a partir dos relatórios de fiscalização de municípios elaborados pela Controladoria Geral da União (CGU). Utilizaram-se os relatórios completos de fiscalizações realizadas entre agosto de 2004 e julho de 2006, disponíveis na Internet. Todos os relatórios publicados foram analisados. Os problemas identificados foram organizados em 15 categorias. RESULTADOS: Foram realizadas 660 fiscalizações e analisados 659 relatórios (um não estava disponível). Em 62 municípios, os recursos da assistência farmacêutica não foram auditados, o que resultou em uma amostra final de 597 municípios (10,7% dos municípios brasileiros). Desses, 90,3% apresentaram problemas na gestão de recursos ou serviços. Em 71% dos municípios foi constatada a falta de controle de estoque ou sua deficiência e em 39% condições inadequadas de armazenamento. Verificou-se falta de medicamentos em 24% dos municípios. CONLUSÕES: Os propósitos da Política Nacional de Medicamentos e da Política Nacional de Assistência Farmacêutica estão distantes da concretização. O tema deve ser novamente incluído na agenda dos governos nas três esferas, pois não é possível falar em efetividade da atenção à saúde sem que a assistência farmacêutica cumpra o seu papel com qualidade.<hr/>OBJECTIVE: To identify items on the agenda of Brazil's Unified Health System that are related to the quality of pharmaceutical services and have not yet been implemented. METHODS: Data were collected from the inspection reports issued by the federal government's controllership office. Inspection reports completed from August 2004-July 2006, available on the Internet, were reviewed. The issues identified were classified into 15 categories. RESULTS: Of the 660 inspections that were carried out, 659 were analyzed (one was unavailable). In 62 cities pharmaceutical assistance services had not been audited, therefore, a the final sample of 597 cities was analyzed (10.7% of Brazil's municipalities). Of these, 90.3% had issues associated with the management of resources or services. In 71% of the municipalities, the reports indicated lack of or deficient inventory control, and in 39%, inadequate storage conditions. A shortage of drugs was observed in 24% of the municipalities. CONCLUSIONS: The goals of Brazil's national drug and pharmaceutical assistance policies are far from being met. Quality pharmaceutical services must again be included on the agenda at all three government levels since it is impossible to have effective health care without quality pharmaceutical services. <![CDATA[<b>Economic impact of pneumococcal conjugate vaccination in Brazil, Chile, and Uruguay</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892008000800004&lng=en&nrm=iso&tlng=en OBJECTIVES: To evaluate the economic impact of vaccination with the pneumococcal 7-valent conjugate vaccine (PCV7) in Brazil, Chile, and Uruguay. METHODS: A decision analytic model was constructed to compare pneumococcal vaccination of children 0-5 years old with no vaccination in Brazil, Chile, and Uruguay. Costs and health outcomes were analyzed from the societal perspective. Vaccine, demographic, epidemiologic, and cost data were incorporated into this economic analysis. RESULTS: At the rate of diphtheria-tetanus-pertussis (DTP) vaccine coverage and a vaccine price of US$ 53 per dose, PCV7 was projected to prevent 23 474 deaths per year in children under 5 years old in the three countries studied, thus averting 884 841 disability-adjusted life years (DALYs) yearly. To vaccinate the entire birth cohort of the three countries, total vaccine costs would be US$ 613.9 million. At US$ 53 per dose, the cost per DALY averted from a societal perspective would range from US$ 664 (Brazil) to US$ 2 019 (Chile). At a cost of US$ 10 per dose, vaccine cost is lower than the overall cost of illness averted (US$ 125 050 497 versus US$ 153 965 333), making it cost effective and cost-saving. CONCLUSIONS: The results of this study demonstrate that the incorporation of PCV7 vaccine at US$ 53 per dose confers health benefits at extra costs. It is unclear whether vaccination at the current price is affordable to these countries.<hr/>OBJETIVOS: Evaluar el impacto económico de la aplicación de la vacuna antineumocócica conjugada heptavalente (PCV7) en Brasil, Chile y Uruguay. MÉTODOS: Se elaboró un modelo analítico de decisiones para comparar la vacunación antineumocócica de los niños de 0-5 años de edad con la no vacunación, en Brasil, Chile y Uruguay. Los costos y los desenlaces para la salud se analizaron desde el punto de vista de la sociedad. Al análisis económico se incorporaron los costos y los datos demográficos, epidemiológicos y de la vacuna. RESULTADOS: Con una cobertura como la de la vacuna contra la difteria, el tétanos y la tos ferina (DTP) y un precio de US$ 53,00 por dosis, la vacuna PCV7 podría evitar 23 474 muertes anuales en niños menores de 5 años en los tres países estudiados, con lo que se evitarían anualmente 884 841 años de vida ajustados por discapacidad (AVAD). Para vacunar toda la cohorte de recién nacidos de los tres países, el costo total de la vacuna sería de US$ 613,9 millones. A US$ 53,00 por dosis, el costo por AVAD evitado desde la perspectiva de la sociedad variaría entre US$ 664,00 (en Brasil) y US$ 2 019,00 (en Chile). A US$ 10,00 por dosis, el costo de la vacuna sería menor que el costo total de la enfermedad evitada (US$ 125 050 497 frente a US$ 153 965 333), lo que sería efectivo en función del costo y representaría un ahorro. CONCLUSIONES: Estos resultados demuestran que la incorporación de la vacuna PCV7 a US$ 53,00 por dosis ofrece beneficios con un costo adicional. No queda claro si estos países pueden costear la vacunación a los precios actuales. <![CDATA[<b>Cost-benefit analysis of vector control in areas of potential dengue transmission</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892008000800005&lng=en&nrm=iso&tlng=en OBJETIVOS: Evaluar el costo-beneficio de una intervención de control de mosquitos adultos con fumigación, junto con actividades de control de formas inmaduras de Aedes aegypti, para evitar la transmisión en una situación de alto riesgo. MÉTODOS: Se realizó un análisis de costo-beneficio desde una perspectiva social. Se comparó una intervención para el control de mosquitos adultos y formas inmaduras contra una hipótesis de no-intervención, de enero a abril de 2007, en la ciudad de Clorinda, Argentina. Se consideraron los costos directos y los beneficios indirectos e intangibles, estandarizados a dólares internacionales (I$) utilizando la paridad de poder adquisitivo. Se asumió una incidencia de 50 casos de dengue por 1 000 habitantes en la hipótesis de no-intervención. RESULTADOS: De enero a abril de 2007 se presentaron 176 casos de dengue en Clorinda, pero sólo cinco fueron autóctonos. El valor presente neto fue de I$ 196 879 en la estrategia de aplicación de control, mientras que en la de no aplicación se calculó en I$ -106 724, lo que significaría un ahorro de I$ 303 602 (I$ 6,46 por habitante) con la intervención. El análisis de sensibilidad evidenció que, con más de 1 363 casos de dengue (incidencia total de 29 por 1 000 habitantes) y un caso de dengue hemorrágico, la intervención es costo-benéfica. CONCLUSIONES: Los resultados sugieren que el control vectorial, incluyendo la fumigación para mosquitos adultos, debe evaluarse en situaciones de alto riesgo de transmisión como una alternativa costo-benéfica en países no endémicos.<hr/>OBJECTIVES: To evaluate the cost-benefit of an intervention utilizing fumigation against adult mosquitoes along with actions to control immature Aedes aegypti to prevent transmission in a high-risk area. METHODS: A cost-benefit analysis was performed from the social perspective. A program to control both adult mosquitoes and immature forms was compared to a non-intervention hypothesis, from January to April 2007, in the city of Clorinda, Argentina. Direct costs, as well as indirect and intangible benefits, were taken into account and standardized in international dollars (I$) using purchasing power parity. An incidence rate of 50 cases of dengue per 1 000 inhabitants was used in the non-intervention hypothesis. RESULTS: From January to April 2007 there were 176 cases of dengue in Clorinda, but only five were autochthonous. The net present value was I$ 196 879 with the control strategy, whereas the non-intervention was calculated to be I$ -106 724, indicating a savings of I$ 303 602 (I$ 6.46 per inhabitant) for the intervention. The sensitivity analysis showed that, with more than 1 363 cases of dengue (total incidence rate of 29 per 1 000 inhabitants) and one case of dengue hemorrhagic fever, there is a cost-benefit to intervention. CONCLUSIONS: The results suggest that vector control, including fumigation of adult mosquitoes, should be considered in high-risk areas as a cost-effective option for non-endemic countries. <![CDATA[<b>Health care costs in the last four years of life for private health plan beneficiaries in Brazil</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892008000800006&lng=en&nrm=iso&tlng=en OBJECTIVE: To examine health care use and expenditures by Brazilians covered by private health care plans in the last four years of life. METHODS: Health plan provider enrollee files and death certificate data were used for 274 health plan beneficiaries who died in 1998, 1999, and 2000. Resources used for a beneficiary in the year of death and in the three years prior to death were identified. Descriptive statistical analyses were used for clinical and socio-demographic characteristics and to describe the costs. RESULTS: Of the 274 deaths included in this analysis, 92 occurred in 1998, 82 in 1999, and 100 in 2000. Most of the deceased were males (61.4%). Distribution in terms of type of health plan coverage (full versus hospitalization-only coverage) was similar among beneficiaries (53% had hospitalization only and 47% had full coverage). The total health plan expenditure in the last four years of life for the 274 decedents was US$ 26 300 283 (US$ 12 287 723 for beneficiaries with hospitalization-only and US$ 14 012 560 for those with full coverage). Expenditures increased progressively in the four years preceding death. About 70% of medical expenses for decedents in the four years of this analysis were incurred in the last year of life. CONCLUSION: Relatively large amounts of health care resources are used by Brazilian private health plan participants in their last year of life, suggesting that specific strategies are needed to optimize the allocation of medical care resources for these patients.<hr/>OBJETIVO: Examinar la utilización de los servicios de salud y los gastos asociados durante los últimos cuatro años de vida de brasileños con seguro privado de salud. MÉTODOS: Se emplearon los expedientes del seguro y los certificados de defunción de 274 beneficiarios de seguros de salud que murieron entre 1998 y 2000. Se identificaron los recursos utilizados para cada beneficiario durante el año que murió y los tres años anteriores. Mediante métodos estadísticos descriptivos se analizaron las características clínicas y sociodemográficas y se describieron los costos. RESULTADOS: De los 274 fallecidos analizados, 92 murieron en 1998, 82 en 1999 y 100 en 2000; la mayoría de ellos (61,4%) eran hombres. La distribución según el tipo de seguro de salud fue similar (cobertura total: 47%; solo cobertura de hospitalización: 53%). El gasto total del seguro de salud en los últimos cuatro años de vida de los 274 fallecidos fue de US$ 26 300 283 (US$ 12 287 723 para los beneficiarios con cobertura de hospitalización solamente y US$ 14 012 560 para los que tenían cobertura total). Los gastos aumentaron progresivamente en los cuatro años previos a la muerte. Cerca de 70% de los gastos médicos de los fallecidos en los cuatro años analizados correspondieron al último año de vida. CONCLUSIONES: Los brasileños con seguro médico privado utilizan una cantidad relativamente grande de recursos sanitarios en su último año de vida, por lo que se requieren estrategias específicas para optimizar la asignación de recursos de atención médica para estos pacientes. <![CDATA[<b>Food consumption in Mexican adolescents</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892008000800007&lng=en&nrm=iso&tlng=en OBJECTIVE: To examine the relationship between demographic and socioeconomic factors and food consumption in Mexican adolescents. METHODS: A representative sample (n = 7 218) of Mexican adolescents (12-19 years old) was analyzed. Independent variables included age, gender, and main activity of the adolescents; gender and age of the head of household; socioeconomic position; size of town (rural, semiurban, or urban); and area of residence. The consumption frequency of 13 food groups was assessed. Through multivariate logistic regression models, the effect of independent variables over consumption frequency was evaluated. RESULTS: Among Mexican adolescents only one-third consumed fruits and vegetables daily, a little less than one-half consumed dairy products daily, one-third drank soft drinks daily, and one-fifth consumed sweets and salty snacks. Males reported higher consumption of legumes. Age increase was associated with higher frequency of milk consumption. Adolescents who worked and those who neither studied nor worked consumed fruits, sweets, and salty snacks less frequently. Eating fruits, vegetables, cereals, dairy products, bread, starchy vegetables, red meat, white meat, and fast food decreased with regard to socioeconomic position; on the other hand, the lower socioeconomic strata had more frequent consumption of legumes and soft drinks. CONCLUSIONS: There are groups of adolescents who are less likely to consume healthy foods (such as fruits, vegetables, and dairy products). Socioeconomic and cultural processes that can explain the differences observed are discussed.<hr/>OBJETIVO: Examinar la relación entre algunos factores demográficos y socioeconómicos y el consumo de alimentos en adolescentes mexicanos. MÉTODOS: Se analizó una muestra representativa (n = 7 218) de adolescentes mexicanos (de 12-19 años). Como variables independientes se emplearon la edad, el sexo y la actividad principal de los adolescentes; el sexo y la edad del jefe del hogar; la posición socioeconómica; el tamaño de la población de residencia (rural, semiurbana o urbana) y la zona del país. Se determinó la frecuencia del consumo de 13 grupos de alimentos y se evaluó el efecto de las variables independientes sobre la frecuencia de consumo mediante modelos de regresión logística multifactorial. RESULTADOS: Solo una tercera parte de los adolescentes mexicanos consumía frutas y vegetales diariamente, poco menos de la mitad consumía diariamente productos lácteos, un tercio bebía refrescos todos los días y una quinta parte consumía dulces y golosinas saladas. Los varones presentaron un mayor consumo de legumbres. Una mayor edad se asoció con una mayor frecuencia de consumo de leche. Los adolescentes que trabajaban y los que no trabajaban ni estudiaban consumían frutas, dulces y golosinas saladas con menor frecuencia. El consumo de frutas, vegetales, cereales, productos lácteos, pan, vegetales ricos en almidón, carne roja, carne blanca y comidas instantáneas disminuyó según la posición socioeconómica; además, los grupos de más baja posición socioeconómica consumían legumbres y refrescos con mayor frecuencia. CONCLUSIONES: Hay grupos de adolescentes menos propensos a consumir alimentos saludables (como frutas, vegetales y productos lácteos). Se discuten las condiciones socioeconómicas y culturales que pueden explicar las diferencias observadas. <![CDATA[<b>Intervenciones para mejorar los servicios de salud maternoinfantil y el estado nutricional de las madres y los niños</b>: <b>barreras y opciones</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892008000800008&lng=en&nrm=iso&tlng=en OBJECTIVE: To examine the relationship between demographic and socioeconomic factors and food consumption in Mexican adolescents. METHODS: A representative sample (n = 7 218) of Mexican adolescents (12-19 years old) was analyzed. Independent variables included age, gender, and main activity of the adolescents; gender and age of the head of household; socioeconomic position; size of town (rural, semiurban, or urban); and area of residence. The consumption frequency of 13 food groups was assessed. Through multivariate logistic regression models, the effect of independent variables over consumption frequency was evaluated. RESULTS: Among Mexican adolescents only one-third consumed fruits and vegetables daily, a little less than one-half consumed dairy products daily, one-third drank soft drinks daily, and one-fifth consumed sweets and salty snacks. Males reported higher consumption of legumes. Age increase was associated with higher frequency of milk consumption. Adolescents who worked and those who neither studied nor worked consumed fruits, sweets, and salty snacks less frequently. Eating fruits, vegetables, cereals, dairy products, bread, starchy vegetables, red meat, white meat, and fast food decreased with regard to socioeconomic position; on the other hand, the lower socioeconomic strata had more frequent consumption of legumes and soft drinks. CONCLUSIONS: There are groups of adolescents who are less likely to consume healthy foods (such as fruits, vegetables, and dairy products). Socioeconomic and cultural processes that can explain the differences observed are discussed.<hr/>OBJETIVO: Examinar la relación entre algunos factores demográficos y socioeconómicos y el consumo de alimentos en adolescentes mexicanos. MÉTODOS: Se analizó una muestra representativa (n = 7 218) de adolescentes mexicanos (de 12-19 años). Como variables independientes se emplearon la edad, el sexo y la actividad principal de los adolescentes; el sexo y la edad del jefe del hogar; la posición socioeconómica; el tamaño de la población de residencia (rural, semiurbana o urbana) y la zona del país. Se determinó la frecuencia del consumo de 13 grupos de alimentos y se evaluó el efecto de las variables independientes sobre la frecuencia de consumo mediante modelos de regresión logística multifactorial. RESULTADOS: Solo una tercera parte de los adolescentes mexicanos consumía frutas y vegetales diariamente, poco menos de la mitad consumía diariamente productos lácteos, un tercio bebía refrescos todos los días y una quinta parte consumía dulces y golosinas saladas. Los varones presentaron un mayor consumo de legumbres. Una mayor edad se asoció con una mayor frecuencia de consumo de leche. Los adolescentes que trabajaban y los que no trabajaban ni estudiaban consumían frutas, dulces y golosinas saladas con menor frecuencia. El consumo de frutas, vegetales, cereales, productos lácteos, pan, vegetales ricos en almidón, carne roja, carne blanca y comidas instantáneas disminuyó según la posición socioeconómica; además, los grupos de más baja posición socioeconómica consumían legumbres y refrescos con mayor frecuencia. CONCLUSIONES: Hay grupos de adolescentes menos propensos a consumir alimentos saludables (como frutas, vegetales y productos lácteos). Se discuten las condiciones socioeconómicas y culturales que pueden explicar las diferencias observadas. <![CDATA[<b>Universities and health promotion</b>: <b>how can the two come together?</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892008000800009&lng=en&nrm=iso&tlng=en Universities play a leading role in the communities in which they are found. Focused on leadership and developing knowledge, universities are the stage on which community members are formed. Through education, research, and by spreading knowledge, universities guide and support changes at the national and international levels. The university that advances health is one that joins health promotion with its purpose, aiming to foster human development and improve quality of life for its students and employees, thus impacting both the labor and social circles. It aspires to take a leading role in cultural change by raising awareness among the more educated, open, enterprising, and upstanding, and those committed to progress. This article's objective is to share a reflective analysis regarding the relationship between the university and health promotion in order to motivate and recommend action items to other universities advanced in this area. This analysis stems from experience gained over several years at the Pontificia Universidad Católica of Chile, through its health program, UC Saludable, in addition to a systematic review of the literature covering several years. The analysis develops four concepts that are central to all universities and that frame the health promotion effort: respond to health issues and educate the public; produce and disseminate health promotion knowledge; direct and support awareness of self-care and healthy lifestyles; and be a model change agent. http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892008000800010&lng=en&nrm=iso&tlng=en