Scielo RSS <![CDATA[Revista Panamericana de Salud Pública]]> http://www.scielosp.org/rss.php?pid=1020-498920100002&lang=en vol. 27 num. 2 lang. en <![CDATA[SciELO Logo]]> http://www.scielosp.org/img/en/fbpelogp.gif http://www.scielosp.org <![CDATA[<b>The role of health care providers in the late diagnosis of pulmonary tuberculosis among adults in Medellín, Colombia</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892010000200001&lng=en&nrm=iso&tlng=en OBJETIVO: Describir el papel que desempeña el personal de salud (PS) en el retraso del diagnóstico de la tuberculosis pulmonar (TBP) en la población adulta de una ciudad colombiana. MÉTODOS: Estudio de caso sobre el diagnóstico de la TBP en adultos de la ciudad de Medellín, Colombia, en 2007. Se recogieron datos cuantitativos y cualitativos mediante entrevistas en profundidad a 19 pacientes (11 con diagnóstico oportuno y 8 con diagnóstico tardío), la revisión de sus historias clínicas y encuestas sobre los conocimientos y las prácticas relacionadas con la TBP a 89 médicos y enfermeros de 12 instituciones prestadoras de servicios de salud. Se realizó un taller investigativo con los pacientes a fin de socializar los resultados y validar las categorías emergentes. RESULTADOS: Se observó un escaso conocimiento sobre la TBP y una imagen estereotipada de los pacientes que llevan a malinterpretar los síntomas y emplear tratamientos sintomáticos. Los insuficientes conocimientos del PS sobre los factores de riesgo y el cuadro clínico dificultaron el diagnóstico cuando el paciente no reflejaba el estereotipo o presentaba una enfermedad ya conocida. La desinformación sobre la transmisión de la TBP y la prescripción incorrecta de medidas de aislamiento propiciaron prácticas discriminatorias y aislamiento social y reforzaron los estereotipos y la estigmatización, lo que también limitó la búsqueda de ayuda médica. CONCLUSIONES: El PS desempeñó un papel fundamental en el diagnóstico tardío de la TBP en los adultos estudiados. Las creencias asociadas con el estigma social y el insuficiente conocimiento sobre la enfermedad -compartidos por el PS y los pacientes- contribuyen a la construcción social del estereotipo de la enfermedad y el enfermo y reducen las posibilidades de llegar a un diagnóstico oportuno de la TBP.<hr/>OBJECTIVE: To describe the role of health care providers in the delayed diagnosis of pulmonary tuberculosis (PTB) among the adult population in a city in Colombia. METHODS: A case study of PTB diagnosis among adults in the city of Medellín, Colombia, in 2007. Quantitative and qualitative data were collected through in-depth interviews with 19 patients (11 with early diagnosis and 8 with late diagnosis), from medical records, and by a survey of PTB-related knowledge and practices among 89 doctors and nurses at health care clinics. A research workshop was held with patients to share the results and validate new categories. RESULTS: A lack of PTB knowledge and patient stereotyping were found to lead to misinterpretation of symptoms and the use of symptomatic treatments. The lack of knowledge regarding risk factors and clinical protocols made diagnosis difficult when the patient did not match the stereotype or presented with a more well-known illness. Misinformation on PTB transmission and inappropriate measures led to discriminatory practices and social isolation and only reinforced stereotypes and stigma, which in turn discouraged the quest for medical attention. CONCLUSIONS: Health care providers played a large part in the late diagnosis of PTB in the adults studied. Beliefs regarding social stigma and a lack of knowledge about the disease-shared by providers and patients-contributed to stereotyping of the illness and the disease-carrier, and limited the probability of an early diagnosis of PTB. <![CDATA[<b>Changes in HIV needs identified by the National AIDS Hotline of Trinidad and Tobago</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892010000200002&lng=en&nrm=iso&tlng=en OBJECTIVES: To examine utilization of the National AIDS Hotline of Trinidad and Tobago (AIDSLINE), evaluate its validity as a reliable data source for monitoring national HIV-related needs, and identify changes in caller requests between two different time periods. METHODS: A total of 7 046 anonymous hotline calls in 1998-2002 (T1) and 2 338 calls in 2007 (T2) were analyzed for associations between caller characteristics and call content. A subsample of the data was also analyzed qualitatively. T1 findings were compared with HIV-related data collected by national policy-makers during that period, to evaluate the hotline's validity as a data source, and findings from T2, to reveal changes in call content over time. RESULTS: In T1, the hotline was well utilized for information and counseling by both the general population and those living with HIV/AIDS. Call content from T2 indicated an increase versus T1 in 1) general awareness of HIV and other sexually transmitted diseases; 2) HIV testing; and 3) knowledge of HIV symptoms and transmission. HIV-related mental health needs, and the relationship between HIV and both child sexual abuse (CSA) and intimate partner violence (IPV), were identified as emerging issues. CONCLUSIONS: AIDSLINE is a well-utilized tool for providing information and counseling on national HIV-related issues, and a valid, cost-effective, easily accessed information source for planners and policy-makers involved in HIV management. Over the two study periods, there was an increase in HIV awareness and testing and in requests related to mental health, CSA, and IPV, but no change in sexual behaviors.<hr/>OBJETIVOS: Evaluar la utilización de la Línea Directa Nacional de Trinidad y Tobago sobre Sida (AIDSLINE) y su validez como fuente confiable de información para monitorear las necesidades nacionales sobre el VIH, e identificar cambios en las preguntas de los usuarios en dos momentos diferentes. MÉTODOS: Se buscaron asociaciones entre las características de los usuarios y el contenido de 7 046 llamadas anónimas recibidas entre 1998 y 2002 (T1) y 2 338 recibidas en 2007 (T2). Se tomó una submuestra para análisis cualitativo. Se compararon las características de las llamadas de T1 con: 1) los datos de la autoridad nacional sobre la infección por VIH en ese período, para evaluar la validez de AIDSLINE como fuente de información, y 2) con las de T2 para revelar los cambios en el contenido de las llamadas en el tiempo. RESULTADOS: En T1, AIDSLINE se utilizó ampliamente para buscar información y consejería, tanto por la población general como por personas con VIH/sida. El contenido de las llamadas en T2 indicó un incremento con respecto a T1 en: 1) preocupación general sobre el VIH y otras enfermedades de transmisión sexual; 2) detección de la infección por el VIH; y 3) información sobre los síntomas de la infección y su transmisión. Se identificaron como preocupaciones emergentes las necesidades en salud mental relacionadas con el VIH y la relación entre esta infección y el abuso sexual de menores (ASM) y la violencia de pareja (VDP). CONCLUSIONES: AIDSLINE es una herramienta ampliamente utilizada para brindar información y consejería sobre el VIH en el país y una fuente de información válida, efectiva en función del costo y de fácil acceso para los encargados de planear y elaborar políticas relacionadas con el VIH. Con respecto a T1, en T2 aumentaron la preocupación por el VIH y su detección y las preguntas sobre la salud mental, el ASM y la VDP, pero sin cambios en cuanto a la conducta sexual. <![CDATA[<b>Awareness, treatment, and control of arterial hypertension</b>: <b>Pró-Saúde study, Brazil</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892010000200003&lng=en&nrm=iso&tlng=en OBJETIVO: Avaliar a prevalência, o reconhecimento, o tratamento e o controle da hipertensão em uma população brasileira em idade laboral. MÉTODO: Este projeto se insere em um estudo prospectivo com funcionários de uma universidade do Rio de Janeiro, Brasil (Estudo Pró-Saúde). A partir de aferições padronizadas de pressão arterial e da história de diagnóstico e tratamento da hipertensão, foi estimada a prevalência de hipertensão em 2 384 participantes de linha de base (1999 a 2001) do estudo. A partir daí, foram determinadas as proporções da população, segundo sexo e idade, que reconhecem o diagnóstico de hipertensão arterial, tratam essa condição e cuja doença encontra-se controlada com medicação anti-hipertensiva. RESULTADOS: Da população do estudo, 704 indivíduos (29,6%) foram classificados como hipertensos; desses, 573 (81,5%) reconheciam previamente sua condição (88,6% das mulheres e 71,6% dos homens). Dos hipertensos que reconheciam previamente a sua condição, 445 (77,8%; 88,8% das mulheres e 59,1% dos homens) estavam em tratamento com anti-hipertensivos. Por sua vez, dos hipertensos que estavam em tratamento, 287 (60,1%; 61,5% das mulheres e 57,4% dos homens) estavam controlados. Entre aqueles na menor faixa etária, os percentuais de reconhecimento e tratamento foram menores e o controle foi maior. CONCLUSÃO: Nessa população, reconhecimento, tratamento e controle da hipertensão foram superiores ao observado em grande parte dos estudos nacionais e internacionais. Considerando-se que a maioria da população reconhecia sua condição e se tratava, era esperada uma proporção maior de controle da doença. O controle adequado da hipertensão deve ser uma prioridade dos programas e serviços de saúde, especialmente entre os homens.<hr/>OBJECTIVE: To evaluate the prevalence, awareness, treatment, and control of hypertension in a working-age population in Brazil. METHOD: This project is part of a prospective study with employees at a university in Rio de Janeiro (Pró-Saúde Study). Based on standardized measurements of blood pressure and on the history of diagnosis and treatment of hypertension, we estimated the prevalence of hypertension in 2 384 participants from the baseline population (1999 to 2001) and determined what percentage, according to sex and age, were aware of the diagnosis of arterial hypertension, treated this condition, and had their disease controlled with anti-hypertensive drugs. RESULTS: Of the population under study, 704 people (29.6%) were classified as hypertensive; of these, 573 (81.5%) were aware of their condition (88.6% of females and 71.6% of males). Of those who were aware, 445 (77.8%; 88.8% of females and 59.1% of males) were being treated with anti-hypertensive drugs. In turn, of the hypertensive subjects being treated for this condition, 287 (60.1%; 61.5% of females and 57.4% of males) were controlled. Awareness and treatment rates were lower and control was higher in those in the lowest age range. CONCLUSION: In the study population, awareness, treatment, and control of hypertension were higher than has been reported by most national and international studies. Considering the fact that most individuals were aware of and treated their condition, a higher rate of hypertension control was expected. Adequate control of hypertension, especially among men, must be a priority of health programs and services. <![CDATA[<b>Factorial structure and psychometric properties of a scale for depression among university students in Colombia</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892010000200004&lng=en&nrm=iso&tlng=en OBJETIVO:Determinar las propiedades psicométricas y la estructura factorial de la escala de depresión del Centro de Estudios Epidemiológicos (CES-D) en una muestra de estudiantes universitarios colombianos. MÉTODOS:Se empleó una muestra de conveniencia no probabilística de 355 estudiantes de dos universidades colombianas (62,0% mujeres y 38,0% hombres), seleccionados por cuotas en las instituciones educativas, un muestreo aleatorio de los grupos y la participación de voluntarios. Se modificó la versión en español de la CES-D para extender el período evaluado a dos semanas. Se calculó la puntuación total de cada escala y de los factores; el análisis factorial exploratorio se realizó por el método de componentes principales. RESULTADOS:Se encontraron cuatro factores: afecto depresivo, aspectos sociales, afecto positivo y síntomas somáticos, que en conjunto explicaron 55,9% de la varianza. La prueba mostró elevados valores de consistencia interna (α de Cronbach = 0,88). Los factores individuales presentaron consistencias internas variables y confluyeron en torno a un factor único de segundo orden. La composición de los factores era congruente con la propuesta original, aunque con variaciones en la composición factorial, tanto para la muestra total, como por sexos. Aunque las puntuaciones difirieron según el sexo de la persona evaluada, la consistencia interna de la escala total se mantuvo por encima de 0,87 para cada sexo. Los niveles de corte propuestos para la prueba fueron: 39 puntos para la población general, 35 para los hombres y 42 para las mujeres, todos ellos ubicados por encima del cuarto quintil. CONCLUSIONES:La escala CES-D tiene propiedades psicométricas satisfactorias que hacen recomendable su aplicación en estudiantes universitarios colombianos. Con estos resultados se abre la posibilidad de utilizar esta escala tanto en estudios clínicos como epidemiológicos.<hr/>OBJECTIVE:To determine the psychometric properties and factor structure of the Center for Epidemiological Studies depression scale (CES-D) with a sample of Colombian university students. METHODS:A non-probabilistic convenience sample of 355 students from two universities (62% women and 38% men) were selected according to quotas from the educational institutions, a random sample of groups, and volunteer participants. The Spanish version of the CES-D was modified by extending the evaluation period to two weeks. The total score was calculated for each scale and factor; the exploratory factor analysis was conducted using the method of principal components. RESULTS:The four factors: depressive affect, somatic symptoms, positive affect, and interpersonal relations, accounted for 55.9% of the variance. The analysis showed high levels of internal consistency (Cronbach's alpha = 0.88). The individual factors showed variations in internal consistency and converged around a single, secondary factor. The factor structure matched the original theory, even with variations in the factor structure for the whole sample, as well as by gender. Although scores differed according to the sex of the person being evaluated, the internal consistency of the scale as a whole remained over 0.87 for each sex. The proposed cutoff levels for the test were: 39 points for the general population, 35 for males, and 42 for females, all above the fourth quintile. CONCLUSIONS:The CES-D scale has satisfactory psychometric properties and can be recommended for use in university students. These results lend themselves to the possibility of using this scale in both clinical and epidemiological studies. <![CDATA[<b>A fully liquid DTPw-HepB-Hib combination vaccine for booster vaccination of toddlers in El Salvador</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892010000200005&lng=en&nrm=iso&tlng=en OBJECTIVES:To compare the safety and immunogenicity of a booster dose of a fully liquid diphtheria-tetanus-whole cell pertussis-hepatitis B-Haemophilus influenzae type b (DTPw-HepB-Hib) vaccine to the separate administration of commercially available DTPw and Hib vaccines in healthy toddlers. METHODS:An open-label, randomized, parallel-group, Phase III study conducted at six centers in San Salvador, El Salvador, during February-June 2006. Toddlers (15-24 months of age) were eligible to participate if they had received primary immunization at 2, 4, and 6 months of age with a commercial DTPw-HepB/Hib vaccine requiring reconstitution. Participants received either one booster dose of DTPw-HepB-Hib fully liquid vaccine or DTPw and Hib vaccines administered separately. Blood samples were taken immediately prior to and at 1 month post-vaccination. For a 5-day period following vaccination, solicited adverse events were collected in subject diaries and assessed. RESULTS:The combined DTPw-HepB-Hib fully liquid vaccine was non-inferior to the separately administered DTPw and Hib vaccines, in terms of seroprotection/seroconversion rates for all antigens evaluated. The combination vaccine elicited a strong booster response as demonstrated by a large increase in antibodies against all vaccine antigens. The geometric mean concentrations (GMCs) of all antibodies in the DTPw-HepB-Hib group exceeded the seroprotection/seroconversion thresholds by very large margins, although for some antigens they were somewhat lower than the corresponding titers in the comparator group. With the combination vaccine, considerably fewer solicited local and systemic adverse events, such as fever and irritability, were reported than with the comparator vaccines. CONCLUSIONS:This study demonstrates that the fully liquid combined DTPw-HepB-Hib vaccine is highly immunogenic and has a favorable safety profile when given as a booster vaccination to toddlers who have received a primary vaccination course with a different pentavalent vaccine that requires reconstitution.<hr/>OBJETIVOS:Comparar la seguridad y la inmunogenicidad en infantes saludables de una dosis de refuerzo de una vacuna líquida combinada contra la difteria, el tétanos, la tosferina (de células enteras), la hepatitis B y Haemophilus influenzae tipo b (DTPw-HepB-Hib), con la aplicación por separado de vacunas DTPw y Hib disponibles comercialmente. MÉTODOS:Se realizó un estudio de fase III abierto, aleatorizado, con grupos paralelos, en seis centros de San Salvador, El Salvador, en febrero-junio de 2006. Los infantes (de 15-24 meses) habían recibido la inmunización primaria a los 2, 4 y 6 meses de edad con una vacuna comercial DTPw-HepB/Hib que necesitaba reconstitución. Los lactantes recibieron una dosis de refuerzo con la vacuna DTPw-HepB-Hib o las vacunas DTPw y Hib por separado. Se tomaron muestras de sangre inmediatamente antes de la vacunación y un mes después. Las reacciones adversas en los cinco días siguientes a la vacunación se anotaron en diarios individuales y se evaluaron. RESULTADOS:Según las tasas de seroprotección/seroconversión de todos los antígenos evaluados, la vacuna DTPw-HepB-Hib no fue inferior que las vacunas DTPw y Hib administradas por separado. La vacuna combinada produjo una fuerte respuesta de refuerzo, reflejada en el gran aumento de anticuerpos contra todos los antígenos presentes. Con respecto al grupo de comparación, en el grupo vacunado con DTPw-HepB-Hib las concentraciones geométricas medias de todos los anticuerpos superaron ampliamente los umbrales de seroprotección/seroconversión -aunque con títulos menores en algunos antígenos- y hubo mucho menos reacciones adversas locales y sistémicas, como fiebre e irritabilidad. CONCLUSIONES:Se demostró que la vacuna líquida combinada DTPw-HepB-Hib es altamente inmunógena y satisfactoriamente segura cuando se aplica como dosis de refuerzo a infantes inmunizados primariamente con una vacuna pentavalente diferente que requiere reconstitución. <![CDATA[<b>Estimated annual cost of arterial hypertension treatment in Brazil</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892010000200006&lng=en&nrm=iso&tlng=en OBJECTIVES: To estimate the direct annual cost of systemic arterial hypertension (SAH) treatment in Brazil's public and private health care systems, assess its economic impact on the total health care budget, and determine its proportion of the 2005 gross domestic product (GDP). METHODS: A decision tree model was used to determine direct costs based on estimated use of various resources in SAH diagnosis and care, including treatment (medication and non-medication), complementary exams, doctor visits, nutritional assessments, and emergency room visits. RESULTS: Estimated direct annual cost of SAH treatment was approximately US$ 398.9 million for the public health care system and US$ 272.7 million for the private system, representing 0.08% of the 2005 GDP (ranging from 0.05% to 0.16%). With total health care expenses comprising about 7.6% of Brazil's GDP, this cost represented 1.11% of overall health care costs (0.62% to 2.06%)-1.43% of total expenses for the Unified Healthcare System (Sistema Único de Saúde, SUS) (0.79% to 2.75%) and 0.83% of expenses for the private health care system (0.47% to 1.48%). Conclusion. To guarantee public or private health care based on the principles of universality and equality, with limited available resources, efforts must be focused on educating the population on prevention and treatment compliance in diseases such as SAH that require significant health resources.<hr/>OBJETIVOS: Estimar el costo directo anual del tratamiento de la hipertensión arterial sistémica (HAS) en los sistemas sanitarios público y privado de Brasil, evaluar su impacto económico en el presupuesto total de salud y determinar la proporción del producto interno bruto (PIB) que ocupó en 2005. MÉTODOS: Se empleó un modelo de árbol de decisión para determinar los costos directos según el uso estimado de varios recursos en el diagnóstico y la atención de la HAS, incluidos el tratamiento (con medicamentos y sin ellos), los exámenes complementarios, las visitas del médico, las evaluaciones nutricionales y las visitas a servicios de emergencia. RESULTADOS: El costo anual directo estimado del tratamiento de la HAS fue de aproximadamente US$ 398,9 millones en el sistema público y US$ 272,7 millones en el privado, lo que representó 0,08% del PIB en 2005 (mínimo: 0,05%; máximo: 0,16%). Con un gasto total en salud de cerca de 7,6% del PIB de Brasil, este costo representó 1,11% del costo total en salud (de 0,62% a 2,06%): 1,43% de los gastos totales del Sistema Único de Salud (de 0,79% a 2,75%) y 0,83% de los gastos del sistema privado (de 0,47% a 1,48%). CONCLUSIONES: Para garantizar servicios públicos o privados de salud basados en los principios de universalidad y equidad, con recursos limitados, los esfuerzos se deben enfocar en educar a la población en el cumplimiento de las medidas de prevención y el tratamiento de enfermedades, que como la HAS, requieren considerables recursos sanitarios. <![CDATA[<b>Sucrose concentration and pH in liquid oral pediatric medicines of long-term use for children</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892010000200007&lng=en&nrm=iso&tlng=en OBJECTIVES: To determine the pH and sucrose concentrations (SC) of pediatric liquid drugs of long-term use by children in order to evaluate the potential risk for dental caries and dental erosion. METHODS: After assessing the pH, we analyzed 71 aqueous medicine samples for sucrose by the Lane-Eynon general volumetric method. The pH and SC values (mean ± standard deviation (SD) were calculated according to therapeutic action. RESULTS: The highest and the lowest SC values (mean ± SD) were found in respiratory (37.75% ± 17.23%) and endocrine drugs (11.97% ± 15.16%) (p < 0.01). The values for medicines prescribed for daily ingestion were 47.15% ± 9.57%, whereas for twice daily and three or four times a day, these numbers were 24.42% ± 18.03% and 34.43% ± 14.83%, respectively (p < 0.01). The SC (mean ± SD)) values were higher in syrups (36.32% ± 17.62%) than in other formulations (p > 0.05). The overall pH (mean ± SD) was 5.89 ± 2.02 (range 2.3 ± 0.01 to 10.6 ± 0.02). In products with acidic pH, the SC (mean ± SD) was significantly lower (22.14% ± 15.72%) than in nonacidic medicines (39.22% ± 15.82%) (p < 0.001). CONCLUSIONS: It can be concluded that the pediatric medicines studied have a high SC and low pH, which vary according to therapeutic class, daily dose, and brand. Caution about dental caries, dental erosion, and systemic diseases such as diabetes mellitus is warranted when these medicines are ingested frequently.<hr/>OBJETIVOS: Determinar el pH y las concentraciones de sacarosa de medicamentos pediátricos líquidos de uso oral a largo plazo, para evaluar el riesgo potencial de caries y erosión dental. MÉTODOS: Se analizaron 71 muestras de medicamentos líquidos; después de evaluar el pH, se determinó la sacarosa por el método volumétrico de Lane&Eynon. El pH y los valores de sacarosa (media ± desviación estándar [DE]) se calcularon de acuerdo con la acción terapéutica. RESULTADOS: El valor de sacarosa más alto (media ± DE) se encontró en los medicamentos respiratorios (37,75% ± 17,23%) y el más bajo en los endocrinos (11,97% 15,16% ±) (p < 0,01). Los medicamentos recetados para ingerir una vez al día tuvieron valores de 47,15% ± 9,57%; los que se administran dos veces al día, 24,42% ± 18,03%, y los recetados tres o cuatro veces al día, 34,43% ± 14,83% (p < 0,01). Los valores de sacarosa fueron mayores en jarabes (36,32% ± 17,62%) que en otras formas farmacéuticas (p > 0,05). El pH general fue 5,89 ± 2,02 (recorrido 2,3 ± 0,01 a 10,6 ± 0,02). La sacarosa fue significativamente inferior en los productos con el pH ácido (22,14% ± 15,72%) que en los medicamentos no ácidos (39,22% ± 15,82%) (p < 0,001). CONCLUSIONES: Los medicamentos pediátricos estudiados tienen una concentración de sacarosa alta y un pH bajo, los cuales varían según la clase terapéutica, la dosis diaria y la marca. Cuando estos medicamentos se ingieren con frecuencia, se debe tener cuidado con la caries y la erosión dental, así como con las enfermedades sistémicas como la diabetes mellitus. <![CDATA[<b>Counterfeit pharmaceuticals in Peru</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892010000200008&lng=en&nrm=iso&tlng=en OBJETIVO: Determinar la cantidad de medicamentos falsificados detectados en el Centro Nacional de Control de Calidad (CNCC) (Instituto Nacional de Salud, Perú) en el periodo 2005-2008 y determinar sus tipos y características. MÉTODOS: Se preparó una ficha para la recolección de los datos pertinentes, los cuales fueron tomados directamente de los informes emitidos por el CNCC. Estos informes fueron sometidos a un proceso de revisión y evaluación, y aquellos en los que se confirmó la falsificación fueron clasificados en cuatro grupos, según el tipo de falsificación. RESULTADOS: El porcentaje de medicamentos falsificados con relación al total de medicamentos analizados fue de 3,0% en 2005, 5,0% en 2006, 7,3% en 2007 y 9,2% en 2008. Los principales grupos de medicamentos falsificados según la clasificación ATC de la OMS fueron: tracto alimentario y metabolismo, 34,5% (29,1%-39,8%); antiinfecciosos para uso sistémico, 21,1% (16,5%-25,7%); sistema nervioso, 17,1% (12,8%-21,3%); y sistema musculoesquelético, 15,4% (11,3%-19,5%). Los tipos de falsificación predominantes fueron aquellos donde el medicamento contenía la dosis correcta del principio activo pero el fabricante era distinto al declarado (62,4%, sobre el total de medicamentos falsificados), y aquellos donde el medicamento no contenía ningún principio activo (22,4%). El 61,0% (56,0%-67,0%) de los medicamentos falsificados fueron nacionales y 39,0% (33,0%-44,0%), importados. Las formas farmacéuti-cas con mayores tasas de falsificación incluyeron comprimidos, 66,0% (60,0%-71,0%), inyectables, 19,0% (14,0%-23,0%) y cápsulas, 7,0% (4,0%-10,0%). CONCLUSIONES: Entre los años 2005 y 2008, la falsificación de medicamentos registró una variación promedio anual de 45%. Se comprobó un predominio de la falsificación de medicamentos de producción nacional -en contraste con los medicamentos importados-, si bien los tipos y formas farmacéuticas de los medicamentos adulterados evidencian cierta sofisticación en el proceso de falsificación. La falsificación de medicamentos que salvan vidas, como los antimicrobianos, representa un peligro serio de salud pública.<hr/>OBJECTIVE: To determine the quantity of counterfeit pharmaceutical drugs found by the National Quality Control Center (Centro Nacional de Control de Calidad (CNCC), Instituto Nacional de Salud, Peru) during the period from 2005&2008, and the types and properties of these drugs. METHODS: A form was created to amass the relevant data collected directly from CNCC reports. The reports underwent a review and analysis process, and where counterfeiting was confirmed, it was categorized by type into one of four groups. RESULTS: The percentage of counterfeit drugs relative to the total drugs evaluated was: 3.0% in 2005, 5.0% in 2006, 7.3% in 2007, and 9.2% in 2008. The main groups of counterfeit drugs, classified according to the World Health Organization Anatomical Therapeutic Chemical Classification System, were: alimentary tract and metabolism, 34.5% (29.1%&39.8%); antiinfectives for systemic use, 21.1% (16.5%&25.7%); nervous system, 17.1% (12.8%&21.3%); and musculo-skeletal system, 15.4% (11.3%&19.5%). The most common type of forgery occurred in cases where the drug contained the correct amount of active ingredients, but the manufacturer was one other than the one indicated (62.4% of the total counterfeit drugs); and medications that did not contain any active ingredient (22.4%). Of the counterfeit drugs, 61.0% (56.0%&67.0%) were national brands and 39.0%, (33.0%&44.0%) were imported. The pharmaceutical formulations with the highest rate of forgery were tablets, 66.0% (60.0%&71.0%); injectables, 19.0% (14.0%&23.0%); and capsules 7.0% (4.0%&10.0%). CONCLUSIONS: From 2005&2008, drug counterfeiting had an average annual variation of 45%. Drug counterfeiting was shown to be most prevalent among national brands& as opposed to imported medications&although the types and formulations of the fake drugs attest to a certain level of sophistication employed in the forgery process. The counterfeiting of life-saving drugs, such as antimicrobials, signifies a serious public health threat. <![CDATA[<b>Community participation in health</b>: <b>the challenge in Chile</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892010000200009&lng=en&nrm=iso&tlng=en Health care reforms implemented in Latin America and the Caribbean over the last 20 years have viewed community participation as a system-wide component. Nonetheless, these reform efforts have yet to break through the conceptual and operational barriers holding back the development and expansion of community participation. In Chile, changes introduced to the health care system are far from achieving any real participation from the community. Therefore, the consumer's role needs to be redefined from merely controlling the parts, to reaching across the whole system in a way that consumer input might identify and quickly correct any posible shortcomings in the health system's design, as well as its operations. With this in mind, the main challenges are to strengthen coordination among the various promotion and participation commitments, as well as community control, and to generate data and other evidence to assess the impact of community participation in health strategies. <![CDATA[<b>Pharmaceutical assistance in the Brazilian public health care system</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892010000200010&lng=en&nrm=iso&tlng=en This article deals with the organization of pharmaceutical assistance within the Brazilian Public Unified Health System (Sistema Único de Saúde, SUS) by analyzing the progress made so far and the challenges that still must be faced to ensure the right to universal therapeutic and pharmaceutical coverage in Brazil. Among the improvements, the article discusses the National List of Essential Drugs and its role to guide the supply, prescription, and dispensing of drugs within SUS. The structure of federal funding and the existing pharmaceutical programs are described, as well as the responsibilities of the Federal Government, states, and municipalities concerning allocation of financial resources. Despite the progress made, the model of access to SUS drugs has not been successful in securing universal therapeutic assistance. It is essential to consider a type of funding and organization of pharmaceutical assistance that is driven by a notion of regionalization, with financing based on health care flows rather than on the population circumscribed to a given territory. It is also essential to qualify pharmaceutical management by hiring pharmacists and support personnel, professionalizing workers, and setting up facilities with appropriate information systems and equipment.