Scielo RSS <![CDATA[Revista Panamericana de Salud Pública]]> http://www.scielosp.org/rss.php?pid=1020-498920100010&lang=en vol. 28 num. 4 lang. en <![CDATA[SciELO Logo]]> http://www.scielosp.org/img/en/fbpelogp.gif http://www.scielosp.org <![CDATA[<b>Water pollution in sources close to oil-producing fields of Bolivia</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892010001000001&lng=en&nrm=iso&tlng=en OBJETIVO: Determinar las concentraciones de compuestos petroquímicos en las fuentes de agua de consumo para comunidades cercanas a campos petrolíferos del Chaco Boliviano. MÉTODOS: Se recogieron datos sobre concentraciones de hidrocarburos totales de petróleo (HTP), 16 hidrocarburos aromáticos policíclicos (HAP), incluidos el benceno, tolueno, etilbenceno y xilenos (BTEX), y 22 metales en muestras de 42 fuentes de agua de consumo humano situadas a menos de 30 km de un campo de extracción de petróleo. Se analizó la distribución de la concentración y el cumplimiento de los estándares definidos en las normativas boliviana, europea y estadounidense, así como en las recomendaciones de la Organización Mundial de la Salud. RESULTADOS: En 76,19% de las muestras se halló algún contaminante petroquímico en concentraciones superiores a alguna de las cuatro normativas de referencia. Las muestras de agua que presentaron mayor contaminación fueron las provenientes de grifos y ríos. Los contaminantes más frecuentes fueron HTP, HAP, aluminio, arsénico, manganeso y hierro. CONCLUSIONES: Las comunidades del Chaco Boliviano ubicadas en un radio de 30 km alrededor de los campos de extracción de petróleo consumen agua con concentraciones de HTP, HAP y metales muy por encima de los niveles permitidos por la normativa boliviana y los estándares internacionales, poniendo en grave riesgo la salud pública de sus habitantes.<hr/>OBJECTIVE: To determine the concentrations of petrochemical compounds in the drinking water sources of communities located near oil-producing fields in the Bolivian Chaco region. METHODS: Data were collected on total petroleum hydrocarbons (TPH), 16 polycyclic aromatic hydrocarbons (PAH), including benzene, toluene, ethylbenzene, and xylenes (BTEX), and 22 metals in samples from 42 sources of water for human consumption located less than 30 km from an oil-producing field. Distribution of the concentration and adherence to the standards contained in the Bolivian, European, and United States regulations, as well as the recommendations of the World Health Organization, were analyzed. RESULTS: In 76.19% of the samples, some petrochemical contaminant was found in concentrations higher than permissible in any of the four sets of regulations mentioned. The water samples with the highest contamination levels were from faucets and rivers. The most common contaminants were TPH, PAH, aluminum, arsenic, manganese, and iron. CONCLUSIONS: Communities within a 30 km radius of the oil-producing fields in the Bolivian Chaco region consume water with TPH, PAH, and metal concentrations well above the levels permitted in the Bolivian regulations and international standards, putting the public health of their residents at serious risk. <![CDATA[<b>Increasing hospital admission rates and economic burden for colorectal cancer in Brazil, 1996</b>-<b>2008</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892010001000002&lng=en&nrm=iso&tlng=en OBJECTIVE: To determine the trends in hospital admission rates for colorectal cancer (CRC) in the Brazilian Public Health System from 1996 to 2008 and to assess the economic costs. METHODS: Data from the Hospital Information Systems database of the Brazilian Unified Health System were used for analysis of all admissions with a primary diagnosis of CRC between 1996 and 2008. RESULTS: There were 297 108 CRC admissions over the study period, with an annual increase from 12 821 in 1996 to 35 040 in 2008. Age-standardized admission rates increased from 8.7 to 23.56 per 100 000 for a percentage increase of 171%. The average length of stay decreased from 11.6 days in 1996 to 7.5 days in 2008. The average hospital mortality declined from 10.4% to 8.5%. Overall costs in United States dollars (US$) of CRC hospitalizations rose from US$ 16.5 million in 1996 to US$ 33.5 million in 2008; the average cost of each admission, however, decreased from US$ 1 283 to US$ 954. CONCLUSIONS: Hospitalization rates for CRC in Brazil significantly increased during a 13-year period, incurring a considerable rise in the inflation-adjusted economic burden; national in-hospital mortality rates have remained relatively high.<hr/>OBJETIVO: Determinar las tendencias de las tasas de ingresos hospitalarios por cáncer colorrectal (CCR) en el sistema de salud pública brasileño de 1996 al 2008 y evaluar sus costos económicos. MÉTODOS: Se utilizó la información de la base de datos de los sistemas de información de los hospitales del Sistema Único de Salud brasileño con objeto de analizar todos los ingresos con diagnóstico primario de CCR entre 1996 y el 2008. RESULTADOS: Durante el período de estudio, se produjeron 297 108 ingresos por CCR, con un aumento anual de 12 821 en 1996 a 35 040 en el 2008. Las tasas de ingresos estandarizadas según la edad aumentaron de 8,7 a 23,56 por 100 000, con un aumento porcentual de 171%. La estancia hospitalaria media disminuyó de 11,6 días en 1996 a 7,5 días en el 2008. La mortalidad hospitalaria promedio descendió de 10,4% a 8,5%. Los costos de las hospitalizaciones por CCR aumentaron de US$16,5 millones en 1996 a US$33,5 millones en el 2008; el costo promedio de cada ingreso, sin embargo, disminuyó de US$1 283 a US$954. CONCLUSIONES: Las tasas de hospitalización por CCR en Brasil han aumentado significativamente a lo largo de un período de 13 años y han acarreado un considerable incremento de la carga económica ajustada según la inflación; las tasas nacionales de mortalidad hospitalaria se han mantenido relativamente elevadas. <![CDATA[<b>Challenges faced by cervical cancer prevention programs in developing countries</b>: <b>a situational analysis of program organization in Argentina</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892010001000003&lng=en&nrm=iso&tlng=en OBJECTIVE: To carry out a situational analysis of cervical cancer prevention activities in Argentina, specifically regarding (a) the organizational framework of cervical cancer prevention activities; (b) Pap-smear coverage; (c) cytology laboratory organization; and (d) follow-up/treatment of women with abnormal lesions. METHODS: A situational analysis of provincial cervical cancer programs using data from an ad-hoc questionnaire sent to the leaders of cervical cancer prevention programs in Argentina's 24 provinces. In addition, the provinces' program guidelines, statistical reports, laws, and program regulations were reviewed and certain key leaders were personally interviewed. RESULTS: Data were obtained for 19 of Argentina's 24 provinces. Four of the 19 provinces had no formal program framework. Conventional cytology was the most commonly used screening test. Screening was mainly opportunistic. The recommended interval between normal tests was 3 years in most provinces. The eligible age for screening ranged from 10-70 years of age; however, annual or biannual screening was the usual practice after becoming sexually active. None of the provincial programs had data available regarding Pap-smear coverage. Most of the cytology laboratories did not have a quality control policy. The number of smears read varied greatly by laboratory (650-24 000 per year). A log of events related to screening and treatment did not exist in most provinces. CONCLUSIONS: Screening in Argentina is mainly opportunistic, characterized by an estimated low coverage, coexisting with over-screening of women with access to health services, and an absence of quality control procedures. Policies for cervical cancer screening in the provinces vary and, most often, deviate from the national recommendation of one Pap smear every 3 years for women 35-64 years of age. Ensuring compliance with national program guidelines is an essential step toward significantly reducing the burden of cervical cancer.<hr/>OBJETIVO: Realizar un análisis de la situación actual de las actividades de prevención del cáncer cervicouterino en Argentina, específicamente con respecto a los siguientes aspectos: a) el marco organizativo de las actividades de prevención del cáncer cervicouterino; b) la cobertura de la prueba de Papanicolaou; c) la organización de los laboratorios de citología; y d) el seguimiento y el tratamiento de las mujeres que presentan lesiones anómalas. MÉTODOS: Se llevó a cabo un análisis de la situación actual de los programas provinciales de prevención del cáncer cervicouterino a partir de los datos de un cuestionario ad hoc enviado a los directivos de los programas en las 24 provincias de Argentina. Además, en cada provincia se examinaron las directrices del programa provincial, los informes estadísticos, las leyes y los reglamentos de los programas, y se entrevistaron algunos directivos clave. RESULTADOS: Se obtuvieron datos de 19 de las 24 provincias argentinas. Cuatro de las 19 provincias no tienen instaurado ningún marco programático formal. La citología convencional es la prueba de tamizaje que más se utiliza y, en general, el tamizaje es oportunista. El intervalo recomendado entre las pruebas de resultado normal es de 3 años en la mayoría de las provincias y la edad a la que se indica efectuar el tamizaje en las distintas provincias se ubica entre los 10 y los 70 años; sin embargo, el tamizaje anual o bianual es la práctica habitual una vez que la mujer comienza a mantener relaciones sexuales. Ninguno de los programas provinciales pudo aportar datos acerca de la cobertura de la prueba de Papanicolaou. La mayoría de los laboratorios de citología no disponen de una política de control de calidad. Es muy variable el número de pruebas de citología cervical que llega a cada laboratorio (entre 650 y 24 000 por año). La mayoría de las provincias carece de un registro de acontecimientos relacionados con la detección y el tratamiento del cáncer cervicouterino. CONCLUSIONES: En Argentina, el tamizaje suele ser oportunista, tiene baja cobertura, se realiza con una frecuencia excesiva en las mujeres que tienen acceso a los servicios de salud y carece de procedimientos de control de calidad. Cada provincia aplica políticas diferentes en relación con el tamizaje del cáncer cervicouterino y, lo más habitual, es que no se atenga a la recomendación nacional de efectuar una prueba de Papanicolaou cada 3 años a las mujeres de entre 35 y 64 años de edad. A fin de reducir significativamente la carga del cáncer cervicouterino, es esencial garantizar el cumplimiento de las directrices del programa nacional de prevención. <![CDATA[<b>All-cause and cardiovascular diseases mortality in three Brazilian states, 1980 to 2006</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892010001000004&lng=en&nrm=iso&tlng=en OBJETIVO: Avaliar a mortalidade por todas as causas e por doenças do aparelho circulatório (DAC), doenças isquêmicas do coração (DIC) e doenças cerebrovasculares (DCBV) de 1980 a 2006 no Rio de Janeiro, Rio Grande do Sul, São Paulo e em suas capitais, considerando o impacto dos óbitos por causas mal definidas. MÉTODOS: Os dados de população e óbitos foram obtidos no Banco de Dados do Sistema Único de Saúde. As taxas de mortalidade para as doenças de interesse e para as causas mal definidas foram ajustadas pelo método direto para adultos acima de 20 anos. Como as taxas por causas mal definidas no Rio de Janeiro aumentaram muito a partir de 1990, foram estimados percentuais de mortalidade proporcional por causas mal definidas. Empregaram-se modelos de regressão linear para análise das tendências. RESULTADOS: Observou-se uma queda relevante da mortalidade por todas as causas nos três estados e capitais. O Rio de Janeiro e sua capital apresentaram taxas mais elevadas. A mortalidade por DAC apresentou queda mais acentuada do que a mortalidade por todas as causas. A mortalidade proporcional por causas mal definidas no Estado do Rio de Janeiro e sua capital superou aquela das demais localidades a partir de 1990. A mortalidade por DCBV apresentou declínio, mais acentuado no Estado do Rio de Janeiro e sua capital. O Estado do Rio de Janeiro apresentou também taxas de mortalidade mais elevadas por DIC até 1993. Entre as capitais, São Paulo apresentou a partir de 1992 as taxas mais elevadas de mortalidade por DIC. CONCLUSÃO: A queda da mortalidade por todas as causas se deveu principalmente ao declínio da mortalidade por DAC. A queda da mortalidade por DAC se deveu em parte à redução da mortalidade por DCBV, notadamente no Estado do Rio de Janeiro.<hr/>OBJECTIVE: To evaluate mortality from all causes, diseases of the circulatory system (DCS), ischemic heart disease (IHD), and cerebrovascular diseases (CVD) from 1980 to 2006 in Rio de Janeiro, Rio Grande do Sul, São Paulo, and their capitals, taking into consideration the impact of deaths due to ill-defined causes. METHODS: Population and mortality data were obtained from the Unified Health System's Data Bank (DATASUS). Mortality from the diseases of interest and from ill-defined causes was adjusted by the direct method for adults older than 20 years of age. Since the mortality rates from ill-defined causes increased markedly after 1990, proportional mortality rates from ill-defined causes were calculated. Linear regression models were used for analysis of trends. RESULTS: A relevant decline in all-cause mortality was observed in the three states and capitals. Rio de Janeiro and its capital had the highest rates of all-cause mortality. DCS mortality declined more than all-cause mortality. Proportional mortality from ill-defined causes in Rio de Janeiro and its capital was higher than in all other states and capitals starting in 1990. CVD mortality fell in the study period, especially in Rio de Janeiro and its capital. The state of Rio de Janeiro also had the highest IHD mortality rates until 1993. Among the capitals, São Paulo presented the highest IHD mortality rates starting in 1992. CONCLUSIONS: The decline in all-cause mortality resulted mainly from the decline in DCS mortality. In turn, the decline in DCS mortality was partly due to the reduction in CVD mortality, especially in the state of Rio de Janeiro. <![CDATA[<b>Sexual intercourse among adolescents in Santiago, Chile</b>: <b>a study of individual and parenting factors</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892010001000005&lng=en&nrm=iso&tlng=en OBJECTIVE: To examine a range of individual, parenting, and family factors associated with sexual intercourse among a community sample of youth and their families in Santiago, Chile. METHODS: Data were taken from the Santiago Longitudinal Study conducted in January 2008-November 2009. Participants were 766 youth (mean age = 14.03 years, 51% male) from municipalities of low- to mid-socioeconomic status. Variables included emotional and behavioral subscales from the Child Behavior Checklist's Youth Self Report, parental monitoring, family involvement, parental control and autonomy, relationship with each parent, and sexual activity. Bivariate and multivariate logistic regression models were used to examine the odds of sexual intercourse initiation. RESULTS: Seventy (9.14%) youth reported having had sex in their lifetime; the average age of first sexual intercourse among this group was 13.5 years (Standard Deviation [SD] = 1.74) for males and 14.08 (SD = 1.40) for females. Having sex was inversely associated with withdrawn-depressed symptoms (Odds Ratio [OR] = 0.84, Confidence Interval [CI] = 0.72-0.97), but positively associated with somatic complaints (OR = 1.20, CI = 1.04-1.38) and rule breaking behavior (OR = 1.21, CI = 1.08-1.36), after adjusting for demographic and other individual and parenting variables. The majority (80%) of the youth who had had sex reported using protection at the time of last intercourse. CONCLUSIONS: Findings highlight the role that mental health problems-some of them not commonly associated with onset of sexual activity-may play in a youth's decision to have sex. The potential protective effects of several parenting and family characteristics disappeared with youth age and youth behavioral problems.<hr/>OBJETIVO: Examinar distintos factores relacionados con el inicio de la actividad sexual que presentan los jóvenes, sus padres y su familia en una muestra de jóvenes y su respectiva familia tomada de la ciudad de Santiago, Chile. MÉTODOS: Se tomaron los datos de la primera ronda del Estudio Longitudinal de Santiago, que se llevó a cabo de enero del 2008 a noviembre del 2009. La muestra estuvo integrada por 766 jóvenes (media de edad = 14,03 años; 51% del sexo masculino) de municipios de nivel socioeconómico bajo a medio. Las variables evaluadas fueron las subescalas emocionales y conductuales del instrumento de autonotificación sobre comportamiento juvenil (Youth Self-Report) que forma parte del inventario de comportamiento infantil (Child Behavior Checklist), la vigilancia de los padres, la participación familiar, el control y la autonomía de los padres, la relación con el padre y la madre, y la actividad sexual. Se emplearon modelos bifactoriales y multifactoriales de regresión logística para examinar las probabilidades de inicio de la actividad sexual. RESULTADOS: Setenta (9,14%) de los jóvenes informaron que ya habían tenido alguna relación sexual; en este grupo, la edad promedio de iniciación fue 13,5 años (desviación estándar [DE] = 1,74) en los hombres y 14,08 (DE = 1,40) en las mujeres. Se observó una relación inversa entre la actividad sexual y los síntomas de retraimiento y depresión (razón de posibilidades [OR] = 0,84; intervalo de confianza [IC] = 0,72-0,97), pero una relación positiva con los síntomas somáticos (OR = 1,20; IC = 1,04-1,38) y el comportamiento transgresor (OR = 1,21; IC = 1,08-1,36), después de ajustar los valores en función de las variables demográficas y otras variables personales, así como las relativas a la crianza. La mayoría de los jóvenes (80%) que habían tenido relaciones sexuales informaron que habían utilizado algún tipo de protección en su última relación. CONCLUSIONES: Estos resultados ponen de manifiesto la importancia que pueden tener para los jóvenes, a la hora de decidir el inicio de su vida sexual, los problemas de salud mental, algunos de los cuales no suelen estar asociados al inicio de la actividad sexual. El efecto protector que potencialmente pueden brindar algunas características de la crianza y de la familia desapareció durante la juventud y algunos problemas conductuales de esa etapa. <![CDATA[<b>Tuberculosis incidence strata in Cuban municipalities</b>: <b>1999</b>-<b>2002 and 2003</b>-<b>2006</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892010001000006&lng=en&nrm=iso&tlng=en OBJETIVO: Identificar los municipios cubanos de alta, mediana y baja incidencia de tuberculosis (TB), comparar las tasas de incidencia de los períodos 1999-2002 y 2003-2006, y analizar la distribución de la enfermedad según la densidad poblacional y la actividad económica. MÉTODOS: Se calculó la incidencia de TB por municipios, el intervalo de confianza (95%) y el porcentaje de variación para los estratos definidos según la densidad demográfica y la actividad económica predominante. Los municipios fueron divididos en tres categorías según su incidencia (&gt; 10 por 100 000; &gt; 5 por 100 000 a < 10 por 100 000, y < 5 por 100 000) y se realizaron mapas temáticos. RESULTADOS: La proporción de municipios con una incidencia < 5 por 100 000 aumentó de 35,5% a 57,4% entre ambos períodos, mientras que la proporción de municipios con incidencia &gt; 10 por 100 000 disminuyó de 22,5% a 5,9%. La incidencia nacional cayó 28,7% -de 8,7 por 100 000 en 1999-2002, a 6,2 en 2003-2006. Los municipios no muy densamente poblados y dedicados principalmente a actividades agropecuarias registraron disminuciones de incidencia significativas. Todavía siguen altas las tasas de los municipios densamente poblados y dedicados a la industria y los servicios. CONCLUSIONES: La incidencia de TB disminuye sostenida y progresivamente en la mayoría de los municipios. Se necesitan estrategias diferenciadas para reducir las tasas de incidencia de TB en los municipios donde siguen siendo relativamente altas.<hr/>OBJECTIVE: Identify Cuban municipalities with high, medium, and low incidence of tuberculosis (TB), compare incidence rates for the periods 1999-2002 and 2003-2006, and analyze distribution of the disease by population density and economic activity. METHODS: TB incidence was calculated by municipality, confidence interval (95%), and the percentage of variation for the defined strata according to population density and the predominant economic activity. The municipalities were divided into three categories based on incidence (&gt; 10 per 100 000; &gt; 5 per 100 000 to < 10 per 100 000, and < 5 per 100 000), and maps were plotted. RESULTS: The proportion of municipalities with an incidence of < 5 per 100 000 rose from 35.5% to 57.4% between the two periods, while the proportion of municipalities with an incidence of &gt; 10 per 100 000 fell from 22.5% to 5.9%. National incidence fell by 28.7%-from 8.7 per 100 000 in 1999-2002 to 6.2 in 2003-2006. Municipalities that were not very densely populated and where agricultural activities predominated showed significant reductions in incidence. The rates in densely populated municipalities devoted primarily to industrial and service activities are still high. CONCLUSIONS: TB incidence is gradually and sustainably declining in the majority of municipalities. Differentiated strategies are needed to reduce TB incidence rates in municipalities where they continue to be relatively high. <![CDATA[<b>Preliminary clinical outcomes from the Peruvian National Cataract Elimination Plan</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892010001000007&lng=en&nrm=iso&tlng=en OBJECTIVE: To evaluate the clinical outcomes of a publicly funded cataract elimination program. METHODS: Outcomes of all patients (186) who received extracapsular cataract extraction (ECCE) surgery free of charge at the Instituto Regional de Oftalmología in northern Peru in the first year (August 2008 to July 2009) of the Peruvian National Cataract Elimination Plan were compared retrospectively with the outcomes of all patients (68) who paid in the highest charge tier for ECCE surgery during the same period. Preoperatively, the median uncorrected visual acuity (UCVA) of National Plan patients was Hand Motion; the UCVA of paying patients was Counting Fingers (P = 0.09). Complication frequency and visual acuity (uncorrected visual acuity, pinhole visual acuity, and best correct visual acuity) were the primary outcome measures. The World Health Organization (WHO) Vision 2020 goal is for 85% of operated eyes to achieve 20/60 vision; the Ministerio de Salud del Perú goal is for 75% of eyes to achieve 20/50. RESULTS: One month postoperatively, only 24% of National Plan patients achieved a UCVA of 20/60. The median UCVA for both groups was 20/100 (P = 0.23). Intraoperative complications occurred in 27% of all patients; postoperative complications occurred in 39%. Patients more likely to have a poor outcome (UCVA < 20/200) were those who experienced a postoperative complication (odds ratio [OR] 3.3, P = 0.002), who experienced an intraoperative complication (OR 2.5, P = 0.01), and who were 75 years or older (OR 2.7, P = 0.008). National Plan patients were more likely to have an OCTET Grade II intraoperative complication (OR 4.2, P = 0.03) and were less likely to receive refractive services (OR 1.5, P = 0.002). CONCLUSIONS: Neither WHO nor Peruvian benchmarks for surgical outcome were achieved in the first year of the Peruvian National Cataract Elimination Plan. Providing more comprehensive services to patients and addressing variables correlated with poor outcomes may improve interventions and help achieve Vision 2020 goals.<hr/>OBJETIVO: Evaluar los resultados clínicos de un programa de lucha contra la ceguera por catarata con financiamiento público. MÉTODOS: Los resultados obtenidos de todos los pacientes (186) sometidos a una operación gratuita de extracción extracapsular de catarata (EECC) en el Instituto Regional de Oftalmología del norte del Perú, durante el primer año (de agosto del 2008 a julio del 2009) de la ejecución del Plan Nacional de Lucha contra la Ceguera por Catarata del Perú, se compararon retrospectivamente con los resultados de los pacientes (68) que pagaron los honorarios más elevados por una operación quirúrgica de EECC durante el mismo período. Antes de la intervención, la mediana de la agudeza visual sin corrección (AVSC) de los pacientes beneficiarios del plan nacional era de percepción de los movimientos de la mano; mientras que en los pacientes de pago era de conteo de dedos (P = 0,09). Como mediciones primarias de los resultados se consideraron la frecuencia de complicaciones y la agudeza visual (agudeza visual sin corrección, agudeza visual con agujero estenopéico y mejor agudeza visual correcta). La meta de la iniciativa Visión 2020 de la Organización Mundial de la Salud (OMS) es lograr que 85% de los ojos operados alcancen un nivel de visión mínimo de 20/60; la meta del Ministerio de Salud del Perú es que 75% alcancen un nivel de 20/50. RESULTADOS: Un mes después de la intervención, solo 24% de los pacientes beneficiarios del plan nacional alcanzaron una AVSC de 20/60. La AVCS mediana en ambos grupos fue de 20/100 (P = 0,23). En 27% de los pacientes aparecieron complicaciones intraoperatorias; y en 39%, complicaciones posoperatorias. Los pacientes con mayor probabilidad de obtener un resultado deficiente (AVSC < 20/200) fueron los que presentaron alguna complicación posoperatoria (razón de posibilidades [OR] 3,3,P = 0,002), los que padecieron una complicación intraoperatoria (OR 2,5, P = 0,01) y los de 75 años de edad o mayores (OR 2,7, P = 0,008). Los pacientes beneficiarios del Plan Nacional tuvieron mayores probabilidades de tener complicaciones intraoperatorias de grado II de la escala de OCTET (OR 4,2, P = 0,03) y menores probabilidades de recibir servicios de corrección refractiva (OR 1,5, P = 0,002). CONCLUSIONES: Durante el primer año de ejecución del Plan Nacional de Lucha contra la Ceguera por Catarata del Perú no se alcanzaron los puntos de referencia peruanos ni los de la OMS en cuanto a los resultados de la cirugía. La prestación de servicios más integrales a los pacientes y la atención de las variables correlacionadas con los resultados deficientes pueden mejorar las intervenciones y contribuir a que se alcancen las metas de la iniciativa Visión 2020. <![CDATA[<b>Urban violence and social capital in a southern Brazilian city</b>: <b>a quantitative and qualitative study</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892010001000008&lng=en&nrm=iso&tlng=en OBJETIVO: Investigar as relações entre a violência urbana referida e capital social em uma cidade de médio porte no Estado do Rio Grande do Sul, Brasil. MÉTODOS: O estudo foi realizado com adultos da zona urbana de São Leopoldo. Na etapa quantitativa, um questionário estruturado foi respondido por 1 100 pessoas maiores de 20 anos responsáveis pelo domicílio no momento da entrevista. A violência foi avaliada com base nas referências a discussão violenta, roubo ou assalto, caso com drogas e homicídio ocorridos no bairro nos últimos 6 meses. O capital social foi definido a partir do grau relatado de confiança entre vizinhos, apoio social, controle social informal, percepção política e ação social nos bairros avaliados. Na etapa qualitativa, foi realizada uma entrevista semiestruturada com 11 participantes, residentes nos setores com o capital social mais alto e mais baixo. RESULTADOS: Os residentes em bairros com baixa confiança entre vizinhos relataram uma ocorrência quase 3 vezes maior de homicídios (RP = 2,82; IC95%: 1,67 a 4,74; P > 0,001) e de discussão violenta (RP = 2,56; IC95%: 1,82 a 3,59; P > 0,001) em comparação aos moradores de bairros com alta confiança entre vizinhos. As situações relacionadas à violência foram mais enfatizadas em vizinhanças com baixo capital social, nas quais também foi referido o descaso público. CONCLUSÕES: Em vizinhanças com maior capital social, menores percentuais de violência foram referidos. É importante priorizar políticas públicas que promovam o capital social voltado ao bem comum.<hr/>OBJECTIVE: To study the relationship between reported urban violence and social capital in a medium-sized city in the state of Rio Grande do Sul, Brazil. METHODS: The study was carried out with adults living in the urban area of São Leopoldo. For the quantitative analysis, a structured questionnaire was answered by 1 100 individuals older than 20 years of age and in charge of the household at the moment of the interview. Violence was evaluated based on the reports of violent arguments, theft or robbery, drug-related events, and homicides in the neighborhood over the previous six months. Social capital was defined based on the reported degree of trust among neighbors, informal social control, opinions on the actions of government and politicians, and social action in the neighborhoods. For the qualitative analysis, 11 participants residing in the area with the lowest or with the highest social capital answered a semi-structured interview. RESULTS: People living in low-trust neighborhoods reported higher rates of homicide (OR = 2.82; 95%CI: 1.67-4.74; P > 0.001) and violent arguments (OR = 2.56; 95%CI: 1.82-3.59; P > 0.001) than people living in high-trust neighborhoods. Violent situations were reported most often in neighborhoods with low social capital, in which a lack of government attention was also reported. CONCLUSIONS: In neighborhoods with the highest social capital, the prevalence of reported violence was lower. Priority should be given to public policies that promote social capital for the common good. <![CDATA[<b>Professional competencies of nursing, medical, and dental interns performing social service in Mexico</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892010001000009&lng=en&nrm=iso&tlng=en OBJETIVO: Identificar hasta dónde los pasantes de enfermería, medicina y odontología que están realizando su servicio social en México poseen las competencias profesionales requeridas para ejercer la profesión. MÉTODOS: Se revisaron los resultados de los exámenes generales para el egreso de la licenciatura, aplicados por el Centro Nacional para la Evaluación de la Educación Superior a los egresados de las carreras de enfermería, medicina y odontología entre 2006 y 2008. RESULTADOS: De 39 824 egresados examinados de las tres carreras en el periodo considerado, 12 845 no contaban con las competencias profesionales mínimas. En enfermería, del total de examinandos en los tres años, 3 765 (30,2%) mostraron desempeño no suficiente; en medicina, 6 704 (32,7%), y en odontología, 2 376 (34,1%). A pesar de esto, todos ellos ejercían, o habían ejercido, como profesionistas, con el respaldo de la normatividad correspondiente y formando parte del personal de salud de las instituciones de salud (aproximadamente 11% de la fuerza de trabajo en esas profesiones, en la Secretaría de Salud). CONCLUSIONES: Los pasantes son la base de la atención de salud de la población rural, pero aproximadamente una tercera parte de ellos no tienen las competencias profesionales mínimas. Es imperativo que demuestren sus competencias profesionales antes de iniciar el servicio social, y que cuenten con una supervisión académica y profesional estrecha durante el término de la pasantía.<hr/>OBJECTIVE: Determine the degree to which nursing, medical, and dental interns performing social service in Mexico have the professional competencies required to practice the profession. METHODS: The results of the general examinations for completion of the undergraduate degree, administered between 2006 and 2008 to students in the nursing, medical, and dentistry programs by the National Center for Higher Education Assessment, were reviewed. RESULTS: Of the 39 824 graduates in the three programs who were tested during the period in question, 12 845 did not exhibit the minimum professional competencies. In nursing, out of the total students tested in the three-year period, 3 765 (30.2%) performed inadequately; in medicine, the figure was 6 704 (32.7%), and in dentistry, 2 376 (34.1%). Notwithstanding, backed by the respective regulations, all them were practicing, or had practiced, as professionals, serving as members of the health team in health institutions (approximately 11% of the Ministry of Health workforce in those professions). CONCLUSIONS: Interns are the bedrock of health care for the rural population, but approximately one-third of them lack the basic competencies to practice their profession. It is imperative that they demonstrate professional competence before beginning their social service and that they be closely supervised, both academically and professionally, during their internship. <![CDATA[<b>Self-owned <i>versus</i> accredited network</b>: <b>comparative cost analysis in a Brazilian health insurance provider</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892010001000010&lng=en&nrm=iso&tlng=en OBJETIVO: Analisar os custos da rede própria de uma operadora brasileira de planos de saúde comparativamente com o preço cobrado pela rede credenciada, visando a identificar se a opção estratégica da operadora em ter rede própria representou vantagem econômica. MÉTODOS: Este estudo exploratório foi desenvolvido mediante pesquisa nos relatórios gerenciais da empresa. O custo da rede própria foi calculado com base nas consultas médicas e odontológicas e nos exames diagnósticos e laboratoriais realizados em uma unidade representativa da operadora. Os custos com terceirizados foram obtidos da tabela de preços praticados pela rede credenciada para os mesmos serviços analisados na rede própria. Para a quantificação dos custos foi utilizado o método de custeio pleno. Os custos são apresentados em termos absolutos (em R$) e em percentuais dos custos próprios em relação aos da rede credenciada. RESULTADOS: De modo geral há vantagem para a operadora em utilizar sua própria rede. Isso é verdadeiro para consultas médicas, odontológicas e exames. São exceções as consultas nas especialidades de pediatria e medicina do trabalho e os exames de raio-X. CONCLUSÕES: A opção da operadora pela verticalização do serviço apresenta vantagens econômicas para a empresa em relação à terceirização.<hr/>OBJECTIVE: To analyze the cost of a self-owned network maintained by a Brazilian health insurance provider as compared to the price charged by accredited service providers, so as to identify whether or not the self-owned network is economically advantageous. METHODS: For this exploratory study, the company's management reports were reviewed. The cost associated with the self-owned network was calculated based on medical and dental office visits and diagnostic/laboratory tests performed at one of the company's most representative facilities. The costs associated with third parties were derived from price tables used by the accredited network for the same services analyzed in the self-owned network. The full-cost method was used for cost quantification. Costs are presented as absolute values (in R$) and percent comparisons between self-owned network costs versus accredited network costs. RESULTS: Overall, the self-owned network was advantageous for medical and dental consultations as well as diagnostic and laboratory tests. Pediatric and labor medicine consultations and x-rays were less costly in the accredited network. CONCLUSIONS: The choice of verticalization has economic advantages for the health care insurance operator in comparison with services provided by third parties. <![CDATA[<b>High blood pressure care: beyond the clinical setting</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892010001000011&lng=en&nrm=iso&tlng=en Se contrastaron las recomendaciones contenidas en el séptimo informe del Comité nacional conjunto para la prevención, detección, evaluación y tratamiento de la hipertensión arterial (JNC 7) con un artículo reciente de Aram V. Chobanian, quien fuera presidente del JNC 7. El propósito fue identificar cuáles son los cambios propuestos por este autor y cómo podrían afectar la actuación clínica, así como sus implicaciones en los servicios sanitarios y la salud pública. El JNC 7 y el mencionado artículo coinciden en todos los puntos esenciales, con la excepción de que este último es más flexible en la utilización de diuréticos para iniciar el tratamiento de la hipertensión arterial (HTA). Se considera que la atención de las enfermedades crónicas debería inscribirse en sistemas de salud con un enfoque de atención primaria, donde la epidemiología de tales enfermedades y los avances en la prevención ofrecen una excelente ocasión para rediseñar y hacer más efectivos los servicios de salud. La HTA, como un problema poblacional, requiere de intervenciones sanitarias orientadas no solo a conjurar los daños sino a modificar sus determinantes etiológicos. El desafío es reconocer que un enfoque integrado de medicina clínica, servicios de salud y salud pública, proporcionaría una atractiva oportunidad para interrumpir y prevenir el continuo y costoso círculo que supone el manejo de la HTA y sus complicaciones.<hr/>The recommendations from the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) were compared with those of a recent article by Aram V. Chobanian, Chairman of the JNC 7. The purpose was to identify the changes that this author proposed and determine how they might affect clinical work, as well as the health services and public health implications. The JNC 7 and the article in question coincide on all essential points, except that the article is more flexible when it comes to the use of diuretics at the start of treatment for high blood pressure. Chronic disease management should take place in health systems with primary care approach, where the epidemiology of such diseases and scientific advances in prevention offer an excellent opportunity for redesigning the health services and making them more effective. High blood pressure, as a public health problem, demands health interventions aimed not only at reducing harm but modifying its etiologic determinants. The challenge is to recognize that an integrated approach to clinical medicine, health services, and public health would offer an attractive opportunity to interrupt and prevent the continuous and costly vicious circle that managing high blood pressure and its complications implies.