Scielo RSS <![CDATA[Revista Panamericana de Salud Pública]]> http://www.scielosp.org/rss.php?pid=1020-498920100012&lang=en vol. 28 num. 6 lang. en <![CDATA[SciELO Logo]]> http://www.scielosp.org/img/en/fbpelogp.gif http://www.scielosp.org <![CDATA[<b>Asthma cases in childhood attributed to atopy in tropical area in Brazil</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892010001200001&lng=en&nrm=iso&tlng=en OBJECTIVE: This study aimed to explore the association between asthma and atopy in a cohort of children living in a large urban center in Brazil. Atopy was defined by the presence of allergen-specific IgE in serum or by a positive skin prick test. METHODS: In a sample of 1 445 Brazilian children, the association between the prevalence of asthma, skin prick test positivity, and allergen-specific IgE in serum was investigated. RESULTS: The prevalence of asthma was 22.6%. The presence of serum allergen-specific IgE was frequent in asthmatics and nonasthmatics, and the prevalence of asthma increased only with levels of allergen-specific IgE > 3.5 kilounits/L. The proportion of asthma attributable to atopy was estimated to be 24.5% when atopy was defined by the presence of allergen-specific IgE. With a given level of specific IgE, no association between skin test reactivity and asthma was observed. Skin prick tests were less sensitive than specific IgE for detection of atopy. CONCLUSIONS: Most asthma cases in an urban underprivileged setting in Brazil were not attributable to atopy. This observation has important implications for understanding the risk factors for the asthma epidemic in Latin America<hr/>OBJETIVO: Explorar la relación entre el asma y la atopia en una cohorte de niños que viven en un gran centro urbano de Brasil. En este estudio, se considera atopia la detección de IgE sérica específica de algún alérgeno o un resultado positivo a la prueba de punción cutánea. MÉTODOS: Se estudió la relación entre la prevalencia del asma, el resultado positivo a la prueba de punción cutánea y la detección de IgE sérica específica de algún alérgeno en una muestra de 1 445 niños brasileños. RESULTADOS: El asma registró una prevalencia de 22,6%. La presencia de IgE séricas específicas de alérgenos fue frecuente tanto en los asmáticos como en los no asmáticos, y la prevalencia del asma fue mayor solo cuando el valor detectado de la IgE específica del alérgeno era > 3,5 kilounidades/litro. Se calculó que la atopia definida como la detección de IgE específicas de alérgenos es responsable de 24,5% de los casos de asma. No se observó ninguna relación entre la reactividad a la prueba de punción cutánea y el asma en función de los valores de IgE específicas. La prueba de punción cutánea es menos sensible que la detección de IgE específicas en lo que respecta al diagnóstico de atopia. CONCLUSIONES: La mayoría de los casos de asma que se registran en entornos urbanos desfavorecidos de Brasil no son atribuibles a atopia. Esta observación tiene implicaciones importantes en lo que respecta a la comprensión de los factores de riesgo que predisponen a la epidemia de asma en América Latina <![CDATA[<b>Direct costs of medical care for patients with type 2 diabetes mellitus in Mexico micro-costing analysis</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892010001200002&lng=en&nrm=iso&tlng=en OBJETIVO: Estimar los costos directos de la atención médica a pacientes con diabetes mellitus tipo 2 (DM2) en el Instituto Mexicano del Seguro Social (IMSS). MÉTODOS: Se revisaron expedientes clínicos de 497 pacientes que ingresaron a unidades de segundo y tercer nivel de atención durante el período 2002-2004. Los costos se cuantificaron utilizando el enfoque de costeo de enfermedad (CDE) desde la perspectiva del proveedor, la técnica del microcosteo y la metodología de abajo-arriba (bottom-up). Se estimaron costos promedio anuales de diagnóstico, por complicación y total de la enfermedad. RESULTADOS: El costo total anual de los pacientes con DM2 para el IMSS fue de US$452 064 988, correspondiente a 3,1% del gasto de operación. El costo promedio anual por paciente fue de US$3 193,75, correspondiendo US$2 740,34 para el paciente sin complicaciones y US$3 550,17 para el paciente con complicaciones. Los días/cama en hospitalización y en unidad de cuidados intensivos fueron los servicios con mayor costo. CONCLUSIONES: Los elevados costos en la atención médica a pacientes con DM2 y complicaciones representan una carga económica que las instituciones de salud deben considerar en su presupuesto, a fin de poder brindar un servicio de calidad, adecuado y oportuno. El empleo de la metodología de microcosteo permite un acercamiento a datos reales de utilización y manejo de la enfermedad<hr/>OBJECTIVE: Estimate the direct cost of medical care incurred by the Mexican Social Security Institute (IMSS, Instituto Mexicano del Seguro Social) for patients with type 2 diabetes mellitus (DM2). METHODS: The clinical files of 497 patients who were treated in secondary and tertiary medical care units in 2002-2004 were reviewed. Costs were quantified using a disease costing approach (DCA) from the provider's perspective, a micro-costing technique, and a bottom-up methodology. Average annual costs by diagnosis, complication, and total cost were estimated. RESULTS: Total IMSS DM2 annual costs were US$452 064 988, or 3.1% of operating expenses. The annual average cost per patient was US$3 193.75, with US$2 740.34 per patient without complications and US$3 550.17 per patient with complications. Hospitalization and intensive care bed-days generated the greatest expenses. CONCLUSIONS: The high cost of providing medical care to patients with DM2 and its complications represents an economic burden that health institutions should consider in their budgets to enable them to offer quality service that is both adequate and timely. Using the micro-costing methodology allows an approximation to real data on utilization and management of the disease <![CDATA[<b>Analysis of protection or risk factors for dental fluorosis in 6 to 8 year-old children in Fortaleza, Brazil</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892010001200003&lng=en&nrm=iso&tlng=en OBJETIVO: Investigar os fatores de risco ou de proteção para a fluorose dentária na dentição permanente de crianças de 6 a 8 anos em um bairro no Município de Fortaleza, Brasil. MÉTODOS: Este estudo de caso-controle incluiu 67 crianças com fluorose nos incisivos superiores e inferiores permanentes erupcionados, conforme o índice de Dean, e 57 controles. A presença de fluorose foi determinada como variável dependente. Os dados acerca das variáveis independentes foram obtidos através de entrevistas com os pais das crianças. O teste exato de Fisher foi utilizado para verificar a existência de associação entre fluorose e as variáveis independentes. Foi calculada a razão de chances (odds ratio, OR) para verificar a associação e a probabilidade de fluorose no grupo-caso, ambos com significância de 95%. RESULTADOS: Houve associação significativa da fluorose com tipo de moradia (própria, alugada ou ocupada), mas não com fonte de água para consumo ou uso de dentifrícios fluoretados e suplementos de flúor. Na análise univariada, o risco de fluorose foi maior em crianças que iniciaram o consumo de leite em pó reconstituído com água antes dos 2 anos de idade (OR = 4,53; IC95%: 1,07 a 26,74) e nas que não mamaram (OR = 6,66; IC95%: 1,61 a 38,62). Na análise multivariada, somente a amamentação apresentou associação com a fluorose (4,54; IC95%: 1,21 a 16,66). CONCLUSÕES: A amamentação se configurou como fator de proteção contra a fluorose. É preciso estabelecer critérios de classificação mais específicos para permitir a investigação de relações entre fluorose e classe socioeconômica<hr/>OBJECTIVE: To investigate protection or risk factors for dental fluorosis in permanent teeth of 6 to 8 year-old children in a neighborhood of Fortaleza, Brazil. METHODS: This case-control study included 57 controls and 67 children with fluorosis affecting superior and inferior incisors teeth as determined by the Dean classification criteria. Presence of fluorosis was considered as the dependent variable. Data concerning independent variables were obtained through interviews with the parents. Fisher's exact test was used to determine associations between fluorosis and the independent variables. Odds ratios (OR) were calculated to investigate associations and likelihood of fluorosis in the case group, with 95% significance level. RESULTS: Fluorosis was significantly associated with type of housing (owned, rented or squatted), but not with the source of drinking water or use of fluoridated toothpaste and fluoride supplements. Univariate analysis showed that the risk of fluorosis was higher in children who began drinking powdered milk mixed with water before 2 years of age (OR = 4.53; IC95%: 1.07-26.74) and in those who did not breastfeed (OR = 6.66; IC95%: 1.61-38.62). In the multivariate analysis, only breastfeeding was associated with fluorosis (4.54; IC95%: 1.21-16.66). CONCLUSIONS: Breastfeeding was a protection factor against fluorosis. More specific categorization criteria must be established to investigate relationships between fluorosis and socioeconomic class <![CDATA[<b>Maternal behavior and experience, care access, and agency as determinants of child diarrhea in Bolivia</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892010001200004&lng=en&nrm=iso&tlng=en OBJECTIVE: In Latin America and the Caribbean, Bolivia has the third highest rate of mortality among children under five years of age (57 per 1 000), with 14.0% of under-five deaths attributable to diarrhea. Because a child's world is predominantly controlled by and experienced through his or her mother, this investigation aims to understand what maternal dimensions may determine child diarrhea. METHODS: Variables were selected from the 2003 Bolivia Demographic and Health Survey to create indices of three maternal dimensions using principal components analysis: behavior and experience, access to care, and agency. The three indices were included in a logistic regression model while controlling for economic status, maternal education, and residence type. RESULTS: A total of 4 383 women who had children less than 5 years old were included in the final sample and 25.0% of mothers reported that their most recent born child had experienced an episode of diarrhea in the 2 weeks before the survey. Mothers with high levels of maternal agency or of high economic status were significantly less likely to report their child experienced an episode of diarrhea than women of low levels. Women with primary education were significantly more likely to report that their child experienced diarrhea than women with no education. CONCLUSIONS: High levels of agency have a significant protective effect even when controlling for other factors. Increasing maternal agency could have a positive impact on child health in Bolivia, and future work should aim to understand what accounts for different levels of agency and how it may be strengthened<hr/>OBJETIVO: En América Latina y el Caribe, Bolivia ocupa el tercer lugar en términos de la tasa de mortalidad de los niños menores de 5 años (57 por 1 000); 14,0% de estas muertes son atribuibles a cuadros de diarrea. Dado que la madre es quien tiene casi todo el control sobre el mundo que rodea al niño y es a través de ella que el niño lo experimenta, esta investigación procura entender las dimensiones maternas que pueden determinar la aparición de diarrea infantil. MÉTODOS: Las variables de estudio se seleccionaron a partir de la Encuesta Nacional de Demografía y Salud efectuada en Bolivia en el año 2003 para elaborar índices representativos de tres dimensiones maternas empleando el análisis de componentes principales: el comportamiento y la experiencia, el acceso a la atención de salud y la capacidad de acción. Los tres índices se incluyeron en un modelo de regresión logística teniendo en cuenta la situación económica, el nivel de educación materna y el lugar de residencia. RESULTADOS: La muestra final estuvo compuesta por 4 383 mujeres que tenían al menos un hijo menor de 5 años; 25,0% de las madres informaron que su hijo menor había presentado un episodio de diarrea en las dos semanas anteriores a la encuesta. La probabilidad de que los niños presentaran un episodio de diarrea fue significativamente menor entre las madres que tienen gran capacidad de acción o una buena situación económica que entre aquellas cuya situación económica es mala o tienen escasa capacidad de acción, y significativamente mayor entre las mujeres que habían finalizado la escuela primaria que entre aquellas sin escolaridad. CONCLUSIONES: Una mayor capacidad de acción de la madre tiene un efecto protector importante aun cuando se consideran otros factores. Mejorar la capacidad de acción materna podría impactar de manera positiva la salud infantil de Bolivia, de modo que las futuras investigaciones deberían proponerse comprender los factores que determinan los diferentes grados de capacidad de acción de la madre y la manera en que pueden mejorarse <![CDATA[<b>Quality of previous diabetes care among patients receiving services at ophthalmology hospitals in Mexico</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892010001200005&lng=en&nrm=iso&tlng=en OBJECTIVE: To survey a large sample of type 2 diabetes mellitus (T2DM) patients in Mexico City to determine if patient experience, access to basic services, treatment, and outcomes differed between those with social security coverage and those without. METHODS: From 2001-2007 a total of 1 000 individuals with T2DM were surveyed in outpatient clinics of the three largest public ophthalmology hospitals in Mexico City. Patients reported information about their health status and receipt of basic diabetes services, such as laboratory glycemic monitoring and diabetes education. Rates were compared between those with (n = 461) and without (n = 539) social security. RESULTS: Almost half of the patients (46%) in these public facilities were social security patients that were unable to access other services and had to pay out-of-pocket for care. Half of respondents were originally identified as potentially diabetic based on symptom complaints (51%), including 11% with visual impairment. Most patients (87.9%) reported that their glycemic level was being monitored exclusively via fasting blood glucose testing or random capillary blood glucose tests; only 5.3% reported ever having a glycated hemoglobin test. While nearly all respondents reported an individual physician encounter ever, only 39% reported ever receiving nutrition counseling and only 21% reported attending one or more sessions of diabetes education in their lifetime. Processes of care and outcomes were no different in patients with and those without social security coverage. CONCLUSIONS: In Mexico, the quality of diabetes care is poor. Despite receiving social security, many patients still have to pay out-of-pocket to access needed care. Without policy changes that address these barriers to comprehensive diabetes management, scientific achievements in diagnosis and pharmacotherapy will have limited impact<hr/>OBJETIVO: Determinar si hay diferencias en cuanto a las experiencias de atención de la diabetes, el acceso a los servicios básicos, el tratamiento y la evolución clínica entre las personas que disponen o no de seguro social de salud mediante la encuesta de una muestra amplia de pacientes que padecen diabetes mellitus tipo 2 en la Ciudad de México. MÉTODOS: Se encuestó a 1 000 pacientes con diabetes tipo 2 en la consulta externa de los tres hospitales públicos de oftalmología más importantes de la Ciudad de México. Los pacientes proporcionaron información acerca de su estado de salud y su experiencia respecto de la atención básica de diabetes; por ejemplo, el control de la glucemia mediante análisis de laboratorio y la información que recibieron acerca de la enfermedad. Se compararon los datos estadísticos entre quienes disponían de un seguro social de salud (n = 461) y quienes carecían de este tipo de seguro (n = 539). RESULTADOS: Casi la mitad de los pacientes (46%) que se atienden en estos hospitales públicos disponen de seguro social de salud, pero no pudieron acceder a otros servicios y debieron pagar de su bolsillo para recibir atención. La mitad de los entrevistados (51%) eran pacientes que habían sido considerados presuntos diabéticos a partir de los síntomas que habían referido, de los cuales 11% presentaron discapacidad visual. La mayoría de los pacientes (87,9%) refirieron que solo se controlaban mediante análisis glucemia en ayunas o análisis aleatorios (sin ayunar) de una muestra de sangre capilar; solo 5,3% refirieron que alguna vez se habían efectuado el análisis de glucohemoglobina (HbA1c). Si bien prácticamente la totalidad de los encuestados refirieron haber tenido alguna consulta médica, solo 39% informaron haber recibido orientación nutricional en alguna ocasión y solo 21% refirieron haber asistido a una o más sesiones informativas sobre la diabetes. No se registraron diferencias en la atención ni la evolución clínica entre los pacientes que disponen de un seguro social de salud y aquellos que carecen de este tipo de seguro. CONCLUSIONES: En México, es deficiente la calidad de la atención en materia de diabetes. A pesar de contar con un seguro social de salud, muchos pacientes deben pagar de su bolsillo para acceder a la atención que necesitan. De no modificarse las políticas con el fin de abordar los obstáculos que encuentran los pacientes para acceder al tratamiento integral de la diabetes, serán limitadas las repercusiones de los avances científicos que tengan lugar en materia de diagnóstico y farmacoterapia <![CDATA[<b>Local governance in the decentralized health care system in Brazil</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892010001200006&lng=en&nrm=iso&tlng=en OBJETIVO: Analisar as mudanças decorrentes do processo de descentralização do Sistema Único de Saúde na governança do setor saúde no âmbito do poder local entre 1996 e 2006. MÉTODOS: Um questionário foi aplicado aos gestores municipais de saúde de todo o Brasil em 1996 e novamente em 2006. Foram coletadas informações sobre as características de inovação da gestão em três dimensões: social, gerencial e assistencial. O presente artigo analisa resultados referentes à dimensão social da gestão (relação entre a gestão municipal e os diferentes atores da sociedade) a partir de quatro atributos: elaboração do orçamento (qual o grau de influência de atores variados), estabelecimento de prioridades, prestação de contas e fluxo de informações para a sociedade. RESULTADOS: Aumentou a influência dos secretários e dos conselhos municipais de saúde na elaboração do orçamento, em detrimento da influência dos políticos locais. Na definição de prioridades em saúde, reduziu-se a solicitação dos políticos locais e a demanda espontânea e fortaleceram-se o parecer do corpo técnico e as propostas dos conselhos e das conferências de saúde. Observa-se a institucionalização da prática de prestação de contas em virtude da diversificação do conjunto de atores a que se direciona (especialmente câmara de vereadores e conselho de saúde) e dos mecanismos utilizados, embora continue prevalecendo o uso de balancete periódico (que implica em conhecimento técnico para interpretação dos resultados). Por fim, as informações oferecidas à população ainda se referem acima de tudo às ações e campanhas de saúde e ao funcionamento de serviços, embora tenha crescido a divulgação de informações inovadoras à sociedade. Esse padrão se observa em todas as regiões e portes populacionais, com tendências mais progressivas na região Sul. CONCLUSÕES: A relação entre estado e sociedade modificou-se em direção a um padrão mais democrático de governança local, embora tenham sido mantidas práticas governamentais concentradoras de poder na tomada de decisão. O processo de descentralização ainda encontra obstáculos importantes para a concretização de um modelo de maior participação, controle social, responsabilização e interação entre Estado e sociedade.<hr/>OBJECTIVE: To analyze the changes in local health care governance resulting from the decentralization process associated with the Unified Health System (SUS) in Brazil between 1996 and 2006. METHODS: A questionnaire was answered in 1996 and again in 2006 by all city officials involved in health care management in Brazil. Information was collected on the innovative characteristics of administrative practices in terms of three dimensions: social, management, and care. The present article analyzes the results relating to the social dimension (relationship between municipal officials and the various community actors) according to four attributes: preparing the budget (degree of influence of various actors), establishing priorities, accountability, and flow of information to the community. RESULTS: The influence of municipal secretaries of health and health councils on budget preparation has increased, with a decrease of local politician influence. In prioritizing health issues, local politicians and spontaneous demands have also become less influential, with strengthening of the influence of technical opinions and proposals by health councils and conferences. Public disclosure of results has become institutionalized as a result of the diversification of stakeholders (especially municipal secretaries and health councils) and of the methods available for disclosure, even though balance sheets are still the most common type of information disclosed (which imply technical knowledge for interpretation of results). Finally, the information conveyed to the community still mainly refers to health actions and campaigns and functioning of health services, even though a larger amount of innovative information is being communicated. This was observed in all regions and in cities of all sizes, with a more progressive trend in the South of Brazil. CONCLUSIONS: The relationship between government and society has changed toward a more democratic standard of local governance, despite the maintenance of centralized government decision-making practices. The process of decentralization still faces important obstacles to the establishment of a more participative model, with enhanced social control, accountability and interaction between government and society. <![CDATA[<b>Opportunity cost for men who visit family medicine units in the city of Querétaro, Mexico</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892010001200007&lng=en&nrm=iso&tlng=en OBJETIVO: Determinar el costo de oportunidad en hombres que solicitan atención en las unidades de medicina familiar (UMF) del Instituto Mexicano del Seguro Social (IMSS) en la ciudad de Querétaro. MÉTODOS: Se seleccionó una muestra de 807 hombres de 20 a 59 años de edad que solicitaban atención en los servicios de medicina familiar, laboratorio y farmacia, proporcionados por UMF del IMSS en Querétaro. Se excluyeron los pacientes referidos a urgencias y los que se retiraron sin recibir atención. La muestra (n = 807) se calculó mediante la fórmula de promedios para población infinita, con un intervalo de confianza de 95% (IC95%) y un costo de oportunidad promedio de US$ 5,5 para medicina familiar, US$ 3,1 para laboratorio y de US$ 2,3 para farmacia. Las estimaciones incluyeron el tiempo invertido en traslado, espera y atención; el número de acompañantes, y el costo del minuto para la actividad remunerada y no remunerada. El costo de oportunidad se calculó a través del costo por minuto estimado para traslado, espera y atención de pacientes y acompañantes. RESULTADOS: El costo de oportunidad correspondiente al traslado del paciente se estimó en US$ 0,97 (IC95%: 0,81-1,15), mientras que el de espera fue de US$ 5,03 (IC95%: 4,08-6,09) en medicina familiar, US$ 0,06 (IC95%: 0,05-0,08) en farmacia y US$ 1,89 (IC95%: 1,56- 2,25) en laboratorio. El costo de oportunidad promedio cuando el paciente acudió sin compañía osciló entre US$ 1,10 para el servicio de farmacia solo y US$ 8,64 para medicina familiar, farmacia y laboratorio. El costo de oportunidad ponderado para medicina familiar fue de US$ 6,24. CONCLUSIONES: Dado que el costo de oportunidad de los hombres que demandan servicios en las unidades de medicina familiar corresponde a más de la mitad de un salario mínimo, desde el enfoque institucional correspondería establecer si esa es la mejor alternativa de atención.<hr/>OBJECTIVE: To determine the opportunity cost for men who seek care in the family medicine units (FMU) of the Mexican Social Security Institute (IMSS, Instituto Mexicano del Seguro Social) in the city of Querétaro. METHODS: A sample was selected of 807 men, ages 20 to 59 years, who sought care through the family medicine, laboratory, and pharmacy services provided by the FMU at the IMSS in Querétaro. Patients referred for emergency services and those who left the facilities without receiving care were excluded. The sample (n = 807) was calculated using the averages for an infinite population formula, with a confidence interval of 95% (CI95%) and an average opportunity cost of US$5.5 for family medicine, US$3.1 for laboratory services, and US$2.3 for pharmacy services. Estimates included the amount of time spent on travel, waiting, and receiving care; the number of people accompanying the patient, and the cost per minute of paid and unpaid job activities. The opportunity cost was calculated using the estimated cost per minute for travel, waiting, and receiving care for patients and their companions. RESULTS: The opportunity cost for the patient travel was estimated at US$0.97 (CI95%: 0.81-1.15), while wait time was US$5.03 (CI95%: 4.08-6.09) for family medicine, US$0.06 (CI95%: 0.05-0.08) for pharmacy services, and US$1.89 (CI95%: 1.56-2.25) for laboratory services. The average opportunity cost for an unaccompanied patient visit varied between US$1.10 for pharmacy services alone and US$8.64 for family medicine, pharmacy, and laboratory services. The weighted opportunity cost for family medicine was US$6.24. CONCLUSIONS: Given that the opportunity cost for men who seek services in FMU corresponds to more than half of a minimum salary, it should be examined from an institutional perspective whether this is the best alternative for care. <![CDATA[<b>Treatment of type 2 diabetes in Latin America</b>: <b>a consensus statement by the medical associations of 17 Latin American countries</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892010001200008&lng=en&nrm=iso&tlng=en Latin America faces unique challenges in the treatment of type 2 diabetes mellitus. The Asociación Latinoamericana de Diabetes (Latin American Diabetes Association, ALAD) brought together medical associations in 17 countries in Latin America to produce a consensus statement regarding the treatment of type 2 diabetes. The goal of the document is to provide practical recommendations that will guide clinicians through a simple decision-making process for managing patients. The cornerstone elements for therapeutic decision making are: severity of hyperglycemia, clinical condition of the patient (stable or with metabolic decompensation), and body mass index. The consensus includes a section devoted specifically to patients with obesity. Information is presented as highly-relevant clinical questions. The algorithm is based on the scientific recommendations of the 2006 ALAD guidelines (a document prepared using an evidence-based approach) and data from recent randomized controlled studies<hr/>América Latina se enfrenta a algunos retos excepcionales en el tratamiento de la diabetes mellitus tipo 2. La Asociación Latinoamericana de Diabetes (ALAD) reunió a las asociaciones médicas de 17 países latinoamericanos con el fin de producir una declaración de consenso sobre el tratamiento de la diabetes tipo 2. El objetivo de ese documento es brindar recomendaciones prácticas que guíen a los médicos a lo largo de un sencillo proceso decisorio para el tratamiento de los pacientes. Los elementos fundamentales para la toma de decisiones terapéuticas son la gravedad de la hiperglucemia, el estado clínico del paciente (estable o con descompensación metabólica) y el índice de masa corporal. El documento contiene un apartado dedicado específicamente a los pacientes obesos y la información se presenta en forma de preguntas clínicas sumamente pertinentes. El algoritmo se basa en las recomendaciones científicas de las directrices de la ALAD del año 2006 (documento preparado con un método basado en datos probatorios) y en datos obtenidos de estudios controlados aleatorizados recientes <![CDATA[<b>Caribbean wellness day</b>: <b>mobilizing a region for chronic noncommunicable disease prevention and control</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892010001200009&lng=en&nrm=iso&tlng=en The member states of the Caribbean Community (CARICOM) have the highest prevalence of chronic noncommunicable diseases (CNCDs) in the Americas. The CARICOM heads of government issued the Port-of-Spain Declaration "Uniting to Stop the Epidemic of Chronic Non-Communicable Diseases in the Caribbean," mandating intersectoral, population-based approaches and commemoration of the summit on the second Saturday in September as "Caribbean Wellness Day (CWD)." CWD, inaugurated in September 2008, is designed to strengthen public, private, and civil society partnerships and to promote multicountry, multisectoral activities in support of wellness. By 2009, the second year of the celebrations, 18 of the 20 CARICOM countries embraced and celebrated with multifaceted, multifocal activities, using this as a catalyst for sustained physical activities, healthy food choices, and health screening in a smoke-free environment. Organizational support and Caribbean branding of products came from the Pan American Health Organization/World Health Organization and CARICOM. Outcomes will be measured by input and process indicators and CNCD risk factor surveillance.<hr/>Los estados miembros de la Comunidad del Caribe (CARICOM) tienen la prevalencia más alta de enfermedades crónicas no transmisibles de la Región de las Américas. Los jefes de gobierno de la CARICOM emitieron la Declaración de Puerto España "Unidos contra las enfermedades no transmisibles en el Caribe", en la que se promueve la adopción de métodos intersectoriales y poblacionales y, en conmemoración de la cumbre, se propone la instauración del segundo sábado de septiembre como el "Día del Bienestar en el Caribe". Ese día, celebrado por primera vez en septiembre del 2008, tiene la finalidad de fortalecer las asociaciones públicas, privadas y de la sociedad civil, y promover actividades multinacionales y multisectoriales en respaldo del bienestar. En el 2009, el segundo año de esta celebración, 18 de los 20 países de la CARICOM adoptaron y celebraron actividades multifacéticas y multifocales, como una manera de catalizar la actividad física sostenida, la elección de alimentos sanos y los exámenes médicos en un entorno sin humo de tabaco. El apoyo para la organización de estas celebraciones y la creación de su imagen institucional en el Caribe provino de la Organización Panamericana de la Salud/Organización Mundial de la Salud y de la CARICOM. Para medir los resultados se utilizarán indicadores con respecto a los procesos y las contribuciones, además de la vigilancia de los factores de riesgo de las enfermedades crónicas no transmisibles. <![CDATA[<b>Generic drugs in Brazil</b>: <b>historical overview and legislation</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892010001200010&lng=en&nrm=iso&tlng=en A política de medicamentos genéricos foi implantada no Brasil em 1999 com o objetivo de estimular a concorrência comercial, melhorar a qualidade dos medicamentos e facilitar o acesso da população ao tratamento medicamentoso. O processo de implementação dessa política permitiu a introdução e a discussão de conceitos nunca antes utilizados para o registro de medicamentos no Brasil: biodisponibilidade, bioequivalência, equivalência farmacêutica, medicamentos genéricos, sistema de classificação biofarmacêutica e bioisenção. Este artigo apresenta a definição desses conceitos no contexto das leis brasileiras e oferece uma descrição histórica e cronológica da implementação da política de genéricos no Brasil, listando ainda as resoluções que atualmente estão em vigor. Os resultados contribuem para a compreensão do processo e facilitam a busca e a identificação de ensaios necessários para satisfazer os critérios legais.<hr/>The Brazilian generic drugs policy was implemented in 1999 with the aim of stimulating competition in the market, improve the quality of drugs and improve the access of the population to drug treatment. The process of implementing this policy allowed the introduction and discussion of concepts that had never before been used in the context of drug registration in Brazil: bioavailability, bioequivalence, pharmaceutical equivalence, generic drugs, biopharmaceutical classification system, biowaiver. The present article provides definitions for these concepts in the context of Brazilian legislation as well as a historical and chronological description of the implementation of the generic drugs policy in Brazil, including a list of current generic drug legislation. This article contributes to the understanding of the Brazilian generic drugs policy and facilitates the search for information concerning the legal requirements for registration of drugs in Brazil.