Scielo RSS <![CDATA[Revista Panamericana de Salud Pública]]> http://www.scielosp.org/rss.php?pid=1020-498920110002&lang=en vol. 29 num. 2 lang. en <![CDATA[SciELO Logo]]> http://www.scielosp.org/img/en/fbpelogp.gif http://www.scielosp.org <![CDATA[<b>Feasibility of salt reduction in processed foods in Argentina</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892011000200001&lng=en&nrm=iso&tlng=en OBJECTIVE: To assess an intervention to reduce salt intake based on an agreement with the food industry. METHODS: Salt content was measured in bakery products through a national survey and biochemical analyses. Low-salt bread was evaluated by a panel of taste testers to determine whether a reduced salt bread could remain undetected. French bread accounts for 25% of the total salt intake in Argentina; hence, reducing its salt concentration from 2% to 1.4% was proposed and tested. A crossover trial was conducted to evaluate the reduction in urinary sodium and blood pressure in participants during consumption of the low-salt bread compared with ordinary bread. RESULTS: Average salt content in bread was 2%. This study evaluated low-salt bread containing 1.4% salt. This reduction remained mostly undetected by the panels of taste testers. In the crossover trial, which included 58 participants, a reduction of 25 milliequivalents in 24hour urine sodium excretion, a reduction in systolic blood pressure of 1.66 mmHg, and a reduction in diastolic blood pressure of 0.76 mmHg were found during the low-salt bread intake. CONCLUSIONS: The study showed that dietary salt reduction was feasible and well accepted in the population studied through a reduction of salt content in bread. Although the effects on urinary sodium and blood pressure were moderate, a countrywide intervention could have a greater public health impact.<hr/>OBJETIVO: Evaluar una intervención destinada a reducir el consumo de sal a partir de un convenio con la industria alimentaria. MÉTODOS: Se midió el contenido de sal de los productos de panadería por medio de una encuesta nacional y análisis bioquímicos. Un grupo de catadores evaluó el pan con bajo contenido de sal para determinar si la disminución pasaba inadvertida. Dado que el pan francés representa 25% del consumo total de sal en la Argentina, se propuso someter a prueba este tipo de pan con una disminución de la concentración de sal de 2% a 1,4%. Se realizó un estudio cruzado con el fin de evaluar si los participantes presentaban una concentración urinaria de sodio más baja y una presión arterial menor durante el período en que consumieron pan con bajo contenido de sal respecto del período en que consumieron pan común. RESULTADOS: El pan común contiene un porcentaje promedio de sal de 2%. En este estudio, el pan con bajo contenido de sal contenía 1,4%, disminución que, en general, pasó inadvertida a los catadores. En el estudio cruzado, en el que participaron 58 sujetos, la eliminación urinaria de sodio disminuyó 25 miliequivalentes en 24 horas, la presión arterial sistólica bajó 1,66 mmHg y la presión arterial diastólica bajó 0,76 mmHg durante el período en que los participantes consumieron pan con bajo contenido de sal. CONCLUSIONES: El estudio demuestra que es factible reducir la ingesta de sal alimentaria y que la población estudiada considera aceptable que el pan contenga esta menor concentración de sal. Aunque los efectos sobre la concentración urinaria de sodio y la presión arterial fueron moderados, es probable que una intervención nacional tenga repercusiones más importantes para la salud pública. <![CDATA[<b>Drug advertising and promotion</b>: <b>regulations and extent of compliance in five Latin American countries</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892011000200002&lng=en&nrm=iso&tlng=en OBJETIVO: Analizar las distintas regulaciones sobre promoción de fármacos y su grado de acatamiento reflejado en piezas publicitarias expuestas al público en Argentina, Colombia, Ecuador, Nicaragua y Perú. MÉTODOS: Se recogieron 683 piezas promocionales expuestas en establecimientos de salud, farmacias y en la vía pública, de las cuales 132 piezas seleccionadas al azar fueron objeto de análisis. Se examinaron las regulaciones sobre publicidad farmacéutica -incluidas sus coincidencias con los criterios éticos de la Organización Mundial de la Salud (OMS)- tomadas de los sitios web oficiales y mediante entrevistas con los responsables de los organismos regulatorios y ministerios de salud de los cinco países del estudio. Se evaluaron los contenidos de los materiales de la muestra para determinar su grado de acatamiento respecto a las regulaciones nacionales y las recomendaciones sobre promoción de medicamentos de la OMS. RESULTADOS: Los países cuentan con regulaciones que incorporan los criterios éticos de la OMS. Más de 80% de las piezas analizadas incluían las indicaciones del fármaco y más de 70% omitían información sobre efectos adversos. Cincuenta por ciento de los anuncios de medicamentos de venta libre (MVL) expuestos en farmacias incluían indicaciones no aprobadas por la autoridad sanitaria correspondiente. En los anuncios expuestos en farmacias, no se hallaron diferencias significativas entre los riesgos de la información inadecuada con relación a su condición de venta (MVL o medicamentos de venta con prescripción médica). El riesgo relativo de ausencia de información sobre posología fue de 2,08 (intervalo de confianza de 95% 1,32-3,39) en las piezas distribuidas en farmacias, comparadas con las expuestas en establecimientos de salud. CONCLUSIONES: Si bien en general los cinco países del estudio incorporan en sus regulaciones sobre promoción y publicidad de medicamentos las recomendaciones de la OMS, con frecuencia dichas ordenanzas no se reflejan en los contenidos de las piezas promocionales.<hr/>OBJECTIVE: To analyze differing regulations regarding drug promotion, and the extent of compliance as seen in samples of advertising directed to the public in Argentina, Colombia, Ecuador, Nicaragua, and Peru. METHODS: A total of 683 pieces of promotional material on display in health facilities, pharmacies, and on the street were collected, 132 of which were randomly selected for analysis. The regulations governing pharmaceutical advertising, taken from official websites and interviews with regulatory officials and Ministry of Health staff in the five countries covered, were reviewed, along with their adherence to the ethical criteria of the World Health Organization (WHO). The contents of the materials in the sample were evaluated to determine their degree of compliance with national regulations and WHO recommendations on drug promotion. RESULTS: The countries have regulations incorporating WHO ethical criteria. Over 80% of the material analyzed included the indications for the drug, while over 70% omitted information on adverse effects. Fifty percent of the advertisements for overthe-counter (OTC) drugs on display in pharmacies listed indications not approved by the relevant health authority. In advertising in pharmacies, the risks from inadequate information were not found to differ significantly for OTC or prescription medications. Compared with materials provided in health facilities, the relative risk of the absence of information on dosage in the material distributed in pharmacies was 2.08 (confidence interval 95% 1.32-3.39). CONCLUSIONS: Although regulations on drug promotion and advertising in the five countries studied generally incorporate the WHO recommendations, promotional materials often fail to reflect the fact. <![CDATA[<b>Strengthening primary health care</b>: <b>a strategy to maximize coordination of care</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892011000200003&lng=en&nrm=iso&tlng=en OBJETIVO: Descrever e analisar ações empreendidas em quatro centros urbanos para fortalecer a estratégia saúde da família (ESF) no Brasil. MÉTODOS: Foram realizados estudos de caso em Aracaju, Belo Horizonte, Florianópolis e Vitória com base em entrevistas semiestruturadas com gestores. Além disso, foi realizado um estudo transversal com questionários aplicados a amostras de profissionais e usuários da ESF. RESULTADOS: Em todos os municípios foram identificadas ações para fortalecer os serviços de atenção primária à saúde, com destaque para: aumento da oferta de atenção primária à saúde com diminuição das barreiras de acesso, estruturação dos serviços de atenção primária à saúde como porta de entrada do sistema, ampliação da resolutividade (apoio diagnóstico e terapêutico, promoção da interlocução entre equipamentos da rede de serviços para organizar o processo de trabalho, capacitação, supervisão) e articulação entre ações de vigilância e assistência. CONCLUSÕES: Os municípios investigados apresentam experiências consolidadas de reorganização do modelo assistencial com base em uma atenção primária à saúde fortalecida, com potencial para tornar-se coordenadora dos cuidados. Todavia, para efetivar a função de porta de entrada e serviço de uso regular são necessárias ações para equalizar o atendimento das demandas programada e espontânea, sendo que a última representa o maior desafio à organização do processo de trabalho das equipes. A conquista de apoio e legitimidade para a ESF é um tema pendente. Iniciativas para divulgar a ESF são necessárias entre a população, profissionais de todos os níveis e organizações da sociedade civil.<hr/>OBJECTIVE: To describe and analyze the actions developed in four large cities to strengthen the family health strategy (FHS) in Brazil. METHODS: Case studies were carried out in Aracaju, Belo Horizonte, Florianópolis, and Vitória based on semi-structured interviews with health care managers. In addition, a cross-sectional study was conducted with questionnaires administered to a sample of FHS workers and services users. RESULTS: Actions needed to strengthen primary health care services were identified in all four cities. These include increasing the number of services offered at the primary health care level, removing barriers to access, restructuring primary services as the entry point to the health care system, enhancing problem-solving capacity (diagnostic and therapeutic support and networking between health units to organize the work process, training, and supervision), as well as improving articulation between surveillance and care actions. CONCLUSIONS: The cities studied have gained solid experience in the reorganization of the health care model based on a strengthening of health primary care and of the capacity to undertake the role of health care coordinator. However, to make the primary care level the customary entry point and first choice for users, additional actions are required to balance supplier-induced and consumer-driven demands. Consumerdriven demand is the biggest challenge for the organization of teamwork processes. Support for and recognition of FHS as a basis for primary health care is still an issue. Initiatives to make FHS better known to the population, health care professionals at all levels, and civil society organizations are still needed. <![CDATA[<b>Leukemia mortality trends among children, adolescents, and young adults in Latin America</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892011000200004&lng=en&nrm=iso&tlng=en OBJECTIVE: To describe and compare trends in leukemia mortality among children (0-14 years of age) and adolescents and young adults (AYA, 15-24 years of age) in 12 countries in Latin America during 1980-2004. METHODS: Data from the World Health Organization mortality database was analyzed using a joinpoint regression model to identify significant mortality rate changes over time and to estimate annual percent change. RESULTS: Leukemia is ranked first among cancer-related causes of death among children and AYA in Latin America. In children, the global percentage changes indicate increased rates for both sexes in Colombia, Ecuador, and Mexico, with substantially higher rates for Mexico. In AYA, significant increases were observed for both sexes in Mexico; Ecuador saw some increase for both sexes; and Colombia and Uruguay had increases in females only. Downward trends were observed in Argentina for both sexes, and in Costa Rica for males only. There were no major changes in the other countries analyzed. CONCLUSIONS: Leukemia mortality rates among AYA are declining, but show less significant decreases than rates among children. The study results point to a global need for further advances, specifically for AYA, similar to those made by childhood leukemia therapeutic protocols. Also, specialized oncological centers exist in most countries of Latin America, but they are often inaccessible. Special attention should be given to Mexico due to the significant increase in mortality rates.<hr/>OBJETIVO: Describir y comparar las tendencias de la mortalidad por leucemia en los niños (entre los 0 y los 14 años de edad) y en los adolescentes y adultos jóvenes (entre los 15 y los 24 años de edad) en 12 países de América Latina entre 1980 y el 2004. MÉTODOS: Se analizaron los datos sobre mortalidad de la base de datos de la Organización Mundial de la Salud mediante un modelo de regresión joinpoint, con el fin de detectar los cambios significativos en la tasa de mortalidad con el transcurso del tiempo y calcular la variación porcentual por año. RESULTADOS: La leucemia ocupa el primer lugar entre las causas de muerte por cáncer en los niños y en los adolescentes y adultos jóvenes en América Latina. En los niños, las variaciones porcentuales mundiales indicaron un aumento en las tasas en ambos sexos en Colombia, Ecuador y México, con cifras considerablemente más altas en México. En los adolescentes y adultos jóvenes, se observaron aumentos significativos en ambos sexos en México; Ecuador presentó un ligero aumento en ambos sexos; y en Colombia y Uruguay solo se observó un incremento en las mujeres. Se encontraron tendencias decrecientes en Argentina en ambos sexos y en Costa Rica solo en los hombres. No se observaron variaciones importantes en los demás países analizados. CONCLUSIONES: Las tasas de mortalidad por leucemia en los adolescentes y adultos jóvenes están disminuyendo, pero en forma menos marcada que la disminución observada en los niños. Los resultados del estudio ponen de manifiesto la necesidad mundial de alcanzar mayores progresos, en especial en cuanto a los adolescentes y los adultos jóvenes, que sean equivalentes a los obtenidos con los protocolos terapéuticos contra la leucemia en la niñez. Además, a pesar de que existen centros oncológicos especializados en la mayoría de los países de América Latina, a menudo son inaccesibles. Se debe prestar especial atención a México, debido al aumento considerable de sus tasas de mortalidad. <![CDATA[<b>Initiation of effective postpartum contraceptive use in public hospitals in Guatemala</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892011000200005&lng=en&nrm=iso&tlng=en OBJECTIVE: Low frequency of effective contraceptive use remains a challenging problem. This article examines the frequency of effective postpartum contraception and the methods used before discharge in public hospitals in Guatemala. It also discusses the need to implement best practices in providing family-planning and contraceptive services. METHODS: In March 2006, a surveillance system was implemented to collect data on the initiation of effective contraceptive methods. Postpartum women were monitored in 34 public hospitals. Univariate and bivariate analyses were performed, and a chi-square test for linear trends was used to compare female surgical sterilization rates after vaginal delivery and cesarean section. RESULTS: Between 1 March 2006 and 31 December 2008, of the 218 656 women who had a postpartum event, 31% received an effective contraceptive method before hospital discharge. The frequency of initiation of effective postpartum methods varied across hospitals. Hospital results were consistent with national data on women of reproductive age. Among women who underwent surgical sterilization, differences between those who had delivered vaginally and those who had a cesarean section were statistically significant. CONCLUSIONS: The overall frequency of initiation of effective postpartum contraceptive use is low in public hospitals in Guatemala. It is higher, however, in hospitals at lower health care levels with strong community ties. Routine data collection revealed specific areas for improvement, particularly the need to enhance health providers' knowledge of medical eligibility criteria for effective contraceptive use postpartum. The priority is to promote the provision of highquality family-planning and contraceptive services in Guatemala's public health system.<hr/>OBJETIVO: La baja frecuencia del uso de métodos anticonceptivos eficaces sigue siendo un arduo problema. En este artículo se analiza la frecuencia con que se adopta un método de anticoncepción eficaz durante el puerperio y los diferentes métodos anticonceptivos empleados antes del egreso de los hospitales públicos de Guatemala. También se analiza la necesidad de mejorar las prácticas de los servicios de planificación familiar y anticoncepción. MÉTODOS: En marzo del 2006, se implantó un sistema de vigilancia para recopilar datos sobre el inicio de métodos anticonceptivos eficaces. Se hizo un seguimiento de mujeres durante el puerperio en 34 hospitales públicos. Se llevaron a cabo análisis de una sola variable y de dos variables, y se utilizó la prueba de la chi al cuadrado de las tendencias lineales con objeto de comparar las tasas de esterilización quirúrgica femenina después del parto vaginal y la cesárea. RESULTADOS: Entre el 1 de marzo del 2006 y el 31 de diciembre del 2008, de las 218 656 mujeres a las que se les hizo un seguimiento durante el puerperio, en 31% se inició un método anticonceptivo eficaz antes del alta hospitalaria. La frecuencia de inicio de un método anticonceptivo eficaz en el puerperio varió entre los diferentes hospitales. Los resultados hospitalarios concordaron con los datos nacionales sobre las mujeres en edad fecunda. En las mujeres que se sometieron a esterilización quirúrgica, las diferencias entre las que habían dado a luz por vía vaginal y las sometidas a una cesárea fueron estadísticamente significativas. CONCLUSIONES: En general, existe una baja frecuencia de inicio de un método anticonceptivo eficaz durante el puerperio en los hospitales públicos de Guatemala. Sin embargo, es mayor en los hospitales de inferior nivel de atención de salud cuyos vínculos con la comunidad son intensos. La recopilación sistemática de datos reveló que determinadas áreas debían ser objeto de mejora, en particular era necesario mejorar el conocimiento de los proveedores de servicios de salud en materia de criterios médicos sobre la indicación del uso de un método anticonceptivo eficaz durante el puerperio. La promoción de la provisión de servicios de planificación familiar y anticoncepción de alta calidad en el sistema de salud pública de Guatemala constituye una prioridad. <![CDATA[<b>Reference birthweights for the Argentine population by multiplicity of birth, sex, and gestational age</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892011000200006&lng=en&nrm=iso&tlng=en OBJETIVO: Desarrollar referencias nuevas y mejoradas de peso al nacer según la edad gestacional (EG), el sexo y la multiplicidad del parto, para la población argentina en su conjunto. MÉTODOS: La población de estudio incluyó a todos los nacidos vivos de partos simples (n = 3 478 286) y dobles (n = 57 654) en Argentina durante el período 2003-2007. Los probables errores en la clasificación de la EG basada en la fecha de la última menstruación fueron corregidos con el uso de modelos de distribuciones normales mixtas. Los percentiles se obtuvieron mediante la regresión de cuantiles, que además posibilitó el suavizamiento de las curvas. RESULTADOS: Se obtuvieron curvas de peso al nacer para partos simples entre las semanas 22 y 43 de gestación y para partos dobles entre las semanas 24 y 41, según el sexo del neonato. Comparadas con estudios previos, estas referencias no sobreestiman la proporción de nacidos vivos grandes para su EG. Se observó también un aumento del peso al nacer a lo largo del período de estudio. CONCLUSIONES: Las curvas propuestas tienen las ventajas de basarse en grandes números, de ser representativas de los nacimientos argentinos más recientes, de distinguir el tipo de parto y el sexo de los neonatos, y de minimizar los errores de clasificación de la EG. Constituyen por lo tanto una herramienta útil para medir desigualdades y así identificar grupos poblacionales con mayor riesgo de eventos perinatales adversos.<hr/>OBJECTIVE: To develop new and improved reference birthweights for the Argentine population as a whole with a breakdown by gestational age (GA), sex and multiplicity of birth. METHODS: The population studied included all live births resulting from single (n = 3,478,286) and double (n = 57,654) births in Argentina during the period 2003- 2007. The probable errors in classifying GA on the basis of last menstruation were corrected using normal mixture models. The percentiles were obtained by quantile regression, which also made it possible to smooth out the curves. RESULTS: Birthweight curves for single births were obtained between weeks 22 and 43 of gestation, and curves for double births between weeks 24 and 41, with a breakdown by the sex of the neonate. Compared with those of previous studies, these reference birthweights do not overestimate the proportion of live births large for their GA. An increase in birthweight was also observed during the period of study. CONCLUSIONS: The proposed curves have the advantages of being based on large numbers, of being representative of the most recent Argentine births, of distinguishing the number of births and the sex of the neonates, and of minimizing GA classification errors. They are therefore a useful tool for measuring inequalities and thus identifying population groups at higher risk of adverse perinatal events. <![CDATA[<b>Analysis of water fluoride concentration in Curitiba, Brazil</b>: <b>comparison of techniques</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892011000200007&lng=en&nrm=iso&tlng=en OBJETIVO: Avaliar a adequação dos níveis de fluoreto nas águas de abastecimento público em Curitiba, Estado do Paraná, Brasil, de acordo com duas técnicas (SPADNS e eletrométrica). MÉTODOS: Foram levantados os dados do heterocontrole na Cidade de Curitiba de janeiro de 2000 a julho de 2008 no banco de dados da Secretaria Municipal da Saúde para cálculo das médias anuais. Na sequência, foram comparadas as concentrações de fluoreto fornecidas pela companhia de saneamento SANEPAR (técnica eletrométrica) com as concentrações obtidas pelo heterocontrole (SPADNS) em 1 470 amostras de água coletadas e analisadas entre 2006 e 2007. Foi calculada a proporção de amostras dentro do padrão ideal de fluoretação para a Cidade (0,8 ppmF), abaixo do ideal e acima do ideal para ambas as metodologias. Foram exploradas diferenças na fluoretação entre distritos sanitários, meses do período dezembro de 2007 a julho de 2008 e estações de tratamento de água (ETA). RESULTADOS: A média geral de flúor entre 2000 a 2008 foi de 0,7 ppmF conforme os dados do heterocontrole. A comparação das técnicas eletrométrica e SPADNS revelou que o valor médio de fluoreto na água é maior quando avaliado pela técnica eletrométrica (0,743 ppmF ± 0,133) quando comparado com a técnica SPADNS (0,637 ppmF ± 0,164). A proporção de amostras dentro do padrão ideal de fluoretação foi de 15,05% para SPADNS e 63,97% para eletrométrica; de 62,03 e 22,85% para amostras abaixo do ideal; e de 21,10 e 13,18% para amostras acima do ideal, respectivamente. Houve diferença estatisticamente significativa na fluoretação entre os distritos sanitários (P < 0,001) e os meses pesquisados. CONCLUSÕES: A escolha da técnica analítica interfere significativamente no processo do heterocontrole. O heterocontrole deve utilizar a mesma técnica de determinação de flúor utilizada pela empresa de tratamento de água. Novos estudos devem definir qual técnica é a mais adequada para medir o teor de flúor.<hr/>OBJECTIVE: To evaluate the adequacy of fluoride levels in the public water system in Curitiba, state of Paraná, Brazil, as determined by two techniques (colorimetric and electrometric). METHODS: Data from independent measurements of fluoride in the public water system in Curitiba routinely performed by the city government were obtained for the period between January 2000 and July 2008. Mean levels of fluoride concentration were calculated for each of these years. After that, fluoride concentrations measured in 1 470 samples by the state water utility (SANEPAR) using the electrometric technique in 2006 and 2007 were compared with the corresponding levels measured by the city using the colorimetric method. The rate of samples meeting the standard for the city (0.8 ppmF), and below and above the standard, was calculated for both methods. Fluoride levels were compared between sanitary districts, months for the period between December 2007 and July 2008, and water treatment facilities. RESULTS: The overall mean fluoride level between 2000 and 2008 was 0.7 ppmF based on the independent measurements. The comparison between techniques showed a higher mean fluoride level with the electrometric technique (0.743 ppmF ± 0.133) vs. the colorimetric technique (0.637 ppmF ± 0.164). The rate of samples meeting the ideal standard of 0.8 ppmF was 15.05% for the colorimetric and 63.97% for the electrometric technique; 62.03% and 22.85% of the samples were below that standard and 21.10% and 13.18% were above that standard, respectively. Fluoride levels were statistically significant (P < 0.001) for the comparison between sanitary districts and months. CONCLUSIONS: The choice of technique significantly influences the resulting levels of fluoride. Independent monitoring of fluoride levels should employ the same technique used by the water utility. Further studies should aim at defining which technique is the most adequate to determine fluoride concentration in public water systems. <![CDATA[<b>Voluntary reduction of trans-fatty acids in Latin America and the Caribbean</b>: <b>current situation</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892011000200008&lng=en&nrm=iso&tlng=en As part of the Pan American Health Organization/World Health Organization Trans-Fat-Free Americas initiative, 12 representatives from food industries in Latin America and the Caribbean signed a declaration stating their intention to voluntarily eliminate industrially produced trans-fatty acids (TFA) from the Americas. A year later, in order to document the extent of the voluntary reduction, each declarant was asked to describe all reformulations and reductions in the TFA content of their products. After up to six requests for data, only three declarants provided such information in detail, and three others offered an overall summary of their reformulations. Additionally, three declarants reported the barriers that limit this process: availability of oil substitutes, cost, and consumers' sensory acceptance. The content of TFA and saturated fat in the food supply in the Americas should be regulated and strictly monitored in order to adequately evaluate a reduction of TFA in the region.<hr/>Como parte de la iniciativa "Las Américas sin grasas trans" de la Organización Panamericana de la Salud/Organización Mundial de la Salud, 12 representantes de empresas alimentarias de América Latina y el Caribe firmaron una declaración en la que se comprometieron a eliminar voluntariamente los ácidos grasos trans (AGT) de los alimentos producidos industrialmente. Un año después, a fin de verificar el progreso en este sentido, se solicitó a cada firmante que describiera todas las reformulaciones y la disminución del contenido de AGT de sus productos. Después de solicitar los datos hasta seis veces en algunos casos, solo tres de las empresas firmantes suministraron información detallada y otras tres ofrecieron un resumen general de las distintas reformulaciones incorporadas. Además, tres proporcionaron información acerca de los obstáculos que dificultan este proceso: la disponibilidad de sucedáneos del aceite, el costo y la aceptación de los consumidores. Es preciso reglamentar y vigilar con rigurosidad el contenido de AGT y grasas saturadas de los alimentos comercializados en la Región de las Américas con el fin de efectuar un seguimiento adecuado de la disminución de los AGT. <![CDATA[<b>Contributions from two Latin American psychiatric classifications to the development of ICD-11</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892011000200009&lng=en&nrm=iso&tlng=en Dentro del marco del análisis de la décima revisión de la Clasificación Internacional de Enfermedades y Problemas de Salud Asociados (CIE-10), se realizó una comparación código a código entre las categorías diagnósticas de dos clasificaciones latinoamericanas -el Tercer Glosario Cubano de Psiquiatría (GC-3) y la Guía Latinoamericana para el Diagnóstico Psiquiátrico (GLADP)- y el capítulo de "Trastornos mentales y del comportamiento" de la CIE-10. El objetivo fue ayudar a definir qué categorías de la clasificación actual deberían ampliarse y qué nuevas categorías podrían añadirse a la futura CIE-11 para lograr una mayor aplicabilidad local en contextos socioculturales y clínicos distintos del estadounidense y del europeo, cuyas perspectivas han dominado la CIE históricamente. Se espera que el resultado contribuya a los esfuerzos que se están llevando a cabo para desarrollar un sistema clasificatorio que sea genuinamente internacional.<hr/>In the context of the updating of the International Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10), this study conducted a code-by-code comparison between the ICD-10 chapter "Mental and Behavioural Disorders" and the diagnostic categories of two Latin American classification schemes: the Third Cuban Psychiatric Glossary (GC-3) and the Latin American Guide to Psychiatric Diagnosis (GLADP). The objective was to help define what categories in the current classification should be broadened and what new categories might be added to the future ICD-11 to make it more applicable in local sociocultural and clinical contexts that differ from those found in regions whose perspectives have historically dominated the ICD, namely, the United States and Europe. It is hoped that the results will contribute to the efforts under way to develop a genuinely international classification system. <![CDATA[<b>Essential drugs and pharmaceutical care</b>: <b>reflection on the access to drugs through lawsuits in Brazil</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892011000200010&lng=en&nrm=iso&tlng=en A garantia do direito à assistência farmacêutica no ordenamento jurídico brasileiro a partir da Constituição de 1988 deu vazão a um aumento das demandas judiciais para efetivação desse direito. Esse fenômeno vem sendo chamado de judicialização da assistência farmacêutica. Estudos sobre o tema têm revelado tanto deficiências no acesso dos usuários do Sistema Único de Saúde aos medicamentos das listas oficiais de assistência farmacêutica como dificuldades do sistema de justiça e do próprio procedimento judicial para lidar com a temática. Este artigo discute essas questões considerando o arcabouço conceitual que informa a política de medicamentos e a política de assistência farmacêutica brasileiras, sobretudo os conceitos de medicamentos essenciais e de alocação de recursos escassos.<hr/>The guarantee of pharmaceutical care as a legal right established by the Brazilian federal constitution of 1988 led to an increase in lawsuits to put that right into practice. This phenomenon has been dubbed the judicialization of pharmaceutical care. Studies on this topic have revealed, on the one hand, deficiencies in the access of Unified Health Care (SUS) users to drugs included in Ministry of Health pharmaceutical care lists, and, on the other hand, limitations of the legal system to deal with the situation. The present article addresses these issues in the context of the conceptual framework that supports the Brazilian drug policy and pharmaceutical care policy, especially the notions of essential drugs and allocation of scarce resources.