Scielo RSS <![CDATA[Revista Panamericana de Salud Pública]]> http://www.scielosp.org/rss.php?pid=1020-498920120003&lang=en vol. 31 num. 3 lang. en <![CDATA[SciELO Logo]]> http://www.scielosp.org/img/en/fbpelogp.gif http://www.scielosp.org <![CDATA[<b>Data availability and morbidity profile in Colombia</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892012000300001&lng=en&nrm=iso&tlng=en OBJETIVO: Caracterizar la morbilidad de la población colombiana según causas diagnósticas, género, edad, región y régimen de cobertura en salud, evaluando al mismo tiempo la disponibilidad y la calidad de la información sobre enfermedades en el país. Estudio de tipo descriptivo, transversal, que analiza la morbilidad atendida en consulta externa, hospitalización y urgencias en Colombia durante el quinquenio 2004-2008. MÉTODOS: Se utilizaron los "Registros individuales de prestación de servicios" (RIPS) de Colombia, clasificándose los diagnósticos según los grupos de causas definidos por la Organización Mundial de la Salud. Cada grupo de causas para utilización de servicios se discriminó por región geográfica, género y régimen de afiliación al sistema de salud. RESULTADOS: Los diagnósticos de enfermedades transmisibles se encontraron más concentrados en los grupos de edad inferiores, mientras que las no transmisibles fueron más frecuentes en los grupos etarios superiores. Las externalidades (accidentes, lesiones autoinfligidas y violencia) fueron una causa importante de morbilidad y afectaron con más fuerza a la población de entre 5 y 44 años de edad. Las patologías transmisibles fueron más prevalentes en mujeres (39,98%) que en hombres (28%), en tanto que los hombres se vieron más afectados por las externalidades que las mujeres (18,5 y 7,3%, respectivamente). CONCLUSIONES: Si bien en Colombia han aumentado los diagnósticos de enfermedades no transmisibles, las infecciones siguen teniendo una presencia relevante en todos los grupos de edad y escenarios de prestación de servicios de salud. Tal situación exige revisar las políticas sanitarias para orientarlas no solo a mejorar la salud de la población sino también a reducir la brecha de servicios que existe entre las diferentes regiones del país. Por otro lado, aun cuando los RIPS constituyen una valiosa fuente de datos sanitarios, es preciso fortalecerlos con el propósito de lograr una cobertura de información que abarque a toda o por lo menos a la gran mayoría de la población colombiana.<hr/>OBJECTIVE: To characterize morbidity in the Colombian population by diagnosis, sex, age, region, and health coverage system, and evaluate the availability and quality of information on diseases in the country. A descriptive, cross-sectional study to analyze morbidity treated in outpatient visits, hospitalization, and emergencies in Colombia during the 2004-2008 five-year period. METHODS: Based on Colombia's personal health records (Registro Individual de Prestación de Servicios-RIPS), diagnoses were classified according to World Health Organization cause groups. Each cause group for services utilization was differentiated by geographical region, sex, and type of affiliation to the health system. RESULTS: Communicable disease diagnoses were more concentrated in younger age groups, while noncommunicable diseases were more frequent in older age groups. External causes (accidents, self-inflicted injuries, and violence) were a major cause of morbidity and more frequently affected the population aged 5-44 years. Communicable diseases were more prevalent in females (39.98%) than in males (28%), while males were more affected by external causes than females (18.5% and 7.3%, respectively). CONCLUSIONS: Although diagnoses of noncommunicable diseases have increased in Colombia, infections continue to have an important presence in all age groups and health services delivery settings. This situation requires a review of health policies, not only to orient them toward improving the health of the population, but also toward bridging the services gap that exists among the country's different regions. Furthermore, although RIPS are a valuable source of health data, they need to be strengthened with a view to achieving information coverage for all or at least the vast majority of Colombians. <![CDATA[<b>Quality of care, quality of life, and attitudes toward disabilities: perspectives from a qualitative focus group study in Porto Alegre, Brazil</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892012000300002&lng=en&nrm=iso&tlng=en OBJECTIVE: To explore the concepts of quality of life (QOL), quality of care (QOC), and attitudes toward disabilities in Porto Alegre, Brazil, from the perspective of people living with disabilities, including their relatives and caregivers. METHODS: This was a qualitative study that interviewed a total of 23 participants in five focus groups, during May-August 2006. After an open discussion about QOL, the WHOQOL-Bref, a generic questionnaire for the assessment of QOL, was presented to participants. The study was performed simultaneously in 15 international centers. Analysis was based on Bardin's content analysis. RESULTS: Regarding QOL, important themes that emerged were: work, education, leisure, universal accessibility, integration in the society, and social inclusion. Concerning QOC, professional qualifications, disabilities-related training for health and education professionals, and access to health services were considered important. Regarding attitudes toward disabilities, the participants perceived the attitudes of others, especially of caregivers, to significantly impact the QOL of people with disabilities. CONCLUSIONS: People living with disabilities value many of the same themes considered important by the general public; however, several additional themes specific to disabilities and specific to these groups of participants emerged. This information highlights the importance of taking into account the unique perceptions and cultural traits of the target population when measuring QOL, QOC, and attitudes toward disabilities.<hr/>OBJETIVO: Explorar los conceptos de calidad de vida, calidad de atención y actitudes hacia la discapacidad en Porto Alegre, Brasil, desde la perspectiva de las personas con discapacidad, incluidos los familiares y cuidadores del individuo discapacitado. MÉTODOS: En este estudio cualitativo se entrevistaron 23 participantes en cinco grupos de discusión entre mayo y agosto del 2006. Después de un debate abierto acerca de la calidad de vida, se presentó el WHOQOL-Bref, un cuestionario genérico empleado para su evaluación. El estudio se realizó simultáneamente en 15 centros internacionales. El análisis se basó en el análisis del contenido de Bardin. RESULTADOS: Respecto de la calidad de vida, los temas importantes que surgieron fueron el trabajo, la educación, el ocio, la accesibilidad universal, la integración en la sociedad y la inclusión social. Respecto de la calidad de atención, se consideraron importantes la formación profesional, la capacitación relacionada con la discapacidad en los profesionales de la educación y la salud y el acceso a los servicios de salud. Con respecto a las actitudes hacia la discapacidad, los participantes percibieron que las actitudes de los demás, en especial las de los cuidadores, repercuten significativamente en la calidad de vida de las personas con discapacidad. CONCLUSIONES: Las personas con discapacidad valoran muchos de los temas también considerados importantes por la población en general; sin embargo, surgieron varios otros temas específicos de la discapacidad y de estos grupos de participantes. Esta información destaca la importancia de tener en cuenta las percepciones y los rasgos culturales singulares de la población destinataria cuando se miden la calidad de vida, la calidad de atención y las actitudes hacia la discapacidad. <![CDATA[<b>Cultural dimensions of dengue that help or hinder its prevention in Mexico</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892012000300003&lng=en&nrm=iso&tlng=en OBJETIVO: Describir las dimensiones culturales que podrían favorecer u obstaculizar la prevención del dengue en dos entidades mexicanas con diferentes experiencias vinculadas a esta enfermedad. MÉTODOS: Se realizó un estudio antropológico cultural cognitivo en el que participaron 160 personas adultas seleccionadas por muestreo propositivo. Se utilizaron las técnicas de listados libres y de sorteo de montones, indagando los términos asociados al concepto "dengue". El análisis de consenso fue realizado mediante factorización de componentes principales, análisis de conglomerados jerárquicos y escalas multidimensionales. RESULTADOS: Se observó mayor consenso entre los participantes de la población de mayor experiencia histórica con el dengue -Santiago Ixcuintla, Nayarit- así como dimensiones culturales más estructuradas y complejas que en Guadalajara, donde los participantes mostraron una concepción más fragmentada sobre el dengue, con información insuficiente en torno a los síntomas, el mecanismo de transmisión y los reservorios del vector. Se identificaron tres dimensiones culturales que obstaculizan la prevención del dengue: información confusa e insuficiente, la atribución de la responsabilidad de prevenir a otras personas u organismos públicos y la excesiva confianza en la fumigación como medida preventiva. CONCLUSIONES: Será necesario considerar estas barreras en el diseño e implementación de las futuras campañas de prevención, difundiendo información que explique los riesgos de la fumigación y la importancia de que ciudadanos y autoridades participen conjuntamente en la búsqueda de una solución integral y sostenible al problema del dengue.<hr/>OBJECTIVE: To describe the cultural dimensions that might help or hinder dengue prevention in two Mexican localities having different experiences related to this disease. METHODS: A cognitive-cultural anthropological study was conducted involving the participation of 160 adults selected through purposeful sampling. The techniques of free lists and pile-sorting were used for investigating terms associated with the concept "dengue." A consensus analysis was carried out by the factoring of principal components, hierarchical cluster analysis, and multidimensional scaling. RESULTS: Greater consensus was observed among participants from the population having more historical experience with dengue-Santiago Ixcuintla, Nayarit-as well as more structured cultural and complex dimensions than in Guadalajara. In the latter case, participants showed a more fragmented conception of dengue, with insufficient information on its symptoms, mechanisms of transmission, and vector reservoirs. Three cultural dimensions were identified as hindering dengue prevention: confusing and insufficient information, placing responsibility for prevention on other people or on public agencies, and excessive confidence in fumigation as a preventive measure. CONCLUSIONS: These obstacles will need to be taken into account in the design and implementation of future prevention campaigns, disseminating information that explains the risks of fumigation and the importance of citizens and authorities jointly participating in the search for a comprehensive and sustainable solution to the dengue problem. <![CDATA[<b>Self-reported discrimination by adolescents in a Brazilian birth cohort: prevalence and associations</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892012000300004&lng=en&nrm=iso&tlng=en OBJETIVO: Avaliar a prevalência e os fatores associados à discriminação autorrelatada por adolescentes. MÉTODOS: Análise transversal dos adolescentes pertencentes à coorte de nascidos vivos em 1993 na cidade de Pelotas, Rio Grande do Sul, Brasil. Dos 5 249 membros da coorte, foram coletadas informações em 2004 e 2005 sobre discriminação autorrelatada, variáveis sociodemográficas, atributos físicos e estado nutricional em 4 452 adolescentes. Regressão de Poisson foi utilizada nas análises bruta e ajustada para estimar as razões de prevalência (RP). RESULTADOS: A prevalência global de discriminação autorrelatada foi de 16,4%. Na análise ajustada, a discriminação foi mais relatada por meninas (RP = 1,27, IC95%: 1,10 a 1,48); heteroclassificados pretos (RP = 1,28, IC95%: 1,04 a 1,57); pelos mais pobres (RP = 1,58, IC95%: 1,23 a 2,02); os que se perceberam como muito magros ou muito gordos (RP = 1,81 e 1,54, respectivamente), com dificuldades financeiras familiares (RP = 1,76, IC95%: 1,49 a 2,08); que usavam óculos (RP = 1,74, IC95%: 1,45 a 2,10), com autopercepção negativa da aparência dental (RP = 1,58, IC95%: 1,21 a 2,07), com reprovação escolar (RP = 1,23, IC95%: 1,01 a 1,51) ou que participaram em brigas no último ano (RP = 1,62, IC95%: 1,36 a 1,94). A associação entre discriminação e estado nutricional foi diferente conforme o sexo (P de interação = 0,009). Meninos magros relataram maior discriminação, enquanto aqueles com sobrepeso e obesidade apresentaram menor prevalência. Em meninas, a prevalência de discriminação foi maior entre as obesas, sendo esse efeito mais forte entre as ricas do que nas pobres. CONCLUSÕES: A discriminação autorrelatada foi prevalente e desigualmente distribuída na população. Intervenções para reduzir experiências discriminatórias devem ser implementadas em fases iniciais da vida.<hr/>OBJECTIVE: To evaluate the prevalence of and factors associated with discrimination self-reported by adolescents. METHODS: Cross-sectional analysis of adolescents belonging to a cohort of live births in 1993 in the city of Pelotas, Brazil. From the 5 249 members of the cohort, information was collected from 4 452 adolescents in 2004 and 2005 regarding self-reported discrimination, sociodemographic variables, physical attributes, and nutritional status. A Poisson regression was utilized in the raw and adjusted analyses to estimate prevalence rates (RP). RESULTS: The global prevalence of self-reported discrimination was 16.4%. In the adjusted analysis, discrimination was reported more by the following groups: girls (RP = 1.27, 95%CI: 1.10-1.48), people identified by others as black (RP = 1.28, 95%CI: 1.04-1.57), poorer adolescents (RP = 1.58, 95%CI: 1.23-2.02), those who perceived themselves to be very thin or very fat (RP = 1.81 and 1.54 respectively), those whose families had financial trouble (RP = 1.76, 95%CI: 1.49-2.08), those who wore glasses (RP = 1.74, 95%CI: 1.45-2.10), those who thought their teeth looked bad (RP = 1.58, 95%CI: 1.21-2.07), those who had been reprimanded in school (RP = 1.23, 95%CI: 1.01- 1.51), and those who had been involved in fights in the past year (RP = 1.62, 95%CI: 1.36-1.94). The association between discrimination and nutritional status varied by sex (interaction P = 0.009). Thin children reported greater discrimination than those who were overweight or obese. Discrimination on the basis of obesity was higher among girls, with this effect more strongly felt among rich girls than among poor ones. CONCLUSIONS: Self-reported discrimination was prevalent and unequally distributed among the population. Actions to reduce experiences of discrimination must be implemented during the initial stages of life. <![CDATA[<b>Alcohol and tobacco consumption in Spanish and Mexican adolescents and its relation to physical and sports-related activity and to the family</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892012000300005&lng=en&nrm=iso&tlng=en OBJETIVO: Identificar la influencia del consumo de alcohol o tabaco junto a variables independientes (sexo y edad; tiempo y actividades de ocio; motivaciones, patrones, modalidades y finalidades físico-deportivas; y conductas del entorno familiar) en la actividad físico-deportiva de alumnos de educación secundaria obligatoria en España y México. MÉTODOS: 3 249 alumnos españoles y 1 083 alumnos mexicanos de entre 12 y 16 años respondieron un cuestionario sobre hábitos físico-deportivos, consumo de bebidas alcohólicas o tabaco e influencia del entorno familiar. Se realizó un análisis descriptivo y una regresión logística multinomial para averiguar la capacidad predictiva de las variables incluidas en el modelo. RESULTADOS: En ambos países el consumo aumenta con la edad. Comparativamente existe mayor prevalencia entre los estudiantes españoles a la hora de consumir sustancias adictivas. Los estudiantes españoles físicamente activos tienen menos probabilidades de consumir alcohol y tabaco; entre los mexicanos no se encuentran diferencias significativas al respecto. Los resultados reflejan que en España las mujeres consumen bebidas alcohólicas y fuman con mayor frecuencia. Los varones españoles, sin embargo, lo hacen de manera esporádica pero en mayores cantidades. En México, los adolescentes consumen alcohol más regularmente que las adolescentes, pero no existen diferencias en la cantidad. CONCLUSIONES: En España, la práctica de actividades físico-deportivas se relaciona claramente con un menor consumo. Ser físicamente activo actúa como agente protector ante hábitos no saludables. En los adolescentes mexicanos no se ha encontrado una relación significativa entre estos factores. Tanto en España como en México, los hermanos y los padres son los familiares que mayor influencia ejercen respecto del consumo de alcohol y tabaco. Además, se ha comprobado la tendencia a un consumo simultáneo de ambas sustancias.<hr/>OBJECTIVE: To identify the influence of alcohol or tobacco consumption along with independent variables (sex and age; time and leisure activities; motivations, patterns, modalities, and goals of physical and sports-related activity; and behaviors within the family environment) in physical and sports-related activity among pupils enrolled in compulsory secondary education in Spain and Mexico. METHODS: A questionnaire on habits related to physical and sports-related activity, consumption of alcoholic beverages or tobacco, and the influence of the family environment was answered by 3 249 Spanish pupils and 1 083 Mexican pupils between 12 and 16 years of age. A descriptive analysis and a multinomial logistic regression were carried out in order to ascertain the predictive capacity of the variables included in the model. RESULTS: In both countries, consumption increases with age. In comparative terms, there is a higher prevalence among Spanish pupils when consuming addictive substances. The Spanish pupils who are physically active are less likely to consume alcohol and tobacco; among their Mexican counterparts, there were no significant differences in this regard. The results show that in Spain, females consume alcoholic beverages and smoke more frequently than do males, who do so sporadically but in greater quantities. In Mexico, adolescent boys consume alcohol more regularly that do adolescent girls, although there are no differences in terms of quantity. CONCLUSIONS: In Spain, being physically active and engaging in sports is clearly related to consuming less. Being physically active acts as a protective agent against unhealthy habits. Among Mexican adolescents, no significant relationship between these factors has been found. Both in Spain and in Mexico, siblings and parents are the family members who have the greatest influence vis-à-vis alcohol and tobacco consumption. Furthermore, the trend towards simultaneous consumption of both substances has been proved. <![CDATA[<b>Multidrug-resistant tuberculosis in Port-au-Prince, Haiti</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892012000300006&lng=en&nrm=iso&tlng=en OBJECTIVE: To determine the prevalence of multidrug-resistant tuberculosis (MDR-TB) among patients with new smear-positive pulmonary TB in Port-au-Prince, Haiti. METHODS: Sputum samples were cultured from 1 006 patients newly diagnosed with TB in 2008. The core region of the rpoB gene that is associated with resistance to rifampin was sequenced. All isolates with rpoB mutations were sent to the New York State reference laboratory for conventional drug susceptibility testing (DST). All isolates were also tested with the GenoType MTBDRplus line-probe assay. RESULTS: Mycobacterium tuberculosis was isolated from 906 patients. Twenty-six (2.9%) of the isolates had missense mutations or deletions in rpoB and were resistant to rifampin by DST. All 26 were also resistant to isoniazid and classified as MDR-TB. Forty-six control isolates without rpoB mutations were found to be rifampin sensitive by DST. The GenoType MTBDRplus line-probe assay correctly identified 26 MDR-TB strains. It misclassified one pansusceptible isolate as rifampin resistant. CONCLUSIONS: This study shows an MDR-TB prevalence of 2.9% in newly diagnosed TB patients in Haiti and suggests that rpoB sequencing and hybridization assays are good screening tools for early detection of MDR-TB.<hr/>OBJETIVO: Determinar la prevalencia de tuberculosis (TB) multirresistente en pacientes con TB pulmonar nueva con baciloscopia positiva en Puerto Príncipe, Haití. MÉTODOS: Se cultivaron muestras de esputo de 1 006 pacientes con diagnóstico reciente de tuberculosis efectuado durante el 2008. Se secuenció la región nuclear del gen rpoB, que se asocia con la resistencia a la rifampicina. Todos los aislados con mutaciones de rpoB se enviaron al laboratorio de referencia del estado de Nueva York para llevar a cabo un antibiograma convencional. Todos los aislados se estudiaron también con el ensayo de sonda lineal GenoType MTBDRplus. RESULTADOS: Se aisló Mycobacterium tuberculosis de 906 pacientes. Veintiséis (2,9%) de los aislados presentaban mutaciones de sentido erróneo o deleciones en rpoB y fueron resistentes a la rifampicina en el antibiograma. Los 26 aislados fueron resistentes también a la isoniacida y se clasificaron como TB multirresistente. Cuarenta y seis aislados de control sin mutaciones de rpoB resultaron sensibles a la rifampicina en el antibiograma. El ensayo de sonda lineal GenoType MTBDRplus identificó correctamente a las 26 cepas de TB multirresistente y clasificó de manera errónea un aislado sensible a múltiples fármacos como resistente a la rifampicina. CONCLUSIONES: Este estudio revela una prevalencia de TB multirresistente de 2,9% en los pacientes con TB recién diagnosticada en Haití e indica que los ensayos de secuenciación e hibridación de rpoB son estudios de detección sistemática adecuados para la detección temprana de la TB multirresistente. <![CDATA[<b>Affordability and availability of drugs for treatment of chronic diseases in the public health care system</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892012000300007&lng=en&nrm=iso&tlng=en OBJETIVO: Avaliar a capacidade aquisitiva do trabalhador para pagar medicamentos utilizados no tratamento de doenças crônicas e a disponibilidade desses medicamentos na forma de referência, similar ou genérica para fornecimento gratuito no setor público. MÉTODOS: Utilizou-se metodologia preconizada pela Organização Mundial da Saúde (OMS) e Health Action International (HAI) para coleta padronizada de informações sobre preços de venda no setor privado e disponibilidade no setor público de medicamentos em seis cidades do Rio Grande do Sul, Brasil. A coleta de dados ocorreu de novembro de 2008 a janeiro de 2009. A capacidade aquisitiva foi estimada como o número de dias do salário que um trabalhador com rendimento de 1 salário mínimo nacional necessita trabalhar para adquirir, em uma farmácia privada, a quantidade necessária de medicamento para 1 mês de tratamento. A disponibilidade foi avaliada verificando-se a presença dos medicamentos nas farmácias do setor público. RESULTADOS: A pesquisa incluiu 22 estabelecimentos públicos e 30 farmácias privadas. Dos 21 medicamentos utilizados no tratamento de sete doenças crônicas, apenas nove eram disponibilizados gratuitamente nos seis municípios pesquisados. O percentual médio da disponibilidade variou de 83,3% (São Leopoldo) a 97,6% (Caxias do Sul). A capacidade aquisitiva variou de 0,4 a 10,5 dias de salário para medicamentos de referência; de 0,2 a 8,4 dias de salário para medicamentos similares; e de 0,3 a 3,8 dias de salário para medicamentos genéricos. CONCLUSÕES: A disponibilidade geral dos medicamentos pesquisados foi superior aos 80% recomendados pela OMS; porém, alguns tratamentos não estavam disponíveis, ou apresentaram uma disponibilidade limitada no setor público. A capacidade aquisitiva dos trabalhadores nos municípios estudados indicou um comprometimento de dias do salário que pode afetar a continuidade dos tratamentos com medicamentos para doenças crônicas.<hr/>OBJECTIVE: To assess the affordability by workers of drugs used for treatment of chronic diseases, as well as the availability of the reference, similar, or generic forms of these drugs in the public health care system. METHODS: We employed the methodology recommended by the World Health Organization (WHO) and Health Action International (HAI) for the standardized collection of information on selling prices in the private sector and availability in the public health care system of drugs in six cities in the state of Rio Grande do Sul, Brazil. Data were collected from November 2008 to January 2009. Affordability was estimated as the number of salary days required for a worker receiving the national minimum wage to buy, in a private pharmacy, the amount of medication required for one month of treatment. Availability was assessed by the presence of these drugs in public health care system facilities. RESULTS: Twenty-two public facilities and 30 private pharmacies were studied. Of 21 drugs used for the treatment of seven chronic disorders, only nine were available free of charge in the six cities. Mean availability ranged from 83.3% (São Leopoldo) to 97.6% (Caxias do Sul). Affordability ranged from 0.4 to 10.5 salary days for reference drugs, 0.2 to 8.4 salary days for similar drugs, and 0.3 to 3.8 salary days for generic drugs. CONCLUSIONS: The overall availability of the drugs surveyed was higher than the 80% recommended by WHO. However, some treatments were not available, or had limited availability in the public system. Concerning affordability, the number of salary days required to buy these drugs may affect the continuation of drug treatments for chronic diseases. <![CDATA[<b>Adapting the <em>Suicide Resilience Inventory</em> (SRI-25) for adolescents and young adults in Colombia</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892012000300008&lng=en&nrm=iso&tlng=en OBJETIVO: Describir las propiedades psicométricas del Suicide Resilience Inventory (SRI-25), adaptado al español, en una muestra de adolescentes y jóvenes escolarizados de San Juan de Pasto, Colombia. MÉTODOS: Se adaptó el SRI-25 al idioma español por medio de una traducción simple. Se contó con 573 participantes, estudiantes de colegios y universidades, de 10 a 25 años de edad. RESULTADOS: En un análisis factorial exploratorio por componentes principales se encontró una estructura de tres factores que explican el 52,83% de la varianza. Se realizaron análisis factoriales según el sexo, el nivel educativo y la etapa evolutiva, a partir de los cuales se confirmó que en todos los grupos, los ítems cargan en los mismos factores de la prueba original, a saber: protección interna, estabilidad emocional y protección externa. Se obtuvo un coeficiente alfa de Cronbach de 0,922 para la prueba total. En cuanto a la validez de constructo, el SRI-25 presentó correlaciones significativas con medidas de autoestima, apoyo social, solución de problemas, razones para vivir, depresión, desesperanza e ideas suicidas. CONCLUSIÓN: Se comprobó que el SRI-25 es un instrumento útil para medir la resiliencia ante el suicidio en adolescentes y jóvenes escolarizados de San Juan de Pasto, Colombia.<hr/>OBJECTIVE: Describe the psychometric properties of the Suicide Resilience Inventory (SRI-25), adapted to Spanish, in a student sample of adolescents and young adults from San Juan de Pasto, Colombia. METHODS: The SRI-25 was adapted to the Spanish language by means of a simple translation. This involved the participation of 573 schoolchildren and college/ university students between 10 and 25 years of age. RESULTS: In an exploratory factorial analysis by principal components, a structure of three factors was found to explain 52.83% of the variance. Factorial analysis was carried out by sex, educational level, and developmental stage. On this basis, it was confirmed that in all the groups, the items are weighted on the same factors as in the original test: namely, internal protection, emotional stability, and external protection. A Cronbach's alpha coefficient of 0.922 was obtained for the total test. Concerning the validity of the construct, the SRI-25 presented significant correlations with measurements of self-esteem, social support, problem-solving skills, reasons for living, depression, despair, and suicidal ideas. CONCLUSIONS: It was proved that the SRI-25 is a useful instrument for measuring resilience to suicide among adolescents and young people pursuing their education in San Juan de Pasto, Colombia. <![CDATA[<b>Research on chronic noncommunicable diseases in Brazil: meeting the challenges of epidemiologic transition</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892012000300009&lng=en&nrm=iso&tlng=en In Brazil, chronic noncommunicable diseases (CNCDs) are the leading cause of death and a major contributor to the national disease burden. This article describes CNCD research funded by the Ministry of Health Department of Science and Technology (DECIT) to support the production and dissemination of scientific evidence for the national health system, in accordance with the National Agenda of Priorities in Health Research, and within the context of Brazil's epidemiologic transition. Data were obtained from Ministry of Health database management systems. CNCD-related projects financed by DECIT from 2002 to 2009 were analyzed by research theme (cancer, obesity, hypertension, diabetes, cardiovascular diseases, CNCDs in general, and CNCD risk factors) and geographic region. In terms of funding and number of projects, the most-supported research theme was cancer, and the most-supported region was the Southeast. Project type varied widely, ranging from basic scientific studies to highly technological research and development. Results obtained included epidemiologic profiles and surveillance, cost, and quality-of-life data.<hr/>En el Brasil, las enfermedades crónicas no transmisibles (ECNT) son la principal causa de mortalidad y un factor contribuyente muy importante a la carga de morbilidad nacional. En este artículo se describe la investigación en ECNT financiada por el Departamento de Ciencia y Tecnología del Ministerio de Salud (DECIT) para apoyar la producción y la difusión de información científica destinada al sistema nacional de salud, en conformidad con el Programa Nacional de Prioridades en Investigación de Salud y dentro del contexto de la transición epidemiológica del Brasil. Los datos se obtuvieron a partir de los sistemas de manejo de bases de datos del Ministerio de Salud. Los proyectos relacionados con las ECNT financiados por el DECIT entre el 2002 y el 2009 fueron analizados por tema de investigación (cáncer, obesidad, hipertensión, diabetes, enfermedades cardiovasculares, ECNT en general y factores de riesgo de ECNT) y por región geográfica. En cuanto al financiamiento y el número de proyectos, el tema de investigación más apoyado fue el cáncer, y la región más apoyada fue el sudeste del país. El tipo de proyecto varió ampliamente, e incluyó desde estudios científicos básicos hasta estudios de investigación y desarrollo muy técnicos. Los resultados obtenidos incluyeron perfiles epidemiológicos y datos de vigilancia, costos y calidad de vida. <![CDATA[<b>Strategies and results of the oral cancer prevention campaign among the elderly in São Paulo, Brazil, 2001 to 2009</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892012000300010&lng=en&nrm=iso&tlng=en OBJETIVO: Descrever estratégias e resultados da campanha de diagnóstico precoce e prevenção do câncer bucal para a população com 60 anos ou mais desenvolvida desde 2001 no Estado de São Paulo. MÉTODOS: A partir de documentos publicados pelo Ministério da Saúde, Instituto Nacional de Câncer, Secretaria de Estado da Saúde de São Paulo, Fundação Oncocentro de São Paulo, Secretaria Municipal da Saúde de São Paulo, Faculdade de Saúde Pública da Universidade de São Paulo e Casa de Saúde Santa Marcelina, procurou-se evidenciar a problemática do câncer bucal e apresentar as principais estratégias utilizadas para desenvolver a campanha. Ainda, avaliou-se o impacto da campanha na incidência de casos novos de câncer bucal entre os examinados. RESULTADOS: Em 2001, foram examinados 90 886 idosos, contra 629 613 idosos em 2009. As estratégias identificadas foram: capacitação dos profissionais, desenvolvimento de material impresso para orientar os municípios sobre como conduzir a campanha, códigos e critérios a serem utilizados, orientações para a consolidação dos dados, estabelecimento de fluxos de referência, capacitação prática junto com o especialista na própria unidade de saúde a partir do reexame dos indivíduos que apresentavam alteração em tecidos moles e ampliação do número de serviços dirigidos ao diagnóstico bucal. Entre 2005 e 2009, houve redução significativa na taxa de casos confirmados de câncer bucal em cada 100 000 examinados, de 20,89 para 11,12 (P = 0,00003). CONCLUSÕES: A campanha trouxe benefícios à saúde bucal da população idosa. Pode ser ampliada para outros grupos etários e outras regiões do país e servir de subsídio para o desenvolvimento de ações de prevenção de câncer bucal em outros países, desde que respeitadas as características locais.<hr/>OBJECTIVE: To describe the strategies and results obtained by the early diagnosis and prevention of an oral cancer campaign targeting the population aged 60 years or older developed since 2001 in the state of São Paulo. METHODS: The main strategies used to develop the campaign were described based on the review of documents issued by the Health Ministry, National Cancer Institute, São Paulo State Health Department, Oncocentro Foundation of São Paulo, São Paulo City Health Department, School of Public Health at the University of São Paulo (USP), and Santa Marcelina Health Care Center. The impact of the campaign on the incidence of new cases of oral cancer in the target population was evaluated. RESULTS: In 2001, 90 886 elderly were examined vs. 629 613 in 2009. The following strategies were identified: training of professionals, development of printed materials to guide municipal governments in developing the campaign and using standardized codes and criteria, guidelines for data consolidation, establishment of patient referral flows, practical training with a specialist at the basic health care unit after the follow-up examination of individuals presenting changes in soft tissues, and increase in the number of oral diagnosis services. Between 2005 and 2009, there was a significant reduction in the rate of confirmed cases of oral cancer per 100 000 individuals examined, from 20.89 to 11.12 (P = 0.00003). CONCLUSIONS: The campaign was beneficial to the oral health of the elderly and could be extended to include other age groups and regions of the country. It may also provide a basis for the development of oral cancer prevention actions in other countries, as long as local characteristics are taken into account. <![CDATA[<b>System of comparable indicators for peaceful coexistence and citizen security: a consensus among countries</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892012000300011&lng=en&nrm=iso&tlng=en La región de las Américas, con una tasa de homicidios de 16,4 por 100 000 habitantes (2004), es la segunda más violenta del mundo, pero la formulación de políticas públicas de prevención de violencia y delincuencia se ve obstaculizada por la ausencia de datos confiables y comparables sobre las diferentes manifestaciones del problema. El presente trabajo detalla un esfuerzo realizado por 14 países, patrocinado por el Banco Interamericano de Desarrollo y en asocio con otros organismos regionales, para desarrollar -de manera colectiva y consensuada- indicadores de convivencia y seguridad ciudadana que permitan comparaciones entre países, sistematizar métodos de producción y recolección de los datos pertinentes, generar políticas regionales y difundir e intercambiar buenas prácticas identificadas. Los indicadores escogidos fueron homicidio, muerte por lesiones de tránsito, suicidio, muerte por arma de fuego, delito sexual, violencia intrafamiliar, maltrato infantil, hurto, robo, hurto/robo de vehículos, secuestro, infracción de tránsito bajo efectos del alcohol, victimización general, victimización por robo, victimización por hurto, percepción de inseguridad, percepción de miedo, confianza en las instituciones y justificación del uso de violencia. Para cada indicador se acordó la forma de medición y las variables mínimas que deben tenerse en cuenta para contar con criterios de comparación apropiados.<hr/>The Region of the Americas, with a homicide rate of 16.4 per 100,000 population (2004), is the second most violent region in the world, but public policy-making for the prevention of violence and crime is hampered by the absence of reliable and comparable data on the problem's various manifestations. This paper describes a 14-country initiative, sponsored by the Inter-American Development Bank in part-nership with other regional agencies, to develop-collectively and by consensus- indicators for peaceful coexistence and citizen security that permit comparisons among countries, systematization of methods for the production and collection of pertinent data, the development of regional policies, and the dissemination and sharing of good practices. The selected indicators were homicide, death from road traffic injuries, suicide, death by firearm, sexual crime, family violence, child abuse, robbery, theft, vehicle theft and robbery, abduction, traffic offenses committed while under the influence of alcohol, general victimization, victimization by theft, victimization by robbery, perception of insecurity, perception of fear, confidence in institutions, and justification of the use of violence. For each indicator, agreement was reached on the type of measurement and the minimum variables that should be taken into account to have appropriate criteria for comparison. <![CDATA[<b>The concepts of health access</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892012000300012&lng=en&nrm=iso&tlng=en Esse artigo descreve quatro dimensões de acesso à saúde - disponibilidade, aceitabilidade, capacidade de pagamento e informação, correlacionado-as aos seus indicadores e tecendo considerações sobre a complexidade do conceito de acesso. Para a revisão desses conceitos foram pesquisadas as bases de dados PubMed/MEDLINE, LILACS, SciELO e World Health Organization Library & Information Networks for Knowledge (WHOLIS). Veículos de grande circulação, como a revista The Economist, o jornal The Washington Post e os arquivos da rede BBC também foram pesquisados. O conceito de acesso à saúde modificou-se ao longo do tempo, tomando uma forma mais complexa. As primeiras análises, datadas da década de 1970, sugeriam uma forte relação do acesso com o aspecto geográfico (disponibilidade) e financeiro (capacidade de pagamento). A literatura mais recente procura abordar aspectos menos tangíveis, como os aspectos cultural, educacional e socioeconômico, incorporando o elemento aceitabilidade nas análises. A literatura mostra ainda que ter informação está na base do acesso à saúde, estando essa noção associada aos conceitos de empoderamento e de letramento para a tomada de decisões de saúde. Concluiu-se que a melhoria do acesso à saúde e a garantia de uma maior equidade não serão obtidas com ações cujo foco se limite aos sistemas de saúde. Em vez disso, dependem de ações inter-setoriais e políticas sociais e econômicas que permitam dissipar diferenças de renda e educação.<hr/>This article describes four dimensions of health access-availability, acceptability, ability to pay and information-correlating these dimensions to indica-tors and discussing the complexity of the concept of access. For a study of these four dimensions, searches were conducted using the PubMed/MEDLINE, LILACS, SciELO, and World Health Organization Library & Information Networks for Knowledge (WHOLIS) databases. Large-circulation media vehicles, such as The Economist, The Washington Post, and the BBC network were also searched. The concept of health access has become more complex with time. The first analyses, carried out in the 1970s, suggested a strong emphasis on geographical (availability) and financial (ability to pay) aspects. More recently, the literature has focused on less tangible aspects, such as cultural, educational, and socioeconomic issues, incorporating the element of acceptability into the notion of health access. The literature also shows that information provides the starting point for access to health, in association with health empowerment and literacy for health care decision-making. The study concludes that improvements in access to health and the guarantee of equity will not be achieved by initiatives focusing on health care systems alone, but rather will depend on intersectoral actions and social and economic policies aimed at eliminating income and education differences.