Revista Panamericana de Salud Públicahttps://www.scielosp.org/feed/rpsp/2009.v26n2/2018-01-01T00:02:00ZVol. 26 No. 2 - 2009WerkzeugCross-border utilization of health care services by United States residents living near the Mexican borderS1020-498920090008000012018-01-01T00:02:00Z2018-01-01T00:02:00ZByrd, Theresa L.Law, Jon G.
<em>Byrd, Theresa L.</em>;
<em>Law, Jon G.</em>;
<br/><br/>
OBJECTIVES: To determine what proportion of El Paso (Texas, United States of America) residents access health care services in Mexico, which services they use, and why they cross for care. METHODS: A cross-sectional, telephone survey of El Paso County residents was conducted from October-November 2007 to determine use of health care services in Mexico. At total of 2560 telephone interviews were completed. Descriptive statistics and Chi-square analysis were used to determine the proportion crossing the US-Mexico border for care and identify correlates of crossing. RESULTS: The proportion of El Paso residents that had crossed into Mexico for some type of health care service during the two years prior to the survey interview was 32.5%. Of border crossers, 27.1% used health services; 63.2%, dental services; 82.0%, pharmacy; and 9.8%, traditional healers. Reasons given were cost, lack of health insurance, language barriers, and convenience. Hispanic ethnicity, having lived in Ciudad Juárez, being uninsured, and younger age were associated with crossing. The majority were satisfied with the health services received. CONCLUSIONS: Crossing the border to access health care services in Mexico is not uncommon for US residents living in El Paso County, Texas. Given the high rate of uninsured in the United States and the increasingly stringent security requirements, health policies may be needed that allow for cross-border care, making use of this alternative health care system easier and safer.Costos médicos directos de enfermedades neumocócicas invasoras y neumonías con diagnóstico radiológico en niños chilenosS1020-498920090008000022018-01-01T00:02:00Z2018-01-01T00:02:00ZLagos, RosannaMuñoz, AlmaEspinoza, AníbalDowes, ÁngelaRuttimann, RicardoColindres, RómuloLevine, Myron M.
<em>Lagos, Rosanna</em>;
<em>Muñoz, Alma</em>;
<em>Espinoza, Aníbal</em>;
<em>Dowes, Ángela</em>;
<em>Ruttimann, Ricardo</em>;
<em>Colindres, Rómulo</em>;
<em>Levine, Myron M.</em>;
<br/><br/>
OBJETIVOS: Determinar los costos médicos directos relacionados con la atención sanitaria de los casos de enfermedades neumocócicas invasoras (ENI) y neumonías adquiridas en la comunidad confirmadas mediante radiología (NAC-Rx) en niños chilenos. MÉTODO: Estudio de seguimiento prospectivo de las prestaciones de salud entregadas a 594 niños de 0 a 35 meses con ENI y 1489 niños de 1 a 35 meses con NAC-Rx, diagnosticados y tratados en establecimientos de la red pública de salud de la Región Metropolitana de Chile. Las prestaciones se valoraron según las tarifas del Fondo Nacional de Salud (FONASA) y los precios de dos clínicas privadas. Se estimó la incidencia nacional anual de ENI y NAC-Rx para calcular la carga económica total nacional de la población afiliada al seguro de salud estatal. RESULTADOS: Los costos promedio de los casos que requirieron hospitalización fueron US$ 1056,20 para las ENI y US$ 594,80 para las NAC-Rx, mientras que para los casos tratados en forma ambulatoria fueron US$ 77,70 y US$ 65,20, respectivamente. Los precios por los mismos servicios de internación fueron US$ 4484,10 y US$ 2962,70 en una de las clínicas privadas y US$ 9967,50 y US$ 6578,40 en la otra. El costo anual nacional estimado de la atención de los niños menores de 5 años según las tarifas de FONASA fue de US$ 789045 para las ENI y US$ 13823289 para las NAC-Rx. CONCLUSIONES: La alta demanda asistencial y económica por NAC-Rx en niños de 0 a 3 años es una razón de salud pública tremendamente poderosa que apoya el uso sistemático de la vacunación antineumocócica en niños chilenos.Maternal low birth weight and adverse perinatal outcomes: the 1982 Pelotas Birth Cohort Study, BrazilS1020-498920090008000032018-01-01T00:02:00Z2018-01-01T00:02:00ZVélez, Maria P.Santos, Iná S.Matijasevich, AliciaGigante, DeniseGonçalves, HelenBarros, Fernando C.Victora, Cesar G.
<em>Vélez, Maria P.</em>;
<em>Santos, Iná S.</em>;
<em>Matijasevich, Alicia</em>;
<em>Gigante, Denise</em>;
<em>Gonçalves, Helen</em>;
<em>Barros, Fernando C.</em>;
<em>Victora, Cesar G.</em>;
<br/><br/>
OBJECTIVE: To explore the association between maternal low birth weight (LBW) and adverse perinatal outcomes and to discriminate between confounders and mediating factors of these associations in a population-based birth cohort of Southern Brazil. METHODS: Data from 794 female members of the 1982 Pelotas Birth Cohort Study known to have delivered a live-born singleton offspring up to December 2004 were analyzed. Maternal birth weights were recorded in 1982. The associations between maternal and offspring characteristics were estimated by Poisson regression. Confounding was tested for socioeconomic, demographic, and psychosocial factors. Maternal anthropometric characteristics and hypertensive diseases during pregnancy were considered mediating factors. RESULTS: An increase of 100 grams (g) in mothers' birth weight predicted a gain of 21 g in their infants' birth weight (95% confidence interval (CI) 13.0-29.0 g, P < 0.001). Maternal LBW was associated with offspring LBW (prevalence ratio (PR) 2.28 (95% CI 1.34-3.89), P = 0.002), preterm birth (PR 1.78 (95% CI 1.12-2.81), P = 0.01), and small for gestational age (SGA) (PR 1.93 (95% CI 1.14-3.26), P = 0.01). A causal chain linking maternal LBW and offspring SGA was mediated by maternal prepregnancy weight. CONCLUSION: Offspring of young women born with LBW are more likely to be LBW, preterm, and SGA. Public health strategies aimed at decreasing the frequency of LBW are necessary to reduce the perpetuation of adverse perinatal outcomes in later generations. The intermediate role of prepregnancy weight among LBW women opens a promising window to decreasing the prevalence of SGA in similar populations.Field and laboratory preparedness: challenges to rolling out new multidrug-resistant tuberculosis diagnosticsS1020-498920090008000042018-01-01T00:02:00Z2018-01-01T00:02:00ZGriffin, Anne M. J.Caviedes, LuzGilman, RobertCoronel, JorgeDelgado, FreddyQuispe, MaryLuzMoore, avid A. J.
<em>Griffin, Anne M. J.</em>;
<em>Caviedes, Luz</em>;
<em>Gilman, Robert</em>;
<em>Coronel, Jorge</em>;
<em>Delgado, Freddy</em>;
<em>Quispe, Maryluz</em>;
<em>Moore, Avid A. J.</em>;
<br/><br/>
OBJECTIVES: In a pilot implementation project of the microscopic-observation drug-susceptibility methodology, we conducted a process evaluation to identify health system and logistic challenges that need to be addressed in order to harness the benefits of rolling out promising new diagnostic tools for multidrug-resistant tuberculosis (MDRTB). METHODS: Regional data relating to health system practices and performance related to the MDRTB diagnostic algorithm were collected at health center, local, and regional laboratories. RESULTS: Parallel implementation of a new test and an existing method creates demands on funds, personnel, sample transport, and information systems in addition to new test startup costs. Obviating the need for primary culture at intermediate laboratories through direct drug susceptibility testing (DST) at the regional reference laboratory significantly reduces delay. Field application of well-defined national guidelines for DST is patchy. If fidelity to national guidelines were perfect, DST requests would increase more than 50-fold, with important implications for laboratory capacity. CONCLUSIONS: Implementing a new MDRTB diagnostic presents challenges to the laboratory environment, the existing DST process, and the application of national guidelines in peripheral clinics. Assessing each element can maximize efficient use of a new tool. Specifically, strengthening systems for transferring samples to the laboratory and delivering results to the requesting clinic in addition to investing in personnel and laboratory resources are integral to harnessing the benefits of high-performance new diagnostic tests and can bring added value to other programs in the health care system.Las bandas juveniles violentas de Madrid: su socialización y aculturaciónS1020-498920090008000052018-01-01T00:02:00Z2018-01-01T00:02:00ZMartín, María JesúsMartínez, José ManuelRosa, Alberto
<em>Martín, María Jesús</em>;
<em>Martínez, José Manuel</em>;
<em>Rosa, Alberto</em>;
<br/><br/>
OBJETIVO: El presente artículo analiza el discurso de jóvenes involucrados en grupos violentos o bandas juveniles con el objetivo de profundizar en la interpretación que realizan de los procesos de adoctrinamiento, socialización y aculturación en sus respectivos colectivos. Complementariamente, de acuerdo con el marco teórico de partida (teoría de la socialización primaria y teoría de la asociación diferencial) se aborda la dinámica de influencia social con otros referentes sociales de los jóvenes violentos (pareja, trabajo, familia, etc.). MÉTODOS: Análisis cualitativo de 40 entrevistas realizadas a jóvenes pertenecientes a bandas o grupos violentos. RESULTADOS: En concordancia con la "teoría de la socialización primaria" y la teoría de la "socialización diferencial", se puede postular una sobresocialización del grupo violento y una infrasocialización del resto de agentes socializadores. En relación con la supervisión y el apoyo parental, se identifican tres tipos de familias claramente asociadas al problema de la violencia juvenil. La diversidad o unicidad de identidad social de los jóvenes violentos, así como su autoestima y autoconcepto individuales, conforman un conjunto de procesos de gran relevancia predictiva. Finalmente, un buen indicador de la evolución de estos jóvenes es el apoyo social percibido, absoluto y relativo (distribuido entre los distintos agentes de influencia). CONCLUSIONES: Se ilustra la necesidad de replantear las bases filosófico-epistemológicas y metodológicas de la investigación sobre esta clase de fenómenos sociales, incorporando elementos centrales del enfoque postmoderno, construccionista y crítico.Proposed methodology for monitoring antiretroviral drugs price negotiations in Latin America and the CaribbeanS1020-498920090008000062018-01-01T00:02:00Z2018-01-01T00:02:00ZOsorio-de-Castro, Claudia G. S.Crisante, MarujaMiranda, Elaine S.Oliveira, Egléubia A.Oliveira, Maria A.
<em>Osorio-De-Castro, Claudia G. S.</em>;
<em>Crisante, Maruja</em>;
<em>Miranda, Elaine S.</em>;
<em>Oliveira, Egléubia A.</em>;
<em>Oliveira, Maria A.</em>;
<br/><br/>
OBJECTIVES: The spread of HIV/AIDS challenges governments to provide antiretroviral (ARV) treatment at affordable prices, and various initiatives have been developed with that intent. In Latin America and the Caribbean, four subregional negotiations were conducted during 2002-2005 to reduce drug prices and thus broaden access to ARVs. Studies were carried out to monitor the negotiations, and the development of a monitoring methodology was recommended. The objective of the current study was to develop and describe a potential methodology for monitoring ARV price negotiations. METHODS: The study, carried out in 2006-2007, consisted of a design phase and validation phase. The design phase included an extensive literature review and development of a theoretical framework. Validation was performed using health professional consensus and pilot studies in three countries-Barbados, Honduras, and Peru-representing the Caribbean, Central American, and Andean subregions. RESULTS: The results included a detailed logic model and a 40-indicator framework. Both were tested in the field. Indicators were evaluated for feasibility, pertinence, and sensitivity, based on the outcome of the pilot study. CONCLUSIONS: This monitoring methodology is designed to help countries self-evaluate progress toward implementation of ARV price negotiations. The results of the pilot study indicate that its implementation in the field helped elucidate the ARV price negotiation process by identifying local conditions and indirectly measuring countries' negotiating capacities.Assistive technology applied to education of students with visual impairmentS1020-498920090008000072018-01-01T00:02:00Z2018-01-01T00:02:00ZAlves, Cássia Cristiane de FreitasMonteiro, Gelse Beatriz MartinsRabello, SuzanaGasparetto, Maria Elisabete Rodrigues FreireCarvalho, Keila Monteiro de
<em>Alves, Cássia Cristiane De Freitas</em>;
<em>Monteiro, Gelse Beatriz Martins</em>;
<em>Rabello, Suzana</em>;
<em>Gasparetto, Maria Elisabete Rodrigues Freire</em>;
<em>Carvalho, Keila Monteiro De</em>;
<br/><br/>
OBJECTIVES: Verify the application of assistive technology, especially information technology in the education of blind and low-vision students from the perceptions of their teachers. METHODS: Descriptive survey study in public schools in three municipalities of the state of São Paulo, Brazil. The sample comprised 134 teachers. RESULTS: According to the teachers' opinions, there are differences in the specificities and applicability of assistive technology for blind and low-vision students, for whom specific computer programs are important. Information technology enhances reading and writing skills, as well as communication with the world on an equal basis, thereby improving quality of life and facilitating the learning process. The main reason for not using information technology is the lack of planning courses. The main requirements for the use of information technology in schools are enough computers for all students, advisers to help teachers, and pedagogical support. CONCLUSIONS: Assistive technology is applied to education of students with visual impairment; however, teachers indicate the need for infrastructure and pedagogical support. Information technology is an important tool in the inclusion process and can promote independence and autonomy of students with visual impairment.Assessment of the quality of immunization data produced by the national individual registration system in Uruguay, 2006S1020-498920090008000082018-01-01T00:02:00Z2018-01-01T00:02:00ZRonveaux, OlivierArrieta, FernandoCurto, SergioLaurani, HildaDanovaro-Holliday, M. Carolina
<em>Ronveaux, Olivier</em>;
<em>Arrieta, Fernando</em>;
<em>Curto, Sergio</em>;
<em>Laurani, Hilda</em>;
<em>Danovaro-Holliday, M. Carolina</em>;
<br/><br/>
OBJECTIVE: The nominal registration system of Uruguay's national immunization program (NIP) tracks administered vaccines on a paper form filled out after each vaccination and collated into a national database, thus allowing for individual follow-up. This study performed a comprehensive assessment of the quality of Uruguay's immunization data in November 2006 to evaluate the validity of the information and to confirm the high national immunization coverage reported by the program. METHODS: The research team analyzed the concordance of the operational-level numerators (infant immunization data from 18 public and private vaccination centers in six country departments) with department- and national-level data, and compared the national-level (NIP) infant denominators with other official sources. A standardized questionnaire was used to evaluate system performance at the operational (vaccination center), department, and national level. Rapid house-to-house monitoring was conducted to generate additional coverage estimates. RESULTS: Numerator accuracy throughout the data flow was 100%, and national-level denominators appeared to be exhaustive. Overall system performance was excellent (proper archiving and recording of form data, sufficient supply of forms, timely flow of information, adequate defaulter tracing practices and computer system security). The main weaknesses were the degree of data analysis and feedback to peripheral levels. House-to-house monitoring showed high overall immunization coverage (97%). CONCLUSION: Uruguay's NIP registration system produces remarkably reliable information, ensuring valid measurement of immunization coverage. In addition, by allowing for monitoring of each child's current vaccination status, it facilitates management of interventions designed to reduce vaccination default and thus helps achieve the country's high level of coverage.Factores económicos relacionados con los Objetivos de Desarrollo del Milenio en salud: una revisión bibliográficaS1020-498920090008000092018-01-01T00:02:00Z2018-01-01T00:02:00ZPalma, MarcoHernández, IldefonsoÁlvarez-Dardet, CarlosGil-González, DianaRuiz, María T.Medina, Manuel
<em>Palma, Marco</em>;
<em>Hernández, Ildefonso</em>;
<em>Álvarez-Dardet, Carlos</em>;
<em>Gil-González, Diana</em>;
<em>Ruiz, María T.</em>;
<em>Medina, Manuel</em>;
<br/><br/>
OBJETIVOS: Sistematizar la información publicada sobre la situación y los avances en el logro de los Objetivos de Desarrollo del Milenio relacionados con la salud (ODMS), así como analizar su asociación con algunos factores económicos y los pronósticos de cumplimiento. MÉTODOS: Se realizó una búsqueda de los artículos científicos sobre los Objetivos de Desarrollo del Milenio en general publicados entre el 1 de enero de 2000 y el 31 de agosto de 2006 en las bases bibliográficas electrónicas EBSCO, CSA Illumina, Thomson Gale, SwetsWise y BIREME. Se seleccionaron los artículos originales en inglés o español que evaluaran la situación de los ODMS o sus avances y se refirieran a factores determinantes. Se analizó la distribución de los factores determinantes de la situación de los ODMS o sus avances, los ODMS referidos, el tipo de evaluación, la relación entre los indicadores económicos y la salud, el lugar estudiado, y la situación y los pronósticos del cumplimiento de los ODMS. Se valoró la calidad de los artículos. RESULTADOS: Se identificaron 304 artículos originales, de ellos 114 (37,5%) se ocupaban de uno o varios ODMS. Los objetivos relacionados con la mortalidad infantil y materna fueron los más frecuentemente abordados. De los 39 artículos que evaluaban los ODMS y su relación con los factores económicos, en 13 se consideraban factores económicos relacionados con la equidad, la política o la globalización. Los factores económicos y políticos fueron los más frecuentemente asociados con la situación de los ODMS o sus avances. CONCLUSIONES: Existe una tendencia a utilizar variables económicas vinculadas con las condiciones de la población para analizar la situación de los ODMS y sus avances. Falta información sobre la relación con el gasto gubernamental, el comercio exterior, la ayuda externa y las políticas económicas mundiales. Los pronósticos para lograr los ODMS en los países pobres son desfavorables.As novas tecnologias de autocuidado e os riscos do autodiagnóstico pela InternetS1020-498920090008000102018-01-01T00:02:00Z2018-01-01T00:02:00ZVasconcellos-Silva, Paulo RobertoCastiel, Luis David
<em>Vasconcellos-Silva, Paulo Roberto</em>;
<em>Castiel, Luis David</em>;
<br/><br/>
Desarrollo de competencias en atención primaria de saludS1020-498920090008000112018-01-01T00:02:00Z2018-01-01T00:02:00ZNebot Adell, CarmeRosales Echevarria, CarlosBorrell Bentz, Rosa M.
<em>Nebot Adell, Carme</em>;
<em>Rosales Echevarria, Carlos</em>;
<em>Borrell Bentz, Rosa M.</em>;
<br/><br/>
Los institutos nacionales de salud pública: un enfoque coordinado e integral contra la influenza A H1N1 y otras amenazas a la salud públicaS1020-498920090008000122018-01-01T00:02:00Z2018-01-01T00:02:00ZBuss, PauloKoplan, Jeffrey P.Dusenbury, CourtenayBinder, SueRosenberg, Félix
<em>Buss, Paulo</em>;
<em>Koplan, Jeffrey P.</em>;
<em>Dusenbury, Courtenay</em>;
<em>Binder, Sue</em>;
<em>Rosenberg, Félix</em>;
<br/><br/>