Revista Panamericana de Salud Pública, Volume: 28, Issue: 5, Published: 2010
  • Mortality from ischemic heart disease in Chile: who, how many, and where Artículos

    Alonso, Faustino Tomás; Nazzal, Carolina; Alvarado, María Elena

    Abstract in Spanish:

    OBJETIVO: Describir las características de la mortalidad por cardiopatía isquémica en Chile y su evolución temporal, e identificar los factores asociados a mortalidad extrahospitalaria por esta patología entre 1997 y 2007. MÉTODOS. Estudio de serie temporal que utiliza las bases de defunciones del Departamento de Estadísticas e Información en Salud entre 1997 y 2007. De un total de 917 029 muertes notificadas, se seleccionaron aquellas cuya causa primaria fue cardiopatía isquémica (códigos I20 a I25 de la CIE-10). Se calcularon tasas crudas y ajustadas por edad y sexo para analizar la tendencia. Se analizaron las características de la mortalidad según el lugar de defunción, evaluando posibles factores asociados a mortalidad extrahospitalaria (casa/habitación u otro lugar), incluidos edad, ruralidad, estado civil, educación y sexo, así como el efecto de la incorporación del infarto agudo al miocardio a la ley de garantías en salud (GES), con regresión binomial. RESULTADOS: Durante el período estudiado se notificaron 87 342 muertes por cardiopatía isquémica, de las cuales 57,7% eran hombres y 59,5% ocurrieron fuera del hospital. La tasa de mortalidad ajustada por edad disminuyó de 52,9 a 40,4 por 100 000 habitantes. Los factores asociados a mortalidad extrahospitalaria en hombres fueron ruralidad, riesgo relativo (RR) 1,24 (1,21-1,27); edad mayor a 70 años, RR 1,03 (1,01-1,05); estado civil soltero, RR 1,10 (1,08-1,12), mientras que en las mujeres los valores correspondientes fueron 1,13 (1,10-1,18); 1,31 (1,27-1,36) y 1,07 (1,04-1,09). La adopción de la GES se asoció con un aumento en el porcentaje de muertes intrahospitalarias en mujeres, RR 0,95 (0,92-0,97). CONCLUSIONES: †La mortalidad por cardiopatía isquémica en Chile ha disminuido. El mayor porcentaje de las muertes ocurren fuera de hospitales o clínicas. Los factores asociados a mortalidad extrahospitalaria en ambos sexos fueron edad avanzada, estado civil soltero y ruralidad.

    Abstract in English:

    OBJECTIVE: To describe the characteristics of mortality from ischemic heart disease in Chile and its trend over time, and to identify the factors associated with extra-hospital mortality from this pathology between 1997 and 2007. METHODS: A time-series study was conducted using the mortality database of the Department of Health Statistics and Information for 1997 to 2007. Of the total of 917 029 deaths reported in this period, those whose primary cause was ischemic heart disease (ICD-10 codes I20-I25) were selected. Crude and adjusted rates were calculated by age and sex in order to analyze the trend. Mortality characteristics were analyzed by the place of death, evaluating potential factors associated with extra-hospital mortality (death at home or elsewhere outside a hospital or clinic). The factors considered, using binomial regression, were age, rurality, marital status, education, and sex, as well as the effect of the incorporation of acute myocardial infarction into the explicit health guarantees law. RESULTS: During the period in question, 87 342 deaths from ischemic heart disease were reported, 57.7% of which were in males and 59.5% outside the hospital. The age-standardized mortality rate declined from 52.9 to 40.4 per 100 000 population. Factors related to extra-hospital mortality in men were rurality, relative risk (RR) 1.24 (1.21-1.27); age of over 70 years, RR 1.03 (1.01-1.05); and being single, RR 1.10 (1.08-1.12). In women, the respective values were rurality, 1.13 (1.10-1.18); advanced age, 1.31 (1.27-1.36); and being single, 1.07 (1.04-1.09). Passage of the explicit health guarantees law was associated with an increase in the percentage of in-hospital deaths in women, RR 0.95 (0.92-0.97). CONCLUSIONS: Mortality from ischemic heart disease in Chile has declined. The majority of deaths from this cause occur outside hospitals or clinics. The factors associated with extra-hospital mortality in both sexes were advanced age, being single, and rurality.
  • Economic impact of fatal and nonfatal road traffic injuries in Belize in 2007 Articles

    Pérez-Núñez, Ricardo; Híjar-Medina, Martha; Heredia-Pi, Ileana; Jones, Sandra; Silveira-Rodrigues, Eugênia Maria

    Abstract in Spanish:

    OBJETIVO: Calcular el costo económico de los traumatismos por accidentes de tránsito registrados en Belice durante el año 2007. MÉTODOS. Se realizó un estudio transversal a partir de datos secundarios sobre los costos, tanto desde la perspectiva social como desde la del sistema de salud. La información epidemiológica se obtuvo a partir de la base de datos de mortalidad, la base de datos nacional de egresos hospitalarios y los expedientes administrativos de la policía y el Ministerio de Salud. Se llevó a cabo una encuesta a los prestadores de servicios de salud para calcular las cifras correspondientes a la atención ambulatoria posterior al egreso. Para calcular los costos directos, se utilizó la base de datos del proyecto WHO-CHOICE (elección de intervenciones eficaces en función de los costos) de la Organización Mundial de la Salud. El equipo de respuesta a las urgencias médicas de Belice aportó los datos sobre los costos prehospitalarios. Después de calcular los años de vida potencial perdidos tomando como parámetro la esperanza de vida de Belice correspondiente al año 2008 y empleando el método propuesto por la Organización Panamericana de la Salud, se calculó el costo indirecto asociado a la muerte prematura desde el enfoque del capital humano. Se utilizó un modelo de árbol de decisiones para calcular el costo económico total derivado de los traumatismos causados por el tránsito y se hizo un análisis de sensibilidad multivariado y probabilístico para incorporar los parámetros de incertidumbre en las estimaciones. RESULTADOS: En Belice, durante el año 2007, los traumatismos causados por el tránsito provocaron la muerte de 61 personas, la hospitalización de 338 y, según se calcula, lesiones menores a 565. Se perdieron 2 501 años de vida potencial a causa de las muertes prematuras, lo que se tradujo en un costo económico total de US$11 062 544. Esta cifra representa 0,9% del producto interno bruto de Belice. Se calculó que el costo directo fue de US$ 163 503, del cual 2,4% fue ocasionado por las muertes, 46,7% por la atención de las personas que sufrieron traumatismos graves y 50,9% por la atención de quienes presentaron lesiones menores. CONCLUSIONES: El costo económico calculado en este estudio pone de manifiesto la necesidad de prevenir los traumatismos causados por el tránsito adoptando un método estratégico y multisectorial que se centre en abordar los principales problemas detectados.

    Abstract in English:

    OBJECTIVE: To estimate the economic cost of road traffic injuries in Belize in 2007. METHODS: A cross-sectional study was conducted using secondary cost data, assuming the health system and social perspectives. Epidemiologic information was obtained from the mortality database, the national hospital discharge database, and administrative records from police and the Ministry of Health. A health provider survey was carried out in order to estimate the postdischarge ambulatory utilization figures. Direct cost was estimated with the World Health Organization WHO-CHOICE (CHOosing Interventions that are Cost Effective) database. Prehospital costs were obtained from the Belize emergency response team. After estimating years of potential life lost using the Belize life expectancy for 2008 and methodology proposed by the Pan American Health Organization, the indirect cost associated with premature death was estimated with the human capital approach. Total estimation of road traffic injuries' economic costs used a decision tree model approach. Multiway sensitivity analysis was used to incorporate uncertainty in the estimations. RESULTS: Sixty-one people died due to road traffic injuries during 2007, 338 were hospitalized, and 565 people were estimated to be slightly injured. A total of 2 501 years of potential life were lost in Belize due to premature death, with a total economic cost of US$11-062-544. This figure represents 0.9% of the Belize gross domestic product. Direct cost was estimated at US$163-503, of which 2.4% was spent on fatalities, 46.7% on the severely injured, and 50.9% on the slightly injured. CONCLUSIONS: The economic cost estimations make clear the need to prevent road traffic injuries with a strategic and multisectoral approach that focuses on addressing the main problems identified.
  • Exposure to contaminated water: perceptions and practices in a neighborhood in the city of Manaus, Brazil

    Giatti, Leandro Luiz; Neves, Natasha Lima da Silva; Saraiva, Giselle Nayara de Moraes; Toledo, Renata Ferraz de

    Abstract in Portuguese:

    OBJETIVO: Investigar o modo de abastecimento de água e a percepção quanto aos problemas causados por essa água entre moradores de um bairro sem abastecimento público e instalado numa área anteriormente utilizada como depósito de lixo na Cidade de Manaus, Brasil. MÉTODOS. Foram realizadas 162 entrevistas semiestruturadas em domicílios do bairro, além de um grupo focal com professores de uma escola pública local, onde também houve uma reunião com moradores. Os instrumentos aplicados enfocaram a percepção e os modos de uso da água e o processo de exposição a contaminantes químicos pela água. RESULTADOS: Predominou entre a população o uso de água de poço sem qualquer tratamento. Essa água foi considerada como "boa" por 64,8% dos entrevistados. A maioria dos moradores (88,3%) declarou saber da existência do lixão; desses, 77,6% afirmaram que o lixão causava problemas ao ambiente e à saúde. Contudo, análises qualitativas das respostas não demonstraram reconhecimento da contaminação por elementos químicos e nem de suas possíveis consequências. Em atividades com os professores, ficou claro que os mesmos conheciam parcialmente o problema, não realizando intervenções a esse respeito. Em reunião com os moradores foi identificada uma militância relativa ao problema dentro do bairro, mas que não extrapolava a localidade e não interagia com esferas governamentais. CONCLUSÕES. O estudo identificou uma situação crítica de exposição que tende a se perpetuar em decorrência de percepções equivocadas e da falta de mobilização da sociedade. A disseminação de resultados junto a professores e moradores locais foi útil para empoderar os sujeitos da pesquisa.

    Abstract in English:

    OBJECTIVE: To investigate the modes of water supply and the perception concerning the problems caused by this water among residents of a neighborhood without public supply of water, settled in an area previously used as a garbage dump in the city of Manaus, Brazil. METHODS: One hundred and sixty-two semi-structured household interviews were conducted. In addition, a focal group with teachers from a local public school and a meeting with residents were held. The instruments employed focused on the perception and modes of water use and on the process of exposure to chemical contaminants through water. RESULTS: Untreated well water was used by most families. This water was considered to be "good" by 64.8% of the individuals interviewed. Most residents (88.3%) declared knowledge about the garbage dump. Of these, 77.6% stated that the garbage dump caused health and environmental problems. However, qualitative analysis of the responses revealed that the residents were not aware of contamination by chemical elements or of the consequences of such contamination. The activities carried out with teachers revealed that they were partially aware of the problem, but did not design interventions to address the issue. In a meeting with neighborhood residents, the presence of social activism concerning the problem was identified, but it did not extend beyond the neighborhood or reach governmental spheres. CONCLUSIONS: The study identified a situation of critical exposure that tends to be maintained as a result of misperceptions and lack of social mobilization. The dissemination of research results to teachers and residents was useful to empower subjects.
  • Health status of southern Arizona border counties: a Healthy Border 2010 midterm review Articles

    Robinson, Keisha L.; Ernst, Kacey C.; Johnson, Babs L.; Rosales, Cecilia

    Abstract in Spanish:

    OBJETIVO: La región estadounidense de la frontera entre México y los Estados Unidos consta de 48 condados distribuidos en cuatro estados, y las poblaciones que viven a uno y otro lado de la frontera tienen problemas de salud similares. El programa binacional "Frontera saludable 2010" está destinado a las poblaciones de la región y se propone mejorar la situación sanitaria en la frontera entre México y los Estados Unidos mediante actividades de promoción de la salud y prevención de enfermedades. Este estudio es un informe sobre la situación sanitaria de los cuatro condados de la frontera sur de Arizona. MÉTODOS. Los datos acerca de los indicadores de salud de los condados de Cochise, Pima, Santa Cruz y Yuma se obtuvieron del registro civil y estadísticas del Departamento de Servicios de Salud de Arizona. Se calculó el progreso mediante un porcentaje que refleja la cercanía o la lejanía del objetivo propuesto para el año 2010. Se compararon los datos correspondientes a los condados fronterizos con los del estado de Arizona. RESULTADOS: El progreso hacia los objetivos del programa "Frontera saludable 2010" no fue uniforme en los distintos condados fronterizos. Los cuatro condados lograron avances hacia los objetivos propuestos en materia de cáncer cervicouterino, hepatitis A y tasa de natalidad entre las adolescentes. La mayoría de los condados fronterizos están más próximos a cumplir con los objetivos en materia de cáncer de mama, mortalidad por diabetes, tuberculosis, colisiones de vehículos automotores, mortalidad infantil por anomalías congénitas y atención prenatal. Sin embargo, ninguno de los cuatro condados se está acercando al objetivo propuesto en cuanto al virus de la inmunodeficiencia humana y la mortalidad infantil. CONCLUSIONES: La evaluación de los objetivos del programa "Frontera saludable 2010" brindó una descripción integral de la situación de salud de la población. Aunque los condados de la frontera sur de Arizona han logrado avances en algunos aspectos, sigue siendo necesario mantener la vigilancia con el fin de detectar las disparidades aún presentes.

    Abstract in English:

    OBJECTIVE: The region on the United States (US) side of the US-Mexico border consists of 44 counties in four states; populations on both sides of the border have similar health problems. Healthy Border 2010: An Agenda for Improving Health on the US-Mexico Border (HB 2010) is a binational agenda of health promotion and disease prevention for individuals in the region. This study reports on the health status of the four southern Arizona border counties. METHODS: Data on health indicators for Cochise, Pima, Santa Cruz, and Yuma Counties were collected from the Arizona Department of Health Services Vital Records and Statistics. Progress was calculated as a percentage made toward or away from the 2010 target. Comparisons were made between the border counties and Arizona. RESULTS: Progress toward the HB 2010 targets varied among the border counties. All border counties made progress toward the targets with the cervical cancer, hepatitis A, and teenage birthrate objectives. Most border counties moved toward the goals for breast cancer, diabetes mortality, tuberculosis, motor vehicle crashes, infant mortality from congenital abnormalities, and prenatal care. Border counties moved away from the target with the human immunodeficiency virus and infant mortality objectives. CONCLUSIONS: Assessment of the HB 2010 objectives provided a comprehensive description of the health status of the population. Although the southern Arizona border counties have shown improvement in some areas, monitoring is still needed to identify the disparities that remain.
  • Malaria in Cruzeiro do Sul (Western Brazilian Amazon): analysis of the historical series from 1998 to 2008

    Costa, Kleynianne Medeiros de Mendonça; Almeida, Walquíria Aparecida Ferreira de; Magalhães, Izanelda Batista; Montoya, Roberto; Moura, Marco Sabóia; Lacerda, Marcus Vinícius Guimarães de

    Abstract in Portuguese:

    OBJETIVO. Descrever as características epidemiológicas da malária e seus principais determinantes no Município de Cruzeiro do Sul, no Estado do Acre, Brasil, entre 1998 e 2008 MÉTODOS. Este estudo descritivo, retrospectivo, utilizou dados secundários disponíveis nos sistemas de informação em malária desenvolvidos pelo Ministério da Saúde do Brasil (SISMAL/SIVEP-Malária). Os dados foram analisados no software TABLEAU®. Dados geo-espaciais foram obtidos para avaliar a distribuição dos casos de malária. RESULTADOS: A incidência parasitária anual (IPA) de 27 casos/1-000 habitantes em 1998 chegou a 571,5 casos/1-000 habitantes em 2006, quando a cidade registrou sua maior epidemia, subsequente ao estabelecimento de um programa estadual de incentivo à perfuração de tanques para piscicultura, em 2005. As localidades rurais apresentaram maior número de casos. Entretanto, as localidades periurbanas que possuíam tanques de piscicultura tiveram IPAs mais elevadas do que áreas sem tanques. Após a intensificação das ações do Programa Nacional de Controle da Malária, a IPA diminuiu para 152,9 casos/1-000 habitantes em 2008. CONCLUSÕES. O incentivo a atividades econômicas em áreas periurbanas de transmissão instável de malária, típicas da América Latina, deve ser muito bem planejado. O controle da malária em Cruzeiro do Sul baseou-se em estratégias integradas implementadas simultaneamente pelos governos federal, estadual e municipal, como preconizado pelo Plano Nacional de Controle da Malária. É importante ressaltar a utilidade de um bom sistema de informação como o SIVEP-Malária para estimar a carga de doença e monitorar de forma eficiente o impacto das intervenções.

    Abstract in English:

    OBJECTIVE: To describe the epidemiological characteristics of malaria and its main determinants in the municipality of Cruzeiro do Sul, State of Acre, Brazil, between 1998 and 2008. METHODS: This descriptive, retrospective study was carried out with secondary data available from the malaria information systems developed by the Brazilian Ministry of Health (SISMAL/SIVEP-Malária). The data were analyzed using the TABLEAU® software. Geospatial data were obtained to assess the distribution of malaria cases. RESULTS: The annual parasite incidence (API) of 27 cases/1 000 population in 1998 reached 571.5 cases/1 000 population in 2006, the year in which the city recorded its largest epidemics, following the establishment of a state program that encouraged the digging of tanks for fish farming in 2005. Rural sites had the highest number of cases. However, peri-urban locations with fish tanks had higher APIs than peri-urban areas without tanks. Following the strengthening of control actions by the National Malaria Control Program, the API in Cruzeiro do Sul dropped to 152.9 cases/1 000 population in 2008. CONCLUSIONS: The type of economic activity fostered in peri-urban areas characterized by unstable malaria transmission, which are typical of Latin America, must be very well planned. Malaria control in Cruzeiro do Sul relied on integrated strategies implemented simultaneously by federal, state, and city governments, as recommended by the National Malaria Control Program. It is important to underscore the usefulness of a reliable information system such as SIVEP-Malária to estimate the burden of disease and efficiently monitor the impact of interventions.
  • Sexual risk behavior among military personnel stationed at border-crossing zones in the Dominican Republic Articles

    Anastario, Michael P.; Tavarez, Maria Isabel; Chun, Helen

    Abstract in Spanish:

    OBJETIVO. Calcular la prevalencia del comportamiento sexual riesgoso del personal militar que sirve en las principales zonas de paso fronterizo entre la República Dominicana y Haití. MÉTODOS. De noviembre del 2008 a enero del 2009, se aplicaron encuestas sobre comportamiento a 498 miembros del personal militar que estaba en servicio activo en las tres zonas principales de paso fronterizo de la frontera occidental de la República Dominicana. Se seleccionó una muestra aleatoria y sistemática de participantes, a los que se les formularon preguntas sobre su comportamiento sexual de los últimos 12 meses, el consumo de bebidas alcohólicas y la salud mental. RESULTADOS: De todos los entrevistados, 41% revelaron que habían mantenido relaciones sexuales casuales en los últimos 12 meses, 37% de los hombres alguna vez habían mantenido relaciones sexuales con un profesional del sexo (19% en los últimos 12 meses) y 7% de los hombres informaron que habían tenido relaciones sexuales con personas de Haití que cruzaron la frontera (6% en los últimos 12 meses). De los entrevistados no monógamos (51%), más de 60% de los que mantuvieran relaciones por vía anal, vaginal u oral no fueron constantes en el uso de preservativos. Refirieron el uso de coacción sexual en los últimos 12 meses 15% de los entrevistados. CONCLUSIONES: †El comportamiento sexual riesgoso es prevalente entre los miembros del personal militar que sirve en las zonas de paso fronterizo entre República Dominicana y Haití. Los programas de prevención contra la transmisión del VIH destinados al personal militar de esta región deben incorporar como temas esenciales la coacción sexual y la salud mental.

    Abstract in English:

    OBJECTIVE: To estimate the prevalence of sexual risk behaviors among military personnel stationed along major border-crossing zones between the Dominican Republic and Haiti. METHODS: From November 2008 to January 2009, behavioral surveys were administered to 498 active duty military personnel stationed along the three largest border-crossing zones on the western border of the Dominican Republic. Participants were selected using systematic random sampling and asked about their sexual behavior over the past 12 months, alcohol use, and mental health. RESULTS: Forty-one percent reported having casual sex during the past 12 months, 37% of men had a history of having sex with a commercial sex worker (19% during the past 12 months), and 7% of men reported a history of having sex with a transmigrating Haitian (6% during the past 12 months). Among sexually non-monogamous respondents (51%), inconsistent condom use exceeded 60% for those engaging in anal, vaginal, or oral sex. Fifteen percent reported using sexual coercion during the past 12 months. CONCLUSIONS. Sexual risk behaviors were prevalent among military personnel stationed along border-crossing zones between the Dominican Republic and Haiti. Prevention programs targeted at military personnel in this region should incorporate sexual coercion and mental health as key elements of their HIV prevention programs.
  • Mortality trends from diabetes mellitus in the seven socioeconomic regions of Mexico, 2000-2007 Articles

    Sánchez-Barriga, Juan Jesús

    Abstract in Spanish:

    OBJETIVO: Determinar las tendencias de mortalidad por diabetes mellitus en México, en función de cada entidad federativa, región socioeconómica y sexo, y establecer la relación entre el nivel de educación, la entidad federativa de residencia y la región socioeconómica, y la mortalidad por diabetes durante el período 2000-2007. MÉTODOS. Los datos de mortalidad asociada a la diabetes correspondientes a los años 2000 y 2007 se obtuvieron del Sistema Nacional de Información de la Secretaría de Salud; esta información es generada por el Instituto Nacional de Estadística y Geografía a partir de los certificados de defunción. Se determinaron los códigos de la Clasificación Internacional de Enfermedades, 10.ª Revisión, que corresponden a la diabetes mellitus como principal causa de muerte. Se calculó la mortalidad por entidad federativa y región socioeconómica, junto con la fuerza de asociación (mediante la regresión de Poisson) entre la entidad federativa de residencia, la región socioeconómica y el nivel de educación, y la mortalidad por diabetes. El Instituto Nacional de Estadísticas y Geografía agrupa las 32 entidades federativas en siete regiones socioeconómicas conforme a los indicadores relativos al bienestar, tales como educación, ocupación, salud, vivienda y empleo. RESULTADOS: Las personas que no finalizaron la escuela primaria están expuestas a un riesgo mayor de morir por diabetes (riesgo relativo [RR] 2 104; intervalo de confianza de 95% [IC] 2 089-2 119). La asociación de mayor fuerza con la mortalidad por diabetes se registró en la ciudad de México (RR 2,5; IC 2,33-2,68 en el 2000; RR 2,06; IC 1,95-2,18 en el 2007) y en la región socioeconómica 7 (RR 2,47; IC 2,36-2,57 en el 2000; RR 2,05; IC 1,98-2,13 en el 2007). CONCLUSIONES: Las tasas de mortalidad aumentaron de 77,9 a 89,2 por 100 000 habitantes en el período 2000-2007 y fueron más altas entre las mujeres que entre los hombres. Las personas que no finalizaron la escuela primaria tuvieron un riesgo mayor de morir por diabetes (RR 2,104; IC 2,089-2,119). La entidad federativa de la ciudad de México y la región socioeconómica 7 presentaron la asociación de mayor fuerza con la mortalidad por diabetes.

    Abstract in English:

    OBJECTIVE: To determine trends in mortality from diabetes mellitus nationwide according to federative entity, socioeconomic region, and sex and to establish the association between education level, federation entity of residence, and socioeconomic region and mortality from diabetes in Mexico during the years 2000-2007. METHODS: Records of mortality associated with diabetes for 2000-2007 were obtained from the National Information System of the Secretariat of Health. This information is generated by the National Institute of Statistics, Geography and Informatics through death certificates. Codes of International Classification of Diseases, 10th Revision, that correspond to the basic cause of death from diabetes mellitus were identified. Rates of mortality by federative entity and socioeconomic region were calculated, along with the strength of association (obtained by Poisson regression) between federative entity of residence, socioeconomic region, and education level and mortality from diabetes. The seven socioeconomic regions elaborated by the National Institute of Statistics, Geography and Informatics include the 32 federative entities according to indicators related to well-being such as education, occupation, health, housing, and employment. RESULTS: Individuals who did not complete elementary school had a higher risk of dying from diabetes (relative risk [RR] 2.104, 95% confidence interval [CI] 2.089-2.119). The federative entity and socioeconomic region with the strongest association with mortality from diabetes were Mexico City (RR 2.5, CI 2.33-2.68 for 2000; RR 2.06, CI 1.95-2.18 for 2007) and region 7 (RR 2.47, CI 2.36-2.57 for 2000; RR 2.05, CI 1.98-2.13 for 2007). CONCLUSIONS: Mortality rates increased from 77.9 to 89.2 per 100 000 inhabitants in the period 2000-2007. Women had higher mortality than men. Individuals who did not complete elementary school had a higher risk of dying from diabetes (RR 2.104, CI 2.089-2.119). Mexico City as federative entity and socioeconomic region 7 presented the strongest association with mortality from diabetes.
  • Methodology for evaluating cost-effectiveness in primary health care centers in Chile Artículos

    Peñaloza, Blanca; Leisewitz, Thomas; Bastías, Gabriel; Zárate, Víctor; Depaux, Ruth; Villarroel, Luis; Montero, Joaquín

    Abstract in Spanish:

    OBJETIVO: Presentar una metodología para la evaluación de la relación costo-efectividad en centros de atención primaria de salud (APS) a partir del modelo de atención familiar promovido en Chile y evaluar los resultados de los dos primeros años de funcionamiento del primer centro piloto que funciona bajo este nuevo modelo de atención primaria. MÉTODOS. Se realizó un estudio de costo-efectividad, con una perspectiva social y un horizonte temporal de un año. Para comparar el centro intervenido (universitario) con el centro de control (municipal) se construyó el índice compuesto de calidad de los centros de salud familiar (ICCESFAM), que combina indicadores técnicos y la percepción de los usuarios de los centros en seis dimensiones: accesibilidad, continuidad de la atención médica, enfoque clínico preventivo y promocional, resolutividad, participación, y enfoque biopsicosocial y familiar. Para calcular los costos se tomó en cuenta el gasto en los centros, el ahorro producido al resto del sistema sanitario y el gasto de bolsillo de los pacientes. Se estimó la razón costo-efectividad incremental (RCEI) y se realizó un análisis de sensibilidad. RESULTADOS: El centro de salud universitario resultó 13,4% más caro (US$ 8,93 anuales adicionales por inscrito) y más efectivo (ICCESFAM 13,3% mayor) que el municipal. Estos resultados hacen que la RCEI sea de US$ 0,67 por cada punto porcentual adicional que aumenta el ICCESFAM. CONCLUSIONES: Según el modelo elaborado de evaluación de centros de APS, los centros que siguen el modelo de salud familiar chileno son más efectivos, tanto por sus indicadores técnicos como por la valoración de sus usuarios, que los centros de APS tradicionales.

    Abstract in English:

    OBJECTIVE: Present a methodology for evaluating cost-effectiveness in primary health care centers (PHCs) in Chile based on the family health care model promoted in Chile and evaluate the results of the first two years of operation of the first pilot center to work under this new primary-care model. METHODS: A cost-effectiveness study with a social perspective and a one-year time frame was conducted. In order to compare the university health center in question with the control (a municipal health center), a Family Health Center Composite Quality Index (FHCCQI) was devised. It combines technical indicators and user perceptions of the health centers in six areas: access, continuity of medical care, a preventive and promotional clinical approach, problem-solving capability, participation, and a biopsychosocial and family approach. In order to calculate the costs, the centers' expenses, the savings realized in the rest of the health system, and patients' out-of-pocket expenditures were considered. The incremental cost-effectiveness ratio (ICR) was estimated and a sensitivity analysis was performed. RESULTS: The university health center was 13.4% more expensive (an additional US$ 8.93 per annum per enrollee) and was more effective (FHCCQI 13.3% greater) than the municipal one. Accordingly, the ICR is US$ 0.67 for each additional percentage point of FHCCQI increase. CONCLUSIONS: According to the PHC evaluation model that was implemented, the centers that follow the Chilean family health care model are more effective than traditional PHC centers, as measured by both technical indicators and user ratings.
  • Selenium in serum and plasma: epidemiology and reference values Artículos de Revisión

    Carmona-Fonseca, Jaime

    Abstract in Spanish:

    OBJETIVO. Revisar y analizar literatura sobre valores de selenio (Se) en suero y plasma humanos; describir algunas variaciones; obtener "valores de referencia" para los países de Europa y América Latina, y proporcionar un marco informativo para estudios futuros sobre el tema. MÉTODOS. Se buscó información sobre niveles séricos o plasmáticos de Se en personas declaradas "sanas" en la literatura científica. Se revisaron las bases LILACS, SciELO, PubMed, Medline. Se buscó información de cualquier fecha (hasta enero de 2010) e idioma disponibles. Se calcularon promedio aritmético y desviación estándar ponderados. RESULTADOS: En la búsqueda para Europa se hallaron 161 informes publicados entre 1972 y 2009, con participación de 49 869 adultos sanos, 28 países y 8 regiones. El Se sérico/ plasmático varió entre 48,2 y 124,00 µg/L. Los valores ponderados continentales fueron 85,19 ± 14,58 (intervalo de confianza [IC] de 95% para promedio: 85,124-85,256). Los promedios por país, región y técnica de medición fueron estadísticamente diferentes, con diferencias significativas entre sexos y edades. Veintitrés de los estudios fueron en menores de 19 años de 10 países europeos. Los valores ponderados fueron 74,21 ± 9,50 µg/L (IC95% 73,95-74,46). Sobre América Latina hubo solo 11 datos. El Se sérico/plasmático fue 91,51 ± 18,78 µg/L en adultos; 93,25 ± 39,20 en menores de 15 años, y 130 ± 30 en recién nacidos menores de 25 horas. CONCLUSIONES: Los valores de Se sérico/plasmático mostraron diferencia estadísticamente significativa por sexo y edad en Europa, fueron más altos en adultos y niños latinoamericanos que en europeos, pero los datos latinoamericanos se basan en pocas personas. La influencia de la técnica de medición de Se en suero/plasma se considera crítica. En América Latina se requieren estudios poblacionales adecuadamente planificados y diseñados para generar valores de referencia autóctonos sobre Se en suero/plasma.

    Abstract in English:

    OBJECTIVE: To review and analyze the literature on selenium (Se) levels in human serum and plasma; to describe some variations; to obtain reference values for the countries of Europe and Latin America, and to provide an information framework for future studies on the subject. METHODS: Scientific literature was reviewed to gather information on selenium serum or plasma levels in people identified as "healthy." The LILACS, SciELO, and PubMed Medline databases were consulted. The search for information could be from any date (up to January 2010) and in any language. Weighted arithmetic means and standard deviations were calculated. RESULTS: For Europe, 161 reports published between 1972 and 2009 were found, covering 49 869 healthy adults, 28 countries, and 8 regions. Serum/plasma Se levels ranged from 48.2 to 124.00 µg/L. Weighted values for Europe were 85.19 ± 14.58 (CI 95% for the weighted average, 85.124-85.256). The averages by country, region, and measurement technique were statistically different, with significant differences associated with sex and age. Twenty-three of the studies involved individuals under 19 years of age in 10 European countries. The weighted values for this population were 74.21 ± 9.50 µg/L (CI 95%, 73.95-74.46). Only 11 studies from Latin America were available. Serum/plasma Se was 91.51 ± 18.78 Ìg/L in adults; 93.25 ± 39.20 in children under 15; and 130 ± 30 in newborns less than 25 hours old. CONCLUSIONS: Se serum/plasma levels in Europe showed statistically significant differences by sex and age. Se levels were higher in Latin American adults and children than in Europeans, but the Latin American data are based on few people. The technique for measuring Se in serum/plasma appears to have a significant influence. Properly planned and designed population studies should be conducted in Latin America in order to establish regional reference values for Se in serum and plasma.
  • Green, healthy environments: training of community health agents in the city of São Paulo, Brazil

    Sousa, Maria Fátima de; Parreira, Clélia Maria de Sousa Ferreira

    Abstract in Portuguese:

    Este artigo tem por objetivo descrever a experiência de formação dos agentes comunitários de saúde (ACS) no contexto do Projeto Ambientes Verdes e Saudáveis: Construindo Políticas Públicas Integradas na Cidade de São Paulo (PAVS). A execução do PAVS foi conduzida pelas secretarias do Verde e Meio Ambiente, de Saúde, de Assistência e Desenvolvimento Social e de Educação, em colaboração com as 31 subprefeituras da Cidade e as cinco coordenadorias regionais de saúde. Além do setor público municipal, foi constituída, para cogestão do PAVS, uma rede de parceiros, entre os quais instituições de cooperação técnica internacional multilateral e acadêmicas. A formação e qualificação de ACS e agentes de proteção social e o desenvolvimento de projetos comunitários que levem em conta as potencialidades e especificidades locais foram os objetivos centrais dessa rede. A gestão localmente integrada para o desenvolvimento de uma agenda de proteção e de promoção de ambientes verdes e saudáveis configurou-se no contexto das redes já existentes nos territórios de atuação da Estratégia Saúde da Família (ESF), junto às Unidades Básicas de Saúde. Os 705 projetos atualmente em funcionamento são evidência dos resultados positivos, em nível local, da gestão intersetorial.

    Abstract in English:

    The aim of this article is to describe the training of community health agents (ACSs) in the context of an intersectorial initiative (Green, Healthy Environments Project: Building Integrated Public Policies in the City of São Paulo). The initiative was developed by four city departments-Environment, Health, Social Support and Development, and Education-in collaboration with the city's 31 superintendencies and five regional health administrations. In addition to these municipal bodies, a network of partners was established, including institutions involved in multilateral international technical cooperation and academic institutions. The training of ACSs and social support agents, and the development of community programs that take into account local potential and characteristics was the main objective of the network. The locally integrated management for the development of an agenda of protection and promotion of green, healthy environments was carried out inside the previously existing networks operating in the territories close to public primary care health units serving populations covered by the Family Health Strategy. There currently are 705 programs created by the Green, Healthy Environments Project. These programs serve as evidence of the positive results obtained locally through intersectorial management efforts.
Organización Panamericana de la Salud Washington - Washington - United States
E-mail: contacto_rpsp@paho.org