Revista Panamericana de Salud Públicahttps://scielosp.org/feed/rpsp/2008.v24n4/2018-01-01T00:02:00ZUnknown authorVol. 24 No. 4 - 2008WerkzeugFactores psicosociales de riesgo de consumo de drogas ilícitas en una muestra de estudiantes mexicanos de educación mediaS1020-498920080010000012018-01-01T00:02:00Z2018-01-01T00:02:00ZDíaz Negrete, BrunoGarcía-Aurrecoechea, Raúl
<em>Díaz Negrete, Bruno</em>;
<em>García-Aurrecoechea, Raúl</em>;
<br/><br/>
OBJETIVOS: Identificar factores psicosociales de riesgo de consumo de sustancias ilícitas en estudiantes mexicanos y ofrecer elementos para el diseño de programas de prevención. MÉTODOS: Estudio transversal no experimental con una muestra de 516 estudiantes de secundaria y bachillerato de seis de las principales ciudades de México. Entre abril y junio de 2005 se aplicó una adaptación de la versión abreviada del Inventario de Tamizaje sobre el Consumo de Drogas (DUSI-R). El análisis comprendió ocho factores: abuso en el consumo de bebidas alcohólicas o drogas, malestar afectivo, bajo control conductual, baja adherencia escolar, baja competencia social, relaciones familiares disfuncionales, aislamiento social y pertenencia a redes sociales desviantes (cuyos integrantes consumen drogas y adoptan actitudes antisocia-les). Se identificaron factores de predicción del consumo de drogas ilícitas mediante regresión logística y se elaboró un modelo de ecuaciones estructurales para determinar las relaciones entre los factores. RESULTADOS: Los factores de predicción del consumo de sustancias ilícitas fueron presentar un bajo control conductual con tendencia a actuar impulsivamente y con agresividad, estar vinculado con pares desviantes y estar expuesto con frecuencia a situaciones familiares de conflicto y violencia y al consumo de sustancias ilícitas y alcohol en el hogar. El modelo de ecuaciones estructurales indicó que el consumo de estas sustancias forma parte de un grupo de trastornos de ajuste conductual, determinado directamente por la vinculación con pares desviantes y por una mayor prevalencia de trastornos socioafectivos, e indirectamente por las relaciones familiares disfuncionales. CONCLUSIONES: Se confirmaron algunas implicaciones de los modelos teóricos propuestos para explicar el consumo de drogas. Estos elementos empíricamente sustentados pueden contribuir al diseño de programas preventivos, principalmente de tipos selectivo e indicado.Pharmacoeconomics of antidepressants in moderate-to-severe depressive disorder in ColombiaS1020-498920080010000022018-01-01T00:02:00Z2018-01-01T00:02:00ZMachado, MárcioLopera, Monica MariaDiaz-Rojas, JorgeJaramillo, Luis EduardoEinarson, Thomas Ray
<em>Machado, Márcio</em>;
<em>Lopera, Monica Maria</em>;
<em>Diaz-Rojas, Jorge</em>;
<em>Jaramillo, Luis Eduardo</em>;
<em>Einarson, Thomas Ray</em>;
<br/><br/>
OBJECTIVE: To compare three antidepressant drugs from different classes used in treating moderate-to-severe major depressive disorder (MDD) in Colombian adults. METHODS: Based on expert input, a decision-tree model was adapted for Colombia to analyze data over 6 months from the government-payer perspective. The cost-effectiveness of amitriptyline, fluoxetine, and venlafaxine was determined. The clinical outcome was remission of depression (a score <7 on the Hamilton Depression [HAM-D] scale or <12 on the Montgomery-Åsberg Depression Rating Scale [MADRS]) after 8 weeks of treatment. Clinical data were obtained from the literature and costs from standard Colombian price lists. One-way and multivariate sensitivity analyses tested model robustness. RESULTS: Costs per patient (in 2007 US$) for treatment were: venlafaxine, $1 618; fluoxetine, $1 207; and amitriptyline, $1 068. Overall remission rates were 73.1%, 64.1%, and 71.3%, respectively. Amitriptyline dominated fluoxetine (i.e., it had lower costs and higher outcomes). The incremental cost-effectiveness ratio (ICER) of venlafaxine over amitriptyline was US$ 31 595. The acquisition price of venlafaxine was the model's cost driver, comprising 53.4% of the total cost/patient treated, compared with 18.5% and 24.8% for fluoxetine and amitriptyline, respectively. For the others, hospitalization comprised the major cost (72.1% and 65.2%, respectively). Probabilistic (Monte Carlo) sensitivity analysis confirmed the original findings of the pharmacoeconomic model. CONCLUSIONS: Amitriptyline is cost-effective in comparison to fluoxetine and venlafaxine in Colombia. However, the cost of venlafaxine was estimated for the brand-name product, as generics were not currently available. These cost-effectiveness results can be substantially affected by the presence of generics or drug cost regulations.Consumo de agrotóxicos e distribuição temporal da proporção de nascimentos masculinos no Estado do Paraná, BrasilS1020-498920080010000032018-01-01T00:02:00Z2018-01-01T00:02:00ZGibson, GerusaKoifman, Sergio
<em>Gibson, Gerusa</em>;
<em>Koifman, Sergio</em>;
<br/><br/>
OBJETIVO: Investigar a tendência temporal da proporção de nascimentos masculinos para o Estado do Paraná no período entre 1994 e 2004 e a correlação dessa tendência com o volume de vendas de agrotóxicos no Estado em 1985. MÉTODO: No presente estudo ecológico, foram empregados como fontes de dados o Instituto Brasileiro de Geografia e Estatística (volume de vendas de agrotóxicos) e o banco DATASUS (nascidos vivos segundo o sexo). Foram analisados 308 municípios, divididos em quartis conforme o consumo de agrotóxicos, resultando em quatro estratos contendo 77 municípios cada um, sendo o quarto quartil o de maior consumo. A proporção de nascimentos masculinos foi obtida ano a ano para cada município e, ao final do período (1994 a 2004), um valor mediano foi calculado para cada uma das localidades. Foi realizada uma análise bivariada e calculados os coeficientes de Pearson para cada quartil de municípios. Uma análise exploratória e comparativa dos quartis foi realizada, na qual se calculou o consumo médio per capita para os mesmos. Posteriormente, foram selecionados e analisados individualmente 10 municípios com intensa atividade agropecuária quanto ao perfil agrícola e à tendência da proporção de nascimentos masculinos ao longo do período de estudo. RESULTADOS: Foi observada uma discreta tendência de declínio na proporção de nascidos vivos do sexo masculino para o Estado como um todo. A magnitude desse declínio foi visivelmente maior quando se analisou individualmente o grupo de 10 municípios, cujos valores observados ao final da série mostraram-se muito abaixo daqueles normalmente descritos na literatura (proporção de nascimentos masculinos < 50%). Em relação aos quartis, todos apresentaram correlação negativa, ainda que sem significância estatística. CONCLUSÕES: A tendência de declínio estatisticamente significativa na proporção de nascimentos masculinos em alguns municípios paranaenses sugere que o fenômeno possa ser decorrente da alta exposição ambiental aos agrotóxicos nessas localidades. Sendo assim, recomendam-se estudos futuros que visem a esclarecer e a dimensionar a força do impacto da contaminação ambiental por agrotóxicos na saúde reprodutiva, representada aqui pela razão de sexos ao nascimento.Culture- and antigen-negative meningitis in Guatemalan childrenS1020-498920080010000042018-01-01T00:02:00Z2018-01-01T00:02:00ZDueger, Erica L.Asturias, Edwin J.Halsey, Neal A.
<em>Dueger, Erica L.</em>;
<em>Asturias, Edwin J.</em>;
<em>Halsey, Neal A.</em>;
<br/><br/>
OBJECTIVE: To compare children with confirmed bacterial meningitis (CBM) and those with culture- and latex-negative meningitis (CLN). METHODS: Children 1 to 59 months of age admitted to three major referral hospitals in Guatemala City with clinical signs compatible with bacterial infections were evaluated prospectively between 1 October 1996 and 31 December 2005. Bacterial cultures and latex agglutination antigen testing were performed on samples of cerebrospinal fluid (CSF). RESULTS: The case-fatality rate was significantly higher in the 493 children with CBM than in the 528 children with CLN (27.6% and 14.9%, respectively; P < 0.001). Children with CBM were less likely to have received antibiotics and more likely to have seizures, shock, or coma on admission than children with CLN. Among the 182 CBM survivors and 205 CLN survivors studied between October 2000 and December 2005, clinically observed sequelae were present at discharge in a higher percentage of the CBM than of the CLN group (78.6% and 46.8%, respectively; P < 0.0001). CSF glucose < 10 mg/dL, peripheral neutrophils < 2 000 cells/mm³, coma or shock at admission, and concurrent sepsis or pneumonia were risk factors for mortality in children with CBM; only coma or shock at admission predicted mortality in children with CLN. CONCLUSIONS: The high case-fatality and sequelae rates suggest that many children with CLN may have had bacterial meningitis. Estimates based on confirmed meningitis alone underestimate the true vaccine-preventable disease burden. Additional studies to determine etiologies of CLN in this population are indicated.Comparación de tres estrategias de tamizaje para la prevención de la infección perinatal por VIH en Colombia: análisis de decisionesS1020-498920080010000052018-01-01T00:02:00Z2018-01-01T00:02:00ZGómez, Marcela
<em>Gómez, Marcela</em>;
<br/><br/>
OBJETIVO: Comparar mediante un modelo de análisis de decisiones tres estrategias de tamizaje de la infección por el VIH en mujeres embarazadas según su relación costo-efectividad y proponer la más apropiada para el sistema de salud colombiano. MÉTODOS: Estudio económico basado en el análisis mediante árboles de decisión según tres estrategias de tamizaje de la infección por el VIH en mujeres embarazadas: la voluntaria, la universal y la opcional. Se consideró a todas las mujeres colombianas embarazadas sin diagnóstico de infección por el VIH que se presentaban para el parto. Se emplearon los costos médicos directos desde la realización de la prueba hasta un año después del parto, según el Sistema General de Seguridad Social en Salud. Se compararon las razones costo-efectividad y el ahorro de cada estrategia analizada. RESULTADOS: Por cada 10 000 mujeres, la estrategia universal permitió detectar 5 casos más que la estrategia voluntaria y 7 casos más que la opcional. La estrategia universal generó costos aproximados de US$ 17,00 por cada recién nacido positivo, es decir, menos de la mitad que lo calculado para la estrategia voluntaria (US$ 38,00) y menor que para la opcional (US$ 24,00). Según el análisis bifactorial, la estrategia de tamizaje universal fue menos costosa que la voluntaria y más efectiva que las otras dos estrategias, independientemente de la prevalencia, la tasa de positivos falsos del sistema de diagnóstico empleado y la tasa de aceptación materna para realizarse la prueba de tamizaje. CONCLUSIONES: La estrategia de tamizaje voluntaria, que se utiliza actualmente en Colombia, es más costosa que la universal a mediano y largo plazos y tiene menor efectividad y capacidad de prevención. Se recomienda a las autoridades nacionales de salud realizar el tamizaje de la infección por el VIH a todas las embarazadas colombianas con pruebas de tercera generación.Knowledge and practices of medical students to prevent tuberculosis transmission in Rio de Janeiro, BrazilS1020-498920080010000062018-01-01T00:02:00Z2018-01-01T00:02:00ZTeixeira, Eleny GuimarãesMenzies, DickCunha, Antonio Jose Ledo AlvesLuiz, Ronir RaggioRuffino-Netto, AntonioScartozzoni, Marcio SamaraPortela, PolianaTrajman, Anete
<em>Teixeira, Eleny Guimarães</em>;
<em>Menzies, Dick</em>;
<em>Cunha, Antonio Jose Ledo Alves</em>;
<em>Luiz, Ronir Raggio</em>;
<em>Ruffino-Netto, Antonio</em>;
<em>Scartozzoni, Marcio Samara</em>;
<em>Portela, Poliana</em>;
<em>Trajman, Anete</em>;
<br/><br/>
OBJECTIVES: To describe knowledge, practices, and associated factors of medical students to prevent transmission of tuberculosis (TB) in five medical schools. METHODS: Cross-sectional survey of undergraduate medical students in preclinical and in early and late clinical years. Information was obtained on sociodemographic profile, previous lectures on TB, knowledge about TB transmission, exposure to patients with active pulmonary TB, and use of respiratory protective masks. RESULTS: Among 1 094 respondents, 575 (52.6%) correctly answered that coughing, speaking, and sneezing can transmit TB. Early [adjusted odds ratio = 4.0 (3.0, 5.5)] and late [adjusted odds ratio = 4.2 (3.1, 5.8)] clinical years were associated with correct answers, but having had previous lectures on TB was not. Among those who had previous lectures on TB, the rate of correct answers increased from 42.1% to 61.6%. Among 332 medical students who reported exposure to TB patients, 194 (58.4%) had not used protective masks. More years of clinical experience was associated with the use of masks [adjusted odds ratio = 2.9 (1.4, 6.1)], while knowledge was inversely associated with the use of masks [adjusted odds ratio = 0.4 (0.2, 0.6)]. CONCLUSIONS: Many medical students are not aware of the main routes of TB infection, and lectures on TB are not sufficient to change knowledge and practices. Regardless of knowledge about TB transmission, students engage in risky behaviors: more than two-thirds do not use a protective mask when examining an active TB case. We suggest innovative, effective active learning experiences to change this scenario.Male midwives: preferred managers of sexually transmitted infections in men in developing countries?S1020-498920080010000072018-01-01T00:02:00Z2018-01-01T00:02:00ZHsieh, Evelyn J.García, Patricia J.La Rosa Roca, Sayda
<em>Hsieh, Evelyn J.</em>;
<em>García, Patricia J.</em>;
<em>La Rosa Roca, Sayda</em>;
<br/><br/>
OBJECTIVES: To describe demographic and practice characteristics of male and female midwives in private practice (MIPPs) in 10 cities of Peru, and their role in the delivery of reproductive health care, specifically management of sexually transmitted infections (STIs). METHODS: As part of an intervention trial in 10 cities in the provinces of Peru designed to improve STI management, detailed information was collected regarding the number of midwives in each city working in various types of practices. A door-to-door survey of all medical offices and institutions in each city was conducted. Each MIPP encountered was asked to answer a questionnaire regarding demographics, training, practice type(s), number of STI cases seen per month, and average earnings per consultation. RESULTS: Of the 905 midwives surveyed, 442 reported having a private practice, either exclusively or concurrently with other clinical positions; 99.3% of these MIPPs reported managing STI cases. Andean cities had the highest density of MIPPs, followed by jungle and coastal cities, respectively. Jungle cities had the largest proportion of male MIPPs (35.5%). While both male and female MIPPs reported seeing male patients, male MIPPs saw a significantly greater number than their female counterparts. CONCLUSIONS: In areas of Peru where physicians are scarce, MIPPs provide needed reproductive health services, including STI management. Male MIPPs in particular appear to serve as health care providers for male patients with STIs. This trend, which may exist in other developing countries with similar healthcare workforce demographics, highlights the need for new areas of training and health services research.Principales marcos conceptuales aplicados para la evaluación de la salud ambiental mediante indicadores en América Latina y el CaribeS1020-498920080010000082018-01-01T00:02:00Z2018-01-01T00:02:00ZSchütz, GabrielHacon, SandraSilva, HiltonMoreno Sánchez, Ana RosaNagatani, Kakuko
<em>Schütz, Gabriel</em>;
<em>Hacon, Sandra</em>;
<em>Silva, Hilton</em>;
<em>Moreno Sánchez, Ana Rosa</em>;
<em>Nagatani, Kakuko</em>;
<br/><br/>
La construcción de indicadores de salud ambiental para evaluar el efecto adverso de los cambios ambientales sobre el bienestar y la calidad de vida de la población es una meta todavía no alcanzada totalmente en América Latina y el Caribe. Por ello, el Programa de las Naciones Unidas para el Medio Ambiente y la Organización Panamericana de la Salud han convocado a instituciones y especialistas de toda la Región para desarrollar un método integral de evaluación del medio ambiente y la salud. En este trabajo se hace un análisis crítico de varias de las metodologías de evaluación ambiental y sanitaria (integrales o no) y se describen, desde una perspectiva histórica, los marcos conceptuales que fundamentan los principales métodos ordenadores o generadores de indicadores de salud ambiental utilizados en América Latina y el Caribe. Se identificaron dos limitaciones metodológicas recurrentes: a) la fuerte dependencia de datos secundarios, lo que implica la necesidad de una capacidad tecnológica instalada poco accesible en América Latina y el Caribe en la actualidad; y b) la falta de criterios claros para desarrollar instrumentos participativos que faciliten la evaluación de problemas de salud ambiental a nivel local. A pesar de los avances alcanzados en el campo de la salud ambiental en cuanto a la comprensión de su complejidad interdisciplinaria, aún se deben mejorar los mecanismos intersectoriales que favorezcan la discusión e implementación de políticas integradas de medio ambiente y salud.Relación costo-efectividad de la vacunación de adultos mayores contra la influenzaS1020-498920080010000092018-01-01T00:02:00Z2018-01-01T00:02:00ZPerspectivas actuales en la asistencia sanitaria al adulto mayorS1020-498920080010000102018-01-01T00:02:00Z2018-01-01T00:02:00ZRomero Cabrera, Angel Julio
<em>Romero Cabrera, Angel Julio</em>;
<br/><br/>
LettersS1020-498920080010000112018-01-01T00:02:00Z2018-01-01T00:02:00ZDavid W, Brown
<em>David W, Brown</em>;
<br/><br/>