Revista Panamericana de Salud Públicahttps://scielosp.org/feed/rpsp/2014.v36n2/2018-01-01T00:02:00ZVol. 36 No. 2 - 2014WerkzeugCan the Perinatal Information System in Peru be used to measure the proportion of adverse birth outcomes attributable to maternal syphilis infection?S1020-498920140007000012018-01-01T00:02:00Z2018-01-01T00:02:00ZBradley, HeatherTapia, VilmaKamb, Mary L.Newman, Lori M.Garcia, Patricia J.Serruya, Suzanne J.Fort, Alfredo L.Broutet, NathalieNelson, RobertKirkcaldy, Robert D.Gonzales, Gustavo F.
<em>Bradley, Heather</em>;
<em>Tapia, Vilma</em>;
<em>Kamb, Mary L.</em>;
<em>Newman, Lori M.</em>;
<em>Garcia, Patricia J.</em>;
<em>Serruya, Suzanne J.</em>;
<em>Fort, Alfredo L.</em>;
<em>Broutet, Nathalie</em>;
<em>Nelson, Robert</em>;
<em>Kirkcaldy, Robert D.</em>;
<em>Gonzales, Gustavo F.</em>;
<br/><br/>
OBJECTIVE: To describe the capacity of Peru's Perinatal Information System (Sistema Informático Perinatal, SIP) to provide estimates for monitoring the proportion of stillbirths and other adverse birth outcomes attributable to maternal syphilis. METHODS: A descriptive study was conducted to assess the quality and completeness of SIP data from six Peruvian public hospitals that used the SIP continuously from 2000 - 2010 and had maternal syphilis prevalence of at least 0.5% during that period. In-depth interviews were conducted with Peruvian stakeholders about their experiences using the SIP. RESULTS: Information was found on 123 575 births from 2000 - 2010 and syphilis test results were available for 99 840 births. Among those 99 840 births, there were 1 075 maternal syphilis infections (1.1%) and 619 stillbirths (0.62%). Among women with syphilis infection in pregnancy, 1.7% had a stillbirth, compared to 0.6% of women without syphilis infection. Much of the information needed to estimate the proportion of stillbirths attributable to maternal syphilis was available in the SIP, with the exception of syphilis treatment information, which was not collected. However, SIP data collection is complex and time-consuming for clinicians. Data were unlinked across hospitals and not routinely used or quality-checked. Despite these limitations, the SIP data examined were complete and valid; in 98% of records, information on whether or not the infant was stillborn was the same in both the SIP and clinical charts. Nearly 89% of women had the same syphilis test result in clinical charts and the SIP. CONCLUSIONS: The large number of syphilis infections reported in Peru's SIP and the ability to link maternal characteristics to newborn outcomes make the system potentially useful for monitoring the proportion of stillbirths attributable to congenital syphilis in Peru. To ensure good data quality and sustainability of Peru's SIP, data collection should be simplified and information should be continually quality-checked and used for the benefit of participating facilities.Patrones de prescripción de hormonas tiroideas en una población colombianaS1020-498920140007000022018-01-01T00:02:00Z2018-01-01T00:02:00ZMachado-Alba, JorgeValencia-Marulanda, JhonJiménez-Canizales, CarlosSalazar, VictoriaRomero, Diego
<em>Machado-Alba, Jorge</em>;
<em>Valencia-Marulanda, Jhon</em>;
<em>Jiménez-Canizales, Carlos</em>;
<em>Salazar, Victoria</em>;
<em>Romero, Diego</em>;
<br/><br/>
OBJETIVO: Determinar los patrones de prescripción de hormonas tiroideas en personas afiliadas al Sistema General de Seguridad Social en Salud de Colombia. MÉTODOS: Estudio descriptivo a partir de una base de datos poblacional de 6,2 millones de personas. Se seleccionaron los pacientes medicados con hormonas tiroideas, de uno y otro sexo y todas las edades, con tratamiento continuo de abril a junio de 2013. Se diseñó una base de datos sobre consumo de medicamentos, obtenidos por la empresa que dispensa dichos fármacos. RESULTADOS: Se hallaron 29 947 pacientes tratados para hipotiroidismo en 82 ciudades colombianas. La mayoría (79,1%) eran mujeres, con una edad media de 63,2 ± 16,1 años. La presentación prescrita con mayor frecuencia fue levotiroxina en tabletas de 50 µg (85,7%) a dosis diarias definidas mayores de las recomendadas, sobre todo como monoterapia. Se detectaron diferencias significativas entre los grupos etarios y las ciudades de residencia para el uso combinado de hormona tiroidea y de comedicación. Los medicamentos prescritos de manera concomitante con mayor frecuencia fueron los antiulcerosos (44%), hipoglucemiantes (17,4%) y sales de hierro (16,1%). CONCLUSIONES: Existen diferencias significativas en las recetas de los médicos en las ciudades estudiadas. Hacen falta guías de manejo clínico que estandaricen las dosis y conductas médicas, pues es probable que su ausencia tenga impacto en la salud de los pacientes. Es necesario explorar la efectividad clínica de las prescripciones estudiadas.Satisfação dos usuários hipertensos com os serviços da rede de atenção primária no Brasil: um estudo de validaçãoS1020-498920140007000032018-01-01T00:02:00Z2018-01-01T00:02:00ZPaes, Neir AntunesSilva, Christiana SoutoFigueiredo, Tânia Maria Ribeiro Monteiro deCardoso, Maria Aparecida AlvesLima, Joab de Oliveira
<em>Paes, Neir Antunes</em>;
<em>Silva, Christiana Souto</em>;
<em>Figueiredo, Tânia Maria Ribeiro Monteiro De</em>;
<em>Cardoso, Maria Aparecida Alves</em>;
<em>Lima, Joab De Oliveira</em>;
<br/><br/>
OBJETIVO: Validar um instrumento para avaliar o grau de satisfação de hipertensos adultos com o controle da hipertensão no contexto da atenção primária à saúde no Brasil. MÉTODOS: O estudo foi realizado em 2009 em dois municípios do Nordeste do Brasil. Realizou-se uma seleção probabilística 725 de indivíduos adultos cadastrados no programa de controle de hipertensos do Ministério da Saúde (Hiperdia). Inicialmente, foram formuladas 65 perguntas com respostas em escala tipo Likert, norteadas pela Primary Care Assessment Tool (PCATool), reunidas em oito dimensões da atenção primária à saúde (saúde do caso confirmado de hipertensão, acesso ao diagnóstico, acesso ao tratamento, adesão/vínculo, elenco de serviços, coordenação, enfoque na família e orientação para a comunidade). O processo de validação do instrumento envolveu: consulta a especialistas, validação da escala tipo Likert, análise fatorial exploratória, análise de consistência interna e análise fatorial confirmatória. RESULTADOS: Quarenta e cinco perguntas que satisfizeram todos os critérios foram confirmadas e utilizadas para compor os fatores definitivos. O estudo de validação do instrumento mostrou uma elevada consistência interna em seu conjunto (a de Cronbach = 91,5%) e em cada uma das oito dimensões (> 70%). Todos os indicativos de confiabilidade e de validade diagnosticados neste estudo mostram que a avaliação do nível de satisfação dos usuários hipertensos medida pelo instrumento é válida e confiável. CONCLUSÕES: O instrumento pode ser reproduzido e utilizado com usuários hipertensos adultos da rede de atenção primária em outras partes do Brasil.Orphans of the Mexican drug war: insights on a public health challengeS1020-498920140007000042018-01-01T00:02:00Z2018-01-01T00:02:00ZCamacho, SalvadorHorstick, OlafSax, Sylvia
<em>Camacho, Salvador</em>;
<em>Horstick, Olaf</em>;
<em>Sax, Sylvia</em>;
<br/><br/>
OBJECTIVE: To describe how the Government of Mexico and other direct stakeholders perceive children orphaned by the drug war; to determine the current measures addressing this as a public health problem; and to compare these measures to international frameworks so that relevant recommendations can be identified. METHODS: This was an exploratory, descriptive case study using qualitative methods. Semi-structured interviews were performed with key informants at the federal, state, and municipal government levels in Mexico, as well as non-governmental organizations, and other institutes working with orphans. Participants were identified with a purposive snowball sample. RESULTS: No official definition of "orphan" was identified; nor was there a shared perception among the key informants of what constitutes being an orphan. An official, collective definition is important because it modifies the quantity of children categorized as such within the target population. Although most of the interviewees perceive that the number of orphans and vulnerable children (OVC) has increased in the last 6 years, they acknowledged there is no reliable data to prove it. The increase, they believe, is due not to the drug war, but to a loss of family cohesion. Stakeholders recommend improving public policies, currently identified as the most difficult barrier to overcome due to a perceived inability to modify existing laws. However, the General Law for Victims was recently passed by the Government of Mexico and addresses many of the challenges identified. CONCLUSIONS: When compared to the international frameworks, there are three major issues in Mexico's current situation: coordination among and within stakeholders; emphasis on using community solutions; and putting in place preventive programs. For two of these problems, the General Law of Victims offers solutions.Human respiratory syncytial virus and metapneumovirus in patients with acute respiratory infection in Colombia, 2000 - 2011S1020-498920140007000052018-01-01T00:02:00Z2018-01-01T00:02:00ZBarbosa Ramirez, JulianaPulido Dominguez, PaolaRey Benito, GloriaMendez Rico, JairoCastellanos, JaimePáez Martinez, Andrés
<em>Barbosa Ramirez, Juliana</em>;
<em>Pulido Dominguez, Paola</em>;
<em>Rey Benito, Gloria</em>;
<em>Mendez Rico, Jairo</em>;
<em>Castellanos, Jaime</em>;
<em>Páez Martinez, Andrés</em>;
<br/><br/>
OBJECTIVE: To describe the epidemiology of respiratory syncytial virus (RSV) and human metapneumovirus (hMPV) in Colombia from 2000 - 2011, including seasonal trends. METHODS: Nasopharyngeal aspirates and/or throat swabs from 14 870 patients with acute respiratory infections (ARI) were studied. Two subgroups were analyzed using molecular biology techniques. The first consisted of 264 RSV indirect fluorescence assay (IFA)-positive samples, the second of 264 RSV IFA-negative samples. RSV and hMPV were detected using reverse transcription polymerase chain reaction (RT-PCR). RESULTS: 2 799 samples (18.8%) contained a respiratory virus. RSV was detected by IFA in 1 333 samples (8.9%). RSV was detected by RT-PCR in 192 samples from the RSV IFA-positive subgroup and in 25 samples from the RSV IFA-negative subgroup. hMPV was detected in eight samples from the RSV IFA-positive subgroup and in 11 samples from the RSV IFA-negative subgroup. Among the RSV infections, subtype A was dominant in two-year intervals, subtype B was dominant in one-year intervals. 85.3% of RSV and 74% of hMPV infections occurred in children younger than 5 years old. RSV and hMPV infections were associated with rainy seasons. Co-infection with RSV A and RSV B was detected in two patients. Five cases of co-infection with RSV and hMPV were detected. CONCLUSIONS: This report is the first to examine the epidemiology of ARIs in Colombia, with an emphasis on RSV and hMPV. The samples studied here were obtained over a 12-year period and represent all age groups and both genders.Diagnostic accuracy of hemoglobin for iron deficiency in pregnancy: disclosing results of a cited clinical trialS1020-498920140007000062018-01-01T00:02:00Z2018-01-01T00:02:00ZSalvi, Cristiane C. BresaniBraga, Maria CynthiaBatista Filho, Malaquias
<em>Salvi, Cristiane C. Bresani</em>;
<em>Braga, Maria Cynthia</em>;
<em>Batista Filho, Malaquias</em>;
<br/><br/>
OBJECTIVE: To analyze the accuracy of hemoglobin (Hb) concentrations as a diagnostic indicator of iron deficiency in pregnant women and to measure the efficacy of oral iron therapy using Hb z-scores rather than Hb absolute values. METHODS: The sensitivity and specificity of Hb < 11.0 g/dL, and its receiver operating characteristic (ROC) curve, in the diagnosis of iron deficiency (serum ferritin (SF) < 12.0 ng/mL) were determined in 318 women in their second trimester of pregnancy who had been screened for a clinical trial conducted in 2001 in Northeast Brazil. A secondary analysis of iron therapy efficacy was carried out using data from the trial's three different treatments (60 mg of oral iron once per week (n = 46), twice per week (n = 50), and once per day (n = 44)). The mean differences between post- and pre-treatment Hb absolute values (g/dL) and z-scores (standard deviation (SD)) were calculated for the three treatment groups for study participants with and without iron deficiency. RESULTS: Hb sensitivity, specificity, and area under the ROC curve were 60.7%, 44.3%, and 0.54 respectively. Women without iron deficiency showed improvements in Hb absolute values (as in the clinical trial's overall results) but did not have improved Hb z-scores (with scores of - 0.6 SD (95% confidence interval (CI): - 0.99, - 0.28); - 0.2 SD (95% CI: - 0.47, 0.08); and - 0.1 SD (95% CI: - 0.33, 0.18) for weekly, twice-per-week, and daily iron treatment schemes respectively). In contrast, iron-deficient women treated with the intermittent schemes had reductions in both Hb absolute values and Hb z-scores, respectively: weekly = - 0.42 g/dL (95% CI: - 0.72, - 0.12) and - 1.4 SD (95% CI: - 1.74, - 0.99); twice per week = - 0.14 g/dL (95% CI: - 0.46, 0.17) and - 1.1 SD (95% CI: - 1.44, - 0.75). CONCLUSIONS: These analyses revealed that Hb concentrations were not an accurate indicator of either iron needs or iron-therapy response in pregnant women.Situações com potencialidade para atuação da fisioterapia na atenção básica no Sul do BrasilS1020-498920140007000072018-01-01T00:02:00Z2018-01-01T00:02:00ZRibeiro, Cristina DutraSoares, Maria Cristina Flores
<em>Ribeiro, Cristina Dutra</em>;
<em>Soares, Maria Cristina Flores</em>;
<br/><br/>
OBJETIVO: Identificar situações com potencialidade para atuação da fisioterapia em uma área de abrangência da Estratégia Saúde da Família no Sul do Brasil. MÉTODOS: Neste estudo transversal, foram visitados 629 domicílios e coletadas informações sobre 2 316 pessoas através de um instrumento semiestruturado que investigou a existência de agravos à saúde com potencialidade para atuação da fisioterapia (diabetes, hipertensão arterial, doenças osteomusculares, doenças neurológicas, doenças respiratórias em adultos e crianças). Na presença desses agravos, investigamos se as famílias ou pacientes haviam recebido orientação para melhora da qualidade de vida e qual profissional havia fornecido essas informações. Finalmente, investigamos se os entrevistados conheciam o atendimento fisioterapêutico e a demanda por esse tipo de atendimento ao longo da vida e nos últimos 12 meses. RESULTADOS: Nas 629 famílias investigadas, foram referidos os seguintes agravos: diabetes (11,9%), hipertensão (46,9%), doenças osteomusculares (36,7%), doenças neurológicas (3,4%), doenças respiratórias em adultos (18,9%) e crianças (15,7%) e atraso do desenvolvimento neuropsicomotor (DNPM) (3,8%). O recebimento de orientações específicas foi referido por 57,3% dos diabéticos, 64,1% dos hipertensos, 39,8% dos portadores de doenças osteomusculares, 45,5% dos doentes neurológicos, 26,9% dos adultos e 60,6% das crianças com doenças respiratórias e 62,5% das crianças com atraso do DNPM. Em relação ao conhecimento sobre a profissão, 92,4% já tinham ouvido falar em fisioterapia. Desses, 41,0% relataram ter necessitado fisioterapia alguma vez na vida, sendo a maioria (54,4%) para patologias traumato-ortopédicas. CONCLUSÕES: Os resultados respaldam a necessidade de inserção do fisioterapeuta na equipe da Estratégia Saúde da Família.Systematic review of risk factors for suicide and suicide attempt among psychiatric patients in Latin America and CaribbeanS1020-498920140007000082018-01-01T00:02:00Z2018-01-01T00:02:00ZTeti, Germán L.Rebok, FedericoRojas, Sasha M.Grendas, LeandroDaray, Federico M.
<em>Teti, Germán L.</em>;
<em>Rebok, Federico</em>;
<em>Rojas, Sasha M.</em>;
<em>Grendas, Leandro</em>;
<em>Daray, Federico M.</em>;
<br/><br/>
OBJECTIVE: To analyze published evidence from the Latin America and Caribbean (LAC) region pertaining to risk factors for completed suicide and suicide attempts among psychiatric populations. METHODS: Potential studies were identified through systematic electronic searches in MEDLINE and LILACS. Included studies were cohort, case-control, and cross-sectional designed investigations of psychiatric samples in which suicide or a suicide attempt was reported as an outcome and evaluated with some measure of impact (odds ratio, risk ratio, or hazard ratio). Methodological quality was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) recommendations. RESULTS: Of the 2 987 identified studies, a total of 17 studies were reviewed to determine potential suicidal risk factors. Eleven studies used a case-control design, five used a cross-sectional design, and only one study used a prospective-cohort design. The main risk factors for suicide attempts in LAC included major depressive disorder (MDD), family dysfunction, and prior suicide attempt, while the main risk factors for completed suicide were male gender and MDD. The methodological quality of most of the studies was low. CONCLUSIONS: This review provides evidence that the majority of relevant risk factors for suicide and suicide attempts in the LAC region are similar to those observed in Western societies but different from those reported in Eastern societies. Studies of higher methodological quality from the region are needed to support these results.Abordagem do desvio positivo para a mudança de comportamento alimentar: revisão sistemáticaS1020-498920140007000092018-01-01T00:02:00Z2018-01-01T00:02:00ZMachado, Juliana CostaCotta, Rosângela Minardi MitreSilva, Luciana Saraiva da
<em>Machado, Juliana Costa</em>;
<em>Cotta, Rosângela Minardi Mitre</em>;
<em>Silva, Luciana Saraiva Da</em>;
<br/><br/>
OBJETIVO: Realizar uma revisão sistemática da literatura sobre a utilização do método do desvio positivo para promover a mudança de comportamento alimentar, a fim de identificar as potencialidades desse método para a educação em saúde e nutrição. MÉTODOS: As bases acessadas foram: Biblioteca Cochrane, LILACS, MEDLINE, SciELO, PubMed e Scopus. Os descritores utilizados para a busca foram: positive deviance, desvio positivo, positive deviance inquiry e positive deviants. Os critérios de inclusão foram presença de dados originais, metodologia claramente definida e textos disponíveis na íntegra. Os estudos selecionados tiveram seus principais resultados descritos e analisados através de critérios psicossociais (condições socioeconômicas e de saúde, hábitos de higiene e alimentares), antropométricos (peso, altura), bioquímicos e clínicos (presença de morbidades e exames bioquímicos) para determinar as potencialidades e limitações do desvio positivo para mudar o comportamento alimentar. RESULTADOS: Dos 47 estudos identificados, nove atenderam os critérios de inclusão. Os objetivos descritos da aplicação do desvio positivo foram: prevenção e reabilitação da desnutrição materna e infantil em áreas de vulnerabilidade socioeconômica e tratamento do sobrepeso e obesidade em adultos. A melhoria de indicadores de nutrição materno-infantil e a sustentabilidade de comportamentos benéficos destacaram-se como potencialidades do desvio positivo. CONCLUSÕES: O desvio positivo pode contribuir para promover mudanças no comportamento alimentar com vistas à reversão de quadros de desnutrição infantil, bem como de sobrepeso e obesidade em adultos. O desvio positivo parece ser eficaz para promover educação em saúde em áreas de vulnerabilidade socioeconômica.Environmental health in Peru: outdoor and indoor air contaminationS1020-498920140007000102018-01-01T00:02:00Z2018-01-01T00:02:00ZGonzales, Gustavo F.Steenland, Kyle
<em>Gonzales, Gustavo F.</em>;
<em>Steenland, Kyle</em>;
<br/><br/>
Vasectomy and prostate cancer: the controversy reignitedS1020-498920140007000112018-01-01T00:02:00Z2018-01-01T00:02:00ZAiken, William DervalDaCosta, Vernon Eric
<em>Aiken, William Derval</em>;
<em>Dacosta, Vernon Eric</em>;
<br/><br/>