Resumo em Espanhol:

OBJETIVO: Identificar los factores asociados con la dependencia funcional de los adultos mayores para realizar actividades básicas de la vida diaria (ABVD) y actividades instrumentales de la vida diaria (AIVD). MÉTODO: Estudio transversal de la información obtenida en la primera vuelta del Estudio Nacional sobre Salud y Envejecimiento en México (ENASEM) en 2001. La muestra estuvo compuesta por 7 171 personas de 60 años o más. Mediante el análisis de regresión logística multifactorial se analizó la asociación de la dependencia funcional para realizar ABVD y AIVD con los hábitos de vida y los antecedentes personales sociales, familiares y de salud desde la infancia de los participantes. RESULTADOS: La edad promedio fue de 69,4 ± 7,6 años (de 60 a 105 años); 53,4% eran mujeres. Los grupos de dependientes para realizar ABVD y AIVD tenían en promedio mayor edad (P < 0,01), en él predominaban las mujeres (P < 0,01) y había más personas analfabetas y que declararon haber tenido un número significativamente mayor de enfermedades crónicas y haber sufrido dolor con mayor frecuencia en los grupos de personas independientes (P < 0,01). Entre los 521 (7,3%) dependientes para realizar ABVD se observó una mayor proporción de personas sin pareja (P < 0,01), viudos (P < 0,01) y con una peor percepción de su salud que entre los independientes (P < 0,01). Seiscientos tres (8,4%) de los entrevistados eran dependientes para realizar AIVD. La mayor edad, padecer de enfermedad cerebrovascular, un mayor número de enfermedades crónicas, síntomas depresivos, deficiencia visual, dolores que limitan sus actividades diarias y tener algún miembro amputado resultaron ser factores significativa e independientemente asociados con la dependencia para realizar AIVD. Un menor número de problemas sociales durante la infancia y menos años de trabajo remunerado estuvieron asociados con una menor dependencia para realizar AIVD. CONCLUSIONES: La dependencia funcional en los adultos mayores está directamente relacionada con el envejecimiento y depende de múltiples factores determinantes. El conocimiento de estos factores debe contribuir a diseñar programas de salud que permitan identificar a los individuos en riesgo de perder su autonomía e implementar intervenciones dirigidas a detener o revertir ese proceso.

Resumo em Inglês:

OBJECTIVES: To identify factors associated with dependence for basic activities of daily living (BADL) and instrumental activities of daily living (IADL) in elderly adults in Mexico. METHODS: A cross-sectional study of data from the first round of Mexico’s National Study on Health and Aging, 2001, was undertaken. The sample consisted of 7 171 participants, 60 years of age or older. Multifactorial regression analysis was used to identify associations between BADL and IADL dependence and lifestyle, sociodemographics, family background, and health history, from childhood to present. RESULTS: The mean age of the participants was 69.4 ± 7.6 years of age, with a range of 60-105 years; females made up 53.4% of the sample. The BADL- and IADL-dependent groups had a higher mean age (P < 0.01), were predominantly female (P < 0.01), had a greater incidence of illiteracy, and reported a significantly higher number of chronic diseases and greater frequency of pain than did the independent participants. Among the 521 (7.3%) BADL-dependent, there was a higher percentage who were single or widowed (P < 0.01), and their self-assessed health was poorer, than that of the independent (P < 0.01). Among the 603 (8.4%) IADL-dependent, significant, independently associated factors were age, cerebrovascular and other chronic diseases, depression, vision issues, excessive pain, and amputation of a limb. Absence of childhood trauma and fewer years of employment were related to a lower incidence of IADL dependence. CONCLUSIONS: Functional dependence in older adults is directly related to aging and has multiple determinants. Awareness of these determinants should help design health programs that can identify individuals who are at high risk of losing their independence, and implement interventions for slowing or reversing the process.

Resumo em Espanhol:

OBJETIVOS: Comprender mejor cómo los médicos generales/no especialistas del sector privado atienden y controlan la diabetes en nueve países de América Latina e identificar los principales problemas relacionados con el paciente y el médico, que obstaculizan la atención. MÉTODOS:Se realizó un estudio epidemiológico, multicéntrico, transversal, en nueve países de América Latina: Argentina, Brasil, Chile, Costa Rica, Ecuador, Guatemala, México, Perú y Venezuela. Se pidió a los médicos generales del sector privado la información sobre la atención y el control de sus pacientes de 18 a 75 años de edad con diabetes mellitus tipo 2 (DMT2), así como los datos demográficos, la historia clínica y de medicación, las pruebas de laboratorio e información sobre los retos relacionados con la atención del paciente. RESULTADOS: De los 3 592 cuestionarios de pacientes entregados por 377 médicos, 60% de los pacientes tenían antecedentes familiares de diabetes, 58% seguían una dieta inadecuada, 71% eran sedentarios y 79% presentaban obesidad o sobrepeso. Se observó un inadecuado control glucémico (glucemia en ayunas > 110 mg/dL) en 78% de los pacientes. La proporción de pacientes con HbA1c < 7,0% fue de 43,2%. El control glucémico se redujo significativamente al aumentar la duración de la DMT2. En 86% de los pacientes se encontraron enfermedades concurrentes asociadas con la DMT2; el uso de insulina y las enfermedades concurrentes -especialmente las asociadas con complicaciones microvasculares- incrementaron significativamente la duración de la diabetes. En cuanto al tratamiento de los pacientes, el reto más frecuentemente citado fue garantizar la adhesión a la dieta y al plan de ejercicios recomendados. CONCLUSIONES: Los niveles de glucemia no están suficientemente controlados en los pacientes con DMT2 que se atienden en el sistema privado de salud de América Latina, particularmente en los pacientes que han tenido la enfermedad por más tiempo (> 15 años). Tomado en cuenta las diferencias entre la atención sanitaria privada y la pública en América Latina, especialmente en lo concerniente a la calidad de la atención y el acceso a los medicamentos, se requieren estudios adicionales en el sector público. En general, se necesita un programa más eficiente e intensivo de control de la DMT2 y programas eficaces de educación de los pacientes, ajustados a las realidades de América Latina.

Resumo em Inglês:

OBJECTIVES: To better understand how diabetes care and control are being administered by general practitioners/nonspecialists in private practice in nine countries of Latin America, and to identify the most significant patient- and physician-related barriers to care. METHODS: A multicenter, cross-sectional, epidemiological survey was conducted in nine countries in Latin America: Argentina, Brazil, Chile, Costa Rica, Ecuador, Guatemala, Mexico, Peru, and Venezuela. General practitioners in private practice were asked to provide care and control data for patients 18 to 75 years of age with type 2 diabetes mellitus (T2DM), including demographics, medical and medication history, laboratory exams, and information on the challenges of patient management. RESULTS: Of the 3 592 patient questionnaires returned by 377 physicians, 60% of the patients had a family history of diabetes, 58% followed a poor diet, 71% were sedentary, and 79% were obese or overweight. Poor glycemic control (fasting blood glucose > 110 mg/dL) was observed in 78% of patients. The number of patients with HbA1c < 7.0% was 43.2%. Glycemic control decreased significantly with increased duration of T2DM. Comorbid conditions associated with T2DM were observed in 86% of patients; insulin use and comorbid conditions, especially those associated with microvascular complications, increased significantly disease duration. Ensuring compliance with recommended diet and exercise plans was the most-cited patient management challenge. CONCLUSIONS: Blood glucose levels are undercontrolled in T2DM patients in the private health care system in Latin America, particularly among those who have had the disease the longest (>15 years). Considering the differences between private and public health care in Latin America, especially regarding the quality of care and access to medication, further studies are called for in the public setting. Overall, a more efficient and intensive program of T2DM control is required, including effective patient education programs, adjusted to the realities of Latin America.

Resumo em Português:

OBJETIVO: Traduzir para português brasileiro, adaptar culturalmente e avaliar as propriedades psicométricas, a confiabilidade e a validade do questionário sobre limitações no trabalho (Work Limitations Questionnaire, WLQ). MÉTODOS:O presente estudo transversal e observacional foi realizado no Hospital São Paulo/Escola Paulista de Medicina da Universidade Federal de São Paulo, Brasil. Os dados de 150 indivíduos empregados no momento do estudo foram obtidos utilizando o WLQ, o SF-36 (questionário genérico de avaliação de qualidade de vida) e o SRQ-20 (usado para triagem de transtornos mentais). O WLQ apresenta 25 itens agrupados em quatro domínios: gerência de tempo, demanda física, demanda mental-interpessoal e demanda de produção. Os questionários foram administrados por entrevista para indivíduos sem escolaridade superior completa e auto-administrados para indivíduos com escolaridade superior. A estatística descritiva foi utilizada para caracterizar a amostra. Para avaliar a confiabilidade (consistência interna, teste-reteste e consistência inter e intra-observador), foram calculados o coeficiente de correlação intraclasse e o alfa de Cronbach. O coeficiente de correlação de Pearson foi utilizado para aferir a validade da construção. RESULTADOS: A idade média dos entrevistados (64,7% do sexo feminino) foi de 37,6 ± 9,6 anos. O tempo médio na função ocupada no momento da entrevista foi de 8,6 ± 8,3 anos; 60,7% estavam satisfeitos com o emprego e 94,0% não tinham faltado ao trabalho nas 2 semanas anteriores à coleta. A perda média de produtividade registrada foi de 4,2%. A confiabilidade interobservador foi significativa e alta (entre 0,600 e 0,800) ou muito alta (0,800 a 1,000) em todos os domínios, com exceção de demanda física (r = 0,497, confiabilidade moderada). A confiabilidade intra-observador não foi significativa nos domínios gerência de tempo e demanda física. As correlações significativas encontradas para a confiabilidade intra-observador foram moderadas (r = 0,400 a 0,600). A consistência interna foi muito alta (alfa de Cronbach de 0,800 a 1,000). Observou-se correlação significativa entre gerência de tempo, demanda mental-interpessoal, demanda de produção e o índice do WLQ e todos os domínios do SF-36. Também houve correlação significativa entre os domínios gerência de tempo, demanda mental-interpessoal, demanda de produção e resultado positivo (escore > 7) no questionário SRQ-20. CONCLUSÃO: A versão do WLQ em português brasileiro é uma medida válida e confiável e pode ser útil para medir o impacto de problemas de saúde sobre a produtividade de trabalhadores brasileiros.

Resumo em Inglês:

OBJECTIVES: To translate into Brazilian Portuguese, cross-culturally adapt, and evaluate the psychometric properties, reliability, and validity of the Work Limitations Questionnaire (WLQ). METHODS: This cross-sectional observational study was performed in 2005 and 2006 at the Hospital São Paulo/Escola Paulista de Medicina of the Federal University of São Paulo, Brazil. Data from 150 individuals who were employed at the time of the study were obtained using the WLQ, the SF-36 (a generic quality of life questionnaire), and the SRQ-20 (used to screen for mental disorders). The WLQ has 25 items, which are divided into four domains: time management, physical demands, mental-interpersonal demands, and output demands. The questionnaires were administered as interviews to individuals without a university education, and were self-administered to individuals with a university degree. Descriptive statistics were used to characterize the sample. The intraclass correlation coefficient and Cronbach’s alpha were used to assess reliability (internal consistency, test-retest, interobserver, and intraobserver agreement). The Pearson’s correlation coefficient was used to assess construct validity. RESULTS: The mean age of the subjects was 37.6 years (standard deviation, ± 9.6 years), and 64.7% of the subjects were female. The mean number of years at the job held at the time of the interview was 8.6 (± 8.3 years); 60.7% of the subjects were satisfied with their job, and 94.0% had not missed work in the preceding two weeks. In comparison to completely healthy persons, the mean productivity loss reported by the study subjects was 4.2%. Interobserver agreement was significant and high (0.600 to 0.800) or very high (0.800 to 1.000) in all domains, except physical demands (r = 0.497, moderate agreement). Intraobserver agreement was not significant for the time management and physical demands domains. The correlations associated with intraobserver agreement were moderately significant (0.400 to 0.600). Internal consistency was very high (Cronbach’s alpha = 0.800 to 1.000). There was a significant correlation between all the SF-36 questionnaire domains and the WLQ domains of time management, mental-interpersonal demands, and output demands as well as the WLQ index score. A positive correlation was also found between the WLQ domains of time management, mental-interpersonal demands, and output demands and a positive result (score > 7) on the SRQ-20. CONCLUSIONS: The Brazilian Portuguese version of the WLQ is a reliable and valid scale to assess the impact of health problems on the productivity of Brazilian workers.

Resumo em Espanhol:

OBJETIVOS: En un contexto de pobreza extrema, la infección por Chlamydia trachomatis puede desencadenar el tracoma. Debido a que se desconocen los niveles de infección ocular con C. trachomatis en México, el objetivo de este estudio fue determinar la presencia de C. trachomatis en la conjuntiva de niños de tres zonas rurales pobres de México. MÉTODOS:El diagnóstico clínico de folículos conjuntivales en los niños se llevó a cabo durante la campaña de evaluación de la agudeza visual en áreas rurales de los estados de Chiapas, Oaxaca y Zacatecas en 2004. Para la detección de C. trachomatis se tomaron muestras de los niños con folículos y se analizaron mediante la tinción de Giemsa o microinmunofluorescencia (MIF). RESULTADOS: En total se examinaron 941 niños de 6 a 12 años de edad en 2004. Se observaron folículos en 30% de los 484 niños de Chiapas, en 22% de los 181 de Zacatecas y en 42% de los 276 niños de Oaxaca. Se detectó C. trachomatis en niveles entre 2% y 5%; de los niños con folículos, 4,5% resultaron positivos por Giemsa y 15,5% por MIF. CONCLUSIONES: Estos resultados subestiman el nivel de infección ocular por clamidia, ya que los procedimientos de muestreo y los métodos de detección de clamidia empleados en este estudio no eran los más sensibles, por lo que representan una valoración conservadora del riesgo de trastornos visuales prevenibles. Como los niveles de C. trachomatis encontrados son similares a los informados para áreas de baja endemia de tracoma, las autoridades de salud deben estar listas para implementar medidas apropiadas si se confirmaran los riesgos para la salud visual de los niños mexicanos.

Resumo em Inglês:

OBJECTIVES: Chlamydia trachomatis infections, in the context of extreme poverty, may trigger trachoma. Because the levels of C. trachomatis eye infections in Mexico are unknown, this study sought to determine if C. trachomatis was present in the conjunctiva of children living in three poor, rural areas of the country. METHODS: Clinical diagnosis of conjunctival follicles in children was conducted during the 2004 visual acuity assessment campaigns in rural areas of the states of Chiapas, Oaxaca, and Zacatecas. C. trachomatis detection was carried out by sampling the children with follicles and examining the specimens after Giemsa or microimmunofluorescence (MIF) staining. RESULTS: A total of 941 children from 6 to 12 years of age were examined in 2004. Of the 484 in Chiapas, 30% were found to have follicles; of the 181 in Zacatecas, 22%; and of the 276 in Oaxaca, 42%. C. trachomatis was detected at levels ranging between 2% and 5%; positive by Giemsa in 4.5% of the children with follicles, and by MIF in 15.5%. CONCLUSIONS: Considering that the chlamydiae sampling procedures and detection methods used in this study were not the most sensitive, the results underestimate the chlamydial eye infections and represent a conservative assessment of a potential risk for preventable visual impairment. Because C. trachomatis was detected here at levels similar to those reported for low-endemic trachoma areas, health authorities should be prepared to implement appropriate measures should it be confirmed that the visual health of Mexico’s children is at risk.

Resumo em Espanhol:

OBJETIVO: Determinar las relaciones matemáticas entre tres técnicas cuantitativas empleadas para medir la actividad de la colinesterasa plasmática, a partir de los valores de referencia ya establecidos para dos poblaciones de Antioquia, Colombia. MÉTODOS:Diseño descriptivo, transversal y prospectivo. Se conformaron dos muestras independientes representativas de la población laboral adulta (18-65 años), no expuesta a plaguicidas inhibidores de la colinesterasa y vinculada al Seguro Social, del valle de Aburrá (415 personas) y del cercano oriente antioqueño (412 personas), del departamento de Antioquia, Colombia. La colinesterasa plasmática (EC 3.1.1.8) se midió mediante tres técnicas cuantitativas: Michel, EQM® y Monotest®. Se elaboraron ecuaciones de regresión que relacionaran entre sí los resultados de las tres técnicas estudiadas. RESULTADOS: Se definieron seis ecuaciones de regresión lineal simple que permitieron relacionar los resultados de las tres técnicas de medición de colinesterasa plasmática analizadas. La correlación entre las técnicas fue moderada (r: de 0,686 a 0,771), pero aumentó (r: de 0,744 a 0,811) al eliminar 12 (1,5%) valores extremos. Las asociaciones entre las técnicas fueron altamente significativas (P < 0,001). Las ecuaciones Y = a + bX ajustadas son: EQM (U/mL) = 0,40773 + 1,8757 (Michel [delta pH/hora]); Michel (delta pH/hora) = 0,25799 + 0,33871 (EQM [U/mL]); Monotest (U/L) = 462,0 + 4 565,0 (Michel [delta pH/hora]); Michel (delta pH/hora) = 0,42956 + 0,00012125 (Monotest [U/L]); EQM (U/mL) = 0,75333 + 0,00031056 (Monotest [U/L]); y Monotest (U/L) = 262,0 + 2 118,0 (EQM [U/mL]). CONCLUSIONES: Los modelos propuestos permiten convertir los valores de actividad de la colinesterasa medida con las tres técnicas estudiadas.

Resumo em Inglês:

OBJECTIVES: To determine mathematical correlations of three quantitative techniques to measure plasma cholinesterase, using reference values already established for two populations in the department of Antioquia, Colombia. METHODS: In this descriptive, cross-sectional, prospective study, two independent, representative samples of working adults (18 to 65 years old) were examined. In both samples the adults worked for businesses associated with Colombia’s Social Security system. Adults in the two samples had not been exposed to cholinesterase-inhibiting pesticides. The samples were from two neighboring regions of the department of Antioquia: one sample (415 adults) was from the Aburrá Valley, and the other (412 adults) was from Oriente Antioqueño (Eastern Antioquia). Plasma cholinesterase (EC 3.1.1.8) was measured using three quantitative methods: Michel, EQM, and Monotest. Linear regression equations were developed to correlate results of these three techniques. RESULTS: Six simple linear regression equations were defined to show the relationship of three measurement techniques for plasma cholinesterase. There was a moderate correlation of the three techniques (r = 0.686 to 0.771), but it increased (r = 0.744 to 0.811) when 12 (1.5%) outliers were eliminated. Associations among the three techniques were highly significant (P < 0.001). The adjusted equations for Y = a + bX are: EQM (U/mL) = 0.40773 + 1.8757 (Michel [delta pH/h]); Michel (delta pH/h) = 0.25799 + 0.33871 (EQM [U/mL]); Monotest (U/L) = 462.0 + 4 565.0 (Michel [delta pH/h]); Michel (delta pH/h) = 0.42956 + 0.00012125 (Monotest [U/L]); EQM (U/mL) = 0.75333 + 0.00031056 (Monotest [U/L]); and Monotest (U/L) = 262.0 + 2 118.0 (EQM [U/mL]). CONCLUSIONS: The proposed mathematical models allow conversion of cholinesterase activity values using the Michel, EQM, and Monotest techniques. These models can be of assistance in Colombia and other countries where a variety of measurement techniques are used, and where it becomes difficult to compare the results of different studies. Having mathematical models available for conversion of established values can be beneficial whether for clinical or epidemiological purposes.

Resumo em Espanhol:

OBJETIVOS: Las tendencias demográficas actuales subrayan la necesidad de comprender los retos de salud que enfrentan los adultos mayores de América Latina. En este estudio se examina si la selección del proveedor de atención sanitaria y los ingresos del hogar influyen en el nivel de utilización y de salud de los adultos mayores en Brasil. MÉTODOS:Se empleó un modelo estructural con una muestra tomada en 1995 en el sur de Brasil, para estimar los parámetros de una función que represente la selección del proveedor de atención sanitaria, controlada por la utilización de los servicios de salud y una función de producción de salud. La variable dependiente para la función de producción fue el autoinforme de salud. Estas dos funciones se relacionaron estructuralmente mediante la probabilidad de escoger un proveedor privado sobre uno público en la función de producción de salud, introducida como variable explicativa adicional. Con este vínculo estructural, la función de producción estableció en qué grado influyó en el estado de salud la selección de un proveedor privado frente a uno público, controlado por la posibilidad de que las personas con peor salud tengan la tendencia de preferir uno u otro tipo de proveedor de atención sanitaria. RESULTADOS: La utilización de los servicios de salud por parte de los adultos mayores se vio limitada por dos factores: el número de proveedores en el municipio y los ingresos del hogar. Los adultos mayores que viven en municipios con un mayor número de proveedores y clínicas ambulatorias públicos mostraron una mayor probabilidad de utilizar el sistema público. Los pacientes que utilizaron el sistema público de atención sanitaria consideraron peor su estado de salud que los que utilizaron el sistema privado. Este resultado no varió después de controlar por las variables demográficas y la morbilidad. CONCLUSIONES: El sistema público de salud de Brasil no responde adecuadamente a las necesidades de salud de los adultos mayores. Entre las recomendaciones de políticas se encuentran invertir más en la infraestructura de los servicios públicos de salud, implementar el Plan Nacional para la Salud de los Adultos Mayores en su totalidad y desarrollar nuevos programas para lograr consultas geriátricas eficacientes en el nivel primario de salud.

Resumo em Inglês:

OBJECTIVES: Current demographic trends point to the need for understanding the health challenges facing the elderly in Latin America today. This study assessed whether health care provider choice and household income impact utilization and health among the elderly in Brazil. METHODS: Using a sample taken in 1995 in southern Brazil, a structural model was used to estimate the parameters of a function that represents the choice of health care provider, controlled for health care services utilization and a health production function. The dependent variable for the production function was self-assessed health. These two functions were structurally linked by introducing the probability of choosing a private over a public provider in the health production function as an added explanatory variable. With this structural linkage, the production function assessed how much the selection of a public versus a private provider affects health, while controlling for the possibility that individuals with poorer health have a tendency to prefer one or other health care provider. RESULTS: Health care services utilization by the elderly was constrained by two factors: the number of providers at the municipality level and household income. The elderly who live in municipalities with a greater number of public, outpatient clinics and providers were more likely to use the public system. Patients who used the public health care system had lower self-assessed health status than those using the private system. This result is valid even after controlling for demographic variables and morbidity. CONCLUSIONS: Brazil’s public health system does not adequately provide for the health needs of the elderly population. Policy recommendations include further investments in the public health care infrastructure, full implementation of the National Plan for Elderly Health, and developing new programs for effective geriatric consultations at the primary care level.

Resumo em Português:

OBJETIVO: Avaliar o efeito da suplementação com retinil palmitato sobre os níveis de retinol no colostro, investigando a influência de variáveis maternas (idade, tipo de parto e estado nutricional bioquímico) sobre esses níveis. MÉTODO:Participaram do estudo 33 nutrizes atendidas na Maternidade Escola Januário Cicco, Estado do Rio Grande do Norte, Brasil. Foram coletadas, nas primeiras horas após o parto, uma amostra de sangue e uma de colostro. Uma nova amostra de colostro foi coletada 6 horas após suplementação materna com 200 000 UI de retinil palmitato. O retinol no sangue e colostro foi determinado por cromatografia líquida de alta eficiência. RESULTADOS: Os níveis médios de retinol no colostro antes da suplementação foram de 110,8 ± 82,3 µg/dL, tendo atingido 164,4 ± 106,5 µg/dL após a suplementação (P < 0,025). Doze puérperas não responderam à suplementação ou tiveram um aumento inferior a 10% nos níveis de retinol no colostro; o nível de retinol sérico dessas mulheres foi significativamente mais baixo do que o daquelas que responderam à suplementação (P = 0,024). Puérperas com parto cesáreo (64%) tiveram níveis menores de retinol no soro (P = 0,036), mas não no leite, em comparação a mulheres com parto normal. A idade não influenciou os níveis de retinol, nem no soro nem no leite. CONCLUSÕES: A suplementação com retinil palmitato foi eficaz na elevação dos níveis de retinol no colostro, garantindo o fornecimento de quantidade suficiente de vitamina A para satisfazer o dobro das necessidades de retinol do recém-nascido.

Resumo em Inglês:

OBJECTIVE: To assess the effect of retinyl palmitate supplementation on colostrum retinol levels, investigating the influence of maternal variables (age, type of delivery, and biochemical nutritional status) on these levels. METHOD: The study included 33 mothers receiving care at the Januário Cicco Maternity School, in the city of Natal, Rio Grande do Norte, Brazil. In the first hours after delivery, blood and colostrum samples were collected. Another colostrum sample was collected six hours after maternal supplementation with 200 000 IU of retinyl palmitate. Serum and colostrum retinol levels were determined by high-performance liquid chromatography. RESULTS: The mean retinol level in colostrum before the supplementation was 110.8 ± 82.3 µg/dL, and after supplementation it was 164.4 ± 106.5 µg/dL (P < 0.025). Of the 33 mothers, 12 of them either did not respond to supplementation or had an increase of less than 10% in colostrum retinol levels; serum retinol in these women was significantly lower as compared to the responders (P = 0.024). In comparison to women with a normal delivery, the mothers who underwent cesarean delivery (64%) had lower serum retinol levels, but not lower colostrum retinol levels (P = 0.036). Maternal age did not influence retinol levels in either serum or colostrum. CONCLUSIONS: The increase in colostrum retinol levels following vitamin A supplementation was sufficient to guarantee double the retinol requirements of a newborn infant.

Resumo em Espanhol:

OBJETIVOS: Analizar los artículos publicados en revistas científicas entre los años 2000 y 2005 enfocados en los hombres que maltratan a sus parejas e identificar las características de los estudios empíricos cuantitativos. MÉTODOS:Revisión sistemática de los artículos publicados entre enero de 2000 y junio de 2005 que se centran en el tema de los hombres que maltratan a sus parejas. La búsqueda se realizó en las bases de datos EconLit, Embase, Eric, Francis, Índice Médico Español, ISI Web of Knowledge -Web of Science y Current Contents-, Medline, Psicodoc, PsycInfo y Sociological Abstracts. RESULTADOS: Se identificaron 944 estudios, de los cuales 61 (6,5%) se centraron en el análisis. Treinta y cuatro (55,7%) se publicaron en revistas especializadas en la violencia y solamente 4 (6,6%) se publicaron en revistas de Ciencias Médicas; 47 (77,0%) procedían de instituciones norteamericanas -especialmente de los Estados Unidos de América (70,5%)- y solamente 1 (1,6%) artículo procedía de América Latina (Puerto Rico). De los 29 artículos que utilizaron métodos de análisis cuantitativo, 19 (65,5%) abordaron las causas o factores de riesgo relacionados con la violencia doméstica como eje central de su investigación y 10 (34,5%) centraron su atención en intervenciones dirigidas a los agresores. CONCLUSIONES: Se encontraron pocos estudios científicos que abordaran la etiología de la violencia contra la mujer en la pareja y los encontrados utilizaron diseños epidemiológicos sin el suficiente poder explicativo para establecer relaciones causales. Los estudios que se centran en el problema desde un punto de vista curativo no presentan suficiente evidencia acerca de la eficacia de los programas dirigidos a maltratadores. No se encontraron estudios publicados en revistas de salud pública. La carencia de mayor información científica puede estar impidiendo que se tomen decisiones políticas informadas y se pongan en marcha intervenciones más eficaces.

Resumo em Inglês:

OBJECTIVES: To analyze articles published in scientific journals from 2000 to 2005 that specifically focus on men who abuse their female partner, and to identify characteristics that the quantitative empirical studies have in common. METHODS: A systematic review of articles published from January 2000 to June 2005 on the topic of men who abuse their female partner was conducted by searching the following databases: EconLit, Embase, Eric, Francis, Índice Médico Español, ISI Web of Knowledge (Web of Science and Current Contents), Medline, Psicodoc, PsycInfo, and Sociological Abstracts. RESULTS: Of the 944 studies identified, victim-specific articles were eliminated, and 61 (6.5%) were analyzed. Of these, violence-related journals had published 34 (55.7%); medical sciences journals had published only 4 (6.6%). North American institutions had published 47 of the 61 articles (77.0%), most of which were from the United States of America (70.5%), and only 1 article (1.6%) came from Latin America (Puerto Rico). Of the 29 articles that employed quantitative analysis, 19 (65.5%) examined the etiology of and risk factors related to domestic violence, and 10 (34.5%) focused on interventions geared toward the aggressor. CONCLUSIONS: Few scientific studies were found that tackled the causes of violence against the female partner, and those that did used epidemiological methods that fell short of quantifying the causes of partner violence. Studies that approach the issue from a curative angle do not provide enough evidence on the effectiveness of programs aimed at abusers. No articles were found in public health journals. The absence of scientific literature on this topic could be impeding informed policy-making and hindering efforts to put more effective intervention programs in place.

Resumo em Espanhol:

A una muestra de médicos de familia del Programa de Médicos de Familia de Niterói, Río de Janeiro, Brasil, se aplicó en abril de 2005 un cuestionario autoadministrado para determinar la percepción de los médicos de atención primaria sobre la calidad del servicio para epilepsia y los patrones de remisión y su opinión sobre la atención que se brinda. Los encuestados consideraron que los neurólogos deben ser los responsables del diagnóstico y de la prescripción inicial de medicamentos antiepilépticos, mientras que los médicos de familia se deben responsabilizar de la atención subsiguiente. Los encuestados informaron estar insatisfechos con sus conocimientos sobre la epilepsia y los medicamentos antiepilépticos. Se consideró que los profesionales mejor calificados para la atención de la epilepsia son los neurólogos (58,9%), seguidos de los médicos de familia (35,7%). Casi todos los encuestados consideraron que los lineamientos y seminarios mejoraron su capacidad para atender a sus pacientes. Los encuestados no se sentían seguros de la atención que brindaban a los pacientes con epilepsia y por lo general los remitían al neurólogo. Sin embargo, el Programa de Médicos de Familia tiene un potencial inexplotado para tratar a los pacientes con epilepsia, debido al interés de estos profesionales en mejorar su calificación.