Resumo em Espanhol:

OBJETIVOS:En los países en desarrollo, el cáncer cervicouterino es la principal causa de muerte por cáncer en mujeres. Este estudio se diseñó para determinar si se puede mejorar la confirmación de lesiones cervicouterinas con la inspección visual con ácido acético y amplificación (VIAM) en comparación con la inspección visual con ácido acético (VIA) sin amplificación, cuando ambas las realizan médicos generales. MÉTODOS:Las mujeres de San Martín, Perú, con diagnóstico positivo mediante VIA realizado por una obstetriz (enfermera graduada con seis años de entrenamiento universitarios) entre abril y diciembre de 2004 se dividieron aleatoriamente en dos grupos para el diagnóstico confirmatorio realizado por médicos generales mediante VIA o VIAM, este último con un AviScopeTM, un dispositivo manual con lente monocular de amplificación 4X y fuente luz verde. Como método estándar de referencia para definir la presencia o ausencia de neoplasia cervicouterina se emplearon la colposcopia y la biopsia dirigida, según el caso. RESULTADOS:En el estudio participaron 358 mujeres, de ellas 161 pasaron la confirmación por VIAM y 159 por VIA. La sensibilidad para las lesiones de bajo y alto grados fue de 68% con VIA y de 77% con VIAM, mientras la especificidad fue de 62% por VIA y de 63% por VIAM; estas diferencias no tuvieron significación estadística. CONCLUSIONES:Se demostró que la VIAM no presentó ventajas significativas sobre la VIA en los casos en que se requiere y está disponible la confirmación de las lesiones del cuello uterino por un médico general.

Resumo em Inglês:

OBJECTIVES: Cervical cancer is the leading cause of cancer death among women in developing countries. This study was designed to evaluate whether visual inspection with acetic acid and magnification (VIAM) improved confirmation of cervical lesions as compared to confirmation with visual inspection with acetic acid (VIA) without magnification when used by physicians. METHODS: From April-December 2004, women in San Martin, Peru, who were referred as VIA-positive by an "obstetriz" (a professional midwife with 6 years of university training) were randomized into two groups for confirmatory screening by a physician using either VIA or VIAM with an AviScope,TM a hand-held 4x magnification scope with a green light source. The reference standard for the presence or absence of cervical neoplasia was colposcopy and directed biopsy, as required. RESULTS: A total of 358 women participated in the study; 161 had a confirmatory examination with VIAM and 159 with VIA. Sensitivity for low- or high-grade lesions was 68% with VIA and 77% with VIAM, and specificity was 62% with VIA and 63% with VIAM; however, these differences were not statistically significant. CONCLUSIONS: For settings where physician confirmation of cervical abnormalities identified through visual inspection is required and available, this study demonstrates that VIAM had no significant advantage over VIA.

Resumo em Espanhol:

OBJETIVO: Evaluar mediante ecuaciones estructurales un modelo del estrés que integra la explicación de los síntomas psicosomáticos y la teoría transaccional del estrés. MÉTODOS: Se seleccionó una muestra representativa, aleatoria y estratificada de estudiantes de la Facultad de Psicología de la Universidad Autónoma de Nuevo León, México. Los sujetos se seleccionaron a partir del listado de alumnos proporcionado por la facultad. Se utilizaron cuestionarios de autoevaluación con adecuadas propiedades psicométricas para valorar cada una de las variables incluidas en el modelo. Los resultados se analizaron con el programa AMOS 5.0, empleando el método de máxima verosimilitud. Asimismo, se compararon el modelo estructural con variables observables y un modelo con variables latentes endógenas. RESULTADOS:Los resultados obtenidos confirman parcialmente el modelo presentado y corroboran los efectos del estrés y el cansancio emocional sobre los síntomas psicosomáticos, y de la autoestima, la autoeficacia y el apoyo social sobre el estrés. El modelo con variables observables (c²/gl = 2,87; GFI (índice de bondad del ajuste) = 0,985; AGFI (índice de bondad de ajuste corregido) = 0,946; RMSEA (error de aproximación cuadrático medio) = 0,072; IFI (índice de ajuste incremental) = 0,982) tiene mejor ajuste que el modelo con variables latentes (c²/gl = 3,74; GFI = 0,924; AGFI = 0,876; RMSEA = 0,09, IFI = 0,927). En ambos casos, el ajuste es adecuado. CONCLUSIONES:El modelo presentado constituye el principal aporte de este trabajo. Se trata de un modelo explicativo de síntomas psicosomáticos, con buen ajuste, que explica el 24,3% de la varianza al utilizar variables observables y el 39,4% al utilizar variables latentes.

Resumo em Inglês:

OBJECTIVES:To evaluate a descriptive model of stress that integrates an explanation of psychosomatic symptoms with the transactional theory of stress. METHODS:A random and stratified representative sample was selected from among the students in the School of Psychology at the Autonomous University of Nuevo León, Mexico. The subjects were chosen randomly from a student directory provided by the school. A self-administered questionnaire was used that contained the psychometric properties necessary for accurately quantifying each of the variables included in the model. Results were analyzed using AMOS 5.0, employing the best probability method. Also, the structural model was compared using discrete variables only and endogenous latent variables. RESULTS: The results that were obtained partly confirmed the model and corroborated the impact that stress and emotional exhaustion have on psychosomatic symptoms and that self-esteem, self-efficacy, and social support have on stress. The model with discrete variables [chi square test/degrees of freedom (c²/df) = 2.87; goodness of fit (GFI) = 0.985; adjusted goodness of fit (AGFI) = 0.946; root mean square error of approximation (RMSEA) = 0.072; incremental fit index (IFI) = 0.982] has a better fit than the model with latent variables (c²/df = 3.74; GFI = 0.924; AGFI = 0.876; RMSEA = 0.09, IFI = 0.927). In both cases, the fit is adequate. CONCLUSIONS:The model discussed is the main contribution of this study. It is a descriptive model of psychosomatic symptoms, with a good fit, that describes 24.3% of the variance for discrete variables and 39.4% when using latent variables.

Resumo em Português:

OBJETIVO: Avaliar os aspectos dietéticos das refeições oferecidas por empresas inscritas no Programa de Alimentação do Trabalhador (PAT) na Cidade de São Paulo, Brasil, em relação às recomendações nutricionais do Guia Alimentar para a População Brasileira do Ministério da Saúde. MÉTODOS:Foram investigadas 72 empresas, caracterizadas conforme setor (indústria, serviços ou comércio), porte (micro, pequenas, médias ou grandes), modalidade do PAT (autogestão, gestão terceirizada do tipo refeição transportada ou gestão terceirizada do tipo preparo e distribuição de refeição na empresa) e supervisão de nutricionista (sim ou não). A quantidade per capita dos alimentos foi determinada nos cardápios de 3 dias de almoço, jantar e ceia. O valor nutricional das refeições foi definido com base nas variáveis energia, carboidrato, proteína, gorduras totais, gordura poliinsaturada, gordura saturada, gordura trans, açúcares livres, colesterol e frutas e hortaliças. RESULTADOS:A maioria dos cardápios teve baixa oferta de frutas e hortaliças (63,9%) e gordura poliinsaturada (83,3%) e excesso de gorduras totais (47,2%) e colesterol (62,5%). O agrupamento 2, composto principalmente por empresas de médio e grande porte do setor industrial e de serviços, com gestão terceirizada e supervisão de nutricionista, teve, em média, refeições com maior valor energético (P < 0,001), maior porcentagem de gorduras poliinsaturadas (P < 0,001), maior quantidade de colesterol (P = 0,015) e maior quantidade de frutas e hortaliças (P < 0,001) do que o agrupamento 1, composto por micro e pequenas empresas do setor de comércio, tendo autogestão como modalidade e sem supervisão de nutricionista. Quanto à adequação dos cardápios oferecidos às metas do Guia Alimentar para a População Brasileira, as refeições do agrupamento 2 foram mais adequadas em relação à oferta de frutas e hortaliças (P < 0,001). Em contrapartida, o agrupamento 1 apresentou maior adequação da quantidade de colesterol (P = 0,05). CONCLUSÕES:É necessária uma ação mais direcionada aos gestores de empresas e aos responsáveis pelas unidades de alimentação e nutrição, principalmente no grupo de empresas que não tem a supervisão de nutricionista.

Resumo em Inglês:

OBJECTIVE:To compare the nutritional value of meals provided by companies participating in the Workers’ Meal Program in the city of São Paulo, Brazil, to the nutritional recommendations and guidelines established by the Ministry of Health for the Brazilian population. METHODS:The 72 companies studied were grouped according to economic sector (industrial, services, or commerce), size (micro, small, medium, or large), meal preparation modality (prepared on-site by the company itself, on-site by a hired caterer, or off-site by a hired caterer), and supervision by a dietitian (yes or no). The per capita amount of food was determined based on the lunch, dinner, and supper menus for three days. The nutritional value of the meals was defined by the amount of calories, carbohydrates, protein, total fat, polyunsaturated fat, saturated fat, trans fat, sugars, cholesterol, and fruits and vegetables. RESULTS:Most of the menus were deficient in the number of fruits and vegetables (63.9%) and amount of polyunsaturated fat (83.3%), but high in total fat (47.2%) and cholesterol (62.5%). Group 2, composed of mostly medium and large companies, supervised by a dietician, belonging to the industrial and/or service sectors, and using a hired caterer, on averaged served meals with higher calorie content (P < 0.001), higher percentage of polyunsaturated fat (P < 0.001), more cholesterol (P = 0.015), and more fruits and vegetables (P < 0.001) than Group 1, which was composed of micro and small companies from the commercial sector, that prepare the meals themselves on-site, and are not supervised by a dietitian. Regarding the nutrition guidelines set for the Brazilian population, Group 2 meals were better in terms of fruit and vegeta-ble servings (P < 0.001). Group 1 meals were better in terms of cholesterol content (P = 0.05). CONCLUSIONS:More specific action is required targeting company officers and managers in charge of food and nutrition services, especially in companies without dietitian supervision.

Resumo em Espanhol:

OBJETIVOS:La cultura del estigma asociado con las enfermedades mentales es especialmente intensa cuando las mismas personas que normalmente son víctimas de la estigmatización (personas con enfermedades mentales y los miembros de su familia) actúan de forma negativa hacia otras personas a las que asocian con enfermedades mentales. El objetivo de este trabajo fue determinar el grado de esta interiorización y la asimilación de actitudes, juicios y comportamientos estigmatizadores en personas en riesgo de sufrir este tipo de estigmatización en Jamaica. MÉTODOS: Se analizaron los datos de la encuesta nacional sobre salud mental de 2006. Se examinaron las variables demográficas, la presencia o ausencia de enfermedades mentales en los encuestados y los miembros de su familia y las respuestas relacionadas con el comportamiento y las actitudes hacia las personas que sufren enfermedades mentales. Se compararon tres submuestras (encuestados con enfermedades mentales, encuestados que tenían familiares con enfermedades mentales y encuestados sin ninguna de las características anteriores) mediante la prueba de la ji al cuadrado. RESULTADOS: Los encuestados que tenían familiares con enfermedades mentales presentaron menos probabilidad de mostrar diversas manifestaciones de estigmatización que los otros subgrupos (P = 0,009-0,019). No se encontraron diferencias significativas entre los encuestados con alguna enfermedad mental y los otros subgrupos en cuanto a la demostración de diversas manifestaciones de estigmatización (P = 0,069-0,515). CONCLUSIONES: El pequeño número de encuestados con enfermedades mentales dio como resultado un bajo poder estadístico para mostrar diferencias entre ese subgrupo y los otros. Las actitudes y el comportamiento significativamente más positivos observados en los encuestados que tenían miembros de su familia con enfermedades mentales indican que se pueden obtener beneficios si se crean más oportunidades para que la población general se relacione con personas que sufren enfermedades mentales.

Resumo em Inglês:

OBJECTIVES: The culture of stigma associated with mental illness is particularly intense when persons who are normally victims of that stigmatization (mentally ill persons and their family members) themselves act negatively toward others whom they associate with mental illness. We attempt to determine the extent of this internalization and assimilation of stigmatizing attitudes, cognitions, and behaviors in persons who are at risk for such stigmatization in Jamaica. METHODS: Data from a 2006 national survey on mental health were analyzed. Demographic variables, the presence or absence of mental illness in respondents and in their family members, and responses pertaining to behaviors and attitudes toward mentally ill persons were examined. Subsamples (respondents with mental illness, respondents with a family member with mental illness, respondents with neither) were compared using the chi-square test. RESULTS: Respondents with family members with mental illness were less likely to demonstrate a number of different manifestations of stigmatization than others (P = 0.009-0.019). Respondents with mental illness showed no difference in the demonstration of a number of different manifestations of stigmatization from other respondents (P = 0.069-0.515). CONCLUSIONS: The small number of mentally ill respondents resulted in low statistical power for demonstrating differences between that subgroup and other respondents. The significantly more positive attitudes and behavior of respondents with family members with mental illness suggest that some benefit may be gained by creating more opportunities for the general public to interact with persons with mental illness.

Resumo em Espanhol:

OBJETIVOS:Describir el uso de medicamentos en los jubilados brasileños, con énfasis en su uso inapropiado. MÉTODOSEstudio transversal mediante entrevistas presenciales a una muestra simple aleatoria de 800 jubilados del Instituto Brasileño de Seguridad Social, de 60 años de edad o más, que residen en la ciudad de Rio de Janeiro. RESULTADOS:Del total de encuestados, 85% informó el uso de medicamentos en los 15 días previos al estudio, con una media de 3,7 productos por persona (desviación estándar = 2,9). Aproximadamente la mitad de los encuestados utilizaron de uno a cuatro medicamentos y una tercera parte empleó cinco o más. El mayor número de medicamentos usado por un paciente fue de 24. Más mujeres que hombres emplearon múltiples medicamentos. Se observó una tendencia hacia una asociación positiva (P < 0,001) entre el consumo de medicamentos y las variables relacionadas con las enfermedades y la atención sanitaria. Esta tendencia se mantuvo al hacer el análisis según el sexo. Los hombres que informaron padecer cinco enfermedades o más tuvieron cinco veces más probabilidad de usar múltiples medicamentos que los hombres con dos enfermedades o menos (razón de prevalencia [RP] = 5,21; intervalo de confianza de 95% [IC95%]: 2,48 a 10,90). Las mujeres que informaron cinco enfermedades o más tuvieron casi cuatro veces más probabilidad de emplear varios medicamentos que las mujeres que padecían dos enfermedades o menos (RP = 3,67; IC95%: 2,24 a 6,02). Se consideró que 10% de las substancias activas empleadas por los encuestados eran inapropiadas. CONCLUSIONES:Para mejorar el tratamiento de los adultos mayores con medicamentos, los médicos pueden tomar medidas tendentes a reducir el uso injustificado de medicamentos y optimizar los beneficios de los medicamentos de interés. Se deben realizar estudios para ajustar las listas de medicamentos inapropiados para los adultos mayores a las condiciones de los países en desarrollo.

Resumo em Inglês:

OBJECTIVE: To describe drug utilization by Brazilian retirees with an emphasis on inappropriate use. METHODS: Cross-sectional study with a simple random sample of 800 retirees of the Brazilian Institute of Social Security, 60 years of age and older, residing in Rio de Janeiro City, through face-to-face interviews. RESULTS:Medication use in the 15 days before the study was reported by 85% of the sample, with a mean of 3.7 products per person (standard deviation = 2.9). About half the sample used one to four medications and a third used five or more. The highest number of drugs used per patient was 24. More women than men used multiple medications. There is a tendency toward positive association (P < 0.001) between drug use and variables relating to disease and health care. This trend continues in the analysis by gender. Men who reported five or more diseases were five times more likely to use multiple drugs than men with up to two (zero, one, or two) diseases (prevalence ratio 5.21, 95% confidence interval = 2.48-10.90). Women who reported five or more diseases were nearly four times more likely to use multiple drugs than women with up to two diseases (prevalence ratio 3.67, 95% confidence interval = 2.24-6.02). Of the active substances used by the sample, 10% were considered inappropriate. CONCLUSIONS:To improve drug therapy for the elderly, health practitioners can take measures to reduce unwarranted use of medication and to optimize the benefits from important drugs. Further studies should be conducted to adjust lists of medications inappropriate for the elderly to the situation in developing countries.

Resumo em Espanhol:

OBJETIVO: Identificar los factores asociados con la dispareunia entre 60 y 180 días después del parto en mujeres con antecedentes de uno o dos partos. MÉTODOS: Estudio de casos y controles, pareados por la edad y la paridad en 304 mujeres que acudieron al servicio de planificación familiar de un hospital de Acapulco, Guerrero, México, entre los 60 y 180 días después del parto. Se aplicó un cuestionario con preguntas sobre su situación socioeconómica (edad, escolaridad propia y de su pareja, estado civil, situación laboral, de seguridad social y de tenencia de su casa) y sus antecedentes obstétricos (características del parto, paridad, lugar de atención, desgarros, episiotomía y complicaciones) y ginecológicos (sensación de estrechez del introito, presencia de cicatriz queloide de la episiorrafia, síntomas de vaginitis, resequedad vaginal, métodos anticonceptivos empleados y tipo y duración de la lactancia). Se consideraron como casos a las mujeres que refirieron dolor, ardor o sangrado al tener relaciones sexuales con penetración vaginal después del parto. Se aplicó un modelo de regresión logística no condicionada y se calcularon las razones de posibilidades (odds ratios, OR) y los intervalos de confianza de 95% (IC95%). RESULTADOS: De 368 mujeres que habían reiniciado relaciones sexuales, 152 (41,3%) refirieron dispareunia. Los factores asociados con dispareunia fueron haber tenido infección con o sin dehiscencia de la episiorrafia (OR = 34,09; IC95%: 10,59 a 109,78), presentar síntomas de vaginitis (OR = 7,43; IC95%: 3,68 a 14,99), tener sensación de estrechez del introito vaginal (OR = 6,38; IC95%: 2,92 a 13,94) y practicar la lactancia exclusiva (OR = 4,86; IC95%: 2,44 a 9,69). CONCLUSIONES: La dispareunia estuvo relacionada con las complicaciones de la episiotomía y sus posibles secuelas, como la infección, la dehiscencia de la episiorrafia y la estrechez del introito vaginal. Se debe realizar una mejor vigilancia de la episiorrafia durante el puerperio y seleccionar más apropiadamente las mujeres a quienes se les realiza la episiotomía.

Resumo em Inglês:

OBJECTIVE: To identify the factors associated with dyspareunia, during the 60-180 days following childbirth, in women with a history of one or two childbirths. METHODS: A case study of 304 women, matched by age and parity who visited family planning services in a hospital in Acapulco, State of Guerrero, Mexico, 60-180 days after giving birth. A questionnaire was administered to assess socioeconomic status (age, level of education, partner’s level of education, marital status, employment, social security, and homeownership), obstetric history (type of birth, parity, location of the birth, tearing, episiotomy, and complications), and gynecological status (constricted introitus, scar tissue at the episiotomy site, symptoms of vaginitis, vaginal dryness, contraceptive use, and breast feeding duration). Cases were defined as those women who related pain, burning, or bleeding following vaginal intercourse after childbirth. An unconditional logistic regression model was applied and odd ratios (OR) and 95% confidence interval were calculated. RESULTS: Of the 368 women who had reinitiated sexual relations, 152 (41.3%) mentioned dyspareunia. The factors associated with dyspareunia were: an infection with or without episiorrhaphy dehiscence (OR = 34.09; CI95%: 10.59-109.78); symptoms of vaginitis (OR = 7.43; CI95%: 3.68-14.99); tightness in the introitus of the vagina (OR = 6.38; CI95%: 2.92-13.94), and breast feeding exclusively (OR = 4.86; CI95%: 2.44- 9.69). CONCLUSIONS: Dyspareunia was related to complications with episiotomy and its possible sequelae, such as infection, episiorrhaphy dehiscence, and constricted introitus. More attention should be given to the episiotomy site during the postpartum period and greater selectivity is needed when deciding which women require an episiotomy.

Resumo em Português:

OBJETIVO: Identificar e discutir a produção acadêmica (teses e dissertações) sobre a rotulagem de alimentos industrializados no Brasil. MÉTODO: Foi pesquisado o portal da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES). Foram utilizados os descritores "rotulagem", "rotulagem nutricional" e "rótulo de alimentos". A pesquisa abrangeu os anos de 1987 (primeiro ano do portal) a 2004. RESULTADOS: Foram identificados 49 estudos que abordavam a temática proposta. Utilizando a técnica de análise de conteúdo foram identificados três tópicos centrais: adequação dos rótulos de produtos alimentícios à legislação específica (57,2%), compreensão dos rótulos de alimentos pelos consumidores (22,4%) e rotulagem de alimentos geneticamente modificados ou transgênicos (20,4%). CONCLUSÕES: A rotulagem de alimentos é um tema freqüente e abordado adequadamente pela produção acadêmica brasileira. A fiscalização ineficiente é apontada pela maioria dos estudos como principal fator para o descumprimento e a banalização das normas estabelecidas para a rotulagem de alimentos no Brasil.

Resumo em Inglês:

OBJECTIVE: To review and discuss academic production (theses and dissertations) on the topic of labeling of prepackaged foods in Brazil. METHOD: A search of the database maintained by the Coordination for the Development of Higher Education Professionals (CAPES), one of the two Brazilian government research funding and support agencies, was conducted on the following keywords: "rotulagem" (labeling), "rotulagem nutricional" (food labeling) and "rótulo de alimentos" (food labels). The search covered the years 1987 (earliest year available) to 2004. RESULTS: We identified 49 studies on this topic. Content analysis identified three major themes: the extent to which food labels meet specific legal requirements (57.2%); the degree to which consumers understand the information on labels (22.4%); and the labeling of transgenic or genetically-modified foods (20.4%). CONCLUSIONS: Food labeling is a frequent topic and is adequately covered by the Brazilian academic production. In most of the studies, ineffective law enforcement appears to be the main factor in the lack of compliance with and disrespect for the food labeling rules and regulations in Brazil.

Resumo em Inglês:

In terms of economics, implementing generic drug policy is nothing other than consolidating (or even, creating) drug markets that set competitive prices, the result of which favors public access to essential drugs. This article approaches the topic of generic drugs from the economic perspective by examining various regulatory models in order to evaluate and leverage generic drug policy implementation options as a mechanism for battling some of the markets’ specific weaknesses. The conclusion is that there is no single unequivocal method for promoting the use of generic drugs, and that the most favorable way to integrate markets may be through a broad combination of alternatives. These alternatives are grouped and analyzed according to the market issues or challenges that must be overcome. Several options are then identified based on the degree of market consolidation to be obtained.