Resumo em Espanhol:
OBJETIVOS: Caracterizar el comportamiento del Sistema Nacional de Salud (SNS) de México en la tarea de reducir el número de muertes por malformaciones congénitas mediante el análisis de la tendencia de las tasas de mortalidad infantil específicas por esas afecciones. MÉTODOS: Análisis de series de tiempos de las defunciones de niños y niñas menores de 1 año entre 1980 y 2005, según las bases de datos nacionales anuales de mortalidad de la Secretaría de Salud de México. Se calcularon las tasas de mortalidad infantil específicas (TMIe) por malformaciones congénitas graves más frecuentes en México: defectos del tubo neural, hernia diafragmática congénita, exonfalos (onfalocele y gastrosquisis) y malformaciones cardíacas y del tubo digestivo, agrupadas según el grado de urgencia y de sofisticación tecnológica que demanda su tratamiento y el desenlace más frecuente. RESULTADOS: Entre 1980 y 2005, la tasa de mortalidad infantil en México descendió de 40,7 a 16,9 por 1 000 nacimientos (β = -0,86; P < 0,001); en cambio, la tasa de mortalidad específica por malformaciones congénitas creció de 2,2 a 3,5 por 1 000 nacimientos (β = 0,05; P < 0,001). La hipertrofia pilórica y la atresia anorrectal, malformaciones con buen pronóstico y tratamiento programable en unidades con equipamiento básico, fueron las únicas que mostraron una tendencia descendente en su TMIe (β = -0,01 a -0,09; P < 0,001), mientras que las que requieren tratamiento urgente en unidades especializadas mostraron TMIe crecientes (β = 0,03 a 0,05; P < 0,001). CONCLUSIONES: El desarrollo del SNS de México entre 1980 y 2005 no se ha traducido en una reducción en la mortalidad por malformaciones congénitas; esta ineficacia fue más notoria en las enfermedades cuyo tratamiento es urgente y requiere tecnología sofisticada.Resumo em Inglês:
OBJECTIVES: To evaluate the role that Mexico's National Health System (Sistema Nacional de Salud-SNS) has played in the task of reducing the number of deaths due to congenital malformations through a trends analysis of cause-specific infant mortality rates (IMRcs). METHODS: Time-series analysis of deaths of boys and girls under 1 year of age from 1980-2005, according to databases of national and annual mortality maintained by the Secretariat of Health of Mexico. Cause-specific mortality rates were calculated for the most frequently occurring, severe, congenital malformations in Mexico: neural tube defects, diaphragmatic hernias, exomphalos (omphalocele and gastroschisis), and heart and digestive tract defects, grouped according to severity, degree of technological sophistication required for treatment, and most frequent outcome. RESULTS: From 1980-2005, the infant mortality rate in Mexico decreased from 40.7 to 16.9 per 1 000 births (β = -0.86; P < 0.001); however, the mortality rate for congenital malformations rose from 2.2 to 3.5 per 1 000 births (β = 0.05; P < 0.001). Only infantile hypertrophic pyloric stenosis and anorectal atresia, anomalies with good prognoses and treatments available in minimally-equipped facilities, exhibited downward trends in their IMRcs (β = -0.01 to -0.09; P < 0.001); while malformations requiring immediate treatment in specialized facilities showed rising IMRcs (β = 0.03 to 0.05; P < 0.001). CONCLUSIONS: The development of Mexico's SNS from 1980-2005 has not translated into a reduction of mortality from congenital malformations; this deficiency was more pronounced for anomalies that require immediate treatment and sophisticated technology.Resumo em Espanhol:
OBJETIVO: En América Latina y el Caribe, la vacunación sistemática de niños contra Streptococcus pneumoniae podría requerir inversiones considerables de los gobiernos y organizaciones donantes. Al evaluar estas inversiones se requiere información sobre los posibles beneficios sanitarios, costos y rentabilidad (relación costo-efectividad) de la vacunación. Se presenta un análisis económico de la vacunación infantil antineumocócica en América Latina y el Caribe a partir de la información de la vacuna y de datos demográficos, epidemiológicos y de costos. MÉTODOS: Se realizó una revisión bibliográfica estructurada previa para llegar a estimados regionales de la incidencia de la enfermedad. Los costos se tomaron de entrevistas a médicos y tarifas públicas. Se construyó un modelo analítico de decisión para comparar la vacunación de los niños de esta región con la vacuna antineumocócica conjugada y la no vacunación, tomando en cuenta solamente el efecto directo de la vacuna en los niños. RESULTADOS: Se proyectó la vacunación antineumocócica con las tasas de cobertura de la vacuna contra la difteria, el tétanos y la tosferina para prevenir 9 500 muertes anuales en menores de 5 años en esta región, o aproximadamente 1 vida salvada por cada 1 100 niños vacunados. Las vidas salvadas y los casos prevenidos de sordera, trastornos psicomotores y convulsiones equivalen a evitar anualmente 321 000 años de vida ajustados por incapacidad (AVAD). A un precio de la vacuna de US$ 5,00 a US$ 53,00 por dosis, el costo por AVAD evitado desde el punto de vista de la sociedad sería de US$ 154,00 a US$ 5 252,00. CONCLUSIONES: La vacuna antineumocócica conjugada fue altamente rentable hasta un precio de US$ 40,00 por dosis. La introducción de esta vacuna en América Latina y el Caribe puede reducir la mortalidad infantil con una alta rentabilidad en un amplio espectro de posibles costos.Resumo em Inglês:
OBJECTIVE: In Latin America and the Caribbean, routine vaccination of infants against Streptococcus pneumoniae would need substantial investment by governments and donor organizations. Policymakers need information about the projected health benefits, costs, and cost-effectiveness of vaccination when considering these investments. Our aim was to incorporate vaccine, demographic, epidemiologic, and cost data into an economic analysis of pneumococcal vaccination of infants in Latin America and the Caribbean. METHODS: We previously used a structured literature review to develop regional estimates of the incidence of disease. Cost data were collected from physician interviews and public fee schedules. We then constructed a decision analytic model to compare pneumococcal conjugate vaccination of infants with no vaccination across this region, examining only vaccine's direct effects on children. RESULTS: Pneumococcal vaccination at the rate of diphtheria-tetanus-pertussis vaccine coverage was projected to prevent 9 500 deaths per year in children aged 0 to 5 years in the region, or approximately one life saved per 1 100 infants vaccinated. These saved lives as well as averted cases of deafness, motor deficit, and seizure result in 321 000 disability-adjusted life years (DALYs) being averted annually. At vaccine prices between US$5 and US$53 per dose, the cost per DALY averted from a societal perspective would range from US$154 to US$5 252. CONCLUSION: Pneumococcal conjugate vaccine was highly cost-effective up to $40 per dose. Introduction of pneumococcal vaccine in the Latin American and Caribbean region is projected to reduce childhood mortality and to be highly cost-effective across a range of possible costs.Resumo em Português:
OBJETIVOS: Descrever as mudanças na utilização de serviços de saúde materno-infantis por residentes em três municípios da Grande São Paulo (Embu, Itapecerica da Serra e Taboão da Serra) 12 anos após a implantação do Sistema Único de Saúde (SUS) e analisar o potencial dos inquéritos de saúde de base populacional como fonte de dados para avaliar as mudanças nesses serviços. MÉTODOS: Em 1990 e 2002, foram realizados dois inquéritos de base populacional, de corte transversal, em municípios da região metropolitana de São Paulo. Para os menores de 1 ano, os dois períodos foram comparados quanto à utilização de serviços de saúde ambulatoriais e hospitalizações; para as mães, os períodos foram comparados quanto à realização de pré-natal e parto. Em ambos os inquéritos, utilizou-se a amostragem por conglomerados em múltiplos estágios e estratificada, com padronização de questões das entrevistas. RESULTADOS: As alterações de maior destaque corresponderam à localização dos serviços utilizados para pré-natal, partos e hospitalização de menores de 1 ano. Houve elevação significativa na utilização dos serviços no município de residência ou região e redução na participação do Município de São Paulo (80% dos partos e praticamente todas as internações de menores de 1 ano em 1990 contra 32% dos partos e 46% das internações de menores de 1 ano em 2002). Também aumentou a utilização de unidades básicas de saúde e prontos-socorros. Essas alterações referiram-se aos atendimentos financiados pelo setor público de saúde. No setor privado, ocorreu queda do desembolso direto e dos convênios de empresa e crescimento dos planos individuais. CONCLUSÕES: As principais mudanças verificadas no segundo inquérito ocorreram paralelamente às alterações provenientes da implantação do SUS. Os inquéritos de saúde de base populacional mostraram-se adequados para analisar e comparar a utilização de serviços em diferentes períodos.Resumo em Inglês:
OBJECTIVES: To describe the changes in the use of maternal and child health care services by residents of three municipalities-Embu, Itapecerica da Serra, and Taboão da Serra-in the São Paulo metropolitan area, 12 years after the implementation of the Unified Health System (SUS) in Brazil, and to analyze the potential of population-based health care surveys as sources of data to evaluate these changes. METHODS: Two population-based, cross-sectional surveys were carried out in 1990 and 2002 in municipalities located within the São Paulo metropolitan area. For children under 1 year of age, the two periods were compared in terms of outpatient services utilization and hospital admission; for the mothers, the periods were compared in terms of prenatal care and deliveries. In both surveys, stratified and multiple-stage conglomerate sampling was employed, with standardization of interview questions. RESULTS: The most important changes observed were regarding the location of services used for prenatal care, deliveries, and hospitalization of children less than 1 year of age. There was a significant increase in the use of services in the surrounding region or hometown, and decrease in the utilization of services in the city of São Paulo (in 1990, 80% of deliveries and almost all admissions for children less than 1 year versus 32% and 46%, respectively, in 2002). The use of primary care units and 24-hour walk-in clinics also increased. All these changes reflect care provided by public resources. In the private sector, there was a decrease in direct payments and payments through company-paid health insurance and an increase in payments through self-paid health insurance. CONCLUSIONS: The major changes observed in the second survey occurred simultaneous to the changes that resulted from the implementation of the SUS. Population-based health surveys are adequate for analyzing and comparing the utilization of health care services at different times.Resumo em Espanhol:
OBJETIVO: Determinar la factibilidad de enviar muestras de sangre seca (MSS) a un centro en el extranjero para el diagnóstico de la infección por el VIH en niños de zonas rurales de Haití. MÉTODOS: El programa se realizó en el Departamento Central de Haití. Se tomó una muestra de sangre en papel de filtro de los niños menores de 18 meses nacidos de madres infectadas con el VIH o que tuvieran una prueba positiva de anticuerpos contra el VIH. Una vez secas, las muestras se etiquetaron con un número de identificación único, se colocaron en sobres sellados impermeable a gases con desecante, se almacenaron a temperatura ambiente y se enviaron por correo a un laboratorio comercial en los Países Bajos, donde se eluyó la sangre del papel de filtro y se analizó mediante el sistema RetinaTM Rainbow para la detección de ARN del VIH-1. Las pruebas se realizaron a los niños de 1 mes y se repitió a los 4 meses de edad. RESULTADOS: El procedimiento de MSS se llevó fácilmente a una escala mayor. En el período de estudio se confirmó el diagnóstico de 138 niños: 15 de ellos estaban infectados y recibieron los cuidados apropiados; 123 niños no tenían la infección, lo que evitó aplicar innecesariamente el tratamiento antibiótico profiláctico y el personal de salud sintió mayor confianza. CONCLUSIONES: El procesamiento centralizado de MSS en el extranjero es una solución factible para el diagnóstico oportuno de la infección por el VIH en niños cuando no hay capacidad local de diagnóstico. Centros regionales para el procesamiento de MSS podrían mejorar el acceso de millones de niños de América Latina y el Caribe al diagnóstico oportuno de esta infección.Resumo em Inglês:
OBJECTIVE: To determine the feasibility of sending dried blood spots (DBS) to an overseas processing center for the diagnosis of HIV infection in infants in rural Haiti. METHODS: The program took place in the Central Department of Haiti. Children under 18 months of age who were born to an HIV-infected mother or who had a positive HIV antibody test had blood collected on filter paper. Once dry, specimens were labeled with a unique identifying number, placed in sealed gas-impermeable envelopes containing a desiccant, stored at room temperature, and mailed to a commercial laboratory in The Netherlands, where blood was eluted from the filter paper and analyzed by the RetinaTM rainbow HIV-1 RNA assay. Infants were tested at 1 month of age and again at 4 months of age. RESULTS: The DBS protocol was easily scaled up. During the study period, 138 infants had HIV status confirmed; 15 of them were found to be HIV infected and were enrolled in appropriate HIV care, and 123 were confirmed to be HIV uninfected, avoiding unnecessary prophylactic antibiotics and providing reassurance to caregivers. CONCLUSION: Central, overseas processing of DBS is a feasible solution for the timely diagnosis of HIV infection in infants where local capacity is unavailable. Regional processing centers for DBS could improve the access of millions of children in Latin America and the Caribbean to timely diagnosis of HIV infection.Resumo em Espanhol:
OBJETIVO: Establecer la calidad de vida relacionada con la salud (CVRS) percibida por las personas con discapacidad intelectual en la provincia de Salamanca, España. MÉTODOS: Estudio descriptivo transversal de base poblacional. Se aplicó el cuestionario de salud SF-36, adaptado y validado para la población española, a 265 personas con discapacidad intelectual de la provincia de Salamanca, España. Se realizaron entrevistas personales a los participantes en presencia de sus padres, tutores o familiares cercanos. Se exploraron ocho dimensiones de la calidad de vida: salud general, función física, rol físico, rol emocional, función social, dolor corporal, vitalidad y salud mental a partir de variables sociodemográficas y de estilo de vida, utilización de servicios de salud, necesidades de apoyo, y estado de salud y CVRS. RESULTADOS: De las 265 personas estudiadas, 69,8% eran hombres y 30,2% eran mujeres (edad media: 35 años; mínima: 16; máxima: 72). Las puntuaciones máximas obtenidas correspondieron a las dimensiones rol físico y función física (por encima de 85 puntos) y las mínimas, a salud general y vitalidad (por debajo de 70 puntos). No se observaron diferencias significativas entre los hombres y las mujeres en ninguna de las ocho dimensiones. Las variables independientes edad, ingresos familiares, nivel educacional y necesidad de apoyo presentaron la mayor cantidad de asociaciones independientes con las dimensiones salud general, función física y función social. De los participantes, 41,5% manifestó que su salud percibida era buena. CONCLUSIONES: Los participantes en este estudio percibieron su CVRS como buena, especialmente en las dimensiones rol físico y función física. Se deben diseñar estudios para evaluar la CVRS en personas con diferentes grados de discapacidad intelectual para contribuir a elaborar intervenciones y programas sanitarios y sociales específicos para esta población y para evaluar las intervenciones y los programas en marcha.Resumo em Inglês:
OBJECTIVE: To measure health-related quality-of-life (HRQL) among people with intellectual disabilities in the province of Salamanca, Spain. METHODS: A population-based, cross-sectional descriptive study. The SF-36 Health Survey, adapted and validated for the Spanish population, was selected and administered to 265 people with intellectual disabilities in the province of Salamanca, Spain. Personal interviews were also conducted with the participants in the presence of their parents, tutors, or close family. Eight quality-of-life scales were explored: general health, physical functioning, role-physical, bodily pain, role-emotional, social functioning, vitality, and mental health, based on questions on sociodemographic and lifestyle variables, health services utilization, support needs, and health status and HRQL. RESULTS: Of the 265 people studied, 69.8% were men and 30.2% were women (median age: 35 years; minimum: 16; maximum: 72). The highest number of points pertained to role-physical and physical functioning (more than 85 points), and the lowest, to general health and vitality (less than 70 points). No significant differences were found between men and women for any of the eight components. The independent variables, age, family income, level of education, and support needs showed the greatest number of independent associations with the general health, physical functioning, and social functioning components. Of the participants, 41.5% indicated that they felt their health was good. CONCLUSIONS: The study participants perceived their HRQL to be good, especially on the role-physical and physical functioning scales. Additional studies should be designed to evaluate HRQL in people with different degrees of intellectual disability to further contribute to intervention efforts and health and social programs designed specifically for this population group and to evaluate the interventions and program already underway.Resumo em Inglês:
In recent years, emerging diseases were defined as being infectious, acquiring high incidence, often suddenly, or being a threat or an unexpected phenomenon. This study discusses the hallmarks of emerging diseases, describing the existence of noninfectious emerging diseases, and elaborating on the advantages of defining noninfectious diseases as emerging ones. From the discussion of various mental health disorders, nutritional deficiencies, external injuries and violence outcomes, work injuries and occupational health, and diseases due to environmental factors, the conclusion is drawn that a wide variety of noninfectious diseases can be defined as emergent. Noninfectious emerging diseases need to be identified in order to improve their control and management. A new definition of "emergent disease" is proposed, one that emphasizes the pathways of emergence and conceptual traits, rather than descriptive features.