• Bibliometric study of scientific output published by the Revista Panamericana de Salud Pública/Pan American Journal of Public Health from 1997-2012 Artículos de Investigación Original

    Sanz-Valero, Javier; Casterá, Vicente Tomás; Wanden-Berghe, Carmina

    Abstract in Spanish:

    OBJETIVO: Caracterizar la producción científica de la Revista Panamericana de Salud Pública/Pan American Journal of Public Health (RPSP), como publicación científica de referencia en el área de la salud pública en las Américas. MÉTODOS: Estudio descriptivo transversal a partir de los artículos publicados en la RPSP entre 1997 y 2012. Se analizaron indicadores bibliométricos de productividad (documentos publicados, idiomas, autoría, e índices de productividad y colaboración); repercusión (factor de impacto según la Red SciELO, Journal Citation Report y SCImago); palabras clave; y referencias bibliográficas, su estructura (tipo de documento y núcleo principal de Bradford) y grado de obsolescencia (semiperíodo de Burton y Kebler, e índice de Price), entre otros. RESULTADOS: Se publicaron 2 815 artículos con una mediana de 3 autores y 2 instituciones por artículo. La proporción de artículos de investigación original aumentó en 2008-2012 con respecto a 2003-2007 y 1997-2002 (P < 0,001). El idioma predominante fue el español, desplazado por el inglés en los últimos 5 años. De las palabras clave, 88,76% se correspondían con los Descriptores en Ciencias de la Salud (DeCS) y mostraron una orientación salubrista y comunitaria dirigida a las Américas. El semiperíodo de Burton y Kebler de las referencias bibliográficas fue de 8 años, aunque bajó a 5 años en 2012; el índice de Price fue de 20,47%, y el núcleo de Bradford lo conformaron 20 revistas de la corriente principal; el porcentaje de autocitas fue bajo (2,07%). CONCLUSIONES: La RPSP es una publicación internacional con indicadores bibliométricos similares a los de las revistas latinoamericanas más representativas de las ciencias de la salud, con mejoras en los últimos años estudiados que la llevan a cumplir totalmente con los criterios editoriales internacionales.

    Abstract in English:

    OBJECTIVE: To characterize the scientific output of the Revista Panamericana de Salud Pública/Pan American Journal of Public Health (RPSP) as a scientific publication of reference in the public health sector in the Americas. METHODS: A descriptive cross-sectional study was conducted based on the articles published in the RPSP from 1997-2012. Bibliometric indicators of productivity (documents published, languages, authorship, and indices of productivity and collaboration); impact (impact factor according to the SciELO Network, Journal Citation Report and SCImago); key words; and bibliographic references, their structure (document type and main nucleus of Bradford) and degree of obsolescence (Burton and Kebler half-life, and Price index), were analyzed. RESULTS: A total of 2 815 articles with a median of 3 authors and 2 institutions per article were published. The percentage of original research articles increased in 2008-2012 compared to 2003-2007 and 1997-2002 (P < 0.001). The predominant language was Spanish, displaced by English in the last 5 years. A total of 88.76% of the key words referred to the Health Sciences Descriptors (DeCS) and had a public health and community orientation related to the Americas. The Burton and Kebler half-life of bibliographic references was 8 years, although it decreased to 5 years in 2012. The Price index was 20.47% and the nucleus of Bradford was made up of 20 mainstream journals. The percentage of self-citation was low (2.07%). CONCLUSIONS: The RPSP is an international publication with bibliometric indicators similar to those of the most representative Latin American health science journals, with improvements in the recent years studied that lead it to fully meet international publishing criteria.
  • Mortality inequality among older adults in Mexico: the combined role of infectious and chronic disease Original Research Articles

    González-González, César; Samper-Ternent, Rafael; Wong, Rebeca; Palloni, Alberto

    Abstract in Spanish:

    OBJETIVO: Evaluar los efectos del nivel de educación y de las enfermedades crónicas o infecciosas, y de la interacción entre ambas variables, sobre el riesgo de muerte en mexicanos de 60 años o mayores. MÉTODOS: Mediante la utilización de datos del Estudio Nacional de Salud y Envejecimiento en México (ENASEM), se llevaron a cabo análisis de regresión logística para calcular el riesgo de mortalidad en mexicanos de 60 años o mayores entre el 2001 y el 2003. Se usaron los riesgos calculados de mortalidad asociada con enfermedades crónicas, enfermedades infecciosas y una combinación de ambas para calcular la esperanza de vida adicional a los 60 años. RESULTADOS: En comparación con el grupo con cierto grado de escolaridad, la probabilidad de muerte en el período de dos años entre las dos fases de recopilación de datos fue 26% mayor en las personas sin escolaridad. La carencia de como mínimo un año de educación formal se tradujo en una esperanza de vida adicional a los 60 años de 1,4 a 2,0 años más corta. La presencia de una enfermedad crónica o infecciosa también aumentó el riesgo de mortalidad durante el mismo período. CONCLUSIONES: Estos resultados indican que 1) un régimen epidemiológico mixto (la presencia de una enfermedad crónica y de una enfermedad infecciosa) incrementa la carga sanitaria en forma de mortalidad experimentada por las personas mayores y 2) siguen existiendo desigualdades en cuanto al riesgo de mortalidad basadas en el nivel socioeconómico.

    Abstract in English:

    OBJECTIVE: To assess the effects of education and chronic and/or infectious disease, and the interaction between both variables, on the risk of dying among Mexicans 60 years and older. METHODS: Using data from the Mexican Health and Aging Study (MHAS), logistic regressions were performed to estimate the risk of mortality for older Mexicans between 2001 and 2003. Estimated mortality risks associated with chronic disease, infectious disease, and a combination of both were used to estimate additional life expectancy at age 60. RESULTS: Compared to the group with some schooling, the probability of dying over the twoyear inter-wave period was 26% higher among those with no schooling. Not having at least one year of formal education translated into a shorter additional life expectancy at age 60 by 1.4-2.0 years. Having chronic and/or infectious disease also increased the risk of mortality during the same period CONCLUSIONS: These results indicate that 1) a mixed epidemiological regime (the presence of both chronic and infectious disease) adds to the mortality health burden experienced by older people, and 2) there are persistent inequalities in mortality risks based on socioeconomic status.
  • School meals: planning, production, distribution, and adequacy

    Issa, Raquel Carvalho; Moraes, Letícia Freitas; Francisco, Raquel Rocha Jabour; Santos, Luana Caroline dos; Anjos, Adriana Fernandez Versiani dos; Pereira, Simone Cardoso Lisboa

    Abstract in Portuguese:

    OBJETIVO: Avaliar o planejamento, processo produtivo, distribuição e adequação nutricional do cardápio da refeição principal ofertada em escolas municipais. MÉTODOS: Este estudo descritivo transversal, realizado de março de 2011 a abril de 2012, utilizou uma amostra representativa (n = 42 escolas) das escolas municipais integradas de Belo Horizonte, estado de Minas Gerais, Brasil. Foram coletados randomicamente cinco cardápios da refeição principal de cada escola para análise por meio da pesagem direta. Realizou-se avaliação dos índices de produção e da adequação nutricional ao planejamento da Secretaria Municipal Adjunta de Segurança Alimentar e Nutricional e às recomendações do Programa Nacional de Alimentação Escolar. RESULTADOS: A análise revelou 79% de alteração dos cardápios servidos em relação aoscardápios planejados por nutricionistas da Secretaria Municipal Adjunta de Segurança Alimentar e Nutricional. Foram observados valores aceitáveis para resto-ingestão (4,90%) e índices elevados de sobras limpa (7,06%) e suja (5,30%). Foram verificadas inadequações nutricionais tanto nos cardápios planejados quanto nos cardápios consumidos nas escolas municipais em termos do Programa Nacional de Alimentação Escolar, principalmente para a faixa etária de 11 a 15 anos. Identificou-se relação da porção consumida pelos funcionários da escola com a quantidade produzida de alimentos (r = 0,353; P < 0,001) e a sobra limpa (r = 0,138; P = 0,046). Ademais, houve correlação significativa proporcional de resto-ingestão com sobra suja (r = 0,145; P = 0,035) e inversamente proporcional com consumo de fibras (r = -0,143; P = 0,038). CONCLUSIONES: Evidencia-se a importância do acompanhamento da elaboração, preparo e distribuição da alimentação escolar, assim como da educação alimentar e nutricional, no intuito de melhorar a oferta e consumo alimentar das crianças e reduzir o desperdício no ambiente escolar.

    Abstract in English:

    OBJETIVE: To evaluate the planning, production, distribution, and nutritional adequacy of meals served at city schools. METHODS: This descriptive cross-sectional study was conducted between March 2011 and April 2012 and included a representative sample (n = 42 schools) of extended shift city schools from Belo Horizonte, Minas Gerais, Brazil. Five meals from each school were randomly selected and analyzed by direct weighing. Production indicators and nutritional adequacy were evaluated in contrast to the recommendations of the city food security bureau and the Brazilian National Program of School Meals (PNAE). RESULTS: Seventy-nine percent of the analyzed meals did not meet the recommendations of the city food security bureau. The rate of waste (food left on plates) was acceptable at 4,90%, but the rates of cooked and not served food (7,06%) and counter leftovers (5,30%) were high. Both the city planned meals and the meals served in the schools were nutritionally inadequate in terms of the PNAE, particularly for children aged 11-15 years. There was a relationship between consumption by school staff and the amount of food that was cooked (r = 0.353; P < 0.001) and the rate of cooked and not served food (r = 0.138; P = 0.045). Waste was positively correlated with the rate of counter leftovers (r = 0.145; P = 0.035), and inversely correlated with fiber intake (r = -0.143; P = 0.038). CONCLUSIONS: The results indicate the importance of monitoring the planning, production, and distribution of school meals and of food and nutrition education in order to improve the quality of food and to reduce waste in schools.
  • Child malnutrition in children under 5 years of age in Peru: trends and determinants Artículos de Investigación Original

    Sobrino, Manuel; Gutiérrez, César; Cunha, Antonio J.; Dávila, Miguel; Alarcón, Jorge

    Abstract in Spanish:

    OBJETIVO: Analizar las tendencias en materia de desnutrición y anemia en menores de 5 años peruanos y su asociación con algunos factores determinantes en el período 2000-2011. MÉTODOS: Se analizaron indicadores nutricionales de menores de 5 años de la Encuesta Demográfica y de Salud Familiar (ENDES) 2011 y su evolución a partir de datos de las ENDES 2000, 2005 y 2008. Se estimaron las tendencias de desnutrición crónica (DC) (talla/ edad ≤ 2DS), de desnutrición aguda (DA) (peso/talla ≤ 2DS) y de anemia. Se encontraron asociaciones con factores como sexo del niño, edad del niño, zona de residencia (urbana o rural), región de residencia, educación de la madre, quintil de riqueza, disponibilidad de red pública de agua, disponibilidad de cloacas, nivel de altitud, presencia de otros niños en el hogar, orden de los nacimientos, presencia de diarrea en los 15 días previos y presencia de tos en los 15 días previos. RESULTADOS: La DA, la DC y la anemia en menores de 5 años peruanos han descendido entre 2000 y 2011. Tal disminución no ha sido homogénea para las tres afecciones, registrando descensos de 1,1% a 0,4% para DA, de 31,6% a 19,6% para DC y de 50,4% a 30,7% para anemia. Si bien los factores analizados se relacionaron con las prevalencias de estos tres padecimientos, al calcular las razones de probabilidades ajustadas se encontraron diferencias significativas para DC (educación de la madre, región de Sierra, altitud por encima de 2 500 msnm, presencia de dos o más hijos en el hogar y ser el tercer hijo o sucesivo) y para anemia (sexo del niño [más en varones], niños menores de 2 años, región Resto de costa y región Selva, altitud por encima de 2 500 msnm, disponibilidad de red pública de agua, disponibilidad de cloacas, presencia de dos o más hijos en el hogar y presencia de diarrea en los 15 días previos a la encuesta). Para DA se observaron diferencias según algunos factores, pero no resultaron significativas en el modelo ajustado. CONCLUSIONES: En el período 2000-2011, Perú ha logrado disminuir sus tasas de DC, DA y de anemia. Las tasas de DA han descendido casi a un tercio, manteniéndose en cifras generales más bien bajas, y afecta en mayor medida a zonas y colectivos muy localizados del país. Sin embargo, las actuales tasas de desnutrición crónica y de anemia siguen siendo muy altas, lo que constituye un verdadero desafío para las políticas públicas, al igual que sucede en otros países de la región. Para superar ese reto será necesario modificar el enfoque, dejando de concebir a la desnutrición infantil como un problema exclusivamente alimentario y haciendo hincapié en los factores determinantes asociados. Por último, en las comunidades más pobres se deberán incentivar y fortalecer iniciativas integrales e integradas.

    Abstract in English:

    OBJECTIVE: Analyze malnutrition and anemia trends in Peruvian children under 5 years of age and their association with determinants in the 2000-2011 period. METHODS: Nutritional indicators for children under 5 years of age from the 2011 Demographic and Family Health Survey (ENDES), and their evolution based on data from the 2000, 2005, and 2008 ENDES, were analyzed. Chronic malnutrition (CM) (height/age ≤ 2 SD), acute malnutrition (AM), (height/weight ≤ 2 SD), and anemia trends were estimated. Associations were found with factors such as sex, age, area of residence (urban or rural), region of residence, mother's education, wealth quintile, availability of public water system, sewer availability, altitude, presence of other children in household, birth order, presence of diarrhea in previous 15 days, and presence of cough in previous 15 days. RESULTS: AM, CM, and anemia in Peruvian children under 5 years of age decreased from 2000-2011. This reduction was not uniform for the three conditions, with decreases of 1.1% to 0.4% recorded for AM, 31.6% to 19.6% for CM, and 50.4% to 30.7% for anemia. Although the factors analyzed were related to the prevalence of these three illnesses, calculation of the adjusted odds ratios showed significant differences for CM (mother's education, Sierra region, altitude greater than 2 500 m above sea level, presence of two or more children in household, and being the third or successive child) and anemia (child sex [higher in males], children under 2 years of age, Resto de costa region and Selva region, altitude greater than 2 500 m above sea level, availability of public water system, sewer availability, presence of two or more children in household, and presence of diarrhea within 15 days prior to the survey). For AM, differences were observed according to some factors but they were not significant in the adjusted model. CONCLUSIONS: In the 2000-2011 period, Peru achieved reduction of its CM, AM, and anemia rates. AM rates decreased to almost one-third, with overall figures remaining fairly low, and affecting to a greater extent highly localized areas and groups of the country. However, the current rates of chronic malnutrition and anemia continue to be very high, which represents a true challenge for public policy, as occurs in other countries of the region. In order to overcome this challenge it will be necessary to change the approach, no longer conceiving of child malnutrition exclusively as a nutritional problem and instead placing greater emphasis on the related determinants. Finally, comprehensive and integrated initiatives should be encouraged and strengthened in the poorest communities.
  • Maternal health and health-seeking behaviors among indigenous Mam mothers from Quetzaltenango, Guatemala Original Research Articles

    Chomat, Anne Marie; Solomons, Noel W.; Montenegro, Gabriela; Crowley, Caitlin; Bermudez, Odilia I.

    Abstract in Spanish:

    OBJETIVO: Obtener información básica acerca de la salud materna y los comportamientos relacionados con la búsqueda de asistencia sanitaria en madres indígenas residentes en comunidades rurales de la etnia maya mam en Quetzaltenango, Guatemala. MÉTODOS: Se llevó a cabo un análisis transversal de 100 mujeres pertenecientes a cuatro comunidades, embarazadas o en período de lactancia, con objeto de determinar la prevalencia y los determinantes de la utilización de servicios. RESULTADOS: La pobreza extrema, la escasa formación y el acceso limitado a los recursos básicos fueron prevalentes. De las 100 mujeres, de 14 a 41 años de edad, 33% no acudieron al sector formal de atención de salud en busca de asistencia prenatal; la mayor parte de ellas consultaron a una partera tradicional. Solo 12% dieron a luz en un hospital. El nivel socioeconómico inferior, la falta de fluidez en español y la carencia de un vehículo motorizado se asociaron con la mayor probabilidad de escasa utilización de los servicios. CONCLUSIONES: Diversos factores afectan a la utilización de los servicios de salud materna por parte de las mujeres indígenas del Quetzaltenango rural. Entre estos factores figuran las desigualdades socioeconómicas, las diferencias lingüísticas y étnicas, y el acceso limitado a los recursos básicos. Es preciso atender a las necesidades reproductivas actuales de las mujeres para mejorar su salud y aumentar sus probabilidades de tener hijos sanos.

    Abstract in English:

    OBJECTIVE: To obtain background information about maternal health and health-seeking behaviors among indigenous mothers living in rural Mam-Mayan communities of Quetzaltenango, Guatemala. METHODS: A cross-sectional analysis of 100 pregnant and breastfeeding women in four communities was performed to determine prevalence and determinants of service utilization. RESULTS: Extreme poverty, poor education, and poor access to basic resources were prevalent. Out of 100 women 14-41 years old, 33% did not use the formal health care sector for antenatal care; the majority consulted a traditional birth attendant. Only 13% delivered in a hospital. Lower socioeconomic status, lack of fluency in Spanish, and no ownership of a motorized vehicle were associated with the highest likelihood of poor utilization of services. CONCLUSIONS: A variety of factors affect utilization of maternal health services by indigenous women in rural Quetzaltenango. These include socioeconomic disparities, ethnic and linguistic differences, and poor access to basic resources. The current reproductive needs of women should be addressed to improve their health and increase their chance of having healthy children.
  • Effect of avoidable and non-avoidable deaths on life expectancy in Mexico, 1998-2000 and 2008-2010 Artículos de Investigación Original

    Agudelo-Botero, Marcela; Dávila-Cervantes, Claudio Alberto

    Abstract in Spanish:

    OBJETIVO: Estimar los cambios en la esperanza de vida por muertes evitables y no evitables en México entre los trienios 1998-2000 y 2008-2010, por sexo y grupo de edad. MÉTODOS: Estudio de corte transversal y descriptivo. Se emplearon datos de defunciones registradas entre 0 y 74 años de edad y estimados de la población (mexicana y mundial) de los trienios 1998-2000 y 2008-2010 de fuentes oficiales. Se calcularon las tasas brutas y estandarizadas de mortalidad y los años de esperanza de vida perdidos en los períodos estudiados. Se estimó el efecto de las muertes evitables y no evitables sobre la esperanza de vida de 0 a 74 años, por el método de Arriaga, y la esperanza de vida temporaria por grupos de edad. RESULTADOS: Las tasas de mortalidad por causas evitables se incrementaron en 2,1%, mientras que las relacionadas con causas no evitables decrecieron en 2,3%, con diferencias por sexo. La esperanza de vida al nacer en el trienio 1998-2000 fue de 74,2 años y para el trienio 2008-2010, de 75,1 años. La esperanza de vida temporaria entre 0 y 74 años permaneció prácticamente igual, alrededor de 68,6 años. CONCLUSIONES: Es posible ganar años de esperanza de vida, principalmente por la reducción de muertes por causas evitables, mediante acciones de promoción de la salud y prevención de enfermedades. Se deben desarrollar estrategias e intervenciones poblacionales transversales, enfocadas en subgrupos específicos, bajo una perspectiva de género y generacional, ajustadas a las particularidades geográficas, socioeconómicas y culturales de la población objetivo.

    Abstract in English:

    OBJECTIVE: Estimate the changes in life expectancy related to avoidable and nonavoidable deaths in Mexico between the three-year periods from 1998-2000 and 2008-2010 by sex and age group. METHODS: A descriptive cross-sectional study was conducted. Data from official sources on deaths recorded from 0-74 years of age and population estimates (Mexican and worldwide) for the three-year periods from 1998-2000 and 2008-2010 was used. The crude and standardized death rates and years of life expectancy lost in the periods studied were calculated. Estimates were made of the effect of avoidable and non-avoidable deaths on life expectancy from 0-74 years of age, using the Arriaga method, and temporary life expectancy by age group. RESULTS: Mortality due to avoidable causes increased by 2.1% whereas mortality related to non-avoidable causes decreased by 2.3%, with differences according to sex. Life expectancy at birth was 74.2 years in the three-year period from 1998-2000 and 75.1 years in the three-year period from 2008-2010. Temporary life expectancy from 0-74 years of age remained nearly the same at about 68.6 years. CONCLUSIONS: Years of life expectancy can be gained through actions that promote health and disease prevention, mainly by reducing deaths due to avoidable causes. Cross-sectional population-based interventions and strategies should be developed, focusing on specific subgroups, from a gender and generational perspective, and adjusted for the specific geographical, socioeconomic, and cultural features of the target population.
  • Social determinants of exclusion from health services and medicines in three Central American countries Artículos de Investigación Original

    Acuña, Cecilia; Marina, Nelly; Mendoza, Adriana; Emmerick, Isabel Cristina Martins; Luiza, Vera Lucía; Azeredo, Thiago Botelho

    Abstract in Spanish:

    OBJETIVO: Examinar los determinantes sociales que afectan la conducta de la población en relación con la búsqueda y obtención de medicamentos, y su relación con la exclusión de los servicios de salud para datos agregados de tres países de América Central: Guatemala, Honduras y Nicaragua. MÉTODOS: Estudio observacional descriptivo de corte transversal, mediante la aplicación de una encuesta de hogares. La muestra del estudio se seleccionó de acuerdo al método de conglomerados. Los datos fueron analizados con el programa SPSS® V.17, utilizando estadística descriptiva y análisis bivariado, multivariado y por componentes principales (ACP). RESULTADOS: Aunque la mayoría de las personas pudo acceder a la atención en salud, la exclusión en salud (razón de probabilidades [RP] 4,10; intervalo de confianza de 95% [IC95%]) fue el principal determinante de la falta de acceso a los medicamentos. Las características de la vivienda (RP 0,747, IC95%), la formalidad del empleo del jefe(a) de hogar (RP 0,707, IC95%) y las condiciones socioeconómicas del hogar (RP 0,462, IC95%) fueron también importantes determinantes de la falta de acceso a los medicamentos. CONCLUSIONES: Los fenómenos de la falta de acceso a servicios de salud y a medicamentos no son independientes entre sí. Se corroboró que el sistema de salud, como determinante social intermediario de la salud, es un factor importante para la mejora del acceso a medicamentos. Las políticas públicas orientadas a alcanzar la cobertura universal deben contemplar esta relación para ser eficaces.

    Abstract in English:

    OBJECTIVE: Examine the social determinants that affect population behavior with regard to the search for and acquisition of medicines, and their relationship to exclusion from health services based on aggregate data from three Central American countries: Guatemala, Honduras, and Nicaragua. METHODS: A descriptive, observational cross-sectional study was conducted by administration of a household survey. The study sample was selected in accordance with the conglomerate method. Data was analyzed with the SPSS® V.17 program using descriptive statistics, bivariate, multivariate, and principal components analysis (PCA). RESULTS: Although the majority of the persons could access health care, health exclusion (odds ratio [OR] 4.10; 95% confidence interval [95% CI]) was the main determinant of lack of access to medicines. The characteristics of housing (OR 0.747, 95% CI), formal employment of head of the household (OR 0.707, 95% CI), and socioeconomic status of the household (OR 0.462, 95% CI) were also important determinants of lack of access to medicines. CONCLUSIONS: The phenomena of lack of access to health services and medicines are not independent from one another. It was corroborated that the health system, as an intermediate social determinant of health, is an important factor for improvement of access to medicines. Public policies that aim to achieve universal coverage should consider this relationship in order to be effective.
  • Geographic information system and multilevel analysis: gingival status among 12-year-old schoolchildren in São Paulo, Brazil Original Research Articles

    Pereira, Stela Márcia; Pardi, Vanessa; Cortellazzi, Karine L.; Ambrosano, Glaucia Maria Bovi; Vettorazzi, Carlos Alberto; Ferraz, Sílvio F.B.; Meneghim, Marcelo de Castro; Pereira, Antonio Carlos

    Abstract in Spanish:

    OBJETIVO: Evaluar el estado gingival y la presencia de sarro en escolares de 12 años de edad mediante el empleo de un sistema de información geográfica y análisis de niveles múltiples. MÉTODOS: En el año 2005, se seleccionó a un total de 1 002 escolares de 18 distritos municipales mediante muestreo por grupos, con la participación de 25 escuelas públicas y privadas de Piracicaba, en el estado de São Paulo, Brasil. Un único examinador calibrado, que utilizó los criterios de la Organización Mundial de la Salud, así como el Índice Periodontal Comunitario, llevó a cabo los exámenes. Mediante un cuestionario, se registraron las variables sociales, económicas y conductuales, y estas se emplearon en el análisis individual (primer nivel). En el análisis contextual (segundo nivel), se utilizaron las variables "porcentaje de cabezas de familia sin ingresos" y "porcentaje de cabezas de familia analfabetas". RESULTADOS: Se construyó un sistema de información geográfica para elaborar mapas de la distribución de la hemorragia gingival. Los mapas, donde se pueden distinguir visualmente las variables, demostraron una tendencia hacia una mejor salud gingival en las zonas del centro de la ciudad, consideradas como privilegiadas. En el nivel contextual, únicamente el "porcentaje de cabezas de familia analfabetas" se asoció significativamente con el sangrado gingival. CONCLUSIONES: El presente estudio confirma una mejor salud bucodental en los escolares pertenecientes a familias privilegiadas, pero no confirma los datos en cuanto a "ingresos". Las personas residentes en zonas donde las cabezas de familia no tenían ingresos no presentaron una mayor prevalencia de problemas gingivales. Esto indica que estas personas, como consecuencia de las actividades de los servicios de atención de salud pública del municipio, están razonablemente protegidas de la repercusión de la privación social.

    Abstract in English:

    OBJECTIVE: To evaluate gingival and calculus status among schoolchildren 12 years of age using a geographic information system and multilevel analysis. METHODS: A total of 1 002 schoolchildren were selected from 18 municipal districts by means of cluster sampling, from among 25 public and private schools in Piracicaba, São Paulo, Brazil, in 2005. Examinations were carried out by a single calibrated examiner utilizing the criteria of the World Health Organization, as well as the Community Periodontal Index. Social, economic, and behavioral variables were recorded with the use of a questionnaire and were used in the individual analysis (first level). The variables "percentage of heads of families without income" and "percentage of illiterate heads of families" were used in the contextual analysis (second level). RESULTS: A geographic information system was constructed for mapping the distribution of gingival bleeding. The variables were visually distinguished in the maps and demonstrated a tendency toward better gingival health in the central areas of the city, which are recognized as more privileged. On the contextual level, only the "percentage of illiterate heads of families" was significantly associated to gingival bleeding. CONCLUSIONS: The study confirms better oral health status among schoolchildren from privileged families, but does not confirm the data regarding "income." The individuals from areas in which the heads of family did not have income were not associated to a higher prevalence of gingival problems. This suggests that these individuals are reasonably protected from the impact of social privation due to the actions of public health care services in the municipality.
  • User embracement in the Family Health Strategy in Brazil: an integrative review

    Garuzi, Miriane; Achitti, Maria Cecília de Oliveira; Sato, Cintia Ayame; Rocha, Suelen Alves; Spagnuolo, Regina Stella

    Abstract in Portuguese:

    OBJETIVO: Revisar a literatura acerca da aplicação do conceito de acolhimento e elucidar as contribuições desse conceito para as práticas na atenção primária à saúde. MÉTODOS: Foi realizada uma revisão integrativa que investigou a produção do conhecimento sobre atenção primária à saúde. Foram pesquisadas as seguintes bases de dados: LILACS, SciELO e MEDLINE, no período de 2006 a 2010. Os termos de busca utilizados na LILACS E SciELO foram: "acolhimento" AND "programa saúde da família" AND "saúde". Na MEDLINE foram usados os termos "user embracement" AND "family health program" AND " health". A coleta de dados se deu no mês de novembro de 2010. RESULTADOS: Foram identificados 21 artigos que preencheram os critérios de inclusão, todos descrevendo estudos brasileiros. Os artigos foram sistematizados em três categorias empíricas: vínculo e acolhimento; processo de trabalho em atenção primária à saúde; e avaliação dos serviços. As categorias são complementares e convergem para duas visões principais de acolhimento: dispositivo capaz de reorganizar a atenção à saúde e postura perante o usuário. Percebe-se ainda o acolhimento como ferramenta de gestão em defesa do Sistema Único de Saúde, associado aos princípios da integralidade e universalidade. CONCLUSÕES: O acolhimento é capaz de promover o vínculo entre profissionais e usuários, possibilitando o estímulo ao autocuidado, melhor compreensão da doença e corresponsabilização pelo tratamento. Auxilia na universalização do acesso, fortalece o trabalho multiprofissional e intersetorial, qualifica a assistência, humaniza as práticas e estimula ações de combate ao preconceito. Entretanto, mereceria maior atenção a perspectiva do usuário sobre a utilização do acolhimento, um tópico a ser enfocado por estudos futuros.

    Abstract in English:

    OBJECTIVE: To review the literature regarding the application of the notion of user embracement and to identify the contributions of this concept for primary health care practices in Brazil. METHOD: We carried out an integrative review of the literature regarding primary health care. The following databases were searched: LILACS, SciELO, and MEDLINE, covering the period from 2006 to 2010. The following search terms were used in LILACS and SciELO: "acolhimento" and "programa saúde da família" and "saúde". For MEDLINE, the terms "user embracement" and "family health program" and "health" were used. The review was performed in November 2010. RESULTS: We identified 21 articles meeting the inclusion criteria, all of which described studies carried out in Brazil. The articles were divided into three empirical categories: integration and embracement; primary care work process; and evaluation of services. These are complementary categories that converge to two main views of embracement: the first sees embracement as a means of reorganizing the primary health care environment, and the second sees embracement as an attitude towards users. The review also shows that embracement may be a management tool that supports the Unified Health System and is associated with the principles of comprehensiveness and universality. CONCLUSIONS: Embracement is able to create a bond between health care workers and users. It promotes self-care, a better understanding of disease, as well as user co-responsibility for treatment. In addition, it facilitates universal access, strengthens multiprofessional and intersectoral work, qualifies care, humanizes practices, and encourages actions to combat prejudice. Nevertheless, the perspective of health care users regarding embracement deserves more attention and should be the focus of future studies.
  • Community-based participatory research in public health: potentials and challenges

    Dias, Sónia; Gama, Ana

    Abstract in Portuguese:

    No campo da saúde pública, advoga-se uma mudança de paradigma de investigação que possibilite maior tradução do conhecimento científico em ações e políticas de saúde mais adaptadas às comunidades. Especial atenção tem sido dada à investigação participativa baseada na comunidade, pelo seu potencial em possibilitar um maior conhecimento sobre as questões complexas de saúde. Neste ensaio, refletiu-se sobre a contribuição da investigação participativa em saúde, analisando as suas perspectivas teóricas, princípios e potencialidades. Também se examinarom alguns aspectos críticos na sua implementação, realçando-se possíveis estratégias para superar esses desafios. A investigação participativa integra uma abordagem colaborativa de envolvimento das comunidades, profissionais, decisores políticos e acadêmicos na produção de conhecimento, incorporando as suas diferentes perspectivas e experiências. Essa abordagem favorece a aceitação do projeto, a adesão das comunidades ao estudo e, consequentemente, a qualidade dos dados coletados. A investigação participativa pode ser, em si só, uma intervenção: o envolvimento das comunidades pode aumentar a sua tomada de consciência sobre a importância das temáticas abordadas e capacitá-las para definir e responder às problemáticas de saúde, promovendo o seu empoderamento. Contudo, os investigadores encontram desafios na utilização dessa abordagem, relacionados com o estabelecimento e manutenção das parcerias de investigação, a partilha de controle da tomada de decisão e a conciliação das motivações e interesses dos parceiros. Mais evidência sobre o processo de implementação da investigação participativa reforçará o seu quadro teórico, a compreensão das suas potencialidades e limitações no estudo de diferentes problemáticas, contextos e populações, e o seu papel benéfico para as comunidades.

    Abstract in English:

    A change in the research paradigm towards a method that more readily allows the translation of scientific knowledge into more community-oriented health actions and policies has been advocated in the field of public health. Special attention has been paid to community-based participatory research, which has the potential to allow the production of deeper knowledge of complex health issues. The present essay reflects on the contributions of participatory research in health, analyzing its theoretical perspectives, principles, and strengths. Some key aspects relating to the implementation of participatory research are also examined, underscoring possible strategies to face this challenge. Participatory research integrates a collaborative approach with involvement of communities, professionals, political decision-makers, and academics to produce knowledge, incorporating the different perspectives and experiences of these stakeholders. This approach facilitates acceptance of the project and engagement of communities, and consequently enhances the quality of the data collected. Participatory research may work in and of itself as an intervention: the involvement of communities may increase their awareness about the importance of the research themes and serve as training to define and address health issues, promoting empowerment. Nevertheless, researchers face challenges in applying this approach. Such challenges are related to the establishment and maintenance of research partnerships, the sharing of decision-making control, and the reconciliation of the motivations and interests of partners. More evidence regarding the process of implementation of participatory research will strengthen the method's theoretical framework and provide further understanding regarding its potential and limitations to address various problems, contexts, and populations, and clarify its beneficial role for communities.
  • Effectiveness of border screening for detecting Influenza in arriving airline travelers Sección Especial

    Priest, Patricia C.; Jennings, Lance C.; Duncan, Alasdair R.; Brunton, Cheryl R.; Baker, Michael G.

    Abstract in Spanish:

    OBJETIVOS: Se midieron los síntomas y la prevalencia de la gripe (también llamada influenza), así como la eficacia del mecanismo de detección sistemática basado en los síntomas y la temperatura para diagnosticar la gripe en viajeros internacionales que llegaban por vía aérea. MÉTODOS: El presente estudio transversal recopiló datos de viajeros que llegaron al aeropuerto internacional de Christchurch (Nueva Zelandia) en el invierno del 2008 mediante un cuestionario de salud, medición de la temperatura y toma de muestras de las vías respiratorias. RESULTADOS: De los viajeros, 15 976 (68%) entregaron los formularios completos. De ellos, 17% notificaron al menos un síntoma de gripe; los síntomas más comunes fueron rinorrea o congestión nasal (10%) y tos (8%). Se tomaron muestras de las vías respiratorias de 3 769 viajeros. La prevalencia estimada de la gripe fue de 1,1% (4% en las personas sintomáticas, 0,2% en las asintomáticas). La sensibilidad de los criterios de detección varió de 84% para "cualquier síntoma" a 3% para la fiebre de 37,8 ºC o mayor. El valor predictivo positivo fue bajo para todos los criterios. CONCLUSIONES: El método de detección sistemática en las fronteras mediante la autonotificación de síntomas y la toma de la temperatura presenta limitaciones para impedir que una gripe pandémica entre en un país. Basarse en criterios como "cualquier síntoma" o la tos haría que se investigara a varias personas no infectadas, mientras que algunas personas infectadas pasarían inadvertidas. Si se usaran criterios más específicos como la fiebre, la mayoría de las personas infectadas entrarían en el país a pesar del mecanismo de detección.

    Abstract in English:

    ABSTRACT OBJECTIVES: We measured symptom and influenza prevalence, and the effectiveness of symptom and temperature screening for identifying influenza, in arriving international airline travelers. METHODS: This cross-sectional study collected data from travelers to Christchurch International Airport, New Zealand, in winter 2008, via a health questionnaire, temperature testing, and respiratory sampling. RESULTS: Forms were returned by 15 976 (68%) travelers. Of these, 17% reported at least 1 influenza symptom, with runny or blocked nose (10%) and cough (8%) most common. Respiratory specimens were obtained from 3769 travelers. Estimated prevalence of influenza was 1.1% (4% among symptomatic, 0.2% among asymptomatic). The sensitivity of screening criteria ranged from 84% for "any symptom" to 3% for a fever of 37.8 ºC or greater. The positive predictive value was low for all criteria. CONCLUSIONS: Border screening using self-reported symptoms and temperature testing has limitations for preventing pandemic influenza from entering a country. Using "any symptom" or cough would lead to many uninfected people being investigated, yet some infected people would remain undetected. If more specific criteria such as fever were used, most infected people would enter the country despite screening.
Organización Panamericana de la Salud Washington - Washington - United States
E-mail: contacto_rpsp@paho.org