Revista Panamericana de Salud Pública, Volume: 35, Número: 3, Publicado: 2014
  • Child malnutrition and prenatal care: evidence from three Latin American countries Original Research Articles

    Forero-Ramirez, Nohora; Gamboa, Luis F.; Bedi, Arjun; Sparrow, Robert

    Resumo em Espanhol:

    OBJETIVO: Analizar el efecto de la atención prenatal sobre el nivel y la distribución del retraso del crecimiento infantil en tres países andinos (Bolivia, Colombia y Perú) donde la ampliación del acceso a este tipo de atención ha constituido una intervención política explícita con objeto de afrontar la desnutrición intrauterina y durante la primera infancia. MÉTODOS: Se llevó a cabo un análisis econométrico de la Encuesta de Demografía y Salud, de carácter transversal. Este análisis incluyó regresiones ordinarias de mínimos cuadrados, cálculos de curvas de concentración y descomposiciones de un índice de concentración. RESULTADOS: El análisis demuestra que la atención prenatal en Bolivia, Colombia y Perú se asocia solo débilmente con una reducción del nivel de desnutrición infantil. CONCLUSIONES: Es poco probable que una mayor extensión de los programas de atención prenatal tenga un amplio efecto en la reducción de las desigualdades en materia de desnutrición.

    Resumo em Inglês:

    OBJECTIVE: To examine the effect of prenatal care (PNC) on the level and distribution of child stunting in three Andean countries-Bolivia, Colombia, and Peru-where expanding access to such care has been an explicit policy intervention to tackle child malnutrition in utero and during early childhood. METHODS: An econometric analysis of cross-sectional Demographic and Health Survey (DHS) data was conducted. The analysis included ordinary least-squares (OLS) regressions, estimates of concentration curves, and decompositions of a concentration index. RESULTS: The analysis shows that the use of PNC in Bolivia, Colombia, and Peru is only weakly associated with a reduction in the level of child malnutrition. CONCLUSIONS: Further expansion of PNC programs is unlikely to play a large role in reducing inequalities in malnutrition.
  • Historia natural del proceso diagnóstico del cáncer de mama Artículos de Investigación Original

    Villarreal-Ríos, Enrique; Escorcia-Reyes, Verónica; Martínez-González, Lidia; Vargas-Daza, Emma Rosa; Galicia-Rodríguez, Liliana; Cervantes-Becerra, Roxana; López-Ramos, José Martín

    Resumo em Espanhol:

    OBJETIVO: Construir un modelo que explique la historia natural de proceso diagnóstico del cáncer de mama. MÉTODOS: Estudio transversal descriptivo con 245 de mujeres de 40 a 69 años, seleccionadas mediante muestreo aleatorio simple a quienes se realizó una mastografía y cumplieron con los principios del proceso diagnóstico de cáncer de mama. El diagnóstico se realizó por biopsia. Para el proceso diagnóstico se estimaron el porcentaje de pacientes atendidas en cada servicio, el total de pacientes por servicio y el total de consultas generadas en cada servicio y sus intervalos de confianza de 95%. RESULTADOS: A 20% de las pacientes que iniciaron el proceso diagnóstico del cáncer de mama en medicina preventiva se le realizó una mastografía, 23,7% fue atendido en medicina familiar, de ellas, 70,9% se derivó a la clínica de mama y a 7,3% se le realizó biopsia con arpón. La prevalencia de cáncer de mama confirmada mediante biopsia fue 0,48% (IC95%: 0,0-1.3). Por cada 1 000 pacientes que iniciaron el proceso, 47,4 se atienden en medicina familiar, 33,6 en clínica de mama y a 2,4 se les realiza biopsia abierta. Por cada 1 000 pacientes que entran en dicho proceso, se generan 211,4 consultas en radiología, 51,6 en medicina familiar y 54,6, en la clínica de mama. CONCLUSIONES: El modelo descrito puede ser útil en actividades de planificación y evaluación.

    Resumo em Inglês:

    OBJECTIVE: To build a model that explains the natural history of breast cancer diagnostic procedures. METHODS: Descriptive cross-sectional study of 245 women between 40 and 69 years of age, selected by simple random sampling, who underwent a mammography and met the requirements of the breast cancer diagnostic procedure. Diagnosis was made by biopsy. For the diagnostic procedure, an estimate was made of the percentage of patients seen by each service, the total number of patients per service, and the total number of consultations in each service, with 95% confidence intervals. RESULTS: Of the patients who initiated the breast cancer diagnostic procedure in preventive medicine services, 20% underwent a mammography; 23.7% were seen in family medicine services and of these patients, 70.9% were referred to a breast clinic, where 7.3% underwent a harpoon biopsy. The prevalence of breast cancer confirmed by biopsy was 0.48% (95%CI: 0.0-1.3). Per 1 000 patients who initiated the procedure, 47.4 were seen in family medicine services and 33.6 in a breast clinic, and open biopsies were performed on 2.4. Per 1 000 patients who initiated the procedure, there were 211.4 consultations in radiology services, 51.6 in family medicine services, and 54.6 in a breast clinic. CONCLUSIONS: The model described here may be useful in planning and evaluation activities.
  • Mental health and poor recovery in female nursing workers: a contribution to the study of gender inequities Original Research Articles

    Rotenberg, Lúcia; Silva-Costa, Aline; Griep, Rosane Härter

    Resumo em Espanhol:

    OBJETIVO: Abordar la asociación entre trabajo y salud mental desde una perspectiva de género mediante la investigación de la combinación del trabajo doméstico y los aspectos adversos del trabajo profesional (turnos nocturnos y estrés psicosocial) con respecto a su asociación con trastornos psiquiátricos menores y la recuperación deficiente tras la actividad laboral. MÉTODOS: En el 2006, se llevó a cabo un estudio transversal en tres hospitales públicos de Rio de Janeiro (Brasil) (n = 1 122). La recopilación de datos se basó en un censo de todo el personal femenino de enfermería, técnico y auxiliar de enfermería. Se empleó un instrumento pluridimensional que contenía información acerca de la salud, el trabajo profesional y el trabajo doméstico. Se combinaron las horas de trabajo doméstico (más de 10 horas por semana, o menos de 10) con el horario de trabajo (turnos diurnos o nocturnos) y el estrés psicosocial (ausencia o presencia de desequilibrio esfuerzo-recompensa). Estas combinaciones se contrastaron con respecto a la asociación con trastornos psiquiátricos menores y la recuperación deficiente tras la actividad laboral. Se calcularon las razones de posibilidades ajustadas (OR) y sus intervalos de confianza mediante modelos de regresión múltiple. RESULTADOS: La combinación de muchas horas de trabajo doméstico con el trabajo nocturno se asoció significativamente con los trastornos psiquiátricos menores (OR = 1,94) y la recuperación deficiente (OR = 2,67). Muchas horas de trabajo doméstico combinadas con un desequilibrio esfuerzo-recompensa dieron lugar a razones de posibilidades significativamente mayores (OR = 4,37 y OR = 5,53, respectivamente). En todos los análisis, se observaron mayores razones de posibilidades en los grupos con muchas horas de trabajo doméstico, en comparación con los de pocas horas. CONCLUSIONES: Llevar a cabo actividades domésticas por encima de un cierto número de horas puede aumentar las consecuencias perjudiciales del trabajo profesional en cuanto a trastornos psiquiátricos menores y recuperación deficiente. En los debates sobre la equidad en salud se deben tener en cuenta la interacción entre el trabajo profesional y el doméstico, y sus potenciales implicaciones en cuanto al sufrimiento mental.

    Resumo em Inglês:

    OBJECTIVE: To address the association between work and mental health from a gender perspective by investigating the combination of domestic work and adverse aspects of professional work (night shifts and psychosocial stress) with regard to minor psychiatric disorders (MPD) and poor recovery from work. METHODS: A cross-sectional study was carried out at three public hospitals in Rio de Janeiro, Brazil, in 2006 (n = 1 122). Data collection was based on a census of all female nurses, technicians, and auxiliary nurses. A multidimensional instrument containing information about health, professional work, and the domestic work was used. The domestic work hours (longer or shorter than 10 hours per week) were combined with the work schedule (day or night shifts) and with psychosocial stress (absence or presence of effort-reward imbalance [ERI]). These combinations were tested with regard to the association with MPD and poor recovery from work. The adjusted odds ratios (OR) and their confidence intervals were calculated using multiple regression models. RESULTS: The combination of long domestic work hours with night work was significantly associated with MPD (OR = 1.94) and poor recovery (OR = 2.67). Long domestic work hours combined with the presence of ERI resulted in significantly higher odds ratios (OR = 4.37 and OR = 5.53, respectively). In all analyses, greater odds ratios were observed in groups with long domestic work hours, compared to short work hours. CONCLUSIONS: These findings suggest that carrying out domestic activities over a certain number of hours can increase the detrimental consequences of professional work in regard to MPD and poor recovery. The interaction between professional and domestic work and its potential implications to mental suffering must be considered in discussions on health equity.
  • Algoritmo para monitoramento da incidência da malária na Amazônia brasileira, 2003 a 2010

    Braz, Rui Moreira; Duarte, Elisabeth Carmen; Tauil, Pedro Luiz

    Resumo em Português:

    OBJETIVO: Avaliar um algoritmo para detecção da variação da incidência da malária nos municípios da Amazônia brasileira. MÉTODOS: Avaliou-se um sistema de monitoramento automatizado, baseado em um algoritmo desenvolvido anteriormente pelos autores. O algoritmo utiliza o diagrama de controle por quartis para classificação dos municípios em quatro grupos, conforme a variação da incidência da malária: grupo 1 (redução da incidência)-aqueles com incidência abaixo dos valores esperados; grupo 2 (incidência esperada)-aqueles com incidência dentro dos valores esperados; grupo 3 (epidemia)-aqueles com incidência acima dos valores esperados; grupo 4 (caso esporádico)-aqueles com apenas um caso durante o ano. O período de análise foi de 2003 a 2010. Foram estudados todos os municípios existentes nos nove estados que compõem a Amazônia brasileira (805 municípios em 2003 e 807 a partir de 2004). RESULTADOS: Com base nessa metodologia, os municípios da região foram assim classificados: grupo 1, 152 municípios (18,8% da região) em 2003 e 109 (13,5%) em 2010; grupo 2, 206 (25,6%) em 2003 e 331 (41,0%) em 2010; grupo 3, 391 (48,6%) em 2003 e 308 (38,2%) em 2010; e grupo 4, 56 (7,0%) em 2003 e 59 (7,3%) em 2010. CONCLUSÕES: O algoritmo possibilitou verificar que, na Amazônia brasileira, o número de municípios com epidemias de malária em 2010 diminuiu em relação a 2003, enquanto o número de municípios com incidência esperada aumentou. No mesmo período, houve pouca variação no número de municípios com redução da incidência e daqueles com casos esporádicos.

    Resumo em Inglês:

    OBJECTIVE: To evaluate an algorithm developed for detecting variations in the incidence of malaria in the Brazilian Amazon. METHODS: An evaluation was conducted of an automated monitoring system based on an algorithm that had been previously developed by the authors. The algorithm employs quartile diagrams to classify municipalities according to variations in the incidence of malaria: group 1 (reduced incidence)-municipalities with below the expected incidence rates; group 2 (expected incidence)- within the expected incidence rates; group 3 (epidemics)-higher than the expected incidence rates; and group 4 (sporadic case)-a single case during a year. The period from 2003 to 2010 was analyzed. All the municipalities in the nine states that make up the Brazilian Amazon were studied (805 municipalities in 2003 and 807 starting in 2004). RESULTS: Based on this method, Amazonian municipalities were classified as follows: group 1, 152 (18.8%) municipalities in 2003 and 109 (13.5%) in 2010; group 2, 206 (25.6%) municipalities in 2003 and 331 (41.0%) in 2010; group 3, 391 (48.6%) municipalities in 2003 and 308 (38.2%) in 2010; and group 4, 56 (7.0%) municipalities in 2003 and 59 (7.3%) in 2010. CONCLUSIONS: The use of the algorithm revealed that in 2010, the number of Amazonian municipalities in group 3 (epidemics) decreased when compared to 2003, while the number of municipalities in group 2 (expected incidence) increased. In the same period, there was no significant variation in the number of municipalities in group 1 (reduced incidence) and in group 4 (sporadic case).
  • Outsourcing versus in-house maintenance of medical devices: a longitudinal, empirical study Original Research Articles

    Miguel-Cruz, Antonio; Rios-Rincón, Adriana; Haugan, Gregory L.

    Resumo em Espanhol:

    OBJETIVO: Establecer los factores que influyen significativamente en el desempeño del mantenimiento de los dispositivos médicos mediante contratación externa, y determinar cómo difiere el desempeño de las estructuras externas de gobernanza según un hospital sea privado o público. MÉTODOS: Se realizó un estudio longitudinal de 590 transacciones de mantenimiento en 20 hospitales de Bogotá (Colombia), que incluyeron 764 dispositivos médicos y 72 proveedores de servicio de mantenimiento. Por medio de un procedimiento de vigilancia, se recopilaron principalmente datos de desempeño del mantenimiento (es decir, el plazo de entrega en horas) por parte de los proveedores del servicio (ya fuera este interno o externalizado) durante un período de 20 meses, desde diciembre del 2009 a agosto del 2011; a continuación, se aplicó un modelo de riesgos. RESULTADOS: La disponibilidad de piezas de repuesto específicas en existencia en la misma ciudad en que se ubicaban los dispositivos médicos tuvo una repercusión positiva sobre el desempeño de ambas estructuras de gobernanza, la interna y la externa. El servicio en línea también tuvo una repercusión positiva en el desempeño de ambas estructuras; pero esta repercusión fue más intensa en el desempeño de la gobernanza interna que en el de la externa. En cuanto a las transacciones regidas por estructuras externas, se observó un mejor desempeño en los hospitales privados que en los públicos. En las instituciones de salud pública, la gobernanza interna mostró un mejor desempeño que la externa. Ambas estructuras de gobernanza mostraron un mejor desempeño en las instituciones de atención de salud privadas que en las públicas. CONCLUSIONES: En las instituciones de salud pública, la gobernanza interna muestra un mejor desempeño que la externa; ello indica que los gerentes de atención de salud deben reconsiderar la tendencia a eliminar al personal de los servicios de mantenimiento interno de las instituciones públicas de atención de salud.

    Resumo em Inglês:

    OBJECTIVE: To determine what factors have a significant influence on the performance of medical device maintenance outsourcing, and to determine how the performance of external governance structures differs depending on whether a hospital is private or public. METHODS: This was a longitudinal study of 590 maintenance transactions at 20 hospitals in Bogotá, Colombia, involving 764 medical devices and 72 maintenance service providers. Maintenance performance data (i.e., turn-around time in hours; TAT) for the service providers (either in-house or outsourced) were primarily collected over a 20-month period, from December 2009-August 2011, by means of a monitoring procedure; then, a hazards model was run. RESULTS: The availability of specific repair parts, in-stock, in the city in which the medical devices were located, had a positive impact on the performance of both internal and external governance structures. Online service also had a positive impact on both, with a stronger positive impact on the performance of internal governance than on that of external governance. For transactions governed by external structures, better performance was seen in private hospitals than in public ones. In public health institutions, internal governance showed better performance than external governance. Both internal and external governance structures showed better performance in private healthcare institutions than in public ones. CONCLUSIONS: In public health institutions, internal governance shows better performance than external governance; this suggests that healthcare managers should reconsider the trend to eliminate in-house maintenance service staff in public healthcare institutions.
  • Health-related quality of life in patients with hepatitis C virus infection in Brazil Original Research Articles

    El Khoury, Antoine C.; Vietri, Jeffrey; Prajapati, Girish

    Resumo em Espanhol:

    OBJETIVO: Cuantificar la carga de la infección por el virus de la hepatitis C (VHC) en cuanto a calidad de vida relacionada con la salud (CVRS) en una amplia muestra de adultos del Brasil, particularmente en los de 40 años de edad o mayores. MÉTODOS: Se llevó a cabo un estudio retrospectivo y de observación de los datos de la Encuesta Nacional de Salud y Bienestar del Brasil del 2011, una amplia encuesta transversal (n = 12 000) que aporta información sobre trastornos médicos y resultados en materia de salud, e incluye el cuestionario de salud denominado Estudio de los Resultados Médicos, en la versión 2 de su forma abreviada de 12 ítems (SF-12v2). Los entrevistados que notificaron un diagnóstico médico de infección por el VHC se compararon con los que afirmaron que nunca habían padecido esta infección en cuanto a las puntuaciones resumen de las componentes mental (MCS) y física (PCS) y las puntuaciones de utilidad en salud del SF-6D. Se llevaron a cabo comparaciones no ajustadas mediante pruebas de ji al cuadrado para las variables categóricas y pruebas t para las variables continuas. Se empleó un modelo de regresión para ajustar los resultados en cuanto a confusiones potenciales. Se realizaron análisis del subgrupo de adultos de 40 años de edad o mayores. RESULTADOS: Las comparaciones no ajustadas entre los entrevistados infectados por el VHC (n = 100) y los controles (n = 11 694) mostraron puntuaciones de MCS y PCS similares, pero los pacientes infectados por el VHC obtuvieron puntuaciones de utilidad del SF-6D inferiores (0,70 frente a 0,73, P < 0.05). Las regresiones de ajuste de las características demográficas y de salud proporcionaron resultados similares a los de las comparaciones no ajustadas. Los análisis del subgrupo de entrevistados de 40 años de edad o mayores mostraron disminuciones tanto en la MCS (45,95 frente a 49,72, P < 0.05) como en el SF-6D (0,71 frente a 0,76, P < 0.05). Las puntuaciones de la PCS fueron comparables en los pacientes infectados por el VHC y los controles. CONCLUSIONES: La infección por el VHC en el Brasil causa una carga significativa en cuanto a CVRS, especialmente en la población de mayor edad. Las medidas preventivas para reducir la propagación del virus en el Brasil deben proporcionar beneficios sociales en cuanto a calidad de vida, además de prevenir la morbilidad y la mortalidad causadas por la infección crónica.

    Resumo em Inglês:

    OBJECTIVE: To quantify the health-related quality of life (HRQoL) burden of hepatitis C virus (HCV) infection among a broad sample of adults in Brazil, particularly among those 40 years of age and older. METHODS: This was a retrospective observational study of data from the 2011 Brazil National Health and Wellness Survey, a large (n = 12 000) cross-sectional survey that includes information on medical conditions and health outcomes, including the Medical Outcomes Study Short-form 12 health questionnaire, version 2 (SF-12v2). Respondents who reported a physician diagnosis of HCV infection were compared with those who reported never experiencing HCV on the Mental (MCS) and Physical (PCS) Component Summary scores and SF-6D health utility scores. Unadjusted comparisons were conducted with chi-square tests for categorical variables and t-tests for continuous variables. Regression was used to adjust outcomes for potential confounds. Subgroup analyses were conducted on those 40 years of age and older. RESULTS: Unadjusted comparisons between respondents infected with HCV (n = 100) and controls (n = 11 694) revealed similar MCS and PCS scores, but HCV patients had lower SF-6D utility scores (0.70 vs. 0.73, P < 0.05). Regressions adjusting for demographic and health characteristics provided similar results to unadjusted comparisons. Subgroup analyses of respondents 40 years of age and older revealed decrements in both MCS (45.95 vs. 49.72, P < 0.05) and SF-6D (0.71 vs. 0.76, P < 0.05). PCS scores were comparable in HCV patients and controls. CONCLUSIONS: HCV infection in Brazil causes significant HRQoL burden, especially among the older population. Prevention measures to curtail the spread of the virus in Brazil should provide societal benefits in terms of quality of life, in addition to preventing morbidity and mortality from chronic infection.
  • "Peri-border" health care programs: the Ecuador-Peru experience Original Research Articles

    Cafagna, Gianluca; Missoni, Eduardo; Beingolea, Rosa Luz Benites de

    Resumo em Espanhol:

    OBJETIVO: Determinar los principales puntos fuertes y débiles, y las dificultades del programa de atención de salud en la zona fronteriza entre Ecuador y Perú, y analizar las disposiciones legislativas, de gestión y de organización adoptadas para integrar los sistemas nacionales de salud de ambos países en la zona fronteriza. MÉTODOS: Se llevó a cabo un estudio de casos descriptivo y cualitativo mediante el empleo de tres métodos complementarios: la revisión bibliográfica y el análisis de documentos oficiales peruanos y ecuatorianos, nacionales y binacionales; 18 entrevistas semiestructuradas a informantes clave; y una encuesta dirigida a todo el personal sanitario de la microrred binacional Suyo-Macará. RESULTADOS: La principal dificultad del programa estribó en la ausencia de reciprocidad; los ciudadanos peruanos tenían derecho a servicios de atención de salud gratuitos en Ecuador, pero los ciudadanos ecuatorianos no recibían la misma prestación en Perú. También se señaló la necesidad de mejoras en materia de recursos humanos del sistema binacional. La principal fortaleza del programa fue su estructura organizativa, diseñada principalmente para la implantación de 1) la red binacional; y 2) un sistema de referencia y contrarreferencia de los pacientes que incluye la transferencia de la información clínica de los pacientes. CONCLUSIONES: A pesar de las considerables dificultades, los programas de atención de salud en zonas fronterizas son factibles y reproducibles. El éxito de los programas parece depender en gran medida de que se cumplan una serie de condiciones tales como 1) la consolidación del memorándum binacional original mediante un acuerdo binacional vinculante entre ambos países; 2) la consecución de estándares similares en ambos países en cuanto a la provisión y la calidad de los servicios de atención de salud, con especial hincapié en la complementariedad; y 3) la creación de un sistema binacional de información integrado.

    Resumo em Inglês:

    OBJECTIVE: To identify the main strengths, weaknesses, and challenges of the Ecuador-Peru "peri-border" health care program and to analyze the legislative, managerial, and organizational arrangements adopted to integrate the two country's national health systems in the border area. METHODS: A descriptive, qualitative case study was carried out using three complementary methods: literature review and analysis of official Peruvian and Ecuadoran national and binational documents, 18 semi-structured interviews of key informants, and a survey of the entire health worker population of the Suyo-Macará binational micro-network. RESULTS: The key program challenge was the absence of reciprocity; Peruvian citizens were entitled to free health care services in Ecuador but Ecuadoran citizens did not receive the same benefit in Peru. The need for improvements in the binational system's human resources was also identified. The program's main strength was its organizational structure, which is designed mainly for the implementation of 1) the binational network and 2) a patient referral / counter-referral system that includes the transfer of patient clinical information. CONCLUSIONS: Notwithstanding considerable challenges, peri-border programs are feasible and replicable. Program success seems to be highly dependent on the completion of a number of steps, including 1) consolidation of the original binational memorandum into a binding binational agreement between the two countries; 2) achievement of similar standards in both countries for the provision and quality of health care services, focusing on complementarities; and 3) development of an integrated binational information system.
  • Conocimientos, actitudes y prácticas sobre el dengue en las escuelas primarias de Tapachula, Chiapas, México Artículos de Investigación Original

    Torres, José Luis; Ordóñez, José Genaro; Vázquez-Martínez, M. Guadalupe

    Resumo em Espanhol:

    OBJETIVO: Identificar los conocimientos, actitudes y prácticas sobre el dengue en alumnos de escuelas primarias de Tapachula, Chiapas, México, antes y después de una intervención educativa. MÉTODOS: El estudio se desarrolló en 19 escuelas primarias públicas seleccionadas al azar. Se aplicaron encuestas de conocimientos, actitudes y prácticas antes y después de una estrategia educativa a alumnos de 5º y 6º grado de nivel primario. La estrategia educativa se denominó "Escuelas sin mosquitos" e hizo énfasis en la importancia de la participación de los alumnos en el autocuidado de sus escuelas y hogares para la prevención del dengue mediante el control del vector. RESULTADOS: Se aplicaron 3 124 encuestas de conocimientos, actitudes y prácticas antes y después de la estrategia educativa, a 1 562 alumnos de 5º y 6º grado (772 y 790 alumnos, respectivamente) con edades que oscilaron entre los 10 y los 12 años. El nivel de conocimiento aumentó de manera significativa en comparación con el que los alumnos tenían antes de la estrategia educativa. Los alumnos de 6º grado tenían y adquirieron significativamente más conocimiento sobre varios aspectos de la enfermedad y el vector en comparación a los de 5º grado. En todas las escuelas se hallaron recipientes con agua y 68% de las escuelas tuvieron recipientes positivos para larvas de Aedes aegypti. CONCLUSIONES: Se demostró que mediante la implementación de una estrategia educativa, aumentan el conocimiento, actitudes y prácticas de los niños sobre el autocuidado de sus escuelas y que pueden actuar como promotores del cambio de actitud sobre esta enfermedad en sus hogares.

    Resumo em Inglês:

    OBJECTIVE: To identify dengue-related knowledge, attitudes, and practices among primary school students in Tapachula, Chiapas, Mexico, before and after an educational intervention. METHODS: The study was carried out at 19 randomly selected public primary schools. Surveys of knowledge, attitudes, and practices were conducted before and after educational sessions with fifthand sixth-grade elementary school students. The educational strategy "Escuelas sin mosquitos" ("Schools without Mosquitoes") emphasized the importance of students' participation in taking care of their schools and homes in order to prevent dengue through vector control. RESULTS: Before and after the educational sessions, a total of 3 124 surveys were conducted on the knowledge, attitudes, and practices of 1 562 fifthand sixth-grade students (772 and 790 students, respectively) between 10 and 12 years of age. The students' level of knowledge was significantly higher after the implementation of the educational strategy. In comparison with the fifth-graders, the sixth-grade students both already had and also acquired significantly more knowledge of several aspects of the disease and the vector. In all the schools, there were containers with water identified as potential breeding sites, and in 68% of the schools, these containers tested positive for Aedes aegypti larvae. CONCLUSIONS: It was demonstrated that by implementing an educational strategy, children's knowledge, attitudes, and practices were improved in terms of taking care of their schools and promoting a change of attitude to this disease at home.
  • Estudos de avaliação econômica de tecnologias em saúde: roteiro para análise crítica

    Silva, Everton Nunes da; Galvão, Taís Freire; Pereira, Maurício Gomes; Silva, Marcus Tolentino

    Resumo em Espanhol:

    OBJETIVO: Propor uma ferramenta para análise crítica de estudos de avaliação econômica a partir da síntese de roteiros existentes na literatura. MÉTODOS: Foram realizadas buscas em: MEDLINE, Embase, Centre for Reviews and Dissemination e International Society for Pharmacoeconomics and Outcomes Research. Dois pesquisadores selecionaram independentemente os estudos e extraíram os dados de interesse. Quantificou-se o número de perguntas que os roteiros continham sobre os seguintes domínios: delineamento do estudo; mensuração dos custos e dos desfechos em saúde; análise e interpretação dos resultados; e informações gerais. Após elaboração da matriz contendo os itens de cada domínio por estudo, os autores construíram um instrumento para análise crítica. RESULTADOS: Foram localizados 406 artigos não duplicados, dos quais 19 foram incluídos. No total, foram identificadas 566 perguntas nos roteiros desses estudos. Dessas, 109 (19%) tratavam de desfechos em saúde, 93 (16%) de quantificação dos custos, 73 (13%) de modelagem, 54 (10%) de generalização dos resultados e 52 (9%) de incertezas. O roteiro de análise crítica resultante contém 32 perguntas organizadas em quatro domínios: delineamento do estudo, mensuração dos custos e dos desfechos em saúde, análise e interpretação dos resultados e informações gerais. CONCLUSÕES: O instrumento de análise crítica proposto pode auxiliar na uniformização do julgamento da qualidade da evidência de todos os tipos de avaliação econômica.

    Resumo em Inglês:

    OBJECTIVE: To propose a tool for critical analysis of economic evaluation studies based on a synthesis of checklists and guidelines available in the literature. METHODS: The following databases were searched: MEDLINE, Embase, Centre for Reviews and Dissemination, and International Society for Pharmacoeconomics and Outcomes Research. Two investigators independently selected the studies and extracted the data of interest. The number of questions that the checklists contained were counted on the following domains: study design, measurement of costs and health outcomes, analysis and interpretation of results, and general information. A matrix containing the items in each domain was constructed, and a tool for critical analysis was built based on that matrix. RESULTS: The literature search retrieved 406 non-duplicated articles, 19 of which were included in the study. Five hundred sixty-six questions were identified in the checklists employed in these studies: 109 (19%) dealt with health outcomes, 93 (16%) with quantification of costs, 73 (13%) with modeling, 54 (10%) with generalization of findings, and 52 (9%) with uncertainty. The resulting critical analysis checklist contains 32 questions organized into four domains: study design, measurement of costs and health outcomes, analysis and interpretation of results, and general information. CONCLUSIONS: The proposed critical analysis checklist is useful to standardize the assessment of the quality of evidence in all types of economic evaluations.
  • Indicadores da seleção de medicamentos em sistemas de saúde: uma revisão integrativa

    Santana, Rafael Santos; Jesus, Elisdete Maria Santos de; Santos, Diana Graziele dos; Lyra Júnior, Divaldo Pereira de; Leite, Silvana Nair; Silva, Wellington Barros da

    Resumo em Português:

    OBJETIVO: Obter um painel dos principais indicadores utilizados para a seleção de medicamentos por meio da realização de uma revisão integrativa da literatura. MÉTODOS: Após elaborar um protocolo de revisão, foram realizadas buscas nas bases LILACS, MEDLINE, Embase e SciELO. Foram utilizados os descritores "indicadores", "critérios", "seleção de medicamentos", "comitê de farmácia e terapêutica" e "formulário de medicamentos", com suas variações em inglês e espanhol. Foram selecionados e revisados 16 artigos originais publicados entre janeiro de 1996 e março de 2012 para compor um painel de indicadores. RESULTADOS: Foram identificados 45 indicadores quantitativos e qualitativos. Esses indicadores foram agrupados de acordo com semelhanças conceituais em três categorias: 1) avaliação da estrutura da comissão de farmácia e terapêutica; 2) avaliação dos processos gerais de seleção de medicamentos; e 3) avaliação dos resultados da seleção de medicamentos. CONCLUSÕES: Os indicadores avaliados demonstram relativa uniformidade nos padrões estabelecidos para a seleção de medicamentos. O grupo de indicadores estabelecidos neste estudo deve servir como referência para fomento e consolidação dessa atividade nos serviços de saúde pública.

    Resumo em Inglês:

    OBJECTIVE: To produce a panel of the main drug selection indicators by performing an integrative literature review. METHODS: After the elaboration of a review protocol, searches were conducted in LILACS, MEDLINE, Embase, and SciELO databases. The following search terms were used: "indicators"; "criteria"; "drug selection"; "pharmacy and therapeutics committee"; and "medication form"; with the applicable variations in English and Spanish. Sixteen original articles published between January 1996 and March 2012 were retrieved and reviewed to compose a panel of indicators. RESULTS: Forty-five quantitative and qualitative indicators were identified. These indicators were grouped according to conceptual similarities in three categories: 1) assessment of pharmacy and therapeutics committee structure; 2) evaluation of the general processes of drug selection; and 3) evaluation of the results of drug selection. CONCLUSIONS: The indicators identified reveal relative uniformity in the established patterns for drug selection. The group of indicators established in this study should serve as reference for the development and consolidation of drug selection in public health services.
Organización Panamericana de la Salud Washington - Washington - United States