[Literacy in sexual and reproductive health as well as associated variables: multicenter study]. / Alfabetización en salud sexual y reproductiva así como variables asociadas: estudio multicéntrico.

OBJECTIVE: Limited Health Literacy implies an insufficient understanding of relevant health information, being associated with various variables. The objective of the study was to measure the prevalence of the level of Limited Sexual and Reproductive Health Literacy (AS-SR), its associated variables and the differences in scores between levels of AS-SR, universities and science of study in Chilean university students. METHODS: A multicenter and cross-sectional study, which applied a validated scale to measure levels of AS-SR, was carried out in a sample of 2,186 Chilean university students, categorizing it as high, medium high, medium low and low. The level of Limited AS-SR was obtained by adding the medium-low and low categories. Tests were carried out: descriptive, psychometric and reliability; association, logistic regression and differences between variables of interest. RESULTS: The prevalence of Limited AS-SR was 52.7%. The variables most associated with the level of Limited AS-SR were: low interest in information about health care (OR=2.819; 95% CI: 2.132-3.726), prevention (OR=2.564; 95% CI: 1.941-3.388), sexuality (OR=2.497; 95% CI: 1.807-3.452) and health promotion (OR=1.515; 95% CI: 1.239-1.853); certain sources of Information (OR=1.915; 95% CI:1.614-2.272); low economic income (OR=1.661; 95% CI: 1.361-2.026), among others. There were statistically significant differences in scores between categories of AS-SR levels, universities and study science. The scale had a reliability of 0.940. CONCLUSIONS: More than half of the students have Limited AS-SR, mainly associated with low interest in health information. The scale presents excellent psychometric indicators, being recommended for diagnoses of health situations.

OBJECTIVE: La Alfabetización en Salud Limitada implica una comprensión insuficiente de la información relevante en salud, asociándose con diversas variables. El objetivo del estudio fue medir la prevalencia del nivel de Alfabetización en Salud Sexual y Reproductiva (AS-SR) Limitada, sus variables asociadas y las diferencias de puntajes entre niveles de AS-SR, universidades y ciencia de estudio en universitarios chilenos. METHODS: Se realizó un estudio multicéntrico y transversal, que aplicó una escala validada para medir niveles de AS-SR, en una muestra de 2.186 estudiantes universitarios chilenos, categorizándola en alta, media-alta, media-baja y baja. El nivel de AS-SR Limitada se obtuvo mediante el sumatorio de categorías media-baja y baja. Se realizaron pruebas: descriptivas, psicométricas y fiabilidad; asociación, regresión logística y de diferencias entre variables de interés. RESULTS: La prevalencia de AS-SR Limitada fue del 52,7%. Las variables mayormente asociadas al nivel de AS-SR Limitada fueron: bajo interés en información sobre atención en salud (OR=2,819; IC 95%:2,132-3,726), prevención (OR=2,564; IC 95%: 1,941-3,388), sexualidad (OR=2,497; IC 95%: 1,807-3,452) y promoción de la salud (OR=1,515; IC 95%: 1,239-1,853); ciertas fuentes de Información (OR=1,915; IC 95%:1,614-2,272); bajo ingreso económico (OR=1,661; IC 95%: 1,361-2,026), entre otras. Existieron diferencias estadísticamente significativas de puntajes entre categorías de niveles de AS-SR, universidades y ciencia de estudio. La escala presentó fiabilidad de 0,940. CONCLUSIONS: Más de la mitad de los estudiantes poseen AS-SR Limitada, asociada principalmente al bajo interés en información en salud. La escala presenta excelentes indicadores psicométricos, siendo recomendable para diagnósticos de situación de salud.

Desigualdad en mortalidad estratificada según la densidad del recurso humano en 32 países americanos / Inequality in mortality stratified according to human resource density in 32 American countries

RESUMEN Objetivos Medir desigualdades en salud mediante 12 indicadores de mortalidad, utilizando la densidad de recurso humano de profesionales de medicina (PMED) y enfermería (PENF) como estratificador de equidad en 32 países americanos. Métodos A partir de 12 indicadores de mortalidad, estratificados mediante densidad de PMED y PENF, se calculan tasas ponderadas, diferencias, correlación, indicadores simples y complejos de desigualdad. Resultados De 12 indicadores, 9 presentan mayor tasa en baja densidad de ambas profesiones y 7 presentan diferencias significativas. Hay alta variabilidad en brechas relativas (8,7 a 1,2); concentración desigual con afectación de grupos vulnerables; y mayor índice de la pendiente en mortalidad: materna, enfermedades transmisibles y diabetes. Conclusiones La densidad del recurso humano presenta alta variabilidad y concentración, con razón heterogénea entre ambas profesiones. Al estratificar países de baja a alta densidad, se evidencian desigualdades y gradiente social en 9 de 12 indicadores.

ABSTRACT Objectives Measure health inequalities through 12 mortality indicators, using the human resource density of medical professionals (pmed) and nursing (penf), as a stratifier of equity in 32 american countries. Methods From 12 mortality indicators, stratified by density of pmed and penf, weighted rates, differences, correlation, simple and complex inequality indicators are calculated. Results Of 12 indicators, 9 show a higher rate in low density of both professions; 7 show significant differences. there is high variability in relative gaps (8.7 to 1.2); unequal concentration affecting vulnerable groups; and higher index of the slope in mortality: maternal, communicable diseases and diabetes. Conclusions The density of human resources shows high variability and concentration, with a heterogeneous ratio between both professions. When stratifying countries from Low to High density, inequalities and social gradient are evident in 9 of 12 indicators.

[Human resource density and inequality in health care spending in the Americas]. / Densidad de recurso humano y desigualdad en gastos en salud en países de las Américas.

OBJECTIVE: To determine the existence of inequality and gradient in out-of-pocket expenses, public spending and private spending, among countries from the Americas stratified according to their human resources for health (HRH) density. METHODS: Analytical and transversal study of health inequalities for out-of-pocket spending (percentage of total health spending), public spending and private spending (percentage of GDP), applying the human resource density (medicine and nursing) as a stratifier. Based on data from the Pan American Health Organization and the World Bank, 32 countries from the Americas were categorized according to their density, and weighted rates, descriptors, differences, correlations, and simple and complex indicators of inequality were calculated. RESULTS: There is high variability in HRH density (3.8 to 171.3; mean 43.97, SD 37.08) with significant differences between high and low density categories. The first quartile concentrates 9% of the population and 4.45% of the HRH; the first 3 quartiles concentrate 48.4% of the population and 17% of the HRH. The stratification showed a gradient and inequalities in expenditure indicators, higher in the out-of-pocket expenditure, with which the HRH density presented a negative correlation. CONCLUSIONS: HRH density shows high variability among countries and categorized groups; it is unevenly concentrated in the population, and is greater in countries with higher public spending. As a stratifier of the sample, it showed inequalities and gradients in health spending; the strata with lower density showed higher out-of-pocket spending, lower public spending and higher private spending.

[Uneven decline in fertility rates in adolescents in 32 countries of the Region of the Americas, 1960-2019Diminuição desigual nas taxas de fecundidade de adolescentes em 32 países da Região das Américas, 1960-2019]. / Disminución desigual de las tasas de fecundidad en adolescentes de 32 países de la Región de las Américas, 1960-2019.

OBJECTIVE: To determine the time pattern of adolescent fertility rates (AFRs) in the countries of the Region of the Americas, categorizing them to evaluate their mobility and differences, and to produce a forecast for 2023. METHODS: Ecological and descriptive study of a time series of AFRs in 32 countries, from 1960 to 2019, based on information from the World Bank and the Pan American Health Organization (PAHO). Trends in the AFR were estimated using a linear regression model (Prais-Winsten method). Differences were evaluated between two subperiods (1960-1989 and 1990-2019) and among four categories of the AFR for 2019 by testing related samples and analysis of variance, respectively. The AFR for 2023 was predicted with autoregressive integrated moving average (ARIMA) models. RESULTS: The AFR time series for the sample was non-stationary and the annual average trend was downward (coefficient = -1.173; p < 0.001; R2 adjusted = 0.968), dropping from 124 per 1 000 in 1960 to 56.1 per 1 000 in 2019. The countries with the largest and smallest annual trend were Saint Vincent and the Grenadines (-2.783) and Argentina (0.017). Between subperiods (1960-1989 compared to 1990-2019) there were no statistically significant differences between the AFR in Uruguay and Argentina, but there were significant differences among the four categories of AFR for 2019. The average AFR for the sample should continue declining to 2023, but it could increase in eight countries. CONCLUSIONS: The time series is largely non-stationary, with a downward trend to 2023. There has been an uneven decline in AFRs, with significant differences among the four groups of countries categorized by their AFR in 2019. The lowest AFRs correspond to two countries in North America, five in the non-Latin Caribbean, and one in South America. The highest AFRs correspond to countries in the Latin Caribbean and in Central and South America.

OBJETIVO: Conhecer a evolução temporal das taxas de fecundidade de adolescentes (TFA) nos países da Região das Américas, classificando-os para avaliar a mobilidade da TFA e as diferenças entre países e gerar uma previsão para 2023. MÉTODOS: Estudo ecológico descritivo de uma série temporal da TFA em 32 países, de 1960 a 2019, com base em informações do Banco Mundial e da OPAS. Estimamos as tendências da TFA com um modelo de regressão linear (método de Prais-Winsten), avaliamos as diferenças entre 2 subperíodos (1960-1989 e 1990-2019) e entre 4 categorias de países com base na TFA de 2019 por testes de amostras relacionadas e ANOVA, respectivamente, e realizamos uma previsão da TFA para 2023 por meio de modelos ARIMA. RESULTADOS: A série temporal da TFA na amostra foi não estacionária; a tendência média anual foi decrescente (coeficiente=-1,173; p<0,001; R2 ajustado=0,968), diminuindo de 124 por 1000 em 1960 para 56,1 por 1000 em 2019. Os países com a maior e menor tendência anual foram São Vicente e Granadinas (-2,783) e Argentina (0,017). Na comparação entre os subperíodos (1960-1989 vs. 1990-2019), não houve diferenças estatisticamente significativas entre a TFA no Uruguai e na Argentina; porém, houve diferenças significativas entre as quatro categorias de países classificados com base na TFA de 2019. A TFA média da amostra deverá manter a tendência de queda até 2023, mas poderá aumentar em 8 países. CONCLUSÕES: A série temporal é predominantemente não estacionária, com uma tendência decrescente até 2023. Observa-se uma diminuição desigual na TFA, com diferenças significativas entre os quatro grupos de países classificados com base na TFA de 2019. As TFAs mais baixas são observadas em dois países da América do Norte, cinco do Caribe não latino e um da América do Sul, e as mais altas são observadas em países do Caribe latino e da América Central e do Sul.

Disminución desigual de las tasas de fecundidad en adolescentes de 32 países de la Región de las Américas, 1960-2019 / Uneven decline in fertility rates in adolescents in 32 countries of the Region of the Americas, 1960-2019 / Diminuição desigual nas taxas de fecundidade de adolescentes em 32 países da Região das Américas, 1960-2019

RESUMEN Objetivo. Conocer la evolución temporal de las tasas de fecundidad en adolescentes (TFA) de los países de la Región de las Américas, categorizándolas para evaluar su movilidad, sus diferencias y generar una predicción para 2023. Métodos. Estudio ecológico y descriptivo de una serie temporal de la TFA de 32 países, de 1960 a 2019, basado en información del Banco Mundial y de la OPS. Se estimaron tendencias de la TFA con un modelo de regresión lineal (método de Prais-Winsten), se evaluaron diferencias entre 2 subperíodos (1960-1989 y 1990-2019) y entre 4 categorías de la TFA de 2019 mediante pruebas de muestras relacionadas y ANOVA, respectivamente, y se hizo una predicción de la TFA para 2023 con modelos ARIMA. Resultados. La serie temporal de la TFA de la muestra fue no estacionaria, la tendencia media anual fue decreciente (coeficiente = -1,173; p < 0,001; R2 ajustada = 0,968) y disminuyó de 124 por 1 000 en 1960 a 56,1 por 1 000 en 2019. Los países con mayor y menor tendencia anual fueron San Vicente y las Granadinas (-2,783) y Argentina (0,017). Entre subperíodos (1960-1989 frente a 1990-2019) no hubo diferencias estadísticamente significativas entre las TFA en Uruguay y Argentina; sí las hubo entre las cuatro categorías de la TFA de 2019. La TFA media muestral mantendría una disminución para 2023, pero en 8 países podría aumentar. Conclusiones. La serie temporal es mayoritariamente no estacionaria, con tendencia decreciente para 2023. Hay disminución desigual de las TFA, con diferencias significativas entre los cuatro grupos de países categorizados con la TFA de 2019. Las menores TFA corresponden a 2 países de Norteamérica, a 5 del Caribe no latino y a 1 sudamericano, y las mayores, a países del Caribe latino y de Centro y Sudamérica.(AU)

SUMMARY Objective. To determine the time pattern of adolescent fertility rates (AFRs) in the countries of the Region of the Americas, categorizing them to evaluate their mobility and differences, and to produce a forecast for 2023. Methods. Ecological and descriptive study of a time series of AFRs in 32 countries, from 1960 to 2019, based on information from the World Bank and the Pan American Health Organization (PAHO). Trends in the AFR were estimated using a linear regression model (Prais-Winsten method). Differences were evaluated between two subperiods (1960-1989 and 1990-2019) and among four categories of the AFR for 2019 by testing related samples and analysis of variance, respectively. The AFR for 2023 was predicted with autoregressive integrated moving average (ARIMA) models. Results. The AFR time series for the sample was non-stationary and the annual average trend was downward (coefficient = -1.173; p < 0.001; R2 adjusted = 0.968), dropping from 124 per 1 000 in 1960 to 56.1 per 1 000 in 2019. The countries with the largest and smallest annual trend were Saint Vincent and the Grenadines (-2.783) and Argentina (0.017). Between subperiods (1960-1989 compared to 1990-2019) there were no statistically significant differences between the AFR in Uruguay and Argentina, but there were significant differences among the four categories of AFR for 2019. The average AFR for the sample should continue declining to 2023, but it could increase in eight countries. Conclusions. The time series is largely non-stationary, with a downward trend to 2023. There has been an uneven decline in AFRs, with significant differences among the four groups of countries categorized by their AFR in 2019. The lowest AFRs correspond to two countries in North America, five in the non-Latin Caribbean, and one in South America. The highest AFRs correspond to countries in the Latin Caribbean and in Central and South America.(AU)

RESUMO Objetivo. Conhecer a evolução temporal das taxas de fecundidade de adolescentes (TFA) nos países da Região das Américas, classificando-os para avaliar a mobilidade da TFA e as diferenças entre países e gerar uma previsão para 2023. Métodos. Estudo ecológico descritivo de uma série temporal da TFA em 32 países, de 1960 a 2019, com base em informações do Banco Mundial e da OPAS. Estimamos as tendências da TFA com um modelo de regressão linear (método de Prais-Winsten), avaliamos as diferenças entre 2 subperíodos (1960-1989 e 1990-2019) e entre 4 categorias de países com base na TFA de 2019 por testes de amostras relacionadas e ANOVA, respectivamente, e realizamos uma previsão da TFA para 2023 por meio de modelos ARIMA. Resultados. A série temporal da TFA na amostra foi não estacionária; a tendência média anual foi decrescente (coeficiente=-1,173; p<0,001; R2 ajustado=0,968), diminuindo de 124 por 1000 em 1960 para 56,1 por 1000 em 2019. Os países com a maior e menor tendência anual foram São Vicente e Granadinas (-2,783) e Argentina (0,017). Na comparação entre os subperíodos (1960-1989 vs. 1990-2019), não houve diferenças estatisticamente significativas entre a TFA no Uruguai e na Argentina; porém, houve diferenças significativas entre as quatro categorias de países classificados com base na TFA de 2019. A TFA média da amostra deverá manter a tendência de queda até 2023, mas poderá aumentar em 8 países. Conclusões. A série temporal é predominantemente não estacionária, com uma tendência decrescente até 2023. Observa-se uma diminuição desigual na TFA, com diferenças significativas entre os quatro grupos de países classificados com base na TFA de 2019. As TFAs mais baixas são observadas em dois países da América do Norte, cinco do Caribe não latino e um da América do Sul, e as mais altas são observadas em países do Caribe latino e da América Central e do Sul.(AU)