RESUMO
Las políticas sobre trabajadores/as de salud deben garantizar su distribución adecuada. En Argentina dicha distribución es desigual, sobre todo en especialistas en atención primaria de la salud (APS). El objetivo de este trabajo fue describir la distribución de médicos/as, especialistas lineales y en APS en Argentina, durante el año 2020, teniendo en cuenta la situación económica y sanitaria de cada jurisdicción. Se trata de un trabajo descriptivo y analítico, que utilizó fuentes de datos primarias y secundarias. Se correlacionó la tasa de mortalidad infantil y el producto bruto per cápita de cada jurisdicción ordenándolas de mejores a peores indicadores. La tasa de médicos fue 3,88 médicos/as cada 1000 habitantes, 72% concentrándose en 4 jurisdicciones (Ciudad Autónoma de Buenos Aires, Provincia de Buenos Aires, Córdoba y Santa Fe). El 53% son especialistas y el 27,6% lo son en APS. CABA tuvo una tasa de 16,5 médicos/as por mil; Santiago del Estero y Formosa alcanzaron valores de 1,8 y 1,9 médicas/os por mil habitantes respectivamente. Con respecto a 2014, se observó disminución de especialistas en APS (-14,8%), registrándose las mayores pérdidas en Santiago del Estero, Formosa y Catamarca (-84,5%; -70,1% y -87,3%). La situación nacional sobre la distribución de médicos/as en Argentina desde 1954 a la actualidad fue empeorando en detrimento de las provincias con mayores necesidades. La baja adherencia al sistema de residencias a especialidades de APS pronostica un empeoramiento de la situación de no haber cambios estructurales. Será necesario un fortalecimiento del rol rector del estado en el abordaje de esta problemática (AU)
Policies on health workers must guarantee their adequate distribution. In Argentina, this distribution is unequal, particularly among primary care specialists (PHC).The objective of this article is to describe the distribution of physicians, PHC and non-PHC specialists in Argentina in 2020, considering the economic and health situation of each jurisdiction.We conducted a descriptive cross-sectional study with an analytical stage using primary and secondary data sources. The jurisdictions were classified according to the correlation between infant mortality rate and gross product per capita.The rate of physicians in Argentina in 2020 was 3.88 physicians per 1,000 inhabitants. 72% are concentrated in 4 jurisdictions (City of Buenos Aires, Province of Buenos Aires, Córdoba and Santa Fe). 53% are specialists and 27.6% are PHC specialists. The City of Buenos Aires has a rate of 16.5 physicians per thousand; and Santiago del Estero and Formosa reach values of 1.8 and 1.9 physicians per thousand inhabitants, respectively.There was a decrease in PHC specialists (-14.8%), with major losses recorded in Santiago del Estero, Formosa and Catamarca (-84.5%; -70.1% and -87.3%, respectively).The distribution of physicians in Argentina from 1954 to the present has worsened to the detriment of the provinces with the greatest needs. The lack of adheren-ce to the specialty of PHC predicts a worsening of the situation if there are no structural changes. It is necessary to strengthen the leading role of the state in addressing this problem (AU)
Assuntos
Humanos , Masculino , Feminino , Atenção Primária à Saúde/tendências , Especialização/estatística & dados numéricos , Distribuição de Médicos , Gestão de Recursos Humanos/estatística & dados numéricos , Argentina , Médicos/tendências , Mortalidade Infantil/tendências , Produto Interno Bruto , Área Carente de Assistência MédicaRESUMO
RESUMEN INTRODUCCIÓN : Los estudios de seroprevalencia permiten monitorear la circulación del SARS-CoV-2 y dan información para evaluar medidas sanitarias. El objetivo fue conocer la proporción y evolución de la seropositividad en puntos de gran circulación de la Ciudad Autónoma de Buenos Aires (CABA) y las características clínico-epidemiológicas de los seropositivos, de abril a octubre de 2020. MÉTODOS : Se realizó un estudio descriptivo transversal de seis rondas de testeos rápidos serológicos y una encuesta de datos epidemiológicos. Se realizó un muestreo por conveniencia en tres estaciones ferroviarias cabeceras de CABA consideradas puntos de alto tránsito bidireccional del Área Metropolitana de Buenos Aires. RESULTADOS : Participaron 7339 personas. La proporción de seropositivos fue 0,6% (IC95%: 0,2-0,9) en la primera ronda y aumentó a 5,6% en la última (IC95%: 4,3-7). Al inicio aumentó la seropositividad en residentes de CABA y de la zona sur de la Región Metropolitana de Buenos Aires. El antecedente de haber presentado síntomas y el de contacto con personas con COVID-19 fueron las únicas variables relacionadas con el resultado de inmunoglobulina G positivo (p <0,05). El 56,1% (n = 97) de los seropositivos no tuvo síntomas. El 78,4% (n = 134) no fue diagnosticado en la etapa aguda. DISCUSIÓN : La seropositividad fue en ascenso en cada ronda, en coincidencia con la situación epidemiológica de la zona de residencia. Las características epidemiológicas como la proporción de seropositivos sin antecedentes de síntomas, reafirman la importancia de las medidas sanitarias poblacionales.
ABSTRACT INTRODUCTION : Seroprevalence studies allow monitoring the circulation of SARS-CoV-2, providing information to evalúate public health measures. The aim of this study was to determine the proportion and evolution of seropositivity in high circulation points in the Ciudad Autónoma de Buenos Aires (CABA) and clinical and epidemiological characteristics of seropositive individuals from April to October 2020. METHODS : A descriptive cross-sectional study was conducted during six rounds, using rapid serological testing together with an epidemiological data survey. A convenience sample was selected in three CABA railway stations considered as high bi-directional traffic points in the Buenos Aires Metropolitan Area (AMBA). RESULTS : 7,339 people participated. The seropositive proportion was 0.6% (95%CI: 0.2-0.9) in the first round, and rose to 5.6% in the last one (95%CI: 4.3-7). Initially, seropositivity increased in CABA residents and those living in the southern part of the Buenos Aires Metropolitan Region. Having presented symptoms and history of contact with COVID-19 cases were the only variables found to be related to positive IgG results (p<0.05). Among seropositive participantes, 56.1% (n=97) had no symptoms and 78.4% (n=134) didn't receive a COVID-19 diagnosis in the acute stage. DISCUSSION : Seropositivity increased between rounds, according to the epidemiological situation in the area of residence. Epidemiological characteristics, such as the proportion of seropositive individuals with no history of symptoms, reaffirm the importance of public health and social measures.
RESUMO
Introduction: The present work describes the clinical characteristics and interventions to minimize morbidity and mortality in hospitalized patients diagnosed with COVID-19. Methods: It is a prospective cohort investigation of patients who received a response from the Health Centers in the southeast region (RS) of the metropolitan area (AMBA) from April 8 to September 30, 2020. A Situation Room was used epidemiological with two monitoring and follow-up boards, one for bed management and the other for patient management. Results: During the analyzed period, 2,588 patients with confirmed COVID-19 diagnosis were admitted, 1,943 with suspected COVID-19 pathology, and 1,464 subjects with other pathologies. 55% of the patients were men and the mean age was 51 years. There were 82.8% patients with pre-existing diseases, hypertension and diabetes were the most frequent. 14% were hospitalized in the Intensive Care Unit. The mortality of the cohort was 15.05%, mortality was higher for men, with a mean age of 60 years, 92.65% had some pre-existing disease. Conclusion: Our cohort is younger than other published works. Older people, men, and people with comorbidities are at increased risk for COVID-19-related mortality. The public health system was able to respond to the demand without collapsing the hospital institutions.
Introducción: En el presente trabajo se describen las características clínicas y las intervenciones para minimizar la morbimortalidad en pacientes hospitalizados con diagnóstico de COVID-19. Métodos: Es una investigación de cohorte prospectiva de pacientes que recibieron respuesta de los Centros de Salud en la región sudeste (RS) del área metropolitana (AMBA) desde el 8 de abril hasta el 30 de septiembre de 2020. Se utilizó una Sala de Situación epidemiológica con dos tableros de monitoreo y seguimiento, uno de gestión de camas y otro de gestión de pacientes. Resultados: Durante el periodo analizado se internaron2.588pacientes con diagnóstico COVID-19 confirmados, 1.943 con sospecha de patología COVID-19, y 1.464sujetos con otras patologías. El 55% de los pacientes eran hombres y la edad media fue de 51 años. Hubo 82,8% pacientes con enfermedades preexistentes, hipertensión y diabetes fueron las más frecuentes. El 14% fue hospitalizado en la Unidad de Terapia Intensiva. La mortalidad de la cohorte fue del 15,05%, la mortalidad fue mayor para los hombres, con una edad media de 60 años, el 92,65% tenía alguna enfermedad preexistente. Conclusión: Nuestra cohorte es más joven que otros trabajos publicados. Las personas mayores, los hombres y las personas con comorbilidades tienen mayor riesgo de mortalidad relacionada con COVID-19. El sistema de salud público pudo responder a la demanda sin llegar a colapsar las instituciones hospitalarias.
Assuntos
COVID-19 , Saúde Pública , Humanos , Estudos Retrospectivos , SARS-CoV-2RESUMO
INTRODUCCIÓN: Los estudios de seroprevalencia permiten monitorear la circulación del SARS-CoV-2 y dan información para evaluar medidas sanitarias. El objetivo fue conocer la proporción y evolución de la seropositividad en puntos de gran circulación de la Ciudad Autónoma de Buenos Aires (CABA) y las características clínico-epidemiológicas de los seropositivos, de abril a octubre de 2020. MÉTODOS: Se realizó un estudio descriptivo transversal de seis rondas de testeos rápidos serológicos y una encuesta de datos epidemiológicos. Se realizó un muestreo por conveniencia en tres estaciones ferroviarias cabeceras de CABA consideradas puntos de alto tránsito bidireccional del Área Metropolitana de Buenos Aires. RESULTADOS: Participaron 7339 personas. La proporción de seropositivos fue 0,6% (IC95%: 0,2-0,9) en la primera ronda y aumentó a 5,6% en la última (IC95%: 4,3-7). Al inicio aumentó la seropositividad en residentes de CABA y de la zona sur de la Región Metropolitana de Buenos Aires. El antecedente de haber presentado síntomas y el de contacto con personas con COVID-19 fueron las únicas variables relacionadas con el resultado de inmunoglobulina G positivo (p <0,05). El 56,1% (n = 97) de los seropositivos no tuvo síntomas. El 78,4% (n = 134) no fue diagnosticado en la etapa aguda. DISCUSIÓN: La seropositividad fue en ascenso en cada ronda, en coincidencia con la situación epidemiológica de la zona de residencia. Las características epidemiológicas como la proporción de seropositivos sin antecedentes de síntomas, reafirman la importancia de las medidas sanitarias poblacionales.
Assuntos
Argentina , Estudos Epidemiológicos , Estudos Soroepidemiológicos , Infecções por Coronavirus , Anticorpos AntiviraisRESUMO
INTRODUCCIÓN: La región sudeste del Gran Buenos Aires (GBA) reformuló el sistema público de salud por la pandemia de COVID19. Entre las medidas que se tomaron, está la ampliación del número de camas mediante la construcción y puesta en marcha de tres hospitales. OBJETIVO: Evaluar el impacto de la ampliación del número de camas en los resultados de internación de los pacientes asistidos por los efectores públicos de salud durante el período de estudio (8 de abril de 2020 al 11 de septiembre de 2020). MÉTODOS: Estudio descriptivo a partir de información registrada en el Tablero COVID-19, software de gestión desarrollado por el equipo del Instituto del Cálculo de la Universidad de Buenos Aires, en el que se obtienen datos de cada paciente internado en la red de efectores de salud; se evalúan los resultados del efecto del aumento de la capacidad instalada. RESULTADOS: Se registraron 2 306 pacientes internados, de los cuales 266 (11,54%) requirieron internación en unidad de cuidados intensivos (UCO), 1 786 (77,4%) en cuidados intermedios y 254 (11%) pacientes en sala general. La media de edad fue de 50,63 y los pacientes de sexo masculino representaron el 55,5% del total. Se produjeron 253 muertes (10,97%), de las cuales el 64% fueron hombres. El 58,3% del total tenían enfermedades preexistentes, estos tienen un riesgo 90% más alto que quienes no las tenían. El promedio total de ocupación de camas en UCI fue del 40,7%, mientras que el de ocupación en cuidados intermedios fue de 61,5%. Sin los hospitales nuevos, 169 pacientes (9,46%) no hubieran tenido camas en cuidados intermedios y 31 pacientes (11,6%) no hubieran tenido cama en la UCI. DISCUSIÓN: El sistema de salud de la región sudeste del GBA se preparó de manera adecuada gracias a la ampliación del número de camas de internación.
Assuntos
Mortalidade , Infecções por Coronavirus , Sistemas Nacionais de SaúdeRESUMO
OBJECTIVE: To analyse the evolution of the frequency of type 2 diabetes (T2D) and its relationship to eating patterns in Mexico from 1961 to 2013, and the Gini coefficient, Human Development Index (HDI) and Gross Domestic Product (GDP). Mexico ranked sixth in world prevalence of diabetes in 2015 with an estimated 11.4 million Mexicans affected. METHOD: Using data from the Balance Sheets Food published by the Food and Agriculture Organization of the United Nations (FAO), the means of apparent food consumption (kcal/person/day) were grouped by decades. Data for mortality rate for diabetes were obtained from 1990 until 2015. Spearman's correlation coefficient was calculated between the diabetes mellitus mortality rate and all food groups. Pearson's correlation explored the relationship between socio economic indicators and the prevalence of T2D diabetes. RESULTS: The mortality rate for T2D has increased over the last decades. An increase of 647.9kcal/person/day in apparent food consumption was observed. Cereal and legume consumption decreased, while apparent sugar, animal food and animal fat and vegetable oil consumption increased substantially. HDI and GDP showed a directly proportional relationship to diabetes. Spearman's correlation coefficient was statistically significant only for sugar. The Gini coefficient suggests that in lower inequalities there is an increased frequency of diabetes. CONCLUSIONS: The increase in the mortality rate of type 2 diabetes was constant during the study period, which coincides with the increase in energy density of Mexican eating patterns from 1961 to 2013. The higher the Gini coefficient, HDI and GDP, the higher the mortality observed for diabetes.
Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Comportamento Alimentar , Feminino , Humanos , Masculino , México/epidemiologia , Fatores de TempoRESUMO
To analyse the changes in eating patterns in Argentina from 1961 to 2011, and to assess changes in overweight and obesity in their socioeconomic and political context, we performed a hierarchical cluster analysis. We used the information from Food Balance Sheets of the United Nations Food and Agriculture Organisation to identify dietary patterns of apparent consumption. Years were grouped into five patterns. The food group with the highest apparent consumption was cereals (30% of total kcal/person/day) although this decreased slightly. Meats were second and their contribution decreased by 12%. The following foods contribution increased during the period: Sugar and milk by 2% and vegetable oils by 6%. The changes observed in the number of kcal/person/day were in line with changes in real wage, and coincided with economic and political crises that Argentina experienced during that period. Changes in eating patterns allow us to interpret that they relate to the increase in overweight and obesity.
Assuntos
Dieta/efeitos adversos , Grão Comestível/efeitos adversos , Ingestão de Energia , Transição Epidemiológica , Carne/efeitos adversos , Obesidade/etiologia , Sobrepeso/etiologia , Argentina/epidemiologia , Análise por Conglomerados , Bases de Dados Factuais , Dieta/classificação , Dieta/etnologia , Dieta/tendências , Inquéritos sobre Dietas , Grão Comestível/economia , Ingestão de Energia/etnologia , Fast Foods/efeitos adversos , Fast Foods/economia , Manipulação de Alimentos , Humanos , Carne/economia , Obesidade/economia , Obesidade/epidemiologia , Obesidade/etnologia , Sobrepeso/economia , Sobrepeso/epidemiologia , Sobrepeso/etnologia , Política , Pobreza/tendências , Prevalência , Fatores de Risco , Salários e Benefícios/tendências , Fatores Socioeconômicos , Nações UnidasRESUMO
OBJECTIVE: To develop an instrument to assess the satisfaction of patients using health services at the first care level of the city of Mexico (SSA), adapted to the socio-cultural characteristics of the population, and to examine its reliability and validity. METHODS: The instrument reagents were designed using the natural semantic networks technique. The dimensions used have been determined from the literature. Participants included 230 adults with type 2 diabetes attending eight SSA health centers. Subsequently, intelligibility was determined by conducting a pilot, then the construct validity of the instrument by means of exploratory factor analysis was evaluated and its internal consistency was determined by calculating Cronbach's alpha. RESULTS: The questionnaire is composed of six factors with a Likert-type scale. Its consistency showed a Crombach´s alpha of 0.94. The factor structure included 29 reagents that correlated with the six dimensions with factorial loads>0.581 that explained 66.8% of the total variance. CONCLUSIONS: The patient satisfaction questionnaire incorporates the sociocultural characteristics of the target population and has an adequate level of validity and reliability and is quick and easy in application.
Assuntos
Satisfação do Paciente , Atenção Primária à Saúde/normas , Inquéritos e Questionários , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos TestesRESUMO
In order to analyze whether the increase in mortality from diabetes in Mexico is related to changes in eating patterns over the period 1961 to 2009, and if they in turn could be explained in the Mexican socioeconomic context, we conducted an ecological study with information from the Food Balance Sheets FAO. A cluster analysis was performed to shape eating patterns (three) and some socioeconomic variables were analyzed. It was observed that the energy derived from cereals and legumes (beans) was significantly reduced, and simultaneously, energy from sugars, animal foods, and vegetable fats had a significant increase. Various socioeconomic conditions may have favored changes in diet and increased mortality from diabetes. These conditions are: trade liberalization, low growth, rising inequality and informal work, declining agriculture, falling real wages in relation to the value of what is called the "basic food and non-food baskets", increasing prices of healthy food,low cost of processed foods and beverages, and the lack of control in the food market.
Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Dieta/tendências , Ingestão de Energia , Análise por Conglomerados , Diabetes Mellitus Tipo 2/mortalidade , Dieta/economia , Comportamento Alimentar , Feminino , Humanos , Masculino , México/epidemiologia , Fatores SocioeconômicosRESUMO
OBJECTIVE: The objective of this study was to propose a model of health care for sexual workers (SWs) and transvestites (Ts) groups who were historically excluded from health services. MATERIALS AND METHODS: A prospective descriptive/analytical study with an intervention stage was performed, focusing on the health status of SWs and Ts. Access to health system, inclusion into social programs, beneficiaries' participation, and rate of risk behaviors were variables measured before and after intervention that consist in a program based on promotion/prevention activities and complete health care service suitable to SW-T needs. RESULTS: Nine hundred and fifty SW-Ts were included. At baseline, 99.7% lacked health insurance and 90.1% had no access to the health care. These data were compared with those obtained after attention quadruplicated among SW because of the implementation of the program. Risky sexual behaviors were reduced by 25 times. SWs have their own leader of health institutions and coordinate themselves with the program's activities. CONCLUSION: Responsibility of the state's authorities on vulnerable groups must focus on their inclusion. To this end, health services must adapt themselves in order to attend those community groups with special needs. Active participation of the target population contributes to viability of this type of proposals, and it is essential for the project's success.
Assuntos
Atenção à Saúde/organização & administração , Profissionais do Sexo , Adulto , Argentina , Atenção à Saúde/métodos , Acessibilidade aos Serviços de Saúde/organização & administração , Humanos , Masculino , Modelos Organizacionais , Avaliação de Programas e Projetos de Saúde , Inquéritos e Questionários , Travestilidade , Sexo sem Proteção/prevenção & controleRESUMO
To demonstrate effectiveness of ambulatory health care plan implementation among institutions and variables associated with the differences observed. Randomized selection of primary health care (PHC) centers was done. Leadership ability of the plan manager was explored. Univariate/bivariate analyses were performed to observe correlation between variables. Two groups of PHC centers were established according to the efficacy of plan implementation: high and low performance. Differences between groups were observed (592%-1023% more efficacy in controls and practices; P < .001). Leadership was responsible for the main differences observed. Leadership of manager for implementation of the health care plan was the major important variable to reach the best efficacy standards.
Assuntos
Pessoal Administrativo , Instituições de Assistência Ambulatorial/organização & administração , Implementação de Plano de Saúde , Liderança , Atenção Primária à Saúde/organização & administração , Competência Profissional , Argentina , Humanos , Objetivos OrganizacionaisRESUMO
El propósito de este trabajo fue identificar si existieron cambios en la composición de los patrones alimentarios de 1961 a 2009, si el gasto en algunos alimentos por nivel de ingresos y el aumento en el precio de ciertos alimentos básicos de la dieta en el contexto socioeconómico mexicano, podrían explicar la transición alimentaria y la doble carga de malnutrición. Se llevó a cabo un estudio ecológico con la información de las Hojas de Balance de la FAO. Para conformar los patrones alimentarios se realizó análisis de conglomerados. Además, con los datos de la Encuesta Nacional de Ingresos y Gastos en los Hogares 2012 del Instituto Nacional de Estadística y Geografía se construyeron curvas de Engel para calcular la evolución del precio relativo de algunos alimentos. La dieta se definió en tres patrones alimentarios. La disponibilidad total de energía aumentó de 2316 kcal/persona/ día en 1961 a 3146 en 2009. Las modificaciones del patrón alimentario están en consonancia con la transición alimentaria y nutricional y con la doble carga de malnutrición. Se observó que la energía derivada de los cereales y la proveniente de las leguminosa (frijol) se redujo considerablemente, y de manera simultánea la energía procedente de azúcares, alimentos de origen animal y grasas vegetales tuvieron un aumento notable. El gasto en alimentos fue diferencial de acuerdo al nivel de ingresos. La malnutrición está mediada por la inequitativa distribución del ingreso, el bajo costo relativo de los alimentos ricos en energía, el encarecimiento de alimentos nutritivos y el escaso apoyo a la agricultura.
The nutrition transition and the double burden of malnutrition: changes in dietary patterns 1961-2009 in the Mexican socioeconomic context.. The purpose of this study was to identify whether there were changes in the composition of dietary patterns from 1961 to 2009, if food patterns by income level and the increase in the price of certainbasic foods of the diet in the socioeconomic Mexican context, could explain the nutrition transition and the double burden of malnutrition. We conducted an ecological study with data from FAO balance sheets. To construct eating patterns cluster analysis was performed. Engel curves were developed with data from the 2012 INEGI ENGH survey and evolution of therelative price of some foods was calculated. The diet was defined in three dietary patterns. The increase in the total availability of energy increased from 2316 kcal/person/day in 1961 to 3146 in 2009. Dietary pattern modifications are in line with the nutrition transition and the double burden of malnutrition. It was observed that the energy derived from cereals andfrom legume (common beans) was significantly reduced, and simultaneously, the energy from sugars, animal foods and vegetable fats had a dramatic increase. Spending on food was differential according to income level.Malnutritionis mediated by theunequal distribution of income, the relatively lowcost ofenergy-dense foods, the increased cost of nutritious foods, and limited support to agriculture.
Assuntos
Humanos , Ingestão de Energia , Comportamento Alimentar , Renda/estatística & dados numéricos , Desnutrição/epidemiologia , Análise por Conglomerados , Gorduras na Dieta/economia , Abastecimento de Alimentos/estatística & dados numéricos , México/epidemiologia , Estado Nutricional , Fatores Socioeconômicos , Estatísticas não Paramétricas , Nações Unidas , Verduras/economiaRESUMO
The purpose of this study was to identify whether there were changes in the composition of dietary patterns from 1961 to 2009, if food patterns by income level and the increase in the price of certain basic foods of the diet in the socioeconomic Mexican context, could explain the nutrition transition and the double burden of malnutrition. We conducted an ecological study with data from FAO balance sheets. To construct eating patterns cluster analysis was performed. Engel curves were developed with data from the 2012 INEGI ENGH survey and evolution of the relative price of some foods was calculated. The diet was defined in three dietary patterns. The increase in the total availability of energy increased from 2316 kcal/person/day in 1961 to 3146 in 2009. Dietary pattern modifications are in line with the nutrition transition and the double burden of malnutrition. It was observed that the energy derived from cereals and from legume (common beans) was significantly reduced, and simultaneously, the energy from sugars, animal foods and vegetable fats had a dramatic increase. Spending on food was differential according to income level. Malnutritionis mediated by the unequal distribution of income, the relatively low cost of energy-dense foods, the increased cost of nutritious foods, and limited support to agriculture.
Assuntos
Ingestão de Energia , Comportamento Alimentar , Renda/estatística & dados numéricos , Desnutrição/epidemiologia , Análise por Conglomerados , Gorduras na Dieta/economia , Abastecimento de Alimentos/estatística & dados numéricos , Humanos , México/epidemiologia , Estado Nutricional , Fatores Socioeconômicos , Estatísticas não Paramétricas , Nações Unidas , Verduras/economiaRESUMO
Introducción: En México, la prevalencia de caries dental en la población es superior al 70 % y sus efectos son la pérdida parcial o total de las piezas dentarias. El uso del flúor previene la aparición de la caries y facilita la introducción de calcio a los tejidos duros del diente y a su remineralización. El presente trabajo mustra la realización de un ejercicio de prromoción y prevención de la salud en una escuela pública de la Ciudad de México...
Introduction: In Mexico, the prevalence of dental caries in the populationis over 70% and the effect is the partial or total loss of teeth. The use of fluoride prevents the delopment of caries and facilitates the incorporation of calcium into the hard tissues of the tooth and its remineralization.This work shows the performance of an exercise promotion and healthprevention at a public school in the city of Mexico...
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Masculino , Feminino , Humanos , Criança , Cárie Dentária , Higiene Bucal , Educação em Saúde Bucal , México , Serviços de Saúde Escolar , Prevenção PrimáriaRESUMO
Desde hace más de 20 años se ha hecho énfasis cada vez con más insistencia en los determinantes sociales de la salud, (DSS), al referirse a las condiciones sociales en las que las personas viven y trabajan, que influyen positiva o negativamente en la salud; actualmente se reconocen al estilo de vida, el ambiente, así como la biología humana y la organización de servicios de salud como los principales determinantes de la salud de los individuos. Este trabajo se realizó en la jurisdicción sanitaria de Álvaro Obregón, Distrito Federal, con objeto de conocer las condiciones socioeconómicas de los hogares y la situación de salud de cada persona que habita en dicho hogar; se realizaron encuestas durante 3 semanas a 1,331 hogares. Los principales datos encontrados fueron: 19.4% de los hogares tienen techo de lámina, en 11.8% se encontró hacinamiento, y el 2.7% de los hogares no tiene acceso a agua potable en la vivienda. En relación con educación, el 38% de los individuos que deben estar en escuela no asiste, y de los 2,903 adultos el 31% no concluyó su educación básica y el 7.7% es analfabeta. Se encontraron 41 mujeres embarazadas, 6 sin atención médica, 283 diabéticos, 33 sin atención médica, 307 hipertensos (52 de ellos sin atención), 109 discapacitados (94 sin atención), 138 adictos al alcohol y 115 adictos a las drogas. Con estos datos se clasificaron los hogares en función del riesgo que tienen para su salud. Se inició un programa de reorganización de los servicios de salud, que permitió mejorar, discreta per efectivamente, el riesgo de los hogares estudiados y sus habitantes. Se concluye que es indispensable incluir la valoración de las condicionantes sociales de la salud en todo programa que pretenda mejorar las condiciones de salud de una comunidad.
For more than 20 years, the social determinants of health have been increasingly emphasized; by describing the social conditions in which people live and work; which affect health either positively or negatively. Lifestyle, the environment, as well as human biology and the organization of health services are currently considered people's main health determinants. The present study was performed in Alvaro Obregon's health district, Mexico City, in order to know the socio-economical conditions of houses and the health situation of each person living in such house. Surveys were applied to 1331 homes within a three-week period. The main data found were: 19.4% houses have sheet roof; overcrowding was found in 11.8%, and 2.7% houses have no access to drinking water. As for education: 38% individuals who should be at school are not enrolled; while out of 2903, 31% did not finish primary school, and 7.7% are illiterate. 41 women were pregnant, six with no medical surveillance, 283 diabetic people (33 with no medical care), 307 hypertensive (52 with no medical care), 109 handicapped (94 with no medical care), 138 alcohol addicts, and 115 drug addicts. Based on these data, houses were classified according to the health risk they represent. A health-service reorganization program was started, which improved, discreetly but effectively, the risk of the houses studied and of their inhabitants. We conclude that it is essential to include the assessment of health social conditions in any program aiming at improving the health conditions in a community.
RESUMO
INTRODUCCIÓN: las condiciones sociales condicionan el estado de salud de las personas. En Argentina, el bajo nivel de los servicios del sistema de salud bucal no impacta de la misma manera en toda la población y, en algunos casos, es el propio sistema quien acentúa estas diferencias reforzando las inequidades en salud. OBJETIVOS: evaluar el impacto de la falta de piezas dentales en las oportunidades laborales de personas jóvenes; evaluar un programa que otorga rehabilitación protésica. METODOLOGÍA: entrevistas a empleadores para la variable oportunidad laboral; evaluación de costos del programa de rehabilitación oral en tres municipios de Buenos Aires. RESULTADOS: Se observa una amplia diferencia en el acceso laboral en personas con dientes comparadas a personas sin piezas dentales. El acceso a prótesis dentales está limitado, debido al elevado costo del tratamiento en el mercado, éste disminuye hasta un 86% cuando es financiado por el estado. CONCLUSIONES: Existe un origen desigual e injusto en la pérdida de dientes. El sistema de salud promueve esta desigual distribución, dejando el acceso a la salud bucal en manos del mercado, se convierte en un determinante social negativo.
INTRODUCTION: social conditions are determinants of inequalities in health status.The poor performance of the oral health system in Argentina does not impactin the same way the whole population, reinforcing inequalities in health. OBJECTIVES: to assess the impact the impact of the lack of teeth of young peoplelow-income, over the employment opportunities. A state program of oral rehabilitation in edentulous young patients is evaluated. METODOLOGY: interviews to entrepreneurs were realized in order to measure the employment opportunities in edentulous young people. The costs of oral rehabilitation treatment are evaluated in the state program against marketoptions. RESULTS: People with teeth have better access to work; treatment improves thisto people without teeth. Access to dental prosthesis is limited, due to the highcost; it decreases in 86% when it is funded by the state. CONCLUSIONS: the most disadvantaged sectors of society are who more suffer the loss of teeth. The health system acts as a negative social determinant inoral health.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Cárie Dentária , Inquéritos de Saúde Bucal , Implantes Dentários , Saúde Bucal , Programas Governamentais , Promoção da Saúde , Odontologia do TrabalhoRESUMO
En el presente artículo nos proponemos discutir el papel que cumplen las escuelas de medicina en la formación del perfil de los profesionales. Para ello, se analiza el impacto de dos experiencias de prácticas en terreno realizadas en 2006 y 2009, por los alumnos de la cátedra de Epidemiología de la Facultad de Ciencias Médicas de la Universidad Nacional de La Plata (Provincia de Buenos Aires, Argentina). Mediante cuestionarios semiestructurados individuales aplicados a los alumnos y estrategias de grupos focales se buscó obtener información de las ideas y representaciones de los estudiantes, antes y después de las experiencias pedagógicas. Entre los principales resultados se destaca la posibilidad de que los alumnos se replanteen los modelos explicativos del proceso salud-enfermedad-atención y el peso real de los problemas sociales sobre los fenómenos de salud y enfermedad.
In this article we discuss the role that medical schools play in the creation of a particular profile of health professionals. To this end, we analyze the impact of two field experiences carried out in 2006 and 2009 with students in the Epidemiology course of the Faculty of Medical Sciences in the Universidad Nacional de La Plata (in the province of Buenos Aires, Argentina). Using individual semistructured questionnaires applied to students as well as focus group strategies, the study sought to obtain information about the ideas and representations of the students before and after these educational experiences. The ability of students to reconsider the explicative models of the health-disease-care process and the weight of social problems in the phenomena of sickness and health is highlighted as one of the study's primary results.
Assuntos
Humanos , Currículo , Educação de Graduação em Medicina/métodos , Modelos Educacionais , Papel do Médico , Argentina , Grupos Focais , Pesquisa Qualitativa , Inquéritos e Questionários , Faculdades de Medicina , Fatores Socioeconômicos , Estudantes de MedicinaRESUMO
INTRODUCTION: Shigellosis represents one of the main causes of bloody diarrhoea in South America. This study aimed to establish the incidence of shigellosis in an urban zone of Buenos Aires, Argentina, by examining the type of Shigella and living conditions associated with this infection. METHODOLOGY: Between January 2009 and December 2010 we analyzed shigellosis in children admitted to the public health service with bloody diarrhoea from La Plata, the capital of Buenos Aires, Argentina. A total of 372 children under 15 years old with Shigella present in their stool samples were admitted to the study. Variables studied were patient age, type of Shigella, family economic status, and access to sewage services and safe drinking water. RESULTS: Shigella flexneri was found to be present in 66.8% of the cases. Incidence was 187 cases/year/100,000 children under 15 years old. Cases were mainly observed during the summer (38.5%) in the population of under 5 years old (69.1% of all cases). The risk of shigellosis increased 12 times in those children who lacked safe drinking water and this risk increased 1.5 times in the population without sewage services. Fewer cases of shigellosis were noted in downtown areas, while hot spots were identified in the suburbs. Treating one case of shigellosis has a local cost of US $976 while assuring safe drinking water and sewage services for one family costs US $634. CONCLUSION: Incidence of shigellosis in urban areas is associated with quality of water and sewage services. Policies aimed at providing education and improving public utilities networks can help to reduce the incidence of shigellosis.
Assuntos
Disenteria Bacilar/epidemiologia , Disenteria Bacilar/microbiologia , Shigella/isolamento & purificação , Adolescente , Argentina/epidemiologia , Criança , Pré-Escolar , Efeitos Psicossociais da Doença , Diarreia/epidemiologia , Diarreia/microbiologia , Disenteria Bacilar/economia , Disenteria Bacilar/terapia , Fezes/microbiologia , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Shigella/classificação , População Urbana , Purificação da Água , Qualidade da Água , Abastecimento de ÁguaRESUMO
In this article we discuss the role that medical schools play in the creation of a particular profile of health professionals. To this end, we analyze the impact of two field experiences carried out in 2006 and 2009 with students in the Epidemiology course of the Faculty of Medical Sciences in the Universidad Nacional de La Plata (in the province of Buenos Aires, Argentina). Using individual semistructured questionnaires applied to students as well as focus group strategies, the study sought to obtain information about the ideas and representations of the students before and after these educational experiences. The ability of students to reconsider the explicative models of the health-disease-care process and the weight of social problems in the phenomena of sickness and health is highlighted as one of the study's primary results.
En el presente artículo nos proponemos discutir el papel que cumplen las escuelas de medicina en la formación del perfil de los profesionales. Para ello, se analiza el impacto de dos experiencias de prácticas en terreno realizadas en 2006 y 2009, por los alumnos de la cátedra de Epidemiología de la Facultad de Ciencias Médicas de la Universidad Nacional de La Plata (Provincia de Buenos Aires, Argentina). Mediante cuestionarios semiestructurados individuales aplicados a los alumnos y estrategias de grupos focales se buscó obtener información de las ideas y representaciones de los estudiantes, antes y después de las experiencias pedagógicas. Entre los principales resultados se destaca la posibilidad de que los alumnos se replanteen los modelos explicativos del proceso salud-enfermedad-atención y el peso real de los problemas sociales sobre los fenómenos de salud y enfermedad.
Assuntos
Currículo , Educação de Graduação em Medicina/métodos , Modelos Educacionais , Papel do Médico , Argentina , Grupos Focais , Humanos , Pesquisa Qualitativa , Faculdades de Medicina , Fatores Socioeconômicos , Estudantes de Medicina , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Latin America's public healthcare model has traditionally offered health services on demand including provision for the most deprived inhabitants. However, this care model has not provided the expected improvement in health conditions or equity for the indigent population. AIM: To compare maternal health indicators between previous services and a new healthcare model based on personalised care and a named healthcare worker. METHODS: Pregnant women in La Plata, Argentina were observed during two periods: a control period using a historical model and an intervention period where a new healthcare model was provided, each period lasting 12 months. Indicators of the quality of antenatal care services were measured, including mortality rate, number of pregnancy related consultations, vaccination coverage, gestational age at delivery, newborn weight, laboratory and scan monitoring, early pregnancy detection and type of delivery. RESULTS: The number of patients undergoing antenatal surveillance increased almost five-fold during the period of the new healthcare model. Also the rate of early detection of pregnancy, average number of health consultations and vaccination coverage were significantly higher with the new model compared with previous care. Maternal gestation at delivery increased from 37.4±3.8% to 39.3±2.5% weeks (P<0.001) and neonatal weight increased from 3048 AE 612 g to 3301 AE 580 g (P=0.003). There were no maternal deaths in the intervention group compared with seven deaths in the control group. Child mortality rate was 13.7 and 11.8 per 1000 for control and intervention groups respectively (P=0.039). CONCLUSIONS: A named responsible health worker and personalised care helped contribute to improvements in quality of antenatal care in the health system.