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OBJECTIVES: Anorectal sexually transmitted infections (STIs) such as Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG), present treatment challenges, potentially increase antibiotic resistance selection and if undetected may facilitate onward transmission. However, there are limited global prevalence data for anorectal STIs. We conducted a cross-sectional study to assess the prevalence and risk factors of non-viral genital and extragenital STIs in female sex workers (FSW) and female non-sex workers (NSW) in Ecuador. METHODS: 250 adult street and brothel FSWs and 250 NSWs, recruited from settlements in north-west Ecuador provided oropharyngeal and vulvo-vaginal swabs (VVS) as well as socio-demographic data. FSWs also provided anorectal swabs. PCR was used to detect CT, NG, Mycoplasma genitalium (MG) from all swabs and additionally Trichomonas vaginalis (TV) from VVS. Risk factors were analysed using logistic regression. RESULTS: Prevalence of FSW vaginal, anorectal and oropharyngeal infection was 32.0% (95% CI 26.5% to 38.0%), 19.7% (95% CI 15.1% to 25.2%) and 3.2% (95% CI 1.6% to 6.2%), respectively, with most vaginal infections being TV (23.4%; 95% CI 18.5% to 29.2%). Overall FSW STI prevalence, at any anatomical site was 39.7% (95% CI 33.8% to 46.1%), with 12.1% (95% CI 8.5% to 16.9%) of infections detected only at the anorectum. Of all the CT and/or NG infections, 64.4% (95% CI 50.4% to 78.4%) were detected only at the anorectum. STI prevalence in NSWs in the vagina and oropharynx were 5.6% (95% CI 3.4% to 9.2%) and 0.8% (95% CI 0.2% to 2.9%), respectively, with most vaginal infections being MG (3.2%; 95% CI 1.6% to 6.2%). In multivariable analysis, risk factors among brothel-based FSWs for having an anorectal STI were vaginal CT, NG or MG (p<0.001), vaginal TV (p=0.029) and being 'in a relationship' (p=0.038). CONCLUSIONS: High prevalence of CT and NG detected only at the anorectum in these FSWs indicate the possibility of missing significant infections if providing only genital testing and calls for greater research into the potential impact on global STI estimates if extragenital infections among at-risk women are not identified.
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OBJECTIVE: To characterize the time in therapeutic range (TTR) and estimate the incidence rate of complications (PTIRc) in adults with warfarin protocol. DESIGN: Retrospective cohort based on medical records of patients older than 18years, between 1996 and 2016 and followed for at least three months. SITE: Hematology unit of a Venezuelan specialized cardiovascular center. PARTICIPANTS: Electronic health record. MAIN MEASUREMENTS: TTR and PTIRc. The variables were sex, functional illiteracy, occupation, International Normalized Ratio (INR) and follow-up time, which were analyzed with TTR and PTIRc using binomial logistic and Poisson regression models, respectively. RESULTS: 2,770 patients were followed up for a total of 1,201,380 days, 42.3% had a TTR<65% and 3.5% had INR 2.5-3.5. 61.8% had complications. PTIRc was 6.84/100 person-months (95%CI: 6.56-7.15). TTR<65% showed significant adjusted OR with functional illiteracy and INR 2.5-3.5, while for higher PTIRc a significant RR was found in the two factors mentioned, shorter follow-up time, TTR<65% and in women. CONCLUSIONS: Despite new anticoagulant treatments, warfarin is useful. As follow-up time increased, control was better and the rate of occurrence of complications decreased; however, the conditions that showed lower TTR and higher rate of occurrence of complications require a thorough review of follow-up especially in patients with functional illiteracy.
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Fibrilación Atrial , Warfarina , Adulto , Anticoagulantes/efectos adversos , Fibrilación Atrial/complicaciones , Femenino , Humanos , Incidencia , Relación Normalizada Internacional , Estudios Retrospectivos , Warfarina/efectos adversosRESUMEN
Air quality in schools is an important public health issue because children spend a considerable part of their daily life in classrooms. Particulate size and chemical composition has been associated with negative health effects. We studied levels of trace element concentrations in fine particulate matter (PM2.5) in indoor versus outdoor school settings from six schools in Chañaral, a coastal city with a beach severely polluted with mine tailings. Concentrations of trace elements were measured on two consecutive days during the summer and winter of 2012 and 2013 and determined using X-ray fluorescence. Source apportionment and element enrichment were measured using principal components analysis and enrichment factors. Trace elements were higher in indoor school spaces, especially in classrooms compared with outdoor environments. The most abundant elements were Na, Cl, S, Ca, Fe, K, Mn, Ti, and Si, associated with earth's crust. Conversely, an extremely high enrichment factor was determined for Cu, Zn, Ni and Cr; heavy metals associated with systemic and carcinogenic risk effects, whose probably origin sources are industrial and mining activities. These results suggest that the main source of trace elements in PM2.5 from these school microenvironments is a mixture of dust contaminated with mine tailings and marine aerosols. Policymakers should prioritize environmental management changes to minimize further environmental damage and its direct impact on the health of children exposed.
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Contaminación del Aire Interior/análisis , Monitoreo del Ambiente/métodos , Metales/análisis , Material Particulado/química , Instituciones Académicas , Población Urbana , Contaminación del Aire , Chile , Exposición a Riesgos Ambientales , Humanos , Minería , Análisis de Componente Principal , Estaciones del Año , Espectrometría por Rayos XRESUMEN
BACKGROUND: Cardiovascular diseases are highly represented in multimorbidity patterns. Nevertheless, few studies have analysed the burden of these diseases in the population with multimorbidity. The objective of this study was to identify and describe the cardiovascular diseases among the patients with multimorbidity. METHODS: We designed a cross-sectional study in patients ≥19 years old assigned to 251 primary health care centres in Catalonia, Spain. The main outcome was cardiovascular morbidity burden, defined as the presence of one or more of 24 chronic cardiovascular diseases in multimorbid patients (≥2 chronic conditions). Two groups were defined, with and without multimorbidity; the multimorbidity group was further divided into cardiovascular and non-cardiovascular subgroups. The secondary outcomes were: modifiable major cardiovascular risk factors (smoking, hypertension, hypercholesterolaemia, diabetes) and cardiovascular risk score (REGICOR, Registre Gironí del Cor). Other variables analysed were: sex, age (19-24, 25-44, 45-64, 65-79, and 80+ years), number of chronic diseases, urban setting, active toxic habits (smoking and alcohol), physical parameters and laboratory tests. RESULTS: A total of 1,749,710 individuals were included (mean age, 47.4 years [SD: 17.8]; 50.7 % women), of which nearly half (46.8 %) had multimorbidity (95 % CI: 46.9-47.1). In patients with multimorbidity,, the cardiovascular burden was 54.1 % of morbidity (95 % CI: 54.0-54.2) and the four most prevalent cardiovascular diseases were uncomplicated hypertension (75.3 %), varicose veins of leg (20.6 %), "other" heart disease (10.5 %) and atrial fibrillation/flutter (6.7 %). In the cardiovascular morbidity subgroup, 38.2 % had more than one cardiovascular disease. The most prevalent duet and triplet combinations were uncomplicated hypertension & lipid disorder (38.8 %) and uncomplicated hypertension & lipid disorder & non-insulin dependent diabetes (11.3 %), respectively. By age groups, the same duet was the most prevalent in patients aged 45-80 years and in men aged 25-44 years. In women aged 19-44, varicose veins of leg & anxiety disorder/anxiety was the most prevalent; in men aged 19-24, it was uncomplicated hypertension & obesity. Patients with multimorbidity showed a higher cardiovascular risk profile than the non-multimorbidity group. CONCLUSIONS: More than 50 % percent of patients with multimorbidity had cardiovascular diseases, the most frequent being hypertension. The presence of cardiovascular risk factors and the cardiovascular risk profile were higher in the multimorbidity group than the non-multimorbidity group. Hypertension, diabetes and dyslipidaemia constituted the most prevalent multimorbidity pattern.
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Trastornos de Ansiedad/epidemiología , Ansiedad/epidemiología , Enfermedades Cardiovasculares/epidemiología , Diabetes Mellitus/epidemiología , Dislipidemias/epidemiología , Obesidad/epidemiología , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Fibrilación Atrial/epidemiología , Comorbilidad , Estudios Transversales , Femenino , Humanos , Hipertensión/epidemiología , Masculino , Persona de Mediana Edad , Factores Sexuales , España/epidemiología , Várices/epidemiología , Adulto JovenRESUMEN
OBJECTIVE: To estimate rates of cases of respiratory symptomatic subjects and the incidence rate of pulmonary tuberculosis in two border areas of Ecuador, and contrast them with official figures. MATERIALS AND METHODS: Cross-sectional survey in the southeastern (SEBA), and the Andean southern Ecuadorian border areas (ASBA), which were conducted, respectively, in 1 598 and 2 419 persons aged over 15 years recruited over periods of three weeks. In identified respiratory symptomatic cases, a sputum sample was taken for smear testing. The results (odds ratios and their respective 95% confidence intervals), were compared with local and national official figures using maximum likelihood contrasts. RESULTS: The rates of respiratory symptomatic subjects (7.7% and 5.9% in the SEBA, and ASBA, respectively) and of pulmonary tuberculosis (cumulative incidence rates of 125 and 140 per 100 000 inhabitants, in the same order) were significantly greater than the official figures (of 0.98 and 0.99% for respiratory symptomatic subjects in the SEBA and ASBA, respectively; and of 38.23 per 100 000 inhabitants for pulmonary tuberculosis in Ecuador as a whole) (p<0.001). CONCLUSION: It is necessary to reinforce both active case finding for respiratory symptomatic subject cases, and epidemiological surveillance of pulmonary tuberculosis in Ecuadorian border regions.
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Vigilancia de la Población/métodos , Tuberculosis Pulmonar/epidemiología , Adolescente , Adulto , Anciano , Estudios Transversales , Aglomeración , Ecuador/epidemiología , Femenino , Encuestas Epidemiológicas , Vivienda , Humanos , Funciones de Verosimilitud , Alfabetización , Masculino , Persona de Mediana Edad , Mycobacterium tuberculosis/aislamiento & purificación , Densidad de Población , Determinantes Sociales de la Salud , Marginación Social , Esputo/microbiología , Tuberculosis Pulmonar/diagnóstico , Adulto JovenAsunto(s)
Tos Ferina , Humanos , México/epidemiología , Tos Ferina/diagnóstico , Tos Ferina/epidemiologíaRESUMEN
OBJECTIVE: To estimate the incidence rate of tuberculosis (TB) in the Highlands (Tsotsil-Tseltal) region of Chiapas and to analyze sociodemographic factors that might influence the success of anti-TB treatment from the period of January 2019 to June 2022. METHODS: Retrospective study in which the TB databases of the National Epidemiological Surveillance System (SINAVE) were analyzed. TB incidence rates were calculated based on the number of registered TB cases and estimated annual populations. The success-failure of anti-TB treatment was analyzed according to sociodemographic indicators, degree of concentration of indigenous population of the municipality of residence and admission to SINAVE. RESULTS: Two hundred thirty-three cases were analyzed. The variables associated to a lower success rate of treatment against TB were: living in a municipality with high-very high concentration of indigenous population, being indigenous, having a primary school education or lower, and agricultural occupation. The number of TB diagnosed from 2020-2022 and the incidence rates from 2020-2021 decreased significantly compared to 2019. CONCLUSIONS: It is necessary to strengthen the follow-up of TB cases in the region, mainly in areas with high-very high indigenous concentration, in people with low levels of education and engaged in agricultural work.
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Factores Sociodemográficos , Tuberculosis , Humanos , México/epidemiología , Estudios Retrospectivos , Tuberculosis/tratamiento farmacológico , Tuberculosis/epidemiología , Incidencia , Antituberculosos/uso terapéuticoRESUMEN
BACKGROUND: Because a strong association was observed between pulmonary tuberculosis (TB) and the use of public transport, increasing with duration of journey, a study was carried out to assess infection by Mycobacterium tuberculosis and working conditions among workers in this sector. METHODS: A cross-sectional study was conducted between June and September 2008. A total of 104 workers from two public transport minibus ('combi') cooperatives covering marginal areas of the Ate-Vitarte district in Lima were interviewed. Demographic and occupational details were collected as well as prior family and personal history of TB and BCG vaccination. The tuberculin skin test (TST) was administered to each study subject and an induration of ≥ 10 mm was considered positive. Statistical analysis was based on logistic models, ORs and their 95% CIs. RESULTS: TST results were obtained for 70.2% (n=73), of whom 76.6% (n=56) were positive. Positivity was significantly associated with those who had worked for more than 2 years (crude OR 11.04; 95% CI 3.17 to 38.43) and more than 60 h/week (crude OR 9.8; 95% CI 2.85 to 33.72). These associations remained significant in a multivariate model as well. CONCLUSION: The association observed between years of working and weekly work burden among minibus workers suggests an occupational risk in service jobs in low-income countries with high TB prevalence. Consequently, other types of users are at increased risk for TB infection, with a causal relationship between effect and duration of exposure.
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Enfermedades Profesionales/epidemiología , Transportes/estadística & datos numéricos , Tuberculosis Pulmonar/epidemiología , Adolescente , Adulto , Anciano , Métodos Epidemiológicos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Vehículos a Motor , Enfermedades Profesionales/etiología , Exposición Profesional/efectos adversos , Exposición Profesional/estadística & datos numéricos , Perú/epidemiología , Factores de Tiempo , Prueba de Tuberculina , Tuberculosis Pulmonar/transmisión , Adulto JovenRESUMEN
Hospitalization rates for Ambulatory Care Sensitive Conditions have been used to assess effectiveness of the first level of health care. From a critical analysis of related concepts, we discuss principles for selecting a list of codes and, taking the example of the Brazilian Family Health Program, propose a methodological pathway for identifying variables in order to inform statistical models of analysis. We argue that for the indicator to be comparable between regions, disease codes should be selected based on sensitivity and specificity principles, not on observed disease frequency. Rates of hospitalization will be determined, at a distal level, by the socio-economic environment and their effect on the social and demographic structure. Timely and effective care depends on the organization of health services, their availability and access barriers, which depend on the ways health and related technology are conceptualised and on their adherence to the biomedical model or to the Primary Health Care (PHC) principles; performance indicators of the health system will be the proximal determinants. This indicator is potentially useful for primary care evaluation. The historical reconstruction of PHC improves the analysis of the indicator variability.
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Atención Ambulatoria , Hospitalización , Atención Primaria de Salud , Brasil , Humanos , Proyectos de InvestigaciónRESUMEN
Objective. To estimate rates of cases of respiratory symptomatic subjects and the incidence rate of pulmonary tuberculosis in two border areas of Ecuador, and contrast them with official figures. Materials and methods. Cross-sectional survey in the southeastern (SEBA), and the Andean southern Ecuadorian border areas (ASBA), which were conducted, respectively, in 1 598 and 2 419 persons aged over 15 years recruited over periods of three weeks. In identified respiratory symptomatic cases, a sputum sample was taken for smear testing. The results (odds ratios and their respective 95% confidence intervals), were compared with local and national official figures using maximum likelihood contrasts. Results. The rates of respiratory symptomatic subjects (7.7% and 5.9% in the SEBA, and ASBA, respectively) and of pulmonary tuberculosis (cumulative incidence rates of 125 and 140 per 100 000 inhabitants, in the same order) were significantly greater than the official figures (of 0.98 and 0.99% for respiratory symptomatic subjects in the SEBA and ASBA, respectively; and of 38.23 per 100 000 inhabitants for pulmonary tuberculosis in Ecuador as a whole) (p<0.001). Conclusion. It is necessary to reinforce both active case finding for respiratory symptomatic subject cases, and epidemiological surveillance of pulmonary tuberculosis in Ecuadorian border regions.
Objetivo. Determinar las tasas de sintomáticos respiratorios y de incidencia de tuberculosis pulmonar en dos zonas fronterizas de Ecuador, y contrastarlas con cifras oficiales. Material y métodos. Encuesta transversal aplicada en comunidades fronterizas Sur Oriental (FSO) y Sur Andina (FSA) a 1 598 y 2 419 mayores de 15 años, respectivamente. A los sintomáticos respiratorios se les realizó una baciloscopía en esputo. Las tasas y razón de momios se compararon frente a cifras oficiales mediante contraste de verosimilitudes. Resultados. Las tasas de sintomáticos respiratorios (7.7 y 5.9% en FSO y FSA, respectivamente) y de tuberculosis pulmonar (incidencia acumulada 125 y 140 por 100 000 habitantes, respectivamente) discrepan de las cifras oficiales (0.98 y 0.99% de sintomáticos respiratorios, respectivamente; y, 38.23 por 10(5) habitantes para tuberculosis pulmonar en Ecuador) (p<0.001). Conclusión. Fortalecer la búsqueda de sintomáticos respiratorios y la vigilancia epidemiológica de la tuberculosis pulmonar en áreas fronterizas.
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Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Adulto Joven , Tuberculosis Pulmonar/epidemiología , Vigilancia de la Población/métodos , Aglomeración , Funciones de Verosimilitud , Estudios Transversales , Encuestas Epidemiológicas , Ecuador/epidemiología , Marginación Social , Determinantes Sociales de la Salud , Alfabetización , Vivienda , Mycobacterium tuberculosis/aislamiento & purificaciónAsunto(s)
Humanos , Tos Ferina , Tos Ferina/diagnóstico , Tos Ferina/epidemiología , México/epidemiologíaRESUMEN
Objetivo: analizar los indicadores de la distribución por sexo de profesionales médicos en el Ministerio de Salud Pública de Ecuador y en estudiantes de medicina de universidades públicas y privadas y su implicación en la planificación del recurso humano en salud. Métodos: diseño transversal a partir de dos bases de datos: a) profesionales médicos del Ministerio de Salud Pública período 2008-2012, b) estudiantes de las 21 facultades ecuatorianas de medicina, cohortes 2000-2013. La descripción se realizó con proporciones y con intervalos de confianza 95 por ciento calculado mediante la distribución binomial. Resultados: el Índice de Paridad por Género entre los médicos de 26 a 29 años de edad que ingresaron al ministerio en el 2008 fue 2,36 y en el 2012 fue 1,41. La presencia de vacantes entre el 2008 al 2012 se incrementó en 6,1 veces. Entre los estudiantes de medicina que ingresaron en el 2008 el Índice de Paridad por Género fue 1,37 en las universidades públicas y 1,42 en las privadas, mientras que el índice de los estudiantes que se graduaron al terminar la carrera en las universidades públicas fue 1,02 y en las privadas 0,63. Conclusiones: el Índice de Paridad por Género en el grupo de los profesionales médicos para el 2012 es menor que en el 2008. Aunque ingresan más mujeres que hombres a estudiar medicina, el número de mujeres que se gradúan es menor. Las políticas de recursos humanos en salud requieren tomar en cuenta la perspectiva de género para afianzar el Buen Vivir(AU)
Objective: to describe indicators of distribution by gender of medical doctors working in the Ecuadorian Ministry of Public Health and of medical students at state and private universities in the country, and the implications for human resource planning. Methods: a cross-sectional design study based on two databases: a) medical professionals working at the Ministry of Public Health from 2008 to 2012, and b) students from the twenty one medical schools in Ecuador; 2000-2013 cohorts. The description used proportions and CI95 percrent calculated according to binomial distribution. Results: the Gender Parity Index among doctors aged 26 to 29 years, who started working for the Ministry of Health in 2008 was 2.36, and in 2012 was 1.41. The amount of vacancies from 2008 to 2012 increased 6.1 times. Among the medical students who started in 2008, the Gender Parity Index was 1.37 in public schools and 1.42 in private schools whereas this index was 1.02 for students who graduated from public universities in that same year and 0.63 for those of private universities. Conclusions: the Gender Parity Index of the medical professionals at the Ministry of Health in 2012 was lower than that of 2008. Although more women begin the medical studies than men, the number of women who graduate is lower than that of men. Human resource policy in public health must take into consideration the gender perspective in line with the Andean philosophy of Good Living(AU)
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Humanos , Transversalidad de Género , Empleos en Salud/educación , Estudios Transversales , EcuadorRESUMEN
OBJECTIVE: Ambulatory care-sensitive conditions (ACSC) are health problems managed by actions at the first level of care. The need for hospitalization by these causes is avoidable through an effective and proper primary health care. The objective of the study was to estimate ACSC among patients hospitalized by the Sistema Unico de Saúde (Brazilian Health System). METHODS: Hospital-based cross-sectional study involving 1,200 inhabitants of Bagé (Southern Brazil) who were inpatients between September/2006 and January/2007. The patients answered a questionnaire applied by interviewers and were classified according to the model of attention utilized prior to hospitalization. ACSC were defined in a workshop promoted by the Ministry of Health. The variables analyzed included demographic and socioeconomic characteristics, health and health services utilized. Multivariate analysis was conducted by the Poisson model, according to a hierarchical conceptual framework, stratified by sex and model of care. RESULTS: ACSC accounted for 42.6% of the hospitalizations. The probability that the main diagnosis for hospitalization is considered an ACSC is greater among women, children under five years of age, individuals with less then five years of schooling, hospitalization in the year prior to the interview, emergency room consultation, and being an inpatient at the university hospital. Among women, ACSC are associated with age, educational level, length of time the health center has been in existence, living in an area covered by the Programa Saúde da Família (Family Health Program), use of this service, emergency room consultation during the month prior to the interview and hospital to which patient was admitted. For men, it was associated with age, have undergone another hospitalization in the year prior to the interview and hospital to which patient was admitted. CONCLUSIONS: Analysis of ACSC allows identifying groups with inadequate access to primary health care. Although we could not infer an effect on the risk of hospital admission, analysis by sex and model of care suggests that Family Health Program is more equitable than "traditional" primary health care.
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Atención Ambulatoria/estadística & datos numéricos , Salud de la Familia , Accesibilidad a los Servicios de Salud , Hospitalización/estadística & datos numéricos , Programas Nacionales de Salud/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Adolescente , Adulto , Brasil , Niño , Preescolar , Estudios Transversales , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Factores Socioeconómicos , Encuestas y Cuestionarios , Adulto JovenRESUMEN
Hospitalization rates for Ambulatory Care Sensitive Conditions have been used to assess effectiveness of the first level of health care. From a critical analysis of related concepts, we discuss principles for selecting a list of codes and, taking the example of the Brazilian Family Health Program, propose a methodological pathway for identifying variables in order to inform statistical models of analysis. We argue that for the indicator to be comparable between regions, disease codes should be selected based on sensitivity and specificity principles, not on observed disease frequency. Rates of hospitalization will be determined, at a distal level, by the socio-economic environment and their effect on the social and demographic structure. Timely and effective care depends on the organization of health services, their availability and access barriers, which depend on the ways health and related technology are conceptualised and on their adherence to the biomedical model or to the Primary Health Care (PHC) principles; performance indicators of the health system will be the proximal determinants. This indicator is potentially useful for primary care evaluation. The historical reconstruction of PHC improves the analysis of the indicator variability.
As taxas de hospitalização por condições sensíveis à atenção primária são um indicador da efetividade do primeiro nível de atenção à saúde. Partindo de breve revisão crítica, este artigo discute princípios para a seleção de códigos de internação por essas causas e, com o exemplo do Programa Saúde da Família, propõe um modelo teórico para a seleção de variáveis para análise estatística. A comparabilidade inter-regional do indicador depende da seleção de códigos de doenças baseada em princípios de sensibilidade e especificidade, não na frequência da doença. As taxas de hospitalização serão distalmente determinadas pela situação socioeconômica e seu efeito sobre a estrutura social e demográfica; em nível intermediário, pela organização dos serviços de saúde, sua disponibilidade e barreiras de acesso, que por sua vez dependem dos conceitos de saúde e tecnologia relacionada adotados e de sua aproximação ao modelo biomédico ou aos princípios da atenção primária à saúde (APS); indicadores de desempenho do sistema de saúde serão os determinantes proximais. O indicador é potencialmente útil para a avaliação da atenção primária. A reconstrução histórica da APS contribui para a análise da variabilidade do indicador.
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Humanos , Atención Ambulatoria , Hospitalización , Atención Primaria de Salud , Brasil , Proyectos de InvestigaciónRESUMEN
OBJETIVO: Condições sensíveis à atenção primária (CSAP) são problemas de saúde atendidos por ações do primeiro nível de atenção. A necessidade de hospitalização por essas causas deve ser evitada por uma atenção primária oportuna e efetiva. O objetivo do estudo foi estimar a probabilidade do diagnóstico de CSAP em pacientes hospitalizados pelo Sistema Único de Saúde. MÉTODOS: Estudo transversal com 1.200 pacientes internados entre setembro/2006 e janeiro/2007 em Bagé (RS). Os pacientes responderam a questionário aplicado por entrevistadoras, sendo classificados segundo o modelo de atenção utilizado previamente à hospitalização. As CSAP foram definidas em oficina promovida pelo Ministério da Saúde. Analisaram-se variáveis demográficas, socioeconômicas, de situação de saúde e relativas aos serviços de saúde utilizados. A análise multivariável foi realizada por modelo de Poisson, seguindo modelo teórico hierárquico de determinação da hospitalização segundo sexo e modelo de atenção. RESULTADOS: O total de 42,6 por cento das internações foi por condições sensíveis à atenção primária. A probabilidade de que o diagnóstico principal de internação seja por uma dessas condições aumenta com as características: ser do sexo feminino, ter idade menor de cinco anos, ter escolaridade menor de cinco anos, ter sido hospitalizado no ano anterior à entrevista, ter consulta médica na emergência, estar internado no hospital universitário. Associaram-se à probabilidade de CSAP: (a) mulheres: faixa etária, escolaridade, tempo de funcionamento da unidade de saúde, residir em área de saúde da família, ser usuária do Programa Saúde da Família, consulta médica na emergência no mês anterior à pesquisa e hospital de internação; (b) homens: faixa etária, ter sofrido outra internação no ano anterior à entrevista e o hospital de internação. CONCLUSÕES: As condições sensíveis à atenção primária permitem identificar grupos carentes de atenção à saúde adequada. Embora o estudo não permita infer...
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Atención Primaria de Salud , Hospitalización , Estrategias de Salud Nacionales , Servicios de Salud , Estudios Transversales , Factores SocioeconómicosRESUMEN
Objetivo. Identificar el sitio y el agente de atención del parto; analizar el agente de atención del parto según la atención prenatal (AP) y factores sociodemográficos; identificar grupos con menor y mayor probabilidad de recibir atención por parte del personal de los serivicios de salud; identificar los motivos de no atenderse en la unidad de salud más cercana al domicilio. Material y métodos. Se analizan datos sobre la atención del parto en 297 mujeres de la Región Fraylesca (Chiapas), usando modelos logit para la identificación de grupos. Resultados. El 32 por ciento de los partos ocurrieron en instituciones de salud, y 60 por ciento en el hogar (mayoritariamente en condiciones higiénico-sanitarias desfavorables). Sólo 10 por ciento del grupo de mujeres con menos de cinco consultas de AP, una escolaridad menor al tercero de primaria y un jefe de hogar dedicado a labores agropecuarias, fue atendido por personal de salud. Conclusiones. Es necesario mejorar la cobertura, la aceptabilidad y la calidad de los servicios de salud e instrumentar un programa dirigido a incrementar el número de partos en condiciones higiénico-sanitarias adecuadas
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Humanos , Femenino , Embarazo , Conductas Relacionadas con la Salud/etnología , Negativa del Paciente al Tratamiento/etnología , Negativa del Paciente al Tratamiento/estadística & datos numéricos , Parto , Accesibilidad a los Servicios de Salud , Atención Prenatal , Poblaciones Vulnerables , Población Rural , Clase Social , Escolaridad , Factores Socioeconómicos , Indicadores Económicos/estadística & datos numéricosRESUMEN
Objetivo. Analizar el uso de servicios de atención prenatal (AP) en la región Fraylesca de Chiapas, México, e identificar grupos con menor probabilidad de recibir AP. Material y métodos. En 1994 se realizó una encuesta en una muestra aleatoria de 1100 viviendas en la que se recopiló información sociodemográfica y sobre AP del último embarazo ocurrido en los dos años previos al estudio (n=297 mujeres de 15 a 49 años). La identificación de grupos con menor probabilidad de recibir AP adecuada (cinco o más consultas) se realizó mediante un modelo log-lineal. Resultados. Cuarenta y dos por ciento de las mujeres recibió AP inadecuada (0 a 4 consultas). Las mujeres en "mejor situación socioeconómica" fueron las de mayor probabilidad de recibir AP adecuada: RM 2.47 (IC 95 por ciento 1.12 - 5.44), respecto a las mujeres ubicadas en "peor condición socioeconómica". Conclusiones. Es menester aumentar la calidad de la atención de los servicios, apoyar la labor de las parteras y mejorar las condiciones socioeconómicas de la población
Objective. To analyze the use of antenatal care services (ACS) in the Fraylesca Region of Chiapas, Mexico, and to identify groups with lower probability of receiving ACS. Material and methods. In 1994, a health survey was performed on a random sample of 1 100 households, which compiled sociodemographic information and on the use of ACS during the last pregnancy within the two years previous to the study (n= 297 women from 15 to 49 years of age). The groups with lower probability of receiving adequate ACS (5 or more visits) were identified with a log-linear model. Results. Forty-two percent of women received inadequate ACS (0 to 4 visits). Women with better socioeconomic status had higher probability of using ACS adequately than women with lower socioeconomic status: OR 2.47 (CI 95% 1.12-5.44). Conclusions. Results provide evidence of the need to improve the quality of ACS, to support the traditional midwives and to improve living conditions of the population.