Relación entre el perfil epidemiológico y nivel socioeconómico de la población que demanda atención en la Cátedra de Odontología Integral Niños / Relationship between the epidemiological profile and socioeconomic level of the population requiring care at the Children´s Comprehensive Dentistry Chair

Se identificó el perfil epidemiológico y se caracterizó la situación de la población en base al Nivel Socio-Económico (NSE) asociado al estado dentario y se es-tablecieron las zonas geográficas de pacientes que asistieron a la Cátedra Odontología Integral Niños (COIN) de FOUBA durante el año 2019. La muestra total se conformó con 541 niños de 9,2±3,3 años; masculi-nos 51,0%. La segmentación de los estratos sociales dio como resultado que del total de pacientes, el 33,3% perteneció a Clase Baja D2/E, el 39,2% a Clase Baja Superior D1, el 22,4% a Clase Media Baja C3, el 4% a Clase Media Alta C2 y el 1,1% a Clase Alta ABC1. La mayor demanda de atención provino de las dos clases más bajas de la pirámide social, aunque se trata de un servicio arancelado. Los indicadores del estado den-tario ceod, ceos, CPOD y CPOS, indicaron que los niños de menor posición socioeconómica presentaron los índices más altos. La mayor concurrencia provino de la Ciudad Autónoma de Buenos Aires (52%), respecto a los pacientes concurrentes del Gran Buenos Aires (37%), el 80% provino de la zona Oeste y Sur (AU)

The epidemiological profile was identified, and the situation of the population was characterized based on Socio-Economic Status (SES) associated with their dental state. Geographical areas of patients who attended the FOUBA Children's Comprehensive Dentistry Chair during 2019 were established. The total sample consisted of 541 children aged 9.2±3.3 years; males 51.0%. The segmentation of the social strata resulted in 33.3% belonging to Low-Class D2/E, 39.2% to Upper Lower-Class D1, 22.4% to Lower Middle-Class C3, 4% to Upper Middle-Class C2, and 1.1% to Upper-Class ABC1. The largest demand for care came from the two lowest classes of the social pyramid, even though it is a fee-based service. The indicators of dental status dmft, dmfs, DMFT and DMFS, showed that children coming from the lowest socio-economic position presented the highest rate of occurrence. The highest attendance came from the City of Buenos Aires (52%), compared to patients from Buenos Aires suburbs (37%), of which 80% were from the Western and Southern suburbs (AU)

Especificidades clínico-epidemiológicas y diagnósticas del cáncer de colon con metástasis hepáticas sincrónicas / Clinical-Epidemiological Specificities of Colon Cancer Diagnosed with Synchronic Metastasis

Introducción: El cáncer de colon se erige como la neoplasia del tubo digestivo más frecuente en la presente centuria. Objetivo: Identificar algunos factores clínicos, epidemiológicos y diagnósticos en pacientes operados de cáncer de colon con metástasis hepática sincrónica. Métodos: Se realizó un estudio observacional, descriptivo y transversal de una muestra de 31 pacientes operados con diagnóstico definitivo de cáncer de colon con metástasis hepática sincrónica, en el servicio de Cirugía General del Hospital Provincial Docente "Saturnino Lora" de Santiago de Cuba durante el periodo comprendido entre 2010 y 2019. Resultados: La edad promedio fue de 63,2 años. Existió predominio de la enfermedad inflamatoria intestinal como antecedente patológico personal, y del alcoholismo como factor de riesgo. La sintomatología predominante fue dolor abdominal y cambios del hábito intestinal, así como el tumor palpable al examen físico del abdomen. La ecografía abdominal y el colon por enema fueron los procederes de diagnóstico más utilizados. Prevalecieron los tumores en el colon izquierdo a nivel del descendente. Todos los tumores malignos fueron adenocarcinomas a predominio de los moderadamente diferenciados. Conclusiones: Las edades avanzadas de la vida, así como la presencia de tabaquismo y alcoholismo son factores epidemiológicos característicos de la población de enfermos aquejados de cáncer de colon con metástasis hepática. Los elementos clínicos identificados constituyeron los habitualmente descritos en la literatura médica, aunque los estudios imaginológicos utilizados preoperatoriamente resultaron limitados para el diagnóstico del cáncer de colon con metástasis hepática sincrónica, precisándose el hallazgo de las lesiones metastásicas durante la intervención quirúrgica(AU)

Introduction: Colon cancer is the most frequent digestive-tract neoplasm in the present century. Objective: To identify some clinical, epidemiological and diagnostic factors in patients operated on for colon cancer and synchronic hepatic metastasis. Methods: An observational, descriptive and cross-sectional study was carried out in a sample of 31 patients operated on with a definitive diagnosis of colon cancer and synchronic hepatic metastasis, in the general surgery service of Saturnino Provincial Teaching Hospital in Santiago de Cuba, during the period between 2010 and 2019. Results: The average age was 63.2 years. There was a predominance of inflammatory intestinal disease as a personal pathological antecedent, as well as alcoholism as a risk factor. The predominant symptoms were abdominal pain and changes in intestinal habits, as well as a tumor palpable on physical abdominal examination. Abdominal ultrasound and lower barium enema were the most used diagnostic procedures. Tumors prevailed at the level of the left descending colon. All malignant tumors were adenocarcinomas, predominantly moderately differentiated ones. Conclusions: Advanced ages of life, as well as smoking and alcoholism are characteristic epidemiological factors among the population of patients suffering from colon cancer with hepatic metastases. The clinical elements identified were those usually described in the medical literature, although the imaging studies used preoperatively were limited for the diagnosis of colon cancer with synchronic hepatic metastasis, a fact that required finding metastatic lesions during surgery(AU)

Prevalence and determinants of gestational weight gain among pregnant women in Niger.

Low gestational weight gain (GWG) and low mid-upper arm circumference (MUAC) are associated with adverse pregnancy outcomes. We aimed to assess the prevalence and determinants of low GWG and low MUAC among pregnant women in rural Zinder, Niger. A community-based survey was conducted among 1,384 pregnant women in the catchment areas of 18 integrated health centers in the region of Zinder, Niger. Weight and MUAC were measured during an in-home visit and again 1 month later, when haemoglobin concentration and micronutrient status were also assessed. The prevalence of low GWG was defined based on the 2009 United States Institute of Medicine (U.S. IOM) guidelines (<0.35 kg/week) and less than the third centile of the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st) standards. Factors associated with GWG and MUAC were identified using logistic regression models adjusting for season, village, and gestational age. The median (interquartile range) age was 25.0 (20.7, 30.0) years, and 16.4% were ≤19 years. The prevalence of low GWG were 62.9% and 27.5% according to 2009 IOM and less than the third INTERGROWTH-21st centile, respectively; 24.9% had low MUAC. Higher α-1-acid glycoprotein (OR = 1.7, 95% CI [1.1, 2.8]) and C-reactive protein (OR = 1.2, 95% CI [1.02, 1.50]) increased the odds of low GWG. Adolescents (OR = 2.7, 95% CI [1.8, 4.0]), housewives (OR = 1.97, 95% CI [1.36, 2.86]), and those who reported recent food assistance (OR = 1.80, 95% CI [1.04, 3.11]) had higher odds of low MUAC. Prevalence of low GWG and low MUAC was high among pregnant women. Determinants of GWG and MUAC included socio-economic, demographic, and biological factors, although only markers of inflammation were consistent predictors across different definitions of low GWG.

Determinants of low birth weight in neonates born in three hospitals in Brong Ahafo region, Ghana, 2016- an unmatched case-control study.

BACKGROUND: Each year, about 20 million Low Birth Weight (LBW) babies are born with very high proportion (96.5%) occuring in developing countries. In the last decade, the incidence of LBW in Ghana has not declined. Brong Ahafo Region of Ghana recorded a LBW prevalence of 11% which was higher than the the national average of 10%. This study identifed determinants of LBW delivery in the Brong Ahafo Region. METHODS: We conducted a 1:2 unmatched case control study among mothers with singleton deliveries in 3 major health facilities in the Brong Ahafo Region. A case was defined as a mother who delivered a baby weighing less than 2500g in any of the three selected health facilities between 1st December, 2015 and 30th April, 2016. A control was defined as a mother who within 24 h of delivery by a case, delivered a baby weighing at least 2500g and not exceeding 3400g in the same health facility. Deliveries that met the inclusion criteria for cases were selected and two controls were randomly selected from the pool of deliveries that meet criteria for controls within 24 h of delivery of a case. A total of 120 cases and 240 control were recruited for the study. We computed odds ratios at 95% confidence level to determine the associations between low birth weight and the dependent factors. RESULTS: After controlling for confounders such as planned pregnancy, mode of delivery, parity and previous LBW in stepwise backward logistic regression, first trimester hemoglobin < 11 g/dl (aOR 3.14; 95%CI: 1.50-6.58), delivery at 32-36 weeks gestation (aOR 13.70; 95%CI: 4.64-40.45), delivery below 32 weeks gestation (aOR 58.5; 95%CI 6.7-513.9), secondary education of mothers (aOR 4.19; 95%CI 1.45-12.07), living with extended family (aOR 2.43; 95%CI 1.15-5.10, living alone during pregnancy (aOR 3.9; 95%CI: 1.3-11.7), and not taking iron supplements during pregnancy (aOR 3.2; 95%CI: 1.1-9.5) were found to be significantly associated with LBW. CONCLUSION: Determinants of LBW were: preterm delivery, mothers with secondary education, living alone during pregnancy, not taking daily required iron supplementation and mothers with first trimester hemoglobin below 11 g/dl. Education during antenatal sessions should be tailored to address the identified risk factors in the mother and child health care services.

Quality of life in aphasia: differences between fluent and non-fluent aphasic Augmentative and Alternative Communication users / Qualidade de vida na afasia: diferenças entre afásicos fluentes e não fluentes usuários de Comunicação Suplementar e/ou Alternativa

Purpose To investigate and to compare quality of life (QOL) in fluent and non-fluent aphasics. Methods This is a prospective, quantitative, and transversal study. We included 11 stroke patients with aphasia (five non-fluent aphasics augmentative and alternative communication users and six fluent aphasics). Data was gathered from the Stroke Specific Quality of Life Scale (SS-QOL), a structure interview, and The Modified Rankin Scale. Results The non-fluent aphasics presented poorer Rankin and quality of life than the fluent aphasics. The major difference occurred in the fields of language and upper extremity function. The three most affected domains in non-fluent aphasics were language, social roles, and thinking, whereas in the fluent aphasics were personality, social roles, and thinking. All the subjects referred a worse quality of life after stroke. The domains of language and self-care were identified as the most affected after stroke. Conclusion This study demonstrated that, in general, non-fluent aphasics have lower quality of life than fluent aphasics. However, this difference is not homogeneous among the several quality of life domains. Additionally, this research evidences a relationship between aphasia severity and individual functionality, implying impairment in quality of life, especially for non-fluent aphasics. .

Objetivo Investigar e comparar a qualidade de vida de afásicos fluentes e não fluentes. Métodos Trata-se de pesquisa prospectiva, quantitativa, transversal, cuja amostra se constituiu de 11 sujeitos afásicos (5 não fluentes, usuários de comunicação suplementar e/ou alternativa e 6 fluentes, não usuários de comunicação suplementar e/ou alternativa. A coleta de dados foi realizada por meio da aplicação de um questionário específico de qualidade de vida, entrevista estruturada e aplicação da escala de Rankin modificada. Resultados Na comparação dos grupos estudados, os afásicos não fluentes apresentaram escores de Rankin e de qualidade de vida menores do que os fluentes e as maiores diferenças referiram-se aos domínios de linguagem e função do membro superior. Os domínios mais prejudicados pelo acidente vascular cerebral foram linguagem, relações sociais e modo de pensar, para os afásicos não fluentes, e comportamento, relações sociais e modo de pensar, para os fluentes. Todos os sujeitos relataram que sua qualidade de vida piorou após o acidente vascular cerebral, sendo que linguagem e cuidados pessoais foram apontados como os aspectos que mais mudaram, após o episódio lesional. Conclusão Os achados mostram relação entre gravidade da afasia e funcionalidade do indivíduo, indicando que, no geral, os afásicos não fluentes apresentam qualidade de vida pior do que os fluentes. As diferenças não são homogêneas nos diversos domínios de qualidade de vida. .

Using participatory epidemiology to assess factors contributing to common enteric pathogens in Ontario: results from a workshop held at the Ontario Veterinary College, University of Guelph, Ontario.

BACKGROUND: Common enteric pathogens that cause gastrointestinal illness are transmitted to humans through food, water or direct contact. This poses a significant concern to public health as enteric pathogens can cause disease in a large number of people, and cost a substantial amount to treat and prevent. In order to gain a better understanding of the occurrence of enteric disease in Ontario, this study explored public health professionals' perceptions of major contributing factors for common enteric pathogens. METHODS: A case study was conducted as part of a two week training workshop in Participatory Epidemiology held at the Ontario Veterinary College, University of Guelph, in May 2013. Eight semi-structured interviews and four focus groups were conducted with representatives from the Public Health Agency of Canada, the University of Guelph, and three health regions in Southern Ontario. Written notes and pictures captured the qualitative information provided. Results were then analyzed using the mixed methods techniques of triangulation, convergence, and paradox. RESULTS: A total of fifty factors that contribute to enteric disease were identified across all interviews and focus groups. These contributing factors were grouped into key themes (travel, food handling, industry (farm-to-fork), water, geography, demographics, and behaviours) and were categorized as either a risk factor or susceptibility factor. Informants emphasized the complex relationships between the identified factors, and highlighted why these complexities make it difficult to determine where and how a person most likely acquired an enteric pathogen. Workshop participants observed differences in the type and quality of information collected during interviews and focus groups; we hypothesize that this may be attributed to the dynamics between group members (i.e. focus group discussions) as opposed to one-on-one interviews. CONCLUSIONS: The information gathered will serve as a starting point to further explore contributing factors for common enteric pathogens. The identified complexities would be best explored by conducting additional surveillance, as well as interviews and focus groups with a more diverse group of stakeholders. This type of qualitative study can enhance knowledge of enteric pathogen surveillance and contribute to the development of resources and initiatives to holistically address the occurrence of gastrointestinal illness.

Guía de sistematización de experiencias en promoción de la salud / Guide to systematization of experiences in health promotion

La presente publicación constituye una herramienta metodológica que facilitará a los equipos multidisciplinarios del Sector Salud, el proceso de sistematización de experiencias en Promoción de la Salud realizadas en los ámbitos regional y local, contribuyendo a la generación y gestión del conocimiento, a partir de la identificación de lecciones aprendidas y alternativas de solución brindadas a las problemáticas sanitarias. Está dirigida a tomadores de decisión y actores sociales y políticos de los diversos sectores y niveles del gobierno, vinculados al abordaje de los Determinantes Sociales de la Salud. Frente a ello, es oportuno emprender procesos de sistematización de experiencias en estas temáticas, que permitan una visión holística de la metodología, procesos, logros y dificultades, resultados y lecciones aprendidas de las intervenciones realizadas por las Direcciones de Salud, Direcciones Regionales de Salud, Gerencias Regionales de Salud y/u otras organizaciones vinculadas al abordaje intersectorial e intergubernamental de los determinantes sociales de la salud(AU)

Guía de sistematización de experiencias en promoción de la salud / Guide to systematization of experiences in health promotion

La publicación constituye una herramienta metodológica que facilitará a los equipos multidisciplinarios del Sector Salud, el proceso de sistematización de experiencias en Promoción de la Salud realizadas en los ámbitos regional y local, contribuyendo a la generación y gestión del conocimiento, a partir de la identificación de lecciones aprendidas y alternativas de solución brindadas a las problemáticas sanitarias. Está dirigida a tomadores de decisión y actores sociales y políticos de los diversos sectores y niveles del gobierno, vinculados al abordaje de los Determinantes Sociales de la Salud. Frente a ello, es oportuno emprender procesos de sistematización de experiencias en estas temáticas, que permitan una visión holística de la metodología, procesos, logros y dificultades, resultados y lecciones aprendidas de las intervenciones realizadas por las Direcciones de Salud, Direcciones Regionales de Salud, Gerencias Regionales de Salud y/u otras organizaciones vinculadas al abordaje intersectorial e intergubernamental de los determinantes sociales de la salud

Characteristics of users and implications for the use of complementary and alternative medicine in Ghanaian cancer patients undergoing radiotherapy and chemotherapy: a cross- sectional study.

BACKGROUND: There is widespread use of Complementary and Alternative Medicine (CAM) in Ghana, driven by cultural consideration and paradigm to disease causation. Whether there is concurrent use of conventional medicine and CAM in cancer patients is unknown. This study investigates the prevalence, pattern and predictors of CAM use in cancer patients. Overlapping toxicity, sources of information, and whether users inform their doctor about CAM use is examined. METHOD: Cross-sectional study using a questionnaire administered to cancer patients, who were receiving radiotherapy and or chemotherapy or had recently completed treatment at a single institution was used. RESULTS: Ninety eight patients participated in the study with a mean age of 55.5 (18-89), made up of 51% females. Married individuals formed 56% of the respondents, whilst 49% had either secondary or tertiary education. Head and neck cancer patients were 15.3%, breast (21.4%), abdomen/pelvic cancers constituted (52%).Seventy seven (78.6%) patients received radiotherapy only, 16.3% received radiation and chemotherapy and 5.3% had chemotherapy only. Ninety five patients were diagnosed of cancer within the past 24 months,73.5% were CAM users as follows; massage(66.3%), herbal(59.2%), mega vitamins(55.1%), Chinese medicine(53.1%),and prayer(42.9%). Sixty eight percent were treated with curative intent. Overlapping toxicity was reported. Majority (83.3%) of users had not informed their doctor about CAM use. On univariate analysis, female (p=0.004) and palliative patients, p=0.032 were more likely to be CAM users. Multivariate analysis identified female (p<0.01), as significant for use, whilst head and neck site was significant for non use (p<0.028). Young, married and highly educated individuals are more likely to use CAM. Friends and Media are the main sources of information on CAM. There was increase in CAM use after the diagnosis of cancer mainly for Chinese Medicine and vitamins. CONCLUSION: There is high CAM usage among Cancer patients, comparable to use in the general population, there is concurrent use of CAM and conventional medicine with reported overlapping toxicity but without informing Oncologist about use. Women and palliative patients are more likely to use CAM. Doctor patient communication on herbal-radiotherapy and drug treatment interaction needs to be strengthened. Standardization and regulation of CAM use is paramount.

Caracterización del derrame pleural en el Servicio de Medicina Interna / Characterization of pleural effusion in the Internal Medicine Department

Se realizó una investigación de carácter descriptivo transversal con el objetivo de describir los aspectos clínico-epidemiológicos del derrame pleural en pacientes atendidos en el Servicio de Medicina del Hospital Provincial Universitario Arnaldo Milián Castro durante el año 2010; el universo estuvo conformado por 62 pacientes y la muestra por 55, según muestreo por conveniencia. El análisis de la historia clínica fue la fuente fundamental de datos; se definieron las variables clínico-epidemiológicas, los antecedentes personales, los factores etiológicos y la terapéutica impuesta y se utilizaron el análisis porcentual y Chi cuadrado. Predominaron las mujeres de la raza banca, de 60-69 años, con el hábito de fumar; la disnea y el dolor en punta de costado fueron síntomas comunes; el hemitórax derecho resultó el más afectado; fueron más frecuentes los derrames pequeños; la neumonía causó mayor número de derrames; el rayo X de tórax fue el complementario más indicado al ingreso y en la sala fueron el hemograma y la glicemia y las cefalosporinas de tercera generación se prescribieron con mayor frecuencia(AU)

Estudio epidemiológico multicéntrico de las técnicas anestésicas en la cirugía de la hernia inguinal en España / Multicentre epidemiological study of anaesthetic techniques in inguinal hernia surgery in Spain

Objetivo: Recientemente se ha producido renovado interés sobre la técnica anestésica en la cirugía de la hernia inguinal y las ventajas y los inconvenientes derivados de las diferentes técnicas anestésicas. En nuestro país no hay información acerca de la la técnica anestésica en la hernioplastia. Nuestro objetivo es realizar un estudio epidemiológico sobre las técnicas anestésicas en la cirugía de la hernia inguinal. Pacientes y métodos: Estudio epidemiológico transversal, descriptivo y multicéntrico en 20 hospitales de España. Cada centro incluyó a 12 pacientes sometidos a herniorrafia y registró datos sociodemográficos, antecedentes patológicos, técnica realizada, parámetros de recuperación y complicaciones. Resultados: Se incluyó a 238 pacientes (el 91% ASA I-II), con una media de edad de 57 (25-84) años, 213 varones y 25 mujeres. El régimen de hospitalización fue: cirugía ambulatoria un 47%, corta estancia un 26% y el resto con ingreso. Se realizó anestesia subaracnoidea en un 60%, anestesia general en un 27% y anestesia local con sedación, habitualmente benzodiacepinas, en un 13% de los casos. El alta de los pacientes intervenidos en régimen de cirugía ambulatoria fue entre 1 y 6 h en el 94 y el 100% de los casos de anestesia general y anestesia local respectivamente, frente a un 68% para la anestesia subaracnoidea. No hubo diferencias en las características del dolor, náuseas y vómitos entre las técnicas anestésicas; sin embargo, hubo 10 episodios de retención urinaria, todos ellos en el grupo de anestesia subaracnoidea, en pacientes varones y con una edad media de 68 años. Conclusiones: La anestesia subaracnoidea es la más utilizada en España para la herniorrafia, y se asocia con una elevada incidencia de retención urinaria y retraso en el alta hospitalaria (> 6 h en un 32% de los casos) en comparación con la anestesia local. Esta debería ser promovida activamente en nuestro país(AU)

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Pluripatología y comorbilidad en pediatría: el niño pluripatológico / Pluripathology and comorbidity in pediatrics: the pluripathologic child

En este artículo científico se patentiza el método holístico del proceso salud-enfermedad, lo cual permite definir la tipología y naturaleza crónica o aguda de la afección, el estado clínico y el pronóstico médico-social del enfermo, en este caso del niño pluripatológico, así como establecer si su proceso morboso es de origen orgánico o si el trastorno funcional depende de condiciones o factores determinantes dañinos (biológicos, ambientales, socioeconómicos e higienosanitarios) para finalmente asumir adecuadas conductas médicas y sociales integradas(AU)

This scientific article licenses the holistic method of health-disease process, which allows to define the typology and chronic or severe nature of the disease, the clinical status and the social-clinic diagnosis of the patient, in this case of the pluripathologic child, such as to establish if his morbid process originates from organic issues or if the functional disorder depends on the conditions or damaging determinant factors (biological, environmental, socioeconomic, and hygienic factors) to finally assume proper medical socially integrated behaviour(AU)

Change and stability: use of complementary and alternative medicine in Israel: 1993, 2000 and 2007.

BACKGROUND: Complementary and alternative health care has gained increasing popularity in Western societies in recent years. The objective of the article is to explore cross-sectional variations and temporal changes in the patterns of complementary and alternative medicine (CAM) consultations in Israel in 1993, 2000 and 2007. METHODS: Interviews were conducted with 2003 respondents in 1993, 2505 in 2000, and 752 in 2007, using identical questions. The samples represented the Israeli Jewish urban population aged 45-75 in the respective years. RESULTS: The rate of use of CAM during the previous year increased from 6% in 1993, to 10% in 2000 and reached 12% in 2007. Women and highly educated persons have been significantly and consistently more likely to use CAM. Among the users, homeopathy, acupuncture and reflexology are the main types of CAM used. Lower back pain became the leading problem for which care was sought. A significant proportion of the users continue to use conventional medicine concurrently, and an increasing share was referred to CAM by their physician. Past good experience has become a major reason for CAM use. CONCLUSIONS: Between 1993 and 2007, CAM use in the Israeli urban Jewish population aged 45-75 years increased significantly. As in other countries CAM grew from an infant industry and entered the mainstream of health care. The evidence reported here highlights the urgent need for the design of health and social policies aiming to achieve more effective integration between CAM and conventional medicine.

El perfil del adicto hondureño en la comunidad terapéutica Proyecto Victoria / Addict profile in the therapeutic community Project Victoria in Honduras

El presente estudio da cumplimiento a la principal recomendación de la investigación que le antecedió, al ampliar la muestra y establecer comparaciones por quinquenios en las variables más relevantes, para lograr una valoración actualizada teniendo en cuenta los rápidos y dinámicos cambios que ocurren en los consumidores de sustancias, con vistas a realizar una caracterización del consumidor hondureño procedente de la más destacada Comunidad Terapéutica existente en la República de Honduras. Para lo cual la muestra contó con todos los pacientes egresados de un decenio (1997-2006), mediante un estudio descriptivo transversal donde se utilizaron como indicadores los descriptivos del tipo de: número absoluto y porcentaje. Dentro de los resultados más relevantes esta el aumento de la demanda por los servicios de rehabilitación, las frecuentes complicaciones como son el trastorno psiquiátrico, delictivo y el gran deterioro familiar presente en estos pacientes. El perfil del adicto egresado del Proyecto Victoria es el de un fármaco dependiente que en la mayoría de los casos inicio su consumo antes de los 15 años, consume varias sustancias, fundamentalmente alcohol, marihuana y tabaco con una tendencia creciente hacia el consumo de drogas de mayor dureza (cocaína y crack). Más de la mitad de los mismos procede de hogares desintegrados, presentan patología dual y trastornos delictivos(AU)

The main recommendation of a preceding investigation is accomplished by expanding the sample making comparisons during five years to the most important variables in order to achieve an up to date valuation of the rapid and dynamic changes that take place in the consumer of substances, thus making a characterization of the Honduran consumer from the most outstanding Therapeutic Community in the Republic of Honduras. The sample included all patients discharged within a decade (1997-2006), through a descriptive cross-sectional study in which indicators were used as descriptive of the type: absolute number and percentage. Among the most relevant results there are pointed out the increasing demand of the rehabilitation services, the frequent complications, for example psychiatric disorders, delinquency, and a high family deterioration present in these patients. The discharged addict profile from Project Victoria is that of a drug dependent who in most of the cases started their consumption before they were 15 years old, and further more they use various substances, principally alcoholic drinks, marihuana and tobacco with an increasing tendency towards the use of hardest drugs, for example cocaine and crack. More than half of these patients come from disintegrated homes and they have dual pathologies and criminal disorders(AU)

Aportes del pensamiento y las ciencias de la Complejidad al estudio de los determinantes de la salud / Contributions of the thinking and sciences of Complexity to the study of health determinants

El desarrollo de las Ciencias de la Modernidad permitió que el saber científico se erigiera como el más importante de todos los saberes, de modo que la medición y la exactitud se convirtieron en virtudes altamente apreciadas. Sin embargo, descubrimientos científicos realizados durante el siglo xix y xx arribaron a conclusiones opuestas: la incertidumbre, la borrosidad la emergencia y el caos, aparecen como expresiones de una nueva forma de pensar científico que quiebra la cadena de cinco siglos de éxitos de las Ciencias Clásicas. Se plantea la existencia de vacíos epistemológicos en la Epidemiología, especialmente relacionados con las categorías epidemiológicas de causalidad y riesgo dado que los problemas actuales de salud se globalizan cada vez más, se tornan holísticos y se determinan, no por la acción de factores de riesgo individuales, sino por la participación de lo social articulado con lo biológico como una totalidad. Se reflexiona acerca de la influencia que ha tenido el pensamiento y las teorías de la Complejidad en la Epidemiología Social Latinoamericana. Se menciona el trabajo que realizan diferentes grupos en Cuba, entre ellos, el Grupo Red de Salud y Complejidad de la Cátedra de Complejidad del Instituto de Filosofía de La Habana y el Grupo de Epidemiología de la Escuela Nacional de Salud Pública, en la búsqueda de alternativas para articular la causalidad y los determinantes desde los presupuestos del pensamiento y las teorías de la Complejidad, de forma que se expresen no sólo como metáforas teóricas, sino como tentativa real de aplicación práctica.

The development of Sciences of Modernity made possible that the scientific knowledge arose as the most important of all knowledge in such a way that measurement and exactitude became highly appreciated virtues. However, the scientific discoveries made during the xix and xx centuries reached opposing conclusions: uncertainty, blurriness, emergency and chaos appear as expressions of a new way of thinking that breaks the chain of five centuries of successes in Classical Sciences. It is stated the existence of epistemological gaps in Epidemiology, especially in relation to the epidemiological categories of causality and risk, since the current health problems are increasingly globalized, become holistic, and are determined not by the action of individual risk factors, but by the participation of the social articulated with "the biological" as a whole. It is reflected on the influence thinking and the theories of Complexity has had on the Social Latin American Epidemiology. Reference is made to the work done by different groups in Cuba, such as the Health and Complexity Network Group of the Professorship of Complexity of the Institute of Philosophy of Havana and the Epidemiology Group of the National School of Public Health in the search of alternatives to articulate causality and the determinants, starting from the assumptions of thought and the theories of Complexity, in order to express them not only as theoretical metaphors, but also as a real attempt of practical application.

Oral health policies in Brazil.

Since Oral Health policies in Brazil have been constructed according to circumstances and possibilities, they should be understood within a given context. The present analysis contextualizes several issues of the Brazilian Oral Health Policy, called "Smiling Brazil", and describes its present stage of development. Today it involves re-organizing basic oral health care by deploying Oral Health Teams within the Family Health strategy, setting up Centers of Dental Specialists within an Oral Health network as a secondary care measure, setting up Regional Laboratories of Dental Prosthesis and a more extensive fluoridation of the public water supply.

Oral health policies in Brazil

Since Oral Health policies in Brazil have been constructed according to circumstances and possibilities, they should be understood within a given context. The present analysis contextualizes several issues of the Brazilian Oral Health Policy, called "Smiling Brazil", and describes its present stage of development. Today it involves re-organizing basic oral health care by deploying Oral Health Teams within the Family Health strategy, setting up Centers of Dental Specialists within an Oral Health network as a secondary care measure, setting up Regional Laboratories of Dental Prosthesis and a more extensive fluoridation of the public water supply.