Universidad latinoamericana y el derecho social a la salud / The Latin-American University and the Social Right to Health

Este artículo se presenta en la sección de Conferencias Magistrales por ser el texto de una conferencia dictada en la IV Conferencia Internacional Educación Médica en el Siglo xxi durante la IV Convención Internacional de Salud, La Habana, octubre de 2022. Se ha mantenido su carácter de discurso oral. Se aborda el tema universidad latinoamericana y el derecho social a la salud, al considerar la relevancia de la salud en el desarrollo social y económico de la población y al tomar en cuenta la importancia de formar recursos humanos comprometidos con la salud como un derecho social, un bien público y una responsabilidad del Estado. Esto permite analizar críticamente el espacio de la salud pública y la formación de los recursos humanos en el siglo xx y el inicio del siglo xxi para aportar a la demanda de una nueva dimensión estratégica que responda, de forma comprometida, a las necesidades y prioridades de salud de nuestras poblaciones(AU)

This article is presented in the Keynote Lectures section because it is the text of a lecture given at the IV International Conference on Medical Education in the 21st Century during the IV International Health Convention, Havana, October 2022. It has been kept as an oral text. The topic on the Latin-American university and the social right to health is addressed, considering the relevance of health in the social and economic development of the population, as well as taking into account the importance of training human resources committed to health as a social right, a public good, and a responsibility of the State. This allows to analyze critically the public health space and the training of human resources in the twentieth century and the beginning of the twenty-first century, in order to contribute to the demand for a new strategic dimension that responds, in a committed manner, to the health needs and priorities of our populations(AU)

Factores socioculturales, sexuales y reproductivos asociados al no uso de métodos anticonceptivos en adolescentes mujeres / Sociocultural, sexual and reproductive factors associated with the non-use of contraceptive methods in female adolescents

Introducción: El embarazo en la adolescencia es un problema de salud pública en Perú; sin embargo, hay una cifra de adolescentes con vida sexual activa, sin protección anticonceptiva. Objetivo: Determinar los factores socioculturales, sexuales y reproductivos asociados al no uso de métodos anticonceptivos en adolescentes mujeres. Métodos: Investigación descriptiva, transversal; se aplicó un análisis de base secundaria de la Encuesta Demográfica y Salud Familiar realizada en Perú en 2019. La población estuvo conformada por 1 871 mujeres de 15 a 19 años y se excluyeron aquellas que no habían iniciado su vida sexual o con datos incompletos. Se utilizó prueba ji cuadrado de Pearson y regresión de Poisson para el análisis estadístico. Resultados: El 46,6 por ciento de adolescentes no utilizaron métodos anticonceptivos. Se asociaron al no uso de métodos anticonceptivos, factores socioculturales como edad de 15 a 17 años, nivel educativo superior, asistencia actual a institución educativa, razón para dejar de estudiar (p< 0,05); y factores sexuales y reproductivos como: no tener parejas sexuales actualmente, edad de la primera relación sexual entre 15 a 19 años, no tener hijos y no vivir con una pareja (p< 0,05). Según el análisis multivariado, tener 15 a 17 años aumenta la prevalencia de no usar métodos anticonceptivos (Rpa: 1,21 IC: 1,09-1,33). Sin embargo, tener parejas sexuales (Rpa: 0,48 IC: 0,44-0,52) e hijos (Rpa: 0,49 IC: 0,45-0,55) redujeron la prevalencia de no uso de anticonceptivos. Conclusiones: Los factores socioculturales, sexuales y reproductivos asociados al no uso de anticoncepción fueron la edad de 15 a 17 años, tener parejas sexuales e hijos(AU)

Introduction: Teenage pregnancy is a public health problem in Peru; however, there is a number of sexually active adolescents without contraceptive protection. Objective: To determine the sociocultural, sexual and reproductive factors associated with the non-use of contraceptive methods in female adolescents. Methods: Descriptive, cross-sectional research; a secondary base analysis of the Demographic and Family Health Survey carried out in Peru, 2019 was applied. The population consisted of 1871 women between the ages of 15 to 19 years and those who had not started their sexual life or with incomplete data were excluded. Pearson's ji-square test and Poisson Regression were used for statistical analysis. Results: 46,6 percent of adolescents did not use contraceptive methods. Non-use of contraceptive methods was associated with sociocultural factors such as age between 15 to 17 years, higher educational level, current attendance at an educational institution, reason for leaving school (p< 0,05); and sexual and reproductive factors such as: not currently having sexual partners, age of first sexual intercourse between 15 and 19 years, not having children and not living with a partner (p< 0,05). According to the multivariate analysis, being 15 to 17 years old increases the prevalence of not using contraceptive methods (RPa: 1,21 CI: 1,09-1,33). However, having sexual partners (RPa: 0,48 CI: 0,44-0,52). However, having sexual partners (RPa: 0,48 CI: 0,44-0,52) and children (RPa: 0,49 CI: 0,45-0,55) reduced the prevalence of non-use of contraceptives. Conclusions: The sociocultural, sexual and reproductive factors associated with the non-use of contraception were the age of 15 to 17 years, having sexual partners and children(AU)

Change in the pattern of frailty among socially vulnerable older adults over a 36-month period and associated factors: a follow-up study / Mudança do padrão de fragilidade entre idosos socialmente vulneráveis no período de 36 meses e fatores associados: um estudo de seguimento

OBJECTIVE: To investigate changes in the frailty levels of older adults in a context of high social vulnerability. METHODS: We conducted a prospective cohort study. Data were collected from 2 surveys conducted in 2015 and 2018. The frailty phenotype and sociodemographic and health characterization instruments were used. Descriptive statistical analysis was performed, including non-parametric tests, test for equality of proportions, and multivariate multinomial logistic regression. The use of the database was authorized, and the research was approved by the Ethics Committee. RESULTS: In 2015, 346 community-dwelling older adults participated in the study. After 36 months, a final sample of 223 participants was obtained. In 2015, the prevalence of non-frail, pre-frail, and frail older adults was 13.0%, 56.5%, and 30.5%, respectively. In 2018, 22.9% were non-frail, 56.0% were pre-frail, and 21.1% were frail. Higher education and better quality of life reduced the likelihood of becoming pre-frail and frail, respectively. CONCLUSION: There was a change in the pattern of frailty among socially vulnerable older adults over a 36-month period.

OBJETIVO: Verificar alterações nos níveis de fragilidade de pessoas idosas em contexto de alta vulnerabilidade social. METODOLOGIA: Trata-se de um estudo de coorte prospectivo. Foram coletados dados de dois inquéritos realizados em 2015 e 2018. Utilizou-se o Fenótipo de Fragilidade e instrumentos de caracterização sociodemográfica e de saúde. Análises estatísticas descritivas foram realizadas, incluindo testes não-paramétricos, teste de igualdade de proporções e regressão logística multinomial multivariada. O uso do banco de dados foi autorizado, e a pesquisa foi aprovada pelo Comitê de Ética. RESULTADOS: Em 2015, 346 idosos comunitários participaram do estudo. Após o período de 36 meses, obteve-se uma amostra final de 223 participantes. Em 2015, a prevalência de não frágeis, pré-frágeis e frágeis foi de 13,0, 56,5 e 30,5%, respectivamente. Em 2018, 22,9% eram não frágeis, 56,0% pré-frágeis e 21,1% frágeis. Maior escolaridade e qualidade de vida diminuíram a probabilidade de se tornar pré-frágil e frágil, respectivamente. CONCLUSÃO: Observou-se uma mudança do padrão de fragilidade entre idosos socialmente vulneráveis no período de 36 meses.

Fatores sociodemográficos e via de parto: revisão sistemática / Sociodemographic factors and type of delivery: systematic review / Factores sociodemográficos y tipo de parto: revisión sistemática

Objetivo: identificar os fatores sociodemográficos associados à via de parto. Método: trata-se de revisão sistemática com busca nas bases de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde, PubMed e Cochrane em maio de 2021. O protocolo do estudo foi registrado na PROSPERO sob o nº CRD42021257340. Os artigos selecionados foram posteriormente analisados pelos sistemas Joanna Briggs Institute e Sistema Grading of Recommendations Assessment, Development and Evaluation. Resultados: mulheres com maior nível socioeconômico, maior nível de escolaridade, com idade acima de 35 anos e parto em instituições privadas possuem maior chance de realizar cesariana comparado ao parto vaginal. A qualidade da evidência para variável de prestador hospitalar foi baixa, para idade e escolaridade materna a qualidade é moderada e classe econômica a qualidade é alta. Conclusões: os fatores sociodemográficos contribuem para o aumento da taxa de cesárea e reforçam o cenário encontrado na literatura.

Objective: to identify the sociodemographic factors associated with the mode of delivery. Method: this is a systematic review with a search in the Latin American and Caribbean Literature on Health Sciences, PubMed and Cochrane databases in May 2021. The study protocol was registered with PROSPERO under number CRD42021257340. The selected articles were analyzed by the Joanna Briggs Institute and the Grading System of Recommendations Assessment, Development and Evaluation systems. Results:women with a higher socioeconomic level, higher education, aged over 35 years and private institutions have a greater chance of having a cesarean section compared to the vaginal level. The quality of quality of quality for the service provider variable was low and the quality of maternal schooling is low and the quality of economic class is high. Conclusion: Sociodemographic conclusions in the literature.

Objetivo: identificar los factores sociodemográficos asociados a la modalidad de parto. Método: se trata de una revisión sistemática con búsqueda en las bases de datos Literatura Latinoamericana y del Caribe en Ciencias de la Salud, PubMed y Cochrane en mayo de 2021. El protocolo de estudio fue registrado en PROSPERO con el número CRD42021257340. Los artículos seleccionados fueron analizados por el Instituto Joanna Briggs y los sistemas Grading System of Recommendations Assessment, Development and Evaluation. Resultados: las mujeres con mayor nivel socioeconómico, educación superior, mayores de 35 años e instituciones privadas tienen mayor probabilidad de tener una cesárea en comparación con el nivel vaginal. La calidad de calidad de calidad para la variable proveedor de servicios fue baja y la calidad de escolaridad materna es baja y la calidad de clase económica es alta.

Trend of social iniquities in reports of sexual violence in Brazil between 2010 and 2014. / Tendência das iniquidades sociais nas notificações de violência sexual no Brasil entre 2010 e 2014.

INTRODUCTION: Sexual violence has emerged in the health field with changes in the epidemiological profiles of populations. METHODOLOGY: An ecological study with 5,565 Brazilian municipalities between 2010 and 2014. A descriptive analysis of the variables (Population rate of sexual violence reporting, household income per capita and HDI) and their stratification by quintile was performed. In order to explore the factors associated with changes in social inequalities regarding the rate of reporting of sexual violence, the Slope Index of Inequality and Relative Index of Inequality were adopted. An Equiplot was constructed for the outcome on each independent variable. RESULTS: The mean rate of reports of sexual violence in Brazil was 4.38 reports/100,000 inhabitants for the period. There was an increase in the rate of sexual violence and improvement in socioeconomic conditions. There was a higher rate of reporting in the quintile with better living conditions. An increase in the inequality of the rate of sexual violence as a function of household income and the HDI was observed. Several factors seem to influence the increase of reports of sexual violence in the country, among them the improvement in the living conditions of the population and greater moral sensitivity to violence. However, there is still a disparity in reporting among municipalities according to their socioeconomic status. CONCLUSION: The lack of public policies on social equity in health has interfered with reports of sexual violence in the country and has widened health inequities.

Tendencia del bajo peso al nacer en recién nacidos a término y su relación con la pobreza y el desarrollo municipal en Colombia. 2000-2014 / Tendency of low birth weight in full-term newborns and its relationship with poverty and municipal development in Colombia. 2000-2014

El objetivo del estudio fue describir las prevalencias de bajo peso al nacer a término y las desigualdades socio-geográficas entre los municipios y regiones de Colombia. Se realizó un estudio ecológico longitudinal a partir de los registros de estadísticas vitales del Departamento Administrativo Nacional de Estadística (DANE) de 1096 municipios de Colombia entre los años 2000 y 2014. La población de estudio fueron 7.514.492 nacidos vivos a término, de partos de único feto de madres entre 15 a 45 años. Se ajustó un modelo jerárquico bayesiano para la estimación de riesgos relativos suavizados y sus intervalos de credibilidad (95%). Como resultados se encontró que la prevalencia de bajo peso al nacer en Colombia fue de 2,28 (2,26-2,29), con una tendencia a la reducción pasando de 2,80 en el 2000 a 1.79 en el 2014. Se observaron desigualdades territoriales, en donde los municipios más pobres y menos desarrollados mostraron mayores riesgos de bajo peso al nacer a término, tendencia que se mantuvo a lo largo del periodo analizado. En conclusión, existe una tendencia a la disminución de bajo peso al nacer a término en Colombia, para cada una de sus regiones y un gradiente social negativo.

The objective of the study was to describe the prevalence of term low birth weight and the relationship with sociogeographical inequalities between the municipalities and regions of Colombia. A longitudinal ecological study was carried out based on the vital statistics records of the National Administrative Department of Statistics (DANE) of 1096 Colombian municipalities between 2000 and 2014. The study population was 7,514,492 live births at term, from deliveries to mothers between 15 and 45 years old. A Bayesian hierarchical model was adjusted for the estimation of smoothed relative risks and their credibility intervals (95%). The prevalence of term low birth weight in Colombia was 2.28 (2.26-2.29), with a tendency to decrease from 2.80 in 2000 to 1.79 in 2014. Territorial inequalities were observed, where poorer and less developed municipalities showed greater risks of term low birth weight, a trend that was maintained throughout the period analyzed. In conclusion, term low birth weight is decreasing in Colombia overall and in each of its regions, with a negative social gradient.

Tendência das iniquidades sociais nas notificações de violência sexual no Brasil entre 2010 e 2014 / Trend of social iniquities in reports of sexual violence in Brazil between 2010 and 2014

RESUMO: Introdução: A violência sexual tem despontado no cenário da saúde com as mudanças nos perfis epidemiológicos das populações. Metodologia: Estudo ecológico com 5.565 municípios brasileiros entre 2010 e 2014. Realizou-se análise descritiva das variáveis (taxa populacional de notificação de violência sexual, renda domiciliar per capita e índice de desenvolvimento humano - IDH) e suas estratificações por quintil. Para explorar os fatores associados às mudanças nas desigualdades sociais na taxa de notificação de violência sexual, foram adotados o coeficiente angular de desigualdade e o índice relativo de desigualdade. Construiu-se equiplot para o desfecho em cada variável independente. Resultados: A taxa média de notificações de violência sexual no Brasil foi de 4,38 notificações/100 mil habitantes para o período. Houve incremento na taxa de violência e melhoria nas condições socioeconômicas. Observou-se maior taxa de notificações no quintil com melhores condições de vida, bem como aumento na desigualdade da taxa de notificações de violência sexual em função da renda domiciliar e do IDH. Diversos fatores parecem influenciar o aumento das notificações de violência sexual no país. Entre eles, destacam-se a melhoria nas condições de vida da população e a maior sensibilidade moral à violência, contudo ainda há disparidade de notificações entre os municípios de acordo com sua condição socioeconômica. Conclusão: A falta de políticas públicas de equidade social em saúde tem interferido nas notificações de violência sexual no país e ampliado as iniquidades em saúde.

ABSTRACT: Introduction: Sexual violence has emerged in the health field with changes in the epidemiological profiles of populations. Methodology: An ecological study with 5,565 Brazilian municipalities between 2010 and 2014. A descriptive analysis of the variables (Population rate of sexual violence reporting, household income per capita and HDI) and their stratification by quintile was performed. In order to explore the factors associated with changes in social inequalities regarding the rate of reporting of sexual violence, the Slope Index of Inequality and Relative Index of Inequality were adopted. An Equiplot was constructed for the outcome on each independent variable. Results: The mean rate of reports of sexual violence in Brazil was 4.38 reports/100,000 inhabitants for the period. There was an increase in the rate of sexual violence and improvement in socioeconomic conditions. There was a higher rate of reporting in the quintile with better living conditions. An increase in the inequality of the rate of sexual violence as a function of household income and the HDI was observed. Several factors seem to influence the increase of reports of sexual violence in the country, among them the improvement in the living conditions of the population and greater moral sensitivity to violence. However, there is still a disparity in reporting among municipalities according to their socioeconomic status. Conclusion: The lack of public policies on social equity in health has interfered with reports of sexual violence in the country and has widened health inequities.

Determinantes sociales del consumo de alcohol en adolescentes del Colegio Daniel Córdova de Cuenca: estudio transversal, 2016 / Social determinants of alcohol consumption in adolescents from Daniel Cordova High School in Cuenca: cross sectional study, 2016

Introduction: the alcohol consumption in adolescence is frequent and it is associated with social determinants. The objective of the study was to determine the prevalence of alcohol consumption in adolescents of the Daniel Córdova High School in Cuenca - Ecuador and its association with some social determinants.Methods: it is a cross-sectional study, with a sample of 218 adolescents. A questionnaire for demo-graphic variables, family structure and migration was used to determine the prevalence of alcohol consumption, the diagnostic criteria of the DSM5 was used to identify the family functioning of the FF-SIL Test and for the lifestyle the FANTASTIC test was applied. The PR was obtained with its confidence intervals to control if the social determinants were a risk or protection factor for the alcohol consumption, and the statistical significance was determined with values of p <0.05.Results: the prevalence of alcohol consumption was 42.2%; a total of 56% of the students come from a "nuclear home", the 55% have a migrant relative, 39% have a good lifestyle and 50% be-long to families qualified as moderately functional. There is a statistically significant association with the fact of having a migrant family member, having a bad lifestyle and belonging to a reconstituted and dysfunctional family.Conclusion: the prevalence of alcohol consumption is higher than those reported in other studies carried out in Cuenca city high schools; It is associated with similar social determinants globally.(AU).

Introducción: el consumo de alcohol en la adolescencia es frecuente y se encuentra asociado a determinantes sociales. El objetivo de nuestro estudio fue determinar la prevalencia de consumo de alcohol en los adoles-centes del colegio "Daniel Córdova" de Cuenca ­ Ecuador y su asociación con algunos determinantes sociales.Métodos: estudio transversal, en una muestra de 218 adolescentes. Se usó un cuestionario para las variables demográficas, estructura familiar y migración; para determinar la prevalencia de consumo de alcohol se usó los criterios diagnósticos del DSM5, para identificar el funcionamiento fa-miliar el Test FF-SIL y para el estilo de vida el test FANTASTIC. Se obtuvo la RP con sus intervalos de confianza para determinar si los determinantes sociales fueron factor de riesgo o de protección para el consumo de alcohol y la significancia estadística se determinó con valores de p<0.05. Resultados: la prevalencia del consumo de alcohol fue del 42.2 %; el 56% de los estudiantes provienen de un "hogar nuclear", el 55% tienen algún fa-miliar migrante, el 39% tienen un buen estilo de vida y el 50% pertenecen a familias calificadas como moderadamente funcionales y existe asociación estadísticamente significativa con el hecho de tener un familiar migrante, poseer un mal estilo de vida y pertenecer a una familia reconstituida y disfuncional. Conclusión: la prevalencia del consumo de alcohol es mayor que los re-portados en otros estudios realizados en colegios de la ciudad de Cuenca y se asocia con determinantes sociales similares a nivel global.(AU).

Social determinants of health and vulnerabilities to sexually transmitted infections in adolescents / Determinantes sociales de la salud y vulnerabilidades a las infecciones sexualmente transmisibles en adolescentes / Determinantes sociais de saúde e vulnerabilidades às infecções sexualmente transmissíveis em adolescentes

ABSTRACT Objective: To verify the association between social determinants of health and the vulnerability of adolescents to Sexually Transmitted Infections (STIs). Method: Cross-sectional study, performed with 287 students aged 11 to 17 years, in the outskirts of Fortaleza, Ceará, Brazil, from August do September 2016. Two instruments were used, one destined to social determinants of health and another to investigating the vulnerability to STIs. The magnitude of associations was expressed through odds ratio and interval of confidence, considering a 5% significance level. This research was approved by the Research Ethics Committee of the Federal University of Ceará. Results: 212 (73.9%) adolescents were considered more vulnerable, with a score ≥ 4. The intermediate social determinant "housing (home ownership)" obtained significant association with with the vulnerability to STIs (p of 0.022; CI 1.1 to 3.3; OR 1.9). Conclusion: The intermediate social determinant "type of housing" influences the vulnerability to STAs.

RESUMEN Objetivo: Comprobar si hay una asociación entre los determinantes sociales de la salud y la vulnerabilidad de los adolescentes a las Infecciones Sexualmente Transmisibles (IST). Método: Estudio transversal, realizado de agosto a septiembre de 2016 con 287 estudiantes de 11 a 17 años, en la periferia de Fortaleza, Ceará, Brasil. Se utilizaron dos instrumentos: el primer estaba destinado a los determinantes sociales de la salud y segundo al estudio de la vulnerabilidad a las IST. La magnitud de las asociaciones se calculó mediante la razón de posibilidades e intervalo de confianza, considerando el nivel de significancia del 5%. La investigación fue aprobada por el Comité de Ética de la Universidad Federal de Ceará. Resultados: Se consideraron más vulnerables a 212 (un 73,9%) adolescentes, con una calificación ≥ 4 puntuaciones. El determinante social intermedio "vivienda (casa propia)" obtuvo una asociación significativa con la vulnerabilidad a las IST (p de 0,022; IC 1,1 a 3,3; OR 1,9). Conclusión: El determinante social intermedio "tipo de vivienda" influye en la vulnerabilidad a las IST.

RESUMO Objetivo: Verificar a associação entre os determinantes sociais de saúde e a vulnerabilidade dos adolescentes às Infecções Sexualmente Transmissíveis (ISTs). Método: Estudo transversal, realizado com 287 escolares de 11 a 17 anos, na periferia de Fortaleza, Ceará, Brasil, de agosto a setembro de 2016. Foram utilizados dois instrumentos, um destinado aos determinantes sociais de saúde e o outro à investigação da vulnerabilidade às ISTs. A magnitude das associações foi expressa através da razão de chances e intervalo de confiança, considerando-se nível de significância de 5%. A pesquisa foi aprovada pelo Comitê de Ética da Universidade Federal do Ceará. Resultados: 212 (73,9%) adolescentes foram considerados mais vulneráveis, com uma pontuação ≥ 4 escores. O determinante social intermediário "moradia (casa própria)" obteve associação significativa com a vulnerabilidade às ISTs (p de 0,022; IC 1,1 a 3,3; OR 1,9). Conclusão: O determinante social intermediário "tipo de moradia" influencia na vulnerabilidade às ISTs.

Evolución del embarazo en adolescentes y distribución de sus determinantes en la ciudad de Córdoba, Argentina, periodo 2015-2018 / Teenage pregnancy evolution and distribution of its determinants in the city of Córdoba, Argentina, 2015-2018 period

Este trabajo describe la tendencia del embarazo en adolescentes según determinantes sociales individuales y contextuales en la ciudad de Córdoba, Argentina, para el periodo 2015 a 2018. Se diseñó un estudio descriptivo bietapico. Inició con un estudio ecológico de grupos múltiples, considerando 99 áreas programáticas sanitarias de la ciudad. Luego uno observacional, incluyendo 6171 mujeres menores de 20 años que tuvieron hijos/as durante 2015-2018. Se observó una tendencia decreciente en la proporción de embarazos en adolescentes: 11,52% (2015) a 8,19% (2018), y de la Tasa de Fecundidad Adolescente (TEFA): 46,3‰ (2015) a 28,2‰ (2018). La TEFA resultó mayor en áreas con hogares con NBI superior a la mediana (p<0,05), siendo su geolocalización concentrada mayormente en las periferias de la ciudad. Fue superior la proporción de madres adolescentes sin cobertura de seguro de salud que con cobertura (p<0,05). La proporción de embarazos de adolescentes entre 18 y 19 años fue superior entre quienes presentaban secundario incompleto o menos (p<0,05). La sostenida reducción del embarazo en adolescentes, aquí objetivada, no debiera traducirse en una desatención a esta problemática, sino por el contrario profundizarse las acciones tendientes a sostener esta tendencia, atendiendo especialmente a grupos de mayor vulnerabilidad social (AU)

This paper describes the trend of teenage pregnancy according to individual and contextual social determinants in the city of Córdoba, Argentina, for the period 2015-2018. A descriptive sequential two-stage study was carried out. First, an ecological study of multiple groups, including the 99 'programmatic health areas´ of the city was developed. Then, an observational study including 6171 women under 20 years who had children between 2015-2018. A decreasing trend in the proportion of teenage pregnancies was observed: 11.52% (2015) to 8.19% (2018), and in the Adolescent Fertility Rate (TEFA): 46.3‰ (2015) to 28,2‰ (2018). TEFA was greater in areas with higher proportion of households with unsatisfied basic needs (NBI) (p <0.05), and these areas were mostly located at the city peripheries. The proportion of teenage mothers was higher among those with health coverage (p <0.05). The proportion of mothers of 18 and 19 years was higher among those who has incomplete secondary educational level or less or less (p <0.05). The sustained reduction of pregnancy in adolescents should not translate into a neglect of this problem, but instead into a deepen of the actions tending to sustain this trend, focusing special attention in groups of greater social vulnerability (AU)

Social determinants of health and vulnerabilities to sexually transmitted infections in adolescents.

OBJECTIVE: To verify the association between social determinants of health and the vulnerability of adolescents to Sexually Transmitted Infections (STIs). METHOD: Cross-sectional study, performed with 287 students aged 11 to 17 years, in the outskirts of Fortaleza, Ceará, Brazil, from August do September 2016. Two instruments were used, one destined to social determinants of health and another to investigating the vulnerability to STIs. The magnitude of associations was expressed through odds ratio and interval of confidence, considering a 5% significance level. This research was approved by the Research Ethics Committee of the Federal University of Ceará. RESULTS: 212 (73.9%) adolescents were considered more vulnerable, with a score ≥ 4. The intermediate social determinant "housing (home ownership)" obtained significant association with with the vulnerability to STIs (p of 0.022; CI 1.1 to 3.3; OR 1.9). CONCLUSION: The intermediate social determinant "type of housing" influences the vulnerability to STAs.

Determinantes sociales y de salud protectores en el ámbito universitario / Health and social determinant protectors in the university environment

Se comenta acerca de los determinantes sociales y sanitarios protectores en las instituciones de educación superior de Latinoamérica, así como también de los factores de riesgo en ese entorno, a la vez que se mencionan algunas experiencias relacionadas con las universidades promotoras de la salud en América Latina y el Caribe, donde representan un gran desafío en el contexto histórico actual.

It is a comment on health and social determinants protectors in the higher education institutions from Latin America; as well as on the risk factors in this environment, at the same time, some experiences are mentioned in relation to health promoter universities in Latin America and the Caribbean, which represent a great challenge in the present historical context.

A Window of Opportunity: Visions and Strategies for Behavioral Health Policy Innovation.

Objective: The New York City's Thrive (ThriveNYC) and the Los Angeles County Health Neighborhood Initiative (HNI) are two local policies focused on addressing the social determinants of behavioral health as a preventive strategy for improving health service delivery. On January 29, 2016, leaders from both initiatives came together with a range of federal agencies in health care, public health, and policy research at the RAND Corporation in Arlington, Virginia. The goal of this advisory meeting was to share lessons learned, consider research and evaluation strategies, and create a dialogue between stakeholders and federal funders - all with the purpose to build momentum for policy innovation in behavioral health equity. Methods: This article analyzes ethnographic notes taken during the meeting and in-depth interviews of 14 meeting participants through Kingdon's multiple streams theory of policy change. Results: Results demonstrated that stakeholders shared a vision for behavioral health policy innovation focused on community engagement and social determinants of health. In addition, Kingdon's model highlighted that the problem, policy and politics streams needed to form a window of opportunity for policy change were coupled, enabling the possibility for behavioral health policy innovation. Conclusions: The advisory meeting suggested that local policy makers, academics, and community members, together with federal agents, are working to implement behavioral health policy innovation.

Social support of people with HIV/AIDS: the Social Determinants of Health Model.

OBJECTIVE: To analyze the social support of people with HIV/AIDS from the perspective of the Social Determinants of Health Model. METHOD: This was a cross-sectional study conducted in 2015 in an infectious disease outpatient clinic. The sample was made up of 116 people with HIV/AIDS. The data was collected through interviews, using a sociodemographic form and a social support scale. The data was analyzed using descriptive statistics, and Student's t-tests and Mann-Whitney tests were performed to determine the association between social support and the social determinants of health. RESULTS: Total social support was satisfactory, emotional support was influenced by smoking (p=0.0432) and instrumental support, by the number of people in the household (p=0.0003). The main source of instrumental and emotional support was relatives living outside the household, corresponding to 66.7% and 56.1%, respectively. CONCLUSION: It was found that smokers havelower emotional support and people living alone received less instrumental support.

Social support of people with HIV/AIDS: the Social Determinants of Health Model / Soporte social de personas con VIH/SIDA: Modelo de la Determinación Social de la Salud / Suporte social de pessoas com HIV/Aids: Modelo da Determinação Social da Saúde

ABSTRACT Objective: To analyze the social support of people with HIV/AIDS from the perspective of the Social Determinants of Health Model. Method: This was a cross-sectional study conducted in 2015 in an infectious disease outpatient clinic. The sample was made up of 116 people with HIV/AIDS. The data was collected through interviews, using a sociodemographic form and a social support scale. The data was analyzed using descriptive statistics, and Student's t-tests and Mann-Whitney tests were performed to determine the association between social support and the social determinants of health. Results: Total social support was satisfactory, emotional support was influenced by smoking (p=0.0432) and instrumental support, by the number of people in the household (p=0.0003). The main source of instrumental and emotional support was relatives living outside the household, corresponding to 66.7% and 56.1%, respectively. Conclusion: It was found that smokers havelower emotional support and people living alone received less instrumental support.

RESUMEN Objetivo: Analizar el soporte social de personas con VIH/SIDA en la perspectiva del Modelo de la Determinación Social de la Salud. Método: Estudio transversal realizado en 2015 en un servicio de Infectología. Muestra integrada por 116 personas con VIH/SIDA. Datos recolectados mediante entrevista, utilizándose formulario sociodemográfico y escala de soporte social. Los datos se analizaron por estadística descriptiva. Se realizaron los tests T de Student y Mann-Whitney para verificar la asociación entre el soporte social y los determinantes sociales de salud. Resultados: El soporte social total fue satisfactorio, el soporte emocional resultó influido por consumo de tabaco (p=0,0432), y el instrumental, por cantidad de personas en el domicilio (p=0,0003). La principal fuente de apoyo del soporte instrumental y emocional fueron los familiares externos al ámbito doméstico, representando 66,7% y 56,1%, respectivamente. Conclusión: Se evidenció que los fumadores presentan menor soporte emocional, y aquellos que viven solos reciben menor soporte instrumental.

RESUMO Objetivo: analisar o suporte social de pessoas com HIV/Aids, na perspectiva do Modelo da Determinação Social da Saúde. Método: estudo transversal, realizado em 2015, em um ambulatório de infectologia. A amostra constituiu-se de 116 pessoas com HIV/Aids. A coleta de dados ocorreu mediante entrevista, utilizando-se o formulário sociodemográfico e a escala de suporte social. Os dados foram analisados por estatística descritiva, e realizaram-se os Testes T de Student e Mann-Whitney para verificar a associação entre o suporte social e os determinantes sociais de saúde. Resultados: o suporte social total foi satisfatório, o suporte emocional foi influenciado pelo uso de tabaco (p=0,0432) e o instrumental, pelo número de pessoas no domicílio (p=0,0003). A principal fonte de apoio do suporte instrumental e emocional foram os familiares externos ao ambiente doméstico representando 66,7% e 56,1%, respectivamente. Conclusão: evidenciou-se que fumantes apresentam menor suporte emocional e que pessoas que residem sozinhas recebem menor suporte instrumental.

Determinantes sociales y mortalidad por cáncer en Comunas de la Ciudad de Buenos Aires: Quinquenio 2011-2015 / Social determinants and cancer mortality in Communes of the City of Buenos Aires: 2011-2015 Period

En la actualidad, las enfermedades crónicas no transmisibles (ECNT) constituyen la principal causa de mortalidad mundial. Las enfermedades crónicas se caracterizan por su larga duración, progresividad y curación no previsible, pudiendo requerir tratamiento y control durante una extensa e indeterminada cantidad de años. El cáncer forma parte del grupo de las enfermedades crónicas no transmisibles (ECNT), junto con las enfermedades cardiovasculares, respiratorias crónicas y diabetes. Estas enfermedades, se encuentran entre los problemas más comunes y más costosos para la salud pública de la población. En Argentina y en la Ciudad Autónoma de Buenos Aires, el cáncer constituye la segunda causa de muerte, después de las enfermedades del sistema circulatorio. Existe amplia evidencia de la relación existente entre las condiciones en que la gente nace, vive, se educa, trabaja y envejece con la situación de salud de las poblaciones.Estas condiciones se relacionan con aspectos sociales, económicos, políticos, culturales y medioambientales, llamados en conjunto "Determinantes sociales de la Salud".Adoptando como base conceptual este modelo de Determinantes Sociales de la Salud, se realizó el presente estudio, con el propósito de describir la forma en que se distribuye la mortalidad por cáncer entre las comunas de la Ciudad de Buenos Aires y conocer las potenciales disparidades entre dichas jurisdicciones, según las características socioeconómicas de las mismas. (AU) .

Social representations of older adults regarding quality of life.

Objective: to identify the social representations of older adults regarding quality of life, and to analyze the care practices adopted to promote it. Method: qualitative, exploratory, descriptive research, applying the Theory of Social Representations. Thirty older people from a Health Academy of Rio de Janeiro participated in the study. The software Alceste was used, and lexical analysis of data was performed. Results: social representations of quality of life are based on the social determinants of health; they evidence knowledge and practices of care by valuing physical activities. The practices promoting quality of life comprise healthy eating habits, daily physical exercise, social participation, interaction and socialization, accomplishment of leisure activities and daily tasks with independence and autonomy, and support and family contact. Final considerations: the elderly have a global understanding of the concept of quality of life, coordinate knowledge built in daily life and knowledge coming from the technical-professional field, which evidences the multidimensionality of the concept.

Objetivo: identificar as representações sociais de idosos sobre qualidade de vida e analisar as práticas de cuidado por eles adotadas para promovê-la. Método: pesquisa qualitativa, exploratória, descritiva, com aplicação da Teoria das Representações Sociais. Participaram 30 idosos de uma Academia Carioca de Saúde. Utilizou-se o software Alceste e realizou-se análise lexical dos dados. Resultados: As representações sociais de qualidade de vida sustentam-se nos determinantes sociais de saúde, evidenciam saberes e práticas de cuidado, com valorização de atividades físicas. As práticas promotoras de qualidade de vida congregam hábitos alimentares saudáveis, exercícios físicos diários, participação social, convívio e interação, realização de atividades de lazer e tarefas cotidianas com independência e autonomia, apoio e contato familiar. Considerações finais: Os idosos têm uma compreensão global do conceito de qualidade de vida, articulam saberes construídos no cotidiano e advindos do campo técnico-profissional, o que evidencia a multidimensionalidade do conceito.

Social representations of older adults regarding quality of life / Representaciones sociales de ancianos sobre calidad de vida / Representações sociais de idosos sobre qualidade de vida

ABSTRACT Objective: to identify the social representations of older adults regarding quality of life, and to analyze the care practices adopted to promote it. Method: qualitative, exploratory, descriptive research, applying the Theory of Social Representations. Thirty older people from a Health Academy of Rio de Janeiro participated in the study. The software Alceste was used, and lexical analysis of data was performed. Results: social representations of quality of life are based on the social determinants of health; they evidence knowledge and practices of care by valuing physical activities. The practices promoting quality of life comprise healthy eating habits, daily physical exercise, social participation, interaction and socialization, accomplishment of leisure activities and daily tasks with independence and autonomy, and support and family contact. Final considerations: the elderly have a global understanding of the concept of quality of life, coordinate knowledge built in daily life and knowledge coming from the technical-professional field, which evidences the multidimensionality of the concept.

RESUMEN Objetivo: identificar las representaciones sociales de ancianos sobre calidad de vida y analizar las prácticas de cuidado por ellos adoptadas para promoverlas. Método: investigación cualitativa, exploratoria, descriptiva, con aplicación de Teoría de las Representaciones Sociales. Participaron 30 ancianos de una Academia Carioca de Salud. Se utilizó software Alceste y se efectuó análisis lexical de datos. Resultados: las representaciones sociales de calidad de vida se sustentan en los determinantes sociales de salud, evidencian saberes y prácticas de cuidado, valorizando la actividad física. Las prácticas promotoras de calidad de vida incluyen hábitos alimentarios saludables, ejercitación física diaria, participación social, convivencia e interacción, realización de actividades recreativas y tareas cotidianas con independencia y autonomía; apoyo y contacto familiar. Consideraciones finales: los ancianos poseen una compresión global del concepto de calidad de vida, articulan saberes construidos en el día a día, devenidos del área técnico-profesional, evidenciando la multidimensionalidad del concepto.

RESUMO Objetivo: identificar as representações sociais de idosos sobre qualidade de vida e analisar as práticas de cuidado por eles adotadas para promovê-la. Método: pesquisa qualitativa, exploratória, descritiva, com aplicação da Teoria das Representações Sociais. Participaram 30 idosos de uma Academia Carioca de Saúde. Utilizou-se o software Alceste e realizou-se análise lexical dos dados. Resultados: As representações sociais de qualidade de vida sustentam-se nos determinantes sociais de saúde, evidenciam saberes e práticas de cuidado, com valorização de atividades físicas. As práticas promotoras de qualidade de vida congregam hábitos alimentares saudáveis, exercícios físicos diários, participação social, convívio e interação, realização de atividades de lazer e tarefas cotidianas com independência e autonomia, apoio e contato familiar. Considerações finais: Os idosos têm uma compreensão global do conceito de qualidade de vida, articulam saberes construídos no cotidiano e advindos do campo técnico-profissional, o que evidencia a multidimensionalidade do conceito.