Efecto del programa SERUMS en la equidad de la distribución de recursos humanos del primer nivel de atención en Perú

Introducción. La adecuada dotación y distribución con equidad de recursos humanos son fundamentales para el desempeño del sistema de salud, especialmente en el primer nivel de atención. El Programa Servicio Rural y Urbano Marginal (SERUMS) es la principal estrategia desarrollada por el Estado peruano para este fin. Objetivo. Describir el efecto de la dotación de médicos, enfermeros y obstetras del Programa SERUMS en la equidad de la distribución de recursos humanos en el primer nivel de atención. Métodos. Estudio observacional, descriptivo y transversal, de carácter censal con base en el Registro Nacional de Personal de Salud - INFORHUS, agosto 2019. Se aplicó indicadores de dotación, se verificó si existe diferencia entre la distribución porcentual de profesionales SERUMS y no SERUMS, se calculó la densidad (profesionales/10 000 hab. a nivel departamental, quintil de pobreza y ruralidad) y coeficientes de Gini (departamental). Resultados. La población estuvo constituida por 6037 profesionales SERUMS y 27 495 no SERUMS. El Programa SERUMS incrementó de manera importante la dotación y densidad de profesionales en casi todas las regiones del país. En 5 regiones los profesionales SERUMS representaron más del 50% de la dotación. Incrementos importantes se encontraron en el análisis por quintil de pobreza y en el ámbito rural, especialmente en la dotación de médicos. El programa SERUMS evidenció una mayor desigualdad en su distribución, según los coeficientes de Gini, a favor de las poblaciones más vulnerables. Conclusiones. El Programa SERUMS incrementa de manera importante la dotación y densidad de profesionales, especialmente en los distritos más pobres del Perú.

Introduction. The adequate allocation and equitable distribution of human resources are essential for the health system›s performance, especially at the first level of care. The Rural and Urban Marginal Service Program (SERUMS) is the primary strategy developed by the Peruvian State for this purpose. Objective. To describe the effect of the number of doctors, nurses, and midwives of the SERUMS Program on the equity of the distribution of human resources at the primary care level. Methods. Observational, descriptive, and cross-sectional study of a census nature based on the National Registry of Health Personnel - INFORHUS, August 2019. Staffing indicators were applied, it was verified if there is a difference between the percentage distribution of SERUMS and non-SERUMS professionals, density (professionals per 10 000 inhabitants at the departmental level, poverty quintile, and rurality), and Gini coefficients (departmental) were calculated. Results. The population consisted of 6037 SERUMS professionals and 27 495 non-SERUMS professionals. The SERUMS Program significantly increased the number and density of professionals in almost all departments. In 5 regions, SERUMS professionals represented more than 50% of the workforce. Significant increases in the number of doctors were found in the poverty quintile and rural areas analysis. According to the Gini coefficients, the SERUMS program showed greater inequality in its distribution in favor of the most vulnerable populations. Conclusions. The SERUMS Program significantly increases the number and density of healthcare professionals, especially in the poorest districts of Peru.

Glycine Receptor Inhibition Differentially Affect Selected Neuronal Populations of the Developing Embryonic Cortex, as Evidenced by the Analysis of Spontaneous Calcium Oscillations.

The embryonic developing cerebral cortex is characterized by the presence of distinctive cell types such as progenitor pools, immature projection neurons and interneurons. Each of these cell types is diverse on itself, but they all take part of the developmental process responding to intrinsic and extrinsic cues that can affect their calcium oscillations. Importantly, calcium activity is crucial for controlling cellular events linked to cell cycle progression, cell fate determination, specification, cell positioning, morphological development and maturation. Therefore, in this work we measured calcium activity in control conditions and in response to neurotransmitter inhibition. Different data analysis methods were applied over the experimental measurements including statistical methods entropy and fractal calculations, and spectral and principal component analyses. We found that developing projection neurons are differentially affected by classic inhibitory neurotransmission as a cell type and at different places compared to migrating interneurons, which are also heterogeneous in their response to neurotransmitter inhibition. This reveals important insights into the developmental role of neurotransmitters and calcium oscillations in the forming brain cortex. Moreover, we present an improved analysis proposing a Gini coefficient-based inequality distribution and principal component analysis as mathematical tools for understanding the earliest patterns of brain activity.

Livelihood capitals on income inequality among rural households: evidence from China / Efeito das capitais de subsistência na desigualdade de renda entre as famílias rurais: evidências da China

We used the data of the China Labor-force Dynamics Survey 2014 to examine the effects of livelihood capitals which include natural, material, human, financial, and social capitals on total household income, per capita income, agricultural income, wage income, operational income, and property income inequality among rural households in China. Results showed that different kinds of livelihood capitals have different effects on different types of rural households income. Specifically; (1) although, the area of cultivated land reduces agricultural income inequality, it increases per capita income inequality. (2) Forest land area enlarges per capita income inequality and total household income inequality. (3) Tractor variable reduces inequality in agricultural income and total household income. (4) While reducing the property income inequality, education variable enlarges the wage income inequality, the per capita income inequality and the total household income inequality. (5) Book variable reduces property income inequality. (6) Loan variable increases inequality in agricultural incomes. (7) Party variable reduces the agricultural income inequality. (8) Although, the internet variable increases agricultural income inequality, and property income inequality, it reduces wage income inequality, operational income inequality, per capita income, and total household income inequality.(AU)

Utilizamos os dados da Pesquisa de Dinâmica da Força de Trabalho da China de 2014 para examinar os efeitos dos capitais de subsistência, que incluem capitais natural, material, humano, financeiro e social sobre a renda total da família, renda per capita, renda agrícola, renda salarial, renda operacional e desigualdade de renda da propriedade entre as famílias rurais da China. Os resultados mostraram que diferentes tipos de capitais de subsistência têm efeitos diferentes sobre os diferentes tipos de renda das famílias rurais. Especificamente, (1) embora a área de terra cultivada reduza a desigualdade de renda agrícola, aumenta a desigualdade de renda per capita. (2) A área florestal aumenta a desigualdade de renda per capita e a desigualdade total de renda familiar. (3) A variável trator reduz a desigualdade na renda agrícola e na renda familiar total. (4) Embora reduza a desigualdade de renda da propriedade, a variável educação aumenta a desigualdade de renda salarial, a desigualdade de renda per capita e a desigualdade total de renda familiar. (5) A variável contábil reduz a desigualdade de renda da propriedade. (6) A variável empréstimo aumenta a desigualdade na renda agrícola. (7) A variável partidária reduz a desigualdade de renda agrícola. (8) Embora a variável internet aumente a desigualdade de renda agrícola e a desigualdade de renda da propriedade, reduz a desigualdade de renda salarial, a desigualdade de renda operacional, a renda per capita e a desigualdade total de renda familiar.(AU)

Impact of incarceration on tuberculosis incidence and its interaction with income distribution inequality in Brazil.

BACKGROUND: Deteriorated conditions in the non-prison population can lead to an approximation of its tuberculosis (TB) risk to that in the prison population. We evaluated the association between incarceration and TB incidence rate and its interaction with population income distribution inequality in Brazilian municipalities (2013-2015). METHODS: We included 954 municipalities with at least one prison. Interaction between the Gini coefficient and prison exposure was analysed in a multiple regression model. We estimated the fraction of TB in the population attributable fraction (PAF) to exposure to prisons according the Gini coefficient. RESULTS: Compared with the non-prison population, the prisoners had 22.07 times (95% confidence interval [CI] 20.38 to 23.89) the risk of TB in municipalities where the Gini coefficient was <0.60 and 14.96 times (95% CI 11.00 to 18.92) the risk where the Gini coefficient was ≥0.60. A negative interaction in the multiplicative scale was explained by a higher TB incidence in the non-prison population in municipalities with a Gini coefficient ≥0.60. The PAF ranged from 50.06% to 5.19% in municipalities with Gini coefficients <0.40 and ≥0.60, respectively. CONCLUSIONS: Interventions to reduce prison exposure would have an ostensible impact in population TB incidence rates mainly in settings with lower Gini coefficients. In those with extreme inequality in income distribution, strategies focused on mitigating the effects of socio-economic factors should also be prioritized.

Livelihood capitals on income inequality among rural households: evidence from China / Efeito das capitais de subsistência na desigualdade de renda entre as famílias rurais: evidências da China

ABSTRACT: We used the data of the China Labor-force Dynamics Survey 2014 to examine the effects of livelihood capitals which include natural, material, human, financial, and social capitals on total household income, per capita income, agricultural income, wage income, operational income, and property income inequality among rural households in China. Results showed that different kinds of livelihood capitals have different effects on different types of rural households' income. Specifically; (1) although, the area of cultivated land reduces agricultural income inequality, it increases per capita income inequality. (2) Forest land area enlarges per capita income inequality and total household income inequality. (3) Tractor variable reduces inequality in agricultural income and total household income. (4) While reducing the property income inequality, education variable enlarges the wage income inequality, the per capita income inequality and the total household income inequality. (5) Book variable reduces property income inequality. (6) Loan variable increases inequality in agricultural incomes. (7) Party variable reduces the agricultural income inequality. (8) Although, the internet variable increases agricultural income inequality, and property income inequality, it reduces wage income inequality, operational income inequality, per capita income, and total household income inequality.

RESUMO: Utilizamos os dados da Pesquisa de Dinâmica da Força de Trabalho da China de 2014 para examinar os efeitos dos capitais de subsistência, que incluem capitais natural, material, humano, financeiro e social sobre a renda total da família, renda per capita, renda agrícola, renda salarial, renda operacional e desigualdade de renda da propriedade entre as famílias rurais da China. Os resultados mostraram que diferentes tipos de capitais de subsistência têm efeitos diferentes sobre os diferentes tipos de renda das famílias rurais. Especificamente, (1) embora a área de terra cultivada reduza a desigualdade de renda agrícola, aumenta a desigualdade de renda per capita. (2) A área florestal aumenta a desigualdade de renda per capita e a desigualdade total de renda familiar. (3) A variável trator reduz a desigualdade na renda agrícola e na renda familiar total. (4) Embora reduza a desigualdade de renda da propriedade, a variável educação aumenta a desigualdade de renda salarial, a desigualdade de renda per capita e a desigualdade total de renda familiar. (5) A variável contábil reduz a desigualdade de renda da propriedade. (6) A variável empréstimo aumenta a desigualdade na renda agrícola. (7) A variável partidária reduz a desigualdade de renda agrícola. (8) Embora a variável internet aumente a desigualdade de renda agrícola e a desigualdade de renda da propriedade, reduz a desigualdade de renda salarial, a desigualdade de renda operacional, a renda per capita e a desigualdade total de renda familiar.

Desigualdade econômica e risco de infecção e morte por COVID-19 no Brasil / Income inequality and risk of infection and death by COVID-19 in Brazil

RESUMO: Objetivo: Avaliar, por meio de análise espaçotemporal, se a desigualdade econômica das Unidades Federativas (UF) do Brasil pode estar associada com o risco de infecção e morte por COVID-19. Métodos: Trata-se de um estudo ecológico, baseado em dados secundários das taxas de incidência e mortalidade para COVID-19. Os dados foram analisados em nível estadual, tendo como principal variável independente o coeficiente de Gini. Foram utilizados os registros de 12 dias, espaçados em uma semana cada, entre 21 de abril e 7 de julho de 2020. A variação semanal das taxas foi calculada pela regressão de Prais-Winsten, com o objetivo de medir a evolução da pandemia em cada UF. O teste de correlação de Spearman foi empregado para avaliar a correlação entre as taxas e suas evoluções semanais e as variáveis independentes. Por fim, realizou-se diagnóstico de dependência espacial dos dados e usou-se o modelo de defasagem da regressão espacial, quando aplicável. Resultados: As taxas de incidência e mortalidade por COVID-19 foram crescentes em todas as UF brasileiras, tendo sido mais acentuada entre aquelas com maior desigualdade econômica. A associação entre coeficiente de Gini e incidência e mortalidade por COVID-19 manteve-se mesmo quando levados em consideração aspectos demográficos e espaciais. Conclusão: A desigualdade econômica pode exercer papel importante no impacto da COVID-19 em território brasileiro, por meio de efeitos absolutos e contextuais. Políticas estruturais para a redução da desigualdade são fundamentais para o enfrentamento dessa e de futuras crises sanitárias no Brasil.

ABSTRACT: Objective: To assess, through space-time analyses, whether the income inequality of the Federative Units (FUs) in Brazil can be associated with the risk of infection and death by COVID-19. Methods: This was an ecological study, based on secondary data on incidence and mortality rates for COVID-19. Data were analyzed at the state level, having the Gini coefficient as the main independent variable. Records of twelve days were used, spaced one week each, between April 21th and June 7th, 2020. The weekly variation in the rates was calculated through Prais-Winsten regression, aiming at measuring the evolution of the pandemic in each FU. Spearman's correlation test was used to assess correlation between the rates and their weekly evolution and the independent variables. Lastly, a spatial dependence diagnosis was conducted, and a Spatial Regression lag model was used when applicable. Results: Incidence and mortality rates of COVID-19 increased in all Brazilian FUs, being more pronounced among those with greater economic inequality. Association between Gini coefficient and COVID-19 incidence and mortality rates remained even when demographic and spatial aspects were taken into account. Conclusion: Income inequality can play an important role in the impact of COVID-19 on the Brazilian territory, through absolute and contextual effects. Structural policies to reduce inequality are essential to face this and future health crises in Brazil.

Introduction of Application of Gini Coefficient to Heart Rate Variability Spectrum for Mental Stress Evaluation / Introdução da Aplicação do Coeficiente de Gini ao Espectro de Variabilidade da Frequência Cardíaca para Avaliação do Estresse Mental

Abstract Background: The Gini coefficient is a statistical tool generally used by economists to quantify income inequality. However, it can be applied to any kind of data with unequal distribution, including heart rate variability (HRV). Objectives: To assess the application of the Gini coefficient to measure inequality in power spectral density of RR intervals, and to use this application as a psychophysiological indicator of mental stress. Methods: Thirteen healthy subjects (19 ± 1.5 years) participated in this study, and their RR intervals were obtained by electrocardiogram during rest (five minutes) and during mental stress (arithmetic challenge; five minutes). These RR intervals were used to obtain the estimates of power spectral densities (PSD). The limits for the PSD bands were defined from 0.15 to 0.40 Hz for high frequency band (HF), from 0.04 to 0.15 Hz for low frequency band (LF), from 0.04 to 0.085 Hz for first low frequency sub-band (LF1) and from 0.085 to 0.15 Hz for second low frequency sub-band (LF2). The spectral Gini coefficient (SpG) was proposed to measure the inequality in the power distribution of the RR intervals in each of above-mentioned HRV bands. SpG from each band was compared with its respective traditional index of HRV during the conditions of rest and mental stress. All the differences were considered statistically significant for p < 0.05. Results: There was a significant decrease in HF power (p = 0.046), as well as significant increases in heart rate (p = 0.004), LF power (p = 0.033), LF2 power (p = 0.019) and LF/HF (p = 0.002) during mental stress. There was also a significant increase in SpG(LF) (p = 0.009) and SpG(LF2) (p = 0.033) during mental stress. Coefficient of variation showed SpG has more homogeneity compared to the traditional index of HRV during mental stress. Conclusions: This pilot study suggested that spectral inequality of Heart Rate Variability analyzed using the Gini coefficient seems to be an independent and homogeneous psychophysiological indicator of mental stress. Also, HR, LF/HF, SpG(LF) of HRV are possibly important, reliable and valid indicators of mental stress.

Resumo Fundamento: O coeficiente de Gini é um instrumento estatístico geralmente usado por economistas para quantificar a desigualdade de renda. No entanto, ele pode ser aplicado a qualquer tipo de dados com distribuição desigual, incluindo a variabilidade da frequência cardíaca (VFC). Objetivos: Avaliar a aplicação do coeficiente de Gini para medir a desigualdade na densidade espectral de potência de intervalos RR, e usar esta aplicação como um indicador psicofisiológico do estresse mental. Métodos: Treze indivíduos saudáveis (19 ± 1,5 anos) participaram deste estudo, e seus intervalos RR foram obtidos por eletrocardiograma durante repouso (cinco minutos) e durante estresse mental (desafio aritmético; cinco minutos). Esses intervalos RR foram utilizados para obter as estimativas de densidades espectrais de potência (PSD). Os limites para as bandas PSD foram definidos de 0,15 a 0,40 Hz para banda de alta frequência (HF), de 0,04 a 0,15 Hz para banda de baixa frequência (LF), de 0,04 a 0,085 Hz para a primeira sub-banda de baixa frequência (LF1) e de 0,085 a 0,15 Hz para a segunda sub-banda de baixa frequência (LF2). O coeficiente de Gini espectral (SpG) foi proposto para medir a desigualdade na distribuição de potência dos intervalos RR em cada uma das bandas de VFC mencionadas acima. O SpG de cada banda foi comparado com seu respectivo índice tradicional de VFC durante as condições de repouso e de estresse mental. Todas as diferenças foram consideradas estatisticamente significativas para p < 0,05. Resultados: Houve uma diminuição significativa no poder de FC (p=0,046), bem como aumentos significativos na frequência cardíaca (p = 0,004), potência da LF (p = 0,033), potência da LF2 (p = 0,019) e LF/HF (p = 0,002) durante estresse mental. Houve também um aumento significativo de SpG(LF) (p = 0,009) e SpG(LF2) (p = 0,033) durante estresse mental. O coeficiente de variação mostrou que o SpG tem mais homogeneidade em comparação com o índice tradicional de VFC durante o estresse mental. Conclusões: Este estudo piloto sugeriu que a desigualdade espectral da VFC analisada pelo coeficiente de Gini parece ser um indicador psicofisiológico independente e homogêneo de estresse mental. Além disso, FC, LF/HF, SpG(LF) da VFC são possivelmente indicadores importantes, confiáveis e válidos de estresse mental.

Migraciones en países de América Latina: Características de la población pediátrica / Migrations in Latin American countries: Characteristics of the pediatric population Abstract

Introducción: Las migraciones constituyen un fenómeno creciente en América Latina (AL), pero hay poca información sobre la magnitud en población pediátrica y asociación con variables sociodemográficas. Objetivo: Estudiar la asociación de variables sociodemográficas con la tasa de inmigración de población pediátrica en países de AL. Material y métodos: Se buscó información sobre migraciones en países de AL en: Organización Internacional para Migraciones, Organización Panamericana de la Salud y Programa de Naciones Unidas para el Desarrollo. Se efectuaron correlaciones o comparación entre países de variables económicas y demográficas: ingreso nacional bruto per cápita (INB), índice de desarrollo humano (IDH), coeficiente de desigualdad Gini (CG) y tasa de alfabetización (% adultos alfabetizados, TA), con tasa neta de migración por país (TNM) y de niños < 15 años (IN15). Resultados: La TNM fue positiva para Costa Rica, Panamá, Venezuela, Chile y Argentina. No observamos asociación entre TNM con: INB, IDH, CG y TA. Hubo una asociación de IN15 con CG (r = 0,668, p = 0,01), con INB (r = -0,720; p = 0,01), con TA (r = -0,755; p = 0,01) y con IDH (r = -0,799; p = 0,01). La IN15 fue más baja en países de AL con mayor INB vs. aquellos con menor INB (Fisher, p < 0,0001). Conclusiones: Hay una asociación inversa entre INB per cápita, IDH, TA y directa del CG, con la proporción de IN15 de cada país. No observamos una asociación entre TNM con IDH, TA, CG. Debe analizarse el impacto en salud de estas migraciones infantiles.

Introduction: Migration is a growing phenomenon among Latin American countries (LAC) as well as others; however, scarce information is available studying its impact on paediatric groups and its association with socioeconomic variables. Objective: To study the association among socioeconomic variables and the immigration rate of paediatric population in LAC. Material and methods: Official rates of migration of LAC were obtained from: International Organization for Migration, Pan American Health Organization, and United Nations Development Programme. Demographic and socioeconomic information was also obtained for: gross domestic product (GDP), human development index (HDI), Gini coefficient of inequality (GC), alphabetization rate for adults (AA), net migration rate (NMR), and immigration of children < 15 years (IM15). Description, linear correlations and analysis of differences between groups of countries were assessed. Results: The NMR was positive for Costa Rica, Panama, Venezuela, Chile and Argentina. No association among NMR and GDP, HDI, GC, AA was found. A correlation of IM15 was found with: GC (r = 0.668, P = .01), with GDP (r = -0.720; P = .01), AA (r = -0.755; P = .01) and with HDI (r = -0.799; P = .01). Rate of IM15 was lower in LA countries with advanced/medium development (GDP> median) vs those with low development (Fisher, P < .0001). Conclusions: There is a direct inverse association between GDP per capita, HDI, AA and GC and the proportion of each country IN15. We did not observe an association between NMR and HDI, AA, and GC. The health impact of these migrations should be analysed.

[Migrations in Latin American countries. Characteristics of the pediatric population]. / Migraciones en países de América Latina. Características de la población pediátrica.

INTRODUCTION: Migration is a growing phenomenon among Latin American countries (LAC) as well as others; however, scarce information is available studying its impact on paediatric groups and its association with socioeconomic variables. OBJECTIVE: To study the association among socioeconomic variables and the immigration rate of paediatric population in LAC. MATERIAL AND METHODS: Official rates of migration of LAC were obtained from: International Organization for Migration, Pan American Health Organization, and United Nations Development Programme. Demographic and socioeconomic information was also obtained for: gross domestic product (GDP), human development index (HDI), Gini coefficient of inequality (GC), alphabetization rate for adults (AA), net migration rate (NMR), and immigration of children<15 years (IM15). Description, linear correlations and analysis of differences between groups of countries were assessed. RESULTS: The NMR was positive for Costa Rica, Panama, Venezuela, Chile and Argentina. No association among NMR and GDP, HDI, GC, AA was found. A correlation of IM15 was found with: GC (r=0.668, P=.01), with GDP (r=-0.720; P=.01), AA (r=-0.755; P=.01) and with HDI (r=-0.799; P=.01). Rate of IM15 was lower in LA countries with advanced/medium development (GDP>median) vs those with low development (Fisher, P<.0001). CONCLUSIONS: There is a direct inverse association between GDP per capita, HDI, AA and GC and the proportion of each country IN15. We did not observe an association between NMR and HDI, AA, and GC. The health impact of these migrations should be analysed.

The changing distribution of malaria in the Brazilian Amazon, 2003-2004 and 2008-2009

Introduction More than half of the malaria cases reported in the Americas are from the Brazilian Amazon region. While malaria is considered endemic in this region, its geographical distribution is extremely heterogeneous. Therefore, it is important to investigate the distribution of malaria and to determine regions whereby action might be necessary. Methods Changes in malaria indicators in all municipalities of the Brazilian Amazon between 2003-2004 and 2008-2009 were studied. The malaria indicators included the absolute number of malaria cases and deaths, the bi-annual parasite incidence (BPI), BPI ratios and differences, a Lorenz curve and Gini coefficients. Results During the study period, mortality from malaria remained low (0.02% deaths/case), the percent of municipalities that became malaria-free increased from 15.6% to 31.7%, and the Gini coefficient increased from 82% to 87%. In 2003, 10% of the municipalities with the highest BPI accumulated 67% of all malaria cases, compared with 2009, when 10% of the municipalities (with the highest BPI) had 80% of the malaria cases. Conclusions This study described an overall decrease in malaria transmission in the Brazilian Amazon region. As expected, an increased heterogeneity of malaria indicators was found, which reinforces the notion that a single ...

The effects of age on sperm quality: an evaluation of 1,500 semen samples.

OBJECTIVE: The aim of this study was to evaluate the effects of aging on semen quality in a population of infertile couples. METHODS: A cross-sectional study of semen samples obtained from 1,500 men randomly selected from couples who attended an infertility clinic was conducted. The analyses were performed using Spearman's correlation and Mann-Whitney tests. The age groups consisted of men ≤ 35 years, from 36-45 years and > 45 years of age. The semen analysis was performed according to the WHO criteria, and morphology was evaluated using the motile sperm organelle morphology examination (MSOME). The percentages of normal spermatozoa and spermatozoa with large nuclear vacuoles (LNV, occupying > 50% nuclear area) were determined. The percentages of DNA fragmentation were assessed using the TUNEL assay. RESULTS: A regression analysis revealed that the percentages of LNV spermatozoa and sperm DNA fragmentation positively correlated with age. Conversely, a regression analysis revealed that the percentage of normal sperm, sperm progressive motility and sperm vitality negatively correlated with age. As in the previous test, the analysis by age group showed that there was a significant reduction (P < 0.05) in the percentage of normal sperm, sperm progressive motility and sperm vitality as age increased. Conversely, the percentage of spermatozoa with LNVs and sperm DNA fragmentation significantly increased (P < 0.05) as age increased. CONCLUSION: Semen quality seems to be influenced by aging. The age-related decrease in sperm quality suggests that delaying childbearing, not only for women but also for men, may jeopardize reproductive capacity.

Modelo de salud en Colombia: ¿financiamiento basado en seguridad social o en impuestos? / Health care system in Colombia: funding based on social security or on taxes? / Modelo de saúde em Colômbia:¿financiamento baseado em segurança social ou em impostos?

El sistema de salud colombiano pasa por la mayor crisis de su historia. Este artículo expone la influencia de organismos económicos internacionales sobre la estructuración y funcionamientodel sistema de salud colombiano, así como los puntos de colisión con lo consagrado en la Constitución Política. Además, se presenta una visión general de la organización actual del sistema, así como sus fallas en financiamiento y administración. Por último, se dan unas recomendaciones para reformar el financiamiento, pasando de un modelo de seguridad social a uno basado en impuestos generales, y se exponen las ventajas de un Estado recaudador y administrador del sistema...

The Health Care System in Colombia has collapsed. This article depicts the influence of international economic organizations on the structure and function of the health system in Colombia, as well as the contradistinctions with the Political Constitution. It also presents an overview of the current system, as well as its setbacks and flaws at financial and administrative levels. Finally, recommendations regarding funding of the system by switching from a social security model to a model based on general taxes are made, and the advantages of a State in charge offunding and administrating are presented...

O sistema de saúde colombiano passa pela maior crise de sua história. Este artigo expõe a influência de organismos económicos internacionais sobre a estructuración e funcionamentodo sistema de saúde colombiano, bem como os pontos de colisão com o consagrado na ConstituiçãoPolítica. Ademais, apresenta-se uma visão geral da organização actual do sistema, bem como suas falhas em financiamento e administração. Por último, dão-se umas recomendaçõespara reformar o financiamento, passando de um modelo de segurança social a um baseado em impostos gerais, e se expõem as vantagens de um Estado recaudador e administrador...

Diferenciales de salud y una aproximación mediante el empleo del coeficiente de Gini y el índice de concentración en las provincias cubanas, 2002-2008 / Health's differentials and a approaching to use of Gini's coefficient and the rate of concentration in the Cuban provinces, 2002-2008

INTRODUCCIÓN: No existen muchas publicaciones científicas que aborden los diferenciales de salud entre las provincias de Cuba, ni que documenten los principales factores que impactaron en los resultados de salud de la población durante el período 1989-2000. En el año 2002 Fidel Castro destacó la existencia de una serie de errores de conducción y organización durante ese periodo, que a su criterio debilitaron el sistema de salud cubano y propiciaron la aparición de determinadas desigualdades. OBJETIVO: Describir los principales diferenciales de salud existentes entre los distintos territorios de Cuba (factores determinantes de la salud de los cubanos) durante el período estudiado (2002-2008). MÉTODOS: Se utilizó como unidad geográfica a la provincia. Las catorce provincias cubanas fueron estratificadas sobre la base de tres ejes fundamentales: demográfico, económico y condiciones de vida, con vista a identificar posibles diferenciales de salud (inequidades en salud y en servicios de salud) mediante el empleo de la técnica del coeficiente de Gini y del índice de concentración. RESULTADOS: Se muestran los principales factores o variables con diferenciales de salud presentes en el país por provincias durante el período estudiado, se identificaron los factores o variables que mayores diferenciales exhibieron por cada uno de los ejes demográfico (densidad poblacional), económico (producción mercantil) y condiciones de vida (cobertura sanitaria). Se definen las diferencias existentes entre cada una de las provincias y por regiones y las características muy particulares de la capital cubana como provincia. CONCLUSIONES: Se confirma la hipótesis de que a pesar de la férrea voluntad política del estado de evitar inequidades en salud, aún se observan diferenciales no importantes en el comportamiento de las variables estudiadas por cada uno de los ejes de análisis entre provincias. No obstante, existen diferencias entre el comportamiento de esos ...(AU)

INTRODUCTION: There is a lack of scientific publications approaching the health differentials among the Cuban provinces and of to document the leading factors with impact on the health results in the population during the period 1989-2000. In 2002 Fidel Castro Rus emphasized on the existence of errors in the management and organization during above mentioned period, that according to his criterion to weaken the Cuban health system and led to appearance of determined inequalities. OBJECTIVE: To describe the leading health differentials present among the different Cuban territories (determinant health factors for Cubans) during the study period (2002-2008). METHODS: The province was used as geographical unit. The fourteen Cuban provinces were stratified on the base of the three fundamental bases: demographic, economic and life conditions to identify the potential health differentials (inequalities in health and in its services) using the Gini's coefficient technique and the concentration's index. RESULTS: The leading factors or variables with health differentials present in our country by provinces during the study period are showed, identifying the factors or variables with greater differentials by each of the demographic bases (population density), economic (commercial production) and life conditions (health coverage). The differences present among each of the provinces and regions are defined as well as the very particular characteristics of the Cuban capital as province. CONCLUSIONS: The hypothesis that despite the strong political and state will to avoid health inequalities, still there are no-significant differences in the behavior of study variables by each of the bases of analysis among provinces. Nevertheless, there differences among the behavior of such differentials according to analysis's bases, features that be and were considered during the process of health politics design, of reorganization of health services, of human ...(AU)

Diferenciales de salud y una aproximación mediante el empleo del coeficiente de Gini y el índice de concentración en las provincias cubanas, 2002-2008 / Health's differentials and a approaching to use of Gini's coefficient and the rate of concentration in the Cuban provinces, 2002-2008

INTRODUCCIÓN: No existen muchas publicaciones científicas que aborden los diferenciales de salud entre las provincias de Cuba, ni que documenten los principales factores que impactaron en los resultados de salud de la población durante el período 1989 - 2000. En el año 2002 Fidel Castro destacó la existencia de una serie de errores de conducción y organización durante ese periodo, que a su criterio debilitaron el sistema de salud cubano y propiciaron la aparición de "determinadas desigualdades". OBJETIVO: Describir los principales diferenciales de salud existentes entre los distintos territorios de Cuba (factores determinantes de la salud de los cubanos) durante el período estudiado (2002-2008). MÉTODOS: Se utilizó como unidad geográfica a la provincia. Las catorce provincias cubanas fueron estratificadas sobre la base de tres ejes fundamentales: demográfico, económico y condiciones de vida, con vista a identificar posibles diferenciales de salud (inequidades en salud y en servicios de salud) mediante el empleo de la técnica del coeficiente de Gini y del índice de concentración. RESULTADOS: Se muestran los principales factores o variables con diferenciales de salud presentes en el país por provincias durante el período estudiado, se identificaron los factores o variables que mayores diferenciales exhibieron por cada uno de los ejes demográfico (densidad poblacional), económico (producción mercantil) y condiciones de vida (cobertura sanitaria). Se definen las diferencias existentes entre cada una de las provincias y por regiones y las características muy particulares de la capital cubana como provincia. CONCLUSIONES: Se confirma la hipótesis de que a pesar de la férrea voluntad política del estado de evitar inequidades en salud, aún se observan diferenciales no importantes en el comportamiento de las variables estudiadas por cada uno de los ejes de análisis entre provincias. No obstante, existen diferencias entre el comportamiento de esos diferenciales de acuerdo con los ejes de análisis, aspectos que deben ser y fueron considerados durante el proceso de diseño de políticas sanitarias, de reorganización de los servicios de salud, de formación de capital humano y de abordaje intersectorial de los determinantes no médicos de la salud durante los años más duros del período especial, lo que viene a confirmar el modelo teórico desarrollado previamente por los autores.

INTRODUCTION: There is a lack of scientific publications approaching the health differentials among the Cuban provinces and of to document the leading factors with impact on the health results in the population during the period 1989-2000. In 2002 Fidel Castro Rus emphasized on the existence of errors in the management and organization during above mentioned period, that according to his criterion to weaken the Cuban health system and led to appearance of "determined inequalities". OBJECTIVE: To describe the leading health differentials present among the different Cuban territories (determinant health factors for Cubans) during the study period (2002-2008). METHODS: The province was used as geographical unit. The fourteen Cuban provinces were stratified on the base of the three fundamental bases: demographic, economic and life conditions to identify the potential health differentials (inequalities in health and in its services) using the Gini's coefficient technique and the concentration's index. RESULTS: The leading factors or variables with health differentials present in our country by provinces during the study period are showed, identifying the factors or variables with greater differentials by each of the demographic bases (population density), economic (commercial production) and life conditions (health coverage). The differences present among each of the provinces and regions are defined as well as the very particular characteristics of the Cuban capital as province. CONCLUSIONS: The hypothesis that despite the strong political and state will to avoid health inequalities, still there are no-significant differences in the behavior of study variables by each of the bases of analysis among provinces. Nevertheless, there differences among the behavior of such differentials according to analysis's bases, features that be and were considered during the process of health politics design, of reorganization of health services, of human resource training and the intersectorial approach of non-health physicians determinants during the more hard year of special period, confirming the theoretical model previously developed by the authors.

Tendencias recientes de tasas de mortalidad por edad, sexo, área geográfica y grupos de causas: Chile 1999 -2005 / Recent trends of mortality rates by geographical area, age, sex and broad groups of causes in Chile, 1999-2005

En el marco del monitoreo de las prioridades y desigualdades comunales de salud de Chile, se presentan las tendencias en el país y en cada uno de sus 28 Servicios de Salud, de las tasas de mortalidad infantil, de mortalidad de hombres y de mujeres de 20 a 44 años de edad, y de la mortalidad a los 20-64 años de edad por algunos grandes grupos de causas, para el período 1999-2005.Se miden las desigualdades de las tasas entre los Servicios de Salud para cada año del período, usando el coeficiente de Gini y el rango de variación. Se miden las tendencias de las desigualdades para cada tasa. Se encuentra que en este amplio tramo de edad hubo un descenso de la mortalidad en el país y en la mayoría de los Servicios de Salud, especialmente marcada para la mortalidad por enfermedades respiratorias. También fue importante el descenso de la mortalidad infantil. Las desigualdades entre Servicios fueron más notorias para la mortalidad por enfermedades respiratorias, por causas externas, por cirrosis hepática y por causas mal definidas. La desigualdad aumentó para algunas tasas y disminuyó para otras. Se recomienda seguir midiendo estos indicadores y utilizar la información como guía para mejorar las tendencias en ciertos Servicios y para reducir las desigualdades en ciertos grupos de causas.

In the framework of monitoring communal health priorities and disparities in Chile, we present, for the country and for each of its 28 Health Services, the trends of the following mortality rates for the period 1999-2005: infant mortality, deaths of men and women of ages 20 to 44 years, deaths of men and women of 45 to 64 years, and deaths for some broad groups of causes at ages 20 to 64 years. We measure the between Health Services disparities of the rates for each year of the period, utilizing the Gini coefficient and the range of values. We measure the trends of the disparities for each rate. Findings: in this broad age group there was a descent of mortality in the country and in most of the Health Services. This was more pronounced in the case of mortality from respiratory diseases. There was also an important reduction in infant mortality. The disparities among Health Services were more evident for mortality from respiratory diseases, from external causes, from liver cirrhosis and from ill-defined causes. They increased for some rates and diminished for others. We suggest that these indicators be followed up on a regular annual basis and that the information be used as a guide for efforts to improve the trends in some Services and to reduce the inequities in some groups of causes.