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1.
PLoS One ; 15(9): e0239873, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32976542

RESUMO

Widespread availability of antibiotics without prescription potentially facilitates overuse and contributes to selection pressure for antimicrobial resistant bacteria. Prior to this study, anecdotal observations in Guatemala identified corner stores as primary antibiotic dispensaries, where people purchase antibiotics without prescriptions. We carried out a cross sectional study to document the number and types of antibiotics available in corner stores, in four study areas in Guatemala. A total of 443 corner stores were surveyed, of which 295 (67%) sold antibiotics. The most commonly available antibiotics were amoxicillin, found in 246/295 (83%) stores, and tetracycline, found in 195/295 (66%) stores. Over the counter sales result from laissez-faire enforcement of antibiotic dispensing regulations in Guatemala combined with patient demand. This study serves as a baseline to document changes in the availability of antibiotics in informal establishments in light of new pharmacy regulations for antibiotic dispensing, which were adopted after this study was completed.


Assuntos
Antibacterianos/provisão & distribução , Uso de Medicamentos/estatística & dados numéricos , Medicamentos sem Prescrição/provisão & distribução , Autoadministração/estatística & dados numéricos , Antibacterianos/administração & dosagem , Antibacterianos/economia , Uso Indevido de Medicamentos/estatística & dados numéricos , Guatemala , Humanos , Medicamentos sem Prescrição/administração & dosagem , Medicamentos sem Prescrição/economia , Empresa de Pequeno Porte/estatística & dados numéricos
2.
Cienc. tecnol. salud ; 7(1): 77-86, 2020. ^c27 cmilus
Artigo em Espanhol | LILACS | ID: biblio-1120572

RESUMO

La Enfermedad Renal Crónica de Causas no Tradicionales (ERCnT) ha aumentado en los últimos 20 años, convirtiéndose en un problema de salud pública importante que se observa principalmente en países de Centroamérica y Asia, afectando especialmente a trabajadores agrícolas jóvenes. La presencia de factores de riesgo relacionados con toxinas, medio ambiente y condiciones laborales sugiere una causa multifactorial, la cual puede que involucre la exposición a agroquímicos, contaminantes ambientales, y episodios repetidos de deshidratación. La comprensión de las condiciones sociales que unen estos factores en grupos específicos de población es fundamental para el desarrollo de programas de salud pública tendientes a la prevención de esta epidemia devastadora. Luego de presentar brevemente los antecedentes, este ensayo discute el paradigma de causalidad de la enfermedad implícito en la literatura disponible sobre ERCnT, concretamente la "multicausalidad", sitúa el enfoque en su contexto histórico, y presenta sus fortalezas y limitaciones. Luego, el ensayo presenta dos paradigmas de causalidad que podrían ayudar a avanzar en la investigación sobre las causas de la enfermedad, específicamente los enfoques socioecológico y de determinación social de la salud. El ensayo concluye con recomendaciones para una agenda de investigación e intervención que enfoque en explicar las causas de la ERCnT.


Chronic Kidney Disease of non-Traditional Causes (CKDnT) has increased over the past 20 years, becoming a significant public health issue observed mainly in countries in Central America and Asia, primarily affecting young male agricultural workers. The presence of toxin-, environmental-, and work-related risk factors in the affected communities suggests a multifactorial cause, which may involve exposure to agrochemicals, environmental contaminants, and repeated episodes of dehydration. An understanding of the social conditions that bring these factors together in specific groups is essential for the development of public health programs to prevent this devastating epidemic. After a brief background, this essay discusses the paradigm of disease causality implied in the available literature on CKDnT, namely "multicausality", puts it in its historical context, and presents its strengths and limitations. The essay then presents two causality paradigms that could help move forward research about the causes of this disease, specifically the socioecological and the social determination of health approaches. The essay concludes with recommendations for a research and intervention agenda that focuses on explaining the causes of CKDnT.


Assuntos
Humanos , Masculino , Adolescente , Adulto , Pessoa de Meia-Idade , Condições Sociais , Causalidade , Insuficiência Renal Crônica/prevenção & controle , Condições de Trabalho , Saúde Pública , Fatores de Risco , Agroquímicos/efeitos adversos , Poluentes Ambientais , Fazendeiros , Guatemala , Nefropatias/epidemiologia
5.
Hum Resour Health ; 17(1): 53, 2019 07 12.
Artigo em Inglês | MEDLINE | ID: mdl-31299994

RESUMO

BACKGROUND: Medical tourism, which involves cross-border travel to access private, non-emergency medical interventions, is growing in many Latin American Caribbean countries. The commodification and export of private health services is often promoted due to perceived economic benefits. Research indicates growing concern for health inequities caused by medical tourism, which includes its impact on health human resources, yet little research addresses the impacts of medical tourism on health human resources in destination countries and the subsequent impacts for health equity. To address this gap, we use a case study approach to identify anticipated impacts of medical tourism sector development on health human resources and the implications for health equity in Guatemala. METHODS: After undertaking an extensive review of media and policy discussions in Guatemala's medical tourism sector and site visits observing first-hand the complex dynamics of this sector, in-depth key informant interviews were conducted with 50 purposefully selected medical tourism stakeholders in representing five key sectors: public health care, private health care, health human resources, civil society, and government. Participants were identified using multiple recruitment methods. Interviews were transcribed in English. Transcripts were reviewed to identify emerging themes and were coded accordingly. The coding scheme was tested for integrity and thematic analysis ensued. Data were analysed thematically. RESULTS: Findings revealed five areas of concern that relate to Guatemala's nascent medical tourism sector development and its anticipated impacts on health human resources: the impetus to meet international training and practice standards; opportunities and demand for English language training and competency among health workers; health worker migration from public to private sector; job creation and labour market augmentation as a result of medical tourism; and the demand for specialist care. These thematic areas present opportunities and challenges for health workers and the health care system. CONCLUSION: From a health equity perspective, the results question the responsibility of Guatemala's medical education system for supporting an enhanced medical tourism sector, particularly with an increasing focus on the demand for private clinics, specific specialities, English-language training, and international standards. Further, significant health inequalities and barriers to care for Indigenous populations are unlikely to benefit from the impacts identified from participants, as is true for rural-urban and public-private health human resource migration.


Assuntos
Mão de Obra em Saúde , Turismo Médico , Competição Econômica , Regulamentação Governamental , Guatemala , Política de Saúde , Acesso aos Serviços de Saúde/economia , Pesquisa sobre Serviços de Saúde , Humanos , Entrevistas como Assunto , Turismo Médico/economia , Pesquisa Qualitativa
6.
PLoS One ; 12(10): e0186644, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29036228

RESUMO

Pediatric patients with Chronic Kidney Disease face several barriers to medication adherence that, if addressed, may improve clinical care outcomes. A cross sectional questionnaire was administered in the Foundation for Children with Kidney Disease (FUNDANIER, Guatemala City) from September of 2015 to April of 2016 to identify the predisposing factors, enabling factors and need factors related to medication adherence. Sample size was calculated using simple random sampling with a confidence level of 95%, confidence interval of 0.05 and a proportion of 87%. A total of 103 participants responded to the questionnaire (calculated sample size was 96). Independent variables were defined and described, and the bivariate relationship to dependent variables was determined using Odds Ratio. Multivariate analysis was carried out using logistic regression. The mean adherence of study population was 78% (SD 0.08, max = 96%, min = 55%). The mean adherence in transplant patients was 82% (SD 7.8, max 96%, min 63%), and the mean adherence in dialysis patients was 76% (SD 7.8 max 90%, min 55%). Adherence was positively associated to the mother's educational level and to higher monthly household income. Together predisposing, enabling and need factors illustrate the complexities surrounding adherence in this pediatric CKD population. Public policy strategies aimed at improving access to comprehensive treatment regimens may facilitate treatment access, alleviating economic strain on caregivers and may improve adherence outcomes.


Assuntos
Adesão à Medicação/estatística & dados numéricos , Insuficiência Renal Crônica/tratamento farmacológico , Adolescente , Criança , Feminino , Guatemala , Política de Saúde , Humanos , Masculino , Análise Multivariada , Inquéritos e Questionários
8.
Glob Health Action ; 9: 32760, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27876457

RESUMO

BACKGROUND: Many governments and health care providers worldwide are enthusiastic to develop medical tourism as a service export. Despite the popularity of this policy uptake, there is relatively little known about the specific local factors prospectively motivating and informing development of this sector. OBJECTIVE: To identify common social, economic, and health system factors shaping the development of medical tourism in three Central American and Caribbean countries and their health equity implications. DESIGN: In-depth, semi-structured interviews were conducted in Mexico, Guatemala, and Barbados with 150 health system stakeholders. Participants were recruited from private and public sectors working in various fields: trade and economic development, health services delivery, training and administration, and civil society. Transcribed interviews were coded using qualitative data management software, and thematic analysis was used to identify cross-cutting issues regarding the drivers and inhibitors of medical tourism development. RESULTS: Four common drivers of medical tourism development were identified: 1) unused capacity in existing private hospitals, 2) international portability of health insurance, vis-a-vis international hospital accreditation, 3) internationally trained physicians as both marketable assets and industry entrepreneurs, and 4) promotion of medical tourism by public export development corporations. Three common inhibitors for the development of the sector were also identified: 1) the high expense of market entry, 2) poor sector-wide planning, and 3) structural socio-economic issues such as insecurity or relatively high business costs and financial risks. CONCLUSION: There are shared factors shaping the development of medical tourism in Central America and the Caribbean that help explain why it is being pursued by many hospitals and governments in the region. Development of the sector is primarily being driven by public investment promotion agencies and the private health sector seeking economic benefits with limited consideration and planning for the health equity concerns medical tourism raises.

9.
Global Health ; 12(1): 60, 2016 10 07.
Artigo em Inglês | MEDLINE | ID: mdl-27717389

RESUMO

BACKGROUND: Medical tourism has attracted considerable interest within the Latin American and Caribbean (LAC) region. Governments in the region tout the economic potential of treating foreign patients while several new private hospitals primarily target international patients. This analysis explores the perspectives of a range of medical tourism sector stakeholders in two LAC countries, Guatemala and Barbados, which are beginning to develop their medical tourism sectors. These perspectives provide insights into how beliefs about international patients are shaping the expanding regional interest in medical tourism. METHODS: Structured around the comparative case study methodology, semi-structured interviews were conducted with 50 medical tourism stakeholders in each of Guatemala and Barbados (n = 100). To capture a comprehensive range of perspectives, stakeholders were recruited to represent civil society (n = 5/country), health human resources (n = 15/country), public health care and tourism sectors (n = 15/country), and private health care and tourism sectors (n = 15/country). Interviews were transcribed verbatim, coded using a collaborative process of scheme development, and analyzed thematically following an iterative process of data review. RESULTS: Many Guatemalan stakeholders identified the Guatemalan-American diaspora as a significant source of existing international patients. Similarly, Barbadian participants identified their large recreational tourism sector as creating a ready source of foreign patients with existing ties to the country. While both Barbadian and Guatemalan medical tourism proponents share a common understanding that intra-regional patients are an existing supply of international patients that should be further developed, the dominant perception driving interest in medical tourism is the proximity of the American health care market. In the short term, this supplies a vision of a large number of Americans lacking adequate health insurance willing to travel for care, while in the long term, the Affordable Care Act is seen to be an enormous potential driver of future medical tourism as it is believed that private insurers will seek to control costs by outsourcing care to providers abroad. CONCLUSIONS: Each country has some comparative advantage in medical tourism. Assumptions about a large North American patient base, however, are not supported by reliable evidence. Pursuing this market could incur costs borne by patients in their public health systems.


Assuntos
Assistência à Saúde/estatística & dados numéricos , Equidade em Saúde/normas , Turismo Médico/tendências , Barbados , Assistência à Saúde/economia , Assistência à Saúde/tendências , Guatemala , Humanos , Turismo Médico/economia , Pesquisa Qualitativa
10.
Rev. cient. (Guatem.) ; 26(2): [18]-[35], octubre. 2016.
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-883272

RESUMO

Existen pocas regulaciones que guíen el uso racional de antibióticos en países de rentas bajas o medias, lo cual facilita la automedicación con antibióticos (AMA). Describir las fuentes de información usadas durante la práctica de AMA, los efectos percibidos, y los motivos que rodean la práctica de AMA en Guatemala. Una encuesta descriptiva transversal se administró entre quienes compraron antibióticos sin receta en cuatro farmacias de ciudad de Guatemala. Las preguntas identificaron las características demográficas de los participantes, el origen de la solicitud de antibiótico, y los efectos percibidos de la AMA. En total, 230 participantes respondieron al cuestionario en cuatro farmacias. Dos farmacias correspondieron a un contexto socioeconómico bajo (FSEB) y dos correspondieron a un contexto socioeconómico alto (FSEA). La mayoría de participantes de las FSEB (93%) y de FSEA (60%) reportaron haberse automedicado con antibióticos previamente (p < .001). Cuarenta y cuatro por ciento de participantes de FSEB y 27% de FSEA usaron viejas recetas como fuentes de información cuando practicaron AMA (p = .010); 27% de participantes de FSEA hablaron por teléfono con médicos para seleccionar el antibiótico. Setenta y tres por ciento de FSEB y 68% de FSEA percibieron mejoras en su salud (p < .001) como resultado de AMA. Veinticinco por ciento de FSEB y 35% de FSEA reportaron efectos secundarios de AMA. Los motivos para automedicarse con antibióticos incluyeron ahorro de tiempo y dinero en consultar a un médico. Los resultados contribuyen a las evidencias crecientes sobre el uso de antibióticos y tienen el potencial de servir para desarrollar prácticas y políticas sobre dispensación de antibióticos en farmacias.


Few regulations guide the rational use of antibiotics in Low to Middle Income Countries (LMIC) facilitating self-medication with antibiotics (SMA). To describe the sources of information used when practicing SMA, perceived effects of SMA, and motives surrounding SMA practice in Guatemala. A descriptive, cross sectional questionnaire was administered to those purchasing antibiotics without a prescription in four Guatemala City pharmacies. Questions identified respondent demographics, origin of antibiotic request, and the perceived effects of SMA. A total of 230 participants responded to the questionnaire in four pharmacies. Two pharmacies represented Low Socio-Economic Setting Pharmacies (LSEP) and two represented High Socio-Economic Setting Pharmacies (HSEP). The majority of LSEP pharmacy respondents (93%), and HSEP respondents (60%) reported previously carrying out SMA (p < .001). Forty-four percent of LSEP and 27% of HSEP respondents used old-prescriptions as a source of information when practicing SMA (p = .01 ); 27% of HSEP respondents spoke over the phone with physicians in order to make antibiotic selection. Seventy-three percent of LSEP and 68% of HSEP perceived improvements in health (p < .001) as a result of SMA. Twenty five percent of LSEP and 35% of HSEP reported side effects from SMA. Motives for self-medicating with antibiotics included saving time and money on visiting a physician. Results contribute to the growing body of evidence regarding antibiotic use and serve to develop antibiotic dispensing practice and policies in pharmacies.

11.
Int J Equity Health ; 15: 77, 2016 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-27177690

RESUMO

BACKGROUND: Health inequalities disproportionally affect indigenous people in Guatemala. Previous studies have noted that the disadvantageous situation of indigenous people is the result of complex and structural elements such as social exclusion, racism and discrimination. These elements need to be addressed in order to tackle the social determinants of health. This research was part of a larger participatory collaboration between Centro de Estudios para la Equidad y Gobernanza en los Servicios de Salud (CEGSS) and community based organizations aiming to implement social accountability in rural indigenous municipalities of Guatemala. Discrimination while seeking health care services in public facilities was ranked among the top three problems by communities and that should be addressed in the social accountability intervention. This study aimed to understand and categorize the episodes of discrimination as reported by indigenous communities. METHODS: A participatory approach was used, involving CEGSS's researchers and field staff and community leaders. One focus group in one rural village of 13 different municipalities was implemented. Focus groups were aimed at identifying instances of mistreatment in health care services and documenting the account of those who were affected or who witnessed them. All of the 132 obtained episodes were transcribed and scrutinized using a thematic analysis. RESULTS: Episodes described by participants ranged from indifference to violence (psychological, symbolic, and physical), including coercion, mockery, deception and racism. Different expressions of discrimination and mistreatment associated to poverty, language barriers, gender, ethnicity and social class were narrated by participants. CONCLUSIONS: Addressing mistreatment in public health settings will involve tackling the prevalent forms of discrimination, including racism. This will likely require profound, complex and sustained interventions at the programmatic and policy levels beyond the strict realm of public health services. Future studies should assess the magnitude of the occurrence of episodes of maltreatment and racism within indigenous areas and also explore the providers' perceptions about the problem.


Assuntos
Grupos Populacionais/etnologia , Qualidade da Assistência à Saúde/normas , Racismo/tendências , Feminino , Grupos Focais , Guatemala/etnologia , Humanos , Masculino , Grupos Populacionais/psicologia , Pesquisa Qualitativa , População Rural
12.
Int J Equity Health ; 15: 69, 2016 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-27108224

RESUMO

BACKGROUND: Early detection of emergent influenza strains is a global health priority. However, maintaining active surveillance is economically and logistically challenging. While community-based surveillance is an attractive alternative, design and operation of an effective epidemiological surveillance program requires community engagement that can be linked to public health reporting and response. We report the results of a study in rural Guatemalan communities aimed at identifying opportunities for and barriers to community engagement in disease surveillance. METHODS: Using an ethnographic approach followed by a descriptive cross-sectional survey, we documented local terms and ideas about animal illnesses, including the possibility of animal-human transmission. RESULTS: The community perceived disease causation principally in terms of changes in the physical environment and weather and categorized illnesses using local terminology based on observable clinical signs. Knowledge about prevention and treatment was derived predominantly from local networks of family and friends without evidence of professionally-based knowledge being regularly introduced into the community. CONCLUSIONS: Bridging the divide between professional and community-based descriptive disease terminology, incorporating animal and human health responsiveness to common illnesses, and providing professional knowledge into the community-based networks were identified as addressable challenges to effective implementation of community-based surveillance.


Assuntos
Redes Comunitárias/tendências , Influenza Humana/epidemiologia , Vigilância da População/métodos , Estudos Transversais , Guatemala/epidemiologia , Humanos , População Rural/estatística & dados numéricos
14.
BMC Pharmacol Toxicol ; 16: 11, 2015 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-25928897

RESUMO

BACKGROUND: Self-medication with antibiotics may result in antimicrobial resistance and its high prevalence is of particular concern in Low to Middle Income Countries (LMIC) like Guatemala. A better understanding of self-medication with antibiotics may represent an opportunity to develop interventions guiding the rational use of antibiotics. We aimed to compare the magnitude of antibiotic self-medication and the characteristics of those who self-medicate in two pharmacies serving disparate socio-economic communities in Guatemala City. METHODS: We conducted a descriptive, cross-sectional study in one Suburban pharmacy and one City Center pharmacy in Guatemala City. We used a questionnaire to gather information about frequency of self-medication, income and education of those who self-medicate. We compared proportions between the two pharmacies, using two-sample z-test as appropriate. RESULTS: Four hundred and eighteen respondents completed the survey (221 in the Suburban pharmacy and 197 in the City Center pharmacy). Most respondents in both pharmacies were female (70%). The reported monthly income in the suburban pharmacy was between $1,250.00-$2,500.00, the city-center pharmacy reported a monthly income between $125.00- $625.00 (p < 0.01). Twenty three percent of Suburban pharmacy respondents and 3% in the City Center pharmacy completed high school (p < 0.01). Proportion of self-medication was 79% in the Suburban pharmacy and 77% in City Center pharmacy. In both settings, amoxicillin was reported as the antibiotic most commonly used. CONCLUSIONS: High proportions of self-medication with antibiotics were reported in two pharmacies serving disparate socio-economic groups in Guatemala City. Additionally, self-medicating respondents were most often women and most commonly self-medicated with amoxicillin. Our findings support future public health interventions centered on the regulation of antibiotic sales and on the potential role of the pharmacist in guiding prescription with antibiotics in Guatemala.


Assuntos
Antibacterianos/uso terapêutico , Assistência Farmacêutica/estatística & dados numéricos , Automedicação/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Guatemala , Humanos , Masculino , Fatores Socioeconômicos , Adulto Jovem
15.
Rev. panam. salud pública ; 36(6): 376-382, dic. 2014. ilus, tab
Artigo em Inglês | LILACS | ID: lil-742266

RESUMO

OBJECTIVE: To describe the distribution of pediatric chronic kidney disease (CKD) in Guatemala, estimate incidence and prevalence of pediatric end-stage renal disease (ESRD), and estimate time to progress to ESRD. METHODS: This study analyzed the registry of the only pediatric nephrology center in Guatemala, from 2004-2013. Incidence and prevalence were calculated for annual periods. Moran's index for spatial autocorrelation was used to determine significance of geographic distribution of incidence. Time to progress to ESRD and associated risk factors were calculated with multivariate Cox regression. RESULTS: Of 1 545 patients from birth to less than 20 years of age, 432 had chronic renal failure (CRF). Prevalence and incidence of ESRD were 4.9 and 4.6 per million age-related population, respectively. Incidence was higher for the Pacific coast and Guatemala City. The cause of CRF was undetermined in 43% of patients. Average time to progress to ESRD was 21.9 months; factors associated with progression were: older age, diagnosis of glomerulopathies, and advanced-stage CKD at consultation. CONCLUSIONS: Prevalence and incidence of ESRD in Guatemala are lower than in other countries. This may reflect poor access to diagnosis. Areas with higher incidence and large proportion of CKD of undetermined cause are compatible with other studies from the geographic subregion. Findings on progression to ESRD may reflect delayed referral.


OBJETIVO: Describir la distribución de enfermedad renal crónica en niños en Guatemala, y calcular la incidencia y la prevalencia de nefropatía terminal en niños, así como el tiempo de progresión hasta la nefropatía terminal. MÉTODOS: Este estudio analizó el registro del único centro de nefrología pediátrica de Guatemala, del 2004 al 2013. La incidencia y la prevalencia se calcularon por períodos anuales. Se utilizó el índice de Moran como medida de la autocorrelación espacial con objeto de determinar la significación de la distribución geográfica de la incidencia. El tiempo de progresión a la nefropatía terminal, así como los factores de riesgo asociados, se calcularon mediante la regresión de Cox de variables múltiples. RESULTADOS: De 1 545 pacientes menores de 20 años, 432 padecían insuficiencia renal crónica. La prevalencia y la incidencia de nefropatía terminal fueron de 4,9 y 4,6 por millón de habitantes de esa misma edad, respectivamente. La incidencia fue mayor en la costa del Pacífico y en la Ciudad de Guatemala. En 43% de los pacientes la causa de la insuficiencia renal crónica era indeterminada. El tiempo promedio de progresión a una nefropatía terminal fue de 21,9 meses; los factores asociados con esa progresión fueron: la edad mayor, el diagnóstico de glomerulopatía y la enfermedad renal crónica en etapa avanzada en el momento de la consulta. CONCLUSIONES: La prevalencia y la incidencia de la nefropatía terminal en Guatemala son inferiores a las de otros países. Ello podría reflejar un acceso limitado al diagnóstico. La mayor incidencia y la amplia proporción de enfermedad renal crónica de causa indeterminada en algunas zonas son compatibles con las de otros estudios de la subregión geográfica. Los resultados en cuanto a progresión a una nefropatía terminal podrían ser el reflejo de la tardanza en la derivación.


Assuntos
Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Adulto Jovem , Insuficiência Renal Crônica/epidemiologia , Bases de Dados Factuais , Progressão da Doença , Guatemala/epidemiologia , Incidência , Falência Renal Crônica/epidemiologia , Prevalência , Modelos de Riscos Proporcionais , Fatores de Risco , Insuficiência Renal Crônica/etiologia , Sistema Urinário/anormalidades
16.
Rev Panam Salud Publica ; 36(6): 376-82, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25711748

RESUMO

OBJECTIVE: To describe the distribution of pediatric chronic kidney disease (CKD) in Guatemala, estimate incidence and prevalence of pediatric end-stage renal disease (ESRD), and estimate time to progress to ESRD. METHODS: This study analyzed the registry of the only pediatric nephrology center in Guatemala, from 2004-2013. Incidence and prevalence were calculated for annual periods. Moran's index for spatial autocorrelation was used to determine significance of geographic distribution of incidence. Time to progress to ESRD and associated risk factors were calculated with multivariate Cox regression. RESULTS: Of 1 545 patients from birth to less than 20 years of age, 432 had chronic renal failure (CRF). Prevalence and incidence of ESRD were 4.9 and 4.6 per million age-related population, respectively. Incidence was higher for the Pacific coast and Guatemala City. The cause of CRF was undetermined in 43% of patients. Average time to progress to ESRD was 21.9 months; factors associated with progression were: older age, diagnosis of glomerulopathies, and advanced-stage CKD at consultation. CONCLUSIONS: Prevalence and incidence of ESRD in Guatemala are lower than in other countries. This may reflect poor access to diagnosis. Areas with higher incidence and large proportion of CKD of undetermined cause are compatible with other studies from the geographic subregion. Findings on progression to ESRD may reflect delayed referral.


Assuntos
Insuficiência Renal Crônica/epidemiologia , Adolescente , Criança , Pré-Escolar , Bases de Dados Factuais , Progressão da Doença , Feminino , Guatemala/epidemiologia , Humanos , Incidência , Lactente , Recém-Nascido , Falência Renal Crônica/epidemiologia , Masculino , Prevalência , Modelos de Riscos Proporcionais , Insuficiência Renal Crônica/etiologia , Fatores de Risco , Sistema Urinário/anormalidades , Adulto Jovem
18.
Am J Public Health ; 101(7): 1186-91, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21566033

RESUMO

The intellectual property rules inscribed in the Central American Free Trade Agreement have generated concern about access to medicines. We examined the implementation of the new intellectual property regime by tracking the policies and practices in place across 4 Central American countries. Although all 4 were responding to the same requirements under the agreement, their implementation of intellectual property rules differed. Not only were institutional practices different, but the lists of drugs to which intellectual property protection was applied varied in both volume and content. We also found that even without the influence of intellectual property, drug pricing in the region was often unpredictable and that lower cost was not the only motivation driving governments' purchasing decisions.


Assuntos
Indústria Farmacêutica/legislação & jurisprudência , Legislação de Medicamentos , Patentes como Assunto/legislação & jurisprudência , América Central , Custos de Medicamentos/legislação & jurisprudência , Humanos , Preparações Farmacêuticas/normas , Saúde Pública/legislação & jurisprudência , Política Pública
19.
Bull World Health Organ ; 87(10): 787-93, 2009 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19876546

RESUMO

Globalization of intellectual property (IP) protection for medicines has been advancing during the past decade. Countries are obliged to adapt their legislation as a requirement of their membership to the World Trade Organization or as a condition of being part of international trade agreements. There is a growing recognition that, in low-income countries, stronger IP protection is a barrier to access to medicines. At the same time, the number of low-income countries writing national legislation to protect IP for pharmaceutical products is growing worldwide, but little research has been done on the ways in which this process is happening at the national level. This paper aims to contribute to the understanding of the implementation of IP legislation at the national level by providing a comparative analysis of the countries that are part of the United States-Dominican Republic-Central America Free Trade Agreement (DR-CAFTA). The analysis shows three trends. First, countries have often implemented stronger IP protection than required by trade agreements. Second, some countries have adopted IP protection before signing the trade agreements. Third, the process of ratification of DR-CAFTA increased public debate around these issues, which in some cases led to IP legislation that considers public health needs. These trends suggest that industrialized countries and the pharmaceutical industry are using more tactics than just trade agreements to push for increased IP protection and that the process of national legislation is a valid arena for confronting public health needs to those of the industry.


Assuntos
Acesso aos Serviços de Saúde/legislação & jurisprudência , Necessidades e Demandas de Serviços de Saúde/legislação & jurisprudência , Disparidades nos Níveis de Saúde , Propriedade Intelectual , Medicamentos sob Prescrição , América Central , Humanos
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