Racial and socioeconomic disparities in adherence to preventive health services for ovarian cancer survivors.

PURPOSE: To examine ovarian cancer survivors' adherence to evidence-based guidelines for preventive health care. METHODS: A case-control, retrospective study of Medicare fee-for-service beneficiaries diagnosed with stage I, II, or III epithelial ovarian cancer from 2001 to 2010 using the Surveillance, Epidemiology, and End Results-Medicare database. Survivors were matched 1:1 to non-cancer controls from the 5% Medicare Beneficiary file on age, race, state of residence, and follow-up time. Receipt of flu vaccination, mammography, and bone density tests were examined in accordance with national guidelines. Adherence was assessed starting 1 year after cancer diagnosis, across 2 years of claims. Interaction with the health care system, including outpatient and cancer surveillance visits, was tested as a potential mechanism for receipt of services. RESULTS: 2437 survivors met the eligibility criteria (mean age, 75; 90% white). Ovarian cancer survivors were more likely to be adherent to flu vaccination (5 percentage points (pp); < 0.001) and mammography guidelines (10 pp.; < 0.001) compared to non-cancer controls, but no differences were found for bone density test guidelines (- 1 pp.; NS). Black women were less likely to be adherent to flu vaccination and bone density tests compared with white women. Women dually eligible for Medicare and Medicaid were less likely to be adherent compared to those without such support. Adherence was not influenced by measures of outpatient visits. CONCLUSION: Ovarian cancer survivors are receiving preventive services with the same or better adherence than their matched counterparts. Minority and dual-eligible survivors received preventive services at a lower rate than white survivors and those with higher income. The number of outpatient visits was not associated with increased preventive health visits. IMPLICATIONS FOR CANCER SURVIVORS: Ovarian cancer survivors are receiving adequate follow-up care to be adherent to preventive health measures. Efforts to improve care coordination post-treatment may help reduce minority and low SES disparities.

Healthcare Service Access and Utilization among Syrian Refugees in Turkey.

Background Aim: Many Syrian civil war refugees are housed in carefully designed camps, however 60% of all refugees in host countries reside outside of specifically designated camps. Turkey hosts the largest number of refugees displaced in the civil war of Syria. In the present study, we aimed to illustrate healthcare services provided to Syrian refugees in Turkey. METHOD: Data presented in this retrospective observational registry study was obtained from multiple sources including official websites and written communications contributed by Turkish Disaster and Emergency Management Agency(AFAD), Turkish Ministry of Health and Turkish Red Crescent as well as the United Nations High Commissioner for Refugees(UNHCR). The number of refugee camps, total number of refugees housed in these camps, the demographic characteristics of the refugees and a breakdown of social and healthcare services provided in the camps including the number of healthcare professionals serving in the refugee camps were analyzed. RESULTS: According to data from UNHCR as of January 12, 2017, there are 4,904,021 registered refugees from Syria of which 2,854,968 (58.2%) are residing in Turkey. Organized health care services specifically for Syrian refugees in Turkey was first established in April 29, 2011 in Hatay. Preventative health services are also provided for Syrian refugees. Among refugees living in the camps 25% and 33% were not vaccinated for polio and measles respectively. The percentage of unvaccinated refugees living outside the camps were even higher for these viruses (45% for polio and 41% for measles). This poses a public health threat for the population where these refugees reside. CONCLUSION: One of the major concerns for countries hosting refugees from Syria is the introduction of infectious diseases. Of the major deficiencies in refugee health care has been preventative services. Within refugee camps, preventative services for pregnant woman, newborns and young children as well as family planning services are not at optimal levels. These services are even more restricted for refugees living outside of established camps. There have also been shortcomings in the care of the elderly and those with chronic health problems.

Are Nigerian Women Pro-Active about Noncommunicable Disease Prevention? A Quantitative Survey.

BACKGROUND: Noncommunicable diseases (NCDs) continue to cause significant morbidity and mortality worldwide with incidence increasing rapidly in developing countries. Poor utilization of preventive healthcare services contributes to this high burden. OBJECTIVE: To assess the knowledge and utilization of preventive healthcare services among women in Lagos, Nigeria. METHODS: This was a cross-sectional descriptive study carried out at Mainland Local Government Area (LGA) between May and July 2014. Respondents were selected using the multistage sampling method. A pretested, interviewer-administered questionnaire was used to obtain information. Data were analyzed using Epi info software version 7. Summary and inferential statistics were done and the level of significance was set at <5% (p < 0.05). FINDINGS: Awareness of specified NCDs among the 322 respondents was 82.61% and of preventive healthcare services for the NCDs was 65.22%. Virtually all (99.05%) of the respondents had poor knowledge of these preventive services. Utilization rates were equally poor. Most common screening/tests done were Blood Pressure measurement (78.18%), Self breast examination (69.96%) and blood sugar test (58.33%). Much lower utilization rates were recorded for lipid profile (37.57%), Pap smear (26.11%), Visual Inspection with Acetic Acid (VIA) (19.72%), Human Papilloma Virus (HPV) immunization (16.55%) and mammography (14.72%). CONCLUSIONS: Respondents were aware of specified NCDs and preventive healthcare services. They considered routine medical check-up important, however they had poor knowledge of the preventive health services for NCDs and hardly utilized them. Women should be given detailed information on the preventive healthcare services to improve their knowledge and utilization so as to reduce the NCD burden.

["VigilanSeu.r.se": A new profession?] / « VigilanSeu.r.se ¼ : un nouveau métier ?

In January 2015, in accordance with decades of scientific work based on maintaining contact, was born an innovative device for suicide prevention: VigilanS. To ensure this link, the choice was made to build a team with an equal number of nurses and psychologists, all located within the medical regulation. Nowadays, they are named "VigilanSeur": an original entity that highlights the emergence of this new profession, at the crossroads of several disciplines.

El cuidado de la salud del Ejército de los Andes del general San Martín / The health care of the Army of Andes of General San Martín

A través de la revisión de documentos históricos y otras fuentes bibliográficas, y desde la perspectiva de la enfermería, se describen los recursos y prácticas sanitarias con que contaba el equipo de salud que acompañó al cuerpo del Ejército de los Andes al mando del general José de San Martín desde el inicio del cruce de los Andes el 19 de enero en las Provincias Unidas del Río de la Plata, hasta finalizada la batalla de Chacabuco, en la Capitanía General de Chile, el 12 de febrero de 1817. Este trabajo nos permite conocer el trabajo de los primeros sanitarios militares que asistieron en el cuidado de los soldados de los ejércitos patrios y contribuir así a difundir la historia de la Medicina Argentina. (AU)

Through the review of historical documents and other bibliographic sources, and from the perspective of nursing, we describe the health resources and practices held by the health team that accompanied the Army of Los Andes under the command of General José de San Martín, from the start of crossing Los Andes on January 19th in the Provincias Unidas del Río de la Plata, to finish in the battle of Chacabuco, in the General Captaincy of Chile on February 12th, 1817. This work allows us to know the work of the first military health professionals who assisted in the care of the soldiers of the patriotic armies and contribute to spread the history of the Argentine Medicine. (AU)

Acciones motivacionales para promover actividad física en la comunidad que asiste a un Hospital Universitario / Taking action for promoting physical activity in the community attending a university hospital

Introducción: el sedentarismo ha llegado para quedarse. Cualquier tipo de acción para combatirlo será de gran utilidad; solo bastará con conocer su eficacia y con que la gente se adhiera. Métodos: se ha realizado un estudio cuasi experimental antes-después no controlado, con 3 intervenciones aditivas sobre la población que concurre al Hospital Italiano de Buenos Aires (Hospital Universitario). Se comparó la proporción de personas que usaban la escalera mecánica con aquellas que subían por la escalera convencional, antes y después de las siguientes intervenciones: con autoadhesivos que anunciaban las calorías perdidas al subir cada escalón, luego se agregaron carteles acerca del beneficio de hacer actividad física y, por último, se entregaron folletos sobre los beneficios de hacer actividad física. Resultados: se realizaron 39 967 observaciones. Cada intervención significó un aumento de personas que subían por la escalera convencional (P < 0,001). Con la intervención de los autoadhesivos se produjo un incremento del 2,39% frente al basal (11,07% - 8,68%, p=0,001) de personas que subieron por la escalera convencional. La intervención autoadhesivos + cartel aumentó 2,33% (13,4% -11,07%, p=0,001) y la intervención autoadhesivos + cartel + folletos produjo un aumento del 1,09% (14,49%-13,4%, p=0,03). Interpretación: en este estudio se midió cuál era el beneficio de las intervenciones para promover que más gente utilizara la escalera convencional; cada una de ellas proveyó una mayor cantidad de personas que, adoptando una actitud más activa, subieron por la escalera convencional. Medidas sencillas y económicas muestran un gran cambio en promover la actividad física. (AU)

Background: The sedentary lifestyle has become predominant in our society. Any measures taken to fight it are useful, it's just necessary to know their effectiveness and get people to stick with them. Methods: we performed a quasi-experimental pre-post study testing three persistent interventions on the population that attends a university hospital. Its main entrance allows the access to different areas through stairs, escalators or an elevator. We took baseline data on the number of people who took the escalator or the stairs. Then we performed progressive interventions designed to promote the use of the stairs. First, we used stickers placed on in each step that announced the amount of calories burned per step climbed. Then, we placed banners which informed the benefits of physical activity. Lastly, brochures were handed out with a list of benefits of doing physical activity. We quantified the number of people taking the stairs or the escalator with each intervention. Results: in eight weeks 39·967 observations were performed. Each intervention found an increase in the number of people that decided to take the stairs. At baseline, 880 people used the escalator and 9264 people took the stairs. With the first intervention, i.e. the use of stickers on the steps, there was an increase of 2·39% in the number of people that took the stairs compared to baseline data (from 8·68% to 11·07%, p=0.001). With the second intervention, i.e. stickers plus physical activity promotion banners, there was an additional increase of 2·33% (from 11·07% to 13·40%, p=0.001) in the proportion of people taking the stairs. Finally, the intervention of stickers in addition to the banners and brochures about benefits of physical activity, was associated with an increase of 1·09% (from 13·40% to 14·49%, p=0.03). Discussion: in this study we aimed to measure the benefits of multiple interventions to promote physical activity in a university hospital setting. Each intervention was associated with a larger number of people that decided to take the stairs instead of taking the escalator or the elevator. The interventions were simple, cheap and very effective to promote change independently from gender, age or health conditions. (AU)

[Investigation and strategy research of eye disease prevention resources in community health service centers in Shanghai].

OBJECTIVE: To investigate the status of eye disease prevention resources in community health service centers, to understand the distribution of ophthalmology service resources in each community, and to understand the main problems existing in the work of blindness prevention and treatment in Shanghai, so as to strengthen the prevention of blindness and improve the primary eye care level. METHODS: Using the survey method, we carried out the investigation of disease control and prevention resources in all community health service centers to obtain the data of eye disease prevention and treatment resources. Using the descriptive statistics, we described the distribution of resources of eye disease prevention and treatment in different districts. RESULTS: There were 244 communities in 17 districts and counties in Shanghai, of which 236 (96.72%) communities participated in the survey and completed the questionnaires. Forty-nine (20.8%) communities had independent outpatient departments of ophthalmology, 96 (40.7%) had departments of ophthalmology and otorhinolaryngology, 33 (14%) had ophthalmology doctor visits from secondary or tertiary medical institutions, and 87 (36.9%) had no outpatient department of ophthalmology. There were 82 oculists, 129 general or otorhinolaryngology doctors treating eye disease, 9 ophthalmic nurses, and 1 optometrist. There were 36 specialized personnel for public health of eye protection and 217 part-time personnel. Moreover, there were a total of 1 103 pieces of ophthalmic equipment in all communities with the use rate of 91%. CONCLUSIONS: Uneven ophthalmology resources and eye care professional ability in community health service centers, lack of technical and public health personnel for prevention of eye disease, backward eye disease screening equipment, and inadequate investment in prevention and treatment of eye disease are major problems. More government supports for prevention and treatment of eye disease in communities and continuous improvement in three-level blindness prevention network systems and information construction are needed.

The impact of directed choice on the design of preventive healthcare facility network under congestion.

Preventive healthcare (PH) programs and services aim at reducing the likelihood and severity of potentially life-threatening illness by early detection and prevention. The effectiveness of these programs depends on the participation level and the accessibility of the users to the facilities providing the services. Factors that impact the accessibility include the number, type, and location of the facilities as well as the assignment of the clients to these facilities. In this paper, we study the impact of system-optimal (i.e., directed) choice on the design of the preventive healthcare facility network under congestion. We present a model that simultaneously determines the location and the size of the facilities as well as the allocation of clients to these facilities so as to minimize the weighted sum of the total travel time and the congestion associated with waiting and service delay at the facilities. The problem is set up as a network of spatially distributed M/G/1 queues and formulated as a nonlinear mixed integer program. Using simple transformation of the nonlinear objective function and piecewise linear approximation, we reformulate the problem as a linear model. We present a cutting plane algorithm based exact (𝜖-optimal) solution approach. We analyze the tradeoff between travel time and queuing time and its impact on the location and capacity of the facilities as well as the allocation of clients to these facilities under a directed choice policy. We present a case study that deals with locating mammography clinics in Montreal, Canada. The results show that incorporating congestion in the PH facility network design substantially reduces the total time spent by clients. The proposed model allows policy makers to direct clients to facilities in an equitable manner resulting in better accessibility.

Improving delivery of Bright Futures preventive services at the 9- and 24-month well child visit.

OBJECTIVES: To determine if clinicians and staff from 21 diverse primary care practice settings could implement the 2008 Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents, 3rd edition recommendations, at the 9- and 24-month preventive services visits. METHODS: Twenty-two practice settings from 15 states were selected from 51 applicants to participate in the Preventive Services Improvement Project (PreSIP). Practices participated in a 9-month modified Breakthrough Series Collaborative from January to November 2011. Outcome measures reflect whether the 17 components of Bright Futures recommendations were performed at the 9- and 24-month visits for at least 85% of visits. Additional measures identified which office systems were in place before and after the collaborative. RESULTS: There was a statistically significant increase for all 17 measures. Overall participating practices achieved an 85% completion rate for the preventive services measures except for discussion of parental strengths, which was reported in 70% of the charts. The preventive services score, a summary score for all the chart audit measures, increased significantly for both the 9-month (7 measures) and 24-month visits (8 measures). CONCLUSIONS: Clinicians and staff from various practice settings were able to implement the majority of the Bright Futures recommended preventive services at the 9- and 24-month visits at a high level after participation in a 9-month modified Breakthrough Series collaborative.

Actuación ante una lesión percutanea contaminada con sangre / Managemetn of blood-contaminated percutaneous injury

Analizamos en este artículo las normas fundamentales para la prevención de las punciones accidentales por parte de los trabajadores sanitarios, así como los pasos a seguir una vez que se ha producido la punción accidental

In the current paper we have assessed the main guidelines for prevention of accidental puntures by helthcare workers as well s the recommended steps to follow once the punture has occurred

Encuestas nacionales de ceguera y deficiencia visual evitables en Argentina, El Salvador, Honduras, Panamá, Perú y Uruguay / National surveys of avoidable blindness and visual impairment in Argentina, El Salvador, Honduras, Panama, Peru, and Uruguay

OBJETIVO: Describir la justificación y metodología usadas en la Evaluación Rápida de Ceguera Evitable empleada para efectuar encuestas a nivel nacional entre 2011 y 2013 en Argentina, El Salvador, Honduras, Panamá, Perú y Uruguay. MÉTODOS: La encuesta se dirige a personas de 50 años o más, lo que reduce al mínimo los requisitos de tamaño de la muestra, que oscila entre 2 000 y 5 000 personas. Se emplean sistemas simples de muestreo y técnicas de examen; el análisis de datos es automático y no requiere de un experto en estadística. Es relativamente económica, ya que no toma mucho tiempo, no requiere equipos oftalmológicos costosos y puede ser llevada a cabo por el personal local. Los informes son generados mediante el propio programa informático de la evaluación. RESULTADOS: Los indicadores generados son la prevalencia de la ceguera y la deficiencia visual severa y moderada (discriminadas por causas evitables y cataratas); la prevalencia de afaquia o pseudofaquia; la cobertura de la cirugía de cataratas; el resultado visual de las cirugías de cataratas; las causas de resultados malos; las barreras de acceso a la cirugía de cataratas; y los indicadores de servicio de la cirugía de cataratas. Los resultados de cada una de las encuestas serán publicados de manera secuencial en números sucesivos de la revista, y en un artículo final de resumen se hará un análisis de los resultados en su conjunto y comparativo entre las encuestas y con aquellas publicadas anteriormente, que aportará un estado de la situación actual en ese grupo de países. CONCLUSIONES: La Evaluación Rápida de Ceguera Evitable es una metodología sólida, sencilla y económica para determinar la prevalencia de ceguera y deficiencia visual y la cobertura y calidad de los servicios de salud ocular, y representa una herramienta muy valiosa para medir el progreso de los programas de prevención de la ceguera y su impacto en la población.

OBJECTIVE: Describe the rationale and methodology of the Rapid Assessment of Avoidable Blindness applied in surveys at the national level in 2011-2013 in Argentina, El Salvador, Honduras, Panama, Peru, and Uruguay. METHODS: The survey includes individuals aged 50 years and older, minimizing required sample sizes, which vary from 2 000 to 5 000 people. It uses straightforward sampling and examination techniques, and data analysis is automatic and does not require a statistician. It is relatively inexpensive, as it does not take a long time, does not require expensive ophthalmic equipment, and can be carried out by local staff. Reports are generated by the assessment software package. RESULTS: Indicators measured are prevalence of blindness and of moderate and severe visual impairment (broken down into avoidable causes and cataracts); prevalence of aphakia or pseudophakia; cataract surgical coverage; visual outcome of cataract surgeries; causes of poor outcomes; access barriers to cataract surgery; and cataract surgery service indicators. Results of each survey will be published sequentially in successive issues of the Journal, and a final summary article will analyze results as a whole and in comparison with the other surveys in this group and with those previously published, which will provide a current picture of the situation in this group of countries. CONCLUSIONS: The Rapid Assessment of Avoidable Blindness is a robust, simple, and inexpensive methodology to determine prevalence of blindness and visual impairment as well as eye health service coverage and quality. It is a very valuable tool for measuring progress by blindness prevention programs and their impact on the population.

National surveys of avoidable blindness and visual impairment in Argentina, El Salvador, Honduras, Panama, Peru, and Uruguay.

OBJECTIVE: Describe the rationale and methodology of the Rapid Assessment of Avoidable Blindness applied in surveys at the national level in 2011-2013 in Argentina, El Salvador, Honduras, Panama, Peru, and Uruguay. METHODS: The survey includes individuals aged 50 years and older, minimizing required sample sizes, which vary from 2 000 to 5 000 people. It uses straightforward sampling and examination techniques, and data analysis is automatic and does not require a statistician. It is relatively inexpensive, as it does not take a long time, does not require expensive ophthalmic equipment, and can be carried out by local staff. Reports are generated by the assessment software package. RESULTS: Indicators measured are prevalence of blindness and of moderate and severe visual impairment (broken down into avoidable causes and cataracts); prevalence of aphakia or pseudophakia; cataract surgical coverage; visual outcome of cataract surgeries; causes of poor outcomes; access barriers to cataract surgery; and cataract surgery service indicators. Results of each survey will be published sequentially in successive issues of the Journal, and a final summary article will analyze results as a whole and in comparison with the other surveys in this group and with those previously published, which will provide a current picture of the situation in this group of countries. CONCLUSIONS: The Rapid Assessment of Avoidable Blindness is a robust, simple, and inexpensive methodology to determine prevalence of blindness and visual impairment as well as eye health service coverage and quality. It is a very valuable tool for measuring progress by blindness prevention programs and their impact on the population.

Fomentar la cultura preventiva entre trabajadores y empresarios / Preventive promote culture between workers and employers

Desde hace más de una década, la entidad trabaja activamente en la puesta en marcha de acciones preventivas que mejoren las condiciones de seguridad y salud de los trabajadores y empresarios de la zona (AU)

For more than a decade, the company is active in the implementation of preventive actions to improve the safety and health of workers and employers in the area (AU)

Workplace health promotion implementation, readiness, and capacity among midsize employers in low-wage industries: a national survey.

OBJECTIVE: To describe workplace health promotion (WHP) implementation, readiness, and capacity among midsize employers in low-wage industries in the United States. METHODS: A cross-sectional survey of a national sample of midsize employers (100 to 4999 employees) representing five low-wage industries. RESULTS: Employers' WHP implementation for both employees and employees' spouses and partners was low. Readiness scales showed that employers believe WHP would benefit their employees and their companies, but they were less likely to believe that WHP was feasible for their companies. Employers' capacity to implement WHP was very low; nearly half the sample reported no capacity. CONCLUSION: Midsize employers in low-wage industries implement few WHP programs; their responses to readiness and capacity measures indicate that low capacity may be one of the principal barriers to WHP implementation.

Characteristics of U.S. emergency departments that offer routine human immunodeficiency virus screening.

OBJECTIVES: The association between emergency department (ED) characteristics, ED director's perceptions of preventive services, and the availability of human immunodeficiency virus (HIV) screening are unknown. The authors hypothesized that, after adjusting for ED operational and demographic characteristics, teaching hospital status would be associated with increased availability, and ED crowding and ED director agreement with barriers to screening would be associated with decreased availability. METHODS: This was a secondary, cross-sectional analysis on previously collected data from 2008 to 2009 regarding availability of ED preventive services. Data were obtained from a random sample of 277 EDs in which ED directors provided information on ED characteristics and availability of HIV screening and rated five barriers to providing preventive services. The association between the availability of HIV screening and teaching hospital and crowding status, ED volume, urban-rural location, ownership, geographic region, patient demographics, state HIV testing consent laws, and ED director opinions on barriers to providing preventive services were determined in univariate analyses and a multivariate logistic regression model. RESULTS: Nineteen percent of the sampled EDs offer HIV screening. Teaching hospitals offer HIV screening more frequently than nonteaching hospitals (38% vs. 18%; p = 0.03), but after adjusting for other characteristics in a multivariate model, this association was not significant (relative risk ratio [RR] = 2.07, 95% confidence interval [CI] = 0.91 to 3.59). ED crowding also was not significantly associated with screening availability (RR = 0.66, 95% CI = 0.34 to 1.21). However, public ownership (RR = 2.13, 95% CI = 1.28 to 3.14), 24-hour social work (RR = 1.87, 95% CI = 1.02 to 2.99), uninsured population ≥35% (RR = 2.48, 95% CI = 1.39 to 3.69), increased local nonwhite minority population percentage (RR = 1.14 per 10%, 95% CI = 1.02 to 1.26), and state laws allowing opt-out consent for testing (RR = 1.76, 95% CI = 1.01 to 2.74) were associated with increased availability of screening in multivariable analysis. EDs whose directors were concerned about added costs were associated with decreased availability of screening (RR = 0.45, 95% CI = 0.23 to 0.85). CONCLUSIONS: After adjusting for other ED operational and demographic characteristics, ED crowding and teaching hospital affiliation were not independently associated with the availability of HIV screening. EDs whose directors were concerned about the cost of preventive services were less likely to provide routine HIV screening. Addressing ED director's concerns about the added costs of ED preventive services, increasing social work availability, and implementing testing laws consistent with Centers for Disease Control and Prevention (CDC) recommendations may facilitate increased adoption of ED HIV screening.

[Tourism, imported parasitic diseases, and their prevention].

The paper gives the results of observations of 1558 patients before and after tourist travels to tropical countries and 368 individuals visiting the north areas of the Russian Federation. Different conditions (malaria, amebiasis, leishmaniasis, intestinal and tissue helminthiasis, insect bites, venomous fish pricks, medusa burn, tick bites, etc.) were found in 402 persons. Prophylactic immunization included vaccination against hepatitis A and B viruses, meningitis, typhus, yellow fever, tick-borne encephalitis in more than 2500 patients (not including influenza vaccination in the epidemic season). The performed observations reinforce the statement that imported pathology is urgent to Russia and suggest that it is necessary to develop this section of medicine and to set up a network of health care facilities with a necessary therapeutic and diagnostic base to render skilled care to tourists. It is essential to improve medical staff training in travel medicine.

Cobertura de programas preventivos en Chile / Coverage with preventive programs in Chile

Introducción: Los Programas de Medicina Preventiva para que tengan un impacto en el nivel de salud deben tener una alta cobertura poblacional. Objetivo: Estudiar la cobertura de los programas preventivos que se realizaron en el Sistema de Salud Público Chileno el año 2007. Material y Métodos: Se revisó la cobertura de los programas preventivos en las bases de datos del Departamento de Estadísticas e Información en Salud del Ministerio de Salud de Chile del año 2007. Resultados: La cobertura global de los programas preventivos medido a través del Índice de Medicina Preventiva fue de0.202. El programa de salud dirigido a los < de 6 años (infantil) fue el que registró una mayor cobertura (0.84), un nivel de cobertura intermedio se observó en los programas de la mujer (0.34) y del adulto mayor (0.29), por su parte los programas dirigidos a la población escolar, adolescente y adulto fueron los que presentaron menores coberturas (<0.1). Discusión: La alta cobertura observada en el programa preventivo dirigido a la población infantil, ha sido un factor que ha favorecido la mejoría en el nivel de salud de este grupo poblacional, particularmente ha contribuido a reducirla mortalidad infantil en Chile. El país debe crear estrategias que permitan incrementar la cobertura en programas preventivos dirigidos a la población escolar, adolescente y adulta, solo de esta forma podrá seguir avanzando en la senda de mejorar el nivel de salud poblacional.

Introduction: In order to have an impact on the level of health, Preventive Medicine Programs should have high population coverage. Objective: To study the coverage of preventive programs which were conducted in the Chilean Public Health System in 2007. Material and Methods: The coverage of preventive programs in the databases of the Department of Health Statistics and Information of the Chilean Ministry of Health in the year 2007 were reviewed. Results: The overall coverage of preventive programs as measured by the index of Preventive Medicine was 0.202. The health program aimed at < 6 years (children) was the one that recorded a greatest coverage (0.84). An intermediate level of coverage was observed in the women’s program (0.34) and in that of elderly (0.29). Programs conducted for school children, teenagers, and adults presented a low coverage (<0.1). Discussion: The high coverage observed in the child health preventive program, has been a factor that has led to the improvement of the health status of this population group. Particularly, it has contributed to reduce the infant mortality in Chile. The country must create strategies to increase the coverage of preventive programs aimed at schoolchildren, teenagers and adults. Only in this way we can go on improving the level of population health.

New Jersey's efforts to improve postpartum depression care did not change treatment patterns for women on medicaid.

Identification and treatment of postpartum depression are the increasing focus of state and national legislation, including portions of the Affordable Care Act. Some state policies and proposals are modeled directly on programs in New Jersey, the first state to require universal screening for postpartum depression among mothers who recently delivered babies. We examined the impact of these policies on a particularly vulnerable population, Medicaid recipients, and found that neither the required screening nor the educational campaign that preceded it was associated with improved treatment initiation, follow-up, or continued care. We argue that New Jersey's policies, although well intentioned, were predicated on an inadequate base of evidence and that efforts should now be undertaken to build that base. We also argue that to improve detection and treatment, policy makers contemplating or implementing postpartum depression mandates should consider additional measures. These could include requiring mechanisms to monitor and enforce the screening requirement; paying providers to execute screening and follow-up; and preliminary testing of interventions before policy changes are enacted.