Fatores associados à busca por serviços preventivos de saúde entre adultos brasileiros: Pesquisa Nacional de Saúde, 2013 / Factors associated with preventive health services search among Brazilian adults: National Health Survey, 2013

Resumo O objetivo deste artigo é verificar os fatores associados à busca por serviços preventivos de saúde pela população adulta brasileira. A amostra foi composta por participantes da Pesquisa Nacional de Saúde (2013), que relataram procura por algum serviço de saúde nos últimos 15 dias, classificado em "tratamento/diagnóstico" ou "preventivo". As variáveis exploratórias incluíram sexo, faixa etária, cor de pele, estado conjugal, escolaridade, localização do domicílio, posse de plano privado de saúde e tempo de cadastro na ESF. As associações foram verificadas pelas razões de prevalência (RP), obtidas pelo modelo de Poisson, considerando a complexidade do desenho amostral. A amostra foi composta por 32.377 indivíduos que buscaram o serviço de saúde, sendo 12,94% para ações "preventivas". A procura por estes cuidados foi mais frequente entre mulheres e menos frequente entre os mais velhos, que não viviam com companheiro, com menor escolaridade. Não possuir plano privado de saúde foi associado a menor busca por prevenção. Ser adscrito à ESF não foi associada a busca por ações preventivas. Mesmo com os esforços e com o reconhecimento da importância da prevenção, a maioria dos indivíduos ainda busca os serviços de saúde para tratamento.

Abstract The objective of this article is to examine factors associated with preventive health services search among Brazilian adults. Sample included adults participants from the National Health Survey (2013), that had reported any health service search in prior 15 days, categorized into "treatment/diagnosis" or "preventive" service. Exploratory variables included sex, age, race, marital status, education, household situation, private health plan enrolment and time of FHS enrolment. Associations were verified by prevalence ratios (PR), estimated using robust Poisson regression, considering complexity of sampling parameters. Final sample included 32,377 individuals, 12,94% have searched "preventive" services. Preventive search was more often among women and less often among the older adults, those not living with partner, with less education. Having private health plan was associated with less preventive services search. FHS enrolment were not associated with preventive search. By conclusion, although some efforts and the importance of preventive actions, most of individuals search for treatment services.

Preventive health services and physical activity improve health-related quality of life in Mexican older adults / Los servicios de salud preventivos y la actividad física mejoran la calidad de vida relacionada con la salud en adultos mayores mexicanos

Abstract: Objective: To evaluate the combined use of IMSS preventive health services (PHS) and the practice of physical activity (PA) in order to determine their association with the perceived health-related quality of life (HRQoL) of older adults. Materials and methods: A survey-based cross-sectional study was conducted at nine primary health care units (PHCUs) in Mexico City. The 36-Item Short-Form Health Survey evaluated the HRQoL, while PA and PHS use were assessed through self-report. Linear regression analyses were performed to determine the relationship between these three variables. Results: Of the 1 085 older adults who participated in the study, 36.8% used PHS, and 23.3% reported that they engage in PA. After controlling for possible effects due to sociodemographic and health differences, we found that participants who were physically active and used PHS reported better perceived HRQoL scores. Conclusions: The combined use of preventive practices such as the use of PHS and the practice of PA can help improve the perceived HRQoL of older adults.

Resumen: Objetivo: Determinar la asociación del uso combinado de servicios de salud preventiva (SSP) y la práctica de la actividad física (AF) sobre la calidad de vida relacionada con la salud (CVRS) de los adultos mayores en México. Material y métodos: Estudio transversal en unidades de atención primaria. La percepción de CVRS fue evaluada a través del instrumento SF-36; el nivel de AF, y el uso de SSP, a través de auto-reporte. Se realizaron análisis de regresión lineal para determinar la relación entre estas tres variables. Resultados: De los 1 085 adultos mayores que participaron en el estudio, 36.8% usaron SSP y 23.3% informaron practicar AF. Los adultos mayores físicamente activos y que usaban SSP reportaron una mejor puntuación de CVRS percibida, ajustando por variables de salud y sociodemográficas. Conclusiones: Prácticas preventivas como la actividad física en conjunto con el uso de servicios preventivos pueden ser útiles para mejorar la percepción de CVRS de los adultos mayores.

Preventive healthcare-seeking behavior among poor older adults in Mexico: the impact of Seguro Popular, 2000-2012 / Comportamiento en cuidado preventivo de salud entre adultos pobres mayores en México: impacto del Seguro Popular, 2000-2012

Abstract: Objective: Determine the effect of Seguro Popular (SP) on preventive care utilization among low-income SP beneficiaries and uninsured elders in Mexico. Materials and methods: Fixed-effects instrumental-variable (FE-IV) pseudo-panel estimation from three rounds of the Mexican National Health and Nutrition Survey (2000, 2006 and 2012). Results: Our findings suggest that SP has no significant effect on the use of preventive services, including screening for diabetes, hypertension, breast cancer and cervical cancer, by adults aged 50 to 75 years. Conclusions: Despite the evidence that suggests that SP has increased access to health insurance for the poor, inequalities in healthcare access and utilization still exist in Mexico. The Mexican government must keep working on extending health insurance coverage to vulnerable adults. Additional efforts to increase health care coverage and to support preventive care are needed to reduce persistent disparities in healthcare utilization.

Resumen: Objetivo: Determinar el efecto del Seguro Popular (SP) en la utilización de la atención preventiva entre beneficiarios de SP de bajos ingresos y ancianos sin seguro en México. Material y métodos: Estimación de pseudopanel de variables instrumentales de efectos fijos (FE-IV) en tres rondas de la Encuesta Nacional de Salud y Nutrición de México (2000, 2006 y 2012). Resultados: El SP no tiene un efecto significativo en el uso de los servicios preventivos, incluida la detección de diabetes, hipertensión, cáncer de mama y cáncer de cuello uterino en adultos de 50 años o más. Conclusiones: Aún existen desigualdades en el acceso a la asistencia médica en México. El gobierno mexicano debe seguir trabajando para extender la cobertura del seguro de salud a la población más vulnerable. Se necesitan esfuerzos adicionales para aumentar la cobertura de atención médica y apoyar la atención preventiva para reducir las disparidades persistentes.

Funcionalidad del adulto mayor de un Centro de Salud Familiar / Functionality of elderly in a Family Health CenterHualpén-Chile

Introducción: la población chilena no ha quedado ajena al proceso de envejecimiento experimentado a nivel mundial, tomando especial énfasis la evaluación geriatría integral como estrategia para detectar de manera oportuna la disminución de la funcionalidad en personas de avanzada edad. Objetivo: determinar la funcionalidad de los adultos mayores pertenecientes al sector 3 del Centro de salud familiar Talcahuano Sur. Métodos: estudio descriptivo de corte transversal llevado a cabo en un centro de salud familiar considerando un 57 por ciento de los adultos mayores del sector 3, seleccionados mediante muestreo de oportunidad (n=72) independiente el sexo y a quienes se les aplicó el Examen Médico Preventivo del Adulto Mayor mientras asistían a su control de salud con enfermera, previa firma del consentimiento informado. Para el análisis de datos se utilizó el programa InfoStat, haciendo uso de estadística descriptiva. Resultados: la edad promedio de los adultos mayores fue de 72 años, con escolaridad básica en 70,9 por ciento . El 97 por ciento presentó alguna patología crónica, prevaleciendo la hipertensión (84,7 por ciento ), y dislipidemia (72,2 por ciento ). En cuanto a la funcionalidad, un 54,2 por ciento era autovalente, un 44,4 por ciento era autovalente con riesgo y un 1,4 por ciento tenía riesgo de dependencia. La totalidad de la población presentó un estado cognitivo normal con un promedio de 18,5 puntos. Un 16,9 por ciento presentó riesgo de caídas. Conclusión: los adultos mayores presentaron altos niveles de funcionalidad y ausencia de deterioro cognitivo, permitiéndoles desarrollar sus actividades de la vida diaria sin mayores problemas, sin embargo, existen factores que amenazan constantemente su funcionalidad, siendo indispensable la detección y control oportuno(AU)

Introduction: The Chilean population has not been outside the aging process experiencing worldwide, taking special emphasis integral geriatric assessment as a strategy to timely detect decreased functionality elderly. Objetive: To determine the functionality of Older Adults belonging to the sector 3 CESFAM Talcahuano Sur. Methods: A descriptive cross-sectional study carried out in a family health center whereas 54 percent of elderly in the sector 3, selected by opportunity sampling (n = 72 ) to separate sex were administered the Elderly Preventive Clinical Test while attending their health control with a nurse, after signing informed consent. For the data analysis program was used InfoStat, using descriptive statistics. Results: The average age of the elderly was 72 years, 70.9 percent in primary school. A 97 percent had a chronic disease, prevalent hypertension (84.7 percent ), and dyslipidemia (72.2 percent ). In terms of functionality, 54.2 percent were independent, 44.4 percent were at risk independent and 1.4 percent were at risk of dependence. The entire population had normal cognitive status with an average of 18.5 points. A 16.9 percent had a risk of falling. Conclusion: Older Adults with high levels of functionality and absence of cognitive impairment, allowing them to develop their activities of daily living without major problems, but there are factors that constantly threaten their functionality being essential detection and opportune control(AU)

Características asociadas a la consulta pre viaje en turistas que visitan Cusco, Perú / Characteristics associated with pre travel medical consultation in tourists visiting Cuzco, Peru

Background: International tourism is increasing. Preventive Medicine remains important, especially the Pre-Travel Consultation (PTC). Objective: To determinate, the characteristics of tourists associated with PTC in tourists at Cuzco, Peru. Methods: A cross-sectional, analytical study, a secondary analysis of data from a database generated by survey of foreign tourists who visited Cuzco, in the waiting room of the airport was performed. The main variable was to have had a PTC at the tourist's country of residence, the area of residence was categorized according to health/risk of acquiring infectious diseases as traveler's diarrhea during their stay. These and other variables were analyzed and statistical association with generalized linear models were done. Results: Of the 1827 tourists, 875 (48%) were men, with a median age of 33 years (range 18-88 years); 42% had a PTC. In the multivariate analysis, it was found that a PTC lower frequency was associated with male gender (aPR: 0.84; 95% CI: 0.75-0.94), and a higher frequency was associated with have born (aPR: 1.77; 95% CI: 1.39-2.27) and reside in an area of low risk of acquiring infectious diseases (aPR: 1.95; 95% CI: 1.26-3.00), adjusted for the history of a disease. Conclusions: Sex, region of birth and residence of tourists (as risk of acquiring infectious diseases) are associated with having a PTC. These findings may serve the health and government attending tourists who come to our country.

Introducción: El turismo internacional continúa aumentando, siendo la medicina preventiva un pilar importante, como las consultas pre viaje (CPV). Objetivo: Determinar las características del turista asociadas a CPV en turistas que visitan Cusco. Materiales y Métodos: Estudio analítico transversal, de análisis de datos secundarios, a partir de una base de datos generada por encuesta aplicada a turistas extranjeros que visitaron el Cusco, en la sala de espera del aeropuerto. La variable principal fue haber tenido CPV en el país de residencia del turista. La zona de residencia se categorizó según la salubridad/riesgo de los turistas para adquirir enfermedades-infectocontagiosas como la diarrea del viajero durante su estadía. Estas y otras variables fueron analizadas y se obtuvieron estadísticos de asociación con los modelos lineales generalizados. Resultados: De los 1.827 turistas, 875 (48%) fueron hombres, con mediana de edad de 33 años (rango 18-88 años). El 42% tuvo una CPV. En el análisis multivariado, se encontró que estuvo asociado a una menor frecuencia de CPV el sexo masculino (RPa: 0,84; IC 95%: 0,750,94%), y a una mayor frecuencia de CPV el haber nacido (RPa: 1,77; IC 95%: 1,39-2,27) y residir en una zona de bajo riesgo para adquirir enfermedades infecciosas (RPa: 1,95; IC 95%: 1,26-3,00), ajustado por el antecedente de una enfermedad. Discusión: El sexo, la zona de nacimiento y residencia del turista (según riesgo de adquirir enfermedades infecciosas) son factores asociados a tener una CPV. Estos hallazgos pueden servir a las instituciones de salud y gubernamentales que atienden a turistas que vienen a nuestro país.

Salas de consumo higiénico en España (2000-2013) / Drug consumption rooms in Spain (2000-2013)

El objetivo de esta revisión es presentar una nueva interpretación de los resultados de la bibliografía sobre las salas de consumo higiénico (SCH) de España publicados en el periodo 2000-2013. Se realizó una búsqueda bibliográfica en las bases de datos PubMed, Índice Bibliográfico Español en Ciencias de la Salud (IBECS), Índice Médico Español (IME), Scientific Electronic Library Online (SciELO) y SIIS Centro de Documentación y Estudios, en otras fuentes secundarias y solicitando información a los profesionales de las SCH. Se seleccionaron 21 artículos o informes de investigación, 17 presentaciones o comunicaciones en jornadas y/o congresos especializados, 5 reportajes y 2 memorias de actividad, para la realización de una metasíntesis desglosada en diferentes temáticas. La apertura de las SCH es una estrategia de salud pública con efectos positivos para los consumidores de drogas y todo el conjunto de la sociedad, pero esta revisión constata que son necesarias mejoras técnicas, estratégicas y de funcionalidad para aumentar su efectividad.

The aim of this review is to provide a new interpretation of the results found in the scientific literature on drug consumption rooms (DCR) in Spain published from 2000-2013. A search was carried out using several data bases - PubMed, Índice Bibliográfico Español en Ciencias de la Salud (IBECS), Índice Médico Español (IME), Scientific Electronic Library Online (SciELO) and SIIS Centro de Documentación y Estudios - as well as other secondary sources and information solicited from professionals of DCR. A total of 21 articles or research reports, 17 presentations or speeches in specialized conferences, 5 journalistic reports and 2 institutional records were included in a meta-synthesis divided into different thematic areas. The opening of DCR is a public health strategy with positive effects for drug consumers and society as a whole, but this review demonstrates that technical, strategic and functional improvements are necessary to increase their effectiveness.

Preventive health screening utilization in older Mexicans before and after healthcare reform / Revisiones preventivas de salud en adultos mayores mexicanos antes y después de la reforma en salud

Objective. To assess changes in preventive screening utilization in older Mexicans, pre- and post-Seguro Popular. Materials and methods. Data from the Mexican Health and Aging Study (MHAS/Enasem) 2001 and 2012 were used. Logistic and ordinary least squares regression adjusted models were used to predict preventive care in 2012 by insurance status categories in 2001-2012, as the focus explanatory variable. Results. Participants who were uninsured in 2001 and had Seguro Popular in 2012 were significantly more likely to be tested for diabetes, high blood pressure and receive a tetanus shot than the continually uninsured. Conclusions. While disparities in preventive screening between the insured and uninsured continue to exist in Mexico, Seguro Popular seems to have provided better access to health services to prevent chronic and infectious diseases for the otherwise uninsured population.

Objetivo. Evaluar los cambios en el uso de pruebas preventivas en adultos mayores mexicanos, antes y después de haber adquirido el Seguro Popular. Material y métodos. Los datos utilizados provienen del Estudio Nacional de Salud y Envejecimiento en México (Enasem) 2001 y 2012. Se utilizaron modelos de regresión logística y mínimos cuadrados ordinarios, ajustados para predecir la atención preventiva en 2012, de acuerdo con el status de los seguros durante el periodo 2001 -2012 como la variable explicativa de enfoque. Resultados. Los participantes que no tenían seguro en 2001 y tuvieron Seguro Popular en 2012 fueron significativamente más propensos a hacerse las pruebas de diabetes y de presión arterial alta, así como a recibir la vacuna contra el tétanos, que aquéllos que no tenían un seguro continuo. Conclusiones. Las desigualdades en la detección preventiva entre los asegurados y los no asegurados seguirán existiendo en México. El Seguro Popular parece haber proporcionado un mejor acceso a servicios de salud para prevenir enfermedades.

Prevalência do exame preventivo de câncer do colo do útero em Rio Branco, Acre, Brasil, e fatores associados à não-realização do exame / Prevalence of uterine cervical cancer testing in Rio Branco, Acre State, Brazil, and factors associated with non-participation in screening

O objetivo do estudo foi determinar a prevalência autorreferida do exame preventivo de câncer do colo uterino em Rio Branco, Acre, Brasil, e avaliar fatores associados com a não realização do exame. Trata-se de estudo transversal de base populacional, composto por 772 mulheres de 18 a 69 anos residentes em Rio Branco, no período 2007 a 2008. Os dados foram analisados no programa Stata 10.0 e estimadas razões de prevalências a partir da regressão multivariada de Poisson. O percentual de mulheres na população alvo que relatou pelo menos um exame nos últimos três anos foi de 85,3%, com acentuada utilização do Sistema Único de Saúde (72,8%). Foram encontradas razões de prevalência estatisticamente significativas quanto à ausência do exame em mulheres de 18 a 24 anos, de 60 a 69 anos, solteiras, com menor renda e baixa escolaridade. As magnitudes encontradas nas razões de prevalência foram consistentes com achados de outros estudos, apontando maior necessidade de intervenção no grupo de mulheres mais vulneráveis à incidência e mortalidade por câncer do colo do útero.

The objective of the study was to determine the self-reported prevalence of uterine cervical cancer testing in Rio Branco, Acre State, Brazil, and to analyze factors associated with non-participation in screening. A population-based cross-sectional study with a sample of 772 women 18 to 69 years of age and living in Rio Branco was conducted in 2007 and 2008. Data were analyzed with Stata 10.0, and prevalence rates were estimated with Poisson multivariate regression (95%CI). 85.3% of women reported at least one cervical cancer screening test in the previous three years. The majority of women (72.8%) were screened in the Brazilian Unified National Health System. After adjusting for selected variables, statistically significant prevalence rates for absence of screening were found in women 18-24 and 60-69 years of age, single, and with low income and low schooling. The prevalence rates were consistent with findings from other studies, highlighting the need for greater intervention in the group of women most vulnerable to cervical cancer incidence and mortality.

Costo-efectividad de prácticas en salud pública: revisión bibliográfica de las intervenciones de la Iniciativa Mesoamericana de Salud / Cost-effectiveness of public health practices: A literature review of public health interventions from the Mesoamerican Health Initiative

OBJETIVO: Presentar y analizar información de costo-efectividad de intervenciones propuestas por la Iniciativa Mesoamericana de Salud (IMS) en las áreas de nutrición infantil, inmunizaciones, paludismo, dengue y salud materno-infantil y reproductiva. MATERIAL Y MÉTODOS: Se llevó a cabo una revisión sistemática de la literatura de evaluaciones económicas publicadas entre el año 2000 y agosto 2009 sobre intervenciones en las áreas de la salud mencionadas, en los idiomas inglés y español. RESULTADOS: Las intervenciones en nutrición y de salud materno-infantil mostraron ser altamente costo-efectivas (con rangos menores a US$200 por año de vida ajustado por discapacidad [AVAD] evitado para nutrición y US$100 para materno-infantil). En dengue sólo se encontró información sobre la aplicación de larvicidas, cuya razón de costo efectividad estimada fue de US$40.79 a US$345.06 por AVAD evitado. Respecto al paludismo, las intervenciones estudiadas resultaron costo-efectivas (

OBJECTIVE: Present and analyze cost-effectiveness information of public health interventions proposed by the Mesoamerican Health Initiative in child nutrition, vaccination, malaria, dengue, and maternal, neonatal, and reproductive health. MATERIAL AND METHODS: A systematic literature review was conducted on cost-effectiveness studies published between January 2000 and August 2009 on interventions related to the health areas previously mentioned. Studies were included if they measured effectiveness in terms of Disability-Adjusted Life Year (DALY) or death averted. RESULTS: Child nutrition and maternal and neonatal health interventions were found to be highly cost-effective (most of them below US$200 per DALY averted for nutritional interventions and US$100 for maternal and neonatal health). For dengue, information on cost-effectiveness was found just for application of larvicides, which resulted in a cost per DALY averted ranking from US$40.79 to US$345.06. Malarial interventions were found to be cost-effective (below US$150 per DALY averted or US$4,000 per death averted within Africa). In the case of pneumococcus and rotavirus vaccination, cost-effectiveness estimates were always above one GDP per capita per DALY averted. CONCLUSIONS: In Mesoamerica there are still important challenges in child nutrition, vaccination, malaria, dengue and maternal, neonatal, and reproductive health, challenges that could be addressed by scaling-up technically feasible and cost-effective interventions.

Diseño mixto de evaluación de la iniciativa Salud Mesoamérica 2015 / Mixed design for the evaluation of the Mesoamerica Health 2015 initiative

El propósito de la iniciativa Salud Mesoamérica 2015 (SM-2015) es mejorar el estado de salud y nutrición de la población con mayor grado de vulnerabilidad en Mesoamérica. El objetivo de la evaluación es generar evidencia sobre la efectividad conjunta de un paquete de intervenciones diseñadas para mejorar las condiciones de salud en la región. Se propone una evaluación de impacto con métodos mixtos, para conocer la magnitud de los cambios atribuibles a la SM-2015, e identificar los significados de estos cambios para la población objetivo, en el contexto de cada país. El eje conductor es un panel de localidades con el que se colectará información de individuos, hogares y unidades de salud de primero y segundo nivel de atención. El diseño que se describe en este documento fue desarrollado entre junio y diciembre de 2009, y su articulación se llevó a cabo en talleres realizados en Cuernavaca (México), Managua (Nicaragua), y San José (Costa Rica). El diseño propuesto permitirá generar evidencia sobre la efectividad conjunta del paquete de intervenciones propuesto en los planes maestros mesoamericanos. El éxito de este diseño radica en la voluntad y en el compromiso político de los países y los donantes.

Since the Salud Mesoamerica 2015 initiative (SM-2015) aim is to improve health and nutrition conditions of those most vulnerable in Mesoamerica, the goal of the evaluation is to generate evidence of the joint effectiveness of a package of interventions designed to improve the health conditions. We propose a mix design for the evaluation, which will allow to know the magnitude of changes attributable to the interventions, as well as the meanings of these changes for the target population, taking into account the specificities of each country. The main axis of this design is a locality panel where information about individuals, households, and health facilities (first and second level) will also be collected. The evaluation design described in this paper was developed between June and December, 2009, and it was integrated during workshops in Cuernavaca (Mexico), Managua (Nicaragua), and San Jose (Costa Rica). The proposed design will allow to generate evidence about the joint effectiveness of the package of interventions proposed for the SM-2015. The success of this design rests on the political commitment of countries and donors.

Prevention for better health among older persons are primary healthcare clinics in Jamaica meeting the challenge? / Prevención para una mejor salud entre las personas mayores de edad: ¿Están las clínicas de atención primaria a la salud dando respuesta a este desafío en Jamaica? - Hallazgos de un estudio transversal

OBJECTIVES: The study sought to determine the level and type ofpreventive care offered to older persons (persons 50 years and over) in the primary healthcare system and to identify the barriers to preventionrelated activities. METHODS: The study was carried out in three phases utilizing quantitative and qualitative methods. Quantitative data were collected over a six-week period from 738 older patients accessing health centre curative services and from 86 health centre staff. Focus group discussions were used to obtain information from non-users ofhealth centres. RESULTS: The findings showed that while clinical practice was good, there were relatively inadequate levels ofprevention care practices and there were barriers to prevention-related activities for older persons in the primary healthcare system. Only 5.1 %, 24.5% and 9.6% of older persons reported being advised about smoking, physical activity and alcohol consumption respectively by health centre staff. A higher proportion (56.5%) reported being advised about diet. Older persons did not appear to understand the role of prevention in maintaining health status. Barriers identified include inadequate numbers ofstaff, overcrowded clinics, rapid staffturnover, high costs ofinvestigations and medications, and poor staffperception of older persons' abilities to care for themselves. CONCLUSION: Health promotion and secondary prevention for older persons in the primary healthcare clinics need strengthening. Training and facilitation ofhealth workers in age-related age-specific prevention activities are recommended. The provision ofappropriate resources for prevention activities among older persons in primary healthcare settings should be addressed.

OBJETIVO: El estudio buscó determinar el nivel y tipo de cuidados preventivos ofrecidos a personas mayores (personas de 50 años y más) en el sistema de atención primaria, e identificar las barreras a las actividades relacionadas con la prevención. MÉTODOS: El estudio se llevó a cabo en tres fases utilizando métodos cuantitativos y cualitativos. Los datos cuantitativos fueron recogidos en un periodo de seis semanas, a partir de 738 pacientes mayores que recibían servicios curativos de centros de salud, y a partir de 86 miembros del personal de atención a la salud. Las discusiones del grupo de foco se usaron para obtener información de no usuarios de los centros de salud. RESULTADOS: Los hallazgos mostraron que aunque la práctica clínica era buena, había niveles relativamente inadecuados de prácticas de cuidados preventivos y había barreras a las actividades relacionadas con la prevención, para las personas mayores en el sistema de atención primaria de salud. Sólo 5.1%, 24.5 y 9.6% de las personas mayores reportaron haber recibido consejos de parte del personal del centro de salud, en relación con el hábito de fumar, la actividad física, y el consumo de alcohol respectivamente. Una proporción más alta (56.5%) reportó haber recibido consejos sobre la dieta. Las personas mayores no parecían entender el papel de la prevención en mantener el estado de salud. Las barreras identificadas incluyen: número inadecuado de personal, clínicas abarrotadas, cambio frecuente del personal, alto costo de las investigaciones y los medicamentos, y pobre percepción del personal en relación con la capacidad de las personas mayores para cuidarse a sí mismas. CONCLUSIÓN: La promoción de la salud y la prevención secundaria para las personas mayores en las clínicas de atención primaria de la salud, necesitan ser fortalecidas. Se recomienda el entrenamiento y la capacitación de los trabajadores de la salud en actividades de prevención relacionadas concretamente con edades específicas. Debe abordarse el problema de proveer recursos apropiados para las actividades de prevención entre las personas mayores, en los establecimientos de atención primaria de la salud.

Fatores de risco e profilaxia para tromboembolismo venoso em hospitais da cidade de Manaus / Risk factors and prophylaxis for venous thromboembolism in hospitals in the city of Manaus, Brazil

OBJETIVO: Identificar e classificar os fatores de risco para tromboembolismo venoso (TEV) em pacientes internados, avaliando as condutas médicas adotadas para a profilaxia da doença. MÉTODOS: Estudo observacional, de corte transversal no período de janeiro a março de 2006, envolvendo uma população de pacientes internados em três hospitais na cidade de Manaus (AM). A estratificação do risco para TEV foi feita com base nos critérios da Sociedade Brasileira de Angiologia e Cirurgia Vascular e da International Union of Angiology. Foram avaliados variáveis sobre os fatores de risco clínicos, cirúrgicos e medicamentosos, assim como os métodos profiláticos para TEV. Os dados foram analisados estatisticamente, adotando-se um alfa de 5 por cento e IC95 por cento. Os dados qualitativos foram analisados pelo teste do qui-quadrado e os dados quantitativos pelo teste t de Student. RESULTADOS: Foram estudados 1.036 pacientes num total de 1.051 internações, sendo 515 (49,7 por cento) homens e 521 (50,3 por cento) mulheres. Um total de 23 de fatores de risco para TEV foram identificados (número total de eventos, 2.319). O risco estratificado para TEV foi de 50,6 por cento, 18,6 por cento e 30,8 por cento das internações para risco alto, moderado e baixo, respectivamente. Em 73,3 por cento das internações, não foram adotadas medidas profiláticas não-medicamentosas durante o período do estudo, e em 74 por cento das internações que apresentavam risco moderado ou alto, não foram adotadas quaisquer medidas terapêuticas medicamentosas. CONCLUSÕES: Este estudo evidenciou que, na população estudada, os fatores de risco foram frequentes e que medidas profiláticas não foram utilizadas para pacientes com riscos potenciais de desenvolverem TEV e suas complicações.

OBJECTIVE: To identify and classify risk factors for venous thromboembolism (VTE) in hospitalized patients, as well as to evaluate medical practices regarding prophylaxis for the disease. METHODS: An observational cross-sectional study, carried out between January and March of 2006, involving inpatients at three hospitals in the city of Manaus, Brazil. Risk stratification for VTE was based on the criteria established by the Brazilian Society of Angiology and Vascular Surgery and by the International Union of Angiology. Clinical, surgical and medication-related risk factors were analyzed. The statistical analysis of the data obtained was conducted, adopting an alpha error of 5 percent and 95 percent CI. Qualitative data were analyzed using the chi-square test, whereas quantitative data were analyzed using Student's t-test. RESULTS: Of the 1,036 patients included (total number of admissions, 1,051), 515 (49.7 percent) were male, and 521 (50.3 percent) were female. A total of 23 risk factors for VTE were identified (total number of occurrences, 2,319). The stratified risk for VTE was 50.6 percent, 16.6 percent and 30.8 percent among the admissions of high-, moderate- and low-risk cases, respectively. In 73.3 percent of the admissions, nonpharmacological prophylaxis was not employed at any point during the study period. In 74 percent of those classified as high- or moderate-risk cases, no prophylactic medications were administered. CONCLUSIONS: This study showed that, in the population studied, risk factors were common and that prophylactic measures were not employed in patients prone to developing VTE and its complications.

Características reprodutivas e utilização de serviços preventivos em saúde por mulheres em idade fértil: resultados de dois estudos transversais de base populacional no extremo Sul do Brasil / Reproductive characteristics and utilization of preventive health services by childbearing-age women: results of two cross-sectional population-based studies in the far South of Brazil

Em 1995 e 2004 foram realizados dois estudos transversais representativos com mulheres de 15 a 49 anos em Rio Grande, Rio Grande do Sul, Brasil, visando avaliar alguns indicadores básicos de saúde. A amostra incluiu 1.339 mulheres em 1995 e 1.311 em 2004. Aplicou-se questionário padronizado no domicílio investigando sobre características demográficas, sócio-econômicas, reprodutivas e utilização de serviços preventivos de saúde. A análise consistiu em comparar estes indicadores nos dois estudos pelo teste do qui-quadrado. Observou-se melhoria nas condições de habitação, saneamento, escolaridade, mas piora da renda familiar. A idade média de início das atividades sexuais diminuiu, a taxa de gravidez na adolescência aumentou em 33 por cento assim como aumentou a realização de exame citopatológico de colo uterino em 48 por cento e mama em 30 por cento. A utilização de métodos contraceptivos diminuiu 3 por cento, enquanto o uso de preservativos masculinos passou de 8 por cento para 21 por cento. Esforços deveriam ser feitos não somente visando incentivar a realização de exames de mama e citopatológico de colo uterino como também de retardar o início das atividades sexuais e de promover o uso de métodos contraceptivos, especialmente de preservativos.

Two surveys were conducted (1995 and 2004) on women 15-49 years of age in Rio Grande, Rio Grande do Sul State, southern Brazil, assess patterns in their use of preventive health services. The sample included 1,339 women in 1995 and 1,311 in 2004. A standardized household questionnaire covered their demographic, socioeconomic, reproductive, and health care-utilization characteristics. The chi-square test was used to compare indicators in the two studies. During the study period, housing conditions, running water, sanitation, and schooling improved, but family income decreased. Mean age at sexual initiation decreased by one year, teenage pregnancy increased 33 percent, and clinical breast examination and Pap smears increased 48 percent and 30 percent, respectively. Overall use of contraceptive methods declined by 3 percent, but condom use increased from 8 percent to 21 percent. Efforts are needed to improve coverage for breast examination and Pap smears, postpone sexual initiation, and promote the use of contraceptive methods, especially condoms.

Brazilian examples of programs for the control of asthma / Exemplos brasileiros de programas de controle de asma

O objetivo do trabalho foi o de determinar quais são os programas brasileiros que apresentam experiência no manejo da asma. As informações sobre os programas e suas características foram obtidas via correio eletrônico. As variáveis analisadas eram relacionadas aos asmáticos, ao próprio programa e aos profissionais envolvidos. Utilizou-se a estatística descritiva. Foram analisados 17 programas. Todos os programas possuíam financiamento público, produção de materiais informativos e de treinamento e presença de médico especialista. Concluiu-se que a experiência acumulada em todos os programas pode ser utilizada como um dos pilares para a consolidação de um programa nacional de controle da asma.

The aim of this study was to determine which Brazilian programs demonstrate experience in asthma management. Data on and characteristics of those programs were obtained by electronic mail. The variables studied were related to the program itself, its patients and staff. Descriptive statistics were used in the study, which evaluated 17 programs. All programs received public funding, produced educational/training materials and had specialized physicians on staff. We concluded that the experience accumulated by all the programs can be used as one of the pillars of a national program for the control of asthma in Brazil.

Asociación del nivel socioeconómico con la higiene bucal en preescolares bajo el programa de odontología preventiva del IMSS en Campeche / Association between socioeconomic status and oral hygiene among preschoolers enrolled in the IMSS preventive dental program in Campeche

Objetivo. Determinar la asociación entre el estado socioeconómico y la higiene bucal en la dentición primaria de niños preescolares. Material y métodos. Se realizó un estudio transversal en 1,303 niños de 10 escuelas de Campeche, México. Todos los sujetos fueron examinados clínicamente en una silla dental portátil por uno de cuatro examinadores. Se aplicó un cuestionario dirigido a las madres para la recolección de las variables socioeconómicas y sociodemográficas, incluyendo variables de actitud hacia la importancia de la salud bucodental. Se evaluó la higiene bucal tomando en consideración la frecuencia de cepillado dental y la presencia de placa dentobacteriana. El análisis se realizó en STATA 8.2® utilizando pruebas no paramétricas. Resultados. La media de edad fue 4.36 ± 0.79 años y 48.3% de los niños examinados fueron mujeres. Del total de los niños bajo estudio, 17.8% (n = 232) fueron asignados al grupo de higiene bucal inadecuada, 50.9% (n = 663) al de regular, y 31.3% (n = 408) al de adecuada. Quienes presentaron más frecuentemente higiene bucal inadecuada (p < 0.05) fueron los hijos de madres con actitud negativa hacia la salud bucal, los que solamente tenían acceso a servicios públicos de salud, y los que no utilizaron servicios dentales en el año previo al estudio. Finalmente, se observó disminución de higiene bucal apropiada conforme disminuía el nivel socioeconómico (NSE). Conclusiones. Los hallazgos de este estudio muestran que la higiene bucal estuvo asociada al NSE. Esto implica que si se desea disminuir las desigualdades en salud bucal, las estrategias que se diseñen y los recursos que se destinen a estos objetivos deben tener en cuenta las diferencias existentes entre los grupos con mayor y menor desventaja social.

OBJECTIVE: Determine the association between socioeconomic status and oral hygiene in the primary dentition of preschool children. MATERIALS AND METHODS: We undertook a cross-sectional study of 1,303 children attending 10 schools in Campeche, Mexico. Every child was clinically examined in a portable dental chair by one of four examiners. We used a questionnaire addressed to the mothers to collect data on socioeconomic and socio demographic variables--including attitudinal variables dealing with the perceived importance of oral health. Oral hygiene was assessed appraising the frequency of tooth brushing and the presence of dental plaque. Data analysis included non-parametric tests using STATA 8.2. RESULTS: Mean age was 4.36 +/- 0.79 years and 48.3% of children were girls. Of the study population, 17.8% (n = 232) were classified as having inadequate oral hygiene, 50.9% (n = 663) having moderate oral hygiene, and 31.3% (n = 408) having adequate oral hygiene. Children who were rated more frequently as having inadequate hygiene (p < 0.05) had mothers with a negative attitude toward oral health, were users only of public medical insurance (as opposed to users of private services), and had not used dental services in the year prior to the study. Finally, we observed a decrease in the adequacy of oral hygiene associated with a decrease in socioeconomic status. CONCLUSIONS: Our findings showed that oral hygiene was closely associated with socioeconomic status. This implies that if a reduction of oral health inequalities is to be achieved, the strategies and resources targeting these goals must take into account the existing differences between population groups with more or fewer social disadvantages.

Salud y desarrollo de adolescentes y jóvenes en Latinoamérica y El Caribe: desafíos para la próxima década / Health and development of adolescents and young adults in Latin America and the Caribbean: challenges for the next decade

Adolescentes y jóvenes representan 30 por ciento de la población de las Américas. Su salud es clave para el progreso social, económico y político de la Región. Sin embargo, con demasiada frecuencia sus necesidades no figuran en la agenda pública ni política y los gobiernos no consideran prioritario invertir en ellos. La Organización Panamericana de la Salud (OPS) propone un nuevo marco conceptual centrado en el desarrollo humano y en la promoción de la salud dentro del contexto de la familia, la comunidad y el desarrollo social, político y económico. El gran desafío de los próximos años será utilizar este marco para implantar programas integrales, recolectar información desagregada, mejorar el acceso a los servicios, el ambiente donde viven adolescentes y jóvenes, el vínculo entre escuelas, familias y comunidades, así como apoyar la transición a la edad adulta, con una amplia participación juvenil y coordinación interinstitucional e intersectorial