Profile of pharmaceutical interventions of a pharmacotherapeutic follow-up model for diabetic patients in a community pharmacy

Abstract The insertion of Pharmaceutical Care in Primary Health Care (PHC) improves patients' clinical outcomes and quality of life. Pharmacotherapeutic follow-up can contribute to the management of chronic diseases such as diabetes, promoting better glycemic control and adherence to therapy. This study aimed to assess the Drug-therapy Problems (DTPs) and Pharmacist Interventions (PIs) on the pharmacotherapeutic management in patients with type 2 diabetes mellitus (T2DM) in a community pharmacy. A quantitative, retrospective, and cross-sectional study was conducted in a Pharmaceutical Care Program within the PHC in Juiz de Fora (Minas Gerais, Brazil). Inclusion criteria were patients with T2DM above 18, who attended at least three pharmaceutical consultations between July 2016 and October 2018 and presented two or more glycated hemoglobin tests. The study group (n = 17) was largely composed of women (65%), elderly (76%), sedentary (72%), and obese people (52%). The resolution was achieved in 79% of the DTPs identified (n = 115). Most of DTPs were related to administration and adherence to pharmacotherapy (46%). 60% of the 437 PIs involved the provision of information and counseling. In other words, accessible interventions lead to high resolvability. Therefore, clinical actuation of pharmacists could improve the prognosis in diabetes treatment

Características de idosos traumatizados hospitalizados em uma unidade de terapia intensiva / Characteristics of traumatized elderly people hospitalized in an intensive care unit

Introdução: o trauma é uma doença significativa em perda de anos de vida, contribuindo para alta morbidade e mortalidade. Seu evento em idosos pode ocasionar desfechos indesejáveis devido às condições fisiológicas do idoso. Objetivo: analisar as características e associação com o óbito de idosos traumatizados hospitalizados em uma unidade de terapia intensiva. Material e métodos: estudo transversal, com dados de prontuários de idosos hospitalizados por trauma em uma unidade de terapia intensiva geral. Foram incluídos pacientes com 60 anos ou mais de idade e admitidos por lesões. As variáveis coletadas relacionam-se às características sociodemográficas, da internação, de saúde, do trauma e do tratamento intensivo. Para identificação das principais características foi realizada análise descritiva, e para associação com o óbito foi realizado o teste de associação qui-quadrado. Resultados: observou-se predominância masculina (62,5%); idosos entre 60 e 79 anos (70,2%); com comorbidades (60,4%); politraumatizados (58,3%); trauma contuso (95,8%) tendo como principal causa externa as quedas (56,3%). A região do corpo mais afetada foi cabeça e pescoço (39,6%); e a gravidade do trauma foi leve (52,1%). Foram associados ao óbito a disfunção pulmonar (p=0,005), uso de nutrição enteral (p=0,027), drogas vasoativas (p=0,003) e ventilação mecânica (p<0,001). Conclusão: as informações sobre idosos hospitalizados por trauma em tratamento intensivo, sobretudo a observação de fatores associados ao óbito, são úteis para a composição de um perfil clínico capaz de direcionar para a assistência intensiva capaz de prevenir esse e demais desfechos indesejados durante a hospitalização.(AU)

Introduction: trauma is a significant disease in terms of loss of years of life, contributing to high morbidity and mortality. Its occurrence in the elderly can cause undesirable outcomes due to the physiological conditions of such a population. Objective: to analyze the characteristics and association with the death of traumatized elderly people hospitalized in an intensive care unit. Material and methods: cross-sectional study, with data collected from medical records of elderly hospitalized for trauma in a general intensive care unit. Patients aged 60 years' old and over, having been admitted for injuries, were included. The variables collected are related to sociodemographic, hospitalization, health, trauma, and intensive care characteristics. In order to identify the main characteristics, a descriptive analysis was performed. The chi-square association test was applied for the association with death. Results: the study presented predominance of male patients (62.5%); age ranging between 60 and 79 years' old (70.2%); with comorbidities (60.4%); polytrauma (58.3%); blunt trauma (95.8%) with falls being considered the main external cause (56.3%). The head and neck were the regions most frequently affected (39.6%), and the severity of the trauma being mild (52.1%). Lung dysfunction (p = 0.005), use of enteral nutrition (p = 0.027), vasoactive drugs (p = 0.003), and mechanical ventilation (p <0.001) were associated with death. Conclusion: information on elderly hospitalized for trauma in intensive care, especially the observation of factors associated with death, are useful for the composition of a clinical profile capable of guiding the patient to intensive care capable of preventing this and other undesirable outcomes during hospitalization.(AU)

Physical activity, TV viewing, and human development index in Brazilian adolescents: Results from the National School Health Survey

Abstract Aim: This study aimed to examine the association between physical activity (PA) indicators and TV viewing as a function of the Human Development Index (HDI). Method: This cross-sectional study was based on data from the National School Health Survey, which was composed of 102,072 students (14.28±1.03; 51.3% girls). Total PA, active commuting to school (ACS) and TV viewing were assessed by questionnaires and classified through a gradual scale ranging from "F" (low) to "A+" (high). The correlation between total PA, ACS, TV viewing and HDI was verified by Spearman's Correlation and presented in rs. Results: HDI was positively associated with total PA [girls: rs = 0.572 (p < 0.001); boys: rs = 0.843 (p < 0.001)] and ACS [girls: rs = 0.433 (p < 0.001); boys: rs = 0.554 (p < 0.001)]; while a negative correlation was found between HDI and TV viewing [girls: rs = -0.330 (p < 0.001); boys: rs = -0.348 (p < 0.001)]. Conclusions: Brazilian adolescents from states with higher HDI were more active and spent more time watching TV than their counterparts from states with lower HDI.

The musculoskeletal impairment negatively impacts the quality of life of children and adolescents with psoriasis

Abstract Background The severity of nail disease, the presence of arthralgia and fatigue are predictors of development of psoriatic arthritis (PsA) in patients with psoriasis (Pso). In children, little is known about the musculoskeletal (MSK) impairment in patients with Pso and its effect on health-related quality of life (HRQoL). Objectives To determine the frequencies of pain and MSK inflammation (i.e., arthritis, enthesitis, and sacroiliitis) among children and adolescents with Pso and its relationship to HRQoL and fatigue. Methods Pediatric patients with Pso underwent a rheumatologic physical examination to evaluate synovitis, enthesalgia, sacroiliac joint (SIJ) pain and tender points of fibromyalgia. The core set of domains recommended by the GRAPPA - OMERACT to be measured in PsA studies was assessed. Ultrasound (US) was performed in clinical cases of enthesitis, and magnetic resonance imaging (MRI) was performed in cases of SIJ pain. Results Forty-three participants (10 ± 2.9 years old) were evaluated. Pain on palpation of the entheses was observed in 10 (23.2%) patients and pain on SIJ palpation was observed in 3 (7%). No patient presented with synovitis; one presented with enthesitis on US, but MRI did not confirm sacroiliitis in any case. Patients with MSK pain had greater skin disease severity (PASI 5.4 vs. 2, p < 0.01), worse fatigue, and lower HRQoL scores on all instruments used. The estimated risk of HRQoL impairment was eight times higher in the presence of MSK pain, which was an independent predictive factor. With a NAPSI greater than 30, the probability of pain was greater than 80%. Conclusion MSK pain is frequent among children with Pso, related to the severity of skin and nail disease, and negatively affects HRQoL. The typically used complementary exams might not detect the inflammatory process caused by Pso.(AU)

Socioeconomic inequalities in access barriers to seeking health services in four Latin American countries / Las desigualdades económicas que representan obstáculos para buscar servicios de salud en cuatro países de América Latina / Desigualdades socioeconômicas no acesso a serviços de saúde em quatro países da América Latina

ABSTRACT Objective. To present summary measures of socioeconomic inequalities in access barriers to health services in Colombia, El Salvador, Paraguay, and Peru. Methods. This cross-sectional study used data from nationally - representative household surveys in Colombia, El Salvador, Peru, and Paraguay to analyze income-related inequalities in barriers to seeking health services. Households that reported having a health problem (disease/accident) and not seeking professional health care were considered to be facing access barriers. The measures of inequality were the slope index of inequality and relative index of inequality. Results. Inequality trends were mixed across the four countries. All showed improvement, but large inequality gaps persisted between the highest and lowest income quintiles, despite health care reforms. Relative inequality gaps were highest in Colombia (60%), followed by Paraguay (30%), Peru (20%), and El Salvador (20%). Conclusions. The effect of national policy initiatives on equity to accessing health services should be the object of future analysis. There is also a need for research on national and regional monitoring of access barriers and explanatory factors for why people do not seek care, even when having a health problem.(AU)

RESUMEN Objetivo. Presentar algunas mediciones de las desigualdades socioeconómicas que representan obstáculos para el acceso a los servicios de salud en Colombia, El Salvador, Paraguay y Perú. Métodos. En este estudio transversal se tomaron datos de encuestas realizadas en hogares representativas a nivel nacional en Colombia, El Salvador, Perú y Paraguay. Mediante estos datos se analizaron las desigualdades en los ingresos como obstáculos para recurrir a los servicios de salud. Los hogares donde se informó algún problema de salud (enfermedad o accidente) y sus habitantes no recurrieron a ningún tipo de atención profesional fueron considerados como población que enfrenta obstáculos para acceder a estos servicios. Para medir la desigualdad se usó el índice de desigualdad de la pendiente y el índice relativo de desigualdad. Resultados. Las tendencias de desigualdad fueron divergentes entre estos países. Se observó un grado de avance en cada país, aunque subsistieron grandes brechas entre el quintil de ingresos superiores y el inferior, a pesar de que hubo reformas en la atención de salud. Las brechas en cuanto al índice relativo de desigualdad fueron más elevadas en Colombia (60%), seguido de Paraguay (30%), Perú (20%) y El Salvador (20%). Conclusiones. La repercusión que tienen las iniciativas de política nacional sobre la igualdad de acceso a los servicios de salud debería ser objeto de análisis en un futuro. Asimismo, es necesario que se realicen investigaciones en cuanto al seguimiento a nivel nacional y regional de los obstáculos al acceso a los servicios de salud y los factores explicativos que indiquen porqué las personas no acuden a los servicios incluso cuando presentan un problema de salud.(AU)

RESUMO Objetivo. Apresentar indicadores das desigualdades socioeconómicas no acesso aos serviços de saúde na Colombia, El Salvador, Paraguai e Peru. Métodos. Este estudo transversal utilizou dados de pesquisas domiciliares representativas da realidade nacional na Colómbia, El Salvador, Peru e Paraguai com o objetivo de analisar as desigualdades relacionadas a renda no acesso aos serviços de saúde. Os domicílios que relataram a presença de um problema de saúde (doença/acidente) e nao buscaram cuidados de saúde profissionais foram considerados como domicílios que apresentavam barreiras no acesso aos serviços de saúde. Os indicadores de desigualdade foram o indice absoluto de desigualdade (slope index of inequality, SII) e o indice relativo de desigualdade. Resultados. As tendencias relativas a desigualdade foram mistas nos quatro países. Todos apresentaram melhorias, mas ainda persistem grandes disparidades entre os quintis com renda mais alta e mais baixa, apesar das reformas nos sistemas de saúde. A desigualdade relativa foi mais elevada na Colómbia (60%), seguida do Paraguai (30%), Peru (20%) e El Salvador (20%). Conclusões. O efeito das iniciativas políticas nacionais sobre a equidade no acesso aos serviços de saúde deve ser o tema de análises futuras. Também é preciso pesquisar o monitoramento nacional e regional das barreiras no acesso aos serviços e os fatores que explicam por que as pessoas nao buscam cuidados de saúde, mesmo quando apresentam um problema de saúde.AU)

Social inequalities and prevalence of depressive symptoms: a cross-sectional study of women in a Mexican border city, 2014 / Desigualdades sociales y prevalencia de síntomas depresivos: estudio transversal en mujeres de una ciudad fronteriza de México, 2014 / Desigualdades sociais e prevalência de sintomas depressivos: estudo transversal em mulheres de uma cidade fronteiriça no México, 2014

ABSTRACT Objective. To assess the association between intersectional disadvantage and clinically significant depressive symptoms (CSDS), describing the magnitude of social inequalities in the prevalence of symptoms among adult women in Tijuana, Mexico. Methods. This was a cross-sectional study. CSDS were assessed using the Centers for Epidemiological Studies Depression Scale among a probability sample of 2 345 women from 18 - 65 years of age in 2014. CSDS prevalence was calculated according to categories of three social stratifiers: socioeconomic status (SES), educational attainment, and fertility (number of children). Social inequality was measured with the slope index of inequality (SII) and the concentration index (CIx). Intersectionality among stratifiers was explored descriptively and with multivariable regression analysis. Results. CSDS prevalence was 17.7% (95%CI: 15.1% - 21.0%). The SII and CIx showed inequity in all social stratifiers. The absolute difference in CSDS prevalence between the lowest and highest ends of the SES gradient was 21.9% (95%CI: 21.5% - 22.4%). Among the most disadvantaged women, i.e., those at the intersection of lowest SES, lowest educational attainment, and highest fertility, the CSDS prevalence was 39.5% (95% CI: 26.0% - 52.9%). Conclusions. Disadvantage along multiple axes was associated with CSDS. Efforts to improve the mental health of women should include equity-oriented policies that address its social determinants.(AU)

RESUMEN Objetivo. Evaluar la asociación entre la desventaja interseccional y los síntomas depresivos clínicamente significativos (SDCS), y describir la magnitud de las desigualdades sociales en la prevalencia de síntomas en mujeres adultas de Tijuana, México. Métodos. Se realizó un estudio transversal. Se evaluaron los SDCS utilizando la Escala de Depresión de los Centros de Estudios Epidemiológicos, en una muestra probabilística de 2 345 mujeres de 18 a 65 años, en 2014. Se calculó la prevalencia de SDCS según las categorías de tres estratificadores sociales: nivel socioeconómico, nivel educativo y fertilidad (número de hijos). Se midió la desigualdad social mediante el índice de desigualdad de la pendiente y el índice de concentración. Se exploró la interseccionalidad entre los estratificadores de manera descriptiva y con análisis de regresión multivariable. Resultados. La prevalencia de SDCS fue de 17,7% (IC 95%: 15,1% - 21,0%). El índice de desigualdad de la pendiente y el índice de concentración mostraron desigualdad en todos los estratificadores sociales. La diferencia absoluta en la prevalencia de SDCS entre los extremos inferior y superior del gradiente de nivel socioeconómico fue de 21,9% (IC 95%: 21,5% - 22,4%). Entre las mujeres más desfavorecidas (las que se encuentran en la intersección del nivel socioeconómico más bajo, el nivel educativo más bajo y la fertilidad más alta) la prevalencia de SDCS fue de 39,5% (IC 95%: 26,0% - 52,9%). Conclusiones. La desventaja a lo largo de múltiples ejes se asoció con SDCS. Los esfuerzos para mejorar la salud mental de las mujeres deben incluir políticas orientadas a la equidad que aborden sus determinantes sociales.(AU)

RESUMO Objetivo. Avaliar a associação entre a sobreposição de desvantagens e sintomas depressivos clinicamente significativos (SDCS), descrevendo a magnitude das desigualdades sociais na prevalência de sintomas entre mulheres adultas em Tijuana, México. Métodos. Foi realizado um estudo transversal. Os SDCS foram avaliados em 2014 por meio da escala Center for Epidemiologic Studies - Depression (CES-D) em uma amostra probabilística de 2 345 mulheres de 18 a 65 anos. A prevalência de SDCS foi calculada de acordo com as categorias de três estratificadores sociais: nível socioeconômico (NSE), nível educacional e fertilidade (número de filhos). A desigualdade social foi medida pelo índice angular de desigualdade e pelo índice de concentração. A sobreposição entre os estratificadores foi explorada de forma descritiva e por análise de regressão multivariada. Resultados. A prevalência de SDCS foi de 17,7% (IC95%: 15,1% a 21,0%). O índice angular de desigualdade e o índice de concentração mostraram desigualdade em todos os estratificadores sociais. A diferença absoluta na prevalência de SDCS entre os extremos mais baixo e mais alto do gradiente de NSE foi de 21,9% (IC95%: 21,5% a 22,4%). Entre as mulheres mais desfavorecidas, ou seja, as que se encontram na intersecção entre a NSE mais baixa, o menor nível educacional e a maior fertilidade, a prevalência de SDCS foi de 39,5% (IC95%: 26,0% a 52,9%). Conclusões. A desvantagem ao longo de múltiplos eixos foi associada aos SDCS. As iniciativas para melhorar a saúde mental das mulheres devem incluir políticas orientadas para a equidade que considerem os determinantes sociais da saúde mental.(AU)

Queda entre idosos: preditores e distribuição espacial / Falls in older adults: predictors and space distribution / Caída entre personas mayores: predictores y distribución del espacio

RESUMO Objetivos Calcular a prevalência de quedas, nos últimos 12 meses, entre idosos da comunidade; verificar a ocorrência de quedas em idosos da comunidade, segundo características sociodemográficas e de saúde e identificar clusters de quedas, entre idosos no município de Uberaba. Métodos Estudo transversal conduzido com 612 idosos residentes na zona urbana de Uberaba. Procederam-se às análises descritiva e bivariada com o teste qui-quadrado (p<0,05). Para estimar a intensidade dos eventos utilizou-se o Kernel estimation. Projeto aprovado pelo Comitê de Ética em Pesquisa, parecer N° 573.833. Resultados Constatou-se que 24,7% dos idosos tiveram quedas nos últimos 12 meses. A maior proporção dos idosos que sofreu quedas era do sexo feminino (p=0,004); com 80 anos ou mais (p=0,001); sem escolaridade (p=0,026); morava só (p=0,049); sem companheiro (p=0,002); com autopercepção de saúde negativa (p<0,001); dependente para as ABVD (p=0,049) e AIVD (p=0,027); com menor participação nas AAVD (p=0,003); pré-frágeis/frágeis (p<0,001) e com desempenho físico baixo/ruim (p<0,001). Os maiores aglomerados de ocorrência de quedas foram na região centro-oeste do município, seguido pela região sudeste. Conclusão Conhecer o perfil e os fatores associados à ocorrência de quedas entre idosos possibilita que os profissionais de saúde desenvolvam ações direcionadas a prevenção, ao monitoramento e controle desses fatores.(AU)

ABSTRACT Objective This work seeks to calculate the prevalence of falls in the last 12 months among the elderly from the community of the city of Uberaba; verify the occurrence of falls in the elderly of the community according to sociodemographic and health characteristics; and identify and group the types of falls among the older individuals in the city of Uberba. Methods Cross-sectional study carried out with 612 elderly people living in the urban area of Uberaba. Descriptive and bivariate analyzes were performed using the chi-square test (p<0.05). The kernel density estimation was used to estimate the intensity of the events. This project was approved by the Research Ethics Committee through Protocol No. 573.833. Results It was found that 24.7% of the elderly had falls in the last 12 months. The highest proportion of the elderly who suffered falls was female (p=0.004); aged 80 years or more (p=0.001); illiterate (p=0.026); who lived alone (p=0.049); without partner (p=0.002); with negative self-perception of health (p<0.001); dependent for BADL (p=0.049) and IALD (p=0.027); with a lower participation in AADL (p=0.003); pre-fragile/fragile (p<0.001); and with low/poor physical performance (p<0.001). The clusters with the most frequently reported falls were in the center-west region of the city, followed by the southeast region. Conclusion To know the profile and the factors associated with the occurrence of falls among the elderly allows health professionals to develop actions directed to prevent, monitor and control these factors.(AU)

RESUMEN Objetivos Calcular la prevalencia de caídas en los últimos 12 meses entre los ancianos que viven en la comunidad; para verificar la ocurrencia de caídas en ancianos de la comunidad, de acuerdo con las características sociodemográficas y de salud, e identificar grupos de caídas, entre los ancianos en la ciudad de Uberaba. Métodos Estudio transversal realizado con 612 ancianos residentes en el área urbana de Uberaba. Se realizaron análisis descriptivos y bivariadas con la prueba de chi-cuadrado (p<0,05). Para estimar la intensidad de los eventos, utilizamos la estimación de Kernel. Proyecto aprobado por el Comité de Ética en Investigación, N°. 573,833. Resultados Se encontró que el 24,7% de los ancianos tuvieron caídas en los últimos 12 meses. La mayor proporción de ancianos que sufrieron caídas fueron mujeres (p=0,004); mayores de 80 años (p=0,001); sin educación (p=0,026); vivió solo (p=0,049); sin pareja (p=0,002); con salud negativa autovalorada (p<0,001); dependiente de ABVD (p=0,049) y IADL (p=0,027); con menor participación en AADL (p=0,003); pre-frágil / frágil (p<0,001) y con un rendimiento físico pobre/pobre (p<0,001). Los grupos más grandes de ocurrencia de caídas se encontraban en la región del medio oeste del municipio, seguidos por la región sureste. Conclusión Conocer el perfil y los factores asociados con la ocurrencia de caídas entre los ancianos permite a los profesionales de la salud desarrollar acciones dirigidas a la prevención, monitoreo y control de estos factores.(AU)

Crianças vítimas de queimaduras hospitalizadas em centro de referência de Fortaleza-Ceará em 2017 / Children victims of burns hospitalized in Fortaleza-Ceará reference center in 2017 / Niños víctimas de quemaduras hospitalizadas en el centro de referencia en Fortaleza-Ceará en 2017

Objetivo: Este estudo tem por objetivo determinar o perfil das crianças na faixa etária entre 1 e 12 anos hospitalizadas no centro de referência para tratamento de queimados em Fortaleza-Ceará no período de janeiro a dezembro de 2017. Método: Estudo observacional, de caráter descritivo e retrospectivo, com ênfase em uma abordagem quantitativa, realizado no Centro de Tratamento de Queimados (CTQ) do Hospital Instituto Doutor José Frota (IJF) em Fortaleza/ CE. Resultados: Foram identificados 333 pacientes acometidos por queimaduras. No entanto, 159 foram excluídos por não apresentarem registro médico completo. Assim, 174 prontuários foram selecionados para compor a amostra. Houve predomínio da faixa etária de 0 e 6 anos, do gênero masculino e queimaduras do 2° grau. No tocante ao agente etiológico, líquido quente foi o principal causador de queimadura. A área mais afetada foi tronco e membros superiores. Conclusões: Os dados obtidos nesta pesquisa corroboram com informações na literatura disponíveis sobre o tema. Apesar do progresso no tratamento de pacientes queimados, acentua-se a necessidade de promoção de estratégias preventivas junto à sociedade que contribuam para a diminuição da incidência dessa injúria.

Objective: This study aims to determine the profile of children aged 1 to 12 years hospitalized in the reference center for burn treatment in Fortaleza-Ceará from January to December 2017. Methods: Observational, descriptive and retrospective study with emphasis on a quantitative approach carried out at the Burn Treatment Center (CTQ) of the Doctor José Frota Institute Hospital (IJF) in Fortaleza/CE, Brazil. Results: 333 patients with burns were identified. However, 159 were excluded for not having a complete medical record. Thus, 174 medical records were selected to compose the sample. There was a predominance between the age group of 0 and 6 years, male and with burns of 2nd degree. Regarding the etiological agent, hot liquids were the main cause of burns. The most affected area was the trunk and upper limbs. Conclusions: The data obtained in this research corroborate with information in the literature available on the subject. Despite the progress in the treatment of burn patients, the need to promote preventive strategies in society that contributes to reducing the incidence of this injury is emphasized.

Objetivo: Este estudio tiene como objetivo determinar el perfil de los niños de 1 a 12 años hospitalizados en el centro de referencia para el tratamiento de quemaduras en Fortaleza-Ceará, Brasil, de enero a diciembre de 2017. Método: Estudio observacional, descriptivo y retrospectivo con énfasis en un enfoque cuantitativo realizado en el Centro de Tratamiento de Quemaduras (CTQ) del Hospital del Instituto Doctor José Frota (IJF) en Fortaleza/CE. Resultados: Se identificaron 333 pacientes con quemaduras. Sin embargo, 159 fueron excluidos por no tener un historial médico completo. Por lo tanto, se seleccionaron 174 registros médicos para componer la muestra. Hubo un predominio entre el grupo de edad de 0 y 6 años, quemaduras en pacientes de sexo masculino y de 2º grado. En cuanto al agente etiológico, los líquidos calientes fueron la principal causa de quemaduras. El área más afectada fue el tronco y las extremidades superiores. Conclusiones: Los datos obtenidos en esta investigación corroboran con la información en la literatura disponible sobre el tema. A pesar del progreso en el tratamiento de pacientes con quemaduras, se enfatiza la necesidad de promover estrategias preventivas en la sociedad que contribuyan a reducir la incidencia de esta lesión.

Desigualdades en la Ciudad Autónoma de Buenos Aires: mortalidad, fecundidad y estructura demográfica / Inequalities in the Autonomous City of Buenos Aires: mortality, fertility and demographic structure

RESUMEN Objetivo Este estudio se propuso cuantificar las desigualdades observadas en la Ciudad Autónoma de Buenos Aires en tres dimensiones relacionadas con el estado de salud de la población: mortalidad, fecundidad y estructura demográfica. Método Se realizó un estudio observacional, cuantitativo, de corte transversal a través de información proveniente de las Estadísticas vitales y el Censo Nacional de Población Hogares y Viviendas de 2010. Se calcularon indicadores para la medición de las dimensiones mencionadas anteriormente en tres áreas de la Ciudad Autónoma de Buenos Aires. Resultados Se observó un alto nivel de desigualdad en las dimensiones estudiadas. En relación a la zona más favorecida, la zona sur presentó una tasa de mortalidad ajustada superior en un 20%, una esperanza de vida de cuatro años menos, una tasa de fecundidad 50% más elevada y un nivel de envejecimiento cercano a los dos tercios del encontrado en el área más envejecida. Conclusión Los hallazgos empíricos reafirman la caracterización previa de la zona sur como área socio-económicamente segregada, con valores asociados a poblaciones con condiciones de vida deficientes. Por otra parte, se destaca que no se observaron desigualdades significativas entre las zonas norte y centro.(AU)

ABSTRACT Objective This study aimed to quantify the inequalities observed in the autonomous city of Buenos Aires in three dimensions related to the health status of the population: mortality, fertility, and demographic structure. Materials and Methods An observational, quantitative, cross-sectional study was carried out using data from the Vital Statistics and the 2010 National Census of Population and Housing. Indicators were calculated to measure three areas of the dimensions mentioned above in the autonomous city of Buenos Aires (north, center, and south areas). Results A high level of inequality was observed in the dimensions studied. Compared to the best performing area, the southern zone had a 20% higher mortality rate, a four-year lower life expectancy, and a 50% higher fertility rate. Moreover, the study found that the level of aging in the southern zone was roughly two thirds of the most aged area. Conclusions The evidence reinforce the previous characterization of the southern area of Buenos Aires as socioeconomically segregated, with values similar to those of populations with inadequate living conditions. On the other hand, no significant differences were found between the northern and central areas.(AU)

Correlation of enthesitis indices with disease activity and function in axial and peripheral spondyloarthritis: a crosssectional study comparing MASES, SPARCC and LEI

Abstract Background: The presence of enthesitis is associated with higher disease activity, more disability and incapacity to work and a poorer quality of life in spondyloarthritis (SpA). There is currently no consensus on which clinical score should be used to assess enthesitis in SpA. The objective of the present work was to compare the correlation of three enthesitis indices (MASES, SPARCC and LEI) with measures of disease activity and function in a heterogeneous population of patients with axial and peripheral SpA. Methods: A cross-sectional study was conducted in three Brazilian public university hospitals; patients fulfilling ASAS classification criteria for peripheral or axial SpA were recruited and measures of disease activity and function were collected and correlated to three enthesitis indices: MASES, SPARCC and LEI using Spearman's Correlation index. ROC curves were used to determine if the the enthesitis indices were useful to discriminate patients with active disease from those with inactive disease. Results: Two hundred four patients were included, 71.1% (N = 145) fulfilled ASAS criteria for axial SpA and 28.9% (N = 59) for peripheral SpA. In axial SpA, MASES performed better than LEI (p = 0.018) and equal to SPARCC (p = 0.212) regarding correlation with disease activity (BASDAI) and function (BASFI). In peripheral SpA, only MASES had a weak but statistical significant correlation with DAS28-ESR (rs 0.310 p = 0.05) and MASES had better correlation with functional measures (HAQ) than SPARCC (p = 0.034). Conclusion: In this sample composed of SpA patients with high coexistence of axial and peripheral features, MASES showed statistical significant correlation with measures of disease activity and function in both axial and peripheral SpA.(AU)

Prevalence of juvenile idiopathic arthritis in schoolchildren from the city of São Paulo, the largest city in Latin America

Abstract Background: Juvenile idiopathic arthritis (JIA) is a chronic inflammatory disease that affects children and adolescents. Its prevalence varies greatly from one study to another according to the population and methodology. Some tools may be helpful in screening for suspected cases. The aim of this study is determine the prevalence of JIA in children and adolescent students in the city of São Paulo, Brazil. Methods: This cross-sectional study was conducted from March 2016 to November 2017. It was based on a populational study envolving school children and adolescents from São Paulo, the largest city of Brazil. We randomly selected students under 16 years old from private schools with more than 1000 students who were evaluated through a specific questionnaire for screening suspected cases of chronic arthropathy (Early Diagnosis of Chronic Arthritis - 12 items - EDA-12) and subsequent anamnesis and rheumatologic physical examination for diagnostic confirmation. Results: We contacted all 79 schools in the universe, of which 12(15, 18%) agreed to participate in the study. A total of 21,119 questionnaires were handed out to the parents. We obtained a response of 5,710 (27%). In 108 cases the EDA-12 score was considered positive (≥ 5). We examined all these 108 suspicious" children. In 10 cases, the rheumatologic evaluation confirmed the diagnosis of arthritis, since the subjects presented a history and physical examination compatible with JIA. The prevalence of JIA in children and adolescents was 0.196% (95% CI = 0.1040.371%). Conclusion: In this first Brazilian population study to evaluate the prevalence of JIA, we observed that the disease is relatively prevalent in our country (196 / 100.000 children), which is similar to that observed in other studies involving children from urban centers.

Demoras en mortalidad materna en el departamento de Santander 2012 a 2015 / Delays related to maternal mortality in the department of Santander from 2012 to 2015

RESUMEN Objetivo Caracterizar las muertes maternas en el departamento de Santander y las demoras que contribuyeron a dichas muertes, durante los años 2012 a 2015, mediante los análisis de las atenciones en salud, con el fin de ofrecer un insumo que permita plantear acciones para disminuir desenlaces fatales. Materiales y Métodos Estudio descriptivo, retrospectivo, de corte transversal, en el cual se determinaron las características de la mortalidad materna en las mujeres gestantes o en puerperio a quienes se les realizaron unidades de análisis completas y que no fueron por causas externas o violentas. Resultados La demora que más se presentó en los 49 casos de muertes maternas fue la tipo IV relacionada con recibir un tratamiento médico adecuado y oportuno (87,8%), debido principalmente a deficiencias en los servicios de promoción y prevención (63,2%). La mayor parte de las muertes fueron evitables (61,2%), en el puerperio (84%) y en usuarias del régimen subsidiado (57,1%). Conclusiones Las mujeres afiliadas al régimen subsidiado presentaron mayor frecuencia del evento, lo cual refleja que existen importantes oportunidades de mejora en la atención que se brinda a las gestantes en el régimen subsidiado.(AU)

ABSTRACT Objective To characterize maternal deaths in the department of Santander, Colombia, and the delays that contributed to these deaths during the period 2012-2015, through a systematic review of health care, in order to offer an input that allows proposing actions that contribute to reduce these fatal outcomes. Materials and Methods Descriptive, retrospective, cross-sectional study that determines the characteristics of maternal mortality in pregnant or postpartum women who were administered complete analysis units and whose death was not caused by external or violent causes. Results The most frequent delay in the 49 cases of maternal deaths was type IV, which refers to the delay in receiving adequate and timely medical treatment (87.8%), mainly due to deficiencies in promotion and prevention strategies (63.2%). The majority of the deaths were avoidable (61.2%) in the puerperium (84%), and in users of the subsidized insurance scheme (57.1%). Conclusions Although 98% of mothers were affiliated to the health system (subsidized, contributory, special or exceptional schemes), it was possible to demonstrate that women who were affiliated to the subsidized regime showed a greater frequency of the event, which reflects that there are important opportunities for improvement in the care provided to pregnant women in this type of scheme.(AU)

Gasto de bolsillo y gasto catastrófico en salud en los hogares de Cartagena, Colombia / Out-of-pocket and catastrophic health expenditure in households of Cartagena, Colombia

RESUMEN Objetivo Estimar el gasto de bolsillo y la probabilidad de gasto catastrófico de los hogares y sus determinantes socioeconómicos en Cartagena, Colombia. Materiales y Métodos Estudio transversal en una muestra poblacional estratificada aleatoria de hogares de Cartagena. Se estimaron dos modelos de regresión cuyas variables dependientes fueron gasto de bolsillo y probabilidad de gasto catastrófico en salud de los hogares. Resultados El gasto de bolsillo promedio anual en hogares pobres fue 1 566 036 COP (US$783) (IC95% 1 117 597-2 014 475); en hogares de estrato medio 2 492 928 COP (US$1246) (IC95% 1 695 845-3 290 011) y en hogares ricos 4 577 172 COP (US$2 288) (IC95% 1 838 222-7 316 122). Como proporción del ingreso, el gasto de bolsillo en salud fue de 14,6% en los hogares pobres, de 8,2% en los hogares de estrato medio y de 7,0% en los hogares ricos. La probabilidad de gasto catastrófico en salud de los hogares pobres fue 30,6% (IC95% 25,6-35,5%), de los de estrato medio del 10,2% (IC95% 4,5-15,9%) y de los hogares de estrato alto del 8,6% (IC95% 1,823,0%). El estrato socioeconómico, la educación y la ocupación fueron los principales determinantes del gasto de bolsillo en salud y de la probabilidad de incurrir en gasto catastrófico en salud. Conclusiones En el sistema de salud persisten desigualdades en la protección financiera de los hogares contra el gasto de bolsillo y la probabilidad de gasto catastrófico. El presente estudio genera evidencia para revisar la política de protección social de los hogares socioeconómicamente más vulnerables.(AU)

ABSTRACT Objective To estimate out-of-pocket (OOP) health expenditure and the probability to incur in catastrophic health expenditure, as well as the socio-demographic determinants of households in Cartagena, Colombia. Materials and Methods Population-based cross-sectional study on a randomized stratified sample of Cartagena households. Two regression models were developed using OOP health expenditure and the probability to incur in catastrophic health expenditure as dependent variables. Results The average annual OOP health expenditure was $1 566 036 COP (US$783) (95%CI: $1 117 597 - $2 014 475) in poor households, $2 492 928 COP (US$1 246) (95%CI: $1 695 845 - $3 290 011) in middle class households, and $4 577 172 COP (uS$2 288) (95%CI: $1 838 222 - $7 316 122) in upper class households. Regarding the household income ratio, the OOP health expenditure was 14.6% in poor households, 8.2% in middle class, and 7.0% in upper class households. The probability to incur in catastrophic health expenditure was 30.6% (95%CI: 25.6% - 35.5%), 10.2% (95%CI: 4.5%-15.9%) and 8.6% (95%CI: 1.8%-23%) in the low, middle- and high-class households, respectively. Educational attainment, socioeconomic strata and employment were the main determinants of OOP and the probability to incur in catastrophic health expenditure. Conclusions The health system has persistent inequalities regarding the financial protection of households related to out-of-pocket expenditure and the probability of catastrophic expenditure. This study provides evidence to review the social protection policy for the most socio-economically vulnerable households.(AU)

Processo de trabalho em saúde bucal na atenção básica: desigualdades intermunicipais evidenciadas pelo PMAQ-AB / Oral health work process in Primary Health Care: intermunicipal inequalities highlighted by the PMAQ-AB

RESUMO O objetivo deste estudo exploratório foi identificar desigualdades na organização do processo de trabalho das Equipes de Saúde Bucal (ESB) na Estratégia Saúde da Família, comparando municípios do Estado do Paraná quanto à condição social, econômica e demográfica. Foram utilizados dados secundários obtidos na etapa de avaliação externa do Programa de Nacional do Acesso e da Qualidade da Atenção Básica (PMAQ-AB), referentes aos padrões de certificação de acesso, qualidade e organização do processo de trabalho das equipes. Os municípios foram estratificados segundo o índice proposto pelo programa. Houve ampla participação dos municípios no PMAQ-AB, com predominância de equipes de saúde da família com saúde bucal. Os resultados demonstram desigualdades desfavoráveis aos municípios menores e mais carentes, o que revela a necessidade de compreender o papel da gestão como apoiadora das ESB, favorecendo o resgate de competências e habilidades necessárias para a boa gestão da clínica e do cuidado na Atenção Primária à Saúde. Evidencia-se a necessidade da qualificação da gestão, com apoio federal e estadual, principalmente aos municípios menores e com baixa capacidade de resposta dos sistemas de saúde. É importante que a regionalização seja efetiva, e que a rede de atenção à saúde bucal seja organizada de forma equânime, para incluir esses municípios.(AU)

ABSTRACT The objective of this exploratory study was to identify inequalities in the organization of the work process of Oral Health Teams in the Family Health Strategy, comparing municipalities of the Paraná State, Brazil, regarding social, economic and demographic conditions. We used secondary data obtained in the external evaluation stage of the National Program of Access and Quality Improvement in Primary Health Care (PMAQ-AB), referring to the certification standards for access, quality, and organization of the work process of the teams. The municipalities were stratified according to the index proposed by the program. We observed wide participation of the municipalities in the program, with predominance of family health teams with oral health. The results show inequalities, unfavorable to the smaller and poorer municipalities, which reveals the need to understand the role of management as a supporter of the Oral Health Teams, favoring the rescue of skills and abilities necessary for the good governance of the clinic and of care in PHC .There is evidence of the need for management qualification, with federal and state support, mainly to smaller municipalities and with a low response capacity of health systems. It is important that regionalization be effective, and that the oral health care network be organized in an equitable way to include those municipalities.(AU)

Mortalidade por queimaduras em pacientes hospitalizados em Manzanillo-Cuba em 2015-2017 / Mortality due to burns in hospitalized patients in Manzanillo-Cuba in 2015-2017 / Mortalidad por quemaduras en pacientes ingresados en Manzanillo-Cuba en 2015-2017

Objetivo: Descrever as características dos pacientes hospitalizadas por queimaduras e que foram a óbito. Método: Foi realizado um estudo descritivo, transversal e retrospectivo no Departamento de Cirurgia Plástica e Queimadura do Hospital Estadual Clínico Cirúrgico "Celia Sánchez Manduley", em Manzanillo, Granma, Cuba, no período de janeiro de 2015 a dezembro de 2017. Foram incluídos registros de 19 pacientes queimados falecidos hospitalizados. Resultados: De um total de 224 pacientes hospitalizados por queimaduras, receberam alta com evolução satisfatória 91,52% e morreram apenas 8,48%. O sexo feminino apresentou maior frequência de pacientes falecidos, com 78,98%, e entre eles a faixa etária de 60 a 74 anos, com 31,58%. A frequência de mortalidade foi maior no pacientes com queimaduras intencionais, com 63,16%. O maior número de mortes por queimaduras foi no grupo com 81-90% de superfície corporal queimada (SCQ), com 31,58%. As principais causas de óbito foram relacionadas ao choque por queimaduras, com 63,16%. Conclusões: Existe uma relação estritamente proporcional que a idade mais elevada (principalmente com 60 anos ou mais) e porcentagem de SCQ acima de 40 aumentam a possibilidade de complicações e morte em pacientes queimados, evidenciando-se a necessidade de campanhas preventivas e de promoção da saúde, o que pode ser feito por meio dos meios de comunicação de massa (televisão, rádio, internet), centros de trabalho e educação, comunidade e centros de saúde.

Objective: To identify the characteristics of patients admitted for burns and who died. Methods: A descriptive, cross and retrospective study was carried out in the Department of Plastic Surgery and Burns of the Provincial Clinical Surgical Hospital "Celia Sánchez Manduley", in Manzanillo, Granma, Cuba, from January 2015 to December 2017. Nineteen burned patients who died were included in the sample. Results: Of a total of 224 patients hospitalized for burns, 91.52% presented a satisfactory evolution and only 8.48% died. The female sex presented a greater frequency of deceased patients, with 78.98%, and includes the age group of 60 to 74 years, with 31.58%. The frequency of mortality was higher in patients with intentional burns, with 63.16%. The highest number of burn deaths was in the group of 81-90% burned body surface (BBS), with 31.58%. The main causes of death were related to the burn shock, with 63.16%. Conclusions: A strictly proportional relation exists than to higher ages (especially 60 years-old or more) and percent of BBS higher of 40, are the main possibilities of complications and death in burnt patients. The need for preventive campaigns and health promotion was evidenced, which can be done by the mass media (TV, radio, internet), work and education centers, community and health centers.

Objetivo: Describir las características de los pacientes ingresados por quemaduras y que egresaron fallecidas. Método: Se realizó un estudio descriptivo, transversal y retrospectivo en el Departamento de Cirugía Plástica y Quemaduras del Hospital Provincial Clínico Quirúrgico "Celia Sánchez Manduley", en Manzanillo, Granma, Cuba, en el período de enero de 2015 a diciembre de 2017. Se incluyeron registros de 19 pacientes quemados fallecidos hospitalizados Resultados: De un total de 224 pacientes internados por quemaduras fueron dados de alta con evolución satisfactoria el 91,52% y apenas murieron 8,48%. El sexo femenino presentó mayor frecuencia de pacientes falecidos, con 78,98%, y entre ellos el grupo de edad de 60 a 74 años, con 31,58%. La frecuencia de mortalidad fue mayor en los pacientes con quemaduras intencionales, con 63,16%. El mayor número de muertes por quemaduras fue en el grupo con 81- 90% superficie corporal quemada (SCQ), con 31,58%. Las principales causas de muerte fueron relacionadas con el choque por quemaduras, con el 63,16%. Conclusiones: Existe una relación estrictamente proporcional que a mayor edades (principalmente edades de 60 años o más) y porciento de superficie corporal quemada mayor de 40, mayor posibilidades de complicaciones y muerte en pacientes quemados, se evidenció la necesidad de campañas preventivas y de promoción de la salud, lo que puede ser realizado a través de los medios de comunicación masiva (televisión, radio, internet), centros de trabajo y educación, comunidad y centros de salud.

Internações hospitalares de pacientes queimados em hospital de referência do estado de Alagoas / Burned patients hospitalization in a hospital of reference in the state of Alagoas / Internaciones hospitalarias de pacientes quemados en un hospital de referencia en el estado de Alagoas

Objetivo: Descrever as internações hospitalares dos pacientes queimados de um hospital referência do estado de Alagoas e identificar os agravos predominantes. Método: Realizou-se uma pesquisa do tipo documental retrospectiva, transversal de caráter quantitativo, sendo avaliados 206 prontuários de pacientes internados na unidade de queimados em um hospital referência de Alagoas no período de janeiro a dezembro de 2017. Resultados: O maior número de casos ocorreu no mês de agosto, do sexo masculino, de 0 a 2 anos, sendo a maioria na capital. A principal causa foi acidentes por agentes térmicos com queimaduras de 2º grau em maior número. A maioria obteve alta hospitalar e apenas um episódio de óbito. Conclusão: A maioria das pessoas, provavelmente, já sofreu algum tipo de queimadura, referindo sinais dolorosos e podendo haver sérias complicações, sendo assim de extrema importância o conhecimento etiológico. O resultado dessa pesquisa é pertinente para possibilitar a criação de estratégias específicas, desse caráter, por meio de um planejamento qualificado da assistência prestada às vítimas de queimadura.

Objective: To describe the hospital admissions of burned patients burned at a reference hospital in the state of Alagoas and to identify the predominant consequences. Methods: A restrospective documental, transversal, quantitative research was perfomed, being evaluated 206 medical records of the hospitalized patients in the burned section in the period from January to December 2017. Results: The higher number of cases was observed in the month of August, male individuals from 0 to 2 years old, mostly in the Capital. The mainly cause was accidents by thermal products with second degree burns. Most of the patients were discharged and only one died. Conclusion: Most people probably have already suffered from a burn of any kind, referring painful symptoms and with risk of serious complications, highlighting the importance of the etiological knowledge. The results from this research is relevant to allow the creation of specific strategies through a qualified planning of assistance to burned victims.

Objetivo: Describir las internaciones hospitalarias de los pacientes quemados de un hospital referencia del estado de Alagoas e identificar los agravios predominantes. Método: Se realizó una investigación del tipo documental retrospectivo, transversal de carácter cuantitativo, siendo evaluados 206 prontuarios de pacientes internos en los quemados en un hospital referencia de Alagoas en el período de enero a diciembre de 2017. Resultados: El mayor número de casos fue visto en el mes de agosto, del sexo masculino, de 0 a 2 años, siendo la mayoría en la capital. La principal causa fue de accidentes por agentes térmicos con quemaduras de 2º grado en mayor número. La mayoría obtuvo alta hospitalaria y sólo un episodio de muerte. Conclusión: La mayoría de las personas, probablemente, ya sufrieron algún tipo de quemadura, refiriendo signos dolorosos y pudiendo haber serias complicaciones, siendo así de extrema importancia el conocimiento etiológico. El resultado de esta investigación es pertinente para posibilitar la creación de estrategias específicas, de ese carácter, a través de una planificación cualificada de la asistencia prestada a las víctimas de quemadura.

Terapia ocupacional en oncología: experiencias en prácticas académicas y revisión de literatura / Occupational therapy in oncology: experiences in academic practices and literature review

RESUMEN Objetivo Indagar sobre la formación de terapeutas ocupacionales en oncología en un programa universitario, e identificar literatura actualizada como evidencia para la formación y práctica profesional. Materiales y Métodos Estudio exploratorio transversal, con una muestra integrada por 29 estudiantes de terapia ocupacional de la Universidad Nacional de Colombia. Revisión sistemática de literatura 2010-2015, sobre intervenciones de terapia ocupacional en oncología. Resultados En la encuesta, menos de una cuarta parte de los estudiantes respondió haber recibido formación sobre manejo clínico de dicho diagnóstico, y sobre la intervención del terapeuta ocupacional con tales casos (24,1%). Poco más de dicho porcentaje (27,6%), ha tenido usuarios con cáncer en sus prácticas académicas. En la revisión de literatura no se encontraron publicaciones nacionales, aunque sí productos inéditos de universidades colombianas. Se recuperaron 54 trabajos internacionales, especialmente en rehabilitación, seguido de las áreas psicosocial y sociolaboral. El cuidado paliativo, la multidisciplinariedad, la experiencia subjetiva del paciente frente al diagnóstico y tratamiento, la atención humanizada e integral desde las diferentes áreas del quehacer terapéutico y el trabajo con cuidadores, se plantean como temas de relevancia profesional en el abordaje del paciente oncológico. Conclusiones Se aportan referentes para el desarrollo curricular de terapia ocupacional y para procesos de actualización profesional, de competencia de la academia y gremial. Es importante la intervención en cáncer no sólo durante, sino también mientras el tratamiento y posteriormente con supervivientes. Deben incentivarse las publicaciones profesionales, asegurando que arrojen evidencias potentes del impacto de la terapia ocupacional y de la rehabilitación oncológica.(AU)

ABSTRACT Objective To inquire about the training of occupational therapists in oncology in a university program, and to identify updated literature as evidence for training and professional practice. Materials and Methods Cross-sectional exploratory study, with a sample of 29 students of occupational therapy from the National University of Colombia. Systematic review of literature 2010-2015 on occupational therapy interventions in oncology. Results In the survey, less than a quarter of the students reported having received training on clinical management of this diagnosis, and on the intervention of the occupational therapist with such cases (24.1%). Little more than this percentage (27.6%), has had users with cancer in their academic practices. In the literature review no national publications were found, although there were unpublished products from Colombian universities. Fifty-four international publications were recovered, especially in rehabilitation, it followed by psychosocial and socio-occupational areas. The palliative care, the multidisciplinarity, the subjective experience of the patient in relation to the diagnosis and treatment, the humanized and integral care from the different areas of the therapeutic task and work with caregivers are considered as relevant issues in the oncological patient's approach. Conclusions Reference points are made for the occupational therapy curriculum development and for professional updating processes, which are both competence of the academy and of the guild. It is important to intervene in cancer not only during, but in the preparation to treatment and subsequently with survivors. Professional publications should be encouraged, making sure they provide powerful evidence of the impact of occupational therapy and oncological rehabilitation.(AU)

Determinantes de la mortalidad infantil en Colombia: path análisis / Determinants of infant mortality in Colombia: path analysis

RESUMEN Objetivo Separar y analizar los efectos de los factores biológicos, ambientales, socioeconómicos, de atención médica y servicios de salud; y su probabilidad de generar una muerte infantil. Materiales y Métodos Se aplica el Path análisis utilizando las características del niño y de la madre en los registros individuales de nacimiento y defunción infantil, y la disponibilidad de camas materno infantil entre 2003 y 2009. Resultados El efecto biológico más importante para asegurar la supervivencia infantil fue el peso al nacer cerca de las 37 semanas de gestación. La principal intervención para reducir la mortalidad infantil fue el control prenatal. Variables socioeconómicas para la supervivencia infantil fueron la educación de la madre, acceso a servicios materno infantil para el régimen contributivo en el mismo municipio de residencia, el cual se encontró asociado a la calidad de los servicios de salud. Conclusiones El estudio sugiere que, además de participar en acciones de promoción de la salud, las madres del régimen subsidiado deben tener acceso a camas de cuidado intensivo neonatal, disponibles en el mismo departamento de residencia, para contribuir a reducir la mortalidad infantil.(AU)

ABSTRACT Objective To disentangle the singular effects of biological, environmental, socioeconomic, and medical factors on the probability for infants to die. Materials and Methods Apply a Path Analysis to Colombia's complete records of infant births and deaths, and the availability of maternal and child health services, during 2003-2009. Results From a biological perspective, a high birth weight resulting from a normal gestational age is the most important variable to ensure the infant's survival. Prenatal care is key to reduce infant mortality. From a socioeconomic perspective, high levels of education and relative access to high quality care in the contributory social health insurance regime for maternal residence, contribute to higher chances of infant survival. Conclusions Related findings suggest that augmenting access to maternal, child and intensive care beds supported by the subsidized regime can reduce infant mortality.(AU)

Factors associated with body image dissatisfaction of weight training practitioners

Abstract AIMS This study aimed at investigating the socio-demographic and health-related variables associated with body image dissatisfaction. METHODS This is a cross-sectional study. 894 (34.04±13.62 years old) weight training practitioners from a medium-large city in the south of Brazil participated in this study. A socio-demographic questionnaire was used along with the Body Shape Questionnaire. The Chi-squared Test and the Binary Logistic Regression (p<0.05) were used to analyze the data. RESULTS Female subjects who have been practicing weight training for two to five years are more likely to be dissatisfied with their bodies (OR=4.305 [95% CI=2.984-6.213; OR=1.773 [95% CI=1.086-2.895], p<0,05, respectively). CONCLUSION There is one group of individuals who are less likely to experience body weight satisfaction. This group of people has three characteristics: 1, 2, and 3.

Síndrome metabólico y actividad física en adultos mayores de la sierra ecuatoriana / Metabolic syndrome and physical activity in elderly people from the Ecuadorian highlands

RESUMEN Objetivo Determinar la prevalencia del síndrome metabólico, el nivel de actividad física y la asociación de estos factores en los adultos mayores de la sierra ecuatoriana. Métodos Estudio transversal que evaluó 387 adultos mayores de Cuenca-Ecuador, quienes desearon participar y firmaron el consentimiento informado. El diagnóstico de síndrome metabólico se realizó mediante los criterios del Programa Nacional de Educación sobre el Colesterol y el Panel de Tratamiento del Adulto III, para el valor de la Circunferencia Abdominal se consideró los criterios usados para la población asiática. El nivel de actividad física fue evaluado por la versión corta del Cuestionario Internacional de Actividad Física. Se compararon los grupos con y sin síndrome metabólico mediante el test Chi-cuadrado y el test t de student. El análisis de variancia fue usado para evaluar la asociación entre los componentes del síndrome metabólico y el nivel de actividad física. Resultados La prevalencia de síndrome metabólico fue alta (59,9 %), así como el nivel alto de actividad física (45 %), sin embargo no se evidenció asociación significativa entre el síndrome metabólico y nivel de actividad física. Conclusión Los adultos mayores diagnosticados con síndrome metabólico presentaron el mismo nivel de actividad física que los individuos sin este diagnóstico. Es necesario confirmar los presentes hallazgos usando instrumentos de medición directa de actividad física.(AU)

ABSTRACT Objective Determine the prevalence of the metabolic syndrome, the level of physical activity and the association with these factors in the elderly from the Ecuadorian highlands. Methods Cross-sectional study that evaluated 387 older adults from Cuenca-Ecuador, who wished to participate and signed the informed consent. The diagnosis of metabolic syndrome was made using the criteria of the National Program of Education on Cholesterol and the Adult Treatment Panel III, for the value of Abdominal Circumference the criteria used for the Asian population was considered. The level of physical activity was evaluated by the short version of the International Physical Activity Questionnaire. The groups with and without metabolic syndrome were compared using the chi-square test and student's t-test. The analysis of variance was used to evaluate the association between the components of the metabolic syndrome and the level of physical activity. Results The prevalence of metabolic syndrome was high (59.9 %), as well as the high level of physical activity (45 %), however, there was no significant association between the metabolic syndrome and physical activity level. Conclusions Older adults diagnosed with metabolic syndrome presented the same level of physical activity as individuals without this diagnosis. It is necessary to confirm the present findings using direct measurement instruments of physical activity.(AU)