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spa/1020-4989/S1020-49892006000900013.xml | es | rapid-communication | Revista Panamericana de Salud Pública | 1680-5348 | SciELO Public Health | Organización Panamericana de la Salud | S1020-49892006000900013 | 10.1590/S1020-49892006000900013 | Health Policy & Services | FONASA | null | Chile: protección social de la salud | Chile: social protection in health | Urriola, Rafael | 2,006 | 10 | null | This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. | null | null | This piece begins with a brief discussion of the concepts leading to the social right to health protection. Special emphasis is placed on the principle of social cohesion, which has influenced social health protection in European countries. Chile’s experience in this field from the 1990s to the present is described, as exemplified in three dimensions. In the first place, social security coverage is presented as a means to achieve universal (horizontal) coverage. A discussion follows on vertical coverage, where the author identifies health problems for which insured persons have guaranteed rights of access to medical care. This section describes available emergency care, primary health care, and the special plan for Universal Access to Explicit Guarantees (Acceso Universal de Garantías Explícitas de salud, or AUGE). Thirdly, the discussion covers the funding sources supporting the Chilean health care system: Government subsidies, contributions to social security, and out-of-pocket disbursements for private care. Chile’s public health system has various special programs. One of them is catastrophic insurance, which covers 100% of the care needed for complex and very costly treatments. Older persons (over 65) have coverage for 100% of the cost of eyeglasses and hearing aids, and for 50% of the cost of home care. If life expectancy is an appropriate indicator of health system results, it is worth noting that Chile and the United States of America have both achieved a life expectancy of 77 years, even though Chile spends only 5.9% of its gross domestic product on health care, as compared to the 15% spent by the United States. | http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892006000900013&lng=en&tlng=en | 39 | scielo_articles/spa/1020-4989/S1020-49892006000900013.xml | scielosp.org | spa | [
"Health Policy & Services"
] | [
"Urriola, Rafael"
] | null | null | null | [
"cobertura universal",
"costos de la atención de salud",
"extensión de la cobertura",
"financiación de la salud",
"seguros de salud",
"Chile"
] | [
"universal coverage",
"health care costs",
"health services accessibility",
"economics",
"insurance",
"Chile"
] | null | [
"FONASA"
] |
spa/1020-4989/S1020-49892006000900011.xml | es | rapid-communication | Revista Panamericana de Salud Pública | 1680-5348 | SciELO Public Health | Organización Panamericana de la Salud | S1020-49892006000900011 | 10.1590/S1020-49892006000900011 | Health Policy & Services | null | null | Los determinantes sociales de la salud, la posición socioeconómica y la inequidad en salud | null | null | 2,006 | 10 | null | This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. | null | null | null | http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892006000900011&lng=en&tlng=en | null | scielo_articles/spa/1020-4989/S1020-49892006000900011.xml | scielosp.org | spa | [
"Health Policy & Services"
] | null | null | null | null | null | null | null | null |
spa/1020-4989/S1020-49892006000900010.xml | es | rapid-communication | Revista Panamericana de Salud Pública | 1680-5348 | SciELO Public Health | Organización Panamericana de la Salud | S1020-49892006000900010 | 10.1590/S1020-49892006000900010 | Health Policy & Services | null | null | Seroprevalencia y factores de riesgo de la infección por el VIH en trabajadoras sexuales de América del Sur | null | null | 2,006 | 10 | null | This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. | null | null | null | http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892006000900010&lng=en&tlng=en | null | scielo_articles/spa/1020-4989/S1020-49892006000900010.xml | scielosp.org | spa | [
"Health Policy & Services"
] | null | null | null | null | null | null | null | null |
spa/1020-4989/S1020-49892006000900009.xml | es | rapid-communication | Revista Panamericana de Salud Pública | 1680-5348 | SciELO Public Health | Organización Panamericana de la Salud | S1020-49892006000900009 | 10.1590/S1020-49892006000900009 | Health Policy & Services | null | null | Reflexiones sobre el desarrollo de capacidades para la promoción de salud en Perú | null | null | 2,006 | 10 | null | This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. | null | null | null | http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892006000900009&lng=en&tlng=en | null | scielo_articles/spa/1020-4989/S1020-49892006000900009.xml | scielosp.org | spa | [
"Health Policy & Services"
] | null | null | null | null | null | null | null | null |
spa/1020-4989/S1020-49892006000900008.xml | es | rapid-communication | Revista Panamericana de Salud Pública | 1680-5348 | SciELO Public Health | Organización Panamericana de la Salud | S1020-49892006000900008 | 10.1590/S1020-49892006000900008 | Health Policy & Services | null | null | Confirman la gran diversidad de Leishmania en el estado de Acre, Brasil | null | null | 2,006 | 10 | null | This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. | null | null | null | http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892006000900008&lng=en&tlng=en | null | scielo_articles/spa/1020-4989/S1020-49892006000900008.xml | scielosp.org | spa | [
"Health Policy & Services"
] | null | null | null | null | null | null | null | null |
spa/1020-4989/S1020-49892006000900007.xml | es | rapid-communication | Revista Panamericana de Salud Pública | 1680-5348 | SciELO Public Health | Organización Panamericana de la Salud | S1020-49892006000900007 | 10.1590/S1020-49892006000900007 | Health Policy & Services | null | null | Efecto del tamaño de las agujas en la inmunogenicidad y reactogenicidad de dos vacunas aplicadas a lactantes | null | null | 2,006 | 10 | null | This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. | null | null | null | http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892006000900007&lng=en&tlng=en | null | scielo_articles/spa/1020-4989/S1020-49892006000900007.xml | scielosp.org | spa | [
"Health Policy & Services"
] | null | null | null | null | null | null | null | null |
spa/1020-4989/S1020-49892006001000003.xml | pt | research-article | Revista Panamericana de Salud Pública | 1680-5348 | SciELO Public Health | Organización Panamericana de la Salud | S1020-49892006001000003 | 10.1590/S1020-49892006001000003 | Health Policy & Services | Universidade de São Paulo | Necropsia e mortalidade por causa mal definida no Estado de São Paulo, Brasil | null | Autopsy and ill-defined cause of death in the state of São Paulo, Brazil | Rozman, Mauro Abrahão | 2,006 | 11 | null | This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. | OBJETIVO: Investigar a proporção de mortes por causa mal definida no Estado de São Paulo entre 1980 e 2002, considerando a influência da realização de necropsia nessa proporção. MÉTODO: O número de óbitos foi obtido do Ministério da Saúde. Dividiu-se o Estado de São Paulo em três áreas: 1) municípios com serviço de verificação de óbitos (SVO, que pode realizar necropsias); 2) municípios sem SVO; e 3) Baixada Santista, região onde houve um aumento marcante na proporção de mortes por causa mal definida entre 1980 e 1995. O impacto das necropsias na proporção de óbitos por causa mal definida foi medido com base na classificação da causa de óbito pelo primeiro médico avaliador (aquele que encaminhou o caso para o SVO para necropsia ou que preencheu a declaração de óbito sem encaminhar o caso). Os óbitos por causas externas foram excluídos por ter necropsia obrigatória. Foram avaliadas as proporções 1) de casos classificados como de causa mal definida pelo primeiro avaliador; 2) de necropsias no total de óbitos excluindo causas externas; e 3) de óbitos com causa esclarecida por necropsia entre os classificados como de causa mal definida pelo primeiro avaliador. RESULTADOS: A proporção de óbitos classificados como de causa mal definida pelo primeiro avaliador aumentou entre 1980 e 2002 em todas as áreas: nos municípios com SVO, nos municípios sem SVO e na Baixada Santista. Para o Estado de São Paulo como um todo, o aumento foi de quase 30% no período de 1980 a 2002. Para o período de 1998 a 2002, a proporção média de necropsias no total de óbitos excluindo causas externas foi de 21,2, 6,4 e 2,6%, respectivamente, nas áreas com e sem SVO e na Baixada Santista. Entre 1998 e 2002, a proporção de óbitos com causa mal definida esclarecidos pela necropsia foi de 92,9 nas áreas com SVO, 32,5 nas áreas sem SVO e 10,7% na Baixada Santista. CONCLUSÕES: A realização de necropsias explica a diferença na mortalidade proporcional por causa mal definida entre as áreas estudadas. O aumento observado entre 1980 e 2002 na classificação de óbitos por causa mal definida pelo primeiro avaliador no Estado de São Paulo indica uma importante piora na qualidade do preenchimento da declaração de óbito nessa instância. São necessárias investigações adicionais para esclarecer as causas dessa mudança. | null | OBJECTIVE: To investigate the proportion of deaths with an ill-defined cause in the Brazilian state of São Paulo between 1980 and 2002, taking into account the influence of autopsies on this proportion. METHOD: Data on the number of deaths were obtained from the Brazilian Ministry of Health. The communities of the state of São Paulo were divided into three groups: (1) municipalities with a service to verify the cause of death (and that may conduct an autopsy), (2) municipalities without a cause of death verification service, and (3) the region of Baixada Santista, which had an extremely large increase in the proportion of deaths from ill-defined causes between 1980 and 1995. The impact of autopsies on the proportion of deaths with an ill-defined cause was defined based on the classification made by the first physician evaluating the cause of death, that is, the physician who referred the case to the verification service for autopsy or who completed the death certificate without referring the case to the verification service. Deaths from external causes were excluded, since autopsy is mandatory in these cases. The following were evaluated: (1) proportion of cases classified by the first evaluating physician as having an ill-defined cause, (2) proportion of autopsies in relation to the total number of deaths (except from external causes), and (3) proportion of deaths classified as ill-defined by the first evaluating physician but explained by the autopsy. RESULTS: The proportion of deaths classified by the first evaluating physician as having an ill-defined cause increased over the 1980-2002 period in all three groups studied: the municipalities with a verification service, the municipalities without a verification service, and in the Baixada Santista region. For the state of São Paulo overall, the increase was almost 30% over that 1980-2002 period. For the 1998-2002 period, the average proportion of autopsies compared to the total number of deaths (except from external causes) was 21.2% in the municipalities with a verification service, 6.4% in the municipalities without a verification service, and 2.6% in Baixada Santista. The proportion of deaths in 1998-2002 initially classified as having an ill-defined cause but that was explained by autopsy was 92.9% in the municipalities with a verification service, 32.5% in the municipalities without a verification service, and 10.7% in Baixada Santista. CONCLUSIONS: The performance of autopsies accounts for the difference in proportional mortality with an ill-defined cause in the three groups of communities studied. The increase in the number of deaths classified as ill-defined by the first evaluating physician occurring in the state of São Paulo over the 1980-2002 period suggests an important decline in the quality of death certificates completed at that first level. More research should be done on the reasons for that change. | http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892006001000003&lng=en&tlng=en | 25 | scielo_articles/spa/1020-4989/S1020-49892006001000003.xml | scielosp.org | spa | [
"Health Policy & Services"
] | [
"Rozman, Mauro Abrahão",
"Eluf-Neto, José"
] | null | null | [
"Atestado de óbito",
"autopsia",
"causa de morte",
"Brasil"
] | null | [
"Cause of death",
"death certificates",
"autopsy",
"Brazil"
] | null | [
"Universidade de São Paulo",
"Universidade Católica de Santos"
] |
spa/1020-4989/S1020-49892006000900012.xml | es | rapid-communication | Revista Panamericana de Salud Pública | 1680-5348 | SciELO Public Health | Organización Panamericana de la Salud | S1020-49892006000900012 | 10.1590/S1020-49892006000900012 | Health Policy & Services | null | null | Efecto independiente de la exposición pasiva prenatal y posnatal al tabaco | null | null | 2,006 | 10 | null | This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. | null | null | null | http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892006000900012&lng=en&tlng=en | null | scielo_articles/spa/1020-4989/S1020-49892006000900012.xml | scielosp.org | spa | [
"Health Policy & Services"
] | null | null | null | null | null | null | null | null |
spa/1020-4989/S1020-49892008000900005.xml | es | research-article | Revista Panamericana de Salud Pública | 1680-5348 | SciELO Public Health | Organización Panamericana de la Salud | S1020-49892008000900005 | 10.1590/S1020-49892008000900005 | Health Policy & Services | Hospital del Niño | null | Impacto de la introducción de la vacuna contra el rotavirus en la hospitalización por gastroenteritis aguda grave en el Hospital del Niño de la Ciudad de Panamá | Impact of rotavirus vaccine introduction on hospital admissions for severe acute gastroenteritis at the Children's Hospital in Panama City | Nieto Guevara, Javier | 2,008 | 9 | null | This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. | null | OBJETIVOS: Determinar si la introducción de la vacunación infantil contra el rotavirus en Panamá permitió reducir la tasa de hospitalización por gastroenteritis en niños menores de 5 años. MÉTODOS: Estudio observacional de corte transversal en dos períodos: del 1 de enero al 31 de agosto de 2005 (antes de la introducción de la vacunación contra el rotavirus) y del 1 de enero al 31 de agosto de 2007 (un año después de la introducción). Se estudiaron todos los niños y niñas entre 2 meses y 5 años de edad hospitalizados con diagnóstico de gastroenteritis aguda grave en la sala de corta estancia de gastroenteritis del Hospital del Niño, en Ciudad de Panamá, Panamá. Las variables fueron: número de episodios de gastroenteritis, número de casos hospitalizados por gastroenteritis aguda grave, días de hospitalización y uso de antibióticos, según dos grupos de edad (de 2 meses a 1 año y de más de 1 año a 5 años). Se calculó el riesgo relativo (RR) con intervalos de confianza de 95% (IC95%) y un nivel de significación P < 0,05. RESULTADOS: Se contabilizaron 1 240 episodios de gastroenteritis aguda grave en 1 222 niños. No se encontraron diferencias significativas entre los dos períodos de estudio en cuanto al número de complicaciones (P = 0,92) y defunciones (P = 1,00). Hubo más episodios de gastroenteritis aguda grave después de la introducción de la vacuna contra el rotavirus humano que en el período previo, pero esta diferencia no fue estadísticamente significativa (RR = 1,12; IC95%: 0,87 a 1,44; P = 0,39). No se encontraron diferencias significativas en relación al tiempo de hospitalización por grupos de edad en los periodos analizados. La proporción de casos tratados con antibióticos fue similar en ambos períodos de estudio (29,7% contra 25,2%; P = 0,08). CONCLUSIONES: No se encontró que la introducción de la vacunación infantil contra el rotavirus en Panamá llevara a una reducción significativa en la tasa de hospitalización por gastroenteritis en niños menores de 5 años. No se observaron cambios significativos en la morbimortalidad y el uso de antibióticos en el tratamiento de la gastroenteritis aguda grave después de la introducción de la vacuna. | OBJECTIVES: To determine if infant rotavirus vaccination in Panama has reduced the rate of hospital admission for gastroenteritis among children under 5 years of age. METHODS: An observational, cross-sectional study of two time periods: 1 January-31 August 2005 (prior to initiating rotavirus vaccination) and 1 January-31 August 2007 (one year after introducing rotavirus vaccination). All the children from 2 months-5 years of age admitted with a diagnosis of acute gastroenteritis to the short-stay gastroenteritis area of the Children's Hospital in Panama City, Panama, were studied. The variables were: number of gastroenteritis episodes; number of cases admitted for severe acute gastroenteritis; number of days hospitalized; and antibiotics treatment for each of the two age groups (2 months-1 year and >1-5 years). The relative risk (RR) was calculated with a 95% confidence interval (95%CI) and a significance level of P < 0.05. RESULTS: There was a total of 1 240 episodes of severe acute gastroenteritis in 1 222 children. No significant differences were found between the two study periods regarding the number of complications (P = 0.92) and deaths (P = 1.00). Although there were more episodes of severe acute gastroenteritis after initiating vaccination against human rotavirus than there were in the period prior, the difference was not statistically significant (RR = 1.12; 95%CI: 087-1.44; P = 0.39). There were no significant differences found in the length of hospital stay by age groups studied in each time period. The percent of cases treated with antibiotics was similar in both study periods (29.7% versus 25.2%; P = 0.08). CONCLUSIONS: The introduction of infant rotavirus vaccination was not found to lead to a significant reduction in hospital admission rates for gastroenteritis among children less than 5 years of age. Significant changes in morbidity and in antibiotics use were not found after the introduction of the vaccine. | http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892008000900005&lng=en&tlng=en | 16 | scielo_articles/spa/1020-4989/S1020-49892008000900005.xml | scielosp.org | spa | [
"Health Policy & Services"
] | [
"Nieto Guevara, Javier",
"López, Óscar",
"González, Gala"
] | null | null | null | [
"Vacuna contra rotavirus",
"diarrea infantil",
"Panamá"
] | [
"Rotavirus vaccines",
"diarrhea, infantile",
"Panama"
] | null | [
"Hospital del Niño"
] |
spa/1020-4989/S1020-49892008000900006.xml | en | research-article | Revista Panamericana de Salud Pública | 1680-5348 | SciELO Public Health | Organización Panamericana de la Salud | S1020-49892008000900006 | 10.1590/S1020-49892008000900006 | Health Policy & Services | Santa Marcelina Hospital | null | Tasa de infecciones asociadas a aparatos en unidades de cuidados intensivos de hospitales brasileños | Device-associated infection rates in intensive care units of Brazilian hospitals: datos de la Comunidad Científica Internacional de Control de Infecciones Nosocomiales | Salomao, Reinaldo | 2,008 | 9 | null | This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. | null | OBJETIVOS: Determinar las tasas de infección asociadas a aparatos (IAA), los perfiles microbiológicos, la resistencia bacteriana, la estancia hospitalaria adicional y la mortalidad atribuible en las unidades de cuidados intensivos (UCI) de tres hospitales brasileños miembros de la Comunidad Científica Internacional de Control de Infecciones Nosocomiales (INICC). MÉTODOS: Se realizó una vigilancia prospectiva de cohorte de las IAA en cinco UCI de tres hospitales urbanos de Brasil, según las definiciones del Sistema Nacional de Vigilancia de Infecciones Nosocomiales de los Centros para el Control y la Prevención de Enfermedades (CDC-NNIS) de los Estados Unidos de América. RESULTADOS: Entre abril de 2003 y febrero de 2006 se hospitalizaron 1 031 pacientes en las cinco UCI estudiadas, con un total de 10 293 días en los que se adquirieron 307 IAA, para una tasa de 29,8% (29,8 IAA por 1 000 días-UCI). Las tasas fueron: de 20,9 casos por 1 000 días-ventilador en neumonía asociada a respiradores (NAR); de 9,1 por 1 000 días-catéter en infecciones circulatorias asociadas con cateterismo venoso central (IC-CVC); y de 9,6 por 1 000 días-catéter en infecciones urinarias asociadas con el uso de catéteres (IUAC). De las IAA causadas por Staphylococcus aureus, 95% se debieron a cepas resistentes a la meticilina. De las infecciones causadas por Enterobacteriaceae, 96,7% fueron resistentes a la ceftriaxona, 79,3% a la ceftazidima y 85,7% a la combinación piperacilina-tazobactam. De las IAA causadas por Pseudomonas aeruginosa, 71,3% resultaron resistentes a la ciprofloxacina, 75,5% a la ceftazidima y 27,7% al imipenem. Los pacientes con IAA en las UCI estudiadas presentaron tasas de mortalidad adicional de 15,3% (riesgo relativo [RR] = 1,79; P = 0,0149) por NAR, 27,8% (RR = 2,44; P = 0,0004) por IC-CVC y 10,7% (RR = 1,56; P = 0,2875) por IUAC. CONCLUSIONES: Las tasas de IAA en las UCI de los hospitales brasileños estudiados fueron elevadas. Se puede mejorar la seguridad de los pacientes mediante la implementación de un programa de control activo de las infecciones, que contemple la vigilancia de las IAA y directivas para la prevención de las infecciones. Estas acciones deben ser una prioridad en todos los países. | OBJECTIVES: To measure device-associated infection (DAI) rates, microbiological profiles, bacterial resistance, extra length of stay, and attributable mortality in intensive care units (ICUs) in three Brazilian hospitals that are members of the International Nosocomial Infection Control Consortium (INICC). METHODS: Prospective cohort surveillance of DAIs was conducted in five ICUs in three city hospitals in Brazil by applying the definitions of the U.S. Centers for Disease Control and Prevention National Nosocomial Infections Surveillance System (CDC-NNIS). RESULTS: Between April 2003 and February 2006, 1 031 patients hospitalized in five ICUs for an aggregate 10 293 days acquired 307 DAIs, a rate of 29.8% or 29.8 DAIs per 1 000 ICU-days. The ventilator-associated pneumonia (VAP) rate was 20.9 per 1 000 ventilator-days; the rate for central venous catheter-associated bloodstream infections (CVC-BSI) was 9.1 per 1 000 catheter-days; and the rate for catheter-associated urinary tract infections (CAUTI) was 9.6 per 1 000 catheter-days. Ninety-five percent of all Staphylococcus aureus DAIs were caused by methicillin-resistant strains. Infections caused by Enterobacteriaceae were resistant to ceftriaxone in 96.7% of cases, resistant to ceftazidime in 79.3% of cases, and resistant to piperacillin-tazobactam in 85.7% of cases. Pseudomonas aeruginosa DAIs were resistant to ciprofloxacin in 71.3% of cases, resistant to ceftazidime in 75.5% of cases, and resistant to imipenem in 27.7% of cases. Patients with DAIs in the ICUs of the hospitals included in this study presented extra mortality rates of 15.3% (RR 1.79, P = 0.0149) for VAP, 27.8% (RR 2.44, P = 0.0004) for CVC-BSI, and 10.7% (RR 1.56, P = 0.2875) for CAUTI. CONCLUSION: The DAI rates were high in the ICUs of the Brazilian hospitals included in this study. Patient safety can be improved through the implementation of an active infection control program comprising surveillance of DAIs and infection prevention guidelines. These actions should become a priority in every country. | http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892008000900006&lng=en&tlng=en | 44 | scielo_articles/spa/1020-4989/S1020-49892008000900006.xml | scielosp.org | spa | [
"Health Policy & Services"
] | [
"Salomao, Reinaldo",
"Rosenthal, Victor D.",
"Grimberg, Gorki",
"Nouer, Simone",
"",
"Buchner-Ferreira, Silvia",
"Vianna, Rosa",
"Maretti-da-Silva, Maria Ângela"
] | null | null | null | [
"Infecciones bacterianas",
"infección hospitalaria",
"farmacorresistencia bacteriana",
"hospitales",
"control de infecciones",
"profesionales para control de infecciones",
"unidades de terapia intensiva",
"tiempo de internación",
"mortalidad",
"Brasil"
] | [
"Bacterial infection",
"cross infection",
"drug resistance, bacterial",
"hospitals",
"infection control",
"infection control practitioners",
"intensive care units",
"length of stay",
"mortality",
"Brazil"
] | null | [
"Santa Marcelina Hospital",
"Medical College of Buenos Aires",
"Porto Alegre General Hospital",
"Clementino Fraga Filho University Hospital"
] |
spa/1020-4989/S1020-49892008000900007.xml | en | research-article | Revista Panamericana de Salud Pública | 1680-5348 | SciELO Public Health | Organización Panamericana de la Salud | S1020-49892008000900007 | 10.1590/S1020-49892008000900007 | Health Policy & Services | null | null | Valor económico de los años de vida ajustados por discapacidad perdidos por la violencia: cálculos para los Estados Miembros de la OMS | Economic value of disability-adjusted life years lost to violence: estimates for WHO Member States | Brown, David W. | 2,008 | 9 | null | This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. | null | La violencia es un importante reto para la salud pública y conlleva considerables consecuencias económicas para las personas afectadas, sus familias y la comunidad. A partir de datos de la Organización Mundial de la Salud (OMS) y del Banco Mundial se estimó el valor económico de los años de vida ajustados por discapacidad (AVAD) perdidos en 2002 por la violencia. Los datos de los Estados Miembros de la OMS se presentan como porcentajes de su producto interno bruto (PIB). Según los resultados, se perdieron 48,4 millones de AVAD como resultado de 1,6 millones de muertes por violencia en el año 2002, para un valor económico total estimado de US$ 151 000 millones (en dólares estadounidenses de 2002). El valor económico de los AVAD perdidos por la violencia en los 193 Estados Miembros de la OMS varió de 0,04% a 5,1% de su PIB. Se debe hacer un mayor esfuerzo en la cuantificación de la carga económica de la violencia en el mundo, particularmente en los países de ingresos bajos y medios, donde la carga de la violencia alcanza los mayores valores. | Violence is an important public health challenge with substantial economic consequences for the affected individuals, families, and communities. Using data from the World Health Organization (WHO) and the World Bank, the economic value of disability-adjusted life years (DALYs) lost due to violence in 2002 was estimated for WHO Member States and presented as a percentage of gross domestic product (GDP). Results indicated an estimated 48.4 million DALYs were lost as a result of 1.6 million deaths due to violence in 2002, for a total estimated economic value of US$ 151 billion (in constant US$ for the year 2000). Expressed as a percentage of GDP, the economic value of DALYs lost due to violence ranged from 0.04% to 5.1% across the 193 Member States. Much more is needed in terms of quantifying the economic burden of violence globally, particularly in low- and middle-income countries, where the burden of violence is greatest. | http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892008000900007&lng=en&tlng=en | 7 | scielo_articles/spa/1020-4989/S1020-49892008000900007.xml | scielosp.org | spa | [
"Health Policy & Services"
] | [
"Brown, David W."
] | null | null | null | [
"Violencia",
"costo de enfermedad"
] | [
"Violence",
"cost of illness"
] | null | null |
spa/1020-4989/S1020-49892008001000011.xml | en | research-article | Revista Panamericana de Salud Pública | 1680-5348 | SciELO Public Health | Organización Panamericana de la Salud | S1020-49892008001000011 | 10.1590/S1020-49892008001000011 | Health Policy & Services | World Health Organization | Cartas | null | Letters | David W, Brown | 2,008 | 10 | null | This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. | null | null | null | http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892008001000011&lng=en&tlng=en | 2 | scielo_articles/spa/1020-4989/S1020-49892008001000011.xml | scielosp.org | spa | [
"Health Policy & Services"
] | [
"David W, Brown"
] | null | null | null | null | null | null | [
"World Health Organization"
] |
spa/1020-4989/S1020-49892008001000010.xml | es | research-article | Revista Panamericana de Salud Pública | 1680-5348 | SciELO Public Health | Organización Panamericana de la Salud | S1020-49892008001000010 | 10.1590/S1020-49892008001000010 | Health Policy & Services | Hospital Universitario Dr. Gustavo Aldereguía | null | Perspectivas actuales en la asistencia sanitaria al adulto mayor | Current perspectives on health care for the older adult | Romero Cabrera, Angel Julio | 2,008 | 10 | null | This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. | null | null | Standing up to the challenges of aging requires a coordinated strategy, disseminating a geriatric focus among all the specialty areas that serve the older adult. This article addresses the reasons that justify this focus and covers the objectives, goals, and methods currently being proposed to develop the approach. Preventive and curative actions, but most importantly, the overall care of seniors and improvements to their functional status, are priorities for securing a better quality of life in old age. | http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892008001000010&lng=en&tlng=en | 46 | scielo_articles/spa/1020-4989/S1020-49892008001000010.xml | scielosp.org | spa | [
"Health Policy & Services"
] | [
"Romero Cabrera, Angel Julio"
] | null | null | null | [
"adulto mayor",
"geriatría",
"atención a la salud",
"Cuba"
] | [
"aged",
"geriatrics",
"health care",
"Cuba"
] | null | [
"Hospital Universitario Dr. Gustavo Aldereguía"
] |
spa/1020-4989/S1020-49892008001000009.xml | es | research-article | Revista Panamericana de Salud Pública | 1680-5348 | SciELO Public Health | Organización Panamericana de la Salud | S1020-49892008001000009 | 10.1590/S1020-49892008001000009 | Health Policy & Services | null | null | Relación costo-efectividad de la vacunación de adultos mayores contra la influenza | null | null | 2,008 | 10 | null | This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. | null | null | null | http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892008001000009&lng=en&tlng=en | 2 | scielo_articles/spa/1020-4989/S1020-49892008001000009.xml | scielosp.org | spa | [
"Health Policy & Services"
] | null | null | null | null | null | null | null | null |
spa/1020-4989/S1020-49892008001000008.xml | es | research-article | Revista Panamericana de Salud Pública | 1680-5348 | SciELO Public Health | Organización Panamericana de la Salud | S1020-49892008001000008 | 10.1590/S1020-49892008001000008 | Health Policy & Services | , Escuela Nacional de Salud Pública | null | Principales marcos conceptuales aplicados para la evaluación de la salud ambiental mediante indicadores en América Latina y el Caribe | Application of key frameworks to an indicator-based evaluation of environmental health in Latin America and the Caribbean | Schütz, Gabriel | 2,008 | 10 | null | This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. | null | La construcción de indicadores de salud ambiental para evaluar el efecto adverso de los cambios ambientales sobre el bienestar y la calidad de vida de la población es una meta todavía no alcanzada totalmente en América Latina y el Caribe. Por ello, el Programa de las Naciones Unidas para el Medio Ambiente y la Organización Panamericana de la Salud han convocado a instituciones y especialistas de toda la Región para desarrollar un método integral de evaluación del medio ambiente y la salud. En este trabajo se hace un análisis crítico de varias de las metodologías de evaluación ambiental y sanitaria (integrales o no) y se describen, desde una perspectiva histórica, los marcos conceptuales que fundamentan los principales métodos ordenadores o generadores de indicadores de salud ambiental utilizados en América Latina y el Caribe. Se identificaron dos limitaciones metodológicas recurrentes: a) la fuerte dependencia de datos secundarios, lo que implica la necesidad de una capacidad tecnológica instalada poco accesible en América Latina y el Caribe en la actualidad; y b) la falta de criterios claros para desarrollar instrumentos participativos que faciliten la evaluación de problemas de salud ambiental a nivel local. A pesar de los avances alcanzados en el campo de la salud ambiental en cuanto a la comprensión de su complejidad interdisciplinaria, aún se deben mejorar los mecanismos intersectoriales que favorezcan la discusión e implementación de políticas integradas de medio ambiente y salud. | The establishment of environmental health indicators for assessing the adverse effects of environmental changes on the population's health and quality of life is, as yet, a goal that has not been fully reached in Latin America and the Caribbean. As such, the United Nations Environment Program and the Pan American Health Organization (PAHO) have convened Region's institutions and experts to develop a comprehensive method for assessing environmental health. This paper evaluates several methodologies, comprehensive or otherwise, for assessing health and the environment, and describes the frameworks that have historically undergirded the key methods that have either structured or generated the environmental health indicators being used in Latin America and the Caribbean. The recurring, methodological limitations were identified: (a) relying heavily on secondary data, which points out the need for technological infrastructure that is rarely available in Latin America and the Caribbean today; and (b) a lack of clear criteria for developing inclusive tools that would facilitate the discussion of environmental health issues at the grass-roots level. Despite the progress made by the field of environmental health with regard to understanding its interdisciplinary complexities, intersectoral operations must be improved to favor open communication and implementation of integrated policies on environmental and health. | http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892008001000008&lng=en&tlng=en | 18 | scielo_articles/spa/1020-4989/S1020-49892008001000008.xml | scielosp.org | spa | [
"Health Policy & Services"
] | [
"Schütz, Gabriel",
"Hacon, Sandra",
"Silva, Hilton",
"Moreno Sánchez, Ana Rosa",
"Nagatani, Kakuko"
] | null | null | null | [
"Salud ambiental",
"indicadores de salud",
"indicadores ambientales",
"América Latina",
"región del Caribe"
] | [
"Environmental health",
"health indicators",
"environmental indicators",
"Latin America",
"Caribbean Region"
] | null | [
", Escuela Nacional de Salud Pública",
"Universidade Federal do Rio de Janeiro",
"Oficina Regional para América Latina y el Caribe",
"Universidad Nacional Autónoma de México"
] |
spa/1020-4989/S1020-49892008001000007.xml | en | research-article | Revista Panamericana de Salud Pública | 1680-5348 | SciELO Public Health | Organización Panamericana de la Salud | S1020-49892008001000007 | 10.1590/S1020-49892008001000007 | Health Policy & Services | Universidad Peruana Cayetano Heredia | null | ¿Se prefieren enfermeros obstétricos para el control de las infecciones de trasmisión sexual en hombres en los países en desarrollo? | Male midwives: preferred managers of sexually transmitted infections in men in developing countries? | Hsieh, Evelyn J. | 2,008 | 10 | null | This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. | null | OBJETIVOS: Describir las características demográficas y de la práctica profesional del personal de enfermería obstétrica en consultorios privados (ECP) según el sexo en 10 ciudades de Perú y el papel que desempeñan en los cuidados de salud reproductiva, específicamente en la atención de las infecciones de transmisión sexual (ITS). MÉTODOS: Como parte de un ensayo de intervención en 10 ciudades de diferentes provincias de Perú, diseñado para mejorar la atención de las ITS, se recogió información detallada del personal de enfermería obstétrica ocupado en diferentes tipos de consultorios de cada ciudad. Se realizó una encuesta de puerta en puerta en todos los consultorios e instituciones médicas de cada ciudad. A cada ECP localizado se le pidió responder un cuestionario sobre datos demográficos, entrenamiento, tipo(s) de consultorio(s), número de casos de ITS atendidos mensualmente e ingresos medios por consulta. RESULTADOS: De los 905 enfermeros y enfermeras encuestados, 442 informaron tener una consulta privada, ya sea de forma exclusiva o concurrente con otros cargos clínicos; 99,3% de estos ECP manifestaron atender casos de ITS. Las ciudades andinas presentaron la mayor densidad de ECP, seguidas por las de la selva y la costa, en ese orden. Las ciudades de la selva presentaron la mayor proporción de ECP hombres (35,5%). Aunque tanto los ECP hombres como las ECP mujeres informaron atender pacientes masculinos con ITS, los ECP hombres atendieron un número significativamente mayor que sus contrapartes mujeres. CONCLUSIONES: En zonas de Perú donde no hay suficientes médicos, los ECP ofrecen los servicios necesarios de salud reproductiva, incluida la atención de las ITS. En particular, los ECP hombres parecen servir como proveedores de atención sanitaria a pacientes masculinos con ITS. Esta tendencia, que podría existir en otros países en desarrollo con personal sanitario con características demográficas similares, resalta la necesidad de establecer nuevas líneas de entrenamiento e investigación en servicios de salud. | OBJECTIVES: To describe demographic and practice characteristics of male and female midwives in private practice (MIPPs) in 10 cities of Peru, and their role in the delivery of reproductive health care, specifically management of sexually transmitted infections (STIs). METHODS: As part of an intervention trial in 10 cities in the provinces of Peru designed to improve STI management, detailed information was collected regarding the number of midwives in each city working in various types of practices. A door-to-door survey of all medical offices and institutions in each city was conducted. Each MIPP encountered was asked to answer a questionnaire regarding demographics, training, practice type(s), number of STI cases seen per month, and average earnings per consultation. RESULTS: Of the 905 midwives surveyed, 442 reported having a private practice, either exclusively or concurrently with other clinical positions; 99.3% of these MIPPs reported managing STI cases. Andean cities had the highest density of MIPPs, followed by jungle and coastal cities, respectively. Jungle cities had the largest proportion of male MIPPs (35.5%). While both male and female MIPPs reported seeing male patients, male MIPPs saw a significantly greater number than their female counterparts. CONCLUSIONS: In areas of Peru where physicians are scarce, MIPPs provide needed reproductive health services, including STI management. Male MIPPs in particular appear to serve as health care providers for male patients with STIs. This trend, which may exist in other developing countries with similar healthcare workforce demographics, highlights the need for new areas of training and health services research. | http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892008001000007&lng=en&tlng=en | 11 | scielo_articles/spa/1020-4989/S1020-49892008001000007.xml | scielosp.org | spa | [
"Health Policy & Services"
] | [
"Hsieh, Evelyn J.",
"García, Patricia J.",
"La Rosa Roca, Sayda"
] | null | null | null | [
"Enfermeras",
"enfermeros",
"práctica privada",
"recursos humanos en salud",
"enfermedades sexualmente transmisibles",
"Perú"
] | [
"Midwives",
"private practice",
"health manpower",
"sexually transmitted diseases",
"Peru"
] | null | [
"Universidad Peruana Cayetano Heredia"
] |
spa/1020-4989/S1020-49892008001000006.xml | en | research-article | Revista Panamericana de Salud Pública | 1680-5348 | SciELO Public Health | Organización Panamericana de la Salud | S1020-49892008001000006 | 10.1590/S1020-49892008001000006 | Health Policy & Services | Universidade de São Paulo | null | Conocimientos y prácticas de los estudiantes de medicina para prevenir la transmisión de la tuberculosis en Río de Janeiro, Brasil | Knowledge and practices of medical students to prevent tuberculosis transmission in Rio de Janeiro, Brazil | Teixeira, Eleny Guimarães | 2,008 | 10 | null | This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. | null | OBJETIVOS: Describir los conocimientos y las prácticas de los estudiantes de medicina para prevenir la transmisión de la tuberculosis (TB) en cinco escuelas de medicina y sus factores asociados. MÉTODOS: Estudio transversal mediante encuesta a estudiantes de medicina de cursos preclínicos, clínicos iniciales y clínicos avanzados. Se obtuvo información del perfil sociodemográfico, las conferencias recibidas sobre TB, el conocimiento sobre la transmisión de la TB, la exposición a pacientes con TB pulmonar activa y el uso de máscaras respiratorias de protección. RESULTADOS: De los 1 094 encuestados, 575 (52,6%) respondieron correctamente que toser, hablar y estornudar pueden transmitir la TB. Estar en los cursos clínicos iniciales (razón de posibilidades ajustada [ORa] = 4,0; intervalo de confianza de 95% [IC95%]: 3,0 a 5,5) y avanzados (ORa = 4,2; IC95%: 3,1 a 5,8) se asociaron con las respuestas correctas, no así haber recibido conferencias sobre TB. La tasa de respuestas correctas aumentó de 42,1% a 61,6% en los estudiantes que habían recibido conferencias sobre TB. De los 332 estudiantes de medicina que informaron haber estado expuestos a pacientes con TB, 194 (58,4%) no usaron máscaras protectoras. El mayor número de años de experiencia clínica se asoció con el uso de máscaras (ORa = 2,9; IC95%: 1,4 a 6,1), mientras que el conocimiento sobre el tema se asoció inversamente con el uso de máscaras (ORa = 0,4; IC95%: 0,2 a 0,6). CONCLUSIONES: Muchos estudiantes de medicina no conocen las vías principales de infección de la TB y las conferencias sobre TB no son suficientes para modificar sus conocimientos y actitudes. Independientemente del conocimiento sobre la transmisión de la TB, los estudiantes incurrieron en conductas de riesgo: más de dos terceras partes no usó máscaras protectoras al examinar casos activos de TB. Se recomienda establecer prácticas docentes innovadoras, efectivas y activas para cambiar este escenario. | OBJECTIVES: To describe knowledge, practices, and associated factors of medical students to prevent transmission of tuberculosis (TB) in five medical schools. METHODS: Cross-sectional survey of undergraduate medical students in preclinical and in early and late clinical years. Information was obtained on sociodemographic profile, previous lectures on TB, knowledge about TB transmission, exposure to patients with active pulmonary TB, and use of respiratory protective masks. RESULTS: Among 1 094 respondents, 575 (52.6%) correctly answered that coughing, speaking, and sneezing can transmit TB. Early [adjusted odds ratio = 4.0 (3.0, 5.5)] and late [adjusted odds ratio = 4.2 (3.1, 5.8)] clinical years were associated with correct answers, but having had previous lectures on TB was not. Among those who had previous lectures on TB, the rate of correct answers increased from 42.1% to 61.6%. Among 332 medical students who reported exposure to TB patients, 194 (58.4%) had not used protective masks. More years of clinical experience was associated with the use of masks [adjusted odds ratio = 2.9 (1.4, 6.1)], while knowledge was inversely associated with the use of masks [adjusted odds ratio = 0.4 (0.2, 0.6)]. CONCLUSIONS: Many medical students are not aware of the main routes of TB infection, and lectures on TB are not sufficient to change knowledge and practices. Regardless of knowledge about TB transmission, students engage in risky behaviors: more than two-thirds do not use a protective mask when examining an active TB case. We suggest innovative, effective active learning experiences to change this scenario. | http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892008001000006&lng=en&tlng=en | 20 | scielo_articles/spa/1020-4989/S1020-49892008001000006.xml | scielosp.org | spa | [
"Health Policy & Services"
] | [
"Teixeira, Eleny Guimarães",
"Menzies, Dick",
"Cunha, Antonio Jose Ledo Alves",
"Luiz, Ronir Raggio",
"Ruffino-Netto, Antonio",
"Scartozzoni, Marcio Samara",
"Portela, Poliana",
"Trajman, Anete"
] | null | null | null | [
"Conocimientos, actitudes y prácticas en salud",
"Mycobacterium tuberculosis",
"infección hospitalaria",
"Brasil"
] | [
"Health knowledge, attitudes, practice",
"Mycobacterium tuberculosis",
"nosocomial infections",
"Brazil"
] | null | [
"Universidade de São Paulo",
"Universidade Federal do Rio de Janeiro",
"McGill University",
"Gama Filho University",
"Universidade Federal do Rio de Janeiro"
] |
spa/1020-4989/S1020-49892008001000005.xml | es | research-article | Revista Panamericana de Salud Pública | 1680-5348 | SciELO Public Health | Organización Panamericana de la Salud | S1020-49892008001000005 | 10.1590/S1020-49892008001000005 | Health Policy & Services | Fundación Universitaria de Ciencias de la Salud | null | Comparación de tres estrategias de tamizaje para la prevención de la infección perinatal por VIH en Colombia: análisis de decisiones | A comparison of three screening strategies for prevention of perinatal HIV infection in Colombia: a decision analysis model | Gómez, Marcela | 2,008 | 10 | null | This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. | null | OBJETIVO: Comparar mediante un modelo de análisis de decisiones tres estrategias de tamizaje de la infección por el VIH en mujeres embarazadas según su relación costo-efectividad y proponer la más apropiada para el sistema de salud colombiano. MÉTODOS: Estudio económico basado en el análisis mediante árboles de decisión según tres estrategias de tamizaje de la infección por el VIH en mujeres embarazadas: la voluntaria, la universal y la opcional. Se consideró a todas las mujeres colombianas embarazadas sin diagnóstico de infección por el VIH que se presentaban para el parto. Se emplearon los costos médicos directos desde la realización de la prueba hasta un año después del parto, según el Sistema General de Seguridad Social en Salud. Se compararon las razones costo-efectividad y el ahorro de cada estrategia analizada. RESULTADOS: Por cada 10 000 mujeres, la estrategia universal permitió detectar 5 casos más que la estrategia voluntaria y 7 casos más que la opcional. La estrategia universal generó costos aproximados de US$ 17,00 por cada recién nacido positivo, es decir, menos de la mitad que lo calculado para la estrategia voluntaria (US$ 38,00) y menor que para la opcional (US$ 24,00). Según el análisis bifactorial, la estrategia de tamizaje universal fue menos costosa que la voluntaria y más efectiva que las otras dos estrategias, independientemente de la prevalencia, la tasa de positivos falsos del sistema de diagnóstico empleado y la tasa de aceptación materna para realizarse la prueba de tamizaje. CONCLUSIONES: La estrategia de tamizaje voluntaria, que se utiliza actualmente en Colombia, es más costosa que la universal a mediano y largo plazos y tiene menor efectividad y capacidad de prevención. Se recomienda a las autoridades nacionales de salud realizar el tamizaje de la infección por el VIH a todas las embarazadas colombianas con pruebas de tercera generación. | OBJECTIVES: To apply decision analysis to compare the cost-effectiveness of three strategies for HIV screening of pregnant women and to recommend the one most appropriate for the health care system of Colombia. METHODS: An economic study applying decision analysis to three types of HIV screening of expectant women: voluntary, universal, and optional. All the women in Colombia with unknown HIV status who were admitted for child birth were included. The study included all the direct medical costs incurred from the time of testing through the first year following delivery, according to the General System for Healthcare Social Security. Cost-effectiveness ratio and the savings of each of the strategies were compared. RESULTS: For every 10 000 women, the universal strategy detected five cases more than the voluntary strategy and seven cases more than the optional. The universal strategy carried a cost of approximately US$ 17 for each HIV-positive newborn; that is, less than half of that of the voluntary strategy (US$ 38) and less than the optional (US$ 24). According to the bifactorial analysis, the universal screening strategy was less costly than the voluntary and more effective than both of the others, regardless of prevalence, the false-positive rate of each method, and the rate of maternal compliance with screening. CONCLUSIONS: The screening strategy currently in use in Colombia is more costly (in both the medium- and long-term), less effective, and less capable of prevention, than the universal screening strategy. The recommendation to the national health authorities of Colombia is to begin screening all pregnant women for HIV infection using third-generation testing. | http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892008001000005&lng=en&tlng=en | 17 | scielo_articles/spa/1020-4989/S1020-49892008001000005.xml | scielosp.org | spa | [
"Health Policy & Services"
] | [
"Gómez, Marcela"
] | null | null | null | [
"Transmisión vertical de enfermedades",
"VIH",
"tamizaje masivo",
"atención perinatal",
"costos y análisis de costo",
"Colombia"
] | [
"Disease transmission, vertical",
"HIV",
"mass screening",
"perinatal care",
"costs and cost analysis",
"Colombia"
] | null | [
"Fundación Universitaria de Ciencias de la Salud"
] |
spa/1020-4989/S1020-49892008001000004.xml | en | research-article | Revista Panamericana de Salud Pública | 1680-5348 | SciELO Public Health | Organización Panamericana de la Salud | S1020-49892008001000004 | 10.1590/S1020-49892008001000004 | Health Policy & Services | Centers for Disease Control and Prevention | null | Meningitis negativa a pruebas antigénicas y de cultivo en niños guatemaltecos | Culture- and antigen-negative meningitis in Guatemalan children | Dueger, Erica L. | 2,008 | 10 | null | This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. | null | OBJETIVO: Comparar los casos infantiles de meningitis bacteriana confirmada (MBC) y meningitis negativa a pruebas de látex y de cultivo (MNLC). MÉTODOS: Se evaluaron los niños de 1 a 59 meses de edad ingresados en tres grandes hospitales de referencia de la Ciudad de Guatemala entre el 1 de octubre de 1996 y el 31 de diciembre de 2005 con signos clínicos de infección bacteriana. Se realizaron cultivos bacterianos y pruebas de aglutinación antigénica con látex en muestras de líquido cefalorraquídeo (LCR). RESULTADOS: La tasa de letalidad fue significativamente mayor en los 493 niños con MBC que en los 528 niños con MNLC (27,6% y 14,9%, respectivamente; P < 0,001). Los niños con MBC tuvieron menor probabilidad de recibir antibióticos y mayor de sufrir convulsiones, choques o entrar en coma al ser ingresados que los niños con MNLC. Se observó un mayor porcentaje de manifestaciones clínicas de secuelas al alta hospitalaria en los 182 niños sobrevivientes con MBC que en los 205 sobrevivientes con MNLC estudiados entre octubre de 2000 y diciembre de 2005 (78,6% y 46,8%, respectivamente; P < 0,0001). Los factores de riesgo de muerte en los niños con MBC fueron: glucosa en LCR < 10 mg/dL, neutrófilos periféricos < 2 000 células/mm³, coma o choque al ingreso, y sepsis o neumonía concurrentes; solo el coma y el choque al ingreso predijeron la muerte en niños con MNLC. CONCLUSIONES: Las altas tasas de letalidad y de secuelas indican que muchos niños con MNLC pueden haber tenido meningitis bacteriana. Las estadísticas basadas solamente en los casos confirmados de meningitis subestiman la verdadera carga de enfermedad prevenible mediante vacuna. Se deben emprender estudios adicionales para determinar las etiologías de la MNLC en esta población. | OBJECTIVE: To compare children with confirmed bacterial meningitis (CBM) and those with culture- and latex-negative meningitis (CLN). METHODS: Children 1 to 59 months of age admitted to three major referral hospitals in Guatemala City with clinical signs compatible with bacterial infections were evaluated prospectively between 1 October 1996 and 31 December 2005. Bacterial cultures and latex agglutination antigen testing were performed on samples of cerebrospinal fluid (CSF). RESULTS: The case-fatality rate was significantly higher in the 493 children with CBM than in the 528 children with CLN (27.6% and 14.9%, respectively; P < 0.001). Children with CBM were less likely to have received antibiotics and more likely to have seizures, shock, or coma on admission than children with CLN. Among the 182 CBM survivors and 205 CLN survivors studied between October 2000 and December 2005, clinically observed sequelae were present at discharge in a higher percentage of the CBM than of the CLN group (78.6% and 46.8%, respectively; P < 0.0001). CSF glucose < 10 mg/dL, peripheral neutrophils < 2 000 cells/mm³, coma or shock at admission, and concurrent sepsis or pneumonia were risk factors for mortality in children with CBM; only coma or shock at admission predicted mortality in children with CLN. CONCLUSIONS: The high case-fatality and sequelae rates suggest that many children with CLN may have had bacterial meningitis. Estimates based on confirmed meningitis alone underestimate the true vaccine-preventable disease burden. Additional studies to determine etiologies of CLN in this population are indicated. | http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892008001000004&lng=en&tlng=en | 34 | scielo_articles/spa/1020-4989/S1020-49892008001000004.xml | scielosp.org | spa | [
"Health Policy & Services"
] | [
"Dueger, Erica L.",
"Asturias, Edwin J.",
"Halsey, Neal A."
] | null | null | null | [
"Meningitis viral",
"meningitis bacteriana",
"meningitis aséptica",
"Guatemala"
] | [
"Viral meningitis",
"bacterial meningitis",
"aseptic meningitis",
"Guatemala"
] | null | [
"Centers for Disease Control and Prevention",
"Johns Hopkins University"
] |
spa/1020-4989/S1020-49892008001000003.xml | pt | research-article | Revista Panamericana de Salud Pública | 1680-5348 | SciELO Public Health | Organización Panamericana de la Salud | S1020-49892008001000003 | 10.1590/S1020-49892008001000003 | Health Policy & Services | Fundação Oswaldo Cruz | Consumo de agrotóxicos e distribuição temporal da proporção de nascimentos masculinos no Estado do Paraná, Brasil | null | Agricultural toxic use and temporal distribution of male birth rate in the state of Paraná, Brazil | Gibson, Gerusa | 2,008 | 10 | null | This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. | OBJETIVO: Investigar a tendência temporal da proporção de nascimentos masculinos para o Estado do Paraná no período entre 1994 e 2004 e a correlação dessa tendência com o volume de vendas de agrotóxicos no Estado em 1985. MÉTODO: No presente estudo ecológico, foram empregados como fontes de dados o Instituto Brasileiro de Geografia e Estatística (volume de vendas de agrotóxicos) e o banco DATASUS (nascidos vivos segundo o sexo). Foram analisados 308 municípios, divididos em quartis conforme o consumo de agrotóxicos, resultando em quatro estratos contendo 77 municípios cada um, sendo o quarto quartil o de maior consumo. A proporção de nascimentos masculinos foi obtida ano a ano para cada município e, ao final do período (1994 a 2004), um valor mediano foi calculado para cada uma das localidades. Foi realizada uma análise bivariada e calculados os coeficientes de Pearson para cada quartil de municípios. Uma análise exploratória e comparativa dos quartis foi realizada, na qual se calculou o consumo médio per capita para os mesmos. Posteriormente, foram selecionados e analisados individualmente 10 municípios com intensa atividade agropecuária quanto ao perfil agrícola e à tendência da proporção de nascimentos masculinos ao longo do período de estudo. RESULTADOS: Foi observada uma discreta tendência de declínio na proporção de nascidos vivos do sexo masculino para o Estado como um todo. A magnitude desse declínio foi visivelmente maior quando se analisou individualmente o grupo de 10 municípios, cujos valores observados ao final da série mostraram-se muito abaixo daqueles normalmente descritos na literatura (proporção de nascimentos masculinos < 50%). Em relação aos quartis, todos apresentaram correlação negativa, ainda que sem significância estatística. CONCLUSÕES: A tendência de declínio estatisticamente significativa na proporção de nascimentos masculinos em alguns municípios paranaenses sugere que o fenômeno possa ser decorrente da alta exposição ambiental aos agrotóxicos nessas localidades. Sendo assim, recomendam-se estudos futuros que visem a esclarecer e a dimensionar a força do impacto da contaminação ambiental por agrotóxicos na saúde reprodutiva, representada aqui pela razão de sexos ao nascimento. | null | OBJECTIVE: To determine the trend in male birth rates from 1994-2004 in the state of Paraná, Brazil, and whether a correlation exists between this trend and the state's agricultural toxic sales in 1985. METHOD: This ecological study employed data from the Brazilian Institute for Geography and Statistics (agricultural toxic sales) and the Unified Health System's data-base "DATASUS" (sex ratio at birth). Three hundred and eight (308) municipalities were analyzed, divided into quartiles by pesticide usage. Each of the four resulting quartiles included 77 municipalities, with the fourth quartile representing the highest consumption. The male birth rate was obtained for each year for each municipality. Then the median rate was calculated for the entire period (1994-2004) for each municipality. A bivariate analysis was carried out. Pearson coefficients were calculated for each quartile. An exploratory and comparative analysis of quartiles was performed, and the mean per capita consumption was calculated for each quartile. Ten municipalities with intense agricultural activity were then selected and analyzed individually in terms of their agricultural profile and male birth rate trend during the study period. RESULTS: A discrete decline was observed in the rate of live male births for the entire state. The magnitude of this decline was more evident when the group of 10 municipalities was analyzed: in this group, the rates observed at the end of the study period were much lower than those usually described in the literature (male birth rate < 50%). Pearson's correlation was negative for all quartiles, although without statistical significance. CONCLUSIONS: The statistically significant trend towards a decline in male births in some of the Paraná municipalities suggests that this phenomenon may be a result of a high level of environmental exposure to pesticides. Future studies should confirm and measure the impact of environmental pesticide contamination on reproductive health, expressed in this study as sex ratio at birth. | http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892008001000003&lng=en&tlng=en | 22 | scielo_articles/spa/1020-4989/S1020-49892008001000003.xml | scielosp.org | spa | [
"Health Policy & Services"
] | [
"Gibson, Gerusa",
"Koifman, Sergio"
] | null | null | [
"Agrotóxicos",
"poluição ambiental",
"saúde reprodutiva",
"Brasil"
] | null | [
"Pesticides",
"environmental pollution",
"reproductive medicine",
"Brazil"
] | null | [
"Fundação Oswaldo Cruz"
] |
spa/1020-4989/S1020-49892008001000002.xml | en | research-article | Revista Panamericana de Salud Pública | 1680-5348 | SciELO Public Health | Organización Panamericana de la Salud | S1020-49892008001000002 | 10.1590/S1020-49892008001000002 | Health Policy & Services | Universidade Nacional | null | Farmacoeconomía de antidepresivos en trastornos de depresión moderada e intensa en Colombia | Pharmacoeconomics of antidepressants in moderate-to-severe depressive disorder in Colombia | Machado, Márcio | 2,008 | 10 | null | This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. | null | OBJETIVO: Comparar tres medicamentos antidepresivos de diferentes clases empleados para tratar trastornos depresivos mayores moderados e intensos en adultos colombianos. MÉTODOS: A partir de los aportes de expertos se adaptó un modelo de árbol de decisión para Colombia a fin de analizar los datos de seis meses desde la perspectiva del gobierno como pagador de los servicios. Se determinó la relación costo-efectividad de la amitriptilina, la fluoxetina y la venlafaxina. El desenlace clínico fue la remisión de la depresión (una puntuación <7 en la escala de depresión de Hamilton o <12 en la escala de valoración de la depresión de Montgomery-Åsberg) después de 8 semanas de tratamiento. Los datos clínicos se obtuvieron de la literatura especializada y los costos, de las listas habituales de precios de Colombia. Se realizaron análisis de sensibilidad simples y multifactoriales para probar la robustez de los modelos. RESULTADOS: Los costos del tratamiento por paciente (en dólares estadounidenses de 2007) fueron: US$ 1 618 para la venlafaxina, US$ 1 207 para la fluoxetina y US$ 1 068 para la amitriptilina. Las tasas de remisión general fueron 73,1%, 64,1% y 71,3%, respectivamente. La amitriptilina tuvo un menor costo y una mayor remisión que la fluoxetina. La razón de rentabilidad incremental de la venlafaxina sobre la amitriptilina fue de US$ 31 595. El inductor de costos (cost driver) del modelo fue el valor de adquisición de la venlafaxina, que representó 53,4% del total del costo por paciente tratado, en comparación con la fluoxetina (18,5%) y la amitriptilina (24,8%). En los otros casos, la hospitalización representó el mayor costo (72,1% y 65,2%, respectivamente). El análisis de sensibilidad probabilístico (Monte Carlo) confirmó los resultados preliminares del modelo farmacoeconómico. CONCLUSIONES: En Colombia, la amitriptilina es más efectiva en función del costo que la fluoxetina y la venlafaxina. No obstante, el costo de la venlafaxina se estimó a partir del medicamento de marca, ya que no había genéricos disponibles. Esta relación costo-efectividad puede variar considerablemente con la aparición de medicamentos genéricos o medidas regulatorias del costo de los medicamentos. | OBJECTIVE: To compare three antidepressant drugs from different classes used in treating moderate-to-severe major depressive disorder (MDD) in Colombian adults. METHODS: Based on expert input, a decision-tree model was adapted for Colombia to analyze data over 6 months from the government-payer perspective. The cost-effectiveness of amitriptyline, fluoxetine, and venlafaxine was determined. The clinical outcome was remission of depression (a score <7 on the Hamilton Depression [HAM-D] scale or <12 on the Montgomery-Åsberg Depression Rating Scale [MADRS]) after 8 weeks of treatment. Clinical data were obtained from the literature and costs from standard Colombian price lists. One-way and multivariate sensitivity analyses tested model robustness. RESULTS: Costs per patient (in 2007 US$) for treatment were: venlafaxine, $1 618; fluoxetine, $1 207; and amitriptyline, $1 068. Overall remission rates were 73.1%, 64.1%, and 71.3%, respectively. Amitriptyline dominated fluoxetine (i.e., it had lower costs and higher outcomes). The incremental cost-effectiveness ratio (ICER) of venlafaxine over amitriptyline was US$ 31 595. The acquisition price of venlafaxine was the model's cost driver, comprising 53.4% of the total cost/patient treated, compared with 18.5% and 24.8% for fluoxetine and amitriptyline, respectively. For the others, hospitalization comprised the major cost (72.1% and 65.2%, respectively). Probabilistic (Monte Carlo) sensitivity analysis confirmed the original findings of the pharmacoeconomic model. CONCLUSIONS: Amitriptyline is cost-effective in comparison to fluoxetine and venlafaxine in Colombia. However, the cost of venlafaxine was estimated for the brand-name product, as generics were not currently available. These cost-effectiveness results can be substantially affected by the presence of generics or drug cost regulations. | http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892008001000002&lng=en&tlng=en | 19 | scielo_articles/spa/1020-4989/S1020-49892008001000002.xml | scielosp.org | spa | [
"Health Policy & Services"
] | [
"Machado, Márcio",
"Lopera, Monica Maria",
"Diaz-Rojas, Jorge",
"Jaramillo, Luis Eduardo",
"Einarson, Thomas Ray"
] | null | null | null | [
"Economía farmacéutica",
"agentes antidepresivos",
"técnicas de apoyo para la decisión",
"Colombia"
] | [
"Pharmaceutical economics",
"antidepressant agents",
"decision support techniques",
"Colombia"
] | null | [
"Universidade Nacional",
"Universidad Nacional de Colombia",
"University of Toronto"
] |
spa/1020-4989/S1020-49892008001000001.xml | es | research-article | Revista Panamericana de Salud Pública | 1680-5348 | SciELO Public Health | Organización Panamericana de la Salud | S1020-49892008001000001 | 10.1590/S1020-49892008001000001 | Health Policy & Services | Centros de Integración Juvenil | null | Factores psicosociales de riesgo de consumo de drogas ilícitas en una muestra de estudiantes mexicanos de educación media | Psychosocial risk factors for illicit drug use in a sample of Mexican high school students | Díaz Negrete, Bruno | 2,008 | 10 | null | This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. | null | OBJETIVOS: Identificar factores psicosociales de riesgo de consumo de sustancias ilícitas en estudiantes mexicanos y ofrecer elementos para el diseño de programas de prevención. MÉTODOS: Estudio transversal no experimental con una muestra de 516 estudiantes de secundaria y bachillerato de seis de las principales ciudades de México. Entre abril y junio de 2005 se aplicó una adaptación de la versión abreviada del Inventario de Tamizaje sobre el Consumo de Drogas (DUSI-R). El análisis comprendió ocho factores: abuso en el consumo de bebidas alcohólicas o drogas, malestar afectivo, bajo control conductual, baja adherencia escolar, baja competencia social, relaciones familiares disfuncionales, aislamiento social y pertenencia a redes sociales desviantes (cuyos integrantes consumen drogas y adoptan actitudes antisocia-les). Se identificaron factores de predicción del consumo de drogas ilícitas mediante regresión logística y se elaboró un modelo de ecuaciones estructurales para determinar las relaciones entre los factores. RESULTADOS: Los factores de predicción del consumo de sustancias ilícitas fueron presentar un bajo control conductual con tendencia a actuar impulsivamente y con agresividad, estar vinculado con pares desviantes y estar expuesto con frecuencia a situaciones familiares de conflicto y violencia y al consumo de sustancias ilícitas y alcohol en el hogar. El modelo de ecuaciones estructurales indicó que el consumo de estas sustancias forma parte de un grupo de trastornos de ajuste conductual, determinado directamente por la vinculación con pares desviantes y por una mayor prevalencia de trastornos socioafectivos, e indirectamente por las relaciones familiares disfuncionales. CONCLUSIONES: Se confirmaron algunas implicaciones de los modelos teóricos propuestos para explicar el consumo de drogas. Estos elementos empíricamente sustentados pueden contribuir al diseño de programas preventivos, principalmente de tipos selectivo e indicado. | OBJECTIVES: To identify psychosocial risk factors for substance abuse among Mexican students and to offer elements for the design of prevention programs. METHODS: A cross-sectional, nonexperimental study of a sample of 516 high school students in six of Mexico's most important cities. From April-June 2005, a customized version of the Drug Use Screening Inventory (revised) (DUSI-R) was administered. The analysis comprised eight factors: alcohol and drug abuse, affective disorders, poor self-control, poor school adjustment, low social competence, dysfunctional family relationships, social isolation, and being part of a detrimental social network (whose members take drugs and have antisocial attitudes). Factors predictive for illicit drug use were found by logistical regression, and a structural equation model was designed to determine the relationships among the factors. RESULTS: The factors that predicted substance abuse were poor self-control with a tendency to act impulsively and aggressively; associating with troublemakers; and being frequently exposed to family conflicts, violence, and drug and/or alcohol use in the home. The structural equation model indicated that substance abuse is one of a group of disorders directly determined by associating with detrimental peers, and a higher rate of socioaffective disorders, and indirectly, by dysfunctional family relationships. CONCLUSIONS: Some of the suggestions made by theoretical models to explain substance abuse were confirmed. These empirically-supported elements can contribute to the design of prevention programs, especially those that are selective and recommended. | http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892008001000001&lng=en&tlng=en | 42 | scielo_articles/spa/1020-4989/S1020-49892008001000001.xml | scielosp.org | spa | [
"Health Policy & Services"
] | [
"Díaz Negrete, Bruno",
"García-Aurrecoechea, Raúl"
] | null | null | null | [
"Drogas ilícitas",
"factores de riesgo",
"estudiantes",
"México"
] | [
"Street drugs",
"risk factors",
"students",
"Mexico"
] | null | [
"Centros de Integración Juvenil"
] |
spa/1020-4989/S1020-49892008000900011.xml | en | letter | Revista Panamericana de Salud Pública | 1680-5348 | SciELO Public Health | Organización Panamericana de la Salud | S1020-49892008000900011 | 10.1590/S1020-49892008000900011 | Health Policy & Services | null | Cartas | null | Letters | null | 2,008 | 9 | null | This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. | null | null | null | http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892008000900011&lng=en&tlng=en | 13 | scielo_articles/spa/1020-4989/S1020-49892008000900011.xml | scielosp.org | spa | [
"Health Policy & Services"
] | null | null | null | null | null | null | null | null |
spa/1020-4989/S1020-49892008000900010.xml | es | rapid-communication | Revista Panamericana de Salud Pública | 1680-5348 | SciELO Public Health | Organización Panamericana de la Salud | S1020-49892008000900010 | 10.1590/S1020-49892008000900010 | Health Policy & Services | null | null | El uso compartido de utensilios para preparar drogas inyectables y no inyectables, ¿una vía de transmisión de la infección por el virus de la hepatitis C? | null | null | 2,008 | 9 | null | This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. | null | null | null | http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892008000900010&lng=en&tlng=en | 4 | scielo_articles/spa/1020-4989/S1020-49892008000900010.xml | scielosp.org | spa | [
"Health Policy & Services"
] | null | null | null | null | null | null | null | null |
spa/1020-4989/S1020-49892008000900009.xml | es | rapid-communication | Revista Panamericana de Salud Pública | 1680-5348 | SciELO Public Health | Organización Panamericana de la Salud | S1020-49892008000900009 | 10.1590/S1020-49892008000900009 | Health Policy & Services | null | null | Diálogo Internacional sobre la Notificación Pública del Desenlace y los Resultados de los Ensayos Clínicos: Reunión PROCTOR | null | null | 2,008 | 9 | null | This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. | null | null | null | http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892008000900009&lng=en&tlng=en | null | scielo_articles/spa/1020-4989/S1020-49892008000900009.xml | scielosp.org | spa | [
"Health Policy & Services"
] | null | null | null | null | null | null | null | null |
spa/1020-4989/S1020-49892008000900008.xml | es | research-article | Revista Panamericana de Salud Pública | 1680-5348 | SciELO Public Health | Organización Panamericana de la Salud | S1020-49892008000900008 | 10.1590/S1020-49892008000900008 | Health Policy & Services | Banco Mundial | null | Mercantilización de los servicios de salud para el desarrollo: el caso de Colombia | Commodification of health care services for development: the case of Colombia | Echeverri, Oscar | 2,008 | 9 | null | This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. | null | null | This is a succinct analysis of the circular relationship between health and development and the changes occurring over recent decades regarding health care services production and delivery that have resulted in a new paradigm. From the late 1970s through the 1980s, three major, worldwide shifts occurred that changed health care services in Colombia and in other Latin American countries: the privatization of government entities, the commodification of health care services, and the failure of the Soviet model. Health care system reform in Colombia, considered by some experts to be a model, is an example of health care commodification that, 15 years later, has not achieved the coverage, nor the equity, nor the efficiency, nor the quality, that it should have. More so than the market, the problem has been with the market entities that seek disproportionate profits. A solution for this situation is to appeal to nonprofit organizations for the purchase and sale of health care services. | http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892008000900008&lng=en&tlng=en | 22 | scielo_articles/spa/1020-4989/S1020-49892008000900008.xml | scielosp.org | spa | [
"Health Policy & Services"
] | [
"Echeverri, Oscar"
] | null | null | null | null | [
"health services",
"health care reform",
"equity in access",
"commodification",
"Colombia"
] | null | [
"Banco Mundial"
] |
spa/1020-4989/S1020-49892008001100002.xml | en | research-article | Revista Panamericana de Salud Pública | 1680-5348 | SciELO Public Health | Organización Panamericana de la Salud | S1020-49892008001100002 | 10.1590/S1020-49892008001100002 | Health Policy & Services | University of Medicine and Dentistry of New Jersey | null | Rentabilidad médica de la vacunación antineumocócica en América Latina y el Caribe: un análisis regional | Cost-effectiveness of pneumococcal conjugate vaccination in Latin America and the Caribbean: a regional analysis | Sinha, Anushua | 2,008 | 11 | null | This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. | null | OBJETIVO: En América Latina y el Caribe, la vacunación sistemática de niños contra Streptococcus pneumoniae podría requerir inversiones considerables de los gobiernos y organizaciones donantes. Al evaluar estas inversiones se requiere información sobre los posibles beneficios sanitarios, costos y rentabilidad (relación costo-efectividad) de la vacunación. Se presenta un análisis económico de la vacunación infantil antineumocócica en América Latina y el Caribe a partir de la información de la vacuna y de datos demográficos, epidemiológicos y de costos. MÉTODOS: Se realizó una revisión bibliográfica estructurada previa para llegar a estimados regionales de la incidencia de la enfermedad. Los costos se tomaron de entrevistas a médicos y tarifas públicas. Se construyó un modelo analítico de decisión para comparar la vacunación de los niños de esta región con la vacuna antineumocócica conjugada y la no vacunación, tomando en cuenta solamente el efecto directo de la vacuna en los niños. RESULTADOS: Se proyectó la vacunación antineumocócica con las tasas de cobertura de la vacuna contra la difteria, el tétanos y la tosferina para prevenir 9 500 muertes anuales en menores de 5 años en esta región, o aproximadamente 1 vida salvada por cada 1 100 niños vacunados. Las vidas salvadas y los casos prevenidos de sordera, trastornos psicomotores y convulsiones equivalen a evitar anualmente 321 000 años de vida ajustados por incapacidad (AVAD). A un precio de la vacuna de US$ 5,00 a US$ 53,00 por dosis, el costo por AVAD evitado desde el punto de vista de la sociedad sería de US$ 154,00 a US$ 5 252,00. CONCLUSIONES: La vacuna antineumocócica conjugada fue altamente rentable hasta un precio de US$ 40,00 por dosis. La introducción de esta vacuna en América Latina y el Caribe puede reducir la mortalidad infantil con una alta rentabilidad en un amplio espectro de posibles costos. | OBJECTIVE: In Latin America and the Caribbean, routine vaccination of infants against Streptococcus pneumoniae would need substantial investment by governments and donor organizations. Policymakers need information about the projected health benefits, costs, and cost-effectiveness of vaccination when considering these investments. Our aim was to incorporate vaccine, demographic, epidemiologic, and cost data into an economic analysis of pneumococcal vaccination of infants in Latin America and the Caribbean. METHODS: We previously used a structured literature review to develop regional estimates of the incidence of disease. Cost data were collected from physician interviews and public fee schedules. We then constructed a decision analytic model to compare pneumococcal conjugate vaccination of infants with no vaccination across this region, examining only vaccine's direct effects on children. RESULTS: Pneumococcal vaccination at the rate of diphtheria-tetanus-pertussis vaccine coverage was projected to prevent 9 500 deaths per year in children aged 0 to 5 years in the region, or approximately one life saved per 1 100 infants vaccinated. These saved lives as well as averted cases of deafness, motor deficit, and seizure result in 321 000 disability-adjusted life years (DALYs) being averted annually. At vaccine prices between US$5 and US$53 per dose, the cost per DALY averted from a societal perspective would range from US$154 to US$5 252. CONCLUSION: Pneumococcal conjugate vaccine was highly cost-effective up to $40 per dose. Introduction of pneumococcal vaccine in the Latin American and Caribbean region is projected to reduce childhood mortality and to be highly cost-effective across a range of possible costs. | http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892008001100002&lng=en&tlng=en | 49 | scielo_articles/spa/1020-4989/S1020-49892008001100002.xml | scielosp.org | spa | [
"Health Policy & Services"
] | [
"Sinha, Anushua",
"Constenla, Dagna",
"Valencia, Juan Esteban",
"O'Loughlin, Rosalyn",
"Gomez, Elizabeth",
"de la Hoz, Fernando",
"Valenzuela, Maria Teresa",
"Quadros, Ciro A. de"
] | null | null | null | [
"Streptococcus pneumoniae",
"vacunas neumocócicas",
"costos y análisis de costo",
"árboles de decisión",
"otitis media",
"neumonía",
"sepsis",
"meningitis",
"América Latina",
"región del Caribe"
] | [
"Streptococcus pneumoniae",
"pneumococcal vaccines",
"costs and cost analysis",
"decision trees",
"otitis media",
"pneumonia",
"sepsis",
"meningitis",
"Latin America and the Caribbean"
] | null | [
"University of Medicine and Dentistry of New Jersey",
"Sabin Vaccine Institute",
"Secretaria de Estado de Salud Publica",
"Universidad Nacional de Colombia",
"University of Medicine and Dentistry of New Jersey",
"Universidad CES",
"Universidad de Los Andes",
"Centers for Disease Control and Prevention"
] |
spa/1020-4989/S1020-49892003000800010.xml | es | review-article | Revista Panamericana de Salud Pública | 1680-5348 | SciELO Public Health | Organización Panamericana de la Salud | S1020-49892003000800010 | 10.1590/S1020-49892003000800010 | Health Policy & Services | null | null | Nueva mutación de Leishmania major facilita el estudio de la infección parasitaria persistente | null | null | 2,003 | 9 | null | This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. | null | null | null | http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892003000800010&lng=en&tlng=en | null | scielo_articles/spa/1020-4989/S1020-49892003000800010.xml | scielosp.org | spa | [
"Health Policy & Services"
] | null | null | null | null | null | null | null | null |
spa/1020-4989/S1020-49892003000800011.xml | es | review-article | Revista Panamericana de Salud Pública | 1680-5348 | SciELO Public Health | Organización Panamericana de la Salud | S1020-49892003000800011 | 10.1590/S1020-49892003000800011 | Health Policy & Services | null | null | El efecto de la pérdida de peso sobre la tensión arterial | null | null | 2,003 | 9 | null | This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. | null | null | null | http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892003000800011&lng=en&tlng=en | null | scielo_articles/spa/1020-4989/S1020-49892003000800011.xml | scielosp.org | spa | [
"Health Policy & Services"
] | null | null | null | null | null | null | null | null |
spa/1020-4989/S1020-49892003000800009.xml | es | review-article | Revista Panamericana de Salud Pública | 1680-5348 | SciELO Public Health | Organización Panamericana de la Salud | S1020-49892003000800009 | 10.1590/S1020-49892003000800009 | Health Policy & Services | null | null | Estudio revela sesgo en las conclusiones de los ensayos clínicos de patrocinio industrial | null | null | 2,003 | 9 | null | This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. | null | null | null | http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892003000800009&lng=en&tlng=en | null | scielo_articles/spa/1020-4989/S1020-49892003000800009.xml | scielosp.org | spa | [
"Health Policy & Services"
] | null | null | null | null | null | null | null | null |
spa/0102-311X/S0102-311X2016000705004.xml | pt | research-article | Cadernos de Saúde Pública | 1678-4464 | SciELO Public Health | Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz | S0102-311X2016000705004 | 10.1590/0102-311X00086715 | Health Policy & Services | Centro de Estudos e Pesquisas do Envelhecimento do Rio de Janeiro | Rastreamento de problemas de idosos na atenção primária e proposta de roteiro de triagem com uma abordagem multidimensional | Localización de problemas de ancianos en la atención primaria y propuesta de guión en la sala de evaluación diagnóstica preliminar con un enfoque multidimensional | Primary care screening of problems in the elderly and a proposal for a screening protocol with a multidimensional approach | Lino, Valéria Teresa Saraiva | 2,016 | null | null | This work is licensed under a Creative Commons Attribution 4.0 International License. | Resumo: O objetivo foi examinar as caraterísticas psicométricas de testes de triagem para idosos e propor um roteiro para a atenção primária. Etapas: (1) confiabilidade interaferidores para testes de desempenho e perguntas de autoavaliação para 8 funções; (2) sensibilidade e especificidade de questões para depressão e apoio social; (3) encontro de especialistas para seleção das atividades instrumentais da vida diária (AIVD); (4) elaboração do roteiro. A triagem durou 16 minutos. A confiabilidade interaferidores para os testes de desempenho foi excelente, mas pobre para perguntas. Depressão e apoio social apresentaram sensibilidade e especificidade satisfatórias (0,74/0,77 e 0,77/0,96). Quatro AIVD foram selecionadas por mais de 55% dos especialistas. Após os resultados, elaborou-se um roteiro que priorizou o uso de testes de desempenho, mantendo questões para humor, apoio social e AIVD. O estudo sugere maior reprodutibilidade de testes de performance em relação a perguntas. Para humor e apoio social, as questões podem constituir uma primeira etapa de triagem. O roteiro proposto possibilita o rápido rastreamento de problemas. | Resumen: El objetivo fue examinar características psicométricas de test de evaluación diagnóstica preliminar para ancianos y proponer un guión para la atención primaria. Etapas: (1) fiabilidad entre evaluadores para el test de desempeño y preguntas de autoevaluación para 8 funciones; (2) sensibilidad y especificidad de cuestiones para depresión y apoyo social; (3) encuentro de especialistas para selección de las actividades instrumentales de vida diaria (AIVD); (4) elaboración del guión. La evaluación preliminar diagnóstica duró 16 minutos. La fiabilidad entre evaluadores para los test de desempeño fue excelente, pero pobre en preguntas. Depresión y apoyo social tuvieron sensibilidad y especificidad satisfactorias (0,74/0,77 y 0,77/0,96). Cuatro AIVD fueron seleccionadas por más de un 55% de los especialistas. Tras los resultados, se elaboró un guión que priorizó el uso de test de desempeño, manteniendo preguntas sobre humor, apoyo social y AIVD. El estudio sugiere mayor reproductibilidad de pruebas de rendimiento en relación con las preguntas. Para humor y apoyo social, las preguntas pueden constituir una primera etapa de evaluación preliminar diagnóstica. El guión propuesto posibilita la rápida localización de problemas. | Abstract: The objectives were to examine psychometric properties of a screening test for the elderly and to propose a protocol for use in primary care. The method consisted of four stages: (1) inter-evaluator reliability for performance tests and self-assessment questions for eight functions; (2) sensitivity and specificity of questions on depression and social support; (3) meeting of experts to select instrumental activities of daily living (IADL); and (4) elaboration of the protocol. Screening lasted 16 minutes. Inter-evaluator reliability was excellent for performance tests but poor for questions. Depression and social support showed satisfactory sensitivity and specificity (0.74/0.77 and 0.77/0.96). Four IADL were selected by more than 55% of the experts. Following the results, a screening protocol was elaborated that prioritized the use of performance tests, maintaining questions on mood, social support, and IADL. The study suggests better reproducibility of performance tests when compared to questions. For mood and social support, the questions may provide a first screening stage. The proposed protocol allows rapid screening of problems. | http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0102-311X2016000705004&lng=en&tlng=en | 49 | scielo_articles/spa/0102-311X/S0102-311X2016000705004.xml | scielosp.org | spa | [
"Health Policy & Services"
] | [
"Lino, Valéria Teresa Saraiva",
"Portela, Margareth Crisóstomo",
"Camacho, Luiz Antonio Bastos",
"Rodrigues, Nadia Cristina Pinheiro",
"Andrade, Monica Kramer de Noronha",
"O'Dwyer, Gisele"
] | null | null | [
"Triagem",
"Programas de Rastreamento",
"Idoso",
"Atenção Primária à Saúde"
] | [
"Triaje",
"Tamizaje Masivo",
"Anciano",
"Atención Primaria de Salud"
] | [
"Triage",
"Mass Screening",
"Aged",
"Primary Health Care"
] | null | [
"Centro de Estudos e Pesquisas do Envelhecimento do Rio de Janeiro",
"Fundação Oswaldo Cruz"
] |
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