Scoping review of 30 years of suicide prevention in university students around the world: efficacy, effectiveness, and cost-effectiveness

A scoping review of systematic reviews was carried out to identify evidence of efficacy, effectiveness, and costeffectiveness of universal and selective suicide prevention programs among university students worldwide. Five databases were reviewed using terms in English, Spanish, and Portuguese. The following were the inclusion criteria: systematic review or meta-analysis or meta-synthesis, suicide prevention in college students, evaluation of the efficacy, effectiveness and/or cost-effectiveness of interventions, and peer-reviewed studies. The quality of reviews was assessed. The field of study features three decades of publication in high-income countries. The strategy used, the components of the program, and the target audience to which they are delivered interfere with efficacy. In the psychoeducation strategy, the experiential and didactic components are more efficacious in the knowledge about suicide. And the motivational enhancement component promotes greater self-efficacy in suicide prevention. Programs that take a multimodal approach are effective in increasing short-term attitudes related to suicide and reducing rates of completed suicide. The gatekeeper strategy delivered to peer counselors is the most effective one in the outcomes, including short-term and long-term knowledge about suicide and its prevention and self-efficacy in suicide prevention. A greater number of evaluated studies of gatekeeper interventions were identified, indicating a trend in this research field. No review addressed the effects on subgroups that were classified based on sex, racial or sexual minorities, and special (indigenous) populations. Only one study addressed cost-effectiveness, pointing out that the psychoeducation and gatekeeper strategies have relevant net benefit rates, but the gatekeeper strategy has a higher cost-benefit ratio compared to the psychoeducation strategy. The findings indicate that psychoeducation and gatekeeper interventions tend to be more efficacious when they combine education and skills training to intervene in suicidal behavior. The components of the intervention and the target audience to which it is delivered influence efficacy. Multimodal interventions evaluate completed suicide outcomes, but require greater implementation efforts, in terms of human and financial resources and more time for the evaluation. (AU)

Oferta de programas para el desarrollo integral de la primera infancia en Chile: revisión exploratoria / Program offer for the integral development of early childhood in Chile: scoping review

OBJETIVO: Describir la oferta programática en primera infancia destinada a favorecer el desarrollo infantil integral en Chile. MÉTODO: Se realizó una revisión exploratoria siguiendo el marco método lógico del Joanna Briggs Institute. La búsqueda fue realizada por un investigador y los criterios de inclusión fueron: programas gubernamentales destinados al desarrollo integral en menores de 5 años en Chile. Los datos fueron organizados y sintetizados para describir características del programa y de la o las prestaciones que entrega. RESULTADOS: La búsqueda identificó 2060 documentos y 72 cumplieron los criterios de inclusión. Se describen 59 programas vigentes que abarcan la primera infancia, es tando principalmente a cargo de los Ministerio de Justicia, Educación, Salud y Desarrollo Social. Los programas están destinados en su mayoría a la promoción e intervención, se encuentran focalizados en población vulnerable, son intersectoriales y utilizan diversas estrategias para su implementación. CONCLUSIÓN: La oferta programática en Chile para la primera infancia presenta características sugeridas como efectivas para favorecer el desarrollo infantil.

OBJECTIVE: To describe the program offering designed to promote comprehensive early childhood de velopment in Chile. METHOD: A scoping review was carried out following the Joanna Briggs Institute's methodological framework. A researcher conducted the review considering as inclusion criteria go vernment programs aimed at the comprehensive development of children under 5 years of age in Chile. The data were organized and synthesized to describe the characteristics of the program and the service(s) it provides. RESULTS: The search identified 2.060 documents and 72 met the inclusion crite ria. 59 current programs are covering early childhood, which are mainly managed by the Ministries of Justice, Education, Health, and Social Development. Most of the programs are aimed at promotion and intervention, focusing on vulnerable populations, are cross-sectoral, and use different strategies for their implementation. CONCLUSION: The program offering in Chile for early childhood has charac teristics suggested as effective to promote child development.

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

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

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

Impacto de un programa de optimización de uso de antimicrobianos en un hospital pediátrico de tercer nivel en Panamá / Impact of an antimicrobial stewardship program in a pediatric third level hospital in Panama

Resumen Introducción: Los programas de optimización de uso de antimicrobianos (PROA) se enfocan en el uso apropiado de antimicrobianos para ofrecer mejores resultados clínicos y menores riesgos de eventos adversos. Objetivos: Comparar consumo y costos de antimicrobianos antes y después de instauración de un programa de regulación de antimicrobianos y describir la proporción de resistencia de bacterias prioritarias. Métodos: Estudio cuasi-experimental, retrospectivo y prospectivo, descriptivo y analítico, que comparó el consumo y costo de antimicrobianos en un período pre- intervención (2007-2010) y un período post-intervención (2011-2017). Se realizó análisis descriptivo de resistencias bacterianas prioritarias. Resultados: El consumo de gentamicina, vancomicina, meropenem, cefotaxima, ceftazidima e imipenem disminuyó significativamente en el período post-intervención comparado con el período pre-intervención (p < 0,05), mientras que el consumo de amikacina, piperacilina/tazobactam, cefepime y levofloxacina en el período post-intervención mostró un aumento significativo. La reducción de costos no fue significativa para gentamicina, vancomicina, meropenem, cefotaxima, ceftazidima e imipenem. Para amikacina, cefepime, piperacilina/tazobactam y levofloxacina el aumento de costos no fue significativo. Los aislamientos de Acinetobacter baumannii, Klebsiella pneumoniae, Staphylococcus aureus y Enterococcus faecalis disminuyeron durante el período post-intervención. Conclusión: el PROA demostró disminución en consumo y costos de algunos antimicrobianos.

Abstract Background: Antimicrobial Stewardship Programs (ASP) focus in the appropriate use of antimicrobials to improve clinical results and minimize risk of adverse events. Aims: To compare consumption and costs of antimicrobials before and after the establishment of an antimicrobial stewardship program and to describe the resistance proportion of priority bacteria. Methods: Quasi-experimental, retrospective and prospective, descriptive and analytical study, to compare consumption and costs of antimicrobials in a pre- intervention period (2007-2010) and a post- intervention period (2011-2017). Additionally, a descriptive analysis of bacterial resistance from 2010 was performed. Results: Gentamicin, vancomycin, meropenem, cefotaxime, ceftazidime and imipenem consumption decreased significantly in the post-intervention period compared to the pre-intervention period (p < 0.05) while consumption of amikacin, piperacillin/tazobactam, cefepime and levofloxacin increased significantly in the post-intervention period. The reduction in costs was not significant for gentamicin, vancomycin, meropenem, cefotaxime, ceftazidime and imipenem, meanwhile, costs increased for amikacin, piperacillin/tazobactam, cefepime and levofloxacin, but this was not significant. The isolation of Acinetobacter baumannii, Klebsiella pneumoniae, Staphylococcus aureus and Enterococcus faecalis decreased during the post-intervention period. Conclusion: The ASP showed a decrease in consumption and costs of some antimicrobials.

Two innovative Brazilian programs relating to road safety prevention. A case study

ABSTRACT BACKGROUND: The World Health Organization (WHO) 2017 Global Conference in Montevideo, Uruguay, was dedicated to promoting successful cases and best practices in fighting and preventing noncommunicable disease (NCDs). The global effort undertaken by WHO aims to reduce road traffic deaths in order to meet goal number 3.4 of the sustainable development goals. OBJECTIVES: To describe two Brazilian road safety prevention programs, presented at the WHO 2017 Global Conference: São Paulo Traffic Safety Movement (Movimento Paulista de Segurança no Trânsito) and Safe Life Program of Brasília (Programa Brasília Vida Segura), along with their governance structures, models and results. DESIGN AND SETTING: This was a descriptive case study conducted in São Paulo and Brasilia from 2015 to 2018. These programs aimed to reduce the number of deaths caused by road accidents to 8.3 deaths per 100,000 inhabitants in São Paulo by 2020 and in Brasília by 2016; and to reduce harmful use of alcohol by 10% by 2020. METHODS: These two initiatives were designed, managed and operated to bring together government and civil society, i.e. industry, academia, non-governmental organizations (NGOs), etc., around the common goal of saving lives. They were collaborative and guided by sharing of best practices, learning and information, thereby making it possible to attain more and better results. Their format enables reproduction in cities across all Brazilian regions. RESULTS: The results attest to the efficacy of the programs implemented in these two cities. In Brasília, the initiative helped reduce the number of traffic-related deaths by 35% (2017). In the same year in the state of São Paulo, 7,600 deaths were avoided. CONCLUSION: Both programs are innovative public policies that deal with health issues caused by the external agents that ultimately account for the rapid increase in days lost to disability. Prevention of external causes of deaths and injuries, such as traffic violence, strongly correlates with changes in habits and actions, especially excessive consumption of alcohol, and with NCDs in Brazil.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Avanzando en la lucha contra la tuberculosis en Chile / Moving forward in the fight against tuberculosis in Chile

In 1973 Chile started a National Tuberculosis Control Programme based in the use of sputum smear for tuberculosis finding and proper treatment. Programme activities lead the country to achieve the threshold of tuberculosis elimination in year 2000. Since then the usual annual 7 percent decrease in the incidence of tuberculosis has leveled off. Between years 2009-2011 tuberculosis rate remained stationary in around 13.1 per 100.000 inhabitants. Such epidemiologic regression was related to a decrease in bacteriological case finding on primary health care and the existence of risk groups like the elderly, prisoners, migrants and HIV infected. The Metropolitan Region of Santiago represents 40 percent of the total incidence of tuberculosis of the country and has a higher proportion of high risk groups. We recommend to increase the tuberculosis detection rate focused in high risk groups, to increase preventive therapy of latent tuberculosis in HIV infected and close child contacts and improve treatment success. In year 2012 we have achieved a lower tuberculosis incidence rate of 12.6 per 100.000 inhabitants due to an increase in sputum smear detection. It is necessary to maintain this measures for the continuous progress in the control of tuberculosis.

Chile inició un programa de actividades de pesquisa bacteriológica y tratamiento de la tuberculosis a través de toda la red de salud nacional en 1973. Producto de esta iniciativa el país alcanzó el umbral de inicio de la eliminación de la enfermedad el año 2000. Desde entonces se ha enlentecido la velocidad de reducción de la incidencia de la enfermedad desde 7 por ciento anual hasta detenerse el año 2009. Entre el año 2009 y 2011 la incidencia se ha mantenido estacionaria con alrededor de 13,1 casos x 100.000 habitantes. Se han identificado algunos factores que han contribuido a esta detención epidemiológica, como por ejemplo la reducción de la pesquisa de los casos pulmonares bacilíferos, especialmente a nivel de atención primaria. También se ha encontrado una mayor concentración de casos entre población vulnerable constituida por grupos de riesgo como adultos mayores, personas privadas de libertad, migrantes e infectados por VIH. La Región Metropolitana aporta el 40 por ciento de los casos de tuberculosis y la proporción de población de riesgo de enfermar es mayor que en el resto del país. En el presente artículo se proponen estrategias para revertir esta situación. Las principales medidas son: incrementar la detección de casos en todos los niveles de salud con intensificación en los grupos de riesgo; aumentar las medidas preventivas con quimioprofilaxis en los infectados VIH y contactos infantiles y optimizar los resultados del tratamiento para interrumpir la cadena de transmisión de la enfermedad. Aún hay esperanzas. El año 2012 la incidencia se redujo a 12,6 x 100.000 y se incrementó la pesquisa baciloscópica después de varios años en que había disminuido. Mantener estas medidas se hace necesario para seguir avanzando en el control sanitario de la tuberculosis.

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

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

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

Critical analysis of cystic echinococcosis control programs and praziquantel use in South America, 1974-2010 / Análisis crítico de los programas de control de la equinococosis quística y uso del prazicuantel en América del Sur, 1974-2010

Cystic echinococcosis (CE) is one of the most prevalent zoonoses in Argentina, Brazil, Chile, Peru, and Uruguay. Control programs in South America were originally modeled after programs developed in insular territories, such as Tasmania and New Zealand. The advent and proven effectiveness of praziquantel, plus the experience of insular models, produced high expectations for rapid advances; however, after 30 years of praziquantel use, no endemic area in South America has obtained eradication. In fact, only modest gains in CE control have been made and impact on prevalence among humans has been slight. A major impediment has been the infrastructure needed to administer praziquantel to dogs in rural areas 8 times per year over numerous years, a requirement for rapid attack stage 1. Such an infrastructure has not been financially or politically sustainable in endemic areas, which tend to be the poorest. On the other hand, certain areas in Argentina have had success with simple and economically viable alternatives. Based primarily on continuous field work supported by the local community, these strategies have significantly decreased transmission to humans, the health sector's main objective. In addition, new possibilities and tools, such as the EG95 vaccine, are being evaluated; as are early detection and treatment of asymptomatic carriers.

La equinococosis quística (EQ) es una de las zoonosis más prevalentes en Argentina, Brasil, Chile, Perú y Uruguay. Los programas de control en América del Sur fueron originalmente hechos a imitación de los programas desarrollados en territorios insulares, como Tasmania y Nueva Zelandia. El advenimiento y la eficacia comprobada del prazicuantel, sumados a la experiencia de los modelos insulares, dieron lugar a altas expectativas de adelantos rápidos; sin embargo, después de 30 años de uso del prazicuantel, ninguna zona endémica en América del Sur ha logrado la erradicación de la enfermedad. De hecho, solo se han obtenido avances moderados en el control de la EQ, y su repercusión sobre la prevalencia en seres humanos ha sido leve. Un impedimento mayor ha sido la infraestructura necesaria para administrar el prazicuantel a los perros en zonas rurales 8 veces por año durante varios años, un requisito para el estadio 1 de ataque rápido. Tal infraestructura no ha sido sostenible desde el punto de vista económico o político en las zonas endémicas, que tienden a ser las más pobres. Por otro lado, ciertas áreas de la Argentina han tenido éxito con opciones sencillas y económicamente viables. Basadas principalmente en el trabajo continuo en el terreno apoyado por la comunidad local, estas estrategias han reducido significativamente la transmisión a los seres humanos, que es el objetivo principal del sector de la salud. Además, se están evaluando nuevas posibilidades y herramientas, como la vacuna EG95, al igual que la detección temprana y el tratamiento de los portadores asintomáticos.

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

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

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

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

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

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

HIV in Indian prisons: Risk behaviour, prevalence, prevention & treatment.

Background & Objectives: HIV is a major health challenge for prison authorities. HIV in prisons has implications for HIV in the general community. The aim of this paper was to gather information on HIV risk, prevalence, prevention and treatment in prisons in India. Methods: Relevant published and unpublished reports and information were sought in order to provide a coherent picture of the current situation relating to HIV prevention, treatment and care in prisons in India. Information covered prison management and population statistics, general conditions in prisons, provision of general medical care and the HIV situation in prison. Results: No data on drug injection in prison were identified. Sex between men was reported to be common in some Indian prisons. A national study found that 1.7 per cent of inmates were HIV positive. Some prisons provided HIV education. Condom provision was considered illegal. A few prisoners received drug treatment for drug use, HIV infection or co-infection with sexually transmitted infections (STIs). Interpretation & conclusions: HIV prevalence in prisons in India was higher than that in the general community. Regular monitoring of information on HIV risk behaviours and prevalence in Indian prisons is strongly recommended. Evidence based treatment for drug injectors and nation-wide provision of HIV prevention strategies are urgently required. Voluntary counselling, testing and treatment for HIV and STIs should be provided.

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

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

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