Percepción social del SARS-CoV-2 en la mirada de una comunidad rural / Social perception of SARS-CoV-2 in the view of a rural community

Introducción: en la actual pandemia por COVID-19, las megalópolis han sido un foco importante de atención por la densidad poblacional con la que cuentan, dado que esta impacta directamente en el número de contagios registrados; sin embargo, el riesgo al que se enfrentan las comunidades rurales es alto y algunas veces desconocido, debido a sus características históricas, geográficas y por su distribución de bienes. Objetivo: interpretar la percepción social de la pandemia por SARS-CoV-2 de los habitantes de una comunidad rural. Metodología: investigación cualitativa, fenomenológica e interpretativa, realizada en dos etapas. En la primera se hizo trabajo de campo exploratorio y en la segunda se utilizó como técnica de recolección de datos una entrevista semiestructurada para siete habitantes, apoyada en una guía de preguntas. El análisis de los datos se basó en la transcripción, lectura, codificación, formación de categorías y subcategorías. Los criterios de rigor científico fueron la credibilidad y la confirmabilidad. Resultados: se construyeron cinco temas: Ver para creer, Desconfianza, Miedo, Canales de aprendizaje y Zona de protección, cada uno con sus respectivos subtemas. Conclusiones: la percepción social es de vital importancia al permitir interpretar el afrontamiento, debilidades y fortalezas de las comunidades rurales ante la COVID-19; generar conocimiento en este campo es relevante para la creación de herramientas y estrategias que ayuden a los sistemas de salud y a los profesionales sanitarios; en el caso de enfermería, su acción comunitaria es primordial para prevenir la propagación del SARS-CoV-2.

Introduction: In the current COVID-19 pandemic, supercities have been an important focus of attention due to the population density, since this has an impact on the number of registered infections; however, the risk faced by rural communities is high and sometimes unknown due to its historical and geographical characteristics and its distribution of assets. Objective: To interpret the social perception of the SARS-CoV-2 pandemic of the inhabitants of a rural community. Methodology: Qualitative, phenomenological and interpretive research, carried out in two stages. In the first one, exploratory field work was done and in the second stage, as a data collection technique, a semi-structured interview with seven inhabitants was used, supported by a question guide. The data analysis was based on the transcription, reading, coding, formation of categories and subcategories. The criteria for scientific rigor were credibility and confirmability. Results: Five themes were constructed: Seeing is believing, Distrust, Fear, Learning channels and Protection zone, each with their respective subtopics. Conclusions: Social perception is of vital importance, since it allows interpreting the coping, weaknesses and strengths of rural communities in the face of COVID-19; generating knowledge in this field is relevant for the creation of tools and strategies that help health systems and health professionals; in the case of nursing, their community action is essential to prevent the spread of SARS-CoV-2.

A população indígena Xavante em Mato Grosso: características sociodemográficas relacionadas à saúde / La población indígena Xavante en Mato Grosso: características sociodemográficas relacionadas con la salud / The Xavante indigenous population in Mato Grosso: health-related sociodemographic characteristics

RESUMO Objetivo Comparar indicadores sociodemográficos dos Xavante de seis terras indígenas com a população não indígena residente em áreas rurais de quatro microrregiões adjacentes. Método Estudo seccional, do tipo ecológico, com análises comparativas entre indígenas e não indígenas residentes no estado de Mato Grosso, Brasil. Compararam-se os seguintes indicadores: estrutura etária e por sexo, taxa de alfabetização, renda, condições de saneamento dos domicílios e mortalidade. Resultados Foram caracterizadas 14.905 pessoas Xavante e 78.106 pessoas não indígenas (brancas, pretas, amarelas e pardas) residentes em domicílios de área rural. A estrutura etária revelou padrões divergentes, 40,0% dos Xavantes tinham menos de 10 anos de idade, contra 15,0% dos não indígenas na mesma faixa etária. Em relação aos não indígenas, os Xavantes apresentaram maior taxa de analfabetismo (31,3% vs. 9,9%) e 84,1% dos domicílios não possuíam banheiro ou sanitário, 39,6% das pessoas Xavante não declararam renda, contra 6,5% para os não indígenas. Conclusão e implicação para a prática Os dados sobre etnia, coletados pela primeira vez por um censo, são essenciais para análises demográficas de segmentos específicos da população, e, no caso dos Xavante, revelam desigualdades em relação aos não indígenas.

RESUMEN Objetivo Comparar los indicadores sociodemográficos del Xavante pertenecientes a seis tierras indígenas con la población no indígena residente en áreas rurales de cuatro microrregiones adyacentes. Método Estudio seccional, tipo ecológico, con análisis comparativo entre indígenas y no indígenas residentes del estado de Mato Grosso, Brasil. Se compararon los siguientes indicadores: estructura de edad y sexo, tasa de alfabetización, ingresos, condiciones de saneamiento y mortalidad inadecuadas. Resultados La muestra estuvo conformada por 14.905 personas Xavante y 78.106 personas no indígenas (blancos, negros, amarillos y morenos) que viven en hogares rurales. La estructura por edades reveló patrones divergentes, siendo el 40,0% de los xavante menores de 10 años, frente al 15,0% de los no indígenas del mismo grupo de edad. En comparación con los no indígenas, los Xavante tenían una tasa de analfabetismo más alta (31,3% vs.9,9%) y el 84,1% de los hogares no tenían baño ni inodoro, el 39,6% de los Xavante no declaraban sus ingresos frente a 6,5% para personas no indígenas. Conclusión e implicación para la práctica Los datos sobre etnicidad, recopilados por primera vez mediante un censo, son fundamentales para el análisis demográfico de segmentos específicos de la población y, en el caso de los xavante, revelan desigualdades en relación con los no indígenas.

ABSTRACT Objective To compare Xavante sociodemographic indicators from six indigenous lands with the non-indigenous population residing in rural areas of four adjacent microregions. Method This is an ecological cross-sectional study, with comparative analyzes between indigenous and non-indigenous residents in the state of Mato Grosso, Brazil. Age and sex structure, literacy rate, income, household sanitation conditions and mortality were compared. Results A total of 14,905 Xavante people and 78,106 non-indigenous people (white, black, yellow and brown) residing in rural areas were characterized. The age structure revealed divergent patterns, 40.0% of Xavante were under 10 years old, against 15.0% of non-indigenous people in the same age group. Regarding non-indigenous people, the Xavante had a higher illiteracy rate (31.3% vs. 9.9%), and 84.1% of the households did not have a bathroom or toilet, 39.6% of Xavante people did not declare an income against 6.5% for the non-indigenous. Conclusion and implication for practice Data on ethnicity, collected for the first time by a census, are essential for demographic analyzes of specific segments of the population, and in the case of the Xavante, they reveal inequalities in relation to non-indigenous people.

Functional limitation on elderly people in the northeast and the feminization of eld in urban and rural areas of Brazil

Population aging in Brazil increases on a large scale due to declining fertility and mortality. This phenomenon can be influenced by several factors (demographic, biological and social), making them determinants for the health conditions of the elderly populations residing in different geographic areas. The present study aims to identify the functional limitation in elderlyresidents of urban and rural areas of Brazil. This is a descriptive epidemiological study with a quantitative approach. It was evidenced that the functional limitation for activities of daily living and instrumental activities of daily living are concentrated in the northeast region, mainly in the urban area. The following states presented the highest proportions of daily life activity limitation in urban areas: Alagoas (11.60%), Rio Grande do Norte (10.95%), Pernambuco (10.36%) and Paraíba (9.62%). For activities of daily living in the rural area were found in the states of Paraíba (12.19%), Maranhão (8.93%), Piauí (8.85%) and then Pernambuco (7.24%). Data from the functional limitation for instrumental activities of daily living again highlighted the Northeast region, with the states of Rio Grande do Norte (26.01%), Paraíba (25.96%), Maranhão (25.72%) and Alagoas (24.57%). Lastly, it was verified that the elderly woman exhibits greater proportions of functional limitation in relation to the elderly of the masculine sex, standing out again the northeastern region of the country.

From rural practice to national strategy for colorectal cancer screening in China--Mr. Zheng Shu who is a pioneer and practitioner / 中华胃肠外科杂志

Haining City and Jiashan County in Zhejiang Province are the first areas to carry out colorectal cancer screening in China, which started in the early 1970s and has been going on for more than 40 years. Meanwhile, Haining and Jiashan have also become the first batch of National Demonstration Bases for Early Diagnosis and Treatment of Colorectal Cancer. In the past 40 years, owing to Professor Zheng Shu who is brave and innovative, with an indomitable spirit, as well as the unremitting efforts and active exploration of all the team members, colorectal cancer screening which was unknown by the public and implemented with difficulties, has gradually been widely accepted and benefited the population. Today, remarkable achievements have been fulfilled in the colorectal cancer screening of Haining and Jiashan which has become the pioneer power in promoting the progress of colorectal cancer prevention and control in China and has certain influence both on China and the world. Meanwhile, a set of colorectal cancer screening strategies suitable for China has been explored and further promoted to be used nationwide, which is of great significance to the prevention and control of colorectal cancer in China. Looking forward to the future, the prevention and control of colorectal cancer in China is still difficult. We will continue to give full play to our existing advantages, not forget our original intention, move forward, explore innovation, and create greater glories!

The moderation effect of identity exploration and basic psychological needs satisfaction on flourishing of Chinese rural children

Abstract Most studies equate children's mental health to a state of flourishing, which is a positive feeling and functions in their lives. Identity exploration and the satisfaction of three basic psychological needs are universal and crucial indicators of children's flourishing. First, according to identity crisis theory, children in the pre-adolescence period begin to explore their own identities, a process which significantly affects their development and flourishing. Meanwhile, self-determination theory points out that the basic psychological needs, namely the needs for autonomy, competence, and relatedness, are essential for children's development and flourishing in the worldwide. Accordingly, this study examined how identity exploration affects the flourishing of rural children in China, one kind of collectivism cultural contexts, with the interaction effect of identity exploration and basic psychological needs satisfaction. To understand the interaction effect of identity exploration and basic psychological needs satisfaction on rural children's flourishing, we form a theoretical framework combining identity crisis theory and self-determination theory. Both these two theories emphasize the importance of self in facilitating mental health and the development of functioning. Specifically, identity crisis theory focuses on intrapsychic process, while self-determination theory stresses the influence of the surrounding environment on the individual, which provides a solid foundation for integrating these two theories to explore rural children's flourishing in China. Accordingly, this study collected 520 left-behind children and 475 other rural children in Liaoning Province in Mainland of China, and used regression analysis to measure the associations among variables. This study found that identity exploration and basic psychological needs satisfaction positively affect rural children's flourishing respectively, while their interaction effects negatively affect on their flourishing.

Association between the type of physical activity and metabolic syndrome in middle-aged and older adult residents of a semi-mountainous area in Japan

BACKGROUND@#Physical activity is reported to prevent metabolic syndrome. However, it is unclear whether exercise or daily physical activity is more beneficial for residents of semi-mountainous areas. This study aimed to identify whether daily physical activity is more beneficial than exercise for the prevention of metabolic syndrome among middle-aged and older residents in semi-mountainous areas.@*METHODS@#We analyzed secondary data of 636 people who underwent a specific health checkup in a semi-mountainous area of Japan. Physical activity was classified into four types: inactivity (I-type; without exercise and without daily physical activity), only exercise (E-type; with exercise and without daily physical activity), only daily physical activity (D-type; without exercise and with daily physical activity), and full physical activity type (F-type; with exercise and with daily physical activity). We compared the means of risk factors for metabolic syndrome by these four types, followed by logistic regression analysis, to identify whether and to what extent the D-type was less likely to have metabolic syndrome than the E-type.@*RESULTS@#The prevalence of metabolic syndrome was 28.5% (men 45.7%, women 15.8%). The proportions of men with exercise and daily physical activity were 38.7% and 52.8%, respectively. For women, the proportions were 33.0% and 47.1%, respectively. In women, the D-type had the significantly lowest BMI, smallest waist circumference, highest HDL-C, and lowest prevalence of metabolic syndrome of the four types; the same was not observed in men. Additionally, D-type activity was more strongly associated with a reduced risk of metabolic syndrome than E-type activity in women (adjusted odds ratio 0.24; 95% confidence interval 0.06-0.85, P = 0.028).@*CONCLUSIONS@#Compared to middle-aged and older women residents with exercise in a semi-mountainous area of Japan, those with daily physical activity may effectively prevent metabolic syndrome.

Prevención de desnutrición aguda moderada con un suplemento alimenticio listo para consumir en niños preescolares de comunidades rurales / Moderate acute malnutrition prevention with a ready-to-use therapeutic food in pre-school children from rural communities

Resumen Introducción: La desnutrición infantil en México alcanza prevalencias de 27.5 % en zonas rurales. Objetivo: Evaluar la efectividad de un suplemento alimenticio listo para consumir (SALC) para corregir desnutrición aguda leve y prevenir desnutrición aguda moderada en preescolares de comunidades rurales. Método: Ensayo clínico aleatorizado por grupos: con y sin SALC (g-SALC y g-S/SALC); se incluyeron niños de dos a cinco años, con puntuaciones-Z de peso para la talla (pZ-P/T) mayor de −2 y menor de −1 y nivel socioeconómico bajo. Todos recibieron educación sobre nutrición, salud e higiene dos veces al mes; los niños del g-SALC debieron consumir diariamente una porción del suplemento. Se evaluó pZ-P/T al inicio y a los cuatro, seis y 12 meses. La comparación entre grupos se realizó con el modelo de riesgos proporcionales de Cox. Resultados: Respecto a la recuperación de desnutrición aguda leve, en g-SALC se observó 68.7 versus 52.1% en el grupo control en el análisis de intención para tratar, con una razón de riesgo (HR) = 1.25; en el análisis por protocolo del primer semestre se observó una HR = 1.48 y en el segundo semestre, HR = 1.56. Un paciente progresó a desnutrición aguda moderada. Conclusiones: El g-SALC mostró resolución significativamente mayor de desnutrición aguda leve.

Abstract Introduction: Child malnutrition in Mexico reaches a prevalence as high as 27.5 % in rural areas. Objective: To assess the effectiveness of a ready-to-use supplementary food (RUSF) to correct mild acute malnutrition and prevent moderate acute malnutrition in preschool children from rural communities. Method: Randomized clinical trial, with assignment to two groups: group with RUSF (RUSF-g) or group without it (non-RUSF-g); children aged from two to five years, with weight-for-height Z-scores (WHZ) between -2 and -1 and low socioeconomic status were included. All received education on nutrition, health and hygiene twice monthly; the RUSF-g children had to consume four biscuits of the supplement every day. WHZ was assessed at baseline and at four, six, and 12 months. The comparison between groups was carried out with Cox proportional hazards model. Results: With regard to mild acute malnutrition correction in the RUSF-g, 68.7 versus 52.1 % in the control group was observed in the intent-to-treat analysis, with a hazard ratio (HR) = 1.25; in the per-protocol analysis of first semester, a HR = 1.48 was observed, and in the second semester, HR = 1.56. One patient progressed to moderate acute malnutrition. Conclusions: The RUSF-g showed a significantly higher resolution of mild acute malnutrition.

Consumo de frutas e verduras por adolescentes catarinenses ao longo de uma década / Fruit and vegetable consumption over a decade among adolescents in the State of Santa Catarina, Brazil

Resumo Compreender mudanças no consumo de frutas e verduras por adolescentes é importante para criação de ações de saúde pública. O objetivo deste artigo é investigar mudanças, em dez anos, no consumo diário de frutas e verduras por adolescentes, de acordo com sexo, idade e área de moradia. Estudo de painel (análise secundária) da pesquisa "Estilo de vida e comportamentos de risco de jovens catarinenses". Adolescentes (15-19 anos) de escolas estaduais, em 2001 (n = 5.028) e 2011 (n = 6.529), responderam questionário sobre consumo de frutas e verduras e aspectos sociodemográficos. Estatística descritiva e regressão logística (2001 vs 2011), estratificada para sexo, idade e área de moradia. Houve diminuição no consumo diário de frutas (39,1% e 16,6%) e de verduras (40,1% e 20,6%). Diferentes prevalências são observadas de acordo com subgrupos, principalmente entre moças. A chance para consumo diário de verduras entre rapazes e adolescentes de área rural continuou a mesma. A diminuição na prevalência do consumo diário de frutas e verduras por adolescentes catarinenses de 15 a 19 anos aponta necessidade de criação de estratégias para reversão deste cenário.

Abstract Understanding the changes in the trends of fruit and vegetable consumption among adolescents is important in order to implement public health actions. The scope of this article is to investigate the changes over a ten-year period in the daily fruit and vegetable consumption among adolescents from Santa Catarina, according to sex, age and housing area. It is a secondary analysis of a panel survey entitled "Lifestyle and Risk Behavior of Adolescents in the State of Santa Catarina, Brazil (ComPAC)." Adolescents (15-19 years of age) of state schools in 2001 (n=5.028) and 2011 (n=6.529) answered a questionnaire about fruit and vegetable consumption as well as about sociodemographic aspects. Descriptive statistics and logistic regression were applied, according to sex, age and housing area. There was a decrease in daily fruit (39.1% and 16.6%) and vegetable (40.1% and 20.6%) consumption. Different prevalence levels were observed when analyzing subgroups, mainly among girls. From 2001 to 2011, daily vegetable consumption among boys and adolescents in rural areas remained the same. The decrease in daily consumption of fruit and vegetables among adolescents aged 15 to 19 in Santa Catarina highlights the need for the development of strategies to reverse this scenario.

Cambios en el calendario de uso de condón masculino en la primera y última relación sexual en distintas cohortes de mujeres / Changes in male condom use at first and last sexual intercourse in different birth cohorts

Resumen: Objetivo: Caracterizar el uso de condón en la primera y última relación sexual en diferentes cohortes para observar posibles diferencias entre grupos generacionales. Material y métodos: Mediante la Encuesta Nacional de Niños, Niñas y Mujeres 2015, representativa a nivel nacional, se ajustaron modelos de regresión Poisson para buscar asociación de variables de interés con el uso del condón en la primera y última relación sexual. Resultados: Las cohortes más jóvenes, con mayor educación y riqueza tienen mayores posibilidades de usar condón en su primera y última relación sexual; hablar lengua indígena se asocia con menores posibilidades de uso en ambos eventos. El uso de condón en el debut sexual incrementa la posibilidad de uso en la última relación sexual. Conclusiones: Existe un cambio generacional en el uso del condón en la primera y última relación sexual entre las más jóvenes. La utilización del condón en el debut sexual favorece su uso posterior.

Abstract: Objective: Characterize the use of condoms in the first and last sexual intercourse in different birth cohorts, to observe possible differences among generations. Materials and methods: Using the National Survey of Boys, Girls and Women, 2015, representative at the national level, we adjust Poisson regression models to find associations between variables of interest and the use of condoms in first and last intercourse. Results: Women from younger cohorts, with higher education and wealth are more likely to use a condom in their first and last sexual intercourse; speaking an indigenous language is associated with a lower likelihood of condom use at both events. Using condom in sexual debut increases the likelihood of using in last intercourse. Conclusions: There is a generational change in condom use at first and last sex among younger cohorts. The use of the condom in sexual debut favors its later use.

Conocimientos, actitudes y prácticas sobre la prueba de citología cervical en una población rural peruana / Knowledge, attitudes and practices on cervical cytology in a Peruvian rural population

Introducción: La citología cervical constituye la principal herramienta para la detección y tratamiento del cáncer de cérvix. Algunos estudios llevados a cabo en población urbana han relacionado la realización y adherencia con los conocimientos, las actitudes y las prácticas favorables de las mujeres con respecto a esta prueba. Objetivo: evaluar los conocimientos, actitudes y prácticas con respecto a la citología cervical en mujeres pertenecientes a un grupo poblacional del ámbito rural. Material y Métodos: estudio de corte transversal-analítico en una población de aproximadamente 3148 mujeres en edad fértil, de ellas se obtuvo una muestra representativa. Se utilizó una encuesta anónima, validada, dirigida, y aplicada por personal de salud capacitado que labora en centros de salud del primer nivel de atención de los distritos de la provincia de Bolívar, La Libertad. Resultados: El 80 por ciento de las mujeres encuestadas tuvo un nivel de conocimiento alto e intermedio, el 70 por ciento una actitud favorable, mientras que el 44 por ciento reportó prácticas correctas en relación con la prueba de citología cervical. El nivel de conocimiento alto e intermedio estuvo asociado a la edad mayor de 30 años (p:0.02), estado civil casada (p:0.05), el mayor grado de instrucción (p:0.00) y el uso de métodos anticonceptivos (p:0.01); no se encontró relación con la edad de inicio de relaciones sexuales (p:0.98). Conclusiones: Existe un alto nivel de conocimientos, actitudes y prácticas correctas hacia la citología cervical en la población rural de la provincia de Bolívar, pero una baja adherencia hacia la misma(AU)

Introduction: Cervical cytology is the main tool for the detection and treatment of cervical cancer. Some studies carried out in the urban population have associated the realization and adherence with knowledge, attitudes and favorable practices of women with respect to this test. Objective: The aim of this study was to determine the level of knowledge, attitudes and practices towards cervical cytology in women of childbearing age in a rural Peruvian province. Material and Methods: A cross-sectional analytical study was conducted in a population of approximately 3148 women of childbearing age, a representative sample was obtained. An anonymous, validated, directed survey was used; it was applied by trained health personnel working in health centers of the primary care level in the districts of the province of Bolívar, La Libertad. Results: A total of 400 surveys were carried out. The results showed that 80 percent of the women surveyed had high and intermediate levels of knowledge, 70 percent had a favorable attitude, while 44 percent reported correct practices related to the cervical cytology test. The high and intermediate levels of knowledge were associated with age over 30 years (p: 0.02), married marital status (p: 0.05), the highest level of instruction (p: 0.00) and the use of contraceptive methods (p: 0.01); no relationship was found with the age of onset of sexual intercourse (p: 0.98). Conclusions: There is a high level of knowledge, attitudes and correct practices towards cervical cytology in the rural population of the province of Bolívar, but a low adherence to it(AU)

Access to rrimary health care by older adults from rural areas in Southern Brazil / Acesso à atenção primária à saúde por idosos residentes em zona rural no Sul do Brasil

ABSTRACT OBJECTIVE To characterize the access and use of health services considered reference among the older rural population from a municipality in southern Brazil, whose rural area has full coverage of the Family Health Strategy (FHS), investigating factors associated with the choice of the Basic Family Health Unit (BFHU) as reference. METHODS This is a cross-sectional study conducted in 2017 with systematic sampling of rural households in the municipality of Rio Grande (RS) using a standardized in-house questionnaire. We performed descriptive analyses of sociodemographic profile, type of reference service chosen, and reasons for choosing/using the prime-choice service and the nearest BFHU. Poisson regression was used to investigate factors associated with the type of reference service chosen. RESULTS Among the 1,030 older adults who participated in the study, 61.4% considered the BFHU a prime choice/reference service mostly due to its proximity (82.6%); the others sought other places due to a greater ease (34.6%) and resoluteness (52.6%). Almost ⅔ of the respondents sought care at the BFHU during the last year, and the reasons differed among those who considered the unit as reference (chronic disease) and those who sought another place (procedures). We also found that the lower the age, income, education, and household-unit distance, the greater the likelihood of the older adult considering the nearest BFHU as reference service. CONCLUSIONS The FHS has reached the vulnerable older rural population, approaching an equitable public health system. However, further evaluations are necessary to verify the quality and adequacy of care, given that social structure, enabling factors (such as economic condition), and possible beliefs regarding health still establish the standards for choosing a service.

RESUMO OBJETIVO Caracterizar o acesso e utilização de serviços de saúde considerados como referência pela população rural idosa de um município do sul do Brasil, com cobertura de 100% da área rural pela Estratégia Saúde da Família (ESF), investigando os fatores associados à escolha da Unidade Básica de Saúde da Família (UBSF) como serviço de referência. MÉTODOS Estudo transversal com amostragem sistemática dos domicílios da área rural do município de Rio Grande (RS), realizado em 2017, através de questionário padronizado, aplicado em domicílio. Foram realizadas análises descritivas referentes a perfil sociodemográfico; tipo de serviço de referência escolhido; e motivos de escolha/utilização do serviço de primeira opção e da UBSF mais próxima. Realizou-se regressão de Poisson para investigar fatores associados ao tipo de serviço de referência escolhido. RESULTADOS Participaram do estudo 1.030 idosos, dos quais 61,4% indicaram a unidade básica como serviço de primeira opção/referência. Enquanto aqueles que escolheram ser atendidos na UBSF o faziam principalmente em razão da proximidade (82,6%), os demais procuraram outros locais pela percepção de maior facilidade (34,6%) e resolutividade (52,6%). Quase ⅔ dos entrevistados buscaram atendimento na UBSF no último ano, e os motivos foram diferentes entre aqueles que consideravam a unidade como referência (doença crônica) e aqueles que procuravam outro local (procedimentos). Além disso, quanto menor a idade, renda, escolaridade e distância residência-unidade, maior a probabilidade do idoso considerar a UBSF mais próxima como serviço de referência. CONCLUSÃO A ESF tem conseguido atingir a parcela rural idosa em situação de vulnerabilidade, indo ao encontro de um sistema de saúde público equitativo. Todavia, novas avaliações para averiguar adequação e qualidade do atendimento se fazem necessárias, visto que estrutura social, fatores capacitantes (como condição econômica) e possíveis crenças sobre saúde ainda definem o padrão de escolha do serviço.

Factors associated with diarrheal disease in the rural Caribbean region of Colombia / Factores asociados con enfermedad diarreica en área rural del Caribe colombiano

ABSTRACT OBJECTIVE: To analyze factors associated with diarrheal disease in the rural Caribbean region of Colombia. METHOD: A cross-sectional study conducted in the rural area of the Cesar Department, Colombia, between November 2017 and June 2018. Self-reported cases of diarrheal disease were surveyed, and water samples from 42 households were collected and analyzed. Descriptive statistics were employed in the analysis of socioeconomic status, environmental and sanitary conditions, and we evaluated their association with the diarrheal disease using the Poisson regression models. Each model was adjusted with variables suggested by specific directed acyclic graphs. RESULTS: Poor water supply conditions, hygiene and basic sanitation were reported in the study area. All water samples were classified either as high risk for health problems or unfit for human consumption. The diarrheal disease had a prevalence of 7.5% across all ages and of 23.5% in children under five years old. The variables rainy season (PR = 0.24; 95%CI 0.07-0.85), children under five years old (PR = 4.05; 95%CI 1.70-9.68), water from deep wells (PR = 16.90; 95%CI 2.45-116.67), water from artificial ponds (PR = 11.47; 95%CI 1.27-103.29), toilets availability (PRA = 0.23; 95%CI 0.06-0.96), and swine presence (PR = 0.20; 95%CI 0.05-0.74) were significantly associated with the occurrence of diarrheal disease. CONCLUSION: Water supply, hygiene and basic sanitation conditions have been associated with the diarrheal disease, affecting almost a quarter of the population under five years old. There is an urge for the design of effective policies that improve environmental and sanitation conditions in rural areas.

RESUMEN OBJETIVO: Analizar factores asociados con enfermedad diarreica en área rural del Caribe colombiano. MÉTODO: Estudio transversal en área rural dispersa del departamento del Cesar, Colombia, entre noviembre de 2017 y junio de 2018. Se indagó sobre morbilidad auto-reportada de enfermedad diarreica y se recolectaron y analizaron muestras de agua en 42 domicilios. Fue realizado un análisis descriptivo de condiciones socioeconómicas, ambientales y sanitarias y evaluamos su asociación con enfermedad diarreica mediante modelo robusto de regresión de Poisson. Cada modelo fue ajustado con variables sugeridas por diagramas causales específicos. RESULTADOS: Se evidenciaron condiciones precarias de abastecimiento de agua, higiene y saneamiento básico en la zona de estudio. Todas las muestras de agua se clasificaron entre los niveles de riesgo alto e inviable sanitariamente. La prevalencia de enfermedad diarreica fue 7,5% en todas las edades y 23,5% en niños menores de cinco años. Las variables estación lluviosa (RP = 0,24; IC95% 0,07-0,85), niños menores de cinco años (RP = 4,05; IC95% 1,70-9,68), abastecimiento de agua desde pozo profundo (RP = 16,90; IC95% 2,45-116,67), abastecimiento de agua desde estanco (RP = 11,47; IC95% 1,27-103,29), tenencia de baño (RPA = 0,23; IC95% 0,06-0,96) y presencia de cerdos (RP = 0,20; IC95% 0,05-0,74) mostraron asociaciones estadísticamente significativas con la ocurrencia de enfermedad diarreica. CONCLUSIÓN: Condiciones de abastecimiento de agua, higiene y saneamiento básico estuvieron asociadas con la ocurrencia de enfermedad diarreica, afectando alrededor de un cuarto de la población menor de cinco años. Urge un diseño efectivo de políticas que contribuyan al mejoramiento de condiciones ambientales y saneamiento en áreas rurales.

Estudo transversal sobre trabalho e comportamentos de risco à saúde entre escolares de zona rural do Rio Grande do Sul, 2010 / Estudio transversal sobre trabajo y conductas de riesgo a la salud entre niños estudiantes en zona rural de Rio Grande do Sul, Brasil, 2010 / Cross-sectional study on work and health risk behaviors among school students in a rural area of Rio Grande do Sul State, Brazil, 2010

Objetivo: avaliar a associação entre trabalho e comportamentos de risco à saúde entre escolares de zona rural. Métodos: estudo transversal com escolares do 5° ao 8° ano do ensino fundamental das escolas municipais de Barão do Triunfo, RS, Brasil, em 2010; utilizou-se questionário autoaplicável; caracterizou-se o perfil de trabalho como 'trabalhadores atuais', 'trabalhadores prévios' e 'não trabalhadores'; revelaram-se comportamentos de risco à saúde o tabagismo, o consumo de álcool, o excesso de peso e a inatividade física (≤300 minutos semanais). Resultados: dos 339 participantes menores de 16 anos (89,9%), 82,3% eram trabalhadores atuais; entre os trabalhadores, predominaram serviços domésticos (39,8%) e agricultura (29,9%); 24,8% estavam com excesso de peso, 51,2% inativos no lazer, 6,6% fumavam; e 27,0% haviam consumido álcool nos últimos 30 dias, principalmente trabalhadores, comparados a não trabalhadores (p=0,02). Conclusão: oito em cada dez escolares trabalhava, e a maioria destes estava em trabalho infanto-juvenil; consumo de álcool foi o comportamento de risco à saúde mais frequente.

Objetivo: evaluar la asociación entre el trabajo y los comportamientos de riesgo a la salud entre los escolares de zona rural. Métodos: estudio transversal con estudiantes de quinto a octavo grado de primaria en las escuelas municipales de Barão do Triunfo, RS, Brasil, en 2010; en cuestionario autoaplicable, se caracterizó el perfil de trabajo como 'trabajadores actuales', 'trabajadores previos' y 'no trabajadores'; los comportamientos de riesgo a la salud fueron el tabaquismo (sí; no) y el consumo de alcohol (sí; no) en el último mes, exceso de peso e inactividad física. Resultados: entre los 339 participantes menores de 16 años (89,9%), el 82,3% eran trabajadores; entre los trabajadores, predominaron los servicios domésticos (39,8%) y la agricultura (29,9%); 24,8% de los estudiantes tenía sobrepeso, 51,2% estaba inactivo en el tiempo libre, 6,6% fumaba y 27,0% consumió alcohol en los últimos 30 días; este consumo fue mayor entre los trabajadores que entre los no trabajadores (p=0,02). Conclusión: ocho de cada diez escolares trabajaba, y la mayoría fue de niños y adolescentes; el comportamiento de mayor riesgo entre ellos fue el alcohol.

Objective: to evaluate association between work and health risk behaviors among rural schoolchildren. Methods: this was a cross-sectional study with 5th to 8th grade elementary and middle school students attending municipal schools in Barão do Triunfo, RS, Brazil in 2010; a self-administered questionnaire was used; their work profile was characterized as 'current workers', 'former workers', and 'non-workers'; health risk behaviors examined were smoking, alcohol consumption, overweight, and physical inactivity (≤300 minutes per week). Results: of the 339 participants under 16 years old (89.9%), 82.3% were current workers; their predominant work was domestic services (39.8%), and farming (29.9%); 24.8% of students were overweight, 51.2% were inactive during leisure, 6.6% smoked, and 27.0% had consumed alcohol in the last 30 days; alcohol consumption was higher among workers than non-workers (p=0.02). Conclusion: eight out of ten schoolchildren worked, most of them as child labor; the most frequent health risk behavior was alcohol consumption.

Autocorrelación espacial de mortalidad por cáncer de mama en la Región Metropolitana, Chile: estudio ecológico / Spatial autocorrelation of breast cancer mortality in the Metropolitan Region, Chile: an ecological study

INTRODUCCIÓN El cáncer de mama es la neoplasia maligna más común en las mujeres en todo el mundo y en Chile, siendo la primera causa de muerte oncológica femenina. Se ha reportado amplia variación en la mortalidad, con focos geográficos de mayor riesgo. OBJETIVO Analizar espacialmente la mortalidad por cáncer de mama en mujeres de la Región Metropolitana en 2015. MÉTODOS Estudio ecológico. Se utilizaron los datos de los registros de defunciones del año 2015 (C50 según CIE10), y las proyecciones poblacionales del Instituto Nacional de Estadísticas. Se calcularon tasas de mortalidad por cáncer de mama brutas y razones de mortalidad estandarizadas. Se realizó un análisis epidemiológico espacial estimando el índice I de Moran Global y Local para evaluar autocorrelación espacial. Los resultados se presentan en mapas (cartografía precenso 2016). RESULTADOS Se registraron 622 defunciones por cáncer de mama en la Región Metropolitana en 2015. La edad promedio de las mujeres fallecidas fue de 66 años (desviación estándar: 15,5). El 92,4% de las muertes se registró en zonas centrales o urbanas. Sin embargo, las mayores tasas de mortalidad se observaron en comunas periféricas. No se observó autocorrelación espacial global en la región (I de Moran de 0,007; p = 0,134). A nivel local, cuatro comunas se diferencian de forma significativa de sus vecinas. CONCLUSIONES El riesgo de morir por cáncer de mama en la Región Metropolitana de Chile se concentra en comunas periféricas. Cuatro comunas de la región presentan riesgos diferentes de sus comunas vecinas, por lo que es necesario explorar factores que explican la desigual distribución de las muertes.

INTRODUCTION Breast cancer is the most common malignancy in women worldwide and Chile, being the leading cause of female cancer death. A wide variation in mortality has been reported, with geographic clusters of higher risk. OBJECTIVE To spatially analyze mortality from breast cancer in women in the Metropolitan Region in 2015. METHODS Ecological study of location. We used death records in 2015 (C50 according to ICD10) and population projections of the Statistics Institute to estimate mortality rates. We calculated crude breast cancer mortality rates and standardized mortality ratios and performed a spatial epidemiological analysis of breast cancer mortality in women, estimating the global and local Moran I index to assess spatial autocorrelation. We present the results in maps according to the 2016 pre-census cartography. RESULTS There were 622 deaths from breast cancer in the Metropolitan Region in 2015. The mean age was 66 years (SD: 15.5). 92.4% of deaths were registered in urban or central areas. However, the highest mortality rates were observed in peripherical districts. No global spatial autocorrelation was observed in the region (Moran's I 0.007 p = 0.134). However, at the local level, four districts differ significantly from their neighbors. CONCLUSIONS The risk of dying from breast cancer in the Metropolitan Region of Chile is concentrated in women from peripherical communes. Four districts in the region present different risks from their neighboring districts. It is necessary to investigate local realities to prevent deaths from this pathology.

Comportamento sedentário em idosos residentes de zona rural no extremo Sul do Brasil / Sedentary behavior in elderly residents from the rural area in Southern Brazil

RESUMO: Introdução: O comportamento sedentário tem sido associado a diversos indicadores de saúde. O objetivo deste estudo é descrever esse desfecho em idosos residentes de zona rural. Metodologia: Realizou-se um estudo transversal com idosos da zona rural de Rio Grande/RS, em 2017. A coleta de dados foi realizada por meio de questionário eletrônico. O comportamento sedentário foi avaliado pelo somatório de oito aspectos: assistir a televisão/vídeos/DVD, usar computador/internet, ler, socializar com amigos e/ou família, dirigir ou andar de carro/moto/transporte público, praticar algum hobby, trabalhar e outras atividades. A análise deu-se pela descrição dos aspectos e pela análise multivariável (regressão linear), para testar associações com características socioeconômicas, demográficas e atividade física. Também foi verificada associação do excesso de comportamento sedentário e tempo assistindo à televisão com as variáveis independentes. Resultados: A média de comportamento sedentário foi de 274,9 minutos/dia (n = 1.030), e assistir televisão representou quase a metade (130,5 minutos/dia). Idade mostrou-se inversamente associada com o comportamento sedentário, enquanto renda e escolaridade apresentaram uma relação direta. Renda apresentou associação positiva com excesso de comportamento sedentário e tempo assistindo televisão. Conclusão: A média de comportamento sedentário foi menor quando comparada com a literatura em idosos. Sugere-se que ações para incentivar hábitos saudáveis visem especialmente diminuir o tempo assistindo televisão.

ABSTRACT: Introduction: Sedentary behavior has been associated with several health indicators. This study aims to describe this outcome in elderly people living in rural areas. Methodology: A cross-sectional study was carried out with elderly people from the rural area in the city of Rio Grande/RS, in 2017. Data were collected using an electronic questionnaire. Sedentary behavior was evaluated by eight aspects: watching television/videos/DVDs, using computer/internet, reading, socializing with friends and/or family, driving or riding a car/bike/taking public transport, practicing a hobby, working, and other activities. The analysis was composed by the description of aspects and multivariable (linear regression) analysis to test associations between the outcome and socioeconomic, demographic and physical activity characteristics. Association of the excess of sedentary behavior and time watching television within the independent variables was also verified. Results: The mean of sedentary behavior was 274.9 minutes/day (n = 1,030), but watching television represented almost half (130.5 minutes/ day). Age was inversely associated with sedentary behavior, while income and schooling presented a direct relation. Income had a positive association with excessive sedentary behavior and time watching television. Conclusion: The mean sedentary behavior was lower when compared with the literature for the elderly. We suggest that actions to encourage healthy habits aim especially at reducing the time spent watching television.

Exposição a agrotóxicos: estudo de base populacional em zona rural do sul do Brasil / Pesticide exposure: a population-based study in a rural area in southern Brazil

RESUMO: Objetivo: Estimar a prevalência de exposição a agrotóxicos e fatores associados entre moradores de zona rural. Métodos: Estudo transversal de base populacional realizado com 1.518 indivíduos, em 2016. Foram aleatoriamente selecionados 24 setores censitários de oito distritos rurais de Pelotas, RS. Indivíduos ≥ 18 anos residentes nos domicílios aleatoriamente selecionados eram elegíveis. Foi realizada análise descritiva e apresentada prevalência de contato com os agrotóxicos. A associação entre desfecho e variáveis independentes deu-se por regressão de Poisson, conforme modelo hierárquico. As variáveis foram ajustadas para todas do mesmo nível, além daquelas que foram mantidas no modelo do nível anterior e das com valor p < 0,20. Resultados: A prevalência de contato com agrotóxicos no último ano foi de 23,7%, e, entre esses participantes, 5,9% relataram intoxicação por agrotóxicos alguma vez na vida. A probabilidade de contato com agrotóxicos no último ano foi maior entre os homens (razão de prevalência - RP = 2,00; intervalo de confiança de 95% - IC95% 1,56 - 2,56); entre aqueles com idades entre 40 e 49 anos (RP = 1,44; IC95% 1,12 - 1,80); entre os menos escolarizados (RP = 2,06; IC95% 1,39 - 3,10); os que exerciam trabalho rural (RP = 2,87; IC95% 2,05 - 4,01); e aqueles que moraram na zona rural a vida inteira (RP = 1,28; IC95% 1,00 - 1,66). Conclusões: Aproximadamente um em cada quatro adultos da zona rural de Pelotas entrou em contato com agrotóxicos no ano anterior ao estudo. Os achados evidenciam a existência de desigualdades sociais relacionadas à exposição aos agrotóxicos e fornecem informações para ações visando à redução da exposição e intoxicação por esses produtos.

ABSTRACT: Objective: To estimate the prevalence of pesticide exposure and associated factors among rural residents. Methods: A population-based, cross-sectional study conducted with 1,518 individuals in 2016. We randomly selected 24 census tracts from the eight rural districts of the city of Pelotas, RS. All individuals aged 18 years or older, living in the randomly selected households were eligible. A descriptive analysis was performed and the prevalence of contact with pesticides was presented. The association between outcome and independent variables was analyzed using Poisson regression according to the hierarchical model. The variables were all adjusted to the same level, including those at the previous level and those with p<0.20 were kept in the model. Results: The prevalence of contact with pesticides in the past year was 23.7% and among the participants, 5.9% reported having pesticide poisoning at some time in their lives. The probability of contact with pesticides in the past year was higher among men (PR=2,00; 95%CI 1.56 - 2.56), among those aged 40-49 years (PR = 2.00; 95%CI 1.12 - 1.80), among individuals with lower levels of education (PR = 2.06; 95%CI 1.39 - 3.10), in those who performed rural work (PR = 2.87; 95%CI 1.39 - 3.10) and in those who had lived in rural areas all their lives (PR = 1.28 95%CI 1.00 - 1.66). Conclusions: Approximately one in four adults in rural Pelotas had come into contact with pesticides in the year before the study. The findings show the existence of social inequalities related to exposure to pesticides and provide information for action aimed at reducing exposure and poisoning from these products.

Health access to immigrants: identifying gaps for social protection in health / Acceso a salud en inmigrantes: identificando brechas para la protección social en salud

ABSTRACT OBJECTIVE To compare the access to and effective use of health services available among international migrants and Chileans. METHODS Secondary analysis of the National Socioeconomic Characterization Survey (CASEN - Caracterización Socioeconómica Nacional ), version 2017. Indicators of access to the health system (having health insurance) and effective use of health services (perceived need, appointment or coverage, barriers and need satisfaction) were described in immigrants and local population, self-reported. Gaps by immigrant status were estimated using logistic regressions, with complex samples. RESULTS Immigrants were 7.5 times more likely to have no health insurance than local residents. Immigrants presented less perceived need than local residents, together with a greater lack of appointments (OR: 1.7 95%CI: 1.2-2.5), coverage (OR: 2.7 95%CI: 2.0-3.7) and unsatisfied need. The difference between immigrants and locals was not statistically significant in barriers to health care access (α = 0.005). CONCLUSIONS Disadvantages persist regarding the access to and use of health services by immigrants as opposed to Chileans compared with information from previous years. It is necessary to reduce the gaps between immigrants and people born in Chile, especially in terms of health system access. This is the first barrier to effective use of services. The generation of concrete strategies and health policies that consider an approach of social participation of the immigrant community is suggested to bring the health system closer to this population.

RESUMEN OBJETIVO Comparar el acceso y uso efectivo de servicios de salud disponibles entre migrantes internacionales y chilenos. MÉTODOS Análisis secundario de la encuesta poblacional de Caracterización Socioeconómica Nacional (CASEN), versión 2017. Se describieron indicadores de acceso al sistema de salud (tener previsión de salud) y uso efectivo de servicios de salud (necesidad sentida, consulta o cobertura, barreras y satisfacción de la necesidad) en inmigrantes y locales, autorreportados. Las brechas por condición de inmigrante se estimaron utilizando regresiones logísticas, con muestras complejas. RESULTADOS Los inmigrantes presentaron 7,5 veces más chances de no tener previsión de salud que los locales. Los inmigrantes presentaron una menor necesidad sentida que los locales, en conjunto con una mayor falta de consulta (OR: 1,7 IC95%: 1,2-2,5), cobertura (OR: 2,7 IC95%: 2,0-3,7) e insatisfacción de necesidades. La diferencia entre inmigrantes y locales no fue estadísticamente significativa en barreras de acceso a atención en salud (α = 0,005). CONCLUSIONES Persisten las desventajas en acceso y uso a servicios de salud en inmigrantes en comparación con los nacidos en Chile en contraste con información de años anteriores. Es necesario reducir las brechas entre inmigrantes y nacidos en Chile, sobre todo en cuanto a pertenencia a un sistema de salud. Esta es la primera barrera para un uso efectivo de servicios. Se sugiere generar estrategias concretas y políticas en salud que consideren un enfoque de participación social de la comunidad inmigrante y, adicionalmente, acerquen al sistema de salud a esta población.

Tendencia y factores asociados a la frecuencia de cepillado dental en menores de doce años, Perú 2013-2018 / Trend and factors associated with the frequency of tooth brushing in children under twelve years old, Peru 2013-2018

RESUMEN Objetivos. Determinar la tendencia y factores asociados al cepillado de dos o más veces por día en niños menores de doce años entre el 2013 y 2018 en Perú. Materiales y métodos. Se realizó un estudio transversal mediante análisis secundario de datos reportados por la Encuesta Demográfica y de Salud Familiar. Se consideró la información de niños con al menos un cepillado al día, considerando como «Adecuada Frecuencia de Cepillado Dental¼ (AFC) para quienes reportaban de dos a más; se generaron medidas porcentuales por ámbito geográfico, características sanitarias, de vivienda y hogar. Se determinaron los factores asociados a la AFC mediante regresión logística binaria para encuestas complejas, la variabilidad de la tendencia se identificó mediante regresión joinpoint con un 95% de confianza. Resultados. En el 2013, la AFC fue del 79,0% con un aumento a 83,9% para el 2018; se identificó que cuatro de 25 espacios geográficos se mantuvieron sin variación de AFC, y otros cuatro disminuyeron. Todas las características sanitarias mostraron favorecer el cepillado, destacándose que el no compartir el cepillo generó un OR de 2,30, IC 95%: 1,46 a 3,60. La región natural, el tipo de lugar de residencia y el quintil de riqueza afectaron la AFC; la AFC fue mayor según se incrementa el grupo etario. Conclusiones . El porcentaje de AFC ha aumentado en los últimos años, siendo influenciado favorablemente por los aspectos sanitarios; a nivel rural este porcentaje es significativamente menor, algo que también se evidencia en la región sierra.

ABSTRACT Objetivos. To determine the trend and factors associated with brushing two or more times per day in children under twelve years of age between 2013 and 2018 in Peru. Materials and Methods. A cross-sectional study was conducted by secondary analysis of data reported by the Demographic and Family Health Survey (ENDES). Information on children with at least one brushing per day was taken into account, considering as an "Adequate Toothbrushing Frequency" (ATF) for those who reported brushing two to more times per day. Percentage measures were generated by geographical area, health, housing, and household characteristics. Factors associated with an ATF were determined by using binary logistic regression for complex surveys, trend variability was identified by joinpoint regression with a 95% confidence. Results. In 2013, the ATF was 79.0%, increasing to 83.9% by 2018. Four out of 25 geographic areas were identified as having no variation on the ATF, and four others decreased. All sanitary characteristics showed favoring brushing, emphasizing that not sharing the toothbrush generated a 2.30 OR, 95% CI: 1.46 to 3.60. The natural region, type of place of residence, and wealth index quintile affected the ATF. The ATF was higher as the age group increased. Conclusions. The percentage of ATF has increased in recent years, being favorably influenced by health aspects; in rural areas, this percentage is significantly lower, something that is also evident in the Highland region.

Factores asociados al uso de servicios de salud oral en adultos mayores peruanos: análisis secundario de encuesta poblacional, 2018 / Factors associated with the use of oral health services in older peruvian adults: secondary analysis of population survey, 2018

RESUMEN Objetivos: Identificar la prevalencia y factores asociados al uso de servicios de salud oral en adultos mayores (AM) peruanos durante el 2018. Materiales y métodos: Análisis secundario de los datos de 4874 AM peruanos de la Encuesta Demográfica y de Salud Familiar (ENDES) 2018. Se consideró el uso de servicio de salud oral (sí/no) en razón de los seis meses previos a la aplicación de la encuesta como variable dependiente, las variables independientes fueron: sexo, edad, área de residencia, nivel educativo, estado civil, dominio geográfico, limitación física, afiliación a un seguro de salud, lengua hablada y quintil de bienestar. Se realizó un análisis descriptivo usando frecuencias absolutas y proporciones ponderadas, y un análisis multivariado empleando modelos lineales generalizados (familia Poisson). Resultados: Del total de AM, 52,6% fueron mujeres, 52,9% pertenecían al grupo de 60 a 69 años de edad, 77% pertenecían al área urbana y 81,1% estuvieron afiliados a un seguro de salud. La prevalencia del uso de servicios odontológicos durante los últimos seis meses fue 24,9%. El análisis multivariado encontró asociación con el área de residencia (p<0,001), el nivel educativo superior (p=0,001), la afiliación a un seguro de salud (p<0,001), el dominio geográfico (p=0,019) y todos los quintiles de bienestar (p<0,001). Conclusiones : La prevalencia de uso de servicios de salud oral en AM fue baja, y sus factores asociados fueron el área de residencia, el nivel educativo, la afiliación a un seguro de salud, el dominio geográfico y los quintiles de bienestar.

ABSTRACT Objectives : To identify the prevalence and factors associated with the use of oral health services in Peruvian older adults (OA) during 2018. Materials and Methods . Secondary analysis of data on 4,874 Peruvian OAs from the Demographic and Family Health Survey (ENDES) carried out in 2018. The use of oral health services was considered (yes/no) based on the six months prior to the application of the survey as a dependent variable. The independent variables were sex, age, area of residence, educational level, marital status, geographical domain, physical limitation, health insurance, spoken language, and welfare index quintile. A descriptive analysis was performed using absolute frequencies and weighted proportions, and a multivariate analysis using generalized linear models (Poisson regression). Results . From the total of OAs, 52.6% were women, 52.9% belonged to the 60-69 age group, 77% belonged to the urban area, and 81.1% had a health insurance. The prevalence of the use of dental care services in the last six months was 24.9%. Multivariate analysis found association with area of residence (p<0.001), higher educational level (p=0.001), health insurance affiliation (p<0.001), geographic domain (p=0.019), and all welfare index quintiles (p<0.001). Conclusions . The prevalence of the use of dental care services in OAs was low, and its associated factors were the area of residence, educational level, health insurance, geographic domain, and welfare index quintiles.

Face validity of the general development assessment test (EVADE) in children and adolescents aged 6-14 years / Validación de apariencia de la prueba general para la evaluación del desarrollo (EVADE) en niños, niñas y adolescentes entre los 6 y 14 años

Abstract Background: The general development assessment test (EVADE) for children and adolescents aged 6-14 years is the only national screening tool for development assessment of school-age children and adolescents. This article presents the results obtained after applying the face validity process to the test, the handbook, and the standardized materials. Methods: An exploratory, descriptive study was conducted with a quantitative-qualitative methodology. The EVADE test was applied to a sample of 730 children and adolescents between 6 and 14 years of age, for which the expert judgment technique was used. Data analysis was carried out through a psychometric analysis of the items and by the triangulation method. Results: From the 730 participants included, 44.5% were from rural areas (n = 325) and 55.4% from urban areas (n = 405), of which 51.7% (n = 378) of females and 48.2% (n = 352) of males were assessed by the test. The difficulty level and discriminative effectiveness quotient of the items were calculated, which, together with the experts' findings, resulted in 22-item modifications and the creation of four new items in the cognitive and language areas. The qualification by areas also changed, improving the handbook and creating new materials. Conclusions: This research provides a validated screening test for the child and adolescent population, which was included in the Costa Rican comprehensive childcare public policy. However, subsequent validation processes are recommended to improve specific areas, such as motor skills and social-affective development.

Resumen Introducción: La prueba general para la evaluación del desarrollo (EVADE) para niñas, niños y adolescentes entre 6 y 14 años es la única prueba a nivel nacional que valora el desarrollo en población escolar y adolescente. Este artículo presenta los resultados tras someter la prueba, el instructivo y los materiales estandarizados al proceso de validación de apariencia. Métodos: Se llevó a cabo un estudio descriptivo exploratorio, con metodología cuantitativa-cualitativa. La prueba EVADE se aplicó a una muestra de 730 niñas, niños y adolescentes entre 6 y 14 años; asimismo, se utilizó la técnica de juicio de expertos. El análisis de los datos se efectuó a través de un análisis psicométrico de los enunciados y triangulación. Resultados: De los 730 participantes, el 44.5% correspondió a zonas rurales (n = 325) y el 55.4% a zonas urbanas (n = 405). El 51.7% de ellos eran de sexo femenino (n = 378) y el 48.2%, de sexo masculino (n = 352). Se calculó el nivel de dificultad y el coeficiente de efectividad discriminativa para los enunciados. A la par de los hallazgos referidos por los expertos, resultó en la modificación de 22 enunciados, la creación de cuatro nuevos artículos en las áreas cognitiva y de lenguaje. También se cambió la calificación por áreas, se mejoró el instructivo y se crearon nuevos materiales. Conclusiones: La presente investigación aporta una prueba validada para la población infantil escolar y adolescente, que fue incluida en la política pública de atención integral de la población infantil costarricense. Se recomiendan procesos de validación subsecuentes con el fin de mejorar áreas específicas, como motricidad y socioafectiva.