A hipótese da equidade inversa na implementação do NASF-AB em municípios do Sul do Brasil / The inverse equity hypothesis in the implementation of NASF-AB in municipalities of Southern Brazil

Resumo O objetivo foi verificar a evolução da implementação do Núcleo Ampliado de Saúde da Família e Atenção Básica (NASF-AB) nos municípios da região Sul do Brasil, de 2008 a 2019, sob à luz da hipótese da equidade inversa. Estudo ecológico considerando 1.188 municípios do Sul do Brasil. As análises foram separadas por estado, com os municípios divididos em quartis de Índice de Desenvolvimento Humano Municipal - Renda. Foi calculado o percentual acumulativo de implementação do NASF-AB no período e a desigualdade entre Q1 (mais rico) e Q4 (mais pobre) verificada por medidas de desigualdade absoluta e relativa. No Paraná o Q1 apresentou maior cobertura do NASF-AB do que o Q4 e, apesar da desigualdade ter reduzido ao final do período, ainda estava bem demarcada, seguindo padrão "top inequality". Em Santa Catarina ocorreu o que prevê a hipótese, com aumento das desigualdades no início e posterior redução quando já existia NASF-AB em cerca de 90% dos municípios do Q1, caracterizando "botton inequality". No Rio Grande do Sul a hipótese foi refutada ao observar, a partir de 2014, maior implementação no Q4 em relação ao Q1.

Abstract The present study aimed to analyze the evolution of the implementation of Family Health and Primary Health Care Expanded Support Centers (NASF-AB, in Portuguese) in the municipalities of Southern Brazil, from 2008 to 2019, in light of the inverse equity hypothesis. This was an ecological study, considering 1,188 municipalities of Southern Brazil. The analyses were separated by state, with municipalities divided into quartiles of Municipal Human Development Index - Income (MHDI-Income). Our study calculated the cumulative percentage of the implementation of NASF-AB within the given period and the inequality between Q1 (richest) and Q4 (poorest), assessed by the absolute and relative inequality measures. In Paraná, Q1 presented a higher coverage of NASF-AB than did Q4, and, although the inequality had decreased at the end of the period, it was still quite distinct, according to the "top inequality" pattern. In Santa Catarina, the predictions of the hypothesis were confirmed, with inequalities found in the beginning of the period and a near 90% decline once NASF-AB had been implemented in the municipalities of Q1, characterizing the "bottom inequality" pattern. In Rio Grande do Sul, the hypothesis was refuted observing that since 2014 there was a greater implementation in Q4 as compared to Q1 was observed.

Incidence and mortality of lung cancer in countries with different human development index / 上海预防医学

ObjectiveTo compare the annual and age trends of the age-standard incidence rate （ASIR） and the age-standard mortality rate （ASMR） of lung cancer in countries with different human development index （HDI） from 1990 to 2019. MethodsThe data were collected from the global burden of disease study and GLOBOCAN 2020. The average annual percentage change （AAPC） and age trends of ASIR and ASMR in lung cancer were analyzed by the Joinpoint regression model， and the comparison between the four groups was analyzed by Kruskale-Wallis analysis. ResultsIn 2020， the incidence and mortality of lung cancer gradually increased with age and HDI grade. From 1990 to 2019， the global ASIR and ASMR of lung cancer decreased， and the ASIR of lung cancer among male decreased， while the ASIR of lung cancer among female increased. The results showed that ASIR of lung cancer in female residents in countries with very high HDI increased significantly from 1996 to 2011， resulting in an overall upward trend in female ASIR， while the other groups showed a downward trend. It was found that ASIR and ASMR of lung cancer in China and India were on the rise， while ASIR and ASMR of lung cancer in Russia and the United States were on the decline. ConclusionAlthough very high/high HDI countries face a higher burden of lung cancer occurrence and death， the accumulation of lung cancer burden is completed in the transitioning period. Therefore， lung cancer prevention measures in countries in transition are critical for global lung cancer control.

Tuberculosis: el contrapunto del progreso / Tuberculosis: the counterpoint of progress

Resumen A lo largo de la historia, las enfermedades infecciosas han influido directamente en el desarrollo de la humanidad y en este proceso, la tuberculosis ha tenido un rol protagónico. Esta enfermedad mata más seres humanos que cualquier otra de causa infecciosa y, a pesar de esto, continúa siendo una entidad olvidada y un grave problema de salud pública, sobre todo en las naciones más pobres. La trascendencia de la tuberculosis va más allá del ámbito médico y una visión holística de ella nos permite comprender el grado de desarrollo económico y social de un Estado. Si bien Chile mantenía un programa de control históricamente exitoso, las cifras actuales no son auspiciosas y obligan a analizar el problema desde una mirada multidisciplinaria. Es en este marco que planteamos que el médico clínico, para aportar en el control de la enfermedad, debe poner nuevamente en práctica uno de los principios básicos de la Medicina: la semiología.

Abstract Along history, infectious diseases have had a direct influence in the development of humanity, with tuberculosis showing a leading role. Despite this disease being the main cause of mortality among infectious diseases, it remains neglected and constitutes a serious public health problem, especially among the poorest countries in the world. Tuberculosis greatest importance goes beyond Medicine, and a holistic view of the disease allows us to comprehend the economic and social development of a nation. Despite a historically successful control program in Chile, current figures are not auspicious and force upon us the need to address this problem with a multidisciplinary approach. The medical physician is required to put again into practice the fundamental principle of Medicine, Semiology to contribute to the control of tuberculosis.

Índice desarrollo humano y la tasa de letalidad por Covid-19: Estudio ecológico en América / Human development and Covid-19 lethality rate: Ecological study in America

Introducción: El Índice de Desarrollo Humano (IDH), usa tres dimensiones de desarrollo como esperanza de vida, acceso a educación y el nivel de ingresos. Se ha visto a nivel mundial que los grupos socioeconómicamente vulnerables son los menos protegidos y enfrentan el mayor riesgo de COVID-19. Este estudio tiene como objetivo evaluar la correlación entre IDH, índice de inequidad GINI con la tasa de letalidad por COVID-19 en países de América. El estudio: Se desarrolló un estudio observacional ecológico, utilizando las métricas de COVID 19 de países de latino américa. La variable desenlace fue tasa de letalidad por COVID-19, y las variables exposición fueron IDH, GINI, esperanza de vida, años de escolaridad, proporción de mayores de 60 años y PBI per cápita. Recopilado los datos se hicieron análisis. Usamos el método de correlación de spearman, con un nivel de significancia de 95%. Hallazgos: Se evaluaron a 24 países de América Latina, encontrándose una tasa de letalidad por COVID 19 con una mediana de 2.41 y con 1.55 y 3.04 como percentil 25 y 75 respectivamente, obteniéndose además con valores extremos a Ecuador, México y Perú con 6.41, 7.57 y 9.12 respectivamente. Al evaluar la correlación de la tasa de letalidad por COVID 19 se encontró correlación lineal negativa débil entre el IDH, índice de escolaridad y esperanza de vida con rho= -0.253, -0.342 y -0.342 respectivamente, sin embargo no se encontró significancia estadística (Valor p >0.05). Conclusiones: Se encontró entre los países de latino américa que existe correlación lineal negativa débil entre la tasa de letalidad por COVID 19 y IDH, índice de escolaridad y esperanza de vida.

Background: The Human Development Index (HDI), uses three dimensions of development such as life expectancy, access to education and income level. It has been seen worldwide that socioeconomically vulnerable groups are the least protected and face the highest risk of COVID-19. This study aims to evaluate the correlation between HDI, GINI inequality index and COVID-19 case fatality rate in American countries. Study: An ecological observational study was developed, using COVID-19 metrics from Latin American countries. The outcome variable was COVID-19 case fatality rate, and the exposure variables were HDI, GINI, life expectancy, years of schooling, proportion of people over 60 years of age and GDPper capita. Once the data were collected, analyses were performed. We used the spearman correlation method, with a significance level of 95%. Findings: Twenty-four Latin American countries were evaluated, finding a COVID 19 case fatality rate with a median of 2.41 and with 1.55 and 3.04 as 25th and 75th percentile respectively, obtaining also with extreme values Ecuador, Mexico and Peru with 6.41, 7.57 and 9.12 respectively. When evaluating the correlation of the COVID 19 case fatality rate, a weak negative linear correlation was found between HDI, schooling index and life expectancy with rho= -0.253, -0.342 and -0.342 respectively, however, statistical significance was not found (p-value >0.05). Conclusions: It was found among Latin American countries that there is a weak negative linear correlation between COVID 19 case fatality rate and HDI, schooling index and life expectancy.

Does the Human Development Index relate with acute lymphoblastic leukemia incidence? / ¿Existe relación entre el Índice de Desarrollo Humano y la incidencia de leucemia linfoblástica aguda?

Abstract Background: The association between childhood cancer and socioeconomic status has been widely studied. However, none of the results are conclusive. This study aimed to analyze the association between the Human Development Index (HDI) and the acute lymphoblastic leukemia (ALL) incidence in children under the Popular Medical Insurance Care. Methods: We conducted an observational, descriptive, and population-based study covering 55% of the Mexican population (58 million). Results: The most impoverished states were located in the south east region of Mexico, while the north was more homogeneous, with HDIs varying between 0.73 and 0.79. Our findings emphasize that the metropolitan area of Mexico City and the State of Nuevo Leon have the highest levels of HDI. Regions were graded from I to IV according to their HDIs in ascending order. The HDIs varied from 0.667 to 0.830/100,000 children/year, with a national average of 0.746. The leukemia incidence for regions I, II, III, and IV was 6.12, 6.53, 4.96, and 9.95. An analysis of ALL incidence in Mexico showed significant differences for region IV in comparison with the other regions based on the HDI values (p = 0.0001). Conclusions: Further in-depth studies, including the economic aspects of the different geographic regions and their ethnographic characteristics, would give a more comprehensive panorama.

Resumen Introducción: Se ha estudiado la relación entre el nivel socioeconómico y el cáncer en niños. Sin embargo, aún no existen resultados concluyentes. El objetivo de este trabajo fue analizar la asociación entre el Índice de Desarrollo Humano (IDH) y la incidencia de leucemia linfoblástica aguda en niños atendidos por el Seguro Popular. Métodos: Se realizó un estudio observacional y descriptivo. La población estudiada representa el 55% de la población mexicana (58 millones). Resultados: Los Estados más pobres se localizaron en la región sureste de México, mientras que el norte del país fue más homogéneo, con un IDH que varió entre 0.73 y 0.79. Los hallazgos muestran que el área metropolitana de la Ciudad de México y el Estado de Nuevo León tienen un IDH más alto. Las regiones se graduaron del I al IV en orden ascendente de acuerdo con su IDH. El IDH varió de 0.667 a 0.830 por 100,000 niños por año, con un promedio nacional de 0.746. La incidencia de leucemia por 100,000 niños por año en las regiones I, II, III y IV fue de 6.12, 6.53, 4.96 y 9.95, respectivamente. El análisis de variabilidad de la incidencia de leucemia linfoblástica aguda en México muestra diferencias entre la región IV y el resto de las regiones de acuerdo con los valores del IDH (p = 0.0001). Conclusiones: Se deben realizar estudios más profundos que consideren no solo los aspectos económicos de las diferentes regiones, sino también sus características etnográficas, lo cual podría dar un panorama más amplio.

Global burden of periodontal disease and its relation with socioeconomic development during 1990-2019 / 浙江大学学报·医学版

To analyze the global burden of periodontal disease and its relation with socioeconomic development. Data of global disability-adjusted life year (DALY) due to periodontal disease and human development index (HDI) from 1990 to 2019 were obtained from Global Health Data Exchange (GHDx) and human development reports. The trend of the global burden of periodontal disease from 1990 to 2019 was described. The correlation between age-standardized DALY rates and HDI were examined in 2019, and between-country periodontal disease burden inequality from 1990 to 2019 was measured using health-related Gini coefficients and concentration indexes. From 1990 to 2019, the global DALY rate due to periodontal disease increased from 78.63 to 85.48, and the epidemiological burden did not increase significantly. Statistical differences were found across different HDI categories for age-standardized DALY rates of periodontal disease ( 44.315, <0.01) in 2019. Linear regression analysis also revealed a negative correlation between age-standardized DALY rate of periodontal disease and HDI ( = -0.417, <0.01) . Gini coefficients decreased from 0.361 to 0.281 and concentration indexes fell from 0.0339 to -0.0538 between 1990 and 2019. The global burden of periodontal disease did not increase between 1990 and 2019, though the socioeconomic-associated inequality still existed. The burden of periodontal disease was more concentrated in less developed countries, and the socioeconomic-associated inequality has increased since 2000.

Association between the incidence and mortality rates for corpus uteri cancer and human development index (HDI): a global ecological study

OBJECTIVE: The aim of this study was to determine the association between the incidence of and mortality due to corpus uteri cancer (CUC) and the human development index (HDI) across the world.METHODS: This was an ecological study. The incidence and mortality rates of CUC along with HDI data were extracted from the Global Cancer Data in 2018. Subsequently, correlation coefficient and linear regression model were used to determine the association between the incidence and mortality rates of CUC and the HDI. STATA-14 was used for data analysis.RESULTS: There was a positive and significant correlation between the incidence (r=0.693; P<0.001) and mortality (r=0.284; P<0.001) rates of uterine cancer and the HDI. A positive and significant correlation was also observed between the incidence rate and the gross national income per 1,000 capita (r=0.440; P<0.001), mean years of schooling (MYS) (r=0.740; P<0.001), life expectancy at birth (LEB) (r=0.590; P<0.001), and expected years of schooling (r=0.650; P<0.001). The results of the linear regression model showed a significant statistical association between MYS and the incidence of CUC (β=1.10; 95% confidence interval [CI], 0.60–1.70) and LEB and mortality due to uteri cancer (β=0.40; 95% CI, 0.10–0.90).CONCLUSION: The results of this study suggest a significant statistical association between the incidence and mortality rates of CUC and the HDI.

Incidencia de tuberculosis, VIH e Índice de Desarrollo Humano en Colombia: un análisis por departamentos 2005-2014 / Incidence of tuberculosis, HIV and Human Development Index in Colombia: an analysis by departments 2005-2014

Objetivo: Correlacionar la incidencia de tuberculosis pulmonar, tuberculosis extrapulmonar y VIH con el índice de desarrollo humano por departamentos en Colombia entre los años 2005 y 2014. Métodos: Estudio ecológico en 29 departamentos de Colombia, con datos de las secretarias de salud, SIVIGILA y del Programa de las Naciones Unidas para el Desarrollo. Los análisis se realizaron con medidas de resumen, intervalos de confianza, Kruskal Wallis y correlación de Spearman en SPSS. Resultados: Se encuentra incremento en la incidencia de tuberculosis pulmonar y VIH en el lapso estudiado. Por otra parte, no se halló correlación entre el IDH con la tasa de tuberculosis pulmonar; sin embargo, con la tuberculosis extrapulmonar y el VIH se identificaron correlaciones positivas y significativas con Rho Spearman de 0,320 y 0,324 respectivamente. Conclusión: Este estudio puso de manifiesto una correlación positiva y significativa entre la infección por VIH, tuberculosis extrapulmonar e índice de desarrollo humano que indica que las regiones del país con mayor nivel de desarrollo presentan las mayores tasas de infección. Esta información es importante para que las autoridades sanitarias realicen acciones que ayuden a comprender las causas que explican este fenómeno.

Objective: To correlate the incidence of pulmonary tuberculosis, extrapulmonary tuberculosis and HIV with the human development index by departments in Colombia between 2005 and 2014. Methods: Ecological study in 29 departments of Colombia. The incidence data of pulmonary, extrapulmonary and HIV tuberculosis were obtained through the request to departmental health secretaries and data registered in SIVIGILA. The information on the human development index (HDI) was obtained from the United Nations Development Program. The description of the variables was made with measures of central tendency, position, dispersion and 95% confidence intervals. The variation of the disease rates over time was done with the H Kruskal Wallis test. The covariation between the rates of diseases and the HDI was evaluated with scatter plots and Spearman correlation coefficients. In all the analyzes p values lower than 0.05 were considered significant. Results: There is an increase in the incidence of pulmonary tuberculosis and HIV in the period studied. On the other hand, no correlation was found between the HDI with the rate of pulmonary tuberculosis; however, positive and significant correlations with Rho Spearman of 0.320 and 0.324 were found with extrapulmonary tuberculosis and HIV, respectively. Conclusion: this study showed a positive and significant correlation between HIV infection, extrapulmonary tuberculosis and human development index, which indicates that the regions of the country with the highest level of development have the highest infection rates. This information is important for the health authorities to carry out actions that help to understand the causes that explain this phenomenon.

Correlation of cervical cancer mortality with fertility, access to health care and socioeconomic indicators / Correlação da mortalidade por câncer do colo do útero com fertilidade, acesso a cuidados de saúde e indicadores socioeconômicos

Abstract Objective The present study aimed to examine which development indicators are correlated with cervical cancer (CC) mortality rates in Brazil. Methods This was an ecological study that correlatedmortality rates and indicators, such as human development index (HDI), gross domestic product (GDP) per capita, illiteracy rate, fertility rate, screening coverage, proportion of private health insurance use, density of physicians, and density of radiotherapy centers. Themortality rateswere obtained fromthe Brazilian national registry, while the indicators were based on official reports from the Ministry of Health. Univariate and multivariate linear regression was used. Results Among the states of Brazil, the average age-specific CC mortality rate from 2008 to 2012 varied from 4.6 to 22.9 per 100,000 women/year. In the univariate analysis, HDI, proportion of private health insurance use, density of physicians, and density of radiotherapy centers were inversely correlated with the mortality rates. Fertility rate was positively correlated with the mortality rates. In the multivariate analysis, only fertility rate was significantly associated with the CC mortality rate (coefficient of correlation: 9.38; 95% confidence interval [CI]: 5.16-13.59). Conclusion A decrease in the fertility rate, as expected when the level of development of the regions increases, is related to a decrease in the mortality rate of CC. The results of the present study can help to better monitor the quality assessment of CC programs both among and within countries.

Resumo Objetivo O presente estudo teve como objetivo examinar quais indicadores de desenvolvimento estão correlacionados com as taxas de mortalidade por câncer do colo do útero no Brasil. Métodos Este foi um estudo ecológico que correlacionou as taxas de mortalidade com indicadores como índice de desenvolvimento humano (IDH), produto interno bruto (PIB) per capita, taxa de analfabetismo, taxa de fertilidade, cobertura do rastreamento, proporção do uso do seguro privado de saúde, densidade de médicos e densidade de centros de radioterapia. A fonte das taxas de mortalidade foi o registro nacional, enquanto que os indicadores foram baseados em relatórios oficiais do Ministério da Saúde. Foi utilizada regressão linear univariada e multivariada. Resultados Entre os estados, a taxa média de mortalidade específica por idade por câncer do colo do útero de 2008 a 2012 variou de 4.6 a 22.9 por 100.000 mulheres/ano. Na análise univariada, foram inversamente correlacionadas com as taxas de mortalidade: IDH, proporção do uso do seguro privado de saúde, densidade de médicos e densidade de centros de radioterapia. A taxa de fertilidade foi positivamente correlacionada com a mortalidade. Na análise multivariada, apenas a taxa de fertilidade foi significativamente associada à taxa de mortalidade por câncer do colo do útero (coeficiente de correlação: 9,38; índice de confiança [IC] 95%: 5,16-13,59). Conclusão A diminuição da taxa de fertilidade, como esperado quando o nível de desenvolvimento das regiões aumenta, está relacionada a uma diminuição da taxa de mortalidade por câncer do colo do útero. Os resultados do presente estudo podem ajudar amonitorarmelhor a avaliação da qualidade dos programas de câncer do colo do útero nos países tanto interna quanto externamente.

Evaluating maternal and child health indicators for the Sustainable Development Goals in 2018: what is Iran's position? / 한국역학회지

OBJECTIVES: Since many Millennium Development Goals (MDGs) were not achieved, countries including Iran—despite achieving some of the MDGs—need regular planning to achieve the Sustainable Development Goals (SDGs) by 2030. This article examines maternal and child health indicators in the early years of the SDGs in Iran relative to several other countries.METHODS: This study was carried out through a secondary analysis of maternal and child health indicators in Iran. The results were compared with data from other countries divided into three groups: countries with upper-middle income levels, countries in the Eastern Mediterranean region, and the countries covered by the Outlook Document 1,404 (a regional classification). Then, the relationship between these indicators and the Human Development Index was investigated.RESULTS: Iran has attained better results than other countries with respect to maternal mortality, family planning, skilled birth attendance, under-5 deaths, incidence of hepatitis B, diphtheria-tetanus-pertussis vaccination coverage, and antenatal care. In contrast, Iran performed worse than other countries with respect to under-5 wasting, under-5 stunting, and care-seeking behavior for children.CONCLUSIONS: Overall, among the 11 indicators surveyed, Iran has attained better-than-average results and seems to be improving. We recommend that Iran continue interventions in the field of maternal and child health.

O Programa Mais Médicos, a infraestrutura das Unidades Básicas de Saúde e o Índice de Desenvolvimento Humano Municipal / The Mais Médicos (More Doctors) Program, the infrastructure of Primary Health Units and the Municipal Human Development Index

Resumo O presente trabalho tem como objeto central o estudo do contexto em que atuam os profissionais do Programa Mais Médicos. Para isto, a pesquisa utiliza a escala de infraestrutura das UBSs, desenvolvida recentemente por Soares Neto e colegas para aprofundar o conhecimento das relações entre a infraestrutura das UBSs e o IDHM dos municípios que receberam médicos do PMM. Utilizando estatísticas exploratórias e inferenciais, o artigo mostra que das UBSs que receberam médicos do PMM, 65,2% têm infraestrutura de média qualidade e apenas 5,8% delas têm infraestrutura de baixa qualidade. A correlação de 0,50 entre o indicador de infraestrutura e o IDHM aponta para uma tendência moderada de que municípios com baixos IDHMs tenham UBSs mais precárias. Por meio de uma análise de regressão linear múltipla, pode-se inferir que o fator que mais contribui para o aumento do indicador de infraestrutura das UBSs é a renda média municipal. Por outro lado, o fator que afeta negativamente a infraestrutura das UBSs é estar localizada na região Norte ou Nordeste.

Abstract The main objective of this article was to examine the context in which professionals working within the Mais Médicos (More Doctors) Program operate. This study used the infrastructure scale of primary health units (PHUs), which was recently developed by Soares Neto and colleagues to provide more information regarding the relationship between the infrastructure of PHUs and the Municipal Human Development Index (MHDI) of municipalities that received Mais Médicos Program doctors. Using exploratory and inferential statistics, the article shows that 65.2% of the PHUs that received Mais Médicos Program doctors had medium-quality infrastructure and only 5.8% of them had low-quality infrastructure. The correlation of 0.50 between the infrastructure indicator and the MHDI points to a moderate tendency for municipalities with low MHDIs to have more precarious PHUs. Using multiple linear regression analysis it can be inferred that the main factor that contributed to the increase in the infrastructure indicator of the PHUs was the average municipal income. On the other hand, the factor that negatively affected the infrastructure of the PHUs was being located in the north or northeast regions.

Relação entre o Índice de Desenvolvimento Humano Municipal e taxas de mortes violentas nas Unidades Federativas Brasileiras / The relationship between the Municipal Human Development Index and rates of violent death in Brazilian Federal Units

Because countries with the highest Human Development Index (HDI) have low rates of violence, it is common to assume that the increase of HDI may correspond with lower rates of violence in a country. This study examined the relationship between the Municipal Human Development Index (MHDI) and violent deaths in the Brazilian States between 1991 and 2010. We tested whether the increase of MHDI indirectly reduces violence or whether the reduction of violence predicts higher MHDI in later years. The raw data were obtained from three sources online, Atlasbrasil, IPEAdata and Map of violence. The analyses do not support the assumption that the increase of MHDI leads to a reduced level of violence. However, there are indications that the decrease of homicides over the years results in improved MHDI rates in 2010. The results suggest that taking measures aimed at development does not automatically imply a lower level of violence, but fighting against violence may increase MHDI.

Porque países com os maiores Índices de Desenvolvimento Humano (IDH) apresentam taxas baixas de violência, é comum supor que o aumento de IDH pode levar à diminuição das taxas de violência num país. O presente trabalho analisou a relação entre os Índices de Desenvolvimento Humano Municipal (IDHM) e mortes violentas nos estados brasileiros entre 1991 e 2010. Foi testado se o aumento de IDHM reduz indiretamente a violência ou se a redução da violência prediz maior IDHM em anos posteriores. Os dados brutos foram obtidos a partir de três fontes online, Atlasbrasil, IPEAdata e Mapa da violência. As análises não confirmam a suposição de que o aumento de IDHM leva a diminuição da violência. Mas há indícios de que a diminuição de homicídios ao longo dos anos resulta em melhores índices de IDHM em 2010. Os resultados sugerem que tomar medidas que visam desenvolvimento não implica automaticamente em redução da violência, mas combater a violência pode representar aumento de IDHM.

Migraciones en países de América Latina: Características de la población pediátrica / Migrations in Latin American countries: Characteristics of the pediatric population Abstract

Introducción: Las migraciones constituyen un fenómeno creciente en América Latina (AL), pero hay poca información sobre la magnitud en población pediátrica y asociación con variables sociodemográficas. Objetivo: Estudiar la asociación de variables sociodemográficas con la tasa de inmigración de población pediátrica en países de AL. Material y métodos: Se buscó información sobre migraciones en países de AL en: Organización Internacional para Migraciones, Organización Panamericana de la Salud y Programa de Naciones Unidas para el Desarrollo. Se efectuaron correlaciones o comparación entre países de variables económicas y demográficas: ingreso nacional bruto per cápita (INB), índice de desarrollo humano (IDH), coeficiente de desigualdad Gini (CG) y tasa de alfabetización (% adultos alfabetizados, TA), con tasa neta de migración por país (TNM) y de niños < 15 años (IN15). Resultados: La TNM fue positiva para Costa Rica, Panamá, Venezuela, Chile y Argentina. No observamos asociación entre TNM con: INB, IDH, CG y TA. Hubo una asociación de IN15 con CG (r = 0,668, p = 0,01), con INB (r = -0,720; p = 0,01), con TA (r = -0,755; p = 0,01) y con IDH (r = -0,799; p = 0,01). La IN15 fue más baja en países de AL con mayor INB vs. aquellos con menor INB (Fisher, p < 0,0001). Conclusiones: Hay una asociación inversa entre INB per cápita, IDH, TA y directa del CG, con la proporción de IN15 de cada país. No observamos una asociación entre TNM con IDH, TA, CG. Debe analizarse el impacto en salud de estas migraciones infantiles.

Introduction: Migration is a growing phenomenon among Latin American countries (LAC) as well as others; however, scarce information is available studying its impact on paediatric groups and its association with socioeconomic variables. Objective: To study the association among socioeconomic variables and the immigration rate of paediatric population in LAC. Material and methods: Official rates of migration of LAC were obtained from: International Organization for Migration, Pan American Health Organization, and United Nations Development Programme. Demographic and socioeconomic information was also obtained for: gross domestic product (GDP), human development index (HDI), Gini coefficient of inequality (GC), alphabetization rate for adults (AA), net migration rate (NMR), and immigration of children < 15 years (IM15). Description, linear correlations and analysis of differences between groups of countries were assessed. Results: The NMR was positive for Costa Rica, Panama, Venezuela, Chile and Argentina. No association among NMR and GDP, HDI, GC, AA was found. A correlation of IM15 was found with: GC (r = 0.668, P = .01), with GDP (r = -0.720; P = .01), AA (r = -0.755; P = .01) and with HDI (r = -0.799; P = .01). Rate of IM15 was lower in LA countries with advanced/medium development (GDP> median) vs those with low development (Fisher, P < .0001). Conclusions: There is a direct inverse association between GDP per capita, HDI, AA and GC and the proportion of each country IN15. We did not observe an association between NMR and HDI, AA, and GC. The health impact of these migrations should be analysed.

Índice de desenvolvimento humano e qualidade de vida de idosos frequentadores de universidades abertas para a terceira idade / Índice de desarrollo humano y calidad de vida de las personas mayores asistentes de universidades abiertas para la tercera edad / Human development index and quality of life of elderly attending universities of the third age

Verificou-se a relação entre "desenvolvimento humano" e qualidade de vida de idosos em um estudo transversal, quantitativo-descritivo de campo, com 182 idosos, de ambos os gêneros, > 60 anos, frequentadores de Universidades Abertas para a Terceira Idade, dos municípios A, B e C. A qualidade de vida foi avaliada pelo WHOQOL -BREF. Foram utilizados os testes estatísticos Kruskal-Wallis e Mann-Whitney, adotando-se nível de significância de 5%. Não houve diferença estatisticamente significante quando comparada a qualidade de vida dos idosos dos três municípios entre si; houve no domínio ambiental comparando-se A com os outros municípios; e nos domínios social e ambiental comparando-se A com C. Concluiu-se que o "desenvolvimento humano", medido pelo IDH/IDHM, exerceu influência sobre a qualidade de vida dos idosos nos domínios social e ambiental, sendo que os melhores resultados foram obtidos entre os habitantes dos municípios A e B, em comparação aos de C.

Investigamos la relación entre el "desarrollo humano" y la calidad de vida de las personas mayores en estudio de campo transversal, cuantitativo-descriptivo, con 182 ancianos de ambos sexos, > 60 años, asistentes de Universidades Abiertas para la Tercera Edad, de las ciudades A, B y C. La calidad de vida se evaluó por el WHOQOL -BREF. Se utilizaron pruebas estadísticas Kruskal-Wallis y Mann-Whitney, nivel de significación de 5%. No se encontraron diferencias significativas cuando se comparan la calidad de vida en los tres municipios juntos; existió en el domínio ambiental mediante la comparación de A con los otros municipios y nos domínios social y ambiental, mediante comparación de A con C. El "desarrollo humano", medido por el IDH/IDHM, ejerció una influencia en la calidad de vida en las cuestiones sociales y ambientales. Los mejores resultados se obtuvieron entre los habitantes de A y B en comparación con C.

We investigated the relationship between "human development" and quality of life of elderly in a cross-sectional, quantitative-descriptive study, with 182 elderly of both genders, > 60 years, attending the Universities of the Third Age, in districts A, B, C. The quality of life was evaluated by WHOQOL-BREF. Kruskal-Wallis and Mann-Whitney statistical tests were applied, considering a significance level of 5%. There was no statistically significant difference when comparing the quality of life of the three districts together; there was in environmental domain when comparing A with the other districts; and in social and environmental domains when comparing A with C. It was concluded that the "human development", measured by HDI, influenced on the quality of life of elderly in social and environmental domains, and the best results were obtained among the inhabitants of A and B, compared to the inhabitants of C.

Relationship between human development and drug use. Human development index and drug use / Relación entre el índice de desarrollo humano y uso de drogas

Human Development Index is currently considered a reference indicator to account for the social and economic situation experienced by countries. Method This study was conducted using the database from the study "Guiding Elements for Public Policies on Drugs in the Subregion -First Comparative Study on Drug Use and Associated Factors in Population of 15 to 64 years", held in Uruguay, Bolivia, Chile, Perú, Ecuador and Argentina. Target was urban population, from both sexes and of 12 to 65 years. Samples were stratified, three-staged and probabilistic. Sample sizes were theoretical with the inclusion of a non-response rate. Results Prevalence of drug consumption during last year and last month prior to the survey is higher in countries with high HDI compared with medium HDI countries. Lifetime prevalence of alcohol consumption is higher in countries with medium HDI compared with those with high HDI. There is less consumption in lifetime prevalence of legal drugs of countries with higher human development index and an equal rate of cigarette consumption. Discussion High development index implies that the inhabitants of a country have a long and healthy life, more access to knowledge and a decent standard of living. Population with a favorable view on these indicators are not only exposed, but they are also active drug users. The higher the index of human development is, the higher the drug consumption rates are, which indicate that although the human development index can reflect material or economic improvements, it is not necessarily traduced in the human value of the people or society and does not assure quality of life or well-being.

El Índice de Desarrollo Humano (IDH) es un indicador de referencia para explicar la situación social y económica de un país. Método Este estudio se realizó con la base de datos del estudio "Elementos Orientadores para las Políticas Públicas sobre Drogas en la Subregión - Primer Estudio Comparativo sobre Consumo de Drogas y Factores Asociados en Población de 15 a 64 Años". La población objetivo fue urbana, de ambos sexos y de entre 12 y 65 años. Las muestras fueron estratificadas, trietápicas y probabilísticas. Se estimaron tamaños de muestras teóricos, incluyendo una tasa de no respuesta. Resultados La prevalencia de consumo de drogas en el último año y en el mes previo al estudio es mayor en los países con IDH alto en comparación con los países con IDH medio. La prevalencia de consumo de alcohol alguna vez en la vida es mayor en los países con IDH medio comparados con aquellos que tienen un IDH alto. En cuanto a las drogas legales, los países con un IDH alto presentan menores prevalencias alguna vez en la vida, situación similar cuando se considera el consumo de tabaco. Discusión Un IDH alto implica que los habitantes de un país tienen una vida larga y saludable, mayor acceso a la educación y un estándar de vida satisfactorio. La población con una puntuación favorable en estos indicadores no sólo está expuesta al consumo de drogas, sino que también es usuaria activa de éstas. Cuanto mayor Índice de Desarrollo Humano, mayor es la prevalencia de consumo de drogas, lo que indica que si bien el índice de desarrollo humano refleja mejoras en la economía o bienes materiales, no necesariamente se traduce en valores humanos para la persona o la sociedad y no garantizan una buena calidad de vida o el bienestar.

O Índice de Desenvolvimento Humano e a Data de Nascimento podem condicionar a ascensão de jogadores de Futebol ao alto nível de rendimento? / Could the Human Development Index and Birth-Date of the players influence the climbing up to higher performance in Soccer?

O presente trabalho objetiva identificar a possível influência do Índice de Desenvolvimento Humano (IDH) e da data de nascimento (DN) na ascensão de jogadores ao alto nível de rendimento. A amostra integra os 643 jogadores que disputaram o Campeonato Brasileiro Série A de 2010. Foram coletados dados referentes à data e ao local de nascimento juntamente com seu IDH. Foi utilizada a estatística descritiva e os testes Kolmogorov-Smirnov, Qui-quadrado, Kruskall-Wallis e coeficiente de corelação de Pearson. O nível de significância adotado foi de α=0,05. Os resultados sugerem que jogadores nascidos em cidades com valores populacionais inferiores a 100 mil habitantes, com IDH médio (entre 0,501-0,800) e, nascidos nos primeiros meses do ano, apresentam maiores chances de atingir a elite. Afigura-se plausível concluir que a DN e o IDH são fatores que associados podem determinar a ascensão de jogadores ao alto rendimento.

The present study verifies the possible influence of the human development index (HDI) and the birth-date (BD) on the climb up to higher performance in sports, considering Brazilian football context. The sample comprised all 643 players from 20 teams of the Premier Football League in Brazil. The data were collected from official website of Brazilian National Federation, United Nations Development Programme and Brazilian Institute of Geography and Statistics. Descriptive analysis, Kolmogorov-Smirnov test, chi-square test (c ²), Pearson correlation and Kruskall-Wallis H test were carried out. The level of significance was set at α=0.05. The results suggested that contextual factors associated with size and HDI of birth-place and birth-date contribute to the achievement of the Premier Football League. Thus, players were born in the first months of the year and in cities with medium or higher HDI had more conditions to climb up the elite level of Brazilian Football.

Human development report 2010: Changes in parameters and perspectives.

Human Development Report (HDR) 2010 in its 20 th year contains several significant changes. Indicators to measure the three dimensions of Human Development Index (HDI) have been changed: Gender-related Development Index (GDI) and Gender Empowerment Index have been replaced by Gender Inequality Index (GII) and Human Poverty Index has been replaced by Multi-dimensional Poverty Index. Inequality-adjusted HDI (IHDI) has been introduced for the first time. Between 1980 and 2010, India's HDI rose by 1.6% annually from 0.320 to 0.519. While India's HDI value has improved over time, the rank has not improved as much as compared to other developing countries. On GII, India ranked at 122 with a GII value of 0.748 (ranges between 0 and 1) in 2010 HDR (based on data of 2008), revealing considerable loss in achievements in three dimensions of human development - reproductive health, empowerment, and labor market - due to inequality between genders. Multi-dimensional Poverty Index was 0.296 (2000-2008) and IHDI was 0.365 (2000-2007).

Proposta metodológica para o cálculo e análise espacial do IDH intraurbano de Viçosa - MG / Propuesta metodológica para el cálculo y análisis espacial del IDH intraurbano de Viçosa - MG / Methodological proposal for spatial calculation and analysis of the intra-urban HDI of Viçosa, Brazil

A análise de indicadores socioeconômicos permite uma leitura da realidade capaz de gerar subsídios para o planejamento urbano e a gestão municipal. O Índice de Desenvolvimento Humano (IDH) é um importante mensurador do nível de desenvolvimento de um município, por aferir condições de renda, educação e longevidade, mas não é capaz de mostrar as diferenças sociais dentro do município. Neste sentido, para melhor entender a questão socioespacial urbana, a construção de indicadores locais (como o IDH setorizado) torna-se uma importante ferramenta de análise. A metodologia de cálculo deste índice foi adaptada aos dados do Censo 2000 do IBGE, disponibilizados de forma agregada por setores censitários, que constituem a menor unidade de análise territorial composta de dados censitários. De modo a compreender melhor a distribuição e continuidade espacial do IDH, este trabalho propõe a aplicação de técnicas de geoestatística aliadas ao geoprocessamento. Tem-se, portanto, a análise da continuidade espacial do IDH intraurbano, por meio do interpolador geoestatístico de Krigagem Ordinária. Esse processo permite inferir sobre o comportamento espacial do desenvolvimento humano, que possui uma variação contínua no espaço. Ressalta-se que se trata de inferências não sobre os valores locais do IDH, mas sim sobre as tendências da variabilidade do indicador. Os resultados se mostraram satisfatórios, visto que é possível fazer a leitura espacial do desenvolvimento humano intraurbano a partir dos dados secundários apresentados pelo Censo.

El análisis de indicadores socioeconómicos permite una lectura de la realidad capaz de contribuir a la planificación urbana y gestión municipal. El Índice de Desarrollo Humano (IDH) es un importante medidor del nivel de desarrollo de un municipio, por contrastar condiciones de renta, educación y longevidad, sin embargo, no es capaz de manifestar las diferencias sociales dentro del municipio. En este sentido, con el objeto de entender mejor la cuestión socio-espacial urbana, la creación de indicadores locales (como el IDH sectorizado) se convierte en una importante herramienta de análisis. La metodología de cálculo de este índice fue adaptada a los datos del Censo 2000 del IBGE, que se encuentran disponibles agregadamente por sectores censitarios, que constituyen la menor unidad de análisis territorial compuesta por datos censitarios. Con el fin de que se comprenda mejor la distribución y continuidad espacial del IDH, este trabajo propone la aplicación de técnicas de geoestadística vinculadas al geoprocesamiento. Se consigue, por tanto, el análisis de la continuidad espacial del IDH intraurbano, por medio del interpolador geoestadístico de Krigeaje Ordinario. Este proceso permite inferir el comportamiento espacial del desarrollo humano, que posee una variación continua en el espacio. Se resalta que se trata de inferencias no sobre los valores locales del IDH, sino sobre las tendencias de la variabilidad del indicador. Los resultados se mostraron satisfactorios, visto que es posible hacer una lectura espacial del desarrollo humano intraurbano, a partir de los datos secundarios presentados por el censo.

Analyses of socioeconomic indicators allow a way to read reality that can generate information for urban planning and municipal management. The Human Development Index (HDI) is an important measure of the level of development in a municipality, as it calculates income, education and longevity. However, it is unable to indicate social differences within a municipality. To better understand the question of urban socio-spatiality, the construction of local indicators (such as sectorial HDIs) becomes an important analytic tool. The methodology for calculating this index was adapted to data from the Brazilian Census of 2000, which is arranged in an aggregated way per census sector, which constitute the smallest unit of territorial analysis based on census data. In order to better understand the distribution and spatial continuity of the intra-urban HDI, this article proposes that geo-statistic techniques be applied in conjunction with geo-processing. In this way, researchers have at hand an analysis of the spatial continuity of an intra-urban HDI by using an ordinary geo-statistic kriging interpolator. It thus becomes possible to infer regarding the spatial behavior of human development, which always shows continuous variation in space. It should be stressed that such inferences refer not to local levels of the HDI but rather to trends in the variability of the indicator. The results are considered satisfactory since a spatial reading of intra-urban human development can be made on the basis of secondary data generated by the census.

Proyección de la disponibilidad de profesionales de la salud en Chile al 2020 / Projection of the availability of health professionals in Chile by the year 2020

En los últimos años hemos observado un consenso mundial en torno a la crisis actual de los recursos humanos para la salud y un acuerdo creciente de la urgencia de realizar un esfuerzo colectivo que aborde algunos de los problemas más apremiantes en esta materia. El objetivo de este estudio fue proyectar la disponibilidad de médicos(as) y enfermeras(os) que estarían en condiciones de ejercer en Chile al año 2020 y contrastar este escenario posible, con la demanda de profesionales que requerirá el sistema de salud nacional según estándares e indicadores de desarrollo humano. El análisis realizado permite concluir que según estándares y la experiencia internacional y considerando la actual matricula de primer año, las tasas de retención, titulación y ejercicio profesional y los factores de inmigración de profesionales, en Chile al año 2009 hay gran falencia de médicos(as) por habitante comparado con las metas de Organización Mundial de la Salud (OMS) y con la situación de países semejantes. Esta brecha seguirá existiendo al año 2020 si se mantienen las tasas antes mencionadas. Para lograr los estándares de países con desarrollo humano equivalente se requiere al menos duplicar la formación de médicos(as) en el país. Caso contrario se invidencia en la disposición de enfermeras(os), la que superará levemente lo requerido llegando a los niveles de países desarrollados el año 2020 si se mantienen las tasas antes mencionadas.

In recent years we have seen a global consensus around the current crisis of human resources for health and a growing agreement on the urgency of a collective effort to address some of the most pressing problems in this area. The aim of this study was to project the physician and nurses that would be able to practice in Chile to 2020 and contrast this scenario the demand for professionals who require the health system as standard and human development indicators. The analysis leads to the conclusion that according to international standards and experience and given the current first-year enrollment, retention rates, qualifications and professional immigration and professional factors in Chile to 2009 there is a great shortcoming of physicians per capita compared with the goals of WHO and the status of such countries. This gap will exist by 2020 if current rates above. To achieve the standards of countries with equivalent human development requires at least double the training of physicians in the country. Otherwise, if current rates above, the provision of nurses will exceed slightly what is required when Chile reach’s level of developed countries by 2020.

Caracterização do grau tecnológico dos sericicultores no território Paraná Centro / Technological degree characterization of silkworm producers in the Paraná territory Center

O objetivo deste trabalho foi caracterizar o grau tecnológico dos sericicultores e inferir os tipos de intervenções a serem empregadas para aumentar a produtividade em 17 municípios do centro do Estado do Paraná, os quais apresentam o menor Índice de Desenvolvimento Humano (IDH) desse Estado. Os dados originais de produção dos casulos verdes da safra 2004/2005 foram disponibilizados pela empresa de Fiação de Seda Bratac S.A. e submetidos à análise estatística multivariada de Componentes Principais. Esta técnica permitiu escolher quatro autovalores das 21 variáveis originais e assim utilizar o novo conjunto formado para realizar a análise descritiva dos dados. As quatro componentes selecionadas foram Capacidade/Intensidade de Produção, Qualidade de Produção, Eficiência na Utilização da Área e Retorno Financeiro da Propriedade. Devido ao grande volume de informações, realizou-se uma análise Cluster para as componentes dos 565 produtores, da qual resultou a formação de quatro grupos de características semelhantes. As análises dos grupos de produtores possibilitaram a observação de dois contrastes principais. Uma parte dos grupos apresenta produtores com maior capacidade e qualidade de produção de casulos na propriedade, e os demais compreendem produtores que exploram sua área produtiva de forma ineficiente.

The goal of this research was to characterize the technological degree of silkworm producers and to infer the types of interventions to be employed to increase productivity in 17 localities in the central region of Paraná State, Southern Brazil, which has the lowest Human Development Index (HDI). The original data of 2004/2005 season from green cocoons production taken from the company Fiação de Seda Bratac S.A. and submitted to multivariate statistical analysis of Principal Components. This technique allowed to choose four eigenvalues of 21 original variables and thus to use the new set to perform a descriptive analysis of the data. The four components selected were capacity/intensity of production, quality of production, efficiency in the use of the area and financial return of the property. Due to the large volume of information, Cluster analysis was performed for the components of the 565 producers, resulting in four groups of similar characteristics. The analysis of group of producers enabled the observation of two main contrasts. One part of groups presented producers with greater capacity and quality of cocoon production in the property, and other include producers who exploit their productive area inefficiently.