Epidemiología de las consultas pediátricas respiratorias en Santiago de Chile desde 1993 a 2009 / Epidemiology of pediatric respiratory consultations in Santiago de Chile, from 1993 to 2009

OBJETIVO: El presente trabajo se propone describir la metodología de análisis y la distribución global de las consultas de morbilidad -particularmente las de tipo respiratorio- en menores de 15 años de edad de la ciudad Santiago de Chile, Chile, con el objetivo de conocer sus diferencias según grupos etarios, su comportamiento estacional y su evolución a lo largo de los años. MÉTODOS: Se investigó la distribución de las consultas de morbilidad pediátrica (CP) -en especial las respiratorias- y su evolución en un período de 17 años. En siete centros centinela de Santiago de Chile se recolectó prospectivamente información diaria de todas las CP, agrupadas en infecciones no respiratorias e infecciones respiratorias agudas (IRA). RESULTADOS: Entre enero de 1993 y diciembre de 2009 se registraron 1 947 477 CP, de las cuales 1 188 029 (61,0%) fueron por causa respiratoria: 656 567 (33,7%) por enfermedad respiratoria aguda de vía aérea baja (IRAb), 418 932 (21,5%) por síndrome bronquial obstructivo (SBO) y 48 669 (2,5%) por neumonía. Neumonía y SBO fueron más frecuentes en menores de 5 años. Las IRAb, SBO y neumonía presentaron una significativa tendencia a la disminución durante el período observado. Las IRA constituyen la primera causa de CP en atención primaria de salud y el SBO es la primera causa específica de consulta pediátrica. CONCLUSIONES: Estos resultados enfatizan la necesidad de asignar o redestinar recursos en programas de promoción, educación, prevención y tratamiento de estas enfermedades, con la debida focalización que determina su variación estacional.

OBJECTIVE: This paper describes the analytical methodology and overall distribution of these consultations-particularly respiratory consultations-for children under 15 years of age in Santiago de Chile, Chile. The aim is to understand differences by age groups, as well as seasonal trends and trends over the years. METHODS: The research covered the distribution of consultations and their evolution over a period of 17 years. Information was collected on a daily basis from all pediatric consultations, grouped into nonrespiratory and acute respiratory categories, in seven sentinel centers of Santiago de Chile. RESULTS: Between January 1993 and December 2009, 1 947 477 cases of pediatric illnesses were recorded, of which 1 188 029 (61.0%) were for respiratory causes. Of those, 656 567 (33.7%) were for acute lower respiratory tract illnesses, 418 932 (21.5%) were for broncho-obstructive syndrome, and 48 669 (2.5%) were for pneumonia. Pneumonia and broncho-obstructive syndrome were more frequent in children under age 5. Lower respiratory tract illnesses, broncho-obstructive syndrome, and pneumonia showed a significant downward trend during the period observed. Lower respiratory tract illnesses are the leading cause of pediatric morbidity in primary health care, while broncho-obstructive syndrome is the leading specific reason for pediatric consultations. CONCLUSIONS: These results point to the need to allocate or reallocate resources for programs for promotion, education, prevention, and treatment of these illnesses with the targeting necessary to address seasonal variations.

Psychological, Social, and Environmental Factors Associated With Utilization of Senior Centers Among Older Adults in Korea / 예방의학회지

OBJECTIVES: The purpose of the study was to examine the relationships among the psychological, social, and environmental factors influencing the utilization of senior centers among older adults in Korea. METHODS: A questionnaire survey was administered to two types of older adults who lived in Seoul, Korea: 262 older adults who used senior centers (3 places) and 156 older adults who did not use senior centers. RESULTS: Our results showed clearly that the utilization of the senior centers in Korea is affected by higher self-efficacy (odds ratio [OR], 6.08; 95% confidence interval [CI], 3.31 to 12.32), higher perceived benefits (OR, 1.71; 95% CI, 1.16 to 4.36), lower perceived barriers (OR, 6.43; 95% CI, 3.07 to 11.45), higher family support (OR, 4.21; 95% CI, 2.02 to 8.77), and higher support from friends (OR, 4.08; 95% CI, 2.38 to 7.81). The results also showed that participants whose total travel time was 15 to 29 minutes (OR, 2.84; 95% CI, 1.21 to 3.64) or less than 14 minutes (OR, 4.68; 95% CI, 3.41 to 8.41) were more likely to use a senior center than those who had to travel more than 30 minutes. CONCLUSIONS: This study showed that the utilization of senior centers in Korea is affected by psychological, social, and environmental factors, specifically by self-efficacy, perceived benefits, perceived barriers, social support, convenience of transportation, and total travel time to the senior centers. The effects of longer-term utilization of the senior centers by non-users on health-related outcomes in a large population warrant attention.

Validity of Self-reported Healthcare Utilization Data in the Community Health Survey in Korea

To evaluate the sensitivity and specificity of Community Health Survey (CHS), we analyzed data from 11,217 participants aged > or = 19 yr, in 13 cities and counties in 2008. Three healthcare utilization indices (admission, outpatient visits, dental visits) as comparative variables and the insurance benefit claim data of the Health Insurance Review & Assessment Service as the gold-standard were used. The sensitivities of admission, outpatient visits, and dental visits in CHS were 54.8%, 52.1%, and 61.0%, respectively. The specificities were 96.4%, 85.6%, and 82.7%, respectively. This is the first study to evaluate the validity of nationwide health statistics resulting from questionnaire surveys and shows that CHS needs a lot of efforts to reflect the true health status, health behavior, and healthcare utilization of the population.

Prevalence of Neisseria gonorrhoeae and Chlamydia trachomatis infection in men attending STD clinics in Brazil / Prevalência de Neisseria gonorrhoeae e infecção pela Chlamydia trachomatis em homens atendidos em clínicas de DST no Brasil

INTRODUCTION: The study aimed to assess the prevalence of Neisseria gonorrhoeae and Chlamydia trachomatis infections and identify demographic, behavioral and clinical factors correlated withsuch infections in men attending six sexually transmitted disease clinics in Brazil. METHODS: Multicentric, cross-sectional study performed among men attending STD clinics in Brazil. The study included STD clinics in six cities distributed throughout the five geographic regions of Brazil in 2005. Patients provided 20 ml of first catch urine for testing for NG and CT by DNA-PCR. RESULTS: A total of 767 (92.9 percent) men were included in the study. The mean age was 26.5 (SD 8.3) years-old. Prevalence of Chlamydia infection was 13.1 percent (95 percentCI 10.7 percent-15.5 percent) and gonorrhea was 18.4 percent (95 percentCI 15.7 percent-21.1 percent). Coinfection prevalence was 4.4 percent (95 percentCI 2.95 percent-5.85 percent) in men who sought attendance in STI clinics. Factors identified as associated with C. trachomatis were younger age (15-24) [OR=1.4 (95 percentCI 1.01-1.91)], present urethral discharge [OR=4.8 (95 percentCI 1.52-15.05)], genital warts [OR=3.0 (95 percentCI 1.49-5.92)] and previous history of urethral discharge [OR=2.4 (95 percentCI 1.11-5.18)]. Variables associated with gonorrhea were younger age (15 to 24) [OR=1.5 (95 percentCI 1.09-2.05)], presence of urethral discharge [OR=9.9 (95 percentCI 5.53-17.79)], genital warts [OR=18.3 (95 percentCI 8.03-41.60)] and ulcer present upon clinical examination [OR=4.9 (95 percentCI 1.06-22.73)]. CONCLUSIONS: These findings have important implications for education and prevention actions directed toward men at risk of HIV/STD. A venue-based approach to offer routine screening for young men in STD clinics should be stimulated.

INTRODUÇÃO: Nosso objetivo foi acessar a prevalência de Neisseria gonorrhoeae e Chlamydia trachomatis e identificar fatores demográficos, comportamentais e clínicos correlacionados a essas infecções em homens atendidos em clínicas de doenças sexualmente transmissíveis no Brasil. MÉTODOS: Estudo multicêntrico, transversal conduzido em homens que procuraram atendimento em clínicas de DST. O estudo incluiu clínicas de DST em seis cidades distribuídas nas cinco regiões geográficas do Brasil em 2005. Pacientes coletaram 20ml do primeiro jato de urina para testar NG e CT por DNA-PCR. RESULTADOS: Um total de 767 (92,9 por cento) homens foi incluído no estudo. A média de idade foi 26,5 (DP 8,3) anos. A prevalência de infecção por CT foi 13,1 por cento (IC95 por cento 10,7 por cento-15,5 por cento) e NG de 18,4 por cento (IC95 por cento 15,7 por cento-21,1 por cento). A prevalência de co-infecção foi 4,4 por cento (IC95 por cento 2,95 por cento-5,85 por cento). Os fatores identificados como sendo associados com a infecção pela CT foram ser jovem (15-24) [OR=1,4 (IC95 por cento 1,01-1,91)], apresentar corrimento uretral ao exame [OR=4.8 (IC95 por cento 1,52-15,05)], verrugas genitais [OR=3,0 (IC95 por cento 1,49-5,92)] e história prévia de corrimento uretral [OR=2,4 (IC95 por cento 1,11-5,18)]. As variáveis associadas com a gonorréia foram ser jovem (15 to 24) [OR=1,5 (IC95 por cento 1,09-2,05)], apresentar corrimento uretral [OR=9,9 (IC95 por cento 5,53-17,79)], verrugas genitais [OR=18,3 (IC95 por cento 8,03-41,60)] e úlcera ao exame clínico [OR=4,9 (IC95 por cento 1,06-22,73)]. CONCLUSÕES: Estes resultados têm implicações importantes para medidas de educação e prevenção direcionadas aos homens com risco acrescido de HIV/DST. A abordagem no serviço para oferecer testes de rotina para homens jovens atendidos em clínica de DST deve ser estimulada.

Análise do Sistema de Informação do Programa de Controle do Câncer de Mama (SISMAMA) mediante avaliação de 1.000 exames nas cidades de Barra Mansa e Volta Redonda / Analysis of the Breast Cancer Control Program Information System (SISMAMA), with review of 1,000 mammograms in the cities of Barra Mansa and Volta Redonda

OBJETIVO: Fazer uma análise do Sistema de Informação do Programa de Controle do Câncer de Mama (SIS-MAMA), implantado em 2009 pelo Ministério da Saúde. MATERIAIS E MÉTODOS: Tratou-se de um estudo retrospectivo, feito mediante análise de 1.000 fichas de requisição e resultado de mamografias realizadas pelo Sistema Único de Saúde (SUS) nos municípios participantes desta pesquisa, no período de tempo compreendido entre agosto e outubro de 2009. Foram analisados a qualidade das informações enviadas através do processamento desses dados e os desvios gerados pelo não preenchimento ou pelo inadequado preenchimento dos dados nessas fichas. RESULTADOS: O problema mais frequentemente encontrado foi a omissão de dados nas fichas, principalmente no quesito cirurgias anteriores, constatando-se 302 omissões (30,2 por cento). CONCLUSÃO: Apesar do Sistema necessitar de alguns ajustes, pelo lapso temporal transcorrido entre sua criação até sua implementação, esses ajustes não afetam diretamente a validade do Sistema, encontrando-se como principal fator de erros na alimentação do banco de dados do Ministério da Saúde o não preenchimento de informações relevantes para o fechamento dos laudos, e a falta de familiarização e capacitação dos profissionais envolvidos nesse processo e no repasse de dados do resultado da mamografia.

OBJECTIVE: To analyze the Breast Cancer Control Program Information System (SISMAMA) implemented in 2009 by the Brazilian Health Ministry. MATERIALS AND METHODS: This was a retrospective study involving the analysis of 1,000 requisition forms and results of mammograms performed by SUS - Sistema Único de Saúde (the Brazilian unified public health system) in the cities participating in the present study, during the period from August to October/2009. The study covered the qualitative analysis of the information sent through the data processing and the deviations resulting from the failure or inappropriateness in the forms filling. RESULTS: The most frequent issue was data omission, particularly regarding data on previous surgeries, achieving 302 omissions (30.2 percent). CONCLUSION: Despite the necessity of adjustments because of the time elapsed between the system creation and implementation, such adjustments do not affect directly the system's validity. Errors in data input in the Health Ministry database corresponded to the failure in the provision of information relevant for reports completion, and the lack of familiarity and capacity of professionals involved in this process and in the forwarding of data regarding mammography results.

Prevalência e fatores de risco da hipertensão arterial no bairro Piratininga de Osasco / Prevalence and risk factors of hypertension blood in the district of Osasco Piratininga

Introdução: A Hipertensão Arterial Sistêmica (HAS) é um importante problema de saúde pública mundial, por sua alta prevalência e por ser causa de doenças que são fatais ou que levam a invalidez permanente. Objetivo: Conhecer a prevalência da hipertensão arterial sistêmica e as relações existentes entre os fatores de risco e a HAS, em adultos, da população cadastrada pelo Programa de Agentes Comunitários de Saúde (PACS), no bairro Piratininga da cidade de Osasco. Métodos: O presente estudo epidemiológico foi realizado através de amostra autoponderada e estratificada por microárea, de 1733 moradores do bairro Piratininga, na cidade de Osasco, com mais de 20 anos cadastrados no PACS. O trabalho de campo foi feito junto com os agentes comunitários de saúde e a enfermeira do PACS, por meio da aplicação de questionário e de medidas de peso, altura e pressão arterial. Resultados: Foram entrevistadas 1576 pessoas, da amostra sorteada de 1733, resultando em 9 por cento de perdas. Eram 32 por cento do sexo masculino e 68 por cento do sexo feminino. A prevalência de HAS encontrada foi de 47 por cento. A análise estatística mostrou associação com HAS com a idade, com acentuado aumento de prevalência a partir dos 30 anos; escolaridade, com maiores prevalências para as pessoas sem escolaridade e até 4 anos de estudo, com p<0,001. Observou-se o efeito protetor familiar com menores prevalencias de hipertensão em famílias mais numerosas.

Tratamento de tuberculose: integração entre assistência hospitalar e rede básica na cidade de São Paulo / Tuberculosis treatment: integration between hospitals and public health care clinics in the city of São Paulo, Brazil

OBJETIVO: Avaliar o nível de acesso aos serviços de saúde de uma população de pacientes internados por tuberculose (TB) em dois hospitais no município de São Paulo, comparando-os com pacientes com TB submetidos somente a tratamento ambulatorial. MÉTODOS: Foram levantados dados sociodemográficos e clínico-epidemiológicos de pacientes internados por TB em dois hospitais do município de São Paulo entre janeiro e dezembro de 2007, utilizando-se um questionário estruturado. Foram também identificados os locais de tratamento ambulatorial para os quais os pacientes foram transferidos após a alta hospitalar. As mesmas variáveis foram obtidas para pacientes ambulatoriais em tratamento de TB na mesma época, por meio de um banco de dados. RESULTADOS: Foram estudados 474 pacientes (166 internados e 308 ambulatoriais), com média de idade de 41,0 e 39,1 anos, respectivamente. A análise univariada mostrou associações positivas entre internação por TB e as seguintes variáveis: faixa etária 30-39 anos (OR = 2,17), faixa etária 50-59 anos (OR = 2,17), forma clínica pulmonar associada à extrapulmonar (OR = 5,31), retratamento de TB (OR = 2,66), procura a outro serviço antes do diagnóstico (OR = 2,05), tempo de sintomas maior que 12 semanas (OR = 2,23) e diagnóstico realizado em hospitais ou prontos-socorros (OR = 4,68). A proporção de pacientes internados que residiam na mesma região da respectiva Coordenadoria Regional de Saúde dos dois hospitais foi, respectivamente, de 77,6 por cento e 36,8 por cento. A proporção de pacientes, após a alta, encaminhados a Unidades Básicas de Saúde nas mesmas regiões dos dois hospitais foi, respectivamente, de 67,1 por cento e 39,7 por cento. CONCLUSÕES: Os pacientes internados por TB devem ser monitorados após alta hospitalar até a sua chegada à Unidade Básica de Saúde.

OBJECTIVE: To evaluate the level of access to health care clinics of a population of patients hospitalized for tuberculosis (TB) at two hospitals in the city of São Paulo, Brazil, comparing them with a population of TB patients under outpatient treatment only. METHODS: We compiled sociodemographic, clinical and epidemiological data related to patients hospitalized for TB at two hospitals in the city of São Paulo, Brazil, between January and December of 2007, using a structured questionnaire. We also identified the outpatient clinics to which the patients were referred at discharge. The same variables were evaluated for TB outpatients during the same period, using a database. RESULTS: The study sample consisted of 474 patients (166 inpatients and 308 outpatients: mean age, 41.0 and 39.1 years, respectively). The univariate analysis showed positive associations between hospitalization due to TB and the following variables: 30-39 year age bracket (OR = 2.17); 50-59 year age bracket (OR = 2.17); combination of pulmonary and extrapulmonary forms of TB (OR = 5.31); TB re-treatment (OR = 2.66); seeking treatment at other health care facilities prior to the diagnosis of TB (OR = 2.05); symptom duration of more than 12 weeks (OR = 2.23); and TB diagnosed at hospitals or in emergency rooms (OR = 4.68). The proportion of inpatients who resided in the same regional health district area as that in which the respective hospital was located was 77.6 percent and 36.8 percent. The proportion of discharged patients who were referred to outpatient clinics in the same areas was 67.1 percent and 39.7 percent, respectively. CONCLUSIONS: Patients hospitalized for TB should be monitored from discharge until their admission to the outpatient clinic.

Início da terapia anti-retroviral em estágio avançado de imunodeficiência entre indivíduos portadores de HIV/AIDS em Belo Horizonte, Minas Gerais, Brasil / Initiation of antiretroviral therapy in HIV-infected patients with severe immunodeficiency in Belo Horizonte, Minas Gerais State, Brazil

O objetivo deste trabalho foi verificar a proporção de início tardio da terapia anti-retroviral (TARV) e seus fatores associados. Estudo de corte transversal com pacientes de dois serviços públicos de referência (n = 310) em Belo Horizonte, Minas Gerais, Brasil. Atraso no início da TARV foi definido como ter contagem de linfócitos T CD4+ < 200 células/mm³ ou manifestação clínica de imunodepressão grave. A maioria era do sexo masculino (63,9 por cento) e não possuía plano de saúde (76,1 por cento). A proporção de início tardio da TARV foi 68,4 por cento. Grande parte (75,2 por cento) iniciou TARV < 120 dias após a primeira consulta médica. Estar desempregado, realizar anti-HIV por indicação de profissional de saúde, < 2 consultas no serviço até seis meses antes do início da TARV e tempo entre primeira consulta para o HIV e início da TARV < 120 dias estiveram associados de forma independente com início tardio da TARV. São necessários estudos que avaliem o custo-efetividade da realização do anti-HIV como teste de rastreamento da população geral. Facilitar o acesso dos pacientes com resultado positivo aos serviços de referência pode contribuir para a redução do número de pacientes que iniciam tardiamente a TARV.

The main objective was to assess the proportion of delayed initiation of antiretroviral therapy (ART) and associated factors. This was a cross-sectional study of 310 patients enrolled in two public health centers in Belo Horizonte, Minas Gerais State, Brazil. Delayed ART initiation was defined as starting treatment with a CD4 count lower than 200 cells/mm³ or clinical symptoms of severe immunodepression at the time of first antiretroviral prescription. The majority of participants were males (63.9 percent), had no health insurance (76.1 percent), and started ART less than 120 days after the first medical visit (75.2 percent). The proportion of delayed ART initiation was 68.4 percent. Unemployment, referral by a health professional for HIV testing, fewer than two medical visits in the six months prior to ART initiation, and time between first medical visit and ART initiation less than 120 days were independently associated with the outcome. Our results suggest that every patient 13 to 64 years of age should be offered HIV testing, which could increase the rate of early HIV diagnosis, and thus patients that tested positive could benefit from timely follow-up and antiretroviral therapy.

Atendimento à demanda pela esterilização cirúrgica na Região Metropolitana de Campinas, São Paulo, Brasil: percepção de gestores e profissionais dos serviços públicos de saúde / Provision of voluntary surgical sterilization in the Campinas Metropolitan Area, São Paulo State, Brazil: perceptions of public health services managers and professionals

A presente pesquisa descreve a percepção de gestores e profissionais de serviços públicos de saúde de municípios da Região Metropolitana de Campinas, São Paulo, Brasil, acerca do atendimento à demanda pela esterilização cirúrgica voluntária. Trata-se de estudo qualitativo, em quatro municípios, onde se realizaram entrevistas semi-estruturadas com 26 gestores e profissionais de saúde envolvidos no atendimento às solicitações de esterilização cirúrgica. Apontaram-se dificuldades para agendamento de consultas nos ambulatórios de planejamento familiar ou centros de referência e número insuficiente de cirurgias que podiam ser agendadas semanalmente nos hospitais credenciados. Enfatizou-se a falta de estrutura física e recursos humanos tanto nas unidades básicas de saúde, quanto nos ambulatórios de planejamento familiar ou centros de referência. Houve críticas aos critérios legais para autorizar a esterilização, bem como se mencionaram adaptações para torná-los mais adequados à situação de cada município. Gestores e profissionais de saúde entendiam que, apesar dos esforços empenhados, o atendimento à demanda pela esterilização cirúrgica na Região Metropolitana de Campinas estava prejudicado pela centralização em ambulatórios de planejamento familiar ou centros de referência, que, na prática, tinham que suprir as deficiências da oferta de ações de planejamento familiar em geral na rede básica de cada município.

This study describes the perceptions of public health services managers and professionals concerning provision of voluntary surgical sterilization in the Campinas Metropolitan Area, São Paulo State, Brazil. The study adopted a qualitative approach in four municipalities (counties), where semi-structured interviews were conducted with 26 health professionals and health services managers involved in the provision of surgical sterilization. The interviewees identified difficulties in scheduling visits at Outpatient Family Clinics or Reference Centers (APF/CR), and the number of available surgeries in the accredited hospitals was insufficient. They emphasized the lack of physical infrastructure and human resources for conducting family planning activities in the primary health units as well as in the APF/CR.They also criticized the legal criteria for authorizing surgical sterilization, and mentioned adaptations to make them more appropriate to the each municipality's situation. According to the health services managers and professionals, despite the efforts, meeting the demand for surgical sterilization in the Campinas Metropolitan Area was jeopardized by its centralization in the APF/CR, which in practice had to cover the gap in family planning activities in each municipality's primary care units.

Nutritional status of Palestinian children attending primary health care centers in Gaza.

OBJECTIVE: To assess the nutritional status of Palestinian children less than two years old and the associated risk factors. METHODS: The study was descriptive cross-sectional of 102 children attending the main four primary health care centers in the Gaza Strip during summer 2003. Data were collected through medical records and meeting interviews with children's mothers by face to face. Questionnaire was subjected to validity and reliability procedures before being used. Descriptive analyses and cross tabulation were used. RESULTS: The study showed that the prevalence of anemia was 72.8% among children. Anthropometrical indices showed that the prevalence of wasting, stunting, underweight were 34.3%, 31.4%, 31.45% respectively. CONCLUSION: Palestinian children are at high risk of health problems related to malnutrition. Informing Gazean families about the importance of following healthy dietary habits especially breastfeeding could improve child's nutritional status in parallel with overcoming the devastating economic condition.

Oral health policies in Brazil

Since Oral Health policies in Brazil have been constructed according to circumstances and possibilities, they should be understood within a given context. The present analysis contextualizes several issues of the Brazilian Oral Health Policy, called "Smiling Brazil", and describes its present stage of development. Today it involves re-organizing basic oral health care by deploying Oral Health Teams within the Family Health strategy, setting up Centers of Dental Specialists within an Oral Health network as a secondary care measure, setting up Regional Laboratories of Dental Prosthesis and a more extensive fluoridation of the public water supply.

Determinants of domestic violence among women attending an human immunodeficiency virus voluntary counseling and testing center in Bangalore, India.

CONTEXT: Violence against women is a global phenomenon that cuts across all social and economic classes. AIMS: This study was designed to measure the prevalence and correlates of domestic violence (DV) among women seeking services at a voluntary counseling and testing (VCT) center in Bangalore, India. SETTINGS AND DESIGNS: A cross-sectional survey was conducted among women visiting an human immunodeficiency virus (HIV) VCT center in Bangalore, between September and November 2005. MATERIALS AND METHODS: An interviewer-administered questionnaire was used to collect information about violence and other variables. STATISTICAL ANALYSIS USED: Univariable associations with DV were made using Pearson Chi-squared test for categorical variables and Student t-test or the Mann-Whitney test for continuous variables. RESULTS: Forty-two percent of respondents reported DV, including physical abuse (29%), psychological abuse (69%) and sexual abuse (1%). Among the women who reported violence of any kind, 67% also reported that they were HIV seropositive. The most common reasons reported for DV included financial problems (38%), husband's alcohol use (29%) and woman's HIV status (18%). Older women (P < 0.001) and those with low income levels were the most likely to have experienced DV (P = 0.02). Other factors included husband's education, HIV seropositivity and alcohol or tobacco use (P < 0.001). CONCLUSION: This study found DV levels comparable to other studies from around the world. The findings highlight the need for additional training among health care providers in VCT centers in screening for DV, detection of signs of physical abuse and provisions and referrals for women suffering from domestic partner violence.

Study on the injection practices of health facilities in Jingzhou district, Hubei, China.

BACKGROUND: Some studies indicate unsafe injection practices, which are associated with the transmission of blood-borne pathogens, exist extensively, in the developing countries. AIMS: To investigate the status of injection services, knowledge and attitude of health workers with regard to injection practices at all levels of the health facilities in Jingzhou district of China; and to provide useful scientific data in order to formulate a feasible, standard measure on injection safety. SETTINGS: Four district health care facilities, 6 township health centers, 14 village clinics and 14 community health stations. DESIGN: A retrospective cross-sectional study. MATERIALS AND METHODS: By examining the medical records in 2004, observing injection practices and interviewing health workers, the quantitative and qualitative data were collected and analyzed. RESULTS: Out of 1,452 medical records sampled, 1,450 patients had received at least one injection in the period of hospitalization, with an injection rate of about 100% and an average of 10.9 injections per patient. The most frequent injected drug was antibiotic (48%, 7,674/15,857). The prescriptions of 5,655 outpatients were detected, with an injection rate of 52% (2,962). The field observation found that the proportion of unsafe injections was 16% (28/175) and that of unnecessary injections was 57% (99/175). Among 118 professional employees interviewed, those who knew that human immunodeficiency virus, hepatitis C virus and hepatitis B virus might be transmitted by the contaminated syringes and needles accounted for 95% (112), 59% (70) and 89% (105) respectively. CONCLUSIONS: Among the medical facilities of Jingzhou district, the injection rate was very high and the quality of injection practices should be further improved.

Fasting Plasma Glucose Cutoff Value for the Prediction of Future Diabetes Development: A Study of Middle-Aged Koreans in a Health Promotion Center

We determined optimal fasting plasma glucose (FPG) cutoff values predictive of future diabetes development in a group of middle-aged Koreans who visited a health promotion center. The medical records of 2,964 subjects, who attended the Health Promotion Center in 1998 and 2003, were examined. Subjects were classified into four groups according to their baseline FPG values (Group 1:FPG <5.0 mM/L; Group 2: 5.0

Community utilisation of subcentres in primary health care--an analysis of determinants in Kerala.

The determinants of utilisation of subcentre services in a random sample of 247 subcentres from three out of 14 districts of Kerala were investigated. Physical verification of the facilities was done in a subset of 90 subcentres and household surveys of 750 households were performed in the service areas of those subcentres. About 30 per cent of the beneficiaries utilised services of the subcentres during the reference period. The relationship of selected predictor variables on utilisation of the services was found out. The district in which a subcentre was physically present was found to be the most important correlate of its utilisation.

Incident HIV infection among men attending STD clinics in Pune, India: pathways to disparity and interventions to enhance equity.

Systematic disparities in rates of HIV incidence by socioeconomic status were assessed among men attending three sexually transmitted disease (STD) clinics in Pune, India, to identify key policy-intervention points to increase health equity. Measures of socioeconomic status included level of education, family income, and occupation. From 1993 to 2000, 2,260 HIV-uninfected men who consented to participate in the study were followed on a quarterly basis. Proportional hazards regression analysis of incident HIV infection identified a statistically significant interaction between level of education and genital ulcer disease. Compared to the lowest-risk men without genital ulcer disease who completed high school, the relative risk (RR) for acquisition of HIV was 7.02 (p < 0.001) for illiterate men with genital ulcer disease, 3.62 (p < 0.001) for men with some education and genital ulcer disease, and 3.02 (p < 0.001) for men who completed high school and had genital ulcer disease. For men with no genital ulcer disease and those with no education RR was 1.09 (p = 0.84), and for men with primary/middle school it was 1.70 (p = 0.03). The study provides evidence that by enhancing access to treatment and interventions that include counselling, education, and provision of condoms for prevention of STDs, especially genital ulcer disease, among disadvantaged men, the disparity in rates of HIV incidence could be lessened considerably. Nevertheless, given the same level of knowledge on AIDS, the same level of risk behaviour, and the same level of biological co-factors, the most disadvantaged men still have higher rates of HIV incidence.

Smoking patterns among primary health care attendees, Al-Qassim region, Saudi Arabia

Prevalence, sociodemographic patterns and medical co-morbidity of smoking among a cross-section of primary health care [PHC] clients in Saudi Arabia were examined. We used a 44-item semistructured questionnaire to collect data from 1752 patients at 25 randomly selected PHC centres. Percentage of smoking was 52.3%. Although 85% were adult smokers, 8.6% began smoking before age 12. Smokers gave overlapping reasons to smoke including peer pressure; non-smokers gave religious and health logics against smoking. Of all smokers, 92.8% wanted to learn cessation strategies, 11.8% were ignorant of hazards and 32.4% reported manifestations of nicotine withdrawal. Besides alcohol use [13.4%], 81.8% had co-morbid physical disease

Malaria and intestinal parasitosis among children presenting to the Paediatric Centre in Sana'a, Yemen

We studied the profile of malaria and intestinal parasitosis among children presenting to the Paediatric Health Centre in Sana'a from January 1998 to December 2000. In stool samples from 9014 children, Ascaris lumbricoides, Entamoeba histolytica, Giardia lamblia and Trichuris trichiura were the most common. Infection with parasites of direct life-cycle were similar in boys and girls. Schistosome infection was significantly higher in boys than girls, but girls were more infected with ascariasis. The only species of malaria parasite found in blood samples from 753 children with suspected malaria was Plasmodium falciparum, with the highest rates in April-June. The majority of positive cases were Yemeni children, but 10.8% were Sudanese or Ethiopian

Health care options in childhood ARI before hospital care.

A cross sectional study was conducted, to examine the pattern of health care options, exercised before seeking care at the district hospital in the event of ARI in under fives. One hundred fifteen under fives selected through systematic sampling technique, from two district hospitals were the subjects of study. Respondents were the care providers, who accompanied children to the Hospitals. Time delay in initiating care and reaching the district hospital was also recorded. Reasons for preferring a particular source as first choice were enquired. District Hospitals stood out as the most preferred source, as 52 (45.2%) of the children used it as the first step. Other sources of health care were Health Center (10.4%), Home Care (25.2%) General Practitioners (10.4%) and Drug Stores (8.7%). On an average a child took 1.8 steps before coming to the district hospital. Children experienced 13 unique treatment patterns. Children initially offered home care followed longer sequence and more variable pattern. Convenience (62.6%) and cost (37.4%) were the main factors in choosing a source of treatment. Children who received home care were brought to district hospital earlier than others.