Prevalence and risk factors of diabetic kidney disease in plain-sand areasand loess hilly areas of Gansu province / 中华全科医师杂志

Objective:To investigate the risk factors of diabetic kidney disease (DKD) in type 2 diabetes mellitus (T2DM) patients in plain-sand areas and loess hilly areas of Gansu province.Methods:A total of 1 599 T2DM patients who participated in chronic disease and risk factors monitoring and basic public health service management were selected by multi-stage stratified random sampling method in the sandy plain areas and loess hilly areas of Gansu province. Questionnaire survey, physical measurement and laboratory tests were performed. Multivariate binary logistic model was used to analyze the influencing factors.Results:The prevalence of DKD was 22.1% (174/787) among T2DM patients in the sandy plain areas and 19.1%(155/812) in the loess hilly area, respectively. Hypertension ( OR=3.022), hyperuricemia ( OR=2.114) and HbA1c≥7%( OR=2.231) were the risk factors for DKD in the plain-sand areas, and the risk of DKD increased with age. In the loess hilly areas, female sex ( OR=0.379) was the protective factor for DKD; while duration of disease≥10 years ( OR=2.476), hyperuricemia ( OR=1.907), HbA1c≥7% ( OR=1.927) were the risk factors for DKD; and the risk of DKD increased with the increase of age, and decreased with the increase of per capita monthly income. Conclusions:The prevalence of DKD and its influencing factors are different between sandy plain areas and loess hilly areas in Gansu province. The prevention and treatment of hypertension should be given more attention in sandy plain areas. In addition, the screening of DKD should be conducted among T2DM patients, particularly for those with old age, hyperuricemia and HbA1c≥7% in both areas of the province.

Sistema de Monitoreo a la equidad territorial y avances en los Objetivos de Desarrollo Sostenible en Colombia

Aunque el cumplimiento de los Objetivos de Desarrollo del Milenio tuvo un balance positivo, con promedios nacionales que en general mejoraron, las desigualdades dentro de los países aumentaron. La agenda de los Objetivos de Desarrollo Sostenible (ODS) busca promover avances en términos de equidad territorial, por esto la incorporación del espacio geográfico en su monitoreo a escalas subnacionales ofrece ventajas importantes. Este artículo tuvo como objetivo describir el Sistema de Monitoreo Territorial a los ODS3 (MOT-ODS3), una herramienta digital diseñada para incrementar la disponibilidad de información a nivel municipal sobre las desigualdades e inequidades territoriales relacionadas con la salud y el bienestar en Colombia. Para demostrar su funcionalidad se describen los componentes del Sistema, indicadores, mapas, gráficos y métricas de desigualdad utilizados, así como también los perfiles de país y departamento, diseñados para reportar los resultados del monitoreo. Como ejemplo práctico de la utilización del Sistema se analizan los indicadores de Colombia entre 2015 y 2017. Según el monitoreo, Colombia mostró mejoras en la salud y el bienestar de la población; sin embargo, se apreciaron diferencias notables intermunicipales en casi todos los indicadores y brechas territoriales en la mortalidad entre municipios ricos y pobres y entre la zona rural y la urbana. Puede decirse que el MOT-ODS3 incrementó la disponibilidad de información para estimular y apoyar el avance del país hacia el logro de los Objetivos de Desarrollo Sostenible.

Although compliance with the Millennium Development Goals had a positive balance, with national averages that generally improved, inequalities within countries increased. The Sustainable Development Goals (SDGs) agenda seeks to promote progress in terms of territorial equity, which is why the incorporation of geographic space in its monitoring at subnational scales offers important advantages. This article aimed to describe the Territorial Monitoring System for the SDGs3 (MOT-ODS3), a digital tool designed to increase the availability of information at the municipal level on territorial inequalities and inequities related to health and well-being in Colombia. To demonstrate its functionality, the components of the System, indicators, maps, graphs and inequality metrics used are described, as well as the country and departmental profiles designed to report monitoring results. As a practical example of the use of the System, the indicators for Colombia between 2015 and 2017 are analyzed. According to the monitoring, Colombia showed improvements in the health and well-being of the population; however, notable inter-municipal differences were seen in almost all indicators and territorial gaps in mortality between rich and poor municipalities and between rural and urban areas. It can be said that the MOT-ODS3 increased the availability of information to stimulate and support the country's progress towards the achievement of the Sustainable Development Goals.

Riesgo y distribución geográfica de neurocisticercosis en Chile según egresos hospitalarios (2002-2019) / Epidemiology of cysticercosis in Chile

BACKGROUND: Neurocysticercosis is the most prevalent parasitic disease of the central nervous system in Chile, where sporadic cases are reported, without information about the epidemiology or distribution of the disease. AIM: To identify the main risk zones for cysticercosis in Chile. MATERIAL AND METHODS: Analysis of hospital discharge databases between 2002 and 2019, available at the website of the Chilean Ministry of Health. Cases with B69 code of the tenth international classification of diseases were identified. RESULTS: In the study period, there were 1752 discharges with the diagnoses of neurocysticercosis, ocular cysticercosis and cysticercosis of other sites. The ages of patients ranged from 0 to 89 years with a clustering between 30 and 59 years. Sixty two percent were males. The zone between the regions of Maule and Araucania concentrated 82% of cases. CONCLUSIONS: We identified the zone with the greatest concentration of cysticercosis in Chile, where preventive strategies should eventually be directed.

Mortality inequalities measured by socioeconomic indicators in Brazil: a scoping review

ABSTRACT OBJECTIVE Summarize the literature on the relationship between composite socioeconomic indicators and mortality in different geographical areas of Brazil. METHODS This scoping review included articles published between January 1, 2000, and August 31, 2020, retrieved by means of a bibliographic search carried out in the Medline, Scopus, Web of Science, and Lilacs databases. Studies reporting on the association between composite socioeconomic indicators and all-cause, or specific cause of death in any age group in different geographical areas were selected. The review summarized the measures constructed, their associations with the outcomes, and potential study limitations. RESULTS Of the 77 full texts that met the inclusion criteria, the study reviewed 24. The area level of composite socioeconomic indicators analyzed comprised municipalities (n = 6), districts (n = 5), census tracts (n = 4), state (n = 2), country (n = 2), and other areas (n = 5). Six studies used composite socioeconomic indicators such as the Human Development Index, Gross Domestic Product, and the Gini Index; the remaining 18 papers created their own socioeconomic measures based on sociodemographic and health indicators. Socioeconomic status was inversely associated with higher rates of all-cause mortality, external cause mortality, suicide, homicide, fetal and infant mortality, respiratory and circulatory diseases, stroke, infectious and parasitic diseases, malnutrition, gastroenteritis, and oropharyngeal cancer. Higher mortality rates due to colorectal cancer, leukemia, a general group of neoplasms, traffic accident, and suicide, in turn, were observed in less deprived areas and/or those with more significant socioeconomic development. Underreporting of death and differences in mortality coverage in Brazilian areas were cited as the main limitation. CONCLUSIONS Studies analyzed mortality inequalities in different geographical areas by means of composite socioeconomic indicators, showing that the association directions vary according to the mortality outcome. But studies on all-cause mortality and at the census tract level remain scarce. The results may guide the development of new composite socioeconomic indicators for use in mortality inequality analysis.

Atenção Domiciliar no Brasil: estudo exploratório sobre a consolidação e uso de serviços no Sistema Único de Saúde / Home Care in Brazil: an exploratory study on the construction process and service use in the Brazilian Health System

Resumo Mudanças no perfil demográfico e epidemiológico, no Brasil e no cenário internacional, fazem emergir a necessidade de adaptação do modelo de atenção em saúde. Nesse contexto, surge a Atenção Domiciliar (AD) como estratégia complementar de cuidado motivada por diversas preocupações: desospitalização, racionalização do uso de leitos hospitalares, redução de custos e organização do cuidado centrado no paciente. O objetivo deste estudo é analisar a AD no âmbito do Sistema Único de Saúde, identificando as modalidades de cuidado e desigualdades no uso. Para tal, foram realizadas análise documental da legislação e exploração de dados secundários disponíveis sobre o volume de serviços e procedimentos produzidos no domicílio. Foram contabilizadas 94.754 internações domiciliares entre 2008-2016 e 4.008.692 de procedimentos domiciliares ambulatoriais entre 2012-2016. A AD ambulatorial mostrou-se mais difundida, enquanto a internação domiciliar concentrou-se em algumas áreas geográficas. A discrepância regional é marcante, desvelando desigualdades na oferta, acesso e uso. Apesar do arcabouço legal, constituição de um programa específico e volume de produção, a AD não parece, ainda, efetivamente inserida como um dos vértices da Rede de Atenção à Saúde.

Abstract Changes in demographic and epidemiological profiles, in Brazil and in the world, have brought the need to adapt the health care model. In this context, Home Care (HC) emerges as an alternative strategy of health care driven by several concerns: dehospitalization, rationalization of the hospital bed use, costs reduction, and the organization of patient-centered care. This study aims to analyze HC in the Brazilian Unified Health System, identifying the modalities of care and inequalities in service use. Thereby a documentary analysis of the legislation and secondary data available on the home care volume of services and procedures explorations were realized. In total, 94,754 home-based hospitalizations occurred in the 2008-2016 period, and 4,008,692 home-based outpatient procedures were carried out in the 2012-2016 period. Outpatient HC was more widespread, while home-based hospitalizations were concentrated in some geographical areas. The regional discrepancy is striking, revealing inequalities in supply, access, and use. Despite the legal framework, the establishment of a specific program, and volume of production, HC does not seem to be yet effectively incorporated as one of the apexes of the Health Care Network.

Trends of clinical trials from 2014 to 2016 in South Korea

Mandatory registration of clinical trials in public registry can ensure the transparency of clinical trials. Public clinical trial registry of can provide current chronological and geographical distribution of clinical trial throughout the country. We used public clinical trial registry provided by Ministry of Food and Drug Safety to analyze current status of clinical trial from 2014 to 2016 in South Korea. The number of clinical trials in antineoplastic and immunomodulating agents area was the greatest, followed by cardiovascular system and antiinfectives for systemic use as a whole. From 2014 to 2016, overall number of clinical trials decreased while the number of phase I clinical trials increased. Seoul accounted for more than half number of clinical trials in Korea. Supports for clinical trials in non-metropolitan area needs to be considered.

Geographical Variations and Trends in Major Cancer Incidences throughout Korea during 1999-2013 / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: We aimed to describe the temporal trends and district-level geographical variations in cancer incidences throughout Korea during 1999-2013. MATERIALS AND METHODS: Data were obtained from the Korean National Cancer Incidence Database. We calculated the age-standardized cumulative cancer incidences according to sex and geographical region (metropolitan cities, provinces, and districts) for three 5-year periods (1999-2003, 2004-2008, and 2009-2013). Each quintile interval contained the same number of regions. Disease maps were created to visualize regional differences in the cancer incidences. RESULTS: Substantial differences in cancer incidences were observed according to district and cancer type. The largest variations between geographical regions were found for thyroid cancer among both men and women. There was little variation in the incidences of stomach, colorectal, and lung cancer according to geographical region. Substantially elevated incidences of specific cancers were observed in Jeollanam-do (thyroid); Daejeon (colorectum); Jeollanam-do, Gyeongsangbuk-do, and Chungcheongbuk-do (lung); Seocho-gu, Gangnam-gu and Seongnam, Bundang-gu (breast and prostate); Chungcheong and Gyeongsang provinces (stomach); Ulleung-gun and the southern districts of Gyeongsangnam-do and Jeollanam-do (liver); and along the Nakdonggang River (gallbladder and biliary tract). CONCLUSION: Mapping regional cancer incidences in Korea allowed us to compare the results according to geographical region. Our results may facilitate the development of infrastructure for systematic cancer incidence monitoring, which could promote the planning and implementation of region-specific cancer management programs.

Presencia de Aedes ( Stegomyia ) aegypti (Linnaeus, 1762) y su infección natural con el virus del dengue en alturas no registradas para Colombia / Presence of Aedes ( Stegomyia ) aegypti (Linnaeus, 1762) and its natural infection with dengue virus at unrecorded heights in Colombia

Introducción. Aedes aegypti es el principal vector de fiebre amarilla urbana, dengue, chikungunya y zika. Se ha demostrado que la distribución biogeográfica de esta especie se ha expandido debido al calentamiento global y a factores socioeconómicos y culturales. Los cambios en los patrones de la distribución altitudinal de este vector y su infección con el virus son prioridades de la investigación encaminada a desarrollar estrategias de vigilancia entomológica y virológica en salud pública. Objetivo. Evaluar la presencia de A. aegypti y su infección natural por el virus del dengue en alturas superiores a los 1.800 msnm en dos municipios periféricos del Valle de Aburrá, Antioquia, Colombia. Materiales y métodos. Se instalaron 21 ovitrampas en los municipios de Bello y San Pedro de los Milagros, en un rango altitudinal de 1.882 a 2.659 msnm. Los adultos que emergieron de las ovitrampas se evaluaron con reacción en cadena de la polimerasa en tiempo real (RT-PCR) para la detección del virus del dengue. Resultados. Se recolectaron 367 adultos de A. aegypti , siete de los cuales se encontraron a una altitud de 2.302 msnm en Tierradentro, Bello. Se detectaron 12 especímenes de A. aegypti positivos para dengue serotipo 2 en el barrio París de Bello, a 1.984 msnm. Conclusión. Por primera vez se registró A. aegypti a 2.302 msnm, la mayor altitud registrada para este vector en Colombia. De igual forma, se encontró infección con el virus del dengue a 1.984 msnm. Estos hallazgos son significativos, ya que determinan regiones de Colombia con riesgo potencial de transmisión autóctona de dengue y otros arbovirus por A. aegypti .

Introduction: Aedes aegypti is the main vector of urban yellow fever, dengue, chikungunya and Zika viruses. The biogeographical distribution of this species has expanded due to global warming, and socioeconomic and cultural factors. The changes in the altitudinal distribution patterns of this vector and its natural infection are priority fields of research to develop entomological, virological and public health surveillance strategies. Objective: To evaluate the presence of A. aegypti and its natural infection with dengue virus in altitudes above 1.800 meters above sea level in two peripheral municipalities of the Valle de Aburrá, Antioquia, Colombia. Materials and methods: Twenty-one ovitraps were set in the municipalities of Bello and San Pedro de los Milagros, at altitudes ranging from 1.882 to 2.659 masl. Emerged adults caught in the ovitraps were tested by RT-PCR for dengue virus detection. Results: We collected 367 A. aegypti adults, seven of which were found as high as 2.302 masl in Tierradentro, Bello. We detected serotype 2 dengue infection in 12 A. aegypti specimens collected in the neighbourhood of París, in Bello, at 1.984 masl. Conclusion: We recorded A. aegypti at 2.302 masl, so far the highest altitudinal record in Colombia for this vector. Furthermore, mosquitoes collected at 1.984 masl were positive for dengue virus. These findings are significant as they identify regions in Colombia at risk of potential autochthonous transmission of dengue and other arboviruses by A. aegypti .

Preparedness for the Rio 2016 Olympic Games: hospital treatment capacity in georeferenced areas / Preparação para os Jogos Olímpicos Rio 2016: capacidade de tratamento hospitalar em áreas georreferenciadas / La preparación para los Juegos Olímpicos de Río 2016: capacidad de tratamiento hospitalario en áreas georreferenciadas

Abstract: Recently, Brazil has hosted mass events with recognized international relevance. The 2014 FIFA World Cup was held in 12 Brazilian state capitals and health sector preparedness drew on the history of other World Cups and Brazil's own experience with the 2013 FIFA Confederations Cup. The current article aims to analyze the treatment capacity of hospital facilities in georeferenced areas for sports events in the 2016 Olympic Games in the city of Rio de Janeiro, based on a model built drawing on references from the literature. Source of data were Brazilian health databases and the Rio 2016 website. Sports venues for the Olympic Games and surrounding hospitals in a 10km radius were located by geoprocessing and designated a "health area" referring to the probable inflow of persons to be treated in case of hospital referral. Six different factors were used to calculate needs for surge and one was used to calculate needs in case of disasters (20/1,000). Hospital treatment capacity is defined by the coincidence of beds and life support equipment, namely the number of cardiac monitors (electrocardiographs) and ventilators in each hospital unit. Maracanã followed by the Olympic Stadium (Engenhão) and the Sambódromo would have the highest single demand for hospitalizations (1,572, 1,200 and 600, respectively). Hospital treatment capacity proved capable of accommodating surges, but insufficient in cases of mass casualties. In mass events most treatments involve easy clinical management, it is expected that the current capacity will not have negative consequences for participants.

Resumo: Recentemente, o Brasil sediou eventos de massa com relevância internacional reconhecida. A Copa do Mundo FIFA de 2014 foi realizada em 12 capitais estaduais e a preparação do setor da saúde contou com a história de outras Copas do Mundo e com a própria experiência do Brasil com a Copa das Confederações FIFA de 2013. O presente artigo objetivou analisar a capacidade de tratamento de instalações hospitalares em áreas georeferenciadas para eventos esportivos, nos Jogos Olímpicos de 2016, na cidade do Rio de Janeiro, com base em um modelo construído a partir da literatura. Os dados foram coletados nas bases de dados de saúde do Brasil e da página de Internet da Rio 2016. As instalações esportivas para os Jogos Olímpicos e os hospitais circundantes em um raio de 10km foram localizados por geoprocessamento; foi designada uma "área de saúde", referindo-se ao afluxo provável de pessoas a serem tratadas em caso de necessidade hospitalar. Seis fatores foram utilizados para calcular necessidades para surtos e um fator de cálculo foi usado para as desastres (20/1.000). Capacidade de tratamento hospitalar é definida pela coincidência de leitos e equipamentos de suporte de vida, ou seja, o número de monitores cardíacos (eletrocardiógrafos) e respiradores em cada unidade hospitalar. O Maracanã, seguido do Estádio Olímpico (Engenhão) e o Sambódromo, teria a maior demanda para internações (1.572, 1.200 e 600, respectivamente). A capacidade de tratamento hospitalar mostrou-se capaz de acomodar surtos, mas insuficiente em casos de vítimas em massa. Em eventos de massa, a maioria dos tratamentos envolve uma fácil gestão clínica. Espera-se que a capacidade atual não terá consequências negativas para os participantes.

Resumen: Recientemente, Brasil fue sede de eventos de masa con relevancia internacional reconocida. La Copa Mundial de la FIFA 2014 se llevó a cabo en 12 capitales de los estados y la preparación del sector de la salud tenía la historia de otras copas mundiales y con la experiencia de Brasil en la Copa Confederaciones de la FIFA 2013. Este artículo tiene como objetivo analizar la capacidad de tratamiento de las instalaciones hospitalarias en zonas georreferenciados para los eventos deportivos, en los Juegos Olímpicos de 2016, en la ciudad de Río de Janeiro, basado en un modelo construido a partir de la literatura. Los datos fueron recogidos en las bases de datos de salud en Brasil y en el sitio web del Río 2016. Las instalaciones deportivas para los Juegos Olímpicos y los hospitales circundantes dentro de un radio de 10km fueron localizados por el geoprocesamiento; un "área de la salud" fue designado, en referencia a la posible afluencia de personas que van a tratarse en el caso de una emergencia hospitalaria. Seis factores se utilizaron para calcular las necesidades a los brotes y un factor de cálculo se utilizó para los desastres (20/1.000). Capacidad de tratamiento hospitalario se define por la coincidencia de camas y equipos de soporte vital, o el número de monitores cardíacos (electrocardiógrafos) y respiradores en cada hospital. El Maracanã, seguido por el Estadio Olímpico (Engenhão) y el Sambódromo, tendría la mayor demanda de hospitalizaciones (1.572, 1.200 y 600, respectivamente). La capacidad de tratamiento hospitalario ha demostrado ser capaz de adaptarse a los brotes, pero insuficiente en casos de víctimas en masa. En los eventos masivos, la mayoría de los tratamientos implican un manejo clínico fácil. Se espera que la capacidad actual no tendrá consecuencias negativas para los participantes.

Mortalidad en menores de cinco años debida a lesiones causadas por el tránsito, Colombia, 2005-2009 / Road traffic deaths in children under the age of five in Colombia, 2005-2009

Introducción. En los últimos años las muertes relacionadas con accidentes de tránsito han aumentado a nivel mundial; durante 2007, la tasa de mortalidad en Colombia fue de 11,7 por 100.000. Objetivo. Describir la tendencia de las muertes causadas por tránsito en niños menores de cinco años para brindar información de soporte a las acciones de prevención, control e intervención. Materiales y métodos. Se hizo un estudio transversal descriptivo de las muertes en niños menores de cinco años registradas en las estadísticas vitales del 2005 al 2009 bajo las causas correspondientes a los códigos V000 al V999 de la Clasificación Internacional de Enfermedades, décima versión. Se hizo un análisis descriptivo, se calcularon las tasas con proyecciones del Departamento Administrativo Nacional de Estadística (DANE), y se establecieron los niveles de riesgo por departamentos y municipios (percentiles) y por conglomerados. Se utilizaron los programas Excel ® , PASW statistics18 ® y EpiInfo ® , para levantar los mapas. Resultados. Se presentaron 713 muertes por lesiones debidas a accidentes de tránsito (0,8 % de ellas en el grupo de edad del estudio); el promedio anual fue de 142,6 (pasó de 159 en 2005 a 136 en 2009). La tasa nacional fue de 3,3 por 100.000, siendo mayor en niños entre uno y cuatro años de edad (3,5 por 100.000) que en el grupo de menores de un año (2,6). La mayor proporción de eventos ocurrió en enero (9,7 %) y julio (10,6 %) y durante los fines de semana (16 %), y fue más elevada en niños. Los departamentos de Meta, Boyacá, Arauca, Norte de Santander y Cundinamarca superaron la tasa nacional. De los 292 conglomerados establecidos (26 % de los municipios), se mantuvieron estables Armenia, Bogotá, Buenaventura, Cúcuta, Medellín, Pereira, San Andrés de Tumaco, Tunja y Villavicencio. Conclusiones. Los niños fueron el grupo más afectado, y los casos aumentaron en épocas en que no estaban en la escuela, tendencia que se acentuó en zonas turísticas y comerciales.

Introduction : Road traffic deaths have increased during the past years worldwide. During 2007, the mortality due to road traffic accidents in children under the age of five was 11.7 per 100,000 in Colombia. Objective: To describe the trend of road traffic deaths in children under the age of five in Colombia from 2005 to 2009. Materials and methods: We conducted a cross - sectional study of death certificates in children under the age of five as registered in the official vital statistics records from 2005 to 2009 (ICD-10, codes V000-V999). We made a descriptive analysis, calculated mortality rates based on projections by the National Administrative Statistics Department and we established risk levels by provinces and municipalities (percentiles), as well as by conglomerates using Excel ® , PASW statistics18 ® and EpiInfo ® for the maps. Results: All in all, 713 road traffic deaths occurred from 2005 to 2009 in children under the age of five corresponding to 0.8% of total deaths in that age group. The total number of road traffic deaths decreased from 2005 (159 deaths) to 2009 (136 deaths). The mean national death rate due to road traffic accidents was 3.3 per 100,000 with a higher rate among one to four year-old children (3.5/100,000) compared to children under the age of one (2.6/100,000). The highest prevalence of road traffic deaths was observed in January (9.7%) and July (10.6%). The provinces with the highest road traffic death rate were Meta, Boyacá, Arauca, Norte de Santander and Cundinamarca. Conclusions: Children were the group mostly affected by the event, which increased during school holidays and was more pronounced in tourist and commercial areas.

Georreferenciación de la oferta de programas de salud pública en cuatro ciudades en el contexto del mercado competitivo del sistema de salud, Colombia 2014 / Georreferenciamento da oferta de programas de saúde pública em quatro cidades no contexto do mercado competitivo do sistema de saúde, Colômbia / Georeferencing provision of public health programs in four Colombian cities within the context of the competitive market of the health system, 2014

Objetivo: georreferenciar la oferta de programas de salud pública de las Instituciones Prestadoras de Servicios de Salud (IPS) públicas y privadas en cuatro ciudades colombianas. Metodología: estudio descriptivo de corte transversal, desarrollado a partir de la base de datos de IPS habilitadas del Ministerio de Salud y Protección Social, que ofrecen programas de salud pública. Resultados: es mayor el número de IPS privadas que ofrecen programas de salud pública; sin embargo, estas se concentran en atender a la población y las zonas de la ciudad con mejor nivel socioeconómico. La población de las zonas más pobres está siendo atendida casi exclusivamente por las IPS del sector público. Conclusión: en un sistema de mercado competitivo la población y las zonas de la ciudad se segmentan según su nivel socioeconómico y no es atractivo para el sector privado proveer servicios de salud pública a las poblaciones más pobres.

Objective: To describe the geographical location of public health programs offered by public and private institutions providing health services in four Colombian cities. Methodology: Descriptive cross-sectional study based on information from the Ministry of Health of institutions that provide public health programs. Results: More private than public institutions offer public health programs, but the former are concentrated on the population and zones with better socioeconomic conditions. In contrast, poor population depends almost exclusively on public sector institutions. Conclusion: In a competitive market system, population and city zones are segmented according to their socioeconomic level, and it is not attractive for the private sector to provide public health services to poorer populations.

Objetivo: georreferenciar a oferta de programas de saúde pública das instituições prestadoras de serviços de saúde (IPS) públicas e privadas em quatro cidades colombianas. Metodologia: estudo descritivo de corte transversal, desenvolvido a partir da base de dados de IPS habilitadas do Ministério de Saúde e Proteção Social, que oferecem programas de saúde pública. Resultados: é maior o número de IPS privadas que oferecem programas de saúde pública; no entanto, estas se concentram em atender à população e as zonas da cidade com melhor nível socioeconômico. A população das zonas mais pobres está sendo atendida quase exclusivamente pelas IPS do setor público. Conclusão: num sistema de mercado competitivo a população e as zonas da cidade se segmentam segundo seu nível socioeconômico e não é atraente para o setor privado prover serviços de saúde pública às populações mais pobres.

Seasonal and regional variations in the causes of anaphylaxis in Korean adults

PURPOSE: To investigate whether causes of anaphylaxis vary according to regions and seasons in Korean adults. METHODS: Based on previous retrospective studies of anaphylaxis between 2007 and 2011 at the 15 university hospitals. Regions were classified into 4 groups: region I, Seoul; region II, Gyeonggi; region III, Chungcheong; and region IV, Chonnam and Busan. The cases induced by 5 major allergens including drugs, food, bee sting, radiocontrast media, and exercise, were analyzed in the present study. RESULTS: Among a total of 1,661 cases reported (53% male, 45.9+/-16.0 years), 367 (22.2%), 706 (42.5%), 319 (19.2%), and 269 cases (16.2%) were enrolled in regions I, II, III, and IV, respectively. Of the 5 major allergens, drugs (37.3%) were the most frequently reported, followed by food (25.7%), bee sting (17.9%), radiocontrast media (12.9%), and exercise (6.2%). There was no significant difference in the total occurrence of anaphylaxis in 4 seasons (374 in spring, 460 in summer, 460 in autumn, and 367 in winter). Multiple logistic regression analysis revealed that drug-induced anaphylaxis was significantly associated with the winter season (odds ratio [OR] 1.0 vs. OR 0.597, P<0.05 for spring; OR 1.0 vs. OR 0.481, P<0.01 for summer; OR 1.0 vs. OR 0.653, P<0.05 for autumn). Food-associated anaphylaxis was mainly reported in region I, whereas the frequency of insect sting was relatively higher in regions II, III, and IV than in region I. Older age and female gender were significantly associated with drug-induced anaphylaxis. CONCLUSION: Specific causative allergens of anaphylaxis in adults may vary according to age, gender, region, and season in Korea.

A evolução do Congresso Brasileiro de Atividade Física e Saúde. Copo meio cheio ou meio vazio? / The evolution of the Brazilian Congress on Physical Activity and Health. Glass half full or half empty?

O objetivo do presente estudo foi resgatar a memória do Congresso Brasileiro de Atividade Física e Saúde (CBAFS) e descrever a evolução da participação no evento segundo localização geográfica da afiliação dos participantes, eixos de pesquisa, e tipo de estudo dos resumos apresentados. A pesquisa foi realizada nos anais das nove edições do CBAFS. Buscou-se identificar o estado (convidados nacionais) e país (convidados internacionais) de origem dos palestrantes, estado de origem do primeiro autor, delineamento de estudo e eixos de pesquisa em atividade física e saúde (em que a atividade física e/ou o comportamento sedentário são exposição ou desfecho do estudo). Os dados foram apresentados em frequências absolutas, relativas e taxas brutas por milhão de habitantes. Em todos os anos foi observada uma predominância de palestrantes e de resumos da região Sul do país, seguido das regiões Sudeste e Nordeste. Quanto aos palestrantes internacionais houve participação da América do Norte (EUA, Canadá), Europa (Portugal, França, Finlândia e Dinamarca) e Colômbia. Para o conteúdo dos resumos há predominância de delineamentos transversais sobre as consequências da atividade física/comportamento sedentário na saúde, determinantes da prática de atividade física e estudos descritivos sobre nível/tendência de atividade física. O eixo de intervenções para aumento dos níveis de atividade física e diminuição do comportamento sedentário permanecem insipientes. Conclui-se que há grande disparidade geográfica em relação aos congressistas e dificuldades em traduzir as evidências em aumento nos níveis de atividade física. Entretanto, tem sido observada uma melhora em relação a representação geográfica e crescente número de participantes.

The aim of this study was to rescue the history of the Brazilian Congress of Physical Activity and Health (CBAFS) and describe the evolution of the event according to participants' geographical location of the affiliation, research axes, and type of study presented in abstracts. The survey was conducted in annals of all nine CBAFS editions. We sought to identify the state (national guests) and country (international guests) of speakers' origin, as well as first author state, study design and research lines in physical activity and health (where physical activity and/or sedentary behavior are exhibition or study endpoint). The data were presented as absolute, relative and crude rates per million population frequencies. In all years a predominance of speakers and abstracts of the Southern region, followed by the Southeast and Northeast regions was observed. Regarding international speakers there was participation from North America (USA, Canada), Europe (Portugal, France, Finland and Denmark) and Colombia. For the content of the abstracts there was a predomination of cross-sectional designs on the physical consequences of physical activity/sedentary behavior, determinants of physical activity and level of descriptive studies on levels/trends of physical activity. The axis of interventions to increase levels of physical activity and decrease sedentary behavior remained ignored. Concluded that there is still great geographical disparity in relation to congressmen and difficulties in translating evidence into increased levels of physical activity. However, an improvement has been observed in relation to geographical representation and growing number of participants'.

Sífilis gestacional y factores asociados en hospitales públicos del Perú en el periodo 2000-2010 / Gestational syphilis and associated factors in public hospitals of Peru during 2000-2010

Objetivos. Determinar el perfil epidemiológico de la sífilis gestacional y factores asociados en una población peruana. Materiales y métodos. El estudio es un análisis secundario de datos obtenidos de hospitales públicos del Perú para el periodo 2000-2010. Se incluyó datos de 652 636 gestantes de 37 ciudades y de 45 establecimientos de salud del Perú. Resultados. Se estimó la prevalencia de sífilis gestacional en 0,7% y de tamizaje de sífilis materna en 80,7%. La mayor prevalencia de sífilis materna se encontró en la selva baja seguida de la selva alta. En las tres regiones del Perú se aprecia una disminución de la prevalencia de sífilis gestacional en el transcurso de los años. Las prevalencias al 2010 son de 0,2% en la costa, 0,23% en la sierra y 0,47% en la selva. La ausencia de educación, el bajo número de control prenatal, la mayor paridad, el ser conviviente o soltera, y el vivir en la selva, son factores asociados a la positividad en la prueba de sífilis. Conclusiones. Los resultados sugieren que la prevalencia de sífilis gestacional ha presentado una tendencia decreciente durante la década 2000-2010.

Objectives. To determine the epidemiological profile of gestational syphilis and associated factors in a Peruvian population. Materials and methods. The study is a secondary analysis of data obtained from public hospitals in Peru for the 2000-2010 period. 652,636 pregnant women were included from 37 cities and 45 health centers in Peru. Results. The prevalence of gestational syphilis was 0.7%, while 80.7% reported screening for gestational syphilis. The highest prevalence of maternal syphilis is found in the lowland rainforest followed by the highland rainforest. In the three regions of Peru decreased prevalence of gestational syphilis has been seen throughout the years. The prevalence for 2010 are 0.2% on the coast, in the highlands 0.23% and 0.47% in the jungle. The lack of education and prenatal care, high parity, cohabiting or single, and living in the jungle, are associated with having a positive syphilis test. Conclusions. The results suggests that prevalence of gestational syphilis has declined over the decade 2000-2010.

Validación del auto-reporte de la localización de residuos sólidos con análisis de Procusto en el contexto de una iniciativa comunitaria participativa / Validation of reported location of solid waste using Procrustes analysis in the context of a participatory community initiative / Validação do auto-relatório na localização de resíduos sólidos com análise de Procusto no contexto de uma iniciativa comunitária participativa

Este estudio forma parte de una iniciativa comunitaria de manejo integral de residuos, basada en "epidemiología popular" y la investigación acción participativa. En este estudio se propone un método de validación de datos espaciales (ordenadas y abscisas) de residuos sólidos auto-reportados por la comunidad. La ubicación de los sitios fue realizada por 76 residentes de la localidad La Nopalera (Yautepec, Morelos, México), y comparada con los reportados por tres expertos en salud ambiental. La concordancia fue explorada con análisis de Procusto. Los expertos identificaron 23 sitios de concentración de residuos sólidos, mientras que la comunidad ubicó solo 22 sitios. Hubo mínimas diferencias en la localización, escala y orientación. El estadístico de Procusto mostró 95% de concordancia entre legos y expertos. Los hallazgos sugieren que el saber popular es una fuente de información válida en estudios epidemiológicos, y que su error de medición puede ser cuantificado. La sencilla metodología descrita podrá ser usada en futuros estudios de "epidemiología popular" o aproximaciones similares.

This study is part of a community initiative for integrated solid waste management based on "popular epidemiology" and participatory action research. The study proposes a method for validation of spatial data (X and Y data) on solid waste reported by community members. Location of sites was conducted by 76 residents of the La Nopalera community (Yautepec, Morelos, Mexico) and compared with reports by three environmental health experts. Agreement was explored using Procrustes analysis. Experts identified 23 sites with abundant solid waste, while community members only identified 22 sites. There were minimal differences in location, scale, and positioning of reported waste. Procrustes statistics showed 95% agreement between community and expert reports. The findings suggest that community knowledge can be a valid source of information in epidemiological studies, and that measurement error can be quantified. The simple methodology described here can be used in further "popular epidemiology" studies or similar approaches.

O estudo é parte de uma iniciativa comunitária de gerenciamento integral de resíduos sólidos, baseada na "epidemiologia popular" e em uma pesquisa de ação participativa. Aqui está sendo proposto um método de validação de dados espaciais (ordenadas e abscissas) de resíduos sólidos auto-relatados pela comunidade. A localização dos pontos foi realizada por 76 moradores da localidade de La Nopalera (Yautepec, Morelos, México), e comparada com os relatórios de três especialistas em saúde ambiental. A concordância foi explorada com análise de Procusto. Os especialistas identificaram 23 pontos de concentração de resíduos sólidos, ao passo que a comunidade localizou apenas 22. Foram verificadas diferenças mínimas na localização, escala e orientação. A estatística de Procusto mostrou 95% de concordância entre leigos e especialistas. Os resultados sugerem que o conhecimento popular constitui uma fonte de informação válida em estudos epidemiológicos, e que seus erros de medição podem ser quantificados. A metodologia simples descrita poderá ser usada em futuros estudos de "epidemiologia popular" ou aproximações similares.

Regional differences associated with drinking and driving in Brazil / Diferenças regionais entre os fatores associados ao beber e dirigir no Brasil

OBJECTIVE: To evaluate regional differences and similarities associated with drinking and driving (DUI) in the five Brazilian macro-regions. METHOD: A roadside survey was conducted in the 27 Brazilian state capitals. A total of 3,398 drivers were randomly selected and given a structured interview and a breathalyzer test. To determine the predictors of positive blood alcohol concentration (BAC) in each region, a MANOVA was performed, and 3 groups were used as follows: 1) North and Northeast, 2) South and Midwest, and 3) Southeast. A Poisson robust regression model was performed to assess the variables associated with positive BAC in each group. RESULTS: Of all surveyed drivers, 2,410 had consumed alcohol in the previous 12 months. Most were male, with a median age of 36. Leisure as the reason for travel was associated with positive BAC in all 3 groups. Low schooling, being older than 30, driving cars or motorcycles and having been given a breathalyzer test at least once in their lives predicted DUI in at least two different groups. CONCLUSIONS: Factors , especially low schooling and leisure as a reason for travel, associated with drinking and driving were similar among regions, although certain region-specific features were observed. This information is important for aiming to reduce DUI in the country.

OBJETIVO: Avaliar diferenças e similaridades em relação a beber e dirigir (DUI) nas cinco macroregiões brasileiras. MÉTODO: Um roadside survey foi realizado nas 27 capitais brasileiras. Foram selecionados aleatoriamente 3.398 condutores que responderam a uma entrevista estruturada e foram testados com uso de etilômetro. Para a construção de modelos preditivos de alcoolemia positiva (BAC), as regiões foram agrupadas de acordo com sua similaridade, obtida por MANOVA, em: 1) Norte e Nordeste; 2) Sul e Centro-Oeste; 3) Sudeste. Em cada grupo foi realizado um modelo de regressão robusta para estimar as variáveis associadas a BAC. RESULTADOS: Dentre os condutores, 2.410 ingeriram bebidas alcoólicas nos 12 meses anteriores, sendo a maioria composta por homens com idade mediana de 36 anos. A única variável associada a BAC em todos os grupos foi ter lazer como motivo da viagem. Baixa escolaridade, idade > 30 anos, dirigir carros/motos e ter realizado teste de bafômetro previamente foram associadas a BAC em ao menos dois grupos. CONCLUSÕES: Os fatores associados a DUI foram semelhantes nas regiões, especialmente o motivo da viagem e a escolaridade, embora algumas especificidades regionais tenham sido observadas. Estas informações são estratégicas para políticas públicas destinadas a redução do DUI.

Factores asociados a violencia física reciente de pareja hacia la mujer en el Perú, 2004-2007 / Factors associated to recent intimate partner physical violence against women in Peru, 2004-2007

Objetivos. Identificar los factores asociados de violencia física reciente (en el último año) de pareja, hacia la mujer en el Perú. Materiales y métodos. Se realizó un análisis secundario de la encuesta demográfica y de salud familiar (ENDES) 2004-2007. Se incluyó a 12 257 mujeres unidas o casadas que respondieron al módulo de violencia, con esta información se realizó la categorización de antecedente de violencia física infringida por la pareja. Se llevaron a cabo análisis descriptivos y regresiones logísticas univariadas y multivariadas para muestras complejas. Resultados. La prevalencia de violencia física a nivel nacional fue de 14,5%, con variación entre regiones geográficas (9,7 a 18,9%). El factor asociado con un mayor riesgo es que la pareja se embriague con frecuencia (OR: 7,2; IC 95%: 5,4-9,6) y que la pareja controle o limite las visitas de la mujer a familiares o amigos (OR: 4,1; IC 95%: 3,3-5,0); otros factores asociados son el antecedente de agresión física del padre hacia la madre, el haber tenido uniones previas de pareja, ser conviviente, tener mayor nivel de educación que la pareja o el desbalance en la toma de decisiones en la pareja. Entre los factores asociados con un menor riesgo, estuvieron la comunicación y respeto dentro de la pareja (OR: 0,3; IC 95%: 0,2-0,3) y el que la mujer tenga algún tipo de seguro de salud. Conclusiones. Diversos factores individuales, de relaciones de pareja u otros factores, están asociadas con una mayor probabilidad de violencia de pareja contra la mujer. Otros factores, como la comunicación y el respeto en la parej a, podrían tener carácter protector.

Objectives. To identify factors associated to recent (during the last year) intimate partner physical violence against women in Peru. Materials and methods. Using the demographic and Family Health National Survey (ENDES) 2004- 2007 a secondary analysis was performed. 12,257 women married or living with a couple who answered the violence module were included, with this information they were assigned to a category according to the history of having been physically assaulted by their couples. Descriptive analysis and univariate and multivariate logistical regression for complex samples were done. Results. Prevalence of physical violence at the national level was 14,5%, with variations according to the geographical areas (9,7% to 18,9%). The factor associated to a higher risk is having a couple who frequently gets drunk (OR: 7,2; 95%CI: 5,4-9,6) and having a couple controlling or limiting the woman’s visits to family or friends (OR: 4,1; 95%CI: 3,3-5,0); other associated factors are history of physical aggression of the father to the mother, having had previous partners, be cohabiting, having a higher educational level than the partner and having a disbalanced decision taking in the couple. Among the factors associated with a lower risk are the communication and respect inside the couple (OR: 0,3; 95%CI: 0,2-0,3), and the fact that the woman has health insurance. Conclusions. Many individual factors, as well as factors of the couple relationship and others are associated with a higher probability of violence against the woman. Other agents, such as the communication and the respect in the couple, could have a protective character.