Sistemas de Salud basados en la Atención Primaria de Salud: estrategias para el desarrollo de los equipos APS / Systems of Health based on the Primary Attention of Health: strategies for the development of equipment APS

El documento trata de los Sistemas de Salud basados en la Atención Primaria de Salud; este reconocimiento se sustenta en la evidencia de su impacto sobre la salud y desarrollo de la población. Así mismo, las experiencias acumuladas tanto en países desarrollados como en proceso de desarrollo han demostrado que la APS puede ser adaptada a los distintos contextos políticos, sociales y culturales.

Características antropométricas de jovens nadadores brasileiros do sexo masculino e feminino em diferentes categorias competitivas / Anthropometric characteristics of brazilian young swimmers in different competitive categories

O objetivo deste estudo foi verificar o perfil e as diferenças nas características antropométricas de jovens nadadores brasileiros, de distintas categorias, em ambos os gêneros. Foram avaliados 90 nadadores do sexo masculino e 70 do sexo feminino das categorias Infantil (12-13 anos), juvenil (14-15 anos) e junior (16-18 anos). As variáveis antropométricas mensuradas foram: massa corporal (Kg), estatura (m), IMC (Kg/m2), massa magra (kg), massa gorda (kg) e envergadura (m). O percentual de gordura (%G) foi obtido através da equação de Lohman. Na estatística, foi utilizado o teste Anova two way seguido de post hoc Tukey, com p<0,05. No gênero masculino, a categoria junior apresentou maior massa corporal, estatura, envergadura e massa magra em relação aos grupos infantil e juvenil. Para o gênero feminino, a massa corporal foi superior na categoria junior comparada à infantil e a juvenil. Foram observadas estatura, envergadura, massa magra e massa gorda maiores na categoria junior, quando comparadas à infantil. No sexo feminino, a categoria juvenil apresentou maior massa corporal e massa magra em relação ao grupo infantil. Na categoria infantil, os meninos apresentaram maior massa corporal e massa magra em relação às meninas. Na categoria juvenil, o masculino teve maior massa corporal, estatura, envergadura e massa magra em relação ao feminino, que teve maior %G. Na categoria junior, os meninos apresentaram maior massa corporal, estatura, envergadura e massa magra em relação às meninas, que apresentaram maior %G. Conclui-se que, existem diferenças nas variáveis antropométricas entre as categorias, em ambos os gêneros, entretanto, para o grupo feminino as diferenças antropométricas entre as categorias infantil e juvenil são menos evidentes, provavelmente, devido às alterações orgânicas e hormonais que ocorrem prematuramente em meninas.

The objective of this study was to establish the profi le as well as the differences in anthropometric characteristics of Brazilian young swimmers of different categories in both sexes. Ninety male and 70 female swimmers were measured in the following categories: 1 (12-13 years), 2 (14-15 years) and 3 (16-18 years). Anthropometric variables analyzed were: body mass (Kg), stature (m), BMI (Kg/m2), fat free mass (LBM, kg), fat mass (kg) and arm span (m). The percent of body fat (% fat) was estimated using the Lohman equation. Two-way ANOVA was used followed by the TukeyÆs post-hoc test, with p< 0.05. For males, the category 3 presented higher body mass, stature, arm span and LBM in relation to the other categories. For females, body mass was higher in category 3 when compared to categories 1 and 2. It was observed higher stature, arm span, LBM andfat mass for category 3 when compared to 1. Category 2 presented higher body mass and LBM than category 1. Comparing to girls, boys in the category 2 had higher BMI and LBM than girls. For both categories 2 and 3, males showed higher body mass, stature, arm span and LBM than females, which, in turn, had higher % fat. It was concluded that anthropometric variables are different between categories for both sexes, however, among girls differences between categories 1 and 2 were less evident, probably because of early maturation changes in females.

Maternity and child health care services delivered by public health centers compared to health cooperatives: Iran's experience

Reform programs in some developing countries are focused in transferring these services to nongovernmental organizations or groups. In this WHO grant study our aim was to implement and evaluate the efficacy of a new model for transferring state service delivery governance to nongovernmental groups and studying if they can be efficient in field of child and maternity health services compared to public health centers. In this comparative study a total of 1000 households were selected systematically from the population covered by 9 health centers transferred to cooperatives and 18 current public health centers. Data were collected during a three months long study period and analyzed by SPSS 10 statistical package. Chi-Square and t-tests were used to analyze data. Overall health care coverage was higher for either cooperative or public health centers compared to private sector physicians [p = 0.005].Around 88.8% of under 6 years aged children were under coverage of health services provided by health centers in both groups and no difference was found. There was no statistically significant difference in quality of child health care services in declaring the date of health care visit and follow up in due time. There was no difference between the groups in perfect filling child growth cards but the ability of mothers in interpreting child growth cards was statistically higher for the population covered by cooperative health centers [p = 0.02]. Growth status of children based on growth percentiles were relatively similar in two groups. Some health indices of target groups covered by public and cooperative health centers such as family planning, child health cares, perinatal cares, and the numbers of households covered by health volunteers were studied. The results showed that in all of these fields cooperative health centers had better rates. Observed differences were statistically significant [family planning: p = 0.03, infant health care: p = 0.03, 1-6 years old children cares: p = 0.009]. The proportion of those women owning a vaccination record [card] was higher in population covered by cooperative health centers [p = 0.004]. The rate for performing a cervical smear examination during the national program for cervical cancer screening was higher for the women covered by cooperative health centers [p = 0.01]. No difference was found between the knowledge level of women covered by cooperative health centers about the importance of cervical examination when compared with public health centers. We conclude that in the field of target group children's health care and maternity health services, cooperatives sector not only acts as well as public sector meeting the standards of the program, but also has got a better function in some areas. This can be assumed as an achievement for the policy of transferring the health services to cooperative health centers along with ongoing governmental supervision