[Reform of health systems in Latin America and the Caribbean: situation and trends]. / Reforma de los sistemas de salud en América Latina y el Caribe: situación y tendencias.

In the early 1990s, most Latin American and Caribbean countries were beginning, or planning to begin, health sector reform processes. This paper presents the status and trends of health sector reform at the end of the 1990s. The authors relied on information in 20 health system and services profiles completed by the Pan American Health Organization between August 1998 and October 1999. The analysis, which follows a methodology that had been applied earlier, was organized on two different levels: (1) monitoring the reform processes (dynamics and content) and (2) evaluating their outcomes. In looking at the dynamics of the reform processes, the article examines the context in which they take place and the actors involved in their different phases: inception, design and negotiation, implementation, and evaluation. The description and analysis of the contents of health sector reform initiatives are organized into 12 broad thematic areas. Outcomes evaluation was only possible in the eight countries that provided enough pertinent information, and should be viewed as preliminary. Nevertheless, the article does present detailed information on the outcomes of health sector reform in terms of equity, effectiveness and quality, efficiency, sustainability, and societal participation and control. The article also discusses the potential causes and determining factors for the observed outcomes.

[Essential functions of public health: emerging topic in health care reform]. / Las funciones esenciales de la salud pública: un tema emergente en las reformas del sector de la salud.

In the Americas, health sector reforms are facing the challenge of strengthening the steering and leadership role of health authorities. An important part of that role consists of fulfilling the essential public health functions (EPHFs) that are incumbent on all levels of government. For that, it's crucial to improve public health practice, as well as the instruments used to assess the current state of public health practice and the areas where it needs to be strengthened. For that purpose, the Pan American Health Organization has started an initiative called "Public Health in the Americas," with the objective of defining and measuring EPHFs, as a way of improving public health practice and strengthening the leadership provided by health authorities at all levels of government. This article summarizes conceptual and methodological aspects of defining and measuring EPHFs. The article also analyzes the implications that measuring performance on these public health roles, responsibilities, and activities would have for improving public health practice in the Americas.

Mortality from polymyositis and dermatomyositis in the United States, 1968-1978.

Mortality from polymyositis and dermatomyositis was estimated between 1968 and 1978. Age-specific average annual mortality rates showed unimodal distributions for all sex-race groups. Synergistic interaction was demonstrated between female sex and nonwhite race, greatest mortality being in nonwhite females through age 74. Increases in annual death rates occurred among both white males and white females during the interval. Finally, the increase in mean age at death among all sex groups correlated with improved prognosis as well as decreased mortality among younger persons over time.