Salud urbana: iniciativas internacionales para retos distritales / Urban Health: International Initiatives for District-wide Challenges / Saúde urbana: iniciativas internacionais para desafios distritais

Objetivo: presentar un panorama general de los retos para la gestión de la salud pública que suponen las condiciones de salud de las poblaciones urbanas en el mundo, las amenazas más importantes para la salud que orientan la gestión del riesgo, y las ciudades saludables y salutogénicas como alternativas de manejo propuestas desde la promoción de la salud. Métodos: por medio de PubMed y Scielo se buscaron revisiones de los últimos 5 años con los términos "salud urbana" en inglés y español. Luego, por medio del título y el abstract se escogieron 52 fuentes que fueron analizadas y sintetizadas. Se incluyeron adicionalmente 8 documentos que complementan la elaboración de este artículo. Resultados: la salud urbana es una preocupación a nivel global, teniendo en cuenta el fenómeno de migración de la población a las ciudades, por lo tanto, la gobernanza urbana para la salud asume que con aproximaciones basadas en la promoción de la salud se puede lograr una planeación urbana que mejore los resultados de esta creciente población. Ejemplos de estos propósitos son la Red Europea de Ciudades Saludables y el Programa de Municipalidades y Comunidades Saludables en América Latina. Conclusiones: se proyecta que Bogotá tenga una tasa de crecimiento del 1,2 % para el 2020, lo cual configura mayores retos en el desarrollo de salud para la población capitalina. Por ello, es imprescindible emplear las estrategias de salutogénesis, gestión del riesgo y sistemas locales de salud para que la capital colombiana se convierta en una ciudad saludable abarcando los diferentes niveles de promoción y prevención. Así mismo, se propone aplicar las herramientas de evaluación de impacto en salud (Health Impact Assessment - HIA) y la evaluación y respuesta de equidad en salud (Urban Health Equity Assessment and Response Tool - Urban HEART) para analizar los resultados del plan territorial en salud 2016-2020 y, a partir de esto, fortalecer la gobernanza urbana para la salud en Bogotá.

Objective: To present an overview of the challenges for public health management posed by the health conditions of urban populations in the world, the most significant threats to health that guide risk management, and healthy and salutogenic cities as management alternatives proposed from the perspective of health promotion. Methods: We searched PubMed and Scielo for reviews of the last 5 years with the terms "urban health" in English and Spanish. Then, by means of the title and abstract, 52 sources were analyzed, and synthesized. In addition, 8 documents were included to complement the preparation of this article. Results: Urban health is a global concern considering the phenomenon of population migration to cities, therefore, urban governance for health assumes that with approaches based on health promotion, urban planning can be achieved to improve the health outcomes of this growing population. Examples of these efforts are the European Healthy Cities Network and the Healthy Municipalities and Communities program in Latin America (Programa de Municipalidades y Comunidades Saludables en América Latina). Conclusions: Bogotá is projected to have a growth rate of 1.2 % by 2020, which poses major challenges in the development of health care for the capital's population. Therefore, it is essential to employ strategies of salutogenesis, risk management and local health systems for the Colombian capital to become a healthy city, covering the different levels of promotion and prevention. Likewise, the application of Health Impact Assessment (HIA) and Urban Health Equity Assessment and Response Tool (Urban HEART) tools is suggested to analyze the results of the 2016-2020 territorial health plan, and based on this, strengthen urban governance for health in Bogotá.

Objetivo: apresentar um panorama dos desafios para a gestão da saúde pública colocados pelas condições de saúde das populações urbanas no mundo, as mais importantes ameaças à saúde que orientam a gestão de riscos, e cidades saudáveis e salutogênicas como alternativas de gestão propostas a partir da promoção da saúde. Métodos: através do PubMED e Scielo, foram pesquisadas revisões dos últimos 5 anos com os termos "saúde urbana" em inglês e espanhol, respectivamente. Em seguida, por meio do título e do resumo, foram escolhidas 52 fontes para serem analisadas e sintetizadas. Adicionalmente, foram incluídos 8 documentos que complementam a elaboração deste artigo. Resultados: a saúde urbana é uma preocupação global, levando em conta o fenômeno da migração da população para as cidades, portanto, a governança urbana para a saúde pressupõe que as abordagens de promoção da saúde podem alcançar um planejamento urbano que melhore os resultados de saúde para esta população em crescimento. Exemplos desses propósitos são a Rede Europeia de Cidades Saudáveis e o Programa de Municípios e Comunidades Saudáveis na América Latina. Conclusões: prevê-se que Bogotá tenha uma taxa de crescimento de 1,2% até 2020, o que representa maiores desafios no desenvolvimento da saúde para a população da capital. Portanto, é essencial utilizar as estratégias de salutogênese, gestão de risco e sistemas locais de saúde para que a capital colombiana se torne uma cidade saudável, englobando os diferentes níveis de promoção e prevenção. Da mesma forma, propõe-se aplicar as ferramentas de avaliação de impacto na saúde (Health Impact Assessment - HIA) e avaliação e resposta da equidade em saúde (Urban Health Equity Assessment and Response Tool - Urban HEART) para analisar os resultados do plano territorial de saúde 2016-2020 (2) e, a partir disso, fortalecer a governança urbana para a saúde em Bogotá.

[Pertussis predictors in hospitalized infants with acute lower respiratory tract infection]. / Predictores de coqueluche al ingreso en lactantes hospitalizados con infección respiratoria aguda baja.

BACKGROUND: Pertussis, or whooping cough, caused by Bordetella pertussis (BP) is a re-emerging problem in our environment. Although generally considered that the disease is relatively easy to identify infections respiratory syncytial virus (RSV) can present with similar symptoms in infants remains difficult discrimination. OBJECTIVE: Compare clinical symptoms at admission and complementary studies in infants hospitalized with acute respiratory infection (ARI) and RSV by BP to establish markers that enable their early clinical prediction. MATERIALS AND METHODS: Observational, analytical, case-crossover cross comparing younger than 6 months hospitalized with suspected IRA and pertussis (2007-2012) in which BP identified (PCR and culture) and / or VRS (immunofluorescence in nasal secretions). Coinfections were excluded. Bivariate analysis was performed by calculating OR with 95% CI. Were considered significant at p <0.05. The variables studied were age, sex, hits cough, cyanosis, vomiting, apnea, wheezing and CBC with differential RESULTS: We included 174 infants, 72 (41%) BP and 102 (59%) VRS. Age 2 ± 1 months (range :1-6). In both groups was documented cough and wheeze (OR: 1.2 (0.9 to 1.5) p: 0.1 and OR = 0.9 (0.8 to 1.06) p: 0.2, respectively ). Cyanosis (87% vs. 6%, OR: 14.8 p <0.01), apnea (38% vs. 3%, OR: 13.4 p <0.01) and vomiting (26% vs. 5% , OR: 3.4 p <0.01) were more frequent in infants with BP. The absolute lymphocyte count was significantly higher in children with BP (9387 ± 6317 vs. 5127 ± 2766, p <0.01). By ROC curve was identified at 9000 cells / ml as the best point to differentiate VSR BP (AUC = 0.73, 95% CI :0,64-0, 81). CONCLUSIONS: In infants under 6 months with IRA income presence of apnea, cyanosis and lymphocytosis allowing predict significantly differentiate between pertussis those with RSV infections.

Antecedentes. La tos ferina o coqueluche, producida por Bordetella pertussis (BP) representa un problema re-emergente en nuestro medio. Aunque suele considerarse que la enfermedad es relativamente fácil de identificar, las infecciones por Virus Respiratorio Sincicial (VRS) pueden presentarse con síntomas similares en los lactantes siendo difícil su discriminación. Objetivo. Comparar síntomas clínicos y estudios complementarios al ingreso en lactantes hospitalizados con infección respiratoria aguda (IRA) por BP y por VSR a fin de establecer marcadores que posibiliten su predicción clínica temprana. Material y método. Estudio observacional, analítico, transversal de casos cruzados, comparando menores de 6 meses internados por IRA y sospecha de coqueluche (2007-2012) en los que se identificó BP (PCR y cultivo) y/o VRS (inmunofluorescencia en secreciones nasales); se excluyeron los pacientes con coinfecciones. Se realizó un análisis bivariado mediante el cálculo de OR con IC95%. Se consideró significativo un valor de p<0,05. Las variables en estudio fueron: edad, sexo, tos en accesos, cianosis, vómitos, apneas, sibilancias y hemograma completo con fórmula leucocitaria Resultados. Se incluyeron 174 lactantes; 72 (41%) BP y 102 (59%) VRS. Edad 2±1 mes (Rango:1-6). En ambos grupos se documentó tos y sibilancias (OR:1,2 (0,9-1,5) p:0,1 y OR:0,9 (0,8-1,06) p:0,2, respectivamente). Cianosis (87% vs. 6%;OR:14,8 p<0,01), apnea (38% vs. 3%;OR:13,4 p<0,01) y vómitos (26% vs. 5%;OR:3,4 p<0,01) fueron más frecuentes en lactantes con BP. El recuento absoluto de linfocitos fue significativamente mayor en niños con BP (9387±6317 vs. 5127±2766;p<0,01). Por curva ROC se identificó a 9000 cel/ml como el mejor punto para diferenciar BP de VSR (abc= 0,73; IC95%:0,64-0,81). Conclusiones. En lactantes menores de 6 meses con IRA la presencia al ingreso de apnea, cianosis y linfocitosis predicen significativamente coqueluche permitiendo diferenciarlos de aquellos con infecciones por VRS.

Predictores de coqueluche al ingreso en lactantes hospitalizados con infección respiratoria aguda baja / [Pertussis predictors in hospitalized infants with acute lower respiratory tract infection].

BACKGROUND: Pertussis, or whooping cough, caused by Bordetella pertussis (BP) is a re-emerging problem in our environment. Although generally considered that the disease is relatively easy to identify infections respiratory syncytial virus (RSV) can present with similar symptoms in infants remains difficult discrimination. OBJECTIVE: Compare clinical symptoms at admission and complementary studies in infants hospitalized with acute respiratory infection (ARI) and RSV by BP to establish markers that enable their early clinical prediction. MATERIALS AND METHODS: Observational, analytical, case-crossover cross comparing younger than 6 months hospitalized with suspected IRA and pertussis (2007-2012) in which BP identified (PCR and culture) and / or VRS (immunofluorescence in nasal secretions). Coinfections were excluded. Bivariate analysis was performed by calculating OR with 95

CI. Were considered significant at p <0.05. The variables studied were age, sex, hits cough, cyanosis, vomiting, apnea, wheezing and CBC with differential RESULTS: We included 174 infants, 72 (41

) BP and 102 (59

) VRS. Age 2 ± 1 months (range :1-6). In both groups was documented cough and wheeze (OR: 1.2 (0.9 to 1.5) p: 0.1 and OR = 0.9 (0.8 to 1.06) p: 0.2, respectively ). Cyanosis (87

, OR: 13.4 p <0.01) and vomiting (26

, OR: 3.4 p <0.01) were more frequent in infants with BP. The absolute lymphocyte count was significantly higher in children with BP (9387 ± 6317 vs. 5127 ± 2766, p <0.01). By ROC curve was identified at 9000 cells / ml as the best point to differentiate VSR BP (AUC = 0.73, 95

CI :0,64-0, 81). CONCLUSIONS: In infants under 6 months with IRA income presence of apnea, cyanosis and lymphocytosis allowing predict significantly differentiate between pertussis those with RSV infections.

Predictores de coqueluche al ingreso en lactantes hospitalizados con infección respiratoria aguda baja. / [Pertussis predictors in hospitalized infants with acute lower respiratory tract infection].

BACKGROUND: Pertussis, or whooping cough, caused by Bordetella pertussis (BP) is a re-emerging problem in our environment. Although generally considered that the disease is relatively easy to identify infections respiratory syncytial virus (RSV) can present with similar symptoms in infants remains difficult discrimination. OBJECTIVE: Compare clinical symptoms at admission and complementary studies in infants hospitalized with acute respiratory infection (ARI) and RSV by BP to establish markers that enable their early clinical prediction. MATERIALS AND METHODS: Observational, analytical, case-crossover cross comparing younger than 6 months hospitalized with suspected IRA and pertussis (2007-2012) in which BP identified (PCR and culture) and / or VRS (immunofluorescence in nasal secretions). Coinfections were excluded. Bivariate analysis was performed by calculating OR with 95

CI. Were considered significant at p <0.05. The variables studied were age, sex, hits cough, cyanosis, vomiting, apnea, wheezing and CBC with differential RESULTS: We included 174 infants, 72 (41

) BP and 102 (59

) VRS. Age 2 ± 1 months (range :1-6). In both groups was documented cough and wheeze (OR: 1.2 (0.9 to 1.5) p: 0.1 and OR = 0.9 (0.8 to 1.06) p: 0.2, respectively ). Cyanosis (87

vs. 6

, OR: 14.8 p <0.01), apnea (38

vs. 3

, OR: 13.4 p <0.01) and vomiting (26

vs. 5

, OR: 3.4 p <0.01) were more frequent in infants with BP. The absolute lymphocyte count was significantly higher in children with BP (9387 ± 6317 vs. 5127 ± 2766, p <0.01). By ROC curve was identified at 9000 cells / ml as the best point to differentiate VSR BP (AUC = 0.73, 95

CI :0,64-0, 81). CONCLUSIONS: In infants under 6 months with IRA income presence of apnea, cyanosis and lymphocytosis allowing predict significantly differentiate between pertussis those with RSV infections.

Evaluación de la calidad de los servicios de salud oral en la red adscrita a la Secretaría Distrital de Salud / Evaluation of the quality of oral health services in the network assigned to the District Health Secretariat

Estudio que tiene como propósito determinar e iniciar procesos que lleven al conocimiento de la calidad total y el mejoramiento continuo de los servicios odontológicos ofrecidos por los hospitales de la red adscrita a la Secretaría Distrital de Salud. La investigación partió de un diagnóstico integral de los servicios de salud oral en el Distrito Capital, realizando una amplia revisión bibliográfica, diseño de una muestra probabilística con un alto grado de confiabilidad, y aplicación de encuestas que permitieron identificar las áreas y aspectos críticos de los servicios, utilizando para ello una metodología de constatación directa mediante trabajo de campo, producción de indicadores y análisis estadísticos. El objetivo general de esta investigación es determinar la calidad en la prestación de los servicios de salud oral en los hospitales de la red adscrita a la Secretaría Distrital de Salud, teniendo en cuenta como indicadores de calidad la atención clínica técnica y la relación interpersonal de las cuales se derivan múltiples componentes agrupados en tres enfoques que corresponden a la estructura, el proceso y el resultado de la atención en salud. La estructura contiene las características del marco en que se prestan los servicios: recursos materiales (tales como instalaciones, dotación y suministros), recursos humanos (tales como cantidad y cualidad del personal) y de la estructura institucional (como la organización del personal y los métodos para evaluar su desempeño). El proceso contiene lo que en realidad se realiza para prestar y recibir servicios e incluye las acciones del profesional para presentar un diagnóstico y recomendar o instrumentar el tratamiento. Por último, el resultado comprende los efectos de la atención para el estado de salud de los pacientes y poblaciones, ya que son ellos los que finalmente determinan lo que significa la calidad, de acuerdo con sus expectativas y valores sobre la atención.

The purpose of this study was to determine and initiate processes that lead to the knowledge of total quality and continuous improvement of the dental services offered by the hospitals of the network assigned to the District Health Secretariat. The research was based on a comprehensive diagnosis of the oral health services in the Capital District, with an extensive literature review, the design of a probabilistic sample with a high degree of reliability, and the application of surveys to identify the critical areas and aspects of the services, using a methodology of direct verification through field work, production of indicators and statistical analysis. The general objective of this research is to determine the quality in the provision of oral health services in the hospitals of the network assigned to the District Health Secretariat, taking into account as quality indicators the technical clinical care and the interpersonal relationship from which multiple components are derived grouped in three approaches that correspond to the structure, the process and the result of health care. Structure contains the characteristics of the framework in which services are provided: material resources (such as facilities, equipment and supplies), human resources (such as quantity and quality of personnel) and institutional structure (such as the organization of personnel and methods for evaluating their performance). The process contains what is actually done to provide and receive services and includes the practitioner's actions to present a diagnosis and recommend or implement treatment. Finally, the outcome comprises the effects of care on the health status of patients and populations, since it is they who ultimately determine what quality means, according to their expectations and values about care.