Delaying sexual onset: outcome of a comprehensive sexuality education initiative for adolescents in public schools.

BACKGROUND: A common risk behavior in adolescence is the early initiation of unprotected sex that exposes adolescents to an unplanned pregnancy or sexually transmitted infections. Schools are an ideal place to strengthen adolescents' sexual knowledge and modify their behavior, guiding them to exercise responsible sexuality. The purpose of this article was to evaluate the knowledge of public secondary school teachers who received training in comprehensive education in sexuality (CES) and estimate the counseling's effect on students' sexual behavior. METHODS: Seventy-five public school teachers were trained in participatory and innovative techniques for CES. The change in teacher knowledge (n = 75) was assessed before and after the training using t-tests, Wilcoxon ranks tests and a Generalized Estimate Equation model. The students' sexual and reproductive behavior was evaluated in intervention (n = 650) and comparison schools (n = 555). We fit a logistic regression model using the students' sexual debut as a dependent variable. RESULTS: Teachers increased their knowledge of sexuality after training from 5.3 to 6.1 (p < 0.01). 83.3% of students in the intervention school reported using a contraceptive method in their last sexual relation, while 58.3% did so in the comparison schools. The students in comparison schools were 4.7 (p < 0.01) times more likely to start sexual initiation than students in the intervention schools. CONCLUSION: Training in CES improved teachers' knowledge about sexual and reproductive health. Students who received counseling from teachers who were trained in participatory and innovative techniques for CES used more contraceptive protection and delayed sexual debut.

Clima Organizacional: estudio de caso en un Centro de Salud del primer nivel de atención Morelos México / Organizational climate: case study of a primary-care health facility in Morelos México / Ambiente organizacional: estudo de caso num centro de saúde de Morelos México / Climat organisationnel: étude de cas d'un établissement de santé de premierniveau de prise en charge, État de Morelos, Mexique

Resumen Objetivo: Analizar el clima organizacional de un Centro de Salud de Primer Nivel de Atención Morelos, México. Materiales y Métodos: Estudio de tipo transversal, descriptivo y analítico que utilizó métodos cuantitativos para conocer el nivel de las cuatro dimensiones del Clima Organizacional que se presentan en esa unidad de salud, Población de estudio: todo el personal de salud del Centro. Para la recolección de los datos se utilizó la metodología propuesta por la OPS/OMS para el programa (PASCAP), modificado. El instrumento usado: cuestionario estructurado auto-aplicable, en dos partes: datos socioeconómicos y 80 preguntas sobre el clima organizacional de cuatro dimensiones: Liderazgo, Motivación, Reciprocidad y Participación. Resultados: Total de integrantes: 13 la mayor representación fue de enfermeras (39%), la motivación fue la dimensión con menor representación (1.3 Sd.0.761), la dimensión del liderazgo al estímulo a la excelencia fue el menor calificado. El centro presenta un clima organizacional en los niveles de medio a poco satisfactorio; el género en el liderazgo (p=0.032) y la reciprocidad (p=0.032) presentan diferencias significativas. Conclusión: El estudio muestra que el Clima Organizacional del Centro presenta niveles poco satisfactorios. Lo anterior influye en el desempeño del Centro.

Abstract Objective: To analyze the organizational climate in a primary-care health facility in Morelos México. Material and method: We conducted a descriptive and analytical cross-sectional study using quantitative methods to assess the levels of the four organizational climate dimensions (leadership, motivation, reciprocity and participation) exhibited by the facility of interest. Our study population included all health personnel in the facility. To collect data, we adopted and partially modified the methodology proposed by the WHO/PAHO for the Program for Health Training in Central America and Panama (PASCAP). Our instrument was divided into two sections: the first explored socio-demographics and the second the organizational climate at the facility. The second section was designed on the basis of 80 randomly distributed items which were used to evaluate the four dimensions of the organizational climate; each dimensional element, in turn, corresponded to four subdimensions. Results: Our sample included a total of 13 participants, with nurses contributing the largest proportion (39%). Of the four dimensions examined, motivation was the least represented (1.3 Sd.0.761), while leadership - the stimulus for excellence - was the lowest rated. The facility analyzed was assessed as having an average to unsatisfactory organizational climate, with gender yielding significant differences as regards leadership (p=0.032) and reciprocity (p=0.032). Discussion: The study shows that the levels of organizational climate at the facility analyzed were only marginally satisfactory. The above influences the performance of the facility.

Resumo Objetivo: Analisar o ambiente organizacional no Centro de Saúde de Morelos México. Material e Método: Estudo de tipo transversal, descritivo e analítico que utilizou métodos quantitativos para conhecer o nivel das 4 dimensoes do ambiente organizacional (Liderança, Motivaçâo, Reciprocidade e Participaçâo) existente nesta unidade da saúde; a populaçâo do estudo consistiu em todo os profissionais do centro de saúde. Os dados foram colhidos utilizando a metodologia proposta pela OPS/ OMS para o programa (PASCAP) modificado. Utilizou-se um questionário estruturado autopreenchido com 2 partes. A primeira permite caracterizar sociodemográficamente a amostra e a segunda conhecer o ambiente organizacional (Liderança, Motivaçâo, Reciprocidade e Participaçâo) através de 80 questoes. Resultados: Total de participantes 13; a maior representaçâo foi a das enfermeiras (39%), a motivaçâo foi a dimensâo com menos representatividade (1.3 Sd.0.761), a dimensâo da liderança para estimular à excelência foi a menor qualificada. O centro apresenta um ambiente organizacional com níveis que vâo de médio a pouco satisfatório, a questâo do genero na liderança (p=0.032) e reciprocidade (p=0.032) apresentam diferenças significativas. Discussao: O estudo demonstra que o ambiente organizacional no Centro apresenta níveis pouco satisfatórios, o que afeta o seu desempenho.

Résumé Objectif: Analyser le climat organisationnel d'un établissement de santé de premier niveau de prise en charge situé dans l'État de Morelos, au Mexique. Matériaux et méthode: Une étude transversale, descriptive et analytique a été réalisée en utilisant des méthodes quantitatives pour évaluer le niveau des quatre dimensions du climat organisationnel. La population à l'étude a été la totalité du personnel de santé de cet établissement. Pour la collecte des données, la méthodologie a été celle proposée par l'OPS/OMS pour le Programme de formation en santé de l'Amérique centrale et du Panama (PASCAP), avec des modifications. L'instrument utilisé a été un questionnaire auto-administrable composé de deux parties (données socio-économiques et climat organisationnel) avec un total de 80 questions englobant les quatre dimensions (Leadership, Motivation, Réciprocité et Participation). Résultats: 13 membres du personnel de santé ont participé à l'étude, avec une prédominance d'infirmières (39%). La motivation a été la dimension la moins représentée (1,3 Sd. 0,761) et la dimension du leadership pour encourager l'excellence la moins bien qualifiée. L'établissement présente un climat organisationnel de niveau peu satisfaisant à moyen. Il existe des différences significatives liées au genre pour le leadership (p = 0,032) et la réciprocité (p = 0,032). Discussion: L'étude montre que le climat organisationnel de l'établissement présente des niveaux peu satisfaisants, ce qui affecte son fonctionnement.

[Contributions of training to the promotion of health in State Health Services: comparative analysis in eight states in Mexico]. / Aportes de la capacitación a la promoción de la salud en los Servicios Estatales de Salud: análisis comparativo en ocho estados de México.

OBJECTIVE: To evaluate the results of the training provided by the National Public Health Institute (INSP per its abbreviation in Spanish) in health promotion to institutional staff of local health services during 2007 and 2008. MATERIALS AND METHODS: A non -experimental evaluative research with comparison group was conducted, in which quantitative and qualitative methods were used. RESULTS: In states intervened a better conceptualization of health promotion, social participation and components of the Health Promotion Operating Model was observed; participatory action research was the basic strategy to work in the community and management showed a tendency to be more participatory and inclusive. CONCLUSION: A better conceptualization of health promotion has allowed health personnel develop more sustainable work processes in the community and has driven the search for consent and participatory management.

Aportes de la capacitación a la promoción de la salud en los Servicios Estatales de Salud: análisis comparativo en ocho estados de México / Contributions of training to the promotion of health in State Health Services: comparative analysis in eight states in Mexico

OBJETIVO: Evaluar los resultados de la capacitación impartida por el Instituto Nacional de Salud Pública en promoción de la salud al personal institucional de los Servicios Estatales de Salud durante el periodo 2007 y 2008. MATERIAL Y MÉTODOS: Se realizó una investigación evaluativa no experimental con grupo de comparación y se combinaron métodos cuantitativos y cualitativos. RESULTADOS: En los estados intervenidos se observó mejor conceptualización de promoción de la salud, participación social y componentes del Modelo Operativo de Promoción de la Salud; la Investigación y Acción Participativa fue la estrategia básica de implementación del trabajo de promoción de la salud en comunidad y la gestión presentó una tendencia a ser más participativa e inclusiva. CONCLUSIÓN: La capacitación ha permitido fortalecer en el personal de salud las competencias para la promoción de la salud y el desarrollo de procesos de trabajo más sostenibles en la comunidad impulsando procesos de gestión concertados y participativos.

OBJECTIVE: To evaluate the results of the training provided by the National Public Health Institute (INSP per its abbreviation in Spanish) in health promotion to institutional staff of local health services during 2007 and 2008. MATERIALS AND METHODS: A non -experimental evaluative research with comparison group was conducted, in which quantitative and qualitative methods were used. RESULTS: In states intervened a better conceptualization of health promotion, social participation and components of the Health Promotion Operating Model was observed; participatory action research was the basic strategy to work in the community and management showed a tendency to be more participatory and inclusive. CONCLUSION: A better conceptualization of health promotion has allowed health personnel develop more sustainable work processes in the community and has driven the search for consent and participatory management.

[Mesoamerican Public Health Institute: technical support and capacity strengthening arm of the Mesoamerican Public Health System]. / Instituto Mesoamericano de Salud Pública: órgano de apoyo técnico y fortalecimiento del Sistema Mesoamericano de Salud Pública.

OBJECTIVE: The Mesoamerican Public Health Institute (IMSP) was constituted in 2009 as the technical organ of the Mesoamerican Public Health System (SMSP) and the Virtual Network of Academic Institutions. Health system capacity strengthening needs and preliminary training results were assessed in the first phase. MATERIAL AND METHODS: The SMSP Master Plans were content-analyzed for each priority and members of the Malaria and Dengue Working Group were surveyed. RESULTS: The training needs required for each SMSP priority area were identified and knowledge management needs for malaria and dengue analyzed. Competencies were mapped across strategic, tactical and operative personnel that will be requiring them. IMSP trained in its first year 91 persons in eight countries. CONCLUSIONS: IMSP is responding to the Mesoamerican region's public health needs.

Instituto Mesoamericano de Salud Pública: órgano de apoyo técnico y fortalecimiento del Sistema Mesoamericano de Salud Pública / Mesoamerican Public Health Institute: Technical support and capacity strengthening arm of the Mesoamerican Public Health System

OBJETIVO: El Instituto Mesoamericano de Salud Pública (IMSP) se constituyó en 2009 como órgano técnico del Sistema Mesoamericano de Salud Pública (SMSP) y la Red Virtual de Instituciones Académicas. En la primera fase se identificaron las necesidades de fortalecimiento de sistemas de salud y se evaluaron los primeros resultados de capacitación. MATERIAL Y MÉTODOS: Se realizó un análisis de contenido de los Planes Maestros del SMSP para cada prioridad y se encuestó a los integrantes del Grupo de Trabajo en Malaria y Dengue. RESULTADOS: Se identificaron los temas de capacitación requeridos por áreas de prioridad del SMSP y las necesidades de gestión de conocimiento para control y eliminación de la malaria y dengue. Se elaboró un mapeo de competencias a desarrollar con el personal estratégico, táctico y operativo. El IMSP capacitó a 91 funcionarios de ocho países en su primer año. Estas actividades se desarrollaron de julio 2009 a junio 2010, en consulta a directivos de servicios de salud de países integrantes del Sistema Mesoamericano de Salud Pública, Colombia y México. CONCLUSIONES: El IMSP está respondiendo a las necesidades de salud pública en la región mesoamericana.

OBJECTIVE: The Mesoamerican Public Health Institute (IMSP) was constituted in 2009 as the technical organ of the Mesoamerican Public Health System (SMSP) and the Virtual Network of Academic Institutions. Health system capacity strengthening needs and preliminary training results were assessed in the first phase. MATERIAL AND METHODS: The SMSP Master Plans were content-analyzed for each priority and members of the Malaria and Dengue Working Group were surveyed. RESULTS: The training needs required for each SMSP priority area were identified and knowledge management needs for malaria and dengue analyzed. Competencies were mapped across strategic, tactical and operative personnel that will be requiring them. IMSP trained in its first year 91 persons in eight countries. CONCLUSIONS: IMSP is responding to the Mesoamerican region's public health needs.