Determinants of vaccination after the Colombian health system reform

OBJECTIVE: To assess the effects of individual, household and healthcare system factors on poor children's use of vaccination after the reform of the Colombian health system. METHODS: A household survey was carried out in a random sample of insured poor population in Bogota, in 1999. The conceptual and analytical framework was based on the Andersen's Behavioral Model of Health Services Utilization. It considers two units of analysis for studying vaccination use and its determinants: the insured poor population, including the children and their families characteristics; and the health care system. Statistical analysis were carried out by chi-square test with 95% confidence intervals, multivariate regression models and Cronbach's alpha coefficient. RESULTS: The logistic regression analysis showed that vaccination use was related not only to population characteristics such as family size (OR=4.3), living area (OR=1.7), child's age (OR=0.7) and head-of-household's years of schooling (OR=0.5), but also strongly related to health care system features, such as having a regular health provider (OR=6.0) and information on providers' schedules and requirements for obtaining care services (OR=2.1). CONCLUSIONS: The low vaccination use and the relevant relationships to health care delivery systems characteristics show that there are barriers in the healthcare system, which should be assessed and eliminated. Non-availability of regular healthcare and deficient information to the population are factors that can limit service utilization.

Determinants of the use of health care services: multilevel analysis in the Metropolitan Region of Sao Paulo

OBJECTIVE To evaluate the individual and contextual determinants of the use of health care services in the metropolitan region of Sao Paulo.METHODS Data from the Sao Paulo Megacity study – the Brazilian version of the World Mental Health Survey multicenter study – were used. A total of 3,588 adults living in 69 neighborhoods in the metropolitan region of Sao Paulo, SP, Southeastern Brazil, including 38 municipalities and 31 neighboring districts, were selected using multistratified sampling of the non-institutionalized population. Multilevel Bayesian logistic models were adjusted to identify the individual and contextual determinants of the use of health care services in the past 12 months and presence of a regular physician for routine care.RESULTS The contextual characteristics of the place of residence (income inequality, violence, and median income) showed no significant correlation (p > 0.05) with the use of health care services or with the presence of a regular physician for routine care. The only exception was the negative correlation between living in areas with high income inequality and presence of a regular physician (OR: 0.77; 95%CI 0.60;0.99) after controlling for individual characteristics. The study revealed a strong and consistent correlation between individual characteristics (mainly education and possession of health insurance), use of health care services, and presence of a regular physician. Presence of chronic and mental illnesses was strongly correlated with the use of health care services in the past year (regardless of the individual characteristics) but not with the presence of a regular physician.CONCLUSIONS Individual characteristics including higher education and possession of health insurance were important determinants of the use of health care services in the metropolitan area of Sao Paulo. A better understanding of these determinants is essential for the development of public policies that promote equitable use of health care services.

Contextual determinants of induced abortion: a panel analysis

ABSTRACT OBJECTIVE Analyze the contextual and individual characteristics that explain the differences in the induced abortion rate, temporally and territorially. METHODS We conducted an econometric analysis with panel data of the influence of public investment in health and per capita income on induced abortion as well as a measurement of the effect of social and economic factors related to the labor market and reproduction: female employment, immigration, adolescent fertility and marriage rate. The empirical exercise was conducted with a sample of 22 countries in Europe for the 2001-2009 period. RESULTS The great territorial variability of induced abortion was the result of contextual and individual socioeconomic factors. Higher levels of national income and investments in public health reduce its incidence. The following sociodemographic characteristics were also significant regressors of induced abortion: female employment, civil status, migration, and adolescent fertility. CONCLUSIONS Induced abortion responds to sociodemographic patterns, in which the characteristics of each country are essential. The individual and contextual socioeconomic inequalities impact significantly on its incidence. Further research on the relationship between economic growth, labor market, institutions and social norms is required to better understand its transnational variability and to reduce its incidence.

Household-based malaria control in a highly endemic area of Africa (Tanzania): determinants of transmission and disease and indicators for monitoring - Kilombero Malaria Project

The Kilombero Malaria Project (KMP) attemps to define opperationally useful indicators of levels of transmission and disease and health system relevant monitoring indicators to evaluate the impact of disease control at the community or health facility level. The KMP is longitudinal community based study (N = 1024) in rural Southern Tanzania, investigating risk factors for malarial morbidity and developing household based malaria control strategies. Biweekly morbidity and bimonthly serological, parasitological and drug consumption surveys are carried out in all study households. Mosquito densities are measured biweekly in 50 sentinel houses by timed light traps. Determinants of transmission and indicators of exposure were not strongly aggregated within households. Subjective morbidity (recalled fever), objective morbidity (elevated body temperature and high parasitaemia) and chloroquine consumption were strongly aggregated within a few households. Nested analysis of anti-NANP40 antibody suggest that only approximately 30% of the titer variance can explained by household clustering and that the largest proportion of antibody titer variability must be explained by non-measured behavioral determinants relating to an individual's level of exposure within a household. Indicators for evaluation and monitoring and outcome measures are described within the context of health service management to describe control measure output in terms of community effectiveness.

Avaliação dos limiares auditivos com e sem equipamento de proteção individual

Os autores realizaram estudo caso-controle audiométrico em indivíduos com e sem protetor auricular auditivo. OBJETIVOS: O objetivo do estudo foi avaliar a real atenuação individual dado pelos protetores. MATERIAL E MÉTODO: Foram avaliados 30 indivíduos (ou 60 orelhas) de diferentes atividades profissionais, de ambos os sexos, com idades entre 20 e 58 anos, apresentando audição normal e tendo realizado repouso auditivo de 10 horas, submetidos a exame audiométrico com e sem protetor auricular auditivo, no período de fevereiro a julho de 2003, utilizando protetor tipo plugue. Avaliou-se as audiometrias nas vias aérea e óssea em freqüências de 500 a 4000Hz. RESULTADOS: Os resultados foram analisados estatisticamente e comparados aos dados fornecidos pelo fabricante. Assim se observou em ouvido real os níveis de atenuação auditiva obtidos com o uso destes produtos. CONCLUSÃO: Os resultados permitiram chegar à conclusão de que os índices fornecidos pelos fabricantes foram compatíveis com os que obtive nos testes.

Efeitos de treinamento nos desempenhos individual e organizacional

O objetivo deste estudo foi desenvolver um método para identificar efeitos de treinamento nos desempenhos dos indivíduos e da organização, combinação ainda rara na literatura científica. Foi realizado no Banco do Brasil, com 218 profissionais que fizeram um MBA em Marketing. Os dados foram coletados por meio de entrevistas e questionários de auto e heteroavaliação. Nos questionários foi avaliada a contribuição do treinamento para a melhoria do desempenho individual e organizacional, e o suporte à transferência de treinamento. Nas entrevistas foram levantados indicadores de melhoria do desempenho organizacional para os maiores impactos percebidos pelos respondentes. Os resultados indicam que, para a maioria dos desempenhos individuais e organizacionais, o impacto percebido do treinamento foi avaliado entre bom e ótimo. A metodologia utilizada foi considerada adequada para a identificação de melhorias nos desempenhos organizacionais, percebidos como os mais afetados pelo treinamento. Também foram discutidas implicações metodológicas, teóricas e perspectivas futuras.

DETERMINANTS OF THE SUCCESS OF GLOBAL AND LOCAL BRANDS IN LATIN AMERICA

ABSTRACTThe purpose of this paper is to address the issue of the implementation of global and local brands in Latin America by drawing on contingency theory to develop and test hypotheses relating to how product category characteristics affect the success of global and local brands in the region. Hypotheses are tested using data obtained from top brands rankings reported in five Latin American markets (Argentina, Brazil, the Caribbean and Central America, Chile and Mexico). The study design considers estimating a logistic regression on a binomial dependent variable measuring whether 475 top brands are global or local brands, with product category characteristics as independent variables. Results reveal that product categories related to subscriptions, local tastes, high-tech, and global citizenship do have an impact on the success of global and local brands in Latin America.

CROSS-COUNTRY STUDY ON THE DETERMINANTS OF BANK FINANCIAL DISTRESS

ABSTRACTBank failures affect owners, employees, and customers, possibly causing large-scale economic distress. Thus, banks must evaluate operational risks and develop early warning systems. This study investigates bank failures in the Organization for Economic Co-operation and Development, the North America Free Trade Area (NAFTA), the Association of Southeast Asian Nations, the European Union, newly industrialized countries, the G20, and the G8. We use financial ratios to analyze and explore the appropriateness of prediction models. Results show that capital ratios, interest income compared to interest expenses, non-interest income compared to non-interest expenses, return on equity, and provisions for loan losses have significantly negative correlations with bank failure. However, loan ratios, non-performing loans, and fixed assets all have significantly positive correlations with bank failure. In addition, the accuracy of the logistic model for banks from NAFTA countries provides the best prediction accuracy regarding bank failure.

Fatores críticos no comportamento do gestor público responsável por compras sustentáveis: diferenças entre consumo individual e organizacional

O presente artigo investiga o comportamento de gestores públicos, identificando os fatores críticos que determinam o processo decisório de compra sustentável, seja no contexto de compras individuais (ou domésticas) ou no contexto de compras organizacionais (nesse caso, refere-se às compras públicas sustentáveis, conceito recentemente inserido na legislação brasileira). Em seguida à aplicação de questionários a um grupo de gestores públicos encarregados da elaboração de editais e condução de certames licitatórios, foram realizadas inferências estatísticas que determinaram as similitudes entre os dois contextos. A partir dos resultados, observou-se diferenças relacionadas com o contexto de compra envolvido, em especial naquelas que envolvem preço, determinações da legislação e tempo gasto nas especificações dos produtos a serem adquiridos. Chamam atenção, ademais, o fato de que alguns padrões pró-ambientais se mostram bem estabelecidos, evidenciado o resultado de campanhas desenvolvidas no âmbito da instituição.

Esterilidad individual en Rhodnius prolixus Stal. tratados con metepa (oxido de tris (1-(2 metil) aziridinil) fosfuro), y accion del mismo sobre Trypanosoma cruzi

Se analizan los factores que interfieren en la esterilidad inducida químicamente en R. Prolixus mediante aplicaciones tópicas en distintas dosis de metepa. Se sugiere profundizar el estudio de la susceptibilidad individual para conocer la composición de la población frente al quimioesterilizante y la probable aparición de resistencia. Se investiga además la acción del metepa sobre T. cruzi en triatominos infectados experimentalmente, obteniéndose resultados negativos.

Antinomias e "suturas" epistemológicas entre biológico-social e individual-coletivo no âmbito da epidemiologia social

A complexidade do objeto epidemiológico tem suscitado, ao longo do tempo, discussão sobre alguns elementos que o compõem, assumindo, muitas vezes, a forma de antinomias. Utilizando-se como substrato textos fundamentais, analisaram-se, no âmbito da epidemiologia social, a formulação e a proposta de solução para as antinomias biológico-social e individual-coletivo. Criticou-se a validade teórica das saídas apontadas pelo discurso epidemiológico-social para resolver o "conflito de leis" que permeia o referido objeto. Destacou-se o conceito marxista-helleriano de indivíduo para contribuir com a "sutura" dos três planos da realidade: o universal, o particular e o singular.

HTLV-I/II and blood donors: determinants associated with seropositivity in a low risk population

OBJECTIVE: Blood donors in Brazil have been routinely screened for HTLV-I/II since 1993. A study was performed to estimate the prevalence of HTLV-I/II infection in a low risk population and to better understand determinants associated with seropositivity. METHODS: HTLV-I/II seropositive (n=135), indeterminate (n=167) and seronegative blood donors (n=116) were enrolled in an open prevalence prospective cohort study. A cross-sectional epidemiological study of positive, indeterminate and seronegative HTLV-I/II subjects was conducted to assess behavioral and environmental risk factors for seropositivity. HTLV-I/II serological status was confirmed using enzyme-linked immunosorbent assay (EIA) and Western blot (WB). RESULTS: The three groups were not homogeneous. HTLV-I/II seropositivity was associated to past blood transfusion and years of schooling, a marker of socioeconomic status, and use of non-intravenous illegal drugs. CONCLUSIONS: The study results reinforce the importance of continuous monitoring and improvement of blood donor selection process.

Determinants of salivary cotinine level: a population-based study in Brazil

OBJECTIVE: A cross-sectional population-based study was conducted to assess, in active smokers, the relationship of number of cigarettes smoked and other characteristics to salivary cotinine concentrations. METHODS: A random sample of active smokers aged 15 years or older was selected using a stepwise cluster sample strategy, in the year 2000 in Rio de Janeiro, Brazil. The study included 401 subjects. Salivary cotinine concentration was determined using gas chromatography with nitrogen-phosphorus detection. A standard questionnaire was used to collect demographic and smoking behavioral data. The relation between the number of cigarettes smoked in the last 24h and cotinine level was examined by means of a nonparametric fitting technique of robust locally weighted regression. RESULTS: Significantly (p<0.05) higher adjusted mean cotinine levels were found in subjects smoking their first cigarette within five minutes after waking up, and in those smoking 1-20 cigarettes in the last 24h who reported inhaling more than ½ the time. In those smoking 1-20 cigarettes, the slope was significantly higher for those subjects waiting for more than five minutes before smoking their first cigarette after waking up, and those smoking "light" cigarettes when compared with their counterparts. These heterogeneities became negligible and non-significant when subjects with cotinine >40 ng/mL per cigarette were excluded. CONCLUSIONS: There was found a positive association between self-reporting smoking five minutes after waking up, and inhaling more than ½ the time are consistent and higher cotinine levels. These can be markers of dependence and higher nicotine intake. Salivary cotinine proved to be a useful biomarker of recent smoking and can be used in epidemiological studies and smoking cessation programs.

Avaliação estratégica de educação em grupo e individual no programa educativo em diabetes

OBJETIVO: Comparar a efetividade de estratégias, em grupo e individual, de programa educativo em diabetes. MÉTODOS: Cento e quatro pacientes com diabetes tipo 2, atendidos no ambulatório e com seguimento em programa educativo de hospital de Belo Horizonte (MG), foram aleatoriamente recrutados e alocados em dois grupos: educação em grupo (n=54) e individual (n=50). A educação em grupo consistia de três encontros mensais, nos quais eram desenvolvidas dinâmicas lúdicas e interativas. Simultaneamente, o outro grupo era acompanhado individualmente. O acompanhamento ocorreu por seis meses durante o ano de 2006, sendo avaliados por questionários específicos: conhecimentos em diabetes, atitudes psicológicas, mudança de comportamento, qualidade de vida. Foi realizada avaliação clínica no tempo inicial, depois de três e seis meses da intervenção. RESULTADOS: A média de idade dos pacientes era de 60,6 anos. Os resultados da educação em grupo e individual foram semelhantes no teste de atitudes, mudança de comportamento e qualidade de vida. Observou-se redução nos níveis de HbA1c nos dois grupos, entretanto apenas no de educação em grupo a diferença apresentou significância estatística (p= 0,012). CONCLUSÕES: As duas estratégias do programa educativo em diabetes foram efetivas, porém a educação em grupo apresentou melhores resultados de controle glicêmico do que a individual.