Small-area variation in health care affecting the choice of cesarean delivery: the case of a Colombian health insurer

In the midst of health care reform, Colombia has succeeded in increasing health insurance coverage and the quality of health care. In spite of this, efficiency continues to be a matter of concern, and small-area variations in health care are one of the plausible causes of such inefficiencies. In order to understand this issue, we use individual data of all births from a Contributory-Regimen insurer in Colombia. We perform two different specifications of a multilevel logistic regression model. Our results reveal that hospitals account for 20% of variation on the probability of performing cesarean sections. Geographic area only explains 1/3 of the variance attributable to the hospital. Furthermore, some variables from both demand and supply sides are found to be also relevant on the probability of undergoing cesarean sections. This paper contributes to previous research by using a hierarchical model and by defining hospitals as cluster. Moreover, we also include clinical and supply induced demand variables.

Carcinoma de tiroides una verdadera pandemia?

El diagnóstico de cáncer de tiroides se ha incrementado y las posibilidades de detección de una enfermedad subclínica son altas, toda vez que disponemos de herramientas de detección más sensibles y de fácil acceso. Por ende, el clínico requiere conocer la historia natural del nódulo tiroideo y del carcinoma papilar de tiroides de bajo riesgo para brindar a su paciente el mejor tratamiento basado en la evidencia clínica. El objetivo de esta revision es reconocer los elementos clínicos que han condicionado el aumento inusitado de casos de cáncer de tiroides. Conclusión: El sobrediagnóstico del cáncer de tiroides es una realidad, que se posibilita por el uso extendido de biopsia por aspiración con aguja fina ((BACAF)) después de la detección de un nódulo tiroideo, en gran parte de manera incidental, sin acarrear la mayoría de las veces un mejor pronóstico después de su tratamiento.

Abordajes teóricos en la comprensión de la influencia de los recursos económicos en la actividad física

Estudio cualitativo que analiza los abordajes teóricos utilizados por diferentes autores en la comprensión de la influencia de los recursos económicos en la actividad física desde los modelos de determinantes y determinación social.

El papel de la cultura en la construcción de la identidad colectiva del partido conservador. Caso: organización “nuevas generaciones” del partido conservador

El presente trabajo de investigación tiene como objetivo realizar un análisis del papel que juega la cultura en la construcción de la identidad partidista de los jóvenes pertenecientes a la organización “Nuevas Generaciones” del Partido conservador. La pertinencia de este tema radica en abordar el estudio de los partidos políticos desde una perspectiva poco desarrollada en Colombia como lo es la psicología política. Será una investigación de tipo cualitativa con un enfoque psicosocial que se desarrollará a través de un análisis teórico y trabajo de campo. Así, se hará uso de la teoría de la identidad social, desarrollada en los años 70 por Henri Tajfel y David Turner, cuyo objetivo principal ha sido el estudio de la identidad partidista. De esta manera, esta investigación permite evidenciar que la identidad partidista de los jóvenes del Partido Conservador se da a partir de un apego afectivo al Partido, por razones puramente culturales.

Métodos de estadística espacial para evaluar la influencia de factores medioambientales sobre la incidencia y mortalidad por cáncer

Los objetivos de la tesis son: 1.- Estudiar la relación entre la incidencia y mortalidad por cáncer y los factores medioambientales, en particular la contaminación atmosférica, controlando por factores socioeconómicos. 2.- Utilizar aquellos métodos de estadística espacial apropiados para cada tipo de diseño. 3.- Distinguir en los modelos las diferentes fuentes de extra-variabilidad espacial. 4.- Controlar el problema de exceso de ceros inherente a alguna de las neoplasias de interés medioambientales. Conclusiones: - Tanto la incidencia como la mortalidad de las neoplasias, presentaron dos fuentes de extravariación. La extravariaicón espacial, por la que unidades vecinas tienden a presentar razones de incidencia/mortalidad similares, y la heterogeneidad no espacial. En general la extravariabilidad espacial ha resultado ser mucho mayor que la no espacial. - Para suavizar las RIE/RME correspondientes a variables con un porcentaje de ceros superior al40-50% debe utilizarse un modelo que capture este comportamiento. - El mejor modelo en términos de ajuste para recoger el exceso de ceros en las variables de interés ha resultado ser el modelo mixto de riesgo relativo. - Las RIE/RME suavizadas presentan un patrón geográfico claro sólo en algunas neoplasias de interés medioambiental. - Parte de la variabilidad remanente en las RIE/RME suavizadas pudo ser explicada mediante la introducción de variables explicativas, en particular la contaminación atmosférica y variables socioeconómicas. -Como los contaminantes atmosféricos fueron observados en un diseño geoestadístico y las neoplasias de interés mediambiental lo fueron en un diseño en rejilla se modelizó la superficie de exposición. - El efecto del contaminante en cada municipio/sección censal se aproximó introduciendo en el modelo el valor promedio en cada área y la variabilidad intra-área. - El efecto del contaminante se consideró aleatorio, en el sentido de que podría ser diferente en cada una de las áreas. - Las condiciones socioeconómicas fueron otra de las variables que redujeron la variabilidad remanente en las RIE/RME suavizadas. -Las variables explicativas observadas con un diseño en rejilla, como el índice de privación, se introdujeron en el modelo como efectos fijos. - El efecto de la privación sobre la incidencia y/o mortalidad por cáncer de tráquea, bronquios y pulmón, controlando por contaminantes atmosféricos, fue mayor en las mujeres que en los hombres. -Altas concentraciones de contaminantes atmosféricos aumentan el riesgo de padecer neoplasias de interés medioambiental, controlando por condiciones socioeconómicas.

Declines of managed honey bees and beekeepers in Europe

Growing evidence indicates that European managed honey bees are in decline, but information for Europe remains patchy and localized. Here we compile data from 18 European countries to assess trends in the number of honey bee colonies and beekeepers between 1965 and 2005. We found consistent declines in colony numbers in central European countries and some increases in Mediterranean countries. Beekeeper numbers have declined in all of the European countries examined. Our data support the view that honey bees are in decline at least in some regions, which is probably closely linked to the decreasing number of beekeepers. Our data on colony numbers and beekeepers must, however, be interpreted with caution due to different approaches and socioeconomic factors in the various countries, thereby limiting their comparability. We therefore make specific recommendations for standardized methodologies to be adopted at the national and global level to assist in the future monitoring of honey bees.

Prevalence of untreated caries in deciduous teeth in urban and rural areas in the state of Sao Paulo, Brazil

Objectives. To describe the prevalence of dental caries in children with deciduous teeth in urban and rural areas in the state of Sao Paulo, Brazil, and to identify associated factors. Methods. The study included 24 744 children ( 5 - 7 years of age) examined as part of an epidemiological survey on oral health carried out in the state of Sao Paulo ( Levan-tamento Epidemiologico de Sa de Bucal do Estado de Sao Paulo). Multilevel analysis was used to investigate whether the prevalence of untreated caries was associated with the sociodemographic characteristics of the children examined or with the socioeconomic aspects of the participating cities. Results. Being black or brown ( adjusted odds ratio ( OR) = 1.27), attending school in rural areas ( adjusted OR = 1.88), and attending public school ( adjusted OR = 3.41) were identified as determinants for an increased probability of presenting deciduous teeth with untreated caries. Being a female ( adjusted OR = 0.83) was identified as a protective factor. The negative coefficients obtained for second- level independent variables indicate that the oral health profile of the cities included in the study were positively impacted by a higher municipal human development index ( beta = - 0.47) and fluoridated drinking water ( beta = - 0.32). Conclusions. The prevalence of untreated caries is influenced by individual and sociodemographic factors. The present study provides epidemiological information concerning the rural areas in the state of Sao Paulo. This information is useful for strategic planning and for establishing guidelines for oral health actions in local health systems, thereby contributing to oral health equity.

Risk of recurrent stroke and death after first stroke in long-distance ski race participants

Background: Physical activity is of benefit for primary prevention of cardiovascular diseases, but it appears to increase the risk for atrial fibrillation. We aimed to study a cohort of patients following a first stroke in individuals with previous high physical activity, compare them to the general population with respect to recurrent stroke and death, and relate these to atrial fibrillation. Methods and results: From the participants of the Vasaloppet, the world's largest ski-race, and matched individuals from the general population (n=708 604), we identified 5964 patients hospitalized with a first-time stroke between 1994 and 2010. Individuals with severe diseases were excluded. One half percent of skiers and 1% of nonskiers were hospitalized due to stroke. The incidence rate was 8.3 per 100 person-years among skiers and 11.1 among nonskiers. The hazard ratio (HR) for recurrent stroke or death between the 2 groups was 0.76 (95% CI 0.67 to 0.86). The result was consistent in subgroups. The HR for death was 0.66 (95% CI 0.56 to 0.78) and for recurrent stroke 0.82 (95% CI 0.70 to 0.96). After adjustment for smoking and socioeconomic factors, the HR for death was consistent at 0.70 (95% CI 0.56 to 0.87) while the HR for recurrent stroke was not statistically significant. Outcomes for skiers with atrial fibrillation tended to show a lower risk than for nonskiers. Conclusions: This large cohort study supports the hypothesis that patients with a stroke and with prior regular physical activity have a lower risk of death, while their risk for recurrent stroke is similar to that of nonskiers. The skiers had a higher incidence of atrial fibrillation, but still no increased risk of recurring stroke.

Meeting the Standards: An Analysis of Eight Grade Educational Assesment Test Scores in Maine

This paper examines the impact of socioeconomic factors on eighth grade achievement test scores in the face of federal and state initiatives for educational reform in Maine. We use student-level data over a five year period to provide a framework for understanding the policy implications of these initiatives. We model performance on standardized tests using a seemingly unrelated regressions approach and then determine the likelihood of meeting the standards defined by the adequate yearly progress requirements of the No Child Left Behind Act and Maine Learning Results initiatives. Our results indicate that the key factors influencing a student’s test scores include the education of a student’s parents, special services received for learning disabilities, and alternative measures of academic achievement.

Mortalidade por câncer de boca e condição sócio-econômica no Brasil

BORGES,D. M. L.et al. Mortalidade por câncer de boca e condição sócio-econômica no Brasil.Cad. Saúde Pública, Rio de Janeiro, v.25,n.2, p.321-327, fev, 2009

A utilização de serviços odontológicos entre crianças e fatores associados em Sobral, Ceará, Brasil

NORO, L. R. A. et al. A utilização de serviços odontológicos entre crianças e fatores associados em Sobral, Ceará, Brasil. Cad. Saúde Pública, v. 24, n. 7, p. 1509-1516. 2008. ISSN 0102-311X.

Síndrome metabólica e risco cardiovascular na pós- menopausa: avaliação por diferentes critérios diagnósticos e influência de fatores sócio-econômicos

The metabolic syndrome (MetS) involves a group of risk factors and is associated with a significantly higher risk of developing cardiovascular diseases (CVD) and type 2 diabetes. Recent studies have shown the importance of preventing CVD through early diagnosis and treatment of patients with MetS. The objective of our study was to determine the prevalence of MetS by different diagnostic criteria in postmenopausal women and analyze the influence of socioeconomic factors on cardiovascular risk in this sample of the population. A cross-sectional study involving 127 postmenopausal women (45 to 64 years) from Natal and Mossoró, Brazil. The study was approved by the Research Ethics Committee of the Federal University of Rio Grande do Norte. The experimental protocol consisted of applying structured interview, clinical examination and implementation of dosages blood. The diagnosis of MetS was based on NCEP-ATP III (National Cholesterol Education Program-Adult Treatment Panel III) and IDF (International Diabetes Federation) criteria. The research was accomplished with the participation of an interdisciplinary team in their several phases. The result of the sample studied had mean age of 53.9 ± 4.6 years and per capita income of 54.5 dollars. The prevalence of MetS, according to NCEP-ATP III and IDF criteria, was 52.8% and 61.4$, respectively. The agreement rate between NCEP-ATP III and IDF criteria was 81.9%, with a kappa value of 0.63 (CI 95%, 0.49-0.76), indicating good agreement between the two definitions. The most prevalent cardiovascular risk factor was HDL < 50 mg/dl, observed in 96.1% of the women analyzed, followed by increased waist circumference (≥ 80 cm) in 78.0%, elevated blood pressure in 51.2%, triglycerides ≥ 150 mg/dl in 40.9% and glycemia ≥ 100 mg/dl in 37.0% of the women. The occurrence of MetS was significantly associated with schooling and body mass index (BMI). High blood pressure was significantly associated with low family income, low schooling and weight gain. There was no significant association between the intensity of climacteric symptomatology and the occurrence of MetS. The conclusions of the research were that MetS and its individual components show a high prevalence in postmenopausal Brazilian women, and significant associations with weight gain and low socioeconomic indicators. The data point to the need for an interdisciplinary approach at the basic health care level, directed toward the early identification of risk factors and the promotion of cardiovascular health of climacteric women.

Avaliação das indicações de ceratoplastia penetrante no interior paulista

Objective: To determinate the corneal diagnoses of patients underwent Penetrating Keratoplasty (PK) in the university hospital of Sao Jose do Rio Preto, São Paulo, Brazil, and their relation to age group, gender and socioeconomic factors. Methods: Retrospective analysis of 1085 registration forms of patients underwent Penetrating Keratoplasty in the university hospital of Sao Jose do Rio Preto, São Paulo, Brazil, from 2000 to 2009. The surgical indications were then correlated to age group, gender and socioeconomic factors, by chi-square test. Results: Fifty-seven percent of all Penetrating Keratoplasties were performed in male patients, and the mean age was 52.3 years. Most surgeries (90.8%) occurred by means of public health care (SUS). The main diagnosis was leukoma (23%), representing 14% of the indications for PK in males and 9% in females. Leukoma was also the diagnosis in 40% of PK performed in patients older than 60 years and in 94.4% of these surgeries in public health care users. Conclusion: The main indication for Penetrating Keratoplasty was leukoma, predominating in males, ages above 60 years and in public health care users.

Vivência de mulheres em situação de cárcere penitenciário durante o período gestacional

The gradual increase of violence in Brazilian society has being resulting in a growing of the prison population over last years, as well as the proportion of women than men. The participation of women in crime and responsibilities within her family makes this phenomenon a growing social problem. Women prisoners are mostly young, in reproductive age, making pregnancy a recurrent situation while they are serving a sentence. The studies about female criminality are poor and not helpful about its real dimension, especially when targeted to women who experienced pregnancy in this environment. Given these considerations, this research had as its object of study the experience of women in prison during pregnancy: analyze the experience of women in prison during the gestational period. This is a descriptive and qualitative study. The data were sourced through a semi-structured interview with nine incarcerated women, between August and September 2011, who met the inclusion criteria previously established, and organized according to the precepts of content analysis according to Bardin. Through this coding and classification process became a central thematic: the experience of women in prison during pregnancy, resulting in three categories: category 1 interpersonal relationships; category 2 - feelings that permeate the pregnant woman in prison; and category 3 absence of health care to incarcerated pregnant. The data were analyzed according to the available literature and the study revealed that interpersonal relationships, maintained by these women in prison, were marked by distance from family members, primarily due to socioeconomic factors, being a challenge for addressing of pregnancy in prison and reports of abuse of power by employees working in the institution. The women, who experience pregnancy in prison are more likely to experience feelings of worry, doubts, sadness and fear for baby s health due to lack of antenatal care and about the prison environment structure to meet your needs. The health care aimed at these women is poor and often does not occur, endangering the baby s life and his own mother, this is being a troubling reality in public health system. Finally, it is expected that this study can give visibility to an issue rarely discussed in the literature and contribute to the construction of specific public policies for this reality, in order to minimize the effects of incarceration during pregnancy

Caracterização da neofobia alimentar em crianças de três a seis anos

Alimentation is essential in life. Concerning omnivores, characterized by the necessity of a varied diet to satisfy their metabolic needs, it is extremely advantageous the assumption of new foods. However, the assumption of new unknown foods is, potentially dangerous, because of possible intoxications. In this sense, one of the most important behaviors related to reducing risks is the so called food neophobia, characterized by the rejection of new foods and/or an ingestion of very little amounts. The aim of the present study was to investigate if age, sex and socio-economical status were able to influence food neophobia. The neophobia has been described in a range of 3-6 years old children taken both from public and private schools within the city of Natal-RN. Four different type of ice-creams, each one characterized by a different flavor, have been utilized. Two flavors were known to the young and the remaining two flavor were new. We didn't find significant differences between the investigated variables. However, the exploitation of data from the survey conducted showed that the ease or not to accept new foods obtained, was correlated with the variables under the same guidelines observed in literature. Aspects related to the stimulus used probably eased the neophobic answer. Then, it is suggested that the food neophobia can be influenced by sex, age and socioeconomic factors of individuaIs. Neophobia tends to be more common in girls, with ages between three to four years old and with a low leveI socioeconomic. In this sense, given the importance of kid neophobic reaction to the development of dietary patterns of other life's stages, it is necessary to make further studies to better explain this phenomenon. Given the pivotal role of food neophobia to the development of alimentary habits within all ages of life, other studies will be necessary for a better comprehension of such phenomena. Key-words: food neophobia; Evolutionary Psychology;children food intake; diet restriction; children's diet development