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Abstract Inefficient use of resources in biomedical technology and low quality in the provision of health services, support the need to implement a process of acquisition and renovation of biomedical technology such as that set out in this Article. It also includes the recommended procedures within this process, which are intended to be standards for all the Institutions that provide Health Services in Colombia.
Resumen El uso ineficiente de los recursos en la tecnología biomédica y la baja calidad en la prestación de servicios de salud, apoyan la necesidad de implementar un proceso de adquisición y renovación de tecnología biomédica como el establecido en este artículo. También incluye los procedimientos recomendados dentro de este proceso, los cuales están destinados a ser estándares para todas las instituciones que proveen servicios de salud en Colombia.
Resumo O uso ineficiente dos recursos da tecnologia biomédica e de baixa qualidade na prestação de serviços de saúde, apoiam a necessidade de implementar um processo de aquisição e renovação da tecnologia biomédica como a estabelecida neste artigo. Também inclui os procedimentos recomendados dentro deste processo, os quais estão destinados a ser padrão para todas as Instituições que proveem Serviços de Saúde na Colômbia.
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Objectives This study investigated the association of the familial coexistence of child stunting and maternal overweight with indigenous women in Guatemala. Methods We selected 2388 child-mother pairs from the data set of the Living Standards Measurement Study conducted in Guatemala in 2000. This study examined the association between maternal and household characteristics and the nutritional status of children aged 6-60 months and mothers aged 18-49 years by using multivariable logistic regression models. Results Compared with non-indigenous households, a significantly higher percentage of indigenous households exhibited stunted child and overweight mother (SCOM) pairs (15.9 vs. 22.2%). Compared with normal-weight mothers, overweight mothers were less likely to have stunted children [adjusted odds ratio (AOR) 0.66, 95% confidence interval (CI) 0.50-0.88]. However, compared with mothers who were not short and overweight, short and overweight mothers were significantly more likely to have stunted children (AOR 1.80, 95% CI 1.19-2.73) and were more likely to be indigenous women living in urban areas (AOR 3.01, 95% CI 1.19-7.60) or rural areas (AOR 3.02, 95% CI 1.28-7.14). The order of observed prevalence of SCOM pairs in different types of households was as follows: urban indigenous (25.0%), rural indigenous (21.2%), rural non-indigenous (19.8%), and urban non-indigenous households (10.7%). Conclusions for Practice Urban indigenous households were more likely to have SCOM pairs. This study provided useful information for identifying the most vulnerable groups and areas with a high prevalence of the familial coexistence of child stunting and maternal overweight.
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Características da Família , Transtornos do Crescimento/etnologia , Mães/estatística & dados numéricos , Estado Nutricional , Sobrepeso/etnologia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Transtornos do Crescimento/epidemiologia , Guatemala/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Sobrepeso/epidemiologia , Prevalência , População Rural , Classe Social , Adulto JovemRESUMO
Adequate nutrition is critical to child development and institutions such as day-care centers could potentially complement childrens diets to achieve optimal daily intakes. The aim of the study was to describe the full-day diet of children, examining and contrasting the relative contribution of home-derived versus institutional energy and nutrient sources. The present comparison should be considered in the domain of a case-study format. The diets of 33, 3-6 y old children attending low-income day-care centers serving either 3 or a single meal were examined. The home-diet was assessed by means of 3 non-consecutive 24-hr recalls. Estimated energy and nutrient intakes at the centers and at home were assessed and related to Recommended Nutrient Intakes (RNI). Nutrient densities, critical densities and main sources of nutrients were computed. We observed that in children attending the day-care center serving three meals, home-foods contributed less than half the daily energy (47.7%) and between 29.9% and 53.5% of daily nutrients. In children receiving only lunch outside the home, energy contribution from the home was 83.9% and 304 kcal lower than for children receiving 3 meals. Furthermore, between 59.0% and 94.8% of daily nutrients were provided at home. Daily energy, nutrient intakes and nutrient densities were well above the nutrient requirements for this age group, and particularly high for vitamin A. The overall dietary variety was superior in the situation of greater contribution of home fare, but overall the nutrient density and adequacy of the aggregate intakes did not differ in any important manner.
Ingesta diaria de alimentos y nutrientes provenientes de la dieta institucional y del hogar en niños que asisten a dos centros de cuidado infantil contrastantes en la ciudad de Guatemala. Una adecuada nutrición es crítica para el desarrollo infantil. Los centros de cuidado infantiles (CCI) podrían jugar un papel fundamental en la complementación de la ingesta de alimentos y nutrientes. El propósito de este estudio fue describir la dieta de niños, comparando la contribución relativa de energía y nutrientes de la dieta-hogar e institucional. El presente estudio debe ser considerado como una presentación de caso. Se examinó la dieta de 33 niños de 3-6 años que asisten a dos CCI utilizados por familias de escasos recursos y con diferencias en número de comidas servidas. Se determinó la dieta-hogar utilizando 3 recordatorios de 24-horas en días no-consecutivos. Se calculó la ingesta estimada de energía y nutrientes en las instituciones y en casa y se comparó con las Ingestas Recomendadas de Nutrientes. Se determinó la densidad de nutrientes y principales fuentes. Se observó que los alimentos consumidos en el hogar contribuyeron 47.7% de la energía diaria y entre 29.9% y 53.5% de los nutrientes diarios requeridos para los niños con 3 comidas en el CCI y de 83.9%, 59.0 y 94.8%, respectivamente, para los niños que consumen únicamente el almuerzo en el CCI. La ingesta diaria de energía fue 304 kcal mayor en los niños que consumieron 3 comidas fuera del hogar. No hubo mayor variación en las dietas cuando mayor era el consumo de alimentos en el hogar, sin embargo la densidad nutricional y la adecuación de la dieta completa fue adecuada en ambos centros, y particularmente elevadas para la vitamina A.
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Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Creches , Dieta , Ingestão de Energia/fisiologia , Comportamento Alimentar , Inquéritos sobre Dietas , Dieta/normas , Serviços de Alimentação/normas , Guatemala , Refeições , Necessidades Nutricionais , Fatores SocioeconômicosRESUMO
Adequate nutrition is critical to child development and institutions such as day-care centers could potentially complement children's diets to achieve optimal daily intakes. The aim of the study was to describe the full-day diet of children, examining and contrasting the relative contribution of home-derived versus institutional energy and nutrient sources. The present comparison should be considered in the domain of a case-study format. The diets of 33, 3-6 y old children attending low-income day-care centers serving either 3 or a single meal were examined. The home-diet was assessed by means of 3 non-consecutive 24-hr recalls. Estimated energy and nutrient intakes at the centers and at home were assessed and related to Recommended Nutrient Intakes (RNI). Nutrient densities, critical densities and main sources of nutrients were computed. We observed that in children attending the day-care center serving three meals, home-foods contributed less than half the daily energy (47.7%) and between 29.9% and 53.5% of daily nutrients. In children receiving only lunch outside the home, energy contribution from the home was 83.9% and 304 kcal lower than for children receiving 3 meals. Furthermore, between 59.0% and 94.8% of daily nutrients were provided at home. Daily energy, nutrient intakes and nutrient densities were well above the nutrient requirements for this age group, and particularly high for vitamin A. The overall dietary variety was superior in the situation of greater contribution of home fare, but overall the nutrient density and adequacy of the aggregate intakes did not differ in any important manner.
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Creches , Dieta , Ingestão de Energia/fisiologia , Comportamento Alimentar , Criança , Pré-Escolar , Dieta/normas , Inquéritos sobre Dietas , Feminino , Serviços de Alimentação/normas , Guatemala , Humanos , Lactente , Masculino , Refeições , Necessidades Nutricionais , Fatores SocioeconômicosRESUMO
BACKGROUND: The positive deviance (PD) approach seeks to devise and promote health-promoting practices identified within the most successful member of a society. The World Cancer Research Fund and the American Institute for Cancer Research (WCRF/AICR) recommendations indicate the need for specific dietary behaviours, which may be considered impractical. Thus, it is important to demonstrate ways in which these dietary practices have been achieved from concordant individuals. The present study aimed to assess the feasibility of constructing healthy eating guides in four international settings. METHODS: Adult participants from the Netherlands (n = 1052), Scotland (n = 849), Mexico (n = 790) and Guatemala (n = 873) enrolled in an international diet survey project. Participants with inadequate diets and current smokers were excluded from the analysis. Concordance with selected WCRF/AICR individual guideline components related to diet and lifestyle were evaluated. A selection of participants was made towards making a set of 14 rotating menus for a cancer-prevention healthy-eating guide. RESULTS: Overall concordance with the WCRF/AICR recommendations was low in all four nations and no participants with an ideal behaviour were found. The selection of candidates for constructing 14 daily menus for a single national guide identified 51, 13 and 12 individuals concordant with 11 of 14 WCRF/AICR recommendation components in Guatemala, Scotland and Mexico, respectively, and 24 individuals concordant with eight of 14 WCRF/AICR components in the Netherlands. CONCLUSIONS: The basis for PD guidance for developing dietary recommendations for cancer prevention was strong across all social classes in Guatemala, marginal for Mexico and Scotland, and effectively impossible for the Netherlands.
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Dieta/métodos , Promoção da Saúde/métodos , Neoplasias/prevenção & controle , Adolescente , Adulto , Idoso , Inquéritos sobre Dietas , Estudos de Viabilidade , Feminino , Guatemala , Comportamentos Relacionados com a Saúde , Humanos , Masculino , México , Pessoa de Meia-Idade , Países Baixos , Educação de Pacientes como Assunto/métodos , Comportamento de Redução do Risco , Escócia , Inquéritos e Questionários , Adulto JovemRESUMO
Loss of stature in certain elderly subjects can be attributed to diseases such as osteoporosis, as well as to age and generational effects. In addition, many elders cannot stand straight for accurate measurement. For these cases, total height can be estimated with regression equations based on knee height. The aims of this study were, firstly, to evaluate the applicability of regression equations based on knee height for estimation of stature and, secondly, to document the differences between measured and estimated height in a group of elderly Hispanics with postural problems (n = 166) in comparison with a group of elderly Hispanic without postural problems (n = 270). Using both, estimated and measured height, we also calculated the body mass index (BMI) of both groups of elders. Statistical analyses were done with paired t-tests, within sex and study group. Within the group with postural problems, estimated height was higher than the measured height for both men (p < or = 0.001) and women (p < or = 0.001). There were no significant differences between measured and estimated height in the group without postural problems. Furthermore, in the group with postural problems, BMI values calculated with estimated height were lower than those estimated with the measured height, and these differences were also significant for both men (p < or = 0.001) and women (p < or = 0.001). With the aging of the Latin American population, there is a need for more nutrition and health research among elders. In order to do this we need to develop and use methods and criteria appropriate for each population.
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Envelhecimento/etnologia , Estatura/etnologia , Hispânico ou Latino , Joelho/anatomia & histologia , Postura , Idoso , Índice de Massa Corporal , Peso Corporal/etnologia , República Dominicana/etnologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Porto Rico/etnologia , Análise de RegressãoRESUMO
OBJECTIVES: We estimated prevalence and control of type 2 diabetes in Puerto Rican, Dominican, and non-Hispanic White (NHW) elders and associated them with sociodemographic and health behavior variables and with body mass index (BMI) and waist circumference. METHODS: We used a cross-sectional analysis with a sample of Hispanic elders in Massachusetts and a comparison group of NHWs (1991-1997). The analysis included 379 Puerto Ricans, 113 Dominicans, and 164 NHWs, aged 60 to 96 years, with complete questionnaires and blood samples. RESULTS: Type 2 diabetes was significantly more prevalent among Puerto Ricans (38%) and Dominicans (35%) than among NHWs (23%). Differences remained after covariates were adjusted for. Hispanics with diabetes were approximately 3 times more likely to use insulin than NHWs. Puerto Ricans were 2 times, and Dominicans 3 times, more likely to have glycosylated hemoglobin concentrations of 7% or above than NHWs. BMI and waist circumference were individually associated with diabetes. When included in the model together, waist circumference, but not BMI, remained independently associated with diabetes. CONCLUSIONS: Ethnicity was more strongly associated with diabetes status and control than were socioeconomic or measured health behavior variables, suggesting that genetic or other culturally related factors may explain these differences.
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Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/prevenção & controle , Hispânico ou Latino , Idoso , Idoso de 80 Anos ou mais , Antropometria , Estudos Transversais , República Dominicana/etnologia , Feminino , Hemoglobinas Glicadas/análise , Humanos , Insulina/uso terapêutico , Modelos Logísticos , Masculino , Massachusetts/epidemiologia , Pessoa de Meia-Idade , Prevalência , Porto Rico/etnologia , Fatores de Risco , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To describe the food intake and food sources of macronutrients in diets of older Hispanic adults in the Northeastern United States and to explore relationships between acculturation, years in the United States, and macronutrient intake. DESIGN: Cross-sectional study using a representative sample of older Hispanic adults and a comparison group of non-Hispanic whites. SUBJECTS/SETTING: Hispanic (n = 711) and non-Hispanic white (n = 226) persons, aged 60 years and older, residing in Massachusetts. STATISTICAL ANALYSIS: Macronutrient intakes, collected by 24-hour dietary recall, were compared across ethnic groups by means of the general linear models procedure (with Bonferroni adjustments). Associations between macronutrient intake and predictor variables were tested with Pearson correlations and linear regression. The contribution of foods to total intake of macronutrients was determined by use of a rank procedure. RESULTS: Hispanic elderly subjects consumed significantly less saturated fat and simple sugars and more complex carbohydrates than did non-Hispanic whites. Hispanics residing in the United States for a longer time tended to have macronutrient profiles more similar to those of the non-Hispanic whites. Rice for Hispanic and bread for non-Hispanics were the major contributors of energy. More acculturated Hispanic elders consumed fewer ethnic foods and more foods related to the non-Hispanic-white eating patterns than those less acculturated. APPLICATIONS/CONCLUSIONS: Efforts to promote better diets among Hispanic elders need to emphasize maintenance or adoption of healthful dietary patterns based on ethnic and modern foods that will satisfy their biological, emotional, and social needs. Dietitians and other dietetics practitioners can use the information presented here in studying nutrition-related chronic diseases, in public health planning, and in nutrition education and promotion efforts directed to ethnic-specific, elderly Hispanic groups.
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Aculturação , Características Culturais , Ingestão de Alimentos , Comportamento Alimentar/etnologia , Hispânico ou Latino , Idoso , Estudos Transversais , Registros de Dieta , Carboidratos da Dieta , Gorduras na Dieta , Proteínas Alimentares , República Dominicana/etnologia , Escolaridade , Ingestão de Energia , Feminino , Humanos , Entrevistas como Assunto , Masculino , Massachusetts , Pobreza , Porto Rico/etnologia , População BrancaRESUMO
BACKGROUND: Limited data suggest that Puerto Ricans experience greater disability than other ethnic groups, but few studies have examined the factors associated with this apparent difference. METHODS: We describe the prevalence of functional limitation and disability in a representative sample of Puerto Rican and Dominican elders in Massachusetts, and in a neighborhood comparison group of non-Hispanic whites (NHWs). We then relate disability scores, based on both prevalence and severity of ADL or IADL limitation, with self-reported history of diagnosed health conditions--adjusting for age, sex, body mass index (BMI; weight kg/height m(2)), income, education, living alone, smoking, and alcohol use. RESULTS: Seventy-five percent of Dominican women and 73% of Puerto Rican women reported difficulty with at least one ADL, compared with 64% of NHW women. Puerto Rican men reported significantly more limitation than did NHW or Dominican men. Conditions significantly associated with at least two disability measures among the NHW included smoking, former heavy alcohol use, arthritis, cataract, respiratory disease, and high BMI, but not stroke, diabetes, history of heart attack, or depression. The patterns for Puerto Ricans differed, with the strongest associations between disability and stroke, arthritis, diabetes, and depression, followed by history of heart attack, high BMI, cataract, poverty status, and respiratory disease. Only arthritis and depression were consistently significantly associated with disability among this smaller sample of Dominican elders. CONCLUSIONS: Functional limitation and disability are more prevalent among Puerto Ricans and among Dominican women than among neighborhood NHWs in Massachusetts. Greater disability is associated with the presence of chronic health conditions, which differ by ethnic group. Additional research is needed to further define the social and health factors that contribute to these ethnic differences.
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Atividades Cotidianas , Pessoas com Deficiência , Nível de Saúde , Hispânico ou Latino , População Branca , Fatores Etários , Idoso , Consumo de Bebidas Alcoólicas/etnologia , Índice de Massa Corporal , Doença Crônica , Doença/classificação , Doença/etnologia , República Dominicana/etnologia , Escolaridade , Família , Feminino , Humanos , Renda , Masculino , Massachusetts , Prevalência , Porto Rico/etnologia , Fatores Sexuais , Fumar/etnologiaRESUMO
To study issues of diet and health among Hispanic adults living in the northeastern United States, the authors adapted a version of the National Cancer Institute (NCI)/Block food frequency questionnaire. Foods that contributed to nutrient intake of Puerto Rican adults in the Hispanic Health and Nutrition Examination Survey (HHANES) were ranked to identify items to be added to the food list. Portion sizes were compared across HHANES and the Second National Health and Nutrition Examination Survey (NHANES II) to assess the adequacy of the assumed values. Within line items, frequencies of consumption of individual foods were ranked and these data were used to adjust the weighting factors within the database. To test the revised form, 24-hour recalls were collected from 90 elderly Hispanics and 35 elderly non-Hispanic whites. These data were coded into the original and revised food frequency forms and nutrient intake results were compared with recall results by paired t-test, and by Pearson and intraclass correlations. Added foods include plantains, avocado, mango, cassava, empanadas, and custard. Portion sizes differed significantly between HHANES and NHANES II, and were left open-ended. Estimated mean nutrient intakes and correlations with recall data were lower with the original versus the revised form. The authors conclude that the use in minority populations of food frequency questionnaires developed for the general population is likely to result in biased estimates of intake unless modifications are made in the questionnaires.
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Inquéritos Nutricionais , Idoso , Métodos Epidemiológicos , Feminino , Alimentos , Hispânico ou Latino , Humanos , Masculino , Pessoa de Meia-Idade , Porto Rico , Inquéritos e Questionários , População BrancaRESUMO
White rats were inoculated with 10(6) trypomastigotes of Trypanosoma lewisi, simultaneously or two days before and after inoculation with 10(5) oocysts of T. gondii. A greater number of cysts was found in the brain of the animals having concomitant inoculations, as compared with rats inoculated with either one of the two parasites. An apparent immunosuppressive effect is likely. Since both organisms can be found in rats, it is possible that infections with T. lewisi, could make this rodent another intermediate host for Toxoplasma infections.
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Encefalopatias/parasitologia , Toxoplasma/imunologia , Toxoplasmose Animal/parasitologia , Trypanosoma lewisi/imunologia , Tripanossomíase/parasitologia , Animais , Encefalopatias/imunologia , Vetores de Doenças , Tolerância Imunológica , Ratos , Ratos Wistar , Toxoplasmose Animal/imunologia , Tripanossomíase/imunologiaRESUMO
Entre diciembre de 1987 y junio de 1988 practicamos valvuloplastía mitral percutánea (VMP) con éxito en 26 de 28 pacientes con estenosis mitral (EM) severa. La edad promedio de los 26 pacientes fue de 38 ñ 9 años, 19 eran mujeres, 5 estaban en fibrilación auricular, 3 tenían insuficiencia mitral leve y 4 presentaban calcificaciones de la válvula mitral. 4 pacientes estaban en capacidad funcional II, (NYHA), 15 en III y 7 en IV. Ninguno tenía trombos visibles en el ecocardiograma bidimensional ni antecedentes de fenomenos embólicos. Después de la VMP (con un balón de 25 mm en 3 pac. y 2 balones de 25 y 20 ó 18 mm en 23 pac.). Hubo un aumento significatiovo del area mitral (0.9 ñ 0.3 cm* a 2.8 ñ 0.7 cm*: p<0.0005), y del gasto cardíaco (3.9 ñ 0.2 lts/min. a 4.9 ñ 0.5 lts/min.: p<0.0005) y una disminución de la presión auricular izquierda media (23.5 ñ 9 mmHg a 8.1 ñ 3.2 mmHg: p<0.0005) y del gradiente transmitral medio (18 ñ 4mmHg a 4 ñ 2mmHg: p<0.0005). Un paciente fallecio luego de completado el procedimiento y 2 aumentaron su grado de insuficiencia mitral. Hubo un caso de paralisis facial central transitoria. 25 de los 26 pacientes fueron dados de alta al día siguiente del procedimiento, habiendo presentado un alivio sintomático inmediato muy importante. De acuerdo a los resultados inmediatos en este grupo de pacientes predominantemente jovenes, con escasa incidencia de calcificación valvular y fibrilación auricular, concluimos que la VMP es un procedimiento no quirúrgico efectivo en el tratamiento de pacientes con estenosis mitral severa
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Adolescente , Adulto , Pessoa de Meia-Idade , Humanos , Masculino , Feminino , Estenose da Valva Mitral/terapia , Cateterismo CardíacoAssuntos
Adulto , Pessoa de Meia-Idade , Humanos , Feminino , Angioplastia com Balão , Estenose da Valva Mitral/terapiaRESUMO
This work consisted in the analysis of anthropometric data collected in 1980 in a representative sample of the adult population of the Republic of Panama, according to sex, place of residence, and age. As the data revealed, the adult Panamanian male has an average weight of 61.8 kg and a height of 165.0 cm, and the female, an average weight of 55.4 kg and a height of 154.0 cm. The average weight and height of the adult population differ in the different provinces of the country. Thus, Veraguas and San Blas have the lowest averages in weight and height while the adult men of the provinces of Panama, Bocas del Toro and Colón present the best nutritional conditions. Women increase in weight as age advances until reaching a maximum peak between 45 and 54 years of age. In the males, the average highest weight occurs at an earlier age, between 25 and 29 years old, and is maintained until the age of 45-54. From then on, a decrease in weight as age advances, begins to be observed in both sexes. Apparently, the height of the Panamanian population has increased through time, as reflected by the average height of the different age groups studied in 1980, when compared with similar information obtained in 1967. It is concluded that a Food and Nutrition Surveillance System in Panama must contemplate the inclusion of anthropometric data that describe the nutritional conditions of the adult Panamanian groups.
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Estatura , Peso Corporal , Adulto , Fatores Etários , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Panamá , Fatores SexuaisRESUMO
Este trabajo consistio en el analisis de los datos antropometricos recabados en 1980 en una muestra representativa de la poblacion adulta de la Republica de Panama de acuerdo al sexo, lugar de resistencia y edad. Segun se determino, el varon adulto panameno tiene un peso promedio de 61.8 kg y una talla de 165.0 cm, y la mujer panamena, un peso de 55.4 kg una talla promedio de 154.5 cm. Los promedio de peso y talla de la poblacion adulta son diferentes en las distintas provincias del pais.Asi, Veraguas y San Blas tienen los promedios de peso y talla mas bajas mientras que, entre los hombres adultos, las provincias de Panama, Bocas del Toro y Colon acusan las mejores condiciones nutricionales. Las mujeres incrementan de peso conforme avanzan en edad hasta alcanzar un pico maximo entre los 45 y 54 anos. En los varones el peso promedio mas elevado ocurre a mas temprana edad, 25 e 29 anos, y se mantiene hasta los 45-54 anos. A partir de entonces se empieza a observar en ambos sexos un descenso de peso conforme la edad avanza. La talla de la poblacion panamena parece haber aumentado a traves del tiempo como lo reflejan los promedios de talla de distintos falanges de edad estudiados en 1980, y la comparacion de esos datos con informacion similar recabada en 1967. Se concluye que un Sistema de Vigilancia Alimentario-Nutricional en Panama debe contemplar la inclusion de datos de orden antropometrico que describen las condiciones nutricionales de los adultos panamenos