RESUMO
This article describes a community referral system for the permanent immunization program, tested in Tijuana, Baja California, Mexico, by the Regional Nucleus for Health Systems Development (NUREDESS-Norte). The model was designed to facilitate the participation of the intermediate organizations that make up the community in urban settings. Through appropriate technology, health counselors identify with precision, ease and rapidity the specific immunization needs of pre-school age children. The counselors also help diminish the barriers in the way to service access, and follow-up the children at highest risk.
Assuntos
Participação da Comunidade , Encaminhamento e Consulta , Vacinação , Criança , Pré-Escolar , Participação da Comunidade/métodos , Atenção à Saúde/métodos , Atenção à Saúde/organização & administração , Seguimentos , Necessidades e Demandas de Serviços de Saúde/organização & administração , Humanos , Esquemas de Imunização , México , Avaliação de Programas e Projetos de Saúde , Controle de Qualidade , Encaminhamento e Consulta/organização & administração , Vacinação/métodos , Vacinação/normasRESUMO
PIP: Blake hypothesized in 1955 that the instability of reproductive unions may affect fertility in 2 opposite ways - it may reduce the rate of reproduction by decreasing the total time of exposure to pregnancy, and it may increase the rate of reproduction because there is often a desire to have children born of each new union or simply because coitus is more frequent at the start of each new union. Independent measurements of the effects on fertility of these 2 components are presented in order to test a modified form of Blake's hypothesis. The source of data for this analysis is the Urban In-Migration and Fertility Survey conducted in Guayaquil, Ecuador, in 1971. When the number of unions was controlled for, a negative correlation between fertility and years of reproductive time loss was found among men, but the evidence among the female population was not conclusive. Women with less than 1 year of loss had .7 fewer children than women with 1-3 years of loss. This is a significant difference which cannot be explained by sampling error. When years spent in union was controlled for, individuals who had 2 unions had a 14% higher fertility rate than those who had been in only 1 union. Similar results were found for both the male and female populations. These findings support the hypothesis that multiplicity of sexual unions has a positive effect on fertility. The desire for children in the current union seems to be stronger among the Ecuadorian men. It can be concluded that in societies where people enter new unions soon after dissolution of a previous union, instability will have a positive effect upon fertility. Instability will tend to reduce fertility in societies where people spend a long time in interunion or postunion celibacy.^ieng