Community participation in health: perpetual allure, persistent challenge.
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The concept of community participation continues to capture the attention of international health policymakers and analysts nearly a quarter of a century after it was formally introduced at the Alma Ata Conference. This paper reviews trends in the participation literature of the 1990s, drawing examples primarily from Latin America. The following topics are discussed: sustainability, new methods for operationalizing and evaluating participation, the significance of local and cultural variability in determining outcomes, participatory self-determination as raised in the social movements literature, the increasing importance of intersectoral linkages, and continuing impediments posed by biomedical ideologies and systems. While the rhetoric and practice of participation have become fully integrated into mainstream health and development discourses, the paper concludes that ideological and political disagreements continue to divide pragmatists, who favour utilitarian models of participation, from activists, who prefer empowerment models. (+info)
Social medicine then and now: lessons from Latin America.
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The accomplishments of Latin American social medicine remain little known in the English-speaking world. In Latin America, social medicine differs from public health in its definitions of populations and social institutions, its dialectic vision of "health-illness," and its stance on causal inference. A "golden age" occurred during the 1930s, when Salvador Allende, a pathologist and future president of Chile, played a key role. Later influences included the Cuban revolution, the failed peaceful transition to socialism in Chile, the Nicaraguan revolution, liberation theology, and empowerment strategies in education. Most of the leaders of Latin American social medicine have experienced political repression, partly because they have tried to combine theory and political practice--a combination known as "praxis." Theoretic debates in social medicine take their bearings from historical materialism and recent trends in European philosophy. Methodologically, differing historical, quantitative, and qualitative approaches aim to avoid perceived problems of positivism and reductionism in traditional public health and clinical methods. Key themes emphasize the effects of broad social policies on health and health care; the social determinants of illness and death; the relationships between work, reproduction, and the environment; and the impact of violence and trauma. (+info)
The 10-year health plan for the Americas.(43/746)
Introduction: an updated self-help perspective on our international activities.
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Reproductive health differences among Latin American- and US-born young women.
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Investigations of reproductive health within Latinos living in the United States suggest that sexual behaviors and contraception use practices vary by ethnicity and between foreign- and US-born adolescents. This article compares high-risk sexual behaviors and reproductive health among foreign-born Latinas, US-born Latinas, and US-born non-Latinas aged 15-24 years. We recruited 361 females from reproductive health clinics in the San Francisco Bay Area of California between 1995 and 1998; these women completed an interview that assessed sexual risk behaviors and history of pregnancy, abortion, and sexually transmitted infections. Current chlamydial and gonococcal infections were detected through biological testing. Among participants aged 15-18 years, US-born Latinas were more likely to have been pregnant (odds ratio [OR] comparing US-born Latinas and US-born non-Latinas = 3.9, 95% confidence interval [CI] 1.3, 11.4), whereas among respondents aged 19-24 years, foreign-born Latinas were more likely to have been pregnant than US-born Latinas (OR = 11.3, 95% CI 1.0, 130.8) and US-born non-Latinas (OR = 64.2, 95% CI 9.9, 416.3). US-born Latinas were most likely to have had an abortion (OR comparing US-born Latinas and US-born non-Latinas = 2.0, 95% CI 0.9, 4.7). They were also most likely to have chlamydial infection at study enrollment (8.2% prevalence compared to 2.2% and 1.0%for foreign-born Latinas and US-born non-Latinas, respectively; P =.009). Reproductive health differences between foreign and US-born females and within the US-born population warrant further examination and highlight the need for targeted prevention. (+info)
Tissue Doppler imaging in the evaluation of the regional diastolic function in chagas' disease.
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AIMS: The main purpose of this study was to evaluate the regional diastolic function in Chagas' disease using tissue Doppler imaging (TDI). METHODS AND RESULTS: Seventy-seven patients were evaluated and divided into three groups: group 0, control; group 1, chagasic patients with normal ECG; and group 2, chagasic patients with abnormal ECG. The following parameters were evaluated: E and A waves, E/A ratio, deceleration time and the isovolumic relaxation time by pulsed wave Doppler and analysis of early (e') and late (a') filling waves by means of TDI, in basal segment of the septal, anterior, inferior, posterior and lateral walls of the left ventricle. The only index of the transmitral flow that presented a significant difference between the chagasic patients and the controls was the deceleration time. As regards the TDI, a significant difference occurred between the various groups in relation to the e' wave, especially in the septal, inferior and posterior walls of the left ventricle. CONCLUSION: TDI proved itself a more sensitive technique for the study of the diastolic function in Chagas' disease than conventional Doppler echocardiography, bringing to light regional abnormalities and allowing differentiation between normal and chagasic individuals with or without cardiomyopathy. TDI could be potentially useful in clinical work and in the stratification of risk of these patients. (+info)
Searching the Literatura Latino Americana e do Caribe em Ciencias da Saude (LILACS) database improves systematic reviews.
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BACKGROUND: An unbiased systematic review (SR) should analyse as many articles as possible in order to provide the best evidence available. However, many SR use only databases with high English-language content as sources for articles. Literatura Latino Americana e do Caribe em Ciencias da Saude (LILACS) indexes 670 journals from the Latin American and Caribbean health literature but is seldom used in these SR. Our objective is to evaluate if LILACS should be used as a routine source of articles for SR. METHODS: First we identified SR published in 1997 in five medical journals with a high impact factor. Then we searched LILACS for articles that could match the inclusion criteria of these SR. We also checked if the authors had already identified these articles located in LILACS. RESULTS: In all, 64 SR were identified. Two had already searched LILACS and were excluded. In 39 of 62 (63%) SR a LILACS search identified articles that matched the inclusion criteria. In 5 (8%) our search was inconclusive and in 18 (29%) no articles were found in LILACS. Therefore, in 71% (44/72) of cases, a LILACS search could have been useful to the authors. This proportion remains the same if we consider only the 37 SR that performed a meta-analysis. In only one case had the article identified in LILACS already been located elsewhere by the authors' strategy. CONCLUSION: LILACS is an under-explored and unique source of articles whose use can improve the quality of systematic reviews. This database should be used as a routine source to identify studies for systematic reviews. (+info)
Child feeding practices are associated with child nutritional status in Latin America: innovative uses of the demographic and health surveys.
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Data from the Demographic and Health Surveys (DHS) for 5 Latin American countries (7 data sets) were used to explore the feasibility of creating a composite feeding index and to examine the association between feeding practices and child height-for-age Z-scores (HAZ). The variables used for the index were as follows: current breast-feeding, use of complementary foods and liquids in the past 24 h, frequency of use over the past week and feeding frequency. The index was made age specific for 6- to 9-, 9- to 12- and 12- to 36-mo-old age groups, and age-specific feeding terciles were created. Bivariate analyses showed that feeding practices were strongly and significantly associated with child HAZ in all 7 data sets, especially after 12 mo of age. Differences in HAZ between child feeding terciles remained significant after controlling for potentially confounding influences, for all countries except Bolivia. Multiple regression analyses also revealed that better feeding practices were more important for children of lower, compared with higher socioeconomic status (in Colombia 1995 and Nicaragua 1998); among children of Ladino (Spanish speaking) compared with indigenous origin (in Guatemala 1995); and among children whose mothers had primary schooling compared with mothers with no schooling, or mothers with higher than primary school level (Peru 1996). The data available in DHS data sets can thus be used effectively to create a composite child feeding index and to identify vulnerable groups that could be targeted by nutrition education and behavior change interventions. (+info)