ABSTRACT Background: The long-term effect of an antimicrobial stewardship program (ASP) and its integrated impact with competitive biddings have been seldom reported. Aim: To evaluate the long-term effect of an ASP on antimicrobial consumption, expenditure, antimicrobial resistance and hospital mortality. To estimate the contribution of competitive biddings on cost-savings. Material and Methods: A comparison of periods prior (2005-2008) and posterior to ASP initiation (2009 and 2015) was done. An estimation of cost savings attributable to ASP and to competitive biddings was also performed. Results: Basal median antimicrobial consumption decreased from 221.3 to 170 daily defined doses/100 beds after the start of the ASP. At the last year, global antimicrobial consumption declined by 28%. Median antimicrobial expenditure per bed (initially US$ 13) declined to US$ 10 at the first year (-28%) and to US$ 6 the last year (-57%). As the reduction in consumption was lower than the reduction in expenditure during the last year, we assumed that only 48.4% of savings were attributable to the ASP. According to antimicrobial charges per bed from prior and after ASP implementation, we estimated global savings of US$ 393072 and US$ 190000 directly attributable to the ASP, difference explained by parallel competitive biddings. Drug resistance among nosocomial bacterial isolates did not show significant changes. Global and infectious disease-associated mortality per 1000 discharges significantly decreased during the study period (p < 0.05). Conclusions: The ASP had a favorable impact on antimicrobial consumption, savings and mortality rates but did not have effect on antimicrobial resistance in selected bacterial strains.

Antecedentes: Existe poca información sobre el impacto a largo plazo de un programa de control de antimicrobianos (PCA) y su efecto combinado con licitaciones públicas de fármacos. Objetivo: Evaluar el impacto de un PCA sobre el consumo, gasto, mortalidad y estimar la contribución de las licitaciones. Material y Métodos: Comparación antes (2005-2008) - después (2009-2015) del PCA y estimación porcentual del ahorro atribuible al PCA y licitaciones. Resultados: El consumo bajó de 221,3 a 170 dosis diarias definidas por 100 días camas (medianas) al primer año. En el último año el consumo declinó un 27,6%. La mediana del gasto por cama ocupada se redujo de 13 a 10 US$ el primer año y a 6 US$ el último año (-57%). Debido a que el gasto bajó más que el consumo, estimamos que solo el 48,4% del ahorro fue debido al PCA (cuociente de ambas reducciones: −27,6%/-57%). De acuerdo con el gasto en antimicrobianos por cama entre ambos períodos, se calculó un ahorro global de 393.000 US$ y de 190.000 US$ directamente atribuible al PCA, siendo la diferencia explicada por licitaciones. Los porcentajes de resistencia en cepas de infecciones nosocomiales no mostraron incrementos o reducciones significativas en el tiempo y la mortalidad por egresos asociada a enfermedades infecciosas (Códigos CIE 10) se redujo significativamente (p < 0,05). Conclusiones: El PCA se asoció a largo plazo a un impacto favorable sobre el consumo de antimicrobianos, gasto por antimicrobianos y egresos por enfermedades infecciosas sin un impacto en la resistencia antimicrobiana. Las licitaciones tuvieron un efecto aditivo en el ahorro.

OBJECTIVE: Estimate the burden of disease from Salmonella spp. and Shigella spp. in four departments of Guatemala in 2010. METHODS: Burden of disease study based on document analysis of published population surveys, laboratory files, and surveillance data from the Health Management Information System (SIGSA) in four departments of Guatemala: Huehuetenango, Jutiapa, Quetzaltenango, and Santa Rosa, in 2010. Information was supplemented by a laboratory survey. Burden of disease was estimated using methodology adapted by the World Health Organization from the United States Centers for Disease Control and Prevention. RESULTS: Surveillance data yielded 72 salmonellosis and 172 shigellosis cases. According to population surveys, the percentage of the population that consults health services for diarrhea is 64.7% (95% CI: 60.6%-68.7%) in Quetzaltenango and 61.0% (95% CI: 56.0%-66.0%) in Santa Rosa. In the 115 laboratories that answered the survey (72.8% response rate), 6 051 suspected samples were collected for stool culture and 3 290 for hemoculture; 39.4% and 100.0% of them were processed, respectively. In all, 85 Salmonella spp. and 113 Shigella spp. strains were isolated. For each reported case of salmonellosis and shigellosis, it was estimated that 40 cases are not reported in Quetzaltenango, 55 in Huehuetenango, 345 in Santa Rosa, and 466 in Jutiapa. Estimated burden of disease ranged from 5 to 2 230 cases per 100 000 population for salmonellosis and from 60 to 1 195 cases per 100 000 population for shigellosis. CONCLUSIONS: Salmonellosis and shigellosis are a major public health problem in the departments studied and in Guatemala. Burden of disease from these pathogens is higher than that reported by SIGSA.

OBJETIVO: Estimar la carga de enfermedad por Salmonella spp. y Shigella spp. en cuatro departamentos de Guatemala en 2010. MÉTODOS: Estudio de carga de enfermedad basado en el análisis documental de las encuestas poblacionales publicadas, los archivos de laboratorio y los datos de vigilancia del Sistema de Información Gerencial de Salud (SIGSA) de cuatro departamentos de Guatemala: Huehuetenango, Jutiapa, Quetzaltenango y Santa Rosa, en 2010. La información se complementó con una encuesta a laboratorios. La carga de enfermedad se estimó según la metodología de los Centros para el Control y la Prevención de Enfermedades de los Estados Unidos de América, adaptada por la Organización Mundial de la Salud. RESULTADOS: Se encontraron 72 casos de salmonelosis y 172 de shigelosis en los datos de vigilancia. Según las encuestas poblacionales, el porcentaje de la población que consulta los servicios de salud por diarrea es de 64,7% (IC95%: 60,6%-68,7%) en Quetzaltenango y 61,0% (IC95%: 56,0%-66,0%) en Santa Rosa. En los 115 laboratorios que respondieron la encuesta (tasa de respuesta: 72,8%) se recolectaron 6 051 muestras sospechadas para coprocultivo y 3 290 para hemocultivo, y se procesaron 39,4% y 100,0% de ellas, respectivamente. Se aislaron 85 cepas de Salmonella spp. y 113 de Shigella spp. Se estimó que por cada caso notificado de salmonelosis y shigelosis existen 40 casos no informados en Quetzaltenango; 55 en Huehuetenango; 345 en Santa Rosa; y 466 en Jutiapa. La carga de enfermedad estimada varió entre 5 y 2 230 casos por 100 000 habitantes para salmonelosis y entre 60 y 1 195 casos por 100 000 habitantes para shigelosis. CONCLUSIONES: La salmonelosis y la shigelosis constituyen un importante problema de salud pública en los departamentos estudiados y en Guatemala. La carga de enfermedad por estos patógenos es mayor que la informada por el SIGSA.

In this paper the behavior of socio-demographic variables in urban and rural zones of Los Ángeles city is analyzed, Biobío region, Chile. The main demographic and social processes are identified in relationship with the fast urban growth of the city, the land use patterns and the socio-spatial segregation processes. A relation between demographic variables and social spaces were defined, mainly in the urban fringe. The importance of empirical studies is recognized in the mid cities which in the last decades have been impact by the economic globalization process and the public policies, mainly in the matter of social house and road infrastructure, recognizing those specific factors and those of nature more general than they have guided its recent urban change. It is assumed, like one of the main hypotheses, that certain demographic and social configurations show a clearly spatial pattern in the city, like the concentration of the poverty and the social vulnerability in some urban areas.

Esta investigación identifica los principales procesos demográficos y sociales que afectan a la población de tres sectores de la ciudad de Los Ángeles, vinculando dichos comportamientos con los nuevos patrones de urbanización y crecimiento urbano observados en las últimas décadas, especialmente la denominada segregación socioespacial urbana. Se analiza el peso que adquiere el factor demográfico en la conformación o producción del espacio social. Se reconoce la importancia de realizar estudios empíricos en ciudades intermedias fuertemente impactadas por el proceso de globalización económica y por diversas políticas públicas, principalmente en materia de vivienda social e infraestructura vial, identificando aquellos factores específicos y aquellos de naturaleza más general que han orientado su evolución más reciente. Se asume, como una de las principales hipótesis de trabajo, que ciertas configuraciones o perfiles sociodemográficos de la población tienen un claro patrón de distribución espacial en la ciudad, como la concentración de la pobreza y la vulnerabilidad social.

Esta pesquisa exploratória teve como objetivo captar as percepções de adolescentes matriculados em estabelecimentos educacionais do Distrito Federal sobre as violências nas escolas e nas comunidades. Considerando que a literatura constata que as violências são comuns às escolas públicas e particulares, embora com diferentes ocorrências, o trabalho focalizou em particular as diferenças entre alunos dos dois tipos de escolas. Para tanto foi utilizada a técnica de grupos focais. Os resultados indicam que, embora se confirme a presença de violências nas escolas públicas e particulares, cada uma é tratada de modo diferente, as primeiras apoiando-se, em parte, no trabalho da polícia, e as últimas mantendo controle preventivo de pessoas e seus movimentos. As conclusões remetem às teorias sociológicas conflituais da Sociologia da Educação e ao seu maior poder explicativo. Enfatizam a necessidade de a escola considerar as sociedades dos adolescentes e o seu protagonismo e dinamismo próprios, abrindo os olhos para as mudanças dentro de si e ao seu redor.

This exploratory research project aims to analyse the perceptions of adolescents enrolled in public and private schools of the Federal District on violences in their schools and commnities. As the literature presents evidence that violences are common to both types of institutions, in spite of diverse characteristics, this study focused particularly upon similarities and differences between their students. The study gathered data using focus groups. Results confirm the occurrence of violences, however, both types of schools use different strategies to deal with them. Public schools often expect police support, whereas private ones maintain preventive control of persons and their movements. Conclusions emphasize the greater explanatory power of conflict theories in Sociology of Education, as well as the need of the schools to be aware of changes inside and around them, considering the adolescent societies and their own dynamism and active roles.

Using satellite images of the area between 32-36°S and 71-75°W, from October 1997 to September 1999, temporal and spatial variability of sea surface temperature (SST) was analyzed. During this period of time, one of the most intense episode of the last century of the warm phase (El Niño) and the beginning of the cold phase (La Niña) of the ENSO cycle were registered, allowing to identify differences in the thermal surface structure. During the warm phase, cold water isotherms in the coastal region (upwelling) warmer than usual were presented, and temperature gradients offshore were smaller than in the cold phase. Several reports suggest that a large part of the Eastern Ocean Pacific Boundary variability (particularly at low frequencies) has equatorial origin. This research shows that part of the observed fluctuations in sea level at Callao, are due to intraseasonal oscillations likely modulated by perturbations of equatorial origin propagating as coastal trapped waves at the eastern boundary of the Pacific Ocean, having a signature in the currents off Valparaiso as a poleward flow, whose core exhibits higher salinity and low oxygen located at 180 m depth. On the other hand, geostrophic currents off Valparaiso consists of alongshore currents and countercurrents, with increasing speeds at fall