Resumo Esta pesquisa surge dos estudos das práticas de gestão de mulheres a partir do lugar da autogestão no âmbito da Rede Feminista da Economia Solidária (Resf) e, por isso, desenvolveu-se ao longo da pesquisa o termo práticas feministas de autogestão, considerando-se as práticas que se performatizam na Economia Solidária (ES). O objetivo desta pesquisa é identificar e analisar uma das práticas feministas de autogestão observadas em campo: o desenvolvimento da aprendizagem coletiva e em rede. Os principais aportes teóricos articulados partem estudos sobre práticas de gestão feministas, da perspectiva da racionalidade substantiva, dos estudos sobre aprendizagem organizacional e a visão pós-colonialista que adere ao contexto das mulheres na ES. A coleta de dados foi implementada a partir da história oral temática em entrevistas semiestruturadas com mulheres da Resf e observação direta e indireta em campo entre os anos de 2018 e 2021, registradas em diários de campo. A perspectiva adotada para a análise dos dados é a análise crítica do discurso. Os resultados apontam para os seguintes achados: (I) não hierarquização da organização das práticas de aprendizagem; (II) troca intensa de informações dentro e fora da rede baseada nos laços de reciprocidade; (III) uma forma de aprendizagem que prioriza as experiências com um sistema de atividades no qual o conhecer não é separado do fazer. Para as mulheres, o conhecimento é integrado e distribuído na vida da comunidade, o que requer necessariamente o envolvimento que advém do sentimento de pertencimento e cuidado mútuo que as une. (Resf isso desenvolveuse desenvolveu considerandose considerando ES . (ES) substantiva póscolonialista pós colonialista 201 2021 discurso achados I (I II (II reciprocidade III (III fazer comunidade une (ES 20 202 2

Abstract This research arises from studies of women's management practices from the place of self-management within the scope of the Feminist Solidarity Economy Network (Resf) and, therefore, the term feminist practices of self-management was developed throughout the research, considering the practices that are performed in the Solidarity Economy (ES). The objective of this research is to identify and analyze one of the feminist practices of self-management observed in the field: the development of collective and networked learning. The main theoretical contributions used to mediate the discussion are based on studies of feminist management practices, on the perspective of substantive rationality, on studies on organizational learning and the post-colonialist view that adheres to the context of women in the SE. The data collection was implemented based on thematic oral history in semi-structured interviews with women from Resf and direct and indirect field observation between the years 2018 and 2021, recorded in field diaries. The perspective adopted for data analysis is critical discourse analysis. The results point to the following findings: (I) no hierarchization of the organization of learning practices; (II) intense exchange of information inside and outside the network based on reciprocal ties; (III) a form of learning that prioritizes experiences with a system of activities in which knowing is not separated from doing. For the women, knowledge is integrated and distributed in the life of the community, which necessarily requires the involvement that comes from the sense of belonging and mutual care that unites them. womens s selfmanagement self (Resf therefore ES. ES . (ES) rationality postcolonialist post colonialist SE semistructured semi structured 201 2021 diaries findings I (I II (II ties III (III doing community them (ES 20 202 2

RESUMEN: Este artículo se centra en conocer los contextos de las organizaciones no gubernamentales (ONG) que trabajan con migrantes para acercarnos a estas realidades desde la Responsabilidad Social Universitaria y, concretamente, desde proyectos de Aprendizaje Servicio Universitario. A través del paradigma interpretativo, se busca revelar cuáles son los mayores retos que afrontan la cooperación y la acción social desde la perspectiva de quienes trabajan directamente con personas migrantes. Para ello, se ha elaborado un grupo de discusión en el que se han recogido las experiencias de nueve personas que trabajan o colaboran en ONG en Granada. Tras el análisis de sus testimonios, las principales conclusiones obtenidas reflejan la ausencia de los gobiernos en la puesta en marcha de medidas de protección social transnacional, la deshumanización de los procesos, la necesidad de situar a las personas migrantes en el centro, y la escasa implicación y colaboración desde el ámbito universitario con este colectivo.

ABSTRACT: This article focuses on the contexts of non-governmental organization (NGO) working with migrant people in order to approach their realities from the perspective of University Social Responsibility, and specifically from Service-Learning projects. Through an interpretative paradigm, it aims to know which are the greatest challenges in the cooperation and social action fields, according to those who directly work with migrants. For this purpose, the perceptions of nine people who either work or volunteer in NGOs in Granada are brought together in a group discussion. After analyzing their testimonies, the main conclusions reflect a notable lack of political will in order to implement any measures of transnational social protection, a dehumanization of any processes, an increasing need of placing migrants at the right center, and a low involvement and collaboration from the university field with the migrant community.

Abstract Although our country has adopted a determined policy towards the equal participation of women in political, educational, health and economic activities, driven by institutions such as the United Nations (UN Women), the International Labor Organization (ILO), the European Commission (EC), the Organization for Economic Cooperation and Development (OECD) and other social organizations; However, neither the General Law on Mercantile Corporations (LGSM) nor the Securities Market Law (LMV) require female participation in the boards of directors (CA) of corporations, although there was a reform initiative that did not succeed and a second one presented in March 2019 subsists only for stock corporations (hereinafter SAB or listed). The absence of parity quotas in the CA makes the natural process of insertion of women in the fundamental decision making of companies and the exercise and effective enjoyment of their human rights of equal opportunities pitiful and tortuous, which, according to the Davos report (World Economic Forum, hereinafter FEM 2018, VIII), will require at least 60 years for the closing of the global gender gap in Mexico.

Resumen Aunque nuestro país ha adoptado una política decidida hacia la participación igualitaria de la mujer en las actividades políticas, educativas, de salud y económicas, impulsada por instituciones como la Organización de Naciones Unidas (ONU Mujeres), la Organización Internacional de Trabajo (OIT), la Comisión Europea (CE), la Organización para la Cooperación y el Desarrollo Económicos (OCDE) y otras organizaciones sociales; ni la Ley General de Sociedades Mercantiles (LGSM) ni la Ley del Mercado de Valores (LMV) han sido reformadas para exigir participación femenina en los consejos de administración (CA) de las sociedades mercantiles, aunque hubo una iniciativa de reforma que no prosperó y subsiste una segunda presentada en marzo de 2019 únicamente para las sociedades anónimas bursátiles (en adelante SAB o cotizadas). La ausencia de cuotas de paridad en los CA hace lastimoso y tortuoso el proceso natural de inserción de la mujer en la toma de las decisiones fundamentales de las empresas y el ejercicio y disfrute efectivo de sus derechos humanos de igualdad de oportunidades, que, según el informe de Davos (Foro Económico Mundial, en adelante FEM 2018, VIII), requerirá cuando menos de 60 años para el cierre de la brecha global de género en México.

Resumen El artículo hace una revisión descriptiva de los estudios más recientes que sobre brechas laborales de género han elaborado las principales entidades de la gobernanza global, enfatizando los hallazgos que señalan la persistencia de menor participación laboral femenina, menores salarios y escasa representación en los cargos de alta dirección en las empresas y el sector público. Los estudios revisados son principalmente de entidades que orientan las acciones legislativas de los gobiernos nacionales, tales como la Organización de las Naciones Unidas, ONU; la Organización Internacional del Trabajo, OIT; El Fondo Monetario internacional, FMI; El Banco Mundial; la Organización de Cooperación para el Desarrollo, OCDE; los cuales coinciden en advertir que las mujeres además de encarar brechas tradicionales, enfrentan nuevos y complejos desafíos como los que traen las trasformaciones tecnológicas y científicas que están cambiando el escenario del trabajo en el mundo. Cuestiones como la digitalización, la automatización, la inteligencia artificial y otras tecnologías emergentes, transformarán aún más la sociedad. Lo efectos pueden ser de gran impacto para las mujeres pues pese a haberse educado en diversas ramas del saber, son minoría y están subrepresentadas en las áreas de mayor crecimiento, las llamadas CTIM, acrónimo para Ciencias, Tecnología, Ingeniería y Matemáticas. Por lo anterior, las entidades sugieren acciones que eviten la rápida erosión de los logros alcanzados y el surgimiento de inéditas formas de segregación, desplazamiento o precarización del trabajo femenino.

Abstract This paper presents a detailed review of the most recent studies on gender-related work gaps that the leading entities of global governance have developed. Emphasis will be placed on the findings that point to persistent lower female participation in the field of work, lower wages, and little representation in senior corporate management positions and the public sector. The reviewed studies come mainly from entities leading the lawmaking actions of national governments, namely, the United Nations (UN), the International Labour Organization (ILO), the International Monetary Fund (IMF), the World Bank, and the Development Cooperation Organization. All agree that women face new and complex challenges, such as those brought on by the technological and scientific transformations that are changing the world’s labor scenario, in addition to the already existing gaps. Issues such as digitization, automation, artificial intelligence, and other emerging technologies will further transform society. Such effects could profoundly impact women because, despite being trained in varied branches of knowledge, they are an underrepresented minority in the fastest growing areas, namely, the so-called STEM (the acronym for Science, Technology, Engineering, and Mathematics). Therefore, the above entities suggest actions that prevent the progress made from rapidly eroding and the emergence of modern forms of segregation, displacement, or precarization of women’s work.

Resumo Este artigo tem o objetivo de analisar os processos históricos que permitiram e impulsionaram a criação da terapia ocupacional na América Latina. Para a identificação dos colaboradores, foram elencados os países que são membros da Confederação Latino-americana de Terapia Ocupacional (Clato), tendo sido contatados seus representantes nessa organização, os quais foram convidados à colaboração, de maneira a ser possível um levantamento inicial de documentos e sujeitos envolvidos com tais processos nos diferentes países. Em relação à reunião e organização de dados, foi realizado um recorte histórico dos primeiros dez anos desde que se identificou o início do primeiro programa de formação em terapia ocupacional na América Latina, a saber, entre os anos de 1956 a 1966. Os países cujos programas foram criados nessas décadas foram: Brasil, México, Argentina, Venezuela, Chile e Colômbia. Como parte dos resultados, foi possível identificar que as histórias da terapia ocupacional e a criação de programas de formação na América Latina passam, dentre outros fatores, pelos antecedentes relacionados às epidemias de poliomielite e à história do cuidado no âmbito do adoecimento psíquico, além da presença dos movimentos de cooperação internacional, da hierarquização das carreiras profissionais e dos processos de subordinação do gênero feminino, no que se refere à inserção das mulheres no mercado de trabalho.

Abstract This article aims to analyze the historical processes that allowed and promoted the creation of occupational therapy in Latin America. For the identification of the collaborators, the countries that are members of the Latin American Confederation of Occupational Therapy (Clato) were listed, the representatives in that organization were contacted and invited to collaborate, in order to be possible an initial survey of documents and subjects involved with such processes in different countries. In relation to the collection and organization of data, was made a historical delimitation of the first ten years in which was identified the beginning of the first programs in occupational therapy in Latin America, namely between 1956 and 1966. The countries whose programs were created in those decades were: Brazil, Mexico, Argentina, Venezuela, Chile and Colombia. As part of the results, it was possible to identify that the histories of occupational therapy and the creation of programs in Latin America include, among other things, the antecedents related to poliomyelitis epidemics and to the history of psychiatric care, as well as the presence of international cooperation movements, the hierarchy of professional careers and the processes of subordination of the female gender, as regards the insertion of women in work activities.

Resumo Este artigo apresenta uma análise pormenorizada de uma carta enviada da Bahia ao porto negreiro de Ajudá em 1839 pela africana Roza Maria da Conceição à também africana Francisca da Silva, a legendária Iyá Nassô, fundadora do candomblé da Casa Branca em Salvador. A trajetória dessas duas libertas e de seus maridos, no contexto da passagem da Colônia para o Império, permite identificar processos de cooperação intergeracional entre os libertos africanos e de ascensão econômica associada ao comércio atlântico e ao tráfico ilegal. Postula-se que a propriedade escrava era uma forma de investimento político na organização da “casa” ou da coletividade doméstica, por sua vez a base do “terreiro”, formas de associativismo através das quais esses casais adquiriam poder e reforçavam sua liderança na comunidade negra. Em última instância, a conexão entre Roza e Francisca permite vislumbrar como o sucesso comercial, o controle social e a autoridade religiosa se emaranhavam de forma indissociável.

Abstract This paper presents a detailed analysis of a letter sent from Bahia to the slave port of Ouidah in 1839 by the African Roza Maria da Conceição to the also African Francisca da Silva, the legendary Iyá Nassô, founder of a famous temple of Afro-Brazilian religion, the Casa Branca in Salvador. The trajectory of these two freed women and their husbands, in the context of the passage from the Colony to the Brazilian Empire, allows to identify processes of intergenerational cooperation between African freedmen and of economic rise associated with the Atlantic commerce and the illegal slave trade. It is postulated that slave ownership was a form of political investment in the organization of the “house” or the domestic community, in turn the basis of the “terreiro” or religious congregation, forms of association through which these couples acquired power and reinforced their leadership in the black community. Ultimately, the connection between Roza and Francisca allows one to glimpse how commercial success, social control and religious authority were inextricably entangled.

Windblown dust can contain radioactive materials from mining. These radionuclides when inhaled in dust produce ionizing radiation which damages the cells and tissues in the body. The aim of this study was to assess dust fallout radionuclides in the West Rand mining area of South Africa. Dust fallout monitoring was done using the method (ASTM) D-1739 of 1998 employing multi-directional buckets. Results show that all 9 locations investigated in the different seasons recorded dust fallout rates within stipulated residential limit according to the National Dust Control Regulations (NDCR) (Government Gazette 36974, 1 Nov 2013). Locations 3 in spring (301.93 mg/m²/day) and 6 in winter (589.8 mg/m²/day) recorded dust fallout rates with values above the target value of 300 mg/m²/day according to guidelines by South African Standards (SANS 1929:2011). The ANOVA tests (p-value < 0.05) indicate that the mean dust fallout rate is significantly different across the seasons, mean dust fallout rate in summer is significantly (p-value < 0.05) more than the autumn by 103.15 mg/m²/day. Moderate, positive correlations (0.4 ≤ r < 0.7) exist between average dust fallout rate and wind speed. A weak, negative correlation exist between average dust fallout rate and rainfall with a value of -0.393. All the investigated elements had Enrichment Factor (EF) greater than 1. Cadmium (Cd) and lead (Pb) were extremely enriched (68.36 and 43.48, respectively), whereas Thorium (Th) (7.26) and Chromium (Cr) (9.79) had significant enrichment. Activity concentrations obtained for 226Ra, 238U, 232Th and 40K were 53.59 ± 20.45 Bq/kg, 15.20 ± 6.74 Bq/kg, 6.62 ± 2.76 Bq/kg and 278.51 ± 84.39 Bq/kg, respectively. Activity concentrations were within world averages except 226Ra which exceeded the 32 Bq/kg world average. Statistically significant (p-value < 0.05), strong (0.7 < r < 0.9) and positive correlation exists between 226Ra and 40K. A moderate, positive correlation (0.4 ≤ r < 0.7) exist between 238U and 232Th. Since EF values showed that the elements in the dust had anthropogenic influence, further studies should look at contributions of different sources to the elements found in dust.

Background: The Falsified Medicines Directive (FMD) is a response of the European Union to the increasing number of falsified medicines present in the legal supply chain within the Member States of the community. Effective implementation of the new regulations will depend on the effective cooperation of all parties involved in the distribution of medicinal products including the managers of pharmaceutical companies. Objective: The objective of the study was to examine awareness of the Implementation of the FMD among pharmaceutical company professionals in the European Economic Area. Methods: Sampling was conducted using a method called purposive sampling. An appropriate research tool in the form of an original questionnaire was made available to the respondents in electronic form. During the period from January 2016 to June 2016, 1,496 e-mail messages were sent. The response rate was 17.37%. Results: The study included 99 women (39.3%) and 153 men (60.7%). In the study group, 95.7% of people had heard of FMD. Doctors had rarely heard about the falsified medicine directive when compared to pharmacists (p=0.0063), people working in the pharmaceutical industry (p=0.0014), and respondents with a different professional profile (p=0.0114). In the study group, 89.6% of people were aware of the role of National Medicines Verification Organization in the process of implementing the provisions of FMD into the national system of distribution of medicinal products. The number of the respondents who knew the deadline for the implementation of FMD was significantly higher in the study population, i.e. 91.9% (p=0.0001). Both the younger respondents and those with lower level of education were less aware of the time requirements posed to national regulators (p=0.0003, p=0.0023, respectively). Conclusions: Awareness of the regulations related to the implementation of the FMD, although relatively high among pharmaceutical company professionals in the EEA, is still insufficient.

Abstract: The dynamics of agricultural and livestock production units, managed by groups of organized men and women producers, represent the result of collective abilities for management and distribution of inputs of organization and trust. This allows characterizing the organizational profile with which these social groups are mobilized and locating the elements or actors that are central in the distribution of the benefits of the organizations. The Social Network Analysis (SNA) facilitated the analysis of the groups in function of their organizational quality and to identify, through the analysis of the exchange of the input of trust between women sheep producers, the possibility of establishing social network processes through actors with the potential of connecting different work groups. The groups analyzed showed an incipient organization fed by kinship processes and relational diversity that moved from the centralization of social prominence to the location of actors that linked different groups.

Resumen: La dinámica de las unidades de producción agropecuaria, gestionadas por grupos de productoras(es) organizadas(os), representa el resultado de capacidades colectivas de gestión y distribución de insumos de organización y confianza. Esto permitió caracterizar el perfil organizativo con el que se movilizan estos grupos sociales y localizar aquellos elementos o actores que son centrales en la distribución de los beneficios de las organizaciones. El Análisis de Redes Sociales (ARS) facilitó el análisis de los grupos en función de su calidad organizacional e identificar, por medio del análisis del intercambio del insumo de confianza entre productoras de ovinos, la posibilidad de establecer procesos de red social a través de actores con el potencial de vincular a diferentes grupos de trabajo. Los grupos analizados mostraron una incipiente organización nutrida de procesos de parentesco y diversidad relacional que se desplazó desde la centralización de la prominencia social hasta la ubicación de actores que vincularon a grupos diferentes.

Resumen Introducción: actualmente más de 350 millones personas de todas las edades viven en el mundo con trastorno de depresión mayor, siendo este un problema común en la población general que por la persistencia y la severidad de los síntomas que presenta afecta las esferas personal y social de los individuos. Objetivo: determinar los factores personales y sociales asociados al trastorno de depresión mayor en la población de 13 a 65 años de edad de la ciudad de Medellín en el periodo 2011-2012. Materiales y métodos: se analizó la información obtenida en el Primer estudio de salud mental poblacional representativo de hogares para la ciudad de Medellín recopilada a través de entrevistas, realizadas con el World Health Organization Composite International Diagnostic Interview. Se tomaron 4.176 registros. El procesamiento de la información se realizó mediante el programa SPSS versión 21.0 (Licencia Universidad CES). Resultados: la prevalencia para el trastorno de depresión mayor anual en la ciudad de Medellín en el año 2012 fue de 4,1 %. Las mujeres presentaron 2,4 veces más el riesgo de estar afectadas por trastorno de depresión mayor en comparación a los hombres. Tener una percepción regular/mala sobre la salud mental representa un riesgo 6,0 veces mayor que tener una percepción muy buena/excelente; presentar un grado medio de resiliencia representa casi 2 veces más el riesgo de presentar trastorno de depresión mayor en comparación con los que presentan un grado alto de resiliencia, y no poder desahogarse con la familia representa un riesgo de 1,9 veces en comparación a los que sí pueden hacerlo. Conclusiones: los factores personales que se asocian al trastorno de depresión mayor son ser mujer, tener una regular o mala percepción sobre su propia salud mental, no hacer ejercicio, presentar un grado medio de resiliencia; mientras que entre los factores sociales asociados se destacaron aspectos relacionados con la familia como no poder desahogarse y que ésta constantemente realice demandas a sus integrantes.

Abstract Introduction: mental disorders are one of the major health problems worldwide, more than 350 million people of all ages are facing major depressive disorder; this is being a common problem in the general population and its persistence and harshness of the symptoms affect personal and social aspects of an individual. Objective: Determining personal and social facts associated to the major depression disorder, in a population aged from 13 to 65 years old, in Medellin city, during 2011-2012 years. Materials and methods: It was analyzed the information obtained in the First Population Mental Health Survey representative of households for Medellin city, collected through interviews and conducted in cooperation with the World Health Organization Composite International Diagnostic Interview. 4,176 records were taken. The information processing was performed using the SPSS software version 21.0 (License for use of CES University). Results: The prevalence for major depressive disorder in the city of Medellin in 2012 was 4.1 %. Women were 2.4 times more likely to be affected by major depressive disorder compared to men. Having a fair / poor perception of mental health represents a 6.0 higher risk than having a very good / excellent perception; Presenting an average degree of resilience would represents almost 2 times of the risk of having major depressive disorder compared to those with a high degree of resilience, and who are not able to relieve oneself with their family represents a risk of 1.9 times in comparison to those who can do it. Conclusions: personal factors associated with major depressive disorder include facts such as: being female, having fair or poor mental health perception, not exercising, having an average degree of resilience; while in terms of the social aspects, they were highlighted aspects related to family, as it is the case of not being heard and being demanded constantly by the family members.

Resumo Este artigo apresenta um estudo em que busca identificar as variáveis econômicas relevantes na prevalência do cigarro para um grupo de 37 países. Utilizou-se a metodologia de estimação por regressão linear múltipla pelo método dos mínimos quadrados. O exercício econométrico é realizado por gênero, procurando examinar se há motivações diferentes para o consumo de cigarros entre a população adulta de homens e mulheres. Os resultados apontam que, embora a tributação seja um elemento comum na decisão de ambos os sexos, a decisão de fumar das mulheres é também sensível a preços e a outros fatores sociais e culturais. Estes fatores foram apreendidos no fato de que mulheres que residem em países que fazem parte da Organização para Cooperação e Desenvolvimento Econômico apresentam, de forma significativa, maior prevalência no consumo de cigarros. As evidências apresentadas neste estudo reforçam, portanto, a percepção de que a tributação é de fato um instrumento fundamental no controle do consumo de cigarros, mas que no caso específico das mulheres, preços mais elevados e a promoção de maior igualdade com os homens, são igualmente importantes.

Abstract This article presents a study that seeks to identify the relevant economic variables in the prevalence of smoking in a group of 37 countries. The chosen methodology was to estimate multiple linear regression using the least square approach. The econometric exercise is performed by gender, seeking to examine whether there are different motivations for cigarette smoking among the adult population of men and women. The results show that although taxation is a common element in the decision of both sexes, the decision to smoke among women is also sensitive to price and other social and cultural factors. These factors were based on the fact that women who live in countries that are part of the Organization for Economic Cooperation and Development reveal a significantly higher prevalence of cigarette consumption. The evidence presented in this study, therefore, reinforces the perception that taxation is in fact a crucial tool in the control of smoking, but in the specific case of women, higher prices and the promotion of greater equality with men, are also important.

Resumo Este artigo apresenta um estudo em que busca identificar as variáveis econômicas relevantes na prevalência do cigarro para um grupo de 37 países. Utilizou-se a metodologia de estimação por regressão linear múltipla pelo método dos mínimos quadrados. O exercício econométrico é realizado por gênero, procurando examinar se há motivações diferentes para o consumo de cigarros entre a população adulta de homens e mulheres. Os resultados apontam que, embora a tributação seja um elemento comum na decisão de ambos os sexos, a decisão de fumar das mulheres é também sensível a preços e a outros fatores sociais e culturais. Estes fatores foram apreendidos no fato de que mulheres que residem em países que fazem parte da Organização para Cooperação e Desenvolvimento Econômico apresentam, de forma significativa, maior prevalência no consumo de cigarros. As evidências apresentadas neste estudo reforçam, portanto, a percepção de que a tributação é de fato um instrumento fundamental no controle do consumo de cigarros, mas que no caso específico das mulheres, preços mais elevados e a promoção de maior igualdade com os homens, são igualmente importantes.

Abstract This article presents a study that seeks to identify the relevant economic variables in the prevalence of smoking in a group of 37 countries. The chosen methodology was to estimate multiple linear regression using the least square approach. The econometric exercise is performed by gender, seeking to examine whether there are different motivations for cigarette smoking among the adult population of men and women. The results show that although taxation is a common element in the decision of both sexes, the decision to smoke among women is also sensitive to price and other social and cultural factors. These factors were based on the fact that women who live in countries that are part of the Organization for Economic Cooperation and Development reveal a significantly higher prevalence of cigarette consumption. The evidence presented in this study, therefore, reinforces the perception that taxation is in fact a crucial tool in the control of smoking, but in the specific case of women, higher prices and the promotion of greater equality with men, are also important.

<img border=0 src="/img/revistas/bwho/v90n9/a12img03.jpg">

OBJECTIF: Réaliser une synthèse des études récentes menées sur les stratégies permettant de fournir des moustiquaires imprégnées d'insecticide (MMI) à grande échelle dans les zones où le paludisme est endémique. MÉTHODES: À partir de bases de données, on a recherché les études publiées entre janvier 2000 et décembre 2010, dans lesquelles: les sujets résidaient dans des zones où le paludisme à Plasmodium falciparum et à Plasmodium vivax était endémique; une distribution à grande échelle de MMI a été évaluée; la détention de MMI dans les foyers, la réception par les femmes enceintes et/ou l'utilisation chez les enfants âgés de moins de 5 ans a été évaluée; la conception de l'étude impliquait un contrôle individuel ou en grappes, était quasi expérimentale, avant et après, en séries temporelles interrompues, ou transversale sans contrôle temporel ou géographique. Les documents de travail décrivant les études qualitatives, les études de cas et les études d'évaluation des processus et de rentabilité, associés à un document de travail éligible, ont également été inclus. La qualité des études a été appréciée à l'aide de la liste de vérification des risques Cochrane et des critères de l'approche GRADE. On a relevé et évalué d'importantes influences sur l'augmentation de la distribution dans les différentes stratégies. RÉSULTATS: Un total de 32 documents de travail décrivant 20 études africaines a été étudié. Bon nombre des stratégies de distribution impliquaient différents secteurs de la santé, ainsi que le réseau du commerce de détail (partiellement subventionné), les maternités (intégralement subventionnées) et les campagnes (intégralement subventionnées). Les stratégies qui ont obtenu une meilleure détention dans les foyers et une plus grande utilisation chez les enfants âgés de moins de 5 ans étaient les campagnes de distribution gratuite des MMI. Les coûts étaient largement comparables dans les stratégies étudiées, les MMI constituant le principal coût. Les estimations de rentabilité variaient surtout en fonction de la durée de vie et de la résistance présumée de la moustiquaire. Parmi les inconvénients les plus courants figuraient le coût, la rupture de stock et une mauvaise logistique. Les facteurs favorables les plus courants étaient la formation et la supervision du personnel, la coopération interdépartementale ou interministérielle, ainsi que l'implication des intervenants. CONCLUSION: Il existe une vaste taxonomie de stratégies pour une distribution à grande échelle des MMI.

OBJECTIVE: To synthesize findings from recent studies of strategies to deliver insecticide-treated nets (ITNs) at scale in malaria-endemic areas. METHODS: Databases were searched for studies published between January 2000 and December 2010 in which: subjects resided in areas with endemicity for Plasmodium falciparum and Plasmodium vivax malaria; ITN delivery at scale was evaluated; ITN ownership among households, receipt by pregnant women and/or use among children aged < 5 years was evaluated; and the study design was an individual or cluster-randomized controlled design, nonrandomized, quasi-experimental, before-and-after, interrupted time series or cross-sectional without temporal or geographical controls. Papers describing qualitative studies, case studies, process evaluations and cost-effectiveness studies linked to an eligible paper were also included. Study quality was assessed using the Cochrane risk of bias checklist and GRADE criteria. Important influences on scaling up were identified and assessed across delivery strategies. FINDINGS: A total of 32 papers describing 20 African studies were reviewed. Many delivery strategies involved health sectors and retail outlets (partial subsidy), antenatal care clinics (full subsidy) and campaigns (full subsidy). Strategies achieving high ownership among households and use among children < 5 delivered ITNs free through campaigns. Costs were largely comparable across strategies; ITNs were the main cost. Cost-effectiveness estimates were most sensitive to the assumed net lifespan and leakage. Common barriers to delivery included cost, stock-outs and poor logistics. Common facilitators were staff training and supervision, cooperation across departments or ministries and stakeholder involvement. CONCLUSION: There is a broad taxonomy of strategies for delivering ITNs at scale.

<img border=0 src="/img/revistas/bwho/v90n9/a12img02.jpg">

<img border=0 src="/img/revistas/bwho/v90n9/a12img01.jpg">

OBJETIVO: Sintetizar los resultados de estudios recientes acerca de las estrategias para distribuir a escala mosquiteros tratados con insecticida (RTI) en zonas con malaria endémica. MÉTODOS: Se examinaron bases de datos en busca de estudios publicados entre enero de 2000 y diciembre de 2010 en los que: los sujetos residían en áreas en las que la malaria por Plasmodium falciparum y Plasmodium vivax es endémica; se evaluó la entrega de RTI a escala; se evaluó la propiedad de RTI en hogares, la recepción por parte de mujeres embarazadas y/o el uso por parte de niños menores de 5 años; y cuyo diseño del estudio era un estudio controlado individual o aleatorio sobre grupos, no aleatorio, cuasiexperimental, antes y después, de series de tiempo interrumpido o transversal sin controles temporales o geográficos. También se incluyeron artículos que describían estudios cualitativos, estudios de caso, evaluaciones de proceso y estudios de efectividad de costes vinculados a un artículo que cumplía con las condiciones. La calidad del estudio fue evaluada por medio de la herramienta Cochrane de riesgo de sesgo y los criterios GRADE. Se identificaron y evaluaron importantes influencias sobre el aumento progresivo en las estrategias de distribución. RESULTADOS: Se revisaron un total de 32 artículos que describían 20 estudios africanos. En muchas de las estrategias de distribución participaron sectores sanitarios y establecimientos de venta al por menor (subsidio parcial), clínicas de atención prenatal (subsidio completo) y campañas (subsidio completo). Las estrategias que consiguieron un grado de participación entre los hogares y un uso entre niños menores de 5 años elevados distribuyeron RTI de forma gratuita mediante campañas. Los costes de las diversas estrategias fueron en gran medida comparables; las RTI supusieron el coste principal. Los cálculos de efectividad de costes fueron sensibles sobre todo a la vida útil esperada del mosquitero y a las fugas. Entre las barreras frecuentes a la distribución figuraron el coste, la falta de existencias y una logística deficiente. Los facilitadores comunes fueron la formación y supervisión del personal, la cooperación entre departamentos o ministerios y la implicación de las partes implicadas. CONCLUSIÓN: Hay una amplia taxonomía de estrategias para distribuir RTI a escala.

PROBLEM: Reliable demographic data is a central requirement for health planning and management, and for the implementation of adequate interventions. This study addresses the lack of demographic data on mobile pastoral communities in the Sahel. APPROACH: A total of 1081 Arab, Fulani and Gorane women and 2541 children (1336 boys and 1205 girls) were interviewed and registered by a biometric fingerprint scanner in five repeated random transect demographic and health surveys conducted from March 2007 to January 2008 in the Lake Chad region in Chad. LOCAL SETTING: Important determinants for the planning and implementation of household surveys among mobile pastoral communities include: environmental factors; availability of women for interviews; difficulties in defining "own" children; the need for informationeducation-communication campaigns; and informed consent of husbands in typically patriarchal societies. RELEVANT CHANGES: Due to their high mobility, only 5% (56/1081) of registered women were encountered twice. Therefore, it was not possible to establish a demographic and health cohort. LESSONS LEARNT: Prospective demographic and health cohorts are the most accurate method to assess child mortality and other demographic indices. However, their feasibility in a highly mobile pastoral setting remains to be shown. Future interdisciplinary scientific efforts need to target innovative methods, tools and approaches to include marginalized communities in operational health and demographic surveillance systems.

SITUACIÓN: Contar con datos demográficos fiables es un requisito fundamental para la planificación y la gestión sanitarias, así como para la puesta en marcha de las medidas necesarias. El estudio aborda la falta de datos demográficos en las comunidades nómadas de pastores de la región del Sahel. ENFOQUE: Se realizaron entrevistas a un total de 1081 mujeres y de 2541 niños (1336 niños y 1205 niñas) árabes, fulanís y goraneses, y se les incluyó en un registro mediante un lector óptico-biométrico de las huellas dactilares en cinco encuestas demográficas y de salud aleatorias, repetidas y transversales que se realizaron entre marzo de 2007 y enero de 2008 en la región del Lago Chad, en Chad. MARCO REGIONAL: Entre los determinantes más importantes de la planificación y la puesta en marcha de las encuestas domiciliarias en las comunidades nómadas pastoriles se encuentran: los factores medioambientales, la disponibilidad de las mujeres para realizar las entrevistas, las dificultades para definir cuáles son «sus» hijos, la necesidad de desarrollar campañas de información-educacióncomunicación y la obtención de los consentimientos informados de los maridos en las sociedades patriarcales típicas. CAMBIOS IMPORTANTES: Debido a su elevada movilidad, sólo pudimos volver a encontrarnos con el 5% (56:1081) de las mujeres registradas. Por lo tanto, no fue posible establecer una cohorte demográfica y sanitaria. LECCIONES APRENDIDAS: Las cohortes prospectivas de carácter demográfico y sanitario son el método más preciso para evaluar la mortalidad infantil y otros índices demográficos. No obstante, sigue sin demostrarse su viabilidad en grupos de pastores que se desplazan mucho. Los futuros esfuerzos científicos interdisciplinarios deben dirigirse a la obtención de métodos, herramientas y enfoques innovadores que incluyan a las comunidades marginadas en los sistemas operativos de control demográfico y sanitario.

PROBLÈME: La fiabilité des données démographiques constitue un critère majeur, tant pour la planification et la gestion sanitaire que pour la mise en oeuvre d'interventions adéquates. Cette étude s'intéresse au manque de données démographiques concernant les communautés pastorales nomades du Sahel. APPROCHE: Au total, 1 081 femmes et 2 541 enfants (1 336 garçons et 1 205 filles) arabes, foulani et goranes ont été interrogés et enregistrés à l'aide d'un lecteur biométrique d'empreintes digitales, au cours de cinq enquêtes sanitaires et démographiques transversales aléatoires successives, réalisées entre mars 2007 et janvier 2008 dans la région du lac Tchad au Tchad. ENVIRONNEMENT LOCALE: Les facteurs déterminants pour la planification et la mise en oeuvre d'enquêtes auprès des ménages des communautés pastorales nomades comprennent: les facteurs environnementaux, la disponibilité des femmes pour les entretiens, les difficultés à identifier leurs «propres» enfants, le besoin en campagnes d'information, d'éducation et de communication, ainsi que le consentement éclairé des époux au sein de ces sociétés typiquement patriarcales. CHANGEMENTS SIGNIFICATIFS: Du fait de leur grande mobilité, seulement 5% (56/1 081) des femmes enregistrées ont été rencontrées à deux reprises. Il n'a donc pas été possible d'établir de cohorte démographique et sanitaire. LEÇONS TIRÉES: Les cohortes démographiques et sanitaires prospectives constituent la méthode la plus précise pour évaluer la mortalité infantile et les autres indices démographiques. Cependant, leur faisabilité dans un contexte pastoral hautement nomade reste à prouver. Les prochains efforts scientifiques interdisciplinaires devront cibler des méthodes, des outils et des approches novateurs, permettant d'inclure les communautés marginalisées dans des systèmes de surveillance démographique et sanitaire opérationnels.

OBJECTIVE: To describe the scale-up of a decentralized HIV treatment programme delivered through the primary health care system in rural KwaZulu-Natal, South Africa, and to assess trends in baseline characteristics and outcomes in the study population. METHODS: The programme started delivery of antiretroviral therapy (ART) in October 2004. Information on all patients initiated on ART was captured in the programme database and follow-up status was updated monthly. All adult patients (> 16 years) who initiated ART between October 2004 and September 2008 were included and stratified into 6-month groups. Clinical and sociodemographic characteristics were compared between the groups. Retention in care, mortality, loss to follow-up and virological outcomes were assessed at 12 months post-ART initiation. FINDINGS: A total of 5719 adults initiated on ART were included (67.9% female). Median baseline CD4+ lymphocyte count was 116 cells/μl (interquartile range, IQR: 53-173). There was an increase in the proportion of women who initiated ART while pregnant but no change in other baseline characteristics over time. Overall retention in care at 12 months was 84.0% (95% confidence interval, CI: 82.6-85.3); 10.9% died (95% CI: 9.8-12.0); 3.7% were lost to follow-up (95% CI: 3.0-4.4). Mortality was highest in the first 3 months after ART initiation: 30.1 deaths per 100 person-years (95% CI: 26.3-34.5). At 12 months 23.0% had a detectable viral load (> 25 copies/ml) (95% CI: 19.5-25.5). CONCLUSION: Outcomes were not affected by rapid expansion of this decentralized HIV treatment programme. The relatively high rates of detectable viral load highlight the need for further efforts to improve the quality of services.

OBJETIVOS: Describir la ampliación de un programa descentralizado de tratamiento del VIH a través del sistema sanitario de atención primaria en zonas rurales de KwaZulu-Natal, Sudáfrica, y evaluar las tendencias de las características iniciales y los resultados de la población en estudio. MÉTODOS: El programa comenzó con la administración de un tratamiento antirretroviral (ARV) en octubre de 2004. La información de todos los pacientes que comenzaron el tratamiento ARV se recopiló en la base de datos del programa y el seguimiento se actualizó mensualmente. Todos los pacientes adultos (> 16 años) que iniciaron el tratamiento ARV entre octubre de 2004 y septiembre de 2008 se incluyeron y estratificaron en grupos de seis meses. Se compararon las características clínicas y sociodemográficas intergrupales. A los 12 meses del inicio del tratamiento ARV se evaluó la continuidad asistencial, la pérdida para el seguimiento y los resultados virológicos. RESULTADOS: Se incluyó a un total de 5719 adultos que habían iniciado el tratamiento ARV, de los que el 67,9% eran mujeres. El recuento medio inicial de linfocitos CD4 fue de 116 células/μl (amplitud intercuartil, AIC: 53 - 173). El porcentaje de mujeres que iniciaron el tratamiento ARV durante el embarazo aumentó, si bien no se produjo ningún cambio en otras características iniciales a lo largo del tiempo. La continuidad asistencial general a los 12 meses fue del 84,0% (intervalo de confianza del 95%, CI: 82; 6 - 85,3); el 10,9% falleció (CI del 95%: 9; 8 - 12,0); el 3,7% se perdió para el seguimiento (CI del 95%: 3,0 - 4,4). La mortalidad fue más elevada en los primeros tres meses posteriores al inicio del tratamiento ARV: 30,1 fallecimientos por cada 100 años-personas (CI del 95%: 26,3 - 34,5). El 23,0% tenía una carga viral detectable a los 12 meses (> 25 réplicas/ml) (CI del 95%: 19,5 - 25,5). CONCLUSIÓN: Los resultados no se vieron afectados por la rápida expansión de este programa descentralizado de tratamiento del VIH. Los índices relativamente altos de la carga vírica detectable ponen en evidencia la necesidad de dedicar un mayor esfuerzo en la mejora de la calidad de los servicios.

OBJECTIF: Décrire le passage à l'échelle supérieure d'un programme décentralisé de traitement du VIH délivré au travers du système de soins de santé primaires au KwaZulu-Natal rural, Afrique du Sud, et évaluer les tendances des caractéristiques de ligne de base et les résultats sur la population étudiée. MÉTHODES: Le programme a commencé la distribution d'une thérapie antirétrovirale (TAR) en octobre 2004. Les informations concernant l'ensemble des patients entamant un traitement TAR ont été recueillies dans une base de données informatisée et le suivi de leur état a été actualisé chaque mois. Tous les patients adultes (> 16 ans) ayant commencé la TAR entre octobre 2004 et septembre 2008 ont été inclus et stratifiés en groupes de 6 mois. Les caractéristiques cliniques et sociodémographiques ont été comparées entre les groupes. Les taux de rétention sous traitement et de mortalité, ainsi que les nombres de perdus pour le suivi et les résultats virologiques ont été évalués 12 mois après le début de la TAR. RÉSULTATS: Au total 5 719 patients ayant initié un traitement TAR ont été inclus (67,9 % de femmes). Le nombre moyen de lymphocytes CD4+ à la ligne de base était de 116 cellules/μL (intervalle interquartile, IQR: 53-173). Une augmentation de la proportion de femmes ayant entamé un traitement TAR alors qu'elles étaient enceintes a été notée, mais aucun changement n'a été observé dans le temps pour les autres caractéristiques à la ligne de base. Le taux global de rétention sous traitement à 12 mois était de 84,0 % (intervalle de confiance à 95 %, IC: 82,6-85,3); 10,9 % sont décédés (IC à 95 %: 9,8-12,0); 3.7 % ont été perdus pour le suivi (IC à 95 %: 3,0-4,4). La mortalité a été plus élevée durant les 3 premiers mois qui ont suivi le début de TAR : 30,1 décès pour 100 personnes-ans (IC à 95 %: 26,3-34,5). À 12 mois, 23,0 % présentaient une charge virale détectable (> 25 copies/ml) (IC à 95 %: 19,5-25,5). CONCLUSION: Les résultats n'ont pas été affectés par la rapide expansion de ce programme de traitement du VIH décentralisé. Les taux relativement élevés de charge virale détectable mettent en évidence la nécessité de futurs efforts à mettre en place pour améliorer la qualité des services.