Assessing the context of health care utilization in Ecuador: A spatial and multilevel analysis

<p>Abstract</p> <p>Background</p> <p>There are few studies that have analyzed the context of health care utilization, particularly in Latin America. This study examines the context of utilization of health services in Ecuador; focusing on the relationship between provision of services and use of both preventive and curative services.</p> <p>Methods</p> <p>This study is cross-sectional and analyzes data from the 2004 National Demographic and Maternal & Child Health dataset. Provider variables come from the Ecuadorian System of Social Indicators (SIISE). Global Moran's I statistic is used to assess spatial autocorrelation of the provider variables. Multilevel modeling is used for the simultaneous analysis of provision of services at the province-level with use of services at the individual level.</p> <p>Results</p> <p>Spatial analysis indicates no significant differences in the density of health care providers among Ecuadorian provinces. After adjusting for various predisposing, enabling, need factors and interaction terms, density of public practice health personnel was positively associated with use of preventive care, particularly among rural households. On the other hand, density of private practice physicians was positively associated with use of curative care, particularly among urban households.</p> <p>Conclusions</p> <p>There are significant public/private, urban/rural gaps in provision of services in Ecuador; which in turn affect people's use of services. It is necessary to strengthen the public health care delivery system (which includes addressing distribution of health workers) and national health information systems. These efforts could improve access to health care, and inform the civil society and policymakers on the advances of health care reform.</p

Considerations on Genre and Gender Conventions in Translating from Old English

The Old English poem The Wife's Lament is an extremely conventional and, at the same time, original text. It portrays a female character suffering for the absence of her loved one, through the framework of the so-called 'elegiac' style and a mainly heroic vocabulary. The traditional exile theme is, thus, interwoven with the uncommon motif of love sickness. While this appraisal of the poem is the most widely accepted one, disagreement still remains about the translation of some keywords, strictly related to the exile theme, such as sīþ or wræcsīþ. The aim of this paper is to examine diverging readings and glosses of the above mentioned 'exilic/elegiac' keywords, and to show that an accurate translation should not neglect a thorough appraisal of the text in its complexity and the association with related literary patterns and imagery in other poetic and prose texts

Os inquéritos domiciliares e o Sistema Nacional de Informações em Saúde The household surveys and the National Health Information System

Neste artigo apresenta-se um breve histórico dos inquéritos domiciliares em saúde de abrangência nacional, que foram desenvolvidos no Brasil ao longo dos últimos 20 anos. Discutem-se alguns problemas metodológicos importantes envolvidos na concepção e no desenho amostral dos inquéritos de base populacional e faz-se uma breve revisão dos aspectos contemplados pelos suplementos de saúde da Pesquisa Nacional por Amostra de Domicílios (PNAD), que foram a campo em 1981, 1986, 1998 e 2003. Tendo em vista o compromisso já assumido pelo Ministério da Saúde e pelo IBGE quanto à inclusão de um novo suplemento na PNAD de 2008, abre-se um debate sobre as vantagens e as limitações da PNAD como instrumento capaz de gerar dados de base populacional sobre morbidade, acesso e utilização de serviços de saúde. Finalmente destaca-se a necessidade de formulação de política para a geração de informações a partir de inquéritos de base populacional e sua incorporação ao Sistema Nacional de Informações em Saúde. Os inquéritos devem ser realizados periodicamente e os recursos financeiros para sua realização garantidos.<br>In this article the authors present a brief review of the household health surveys developed in Brazil in the last 20 years. Some important methodological problems related to their conception and sample design are discussed, and a brief review of the National Household Survey Health supplements conducted in 1981, 1986, 1998 and 2003 is presented. Given the already established agreement between the Ministry of Health and the Brazilian Institute of Geography and Statistics as to inclusion of a Health supplement in the 2008 National Household Survey, the authors propose a debate on the advantages and limitations of this instrument for the collection of data on morbidity, access to and utilization of health services. Finally, the authors stress the need for a policy towards generation of population-based information and its incorporation in the National Health Information System. Surveys must be periodically conducted and their financing must be guaranteed