Resumen América Latina se ha convertido en uno de los epicentros de la pandemia de Covid-19, con una crisis sanitaria y humanitaria. El objetivo del artículo es analizar las medidas para enfrentar la pandemia en países de la Región y el rol de la Atención Primaria de Salud, discutiendo obstáculos y potencialidades. Son analizados los casos de Bolivia, Brasil, Chile, Colombia, Cuba, Uruguay y Venezuela. Los siete países adoptaran medidas de aislamiento social de diferentes alcances, con grados distintos de sostenibilidad. El énfasis de las respuestas estuvo más en la atención hospitalaria que en la vigilancia de la salud, identificación de casos y contactos y disposición de condiciones adecuadas para el confinamiento. En casi todos los países, se subestimó la capacidad de los servicios de atención primária en el territorio. No obstante, iniciativas de enfoque territorial y comunitario buscaron integrar la vigilancia de la salud con actividades de promoción, prevención y cuidado, aunque con alcance parcial. En este contexto la Atención Primaria Integral e integrada toma nuevo sentido y reclama desarrollos que contribuyan a recobrar el equilibrio entre sociedad y medio ambiente. Es necesario repensar los sistemas de salud y la importancia de la atención primaria de salud integrada e integral.

Objectives-To assess neurobehavioural effects of low exposure to lead, 43 workers from a lead smelter and 45 workers from a glass factory were evaluated with the World Health Organisation neurobehavioural core test battery (NCTB) in a cross sectional study. Methods-The NCTB comprises a questionnaire and seven tests that measure simple reaction time, short term memory (digit span, Benton), mood (profile of mood states), eye-hand coordination (Santa Ana pegboard, pursuit aiming II), and perceptual speed (digit-symbol). Results-Smelter workers were employed on average for four years, and had a mean blood lead concentration of 2'0 cumolll (42 ug/dl). Glass factory workers had a mean of 0*72 umoill (15 ugldl). Historical blood lead concentrations were used to classify exposure based on current, peak, and time weighted average. Although the exposed workers performed less well than the non-exposed in 10 of 14 response variables, only profile of mood states tension-anxiety, hostility, and depression mood scales showed a significantly poorer dose-response relation with blood lead concentration in multiple linear regression models that included age, education, and alcohol intake as covariates. The frequency of symptoms of anger, depression, fatigue, and joint pain were also significantly increased in the exposed group. Conclusion-This study is consistent with the larger body of neurobehavioural research of low occupational exposure to lead. The small effects found in this study occurred at blood lead concentrations slightly lower than those reported in several previous studies.

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To assess the applicability of the World Health Organization (WHO) Neurobehavioral Core Test Battery (NCTB), we evaluated 53 male and 29 female Venezuelan workers exposed to mixtures of organic solvents in an adhesive factory, and 56 male and 11 female workers unexposed to any type of neurotoxic chemical. The average age of unexposed workers was 30 years and 33 years for those exposed, average schooling for both groups was 8 years, and the mean duration of exposure was 7 years. The NCTB, which assesses central nervous system functions, is composed of seven tests that measure simple motor function, short-term memory, eye-hand coordination, affective behavior, and psychomotor perception and speed. The battery includes: profile of mood states (POMS); Simple Reaction Time for attention and response speed; Digit Span for auditory memory; Santa Ana manual dexterity; Digit-Symbol for perceptual motor speed; the Benton visual retention for visual perception and memory; and Pursuit Aiming II for motor steadiness. In each of 13 subtests, the exposed group had a poorer performance than the nonexposed group. The range of differences in mean performance was between 5% and 89%, particularly in POMS (tension-anxiety, anger-hostility, depression-rejection, fatigue-inertia, confusion-bewilderment), Simple Reaction Time, Digit-Symbol, and Santa Ana Pegboard (p < .05). In multivariate regression analyses, controlling for the effects of age, sex, and education, significantly poorer performance in the exposed was found for tension-anxiety, hostility, depression, and confusion moods in the POMS, and in digit-symbol and simple reaction time (p < .05). These alterations were also dose-related using years of exposure in analyses of covariance. Compared to the nonexposed, the exposed subjects demonstrated an increased frequency of subjective symptoms of fatigue, difficulties with memory, confusion, paresthesias in upper and lower extremities, and sleep disturbances. We conclude that the methodology is applicable to the population studied. The tests of the NCTB were accepted by the subjects and were administered satisfactorily, except for occasional difficulties in verbal comprehension in subtests of POMS, which is the only test that requires more demanding verbal skills. The magnitude of the behavioral deficits is consistent with the probable high level of exposure and with the range of deficits previously reported in workers with long-term solvent exposures.

The authors present a synthesis of the proposals put forth by the health sector of Venezuela during the framing of the new Venezuelan Constitution. They summarize the background to the National Constituent Assembly and the legal framework typical of the health sector at that time, identify the methodological aspects that substantiated the health topics included in the new Constitution, and analyze the articles that shape the current constitutional health framework in Venezuela, summarizing their most important features and comparing them with neoliberal health proposals.