Revista Panamericana de Salud Públicahttps://scielosp.org/feed/rpsp/2002.v12n2/2018-01-01T00:02:00ZUnknown authorVol. 12 No. 2 - 2002WerkzeugNada es más importante que un niñoS1020-498920020008000012018-01-01T00:02:00Z2018-01-01T00:02:00ZJordán, José
<em>Jordán, José</em>;
<br/><br/>
Atención primaria y trastornos por consumo de alcohol: evaluación de un programa de formación del profesorado en VenezuelaS1020-498920020008000022018-01-01T00:02:00Z2018-01-01T00:02:00ZGaskin de Urdaneta, AlviaSeale, J. PaulFleming, MichaelMurray, Margaret
<em>Gaskin De Urdaneta, Alvia</em>;
<em>Seale, J. Paul</em>;
<em>Fleming, Michael</em>;
<em>Murray, Margaret</em>;
<br/><br/>
Objetivos. La atención primaria proporciona la oportunidad de identificar y tratar a personas cuyo consumo de alcohol se encuentra por encima de los niveles permisibles. Con el fin de preparar a los médicos de atención primaria de todo el mundo para prevenir y tratar los problemas relacionados con el alcohol, el Instituto Nacional sobre el Abuso de Alcohol y el Alcoholismo (National Institute on Alcohol Abuse and Alcoholism: NIAAA) de los Estados Unidos de América (EE. UU.) ha creado y probado un Programa Internacional de Educación Médica sobre el Alcohol, destinado a aumentar las aptitudes clínicas, educativas e investigadoras del profesorado de las facultades de medicina que trabaja con los estudiantes universitarios, los residentes y los médicos de atención primaria. Venezuela fue uno de los países seleccionados para la puesta en marcha de esta iniciativa. Métodos. Durante 5 días del mes de septiembre de 1999 se realizó en la Universidad del Zulia, Maracaibo, Venezuela, un curso de formación del profesorado que consistió en 19 talleres. Los métodos de enseñanza fueron clases, representaciones demostrativas, presentaciones de casos, talleres de desarrollo de aptitudes y la creación de un plan educativo por cada uno de los participantes. Resultados. En el proyecto participaron 33 profesores de nueve de las 10 escuelas de medicina en Venezuela: 18 mujeres y 15 hombres con un promedio de 44 años, 9 de ellos con formación en medicina de familia, 7 en psiquiatría, 6 en pediatría, 4 en obstetricia, 3 en medicina interna, y 4 en especialidades no especificadas. El 76% de los participantes completaron una entrevista 6 meses más tarde. Este grupo refirió que su competencia en 14 áreas clínicas había aumentado de forma significativa y que había emprendido con buenos resultados nuevas actividades curriculares en sus respectivas facultades de medicina y programas de residencia. Conclusiones. Este modelo demostró ser eficaz para incrementar la formación de los médicos en la prevención y el tratamiento de los problemas relacionados con el alcohol en Venezuela. La evaluación del programa proporcionó resultados similares a los obtenidos en otros países en los que también se ha puesto en marcha.Predictors of compliance with short-term treatment among patients with back painS1020-498920020008000032018-01-01T00:02:00Z2018-01-01T00:02:00ZAlexandre, Neusa Maria CostaNordin, MargaretaHiebert, RudiCampello, Marco
<em>Alexandre, Neusa Maria Costa</em>;
<em>Nordin, Margareta</em>;
<em>Hiebert, Rudi</em>;
<em>Campello, Marco</em>;
<br/><br/>
Objective. Great efforts have been made to find effective treatments for back pain. Nevertheless, the effectiveness of a particular treatment can depend on patient compliance. The objective of this study was to prospectively investigate whether patients' demographic factors, clinical factors, external barriers in following the treatment, and perceptions of disability, quality of life, depression, and control over health were predictive of compliance with a physical therapy program carried out with patients with low back pain. Methods. This was an exploratory prospective cohort study that was carried out in New York City during 1999. All study participants answered a questionnaire at the initial clinical evaluation by a physical therapist and were followed during the treatment. The study assessed compliance with the three treatment regimens that were prescribed for every patient: attending scheduled physical therapy sessions, following a program of home exercises, and watching back-education videotapes. Depending on the individual patient, the planned treatment program could last from 2 to 6 weeks. The study employed a battery of instruments to measure patient characteristics that included perceived functional limitations, perceived quality of life, depression, and their beliefs about their health. Student's t tests and chi-square tests were used to determine if non- and low-compliant patients differed significantly from high-compliant patients. Logistic regression was used to estimate adjusted odds ratios expressing the association of selected variables with compliance. Results. We found that 51% of the patients were either noncompliant or low-compliant overall with the low back pain treatment program. There were differences in compliance behavior among the three treatment regimens, with compliance being highest for watching the back-education videotapes and lowest for doing the home exercises. Poor compliance overall was positively associated with the expectation of barriers in following the proposed treatment, with comorbidity, and with longer duration of treatment in this program. Conclusions. The findings of our study indicate that patient compliance with back pain treatment is a serious and complex problem. Nevertheless, while this study was only an exploratory one, we believe that the results of this study can be used by care providers to identify patients likely to become noncompliant and also by researchers to plan specific studies on the effectiveness of treatment programs for patients with low back pain.Estudo comparativo de padrões de sono em trabalhadores de enfermagem dos turnos diurno e noturnoS1020-498920020008000042018-01-01T00:02:00Z2018-01-01T00:02:00ZMartino, Milva Maria Figueiredo de
<em>Martino, Milva Maria Figueiredo De</em>;
<br/><br/>
Objetivo. Comparar os padrões de sono de enfermeiros dos turnos diurno e noturno em um hospital de Campinas (SP), Brasil. Métodos. Participaram 59 enfermeiros entre 23 e 59 anos. Para os enfermeiros do dia, analisou-se o sono noturno, e, para os da noite, os sonos diurno e noturno. Os informantes preencheram um diário do sono durante 1 semana, ao acordar. Foram analisados hora de ir deitar, de dormir, e de acordar; latência do sono; horas de sono noturno e diurno; cochilos; qualidade do sono; modo de acordar; e comparação do sono registrado no diário com o sono habitual. Também foram coletadas informações pessoais e profissionais. Resultados. O grupo diurno ia dormir às 23h36min e o grupo noturno, às 23h52min (P <=0,004, Wilcoxon). Os enfermeiros diurnos acordavam mais cedo (7h3min) do que os noturnos quando dormiam à noite (8h30min). A latência média do sono foi de 23min26s para os enfermeiros diurnos contra 22min50s para os noturnos; a duração do sono noturno foi de 7h11min e 9h6min, respectivamente. O cochilo esteve presente apenas no grupo diurno (média de 2h3min). O sono diurno dos enfermeiros da noite foi caracterizado pelo fracionamento (dois períodos, tempo de sono de 4h7min e 2h38min). O sono noturno do grupo noturno foi de melhor qualidade. O tempo médio de trabalho em hospital foi de 14,31 anos no grupo diurno contra 7,07 no grupo noturno (P <=0,05, Wilcoxon). Os sujeitos possuíam hábitos saudáveis, principalmente quanto ao consumo de álcool. Verificou-se uso de anti-hipertensivos, diuréticos e analgésicos. Conclusões. Os achados foram semelhantes aos descritos anteriormente. Seria recomendável que os enfermeiros do turno da noite pudessem tirar cochilos para compensar o déficit de sono durante a atividade noturna.The effectiveness of community-based interventions to improve maternal and infant health in the Northeast of BrazilS1020-498920020008000052018-01-01T00:02:00Z2018-01-01T00:02:00ZEmond, AlanPollock, JonCosta, Nilma daMaranhão, TéciaMacedo, Albanita
<em>Emond, Alan</em>;
<em>Pollock, Jon</em>;
<em>Costa, Nilma Da</em>;
<em>Maranhão, Técia</em>;
<em>Macedo, Albanita</em>;
<br/><br/>
Objective. To evaluate the effectiveness of a community-based intervention project aimed at reducing maternal and infant mortality in a poor urban district in the city of Natal, in the Northeast of Brazil. Methods. The intervention, called the ProNatal project, introduced a program of integrated community health care to a geographically defined population. The interventions included the establishment of antenatal clinics at the district's health centers, the opening of the maternity facilities at the polyclinic for low-risk deliveries, the introduction of a family planning clinic and a breast-feeding clinic, support from pediatricians for under-5 (well-baby) clinics, children's outpatient services and children's emergency care, and the introduction of health agents recruited from the local community. Representative surveys of the population were taken at the project's inception (July 1995) and then 30 months later (December 1997), using a general health questionnaire adapted to the local conditions. Mortality data were collected from local registration systems as well as from an autopsy survey of perinatal and infant deaths. Results. During 1995 there were 4 maternal deaths from 1 195 pregnancies (maternal mortality of 335/100 000); three of the deaths were related to hypertension and one to uterine perforation after an illegal abortion. During 1998 (post-intervention), there were no maternal deaths in pregnancy or childbirth. In 1993 no deliveries took place at the polyclinic, but in 1998 there were 946 deliveries at the clinic without any serious complications. The method of delivery, the incidence of prematurity, and the incidence of low birthweight did not change significantly over the study period. In the post-intervention survey, 75% of women reported receiving contraceptive advice from a doctor in the preceding year, compared to 50% in the first sample. A mortality survey carried out in 1993-1995 estimated the infant mortality rate to be 60/1 000 live births. By 1998, using data collected locally by active surveillance, the infant mortality rate was 37/1 000 live births. The causes of infant death in both those periods were dominated by respiratory infections and diarrheal disease. Over 95% of both samples initiated breast-feeding, but a higher proportion of the post-intervention sample reported breast-feeding for longer than 6 months (41% vs. 32%, P = 0.0005). No differences were apparent in the use of under-5 clinics, but immunization rates improved. Post-intervention, significant improvements were documented in the mothers' understanding of basic hygiene, their knowledge of causes of common diseases, and their management of acute respiratory infections and diarrhea in children. This was particularly true for the households visited by a community health agent. Conclusions. Inequalities in health care in poor urban populations can be reduced by integrated community-based interventions, including the use of health agents recruited from the local community.Complicaciones y costos asociados a la varicela en niños inmunocompetentesS1020-498920020008000062018-01-01T00:02:00Z2018-01-01T00:02:00ZSáez-Llorens, XavierSuman, Onix deMorós, Daysi dePilar Rubio, María del
<em>Sáez-Llorens, Xavier</em>;
<em>Suman, Onix De</em>;
<em>Morós, Daysi De</em>;
<em>Pilar Rubio, María Del</em>;
<br/><br/>
Objetivos. La varicela es una infección común de la infancia en países que no han incorporado la vacunación correspondiente en sus calendarios vacunales. Generalmente es benigna en niños inmunocompetentes y no necesita tratamiento. Los objetivos de este estudio consistieron en investigar la frecuencia y características de las complicaciones de la varicela que requieran tratamiento hospitalario en niños inmunocompetentes y el curso clínico de los hijos de madres con varicela perinatal. Además, se calculó el gasto hospitalario asociado a la varicela en los niños estudiados. Métodos. Estudio retrospectivo de los expedientes clínicos de niños con varicela ingresados en el Hospital del Niño de Panamá, de enero de 1991 a diciembre de 2000. Se analizaron el tipo de complicaciones, el curso clínico y los costos hospitalarios de los pacientes afectados por varicela. Resultados. De 5 203 niños atendidos en consultas externas, 568 (11%) fueron hospitalizados. En el estudio se incluyeron 513 niños: 381 (74%) con varicela adquirida en la comunidad, 92 (18%) hijos de madres con varicela y 40 (8%) con varicela nosocomial. Las complicaciones más frecuentes fueron las infecciones cutáneas y subcutáneas (45%), las infecciones respiratorias (25%) y las alteraciones neurológicas (7%). Las complicaciones respiratorias y cutáneas ocurrieron a menor edad y en fases más tempranas de la varicela que las alteraciones neurológicas. Trece niños (2,5%) fallecieron, con una letalidad del 8% para la varicela con complicaciones respiratorias y neurológicas y nula para las complicaciones cutáneas. Sesenta de los 92 (65%) hijos de madres con varicela no desarrollaron la enfermedad y ninguno falleció. En cambio, 2 de los 32 neonatos (6%) con varicela perinatal fallecieron. La duración media de la hospitalización fue de 8,9 (1 a 27) días. Se utilizó farmacoterapia parenteral en una gran proporción de los niños, especialmente antibióticos (54%), aciclovir (17%) e inmunoglobulinas intravenosas (14%). El costo medio por paciente hospitalizado fue de 1 209 dólares estadounidenses. Conclusiones. Los resultados obtenidos indican que la varicela es una infección que puede asociarse a un número importante de complicaciones costosas y a una letalidad no despreciable en niños inmunocompetentes. La vacunación rutinaria contra la varicela podría reducir el impacto de esta enfermedad sobre la salud infantil en nuestro país.Hipovitaminose A no Brasil: um problema de saúde públicaS1020-498920020008000072018-01-01T00:02:00Z2018-01-01T00:02:00ZRamalho, Rejane AndréaFlores, HernandoSaunders, Cláudia
<em>Ramalho, Rejane Andréa</em>;
<em>Flores, Hernando</em>;
<em>Saunders, Cláudia</em>;
<br/><br/>
A deficiência de vitamina A é considerada um dos problemas de saúde pública de fácil prevenção mais importantes em diversos países, inclusive o Brasil. Assim, o objetivo do presente trabalho foi revisar a literatura sobre carência de vitamina A publicada entre 1970 e 2000, disponível nas bases de dados MEDLINE e LILACS, e avaliar a hipovitaminose A na América Latina e no Brasil. A pesquisa revelou que até os anos 1980, a atenção dada pela saúde pública à vitamina A se concentrou na importância dessa vitamina para a visão. Na segunda metade dessa década, estudos epidemiológicos sugeriram que, em nível populacional, a deficiência sub-clínica de vitamina A também poderia ser deletéria para certas etapas do metabolismo, com grande influência sobre os índices de morbidade e mortalidade infantil. Em todas as regiões brasileiras para as quais existem dados, foi constatada a carência marginal de vitamina A, com alta prevalência em diferentes faixas etárias, o que não se justifica com a tecnologia e os recursos atualmente disponíveis. É preciso que se assuma o compromisso de reduzir a deficiência de vitamina A para garantir o desenvolvimento adequado das próximas gerações.Desarrollo de fármacos para las enfermedades desatendidasS1020-498920020008000082018-01-01T00:02:00Z2018-01-01T00:02:00ZPrimer aislamiento en humanos de un hantavirus, el virus de los Andes, en las AméricasS1020-498920020008000092018-01-01T00:02:00Z2018-01-01T00:02:00ZLos anticonceptivos orales y el riesgo de cáncer de mamaS1020-498920020008000102018-01-01T00:02:00Z2018-01-01T00:02:00ZUn nuevo método, más sensible, para detectar huevos de helmintos en hecesS1020-498920020008000112018-01-01T00:02:00Z2018-01-01T00:02:00ZSuplementos de vitamina E y degeneración macularS1020-498920020008000122018-01-01T00:02:00Z2018-01-01T00:02:00ZMedicina social latinoamericana: aportes y desafíosS1020-498920020008000132018-01-01T00:02:00Z2018-01-01T00:02:00ZIriart, CeliaWaitzkin, HowardBreilh, JaimeEstrada, AlfredoMerhy, Emerson Elías
<em>Iriart, Celia</em>;
<em>Waitzkin, Howard</em>;
<em>Breilh, Jaime</em>;
<em>Estrada, Alfredo</em>;
<em>Merhy, Emerson Elías</em>;
<br/><br/>
Work-related accidents and diseases take a heavy toll worldwideS1020-498920020008000142018-01-01T00:02:00Z2018-01-01T00:02:00ZUnknow titleS1020-498920020008000152018-01-01T00:02:00Z2018-01-01T00:02:00ZEl cáncer de mama en América Latina y el CaribeS1020-498920020008000162018-01-01T00:02:00Z2018-01-01T00:02:00ZRobles, Sylvia C.Galanis, Eleni
<em>Robles, Sylvia C.</em>;
<em>Galanis, Eleni</em>;
<br/><br/>
Unknow titleS1020-498920020008000172018-01-01T00:02:00Z2018-01-01T00:02:00ZSachs, Jeffrey D.
<em>Sachs, Jeffrey D.</em>;
<br/><br/>
La información en saludS1020-498920020008000182018-01-01T00:02:00Z2018-01-01T00:02:00ZFuente, Juan Ramón de laTapia Conyer, RobertoLezana Fernández, Miguel A.
<em>Fuente, Juan Ramón De La</em>;
<em>Tapia Conyer, Roberto</em>;
<em>Lezana Fernández, Miguel A.</em>;
<br/><br/>
Unknow titleS1020-498920020008000192018-01-01T00:02:00Z2018-01-01T00:02:00ZTapia Granados, José A.
<em>Tapia Granados, José A.</em>;
<br/><br/>