Revista Panamericana de Salud Públicahttps://scielosp.org/feed/rpsp/2002.v12n4/2018-01-01T00:02:00ZUnknown authorVol. 12 No. 4 - 2002WerkzeugMy journey in public health in the CaribbeanS1020-498920020010000012018-01-01T00:02:00Z2018-01-01T00:02:00ZStandard, Kenneth Livingstone
<em>Standard, Kenneth Livingstone</em>;
<br/><br/>
Informe mundial sobre la salud y la violencia de la OMS: una herramienta de trabajoS1020-498920020010000022018-01-01T00:02:00Z2018-01-01T00:02:00ZConcha-Eastman, AlbertoKrug, Etienne
<em>Concha-Eastman, Alberto</em>;
<em>Krug, Etienne</em>;
<br/><br/>
La epidemiología de los homicidios en Cali, 1993-1998: seis años de un modelo poblacionalS1020-498920020010000032018-01-01T00:02:00Z2018-01-01T00:02:00ZConcha-Eastman, AlbertoEspitia, Victoria E.Espinosa, RafaelGuerrero, Rodrigo
<em>Concha-Eastman, Alberto</em>;
<em>Espitia, Victoria E.</em>;
<em>Espinosa, Rafael</em>;
<em>Guerrero, Rodrigo</em>;
<br/><br/>
Objetivos. Mostrar la utilidad de un modelo eficaz y oportuno de información y llamar la atención acerca de la gravedad del problema de los homicidios, así como demostrar la necesidad de mantener este tipo de modelo y de sostener proyectos preventivos integrales, como el Programa Desarrollo, Seguridad y Paz (DESEPAZ). En el período de 1993 a 1998, en Cali, Colombia hubo 11 457 homicidios que fueron registrados mediante un modelo de vigilancia epidemiológica inscrito en DESEPAZ, de la Alcaldía de Cali. Métodos. A partir de enero de 1993, un grupo de trabajo organizado por el DESEPAZ revisó y homogeneizó las variables que diversas instituciones recopilaron sobre las víctimas, los victimarios y las características de los hechos, y produjo un boletín semanal de resumen para el alcalde y las demás autoridades municipales. Resultados. Las tasas de homicidios aumentaron de 23 a 124 por 100 000 habitantes en el período de 1983-1994. Posteriormente disminuyeron en 1995, 1996 y 1997 a 112, 102 y 86,1 por 100 000, respectivamente, y en 1998 ascendieron ligeramente hasta 88 por 100 000 habitantes. Aunque han sido víctimas de homicidios personas de todas las edades, hasta las menores de 5 años, los hombres entre los 20 y 34 años fueron los más afectados. La razón de hombre a mujer ha oscilado entre 14,3:1 y 19,2:1. Los estratos económicos bajos son los más afectados en número, proporción y tasa, aunque los del estrato alto han presentado tasas que llegan hasta 160 por 100 000 habitantes. En más del 80% de los homicidios se utilizó un arma de fuego y el siniestro ocurrió con mayor frecuencia en horas de la noche y durante los fines de semana. En pocos casos (entre 8 y 21%) hubo un sindicado por el hecho. El análisis con dos variables mostró una asociación positiva con el consumo de alcohol por la víctima, y también con el uso de armas de fuego por el victimario (OR: 3,1; IC95%: 2,6 a 3,6). En los casos que ocurrieron durante una riña personal o de grupo se observó su asociación con el uso de un arma cortopunzante y con el consumo de bebidas alcohólicas por parte de la víctima (OR: 1,9; IC95%: 1,4-2,6). Conclusiones. Se presenta un mapa de la distribución de los homicidios por barrio y se comentan los beneficios del modelo de vigilancia de base poblacional, en especial su valor para identificar los factores de riesgo y las medidas para prevenir y controlar este tipo de violencia.An evaluation of the adverse reaction potential of three measles-mumps-rubella combination vaccinesS1020-498920020010000042018-01-01T00:02:00Z2018-01-01T00:02:00ZSantos, Boaventura Antônio dosRanieri, Tani SchillingBercini, MarilinaSchermann, Maria TerezaFamer, SirleiMohrdieck, RenateMaraskin, TeresinhaWagner, Mário Bernardes
<em>Santos, Boaventura Antônio Dos</em>;
<em>Ranieri, Tani Schilling</em>;
<em>Bercini, Marilina</em>;
<em>Schermann, Maria Tereza</em>;
<em>Famer, Sirlei</em>;
<em>Mohrdieck, Renate</em>;
<em>Maraskin, Teresinha</em>;
<em>Wagner, Mário Bernardes</em>;
<br/><br/>
Objective. To compare the incidence of adverse events following the administration of three commercially available measles-mumps-rubella (MMR) combination vaccines. Methods. A randomized double-blind clinical trial was performed in 1996 that involved a total of 10 142 students 6-12 years of age in the state of Rio Grande do Sul, in Brazil. An MMR vaccine containing the Edmonston-Zagreb, Leningrad-Zagreb, and RA 27/3 strains ("vaccine A") was administered to 2 226 students (21.9% of the total); an MMR vaccine with the Moraten, Jeryl Lynn, and Wistar 27/3 strains ("vaccine B") was administered to 2 216 children (21.8%); and an MMR vaccine containing the Schwartz, Urabe AM-9, and Wistar 27/3 strains ("vaccine C") was given to 2 179 students (21.5%). A control group of 3 521 students (34.7%) was not vaccinated. Both the vaccinated subjects and the control subjects were followed daily for 30 days to detect any clinical manifestations. Results. Adverse events were more frequent in the vaccinated children than in the control group (P < 0.01). In terms of causing parotitis, vaccine A had a relative risk (RR) of 5.72 (95% confidence interval (CI) = 3.11-10.54) when compared with vaccine B, and an RR of 2.33 (95% CI = 1.52-3.58) when compared with vaccine C. Vaccine A was also associated with an increased risk of lymphadenopathy when compared with vaccine B (RR = 3.11; 95% CI = 1.78-5.45) and with vaccine C (RR = 2.22; 95% CI = 1.35-3.66). Vaccine C was associated with an increased risk of parotitis when compared with vaccine B (RR = 2.46; 95% CI = 1.26-4.80). Three cases of aseptic meningitis were detected among the children in the study group, but only one case of vaccine-related aseptic meningitis was identified, among the children receiving vaccine A. Conclusions. The three MMR vaccines that we studied are associated with different risks of adverse events. We found vaccine A to cause more reactions than the two other vaccines, especially vaccine B. In addition, vaccine A presented both a temporal and a cause-and-effect association with one case of aseptic meningitis. We hope that this study will contribute information that can be used in choosing MMR vaccines with safe and effective strains, especially for mass vaccination strategies.Primary and booster vaccination with DTPw-HB/Hib pentavalent vaccine in Costa Rican children who had received a birth dose of hepatitis B vaccineS1020-498920020010000052018-01-01T00:02:00Z2018-01-01T00:02:00ZFaingezicht, IdisAvila-Aguerro, Maria LuisaCervantes, YolandaFourneau, MarcClemens, Sue Ann Costa
<em>Faingezicht, Idis</em>;
<em>Avila-Aguerro, Maria Luisa</em>;
<em>Cervantes, Yolanda</em>;
<em>Fourneau, Marc</em>;
<em>Clemens, Sue Ann Costa</em>;
<br/><br/>
Objective. The DTPw-HB/Hib pentavalent combination vaccine has been developed following recommendations of the World Health Organization for the introduction of hepatitis B (HB) and Haemophilus influenzae type b (Hib) vaccines into routine childhood vaccination programs. The objectives of this study were to: 1) analyze the immunogenicity and the reactogenicity of the DTPw-HB/Hib pentavalent combination vaccine in comparison to separate injections of DTPw-HB and Hib vaccines as primary vaccination in a group of children who had received a dose of HB vaccine at birth and 2) in the second year of life to assess the antibody persistence as well as the response to a DTPw-HB/Hib or DTPw/Hib booster. Methods. In the first part of the study (primary-vaccination stage), conducted in 1998-1999, we analyzed the immunogenicity and reactogenicity of the DTPw-HB/Hib combination vaccine in comparison to separate injections of DTPw-HB and Hib vaccines as primary vaccination at 2, 4, and 6 months of age in 207 Costa Rican children who had received a dose of HB vaccine at birth. Later, in the booster-vaccination stage of the study, in 1999-2000, in a subset of the children (69 toddlers, now 15-18 months old), antibody persistence was measured, and response to a DTPw-HB/Hib or DTPw/Hib booster was also assessed. Results. In both primary-vaccination groups, at least 97.5% of the infants reached protective levels of antibodies (seropositivity) against the antigens employed in the vaccines. The DTPw-HB/Hib pentavalent combination vaccine did not result in more local reactions than did the DTPw-HB vaccine alone, and, in terms of general reactions, there was no clinically significant difference between the combination or separate injections, and with the pentavalent vaccine having the benefit of needing one less injection. Nine months after the third dose of the primary-vaccination course, antibody persistence was similar in both groups, with over 93% of children still having protective/seropositive titers for Hib, HB, and tetanus and about 50% for diphtheria and Bordetella pertussis. At 15 months of age, virtually all the toddlers responded with a strong boost response to all the vaccine antigens, whether they received the DTPw-HB/Hib pentavalent vaccine or the DTPw/Hib vaccine as a booster. Both booster regimens were equally well tolerated, indicating that up to five doses of the HB vaccine can be given without impact on safety. Conclusions. Our study confirms that the DTPw-HB/Hib pentavalent vaccine is highly immunogenic as a primary vaccination in children who received an HB vaccine at birth, with the pentavalent combination inducing both persisting immunity and boostable memory. The pentavalent vaccine was safe both for primary and booster vaccinations. Thus, this study in Costa Rican infants supports the routine use of the pentavalent DTPw-HB/Hib vaccine as part of childhood vaccination programs in Latin America and the Caribbean.Características clínicas e laboratoriais da meningite asséptica associada à vacina tríplice viralS1020-498920020010000062018-01-01T00:02:00Z2018-01-01T00:02:00ZLucena, RitaGomes, IrenioNunes, LucianaCunha, SérgioDourado, InêsTeixeira, Maria da GlóriaGoes, JulietaCardoso, EduardoRodrigues, BernardoCardoso, AdrianaBarreto, Maurício L.Melo, Ailton
<em>Lucena, Rita</em>;
<em>Gomes, Irenio</em>;
<em>Nunes, Luciana</em>;
<em>Cunha, Sérgio</em>;
<em>Dourado, Inês</em>;
<em>Teixeira, Maria Da Glória</em>;
<em>Goes, Julieta</em>;
<em>Cardoso, Eduardo</em>;
<em>Rodrigues, Bernardo</em>;
<em>Cardoso, Adriana</em>;
<em>Barreto, Maurício L.</em>;
<em>Melo, Ailton</em>;
<br/><br/>
Objetivos. Descrever os achados epidemiológicos, clínicos e liquóricos dos casos de meningite asséptica associada à vacina tríplice viral (sarampo, caxumba e rubéola), ocorridos no Estado da Bahia após campanha de vacinação em massa promovida pelo Ministério da Saúde do Brasil em agosto de 1997, e comparar esses casos aos de meningite asséptica não associada à vacina ocorridos no mesmo ano. Métodos. Entre março e outubro de 1997, foi realizado acompanhamento prospectivo de todos os indivíduos com idade de 1 a 12 anos admitidos no Hospital Couto Maia com diagnóstico clínico e laboratorial de meningite asséptica. A população do estudo foi dividida em dois grupos, representando indivíduos vacinados e não vacinados. Foram coletadas informações demográficas, clínicas e laboratoriais para ambos os grupos. Resultados. No mês de setembro, logo após a campanha de vacinação, 74 casos de meningite asséptica foram atendidos no Hospital Couto Maia, em comparação com a média mensal de 7,5 casos. Verificamos maior freqüência de rigidez de nuca e níveis mais altos de celularidade liquórica nas crianças cuja meningite foi associada à vacina. Por outro lado, houve maior número de casos com comprometimento encefálico no grupo de meningites não associadas à vacinação. Conclusões. Embora a meningite pós-vacinal tenha curso mais benigno, seu tratamento continua gerando custos com exames complementares e internações. As campanhas de vacinação em larga escala devem utilizar vacinas contendo cepas menos reatogênicas.Mortalidad prematura por enfermedades infecciosas en España, 1908-1995S1020-498920020010000072018-01-01T00:02:00Z2018-01-01T00:02:00ZMirón Canelo, José AntonioAlonso Sardón, MontserratMéndez Pardo, MercedesLópez León, IsabelSáenz González, María del Carmen
<em>Mirón Canelo, José Antonio</em>;
<em>Alonso Sardón, Montserrat</em>;
<em>Méndez Pardo, Mercedes</em>;
<em>López León, Isabel</em>;
<em>Sáenz González, María Del Carmen</em>;
<br/><br/>
Objetivos. Las enfermedades infecciosas han sido tradicionalmente una de las principales causas de muerte en los países desarrollados. Los objetivos del presente trabajo consistieron en cuantificar la importancia de las enfermedades infecciosas como causa de muerte prematura en España entre 1908 y 1995, y conocer la frecuencia y distribución de las enfermedades infecciosas con mayor impacto sobre la mortalidad prematura. Métodos. El estudio se realizó a partir de los datos de mortalidad por causas infecciosas publicados por el Instituto Nacional de Estadística en el Movimiento Natural de la Población para el período en estudio. Se utilizan como indicadores de mortalidad prematura los años de vida potencial perdidos (AVPP), la tasa bruta de AVPP por 1 000 habitantes y el porcentaje y la media de AVPP. Resultados. Entre 1908 y 1995, el número y la tasa de AVPP por causas infecciosas experimentaron una evolución claramente descendente. El descenso fue más acusado a partir de los años 50 y se observó en todos los grupos de edad. La tuberculosis fue la primera causa de muerte prematura desde principios de siglo hasta los años 70. A partir de esta fecha toman el relevo las neumonías y el sida. Conclusiones. El impacto de las enfermedades infecciosas como determinantes de muerte prematura en España ha descendido a lo largo del siglo XX, sobre todo a partir de los años 70.Congenital rubella syndrome in HaitiS1020-498920020010000082018-01-01T00:02:00Z2018-01-01T00:02:00ZGolden, NancyKempker, RussellKhator, ParulSummerlee, RobertFournier, Arthur
<em>Golden, Nancy</em>;
<em>Kempker, Russell</em>;
<em>Khator, Parul</em>;
<em>Summerlee, Robert</em>;
<em>Fournier, Arthur</em>;
<br/><br/>
Objective. To determine if there is an unrecognized problem of congenital rubella syndrome (CRS) in Haiti, a country without a national rubella immunization program. Methods. During March 2001 and June 2001, screening physicals were conducted on approximately 80 orphans at three orphanages in Haiti that accept disabled children. Children were classified as probable CRS cases based on established clinical criteria. Photo documentation of findings was obtained whenever possible. Results. Six children met the criteria for probable CRS. Using data from surrounding Caribbean countries and from the United States of America prior to rubella immunization, we estimated that there are between 163 and 440 new cases of CRS per year in Haiti. Conclusions. CRS exists in Haiti, but its presence is generally unrecognized. A national rubella immunization policy should be considered.Nuevo nombre para el Pneumocystis del humano: Pneumocystis jiroveciS1020-498920020010000092018-01-01T00:02:00Z2018-01-01T00:02:00ZEnteritis por Escherichia coli O157:H7: tratamiento con antibióticos y riesgo de síndrome hemolítico urémicoS1020-498920020010000102018-01-01T00:02:00Z2018-01-01T00:02:00ZLa viudez como factor de riesgo de suicidioS1020-498920020010000112018-01-01T00:02:00Z2018-01-01T00:02:00ZTratamientos tópicos de las verrugas cutáneasS1020-498920020010000122018-01-01T00:02:00Z2018-01-01T00:02:00ZRifapentina una vez a la semana frente a rifampicina dos veces a la semana en pacientes negativos al VIHS1020-498920020010000132018-01-01T00:02:00Z2018-01-01T00:02:00ZRetiros del mercadoS1020-498920020010000142018-01-01T00:02:00Z2018-01-01T00:02:00ZReacciones adversasS1020-498920020010000152018-01-01T00:02:00Z2018-01-01T00:02:00ZUso racionalS1020-498920020010000162018-01-01T00:02:00Z2018-01-01T00:02:00ZEnmiendas a la rotulación/cambios de formulaciónS1020-498920020010000172018-01-01T00:02:00Z2018-01-01T00:02:00ZDecisiones diversasS1020-498920020010000182018-01-01T00:02:00Z2018-01-01T00:02:00ZEvaluación de nuevos productosS1020-498920020010000192018-01-01T00:02:00Z2018-01-01T00:02:00ZPolíticas de medicamentosS1020-498920020010000202018-01-01T00:02:00Z2018-01-01T00:02:00ZEffectively managing public concerns about immunization safetyS1020-498920020010000212018-01-01T00:02:00Z2018-01-01T00:02:00ZTamizaje del cáncer colorrectalS1020-498920020010000222018-01-01T00:02:00Z2018-01-01T00:02:00Z