Revista Panamericana de Salud Públicahttps://scielosp.org/feed/rpsp/2006.v19n3/2018-01-01T00:02:00ZUnknown authorVol. 19 No. 3 - 2006WerkzeugEl dengue, un problema creciente de salud en las AméricasS1020-498920060003000012018-01-01T00:02:00Z2018-01-01T00:02:00ZGustavo, Kourí
<em>Gustavo, Kourí</em>;
<br/><br/>
Assessing HIV resistance in developing countries: Brazil as a case studyS1020-498920060003000022018-01-01T00:02:00Z2018-01-01T00:02:00ZPetersen, Maya L.Boily, Marie-ClaudeBastos, Francisco I.
<em>Petersen, Maya L.</em>;
<em>Boily, Marie-Claude</em>;
<em>Bastos, Francisco I.</em>;
<br/><br/>
Increased transmission of resistant HIV has been raised as a potential consequence of expanded access to antiretroviral therapy. We review how limitations in resources and health care infrastructure may impact the transmission of resistant HIV, and we examine data from Brazil as a case study. We introduce a biological and clinical framework to identify the major determinants of transmitted resistance and to discuss how these determinants may be affected by a lack of infrastructure. We then use our framework to examine HIV resistance data from Brazil. This country was chosen as a case study due to its extensive experience delivering antiretroviral drugs and because of the availability of data on the prevalence of resistant HIV there. The data from Brazil show that antiretroviral therapy can be delivered in a resource-limited setting without resulting in widespread transmission of resistant virus. While the Brazilian experience does not necessarily generalize to countries with less health care infrastructure, neither theory nor data support a foregone conclusion that resistance will necessarily dominate HIV epidemics in the developing world to a greater extent than it does in the developed world.Validación de un cuestionario para el diagnóstico de la epilepsia en servicios de atención primariaS1020-498920060003000032018-01-01T00:02:00Z2018-01-01T00:02:00ZCarpio, ArturoLisanti, NoemíCalle, HugoBorrero, InésTorres, María ElisaToral, Ana MaríaVásquez, Ismael
<em>Carpio, Arturo</em>;
<em>Lisanti, Noemí</em>;
<em>Calle, Hugo</em>;
<em>Borrero, Inés</em>;
<em>Torres, María Elisa</em>;
<em>Toral, Ana María</em>;
<em>Vásquez, Ismael</em>;
<br/><br/>
OBJETIVOS: Evaluar la utilidad de un cuestionario para establecer el diagnóstico de epilepsia en niños de 1 a 10 años de edad y clasificar las crisis epilépticas en los servicios de atención primaria. MÉTODOS: Estudio observacional transversal; participaron 204 niños de 1 a 10 años de edad (102 con diagnóstico de epilepsia y 102 sin epilepsia) escogidos al azar en el Centro Regional de Epilepsias y en el Hospital Vicente Corral Moscoso, ambos de la ciudad de Cuenca, Ecuador. Los niños fueron pareados por grupos de edad (de 1 a 5 y de 6 a 10 años). Cuatro estudiantes del último año de la Escuela de Medicina de esa ciudad que desconocían el diagnóstico del niño aplicaron el cuestionario a un familiar del niño o a su representante. Se evaluó el grado de discriminación diagnóstica (validez) del cuestionario, la sensibilidad, la especificidad y el valor diagnóstico de un resultado positivo o negativo, con un intervalo de confianza de 95% (IC95%). Como criterio de referencia se utilizó el diagnóstico clínico emitido por especialistas. RESULTADOS: La evaluación realizada demostró que el cuestionario de diagnóstico estudiado tiene buena sensibilidad (95,10%; IC95%: 94,58 a 95,61) y especificidad (97,06%; IC95%: 96,58 a 97,59). El índice de validez fue de 96,08 (IC95%: 95,84 a 96,36), con un valor pronóstico de un resultado positivo de 97,00% (IC95%: 96,48 a 97,52) y un valor pronóstico de un resultado negativo de 95,19% (IC95%: 94,74 a 95,74). El grado de concordancia de la clasificación de las crisis epilépticas realizadas por los neurólogos y los estudiantes de medicina que utilizaron el cuestionario fue satisfactorio para las crisis generalizadas (índice k: 0,67). Según la prueba de reproducibilidad de resultados entre observadores, el índice k para el diagnóstico de los neurólogos fue de 0,80 y para el diagnóstico de los pediatras de 0,89. CONCLUSIONES: El cuestionario de diagnóstico evaluado posee una buena sensibilidad y una adecuada especificidad y puede ayudar a los médicos generales, después de un breve entrenamiento, a diagnosticar las crisis epilépticas en los servicios de atención primaria.The mental health status of Mayan refugees after repatriation to GuatemalaS1020-498920060003000042018-01-01T00:02:00Z2018-01-01T00:02:00ZSabin, MiriamSabin, KeithKim, Hyoung YongVergara, MarianelaVarese, Luis
<em>Sabin, Miriam</em>;
<em>Sabin, Keith</em>;
<em>Kim, Hyoung Yong</em>;
<em>Vergara, Marianela</em>;
<em>Varese, Luis</em>;
<br/><br/>
OBJECTIVE: Only one previous study had examined the epidemiology of mental health in Guatemalan refugees. The objective of this new study was to estimate the prevalence of mental illness and to assess factors associated with poor mental health among Guatemalan Mayan refugees who had been repatriated to Guatemala after spending 12-18 years in refugee camps in Mexico, and to compare the results for the repatriated Guatemalans with those for Guatemalan refugees who were continuing to live in Mexico. METHODS: In 2001 a cross-sectional survey of adults (> 16 years) was conducted with random household sampling proportional to the population size in each of the five repatriation villages surveyed. Posttraumatic stress disorder (PTSD), anxiety, and depression were measured by the Harvard Trauma Questionnaire and the Hopkins Symptom Checklist-25. RESULTS: Together, the five repatriation villages had 565 households. Of the 565 households, 203 of them were approached to solicit study participation. A total of 179 households (one adult per household) agreed to participate, representing an overall participation rate of 88%, and one-third of all the households in the five communities. The respondents had personally experienced a mean of 5.5 trauma events and had witnessed a mean of 7.3 other trauma events. Of the respondents, 8.9% met the symptom criteria for PTSD, 17.3% for anxiety, and 47.8% for depression. PTSD was associated with being seriously wounded and with having relatives or friends mutilated. Logistic regression analyses indicated that anxiety was associated with being sexually assaulted, being female, having friends or family mutilated, being seriously wounded, and having 6-12 children (vs. having 1-5 children). Depression was associated with having 6-12 children. Anxiety was significantly more prevalent among the refugees remaining in Mexico (54.4%) than it was among the repatriated refugees (17.3%). The difference in the prevalence rates was not significant for PTSD (11.8% for refugees remaining in Mexico vs. 8.9% for those repatriated) or for depression (38.8% for refugees remaining in Mexico vs. 47.8% for those repatriated). CONCLUSIONS: Psychiatric morbidity was common among the repatriated Mayans. The repatriation of refugees involves moving an already vulnerable, often traumatized population back to a place of distressing memories and still-unsettled conditions. There is a need to consider and plan for adequate mental health services for repatriating refugees.Vigilância epidemiológica do sarampo e da rubéola no Município de Campinas (SP), Brasil: confiabilidade dos dadosS1020-498920060003000052018-01-01T00:02:00Z2018-01-01T00:02:00ZBarros, Eliana Nogueira Castro deSilva, Eliete Maria
<em>Barros, Eliana Nogueira Castro De</em>;
<em>Silva, Eliete Maria</em>;
<br/><br/>
OBJETIVO: Avaliar e validar as informações sobre o sarampo e a rubéola existentes no Sistema Nacional de Informação de Agravos de Notificação (SINAN) em Campinas, tomando como referência os dados do Sistema de Vigilância Sindrômica de Febre e Exantema (VigiFEx), que funcionou paralelamente ao SINAN no período de maio de 2003 a junho de 2004. MÉTODO: Foram comparados os dados anuais do SINAN de 1999 a 2003 e os dados do SINAN e do VigiFEx para o período de junho de 2003 a maio de 2004. Analisou-se o preenchimento dos campos número, data e município da notificação (variáveis chaves), nome da doença, data dos primeiros sintomas, nome do paciente, data de nascimento e idade, sexo e município de residência, data da investigação, antecedentes vacinais, presença de exantema, data de início do exantema e presença de febre; e casos suspeitos em gestantes, sinais e sintomas, data da coleta da primeira amostra, resultados, coleta de isolamento viral, classificação final, critério de confirmação/descarte, diagnóstico do caso descartado, evolução do caso e data de encerramento. Também foi analisada a concordância dos casos registrados entre as bases de dados. RESULTADOS: Foram identificadas 211 suspeitas de sarampo ou rubéola na base VigiFEx e 275 na base SINAN 12 meses. Todos os casos registrados apresentaram dados completos em relação às variáveis chaves. Os campos nome do paciente, agravo ou doença e município de residência também tiveram 100% de preenchimento. Mais de 95% de preenchimento foi observado para data de investigação, vacina contra o sarampo, vacina contra o sarampo e a rubéola e vacina contra a rubéola. As demais variáveis vacinais (número de doses e data da última dose) apresentaram elevados percentuais de não-preenchimento, assim como as variáveis exantema, febre e data de início do exantema. Houve inconsistência entre os sistemas, principalmente em relação às variáveis sobre antecedentes epidemiológicos, dados clínicos e conclusão do caso. Os dados do VigiFEx apresentaram melhor qualidade. CONCLUSÕES: É preciso avaliar rotineiramente os sistemas de informação de vigilância, imunização e laboratório para garantir a confiabilidade dos dados, de forma que possam embasar o planejamento de ações em saúde.A new DTPw-HB/Hib combination vaccine for primary and booster vaccination of infants in Latin AmericaS1020-498920060003000062018-01-01T00:02:00Z2018-01-01T00:02:00ZTregnaghi, MiguelLópez, PioRocha, CrisantaRivera, LuisDavid, Marie-PierreRüttimann, RicardoSchuerman, Lode
<em>Tregnaghi, Miguel</em>;
<em>López, Pio</em>;
<em>Rocha, Crisanta</em>;
<em>Rivera, Luis</em>;
<em>David, Marie-Pierre</em>;
<em>Rüttimann, Ricardo</em>;
<em>Schuerman, Lode</em>;
<br/><br/>
OBJECTIVES: In 1998 the World Health Organization (WHO) recommended the inclusion of Haemophilus influenza type B (Hib) conjugate vaccines in infant immunization programs, whenever in accordance with national priorities. GlaxoSmithKline Biologicals has developed a new pentavalent combined diphtheria-tetanus-whole cell pertussis-hepatitis B/Hib (DTPwHB/Hib) vaccine containing 5 µg of polyribosylribitol phosphate (PRP), and we assessed the immunogenicity and reactogenicity of primary and booster vaccination of healthy children with this new vaccine compared with a reference regimen consisting of the licensed DTPomega-HB (Tritanrix) and Hib (Hiberix) vaccines given as simultaneous concomitant injections. METHODS: We performed a randomized, double-blind study from September 1998 to August 1999 to establish the immunogenicity and reactogenicity of primary and booster vaccination of healthy children with the new pentavalent combined DTPomega-HB/Hib vaccine given as a single injection, compared with the reference regimen. RESULTS: Both vaccination regimens elicited excellent immune responses, with all subjects in both groups achieving seroprotective anti-PRP antibody concentrations of > 0.15 µg/mL one month after primary vaccination. The combined DTPomega-HB/Hib vaccine was non-inferior to the licensed vaccines in terms of seroprotection/seropositivity/vaccine response rates for all antigen components. Persistence of antibodies against all study vaccine antigens up to the time of booster vaccination was comparable between groups, and a marked increase of all antibody concentrations was observed after the booster dose. Both vaccine regimens were similar in terms of their overall reactogenicity profiles. CONCLUSIONS: Our results indicate that the new DTPomega-HB/Hib pentavalent combination vaccine provides an efficient and reliable way of implementing WHO recommendations for controlling hepatitis B and Hib infections on a worldwide basis.Os riscos genômicos e a responsabilidade pessoal em saúdeS1020-498920060003000072018-01-01T00:02:00Z2018-01-01T00:02:00ZCastiel, Luis DavidGuilam, Maria Cristina RodriguesVasconcellos-Silva, Paulo RobertoSanz-Valero, Javier
<em>Castiel, Luis David</em>;
<em>Guilam, Maria Cristina Rodrigues</em>;
<em>Vasconcellos-Silva, Paulo Roberto</em>;
<em>Sanz-Valero, Javier</em>;
<br/><br/>
Actitudes ante el tamizaje de cáncer de colon y recto en personas de origen mexicano que viven en los Estados UnidosS1020-498920060003000082018-01-01T00:02:00Z2018-01-01T00:02:00ZPatrones de consumo de tabaco en estudiantes de 13 a 15 añosS1020-498920060003000092018-01-01T00:02:00Z2018-01-01T00:02:00ZPapel de las comadronas en las comunidades cakchiqueles de GuatemalaS1020-498920060003000102018-01-01T00:02:00Z2018-01-01T00:02:00ZPercepciones acerca del uso de fármacos abortivos en mujeres de Colombia, Ecuador, México y PerúS1020-498920060003000112018-01-01T00:02:00Z2018-01-01T00:02:00ZAbandono espontáneo del hábito de fumar durante el embarazo en mujeres estadounidenses de bajos ingresosS1020-498920060003000122018-01-01T00:02:00Z2018-01-01T00:02:00ZRiesgo de transmisión de la tripanosomiasis americana por triatominos en MéxicoS1020-498920060003000132018-01-01T00:02:00Z2018-01-01T00:02:00ZLa temporada de picadura de Anopheles darlingi y su relación con el control del paludismo en BoliviaS1020-498920060003000142018-01-01T00:02:00Z2018-01-01T00:02:00ZEl dengue y el dengue hemorrágico: prioridades de investigaciónS1020-498920060003000152018-01-01T00:02:00Z2018-01-01T00:02:00ZGuzmán, María G.García, GisselKourí, Gustavo
<em>Guzmán, María G.</em>;
<em>García, Gissel</em>;
<em>Kourí, Gustavo</em>;
<br/><br/>
ErratumS1020-498920060003000162018-01-01T00:02:00Z2018-01-01T00:02:00Z