Revista Panamericana de Salud Públicahttps://scielosp.org/feed/rpsp/2013.v33n5/2018-01-01T00:02:00ZVol. 33 No. 5 - 2013WerkzeugConocimientos, actitudes y prácticas sobre la enfermedad de Carrión en población rural de Ancash, PerúS1020-498920130005000012018-01-01T00:02:00Z2018-01-01T00:02:00ZLlerena Luna, CarolinaSchweig Groisman, MaggieUgarte-Gil, César Augusto
<em>Llerena Luna, Carolina</em>;
<em>Schweig Groisman, Maggie</em>;
<em>Ugarte-Gil, César Augusto</em>;
<br/><br/>
OBJETIVO: Evaluar el conocimiento, las prácticas y las actitudes sobre la enfermedad de Carrión (bartonelosis) en poblaciones rurales con antecedentes de brotes epidémicos. MÉTODOS: Estudio transversal realizado en las poblaciones de Huaripampa, Orcosh y Opayaco (Ancash, Perú) durante el mes de julio del 2010, utilizando una encuesta para evaluar el conocimiento, las prácticas y las actitudes sobre la enfermedad de Carrión. Se entrevistó solo a mayores de 18 años que tuviesen una antigüedad mínima de un año residiendo en esos poblados. RESULTADOS: Se realizaron encuestas a un total de 276 pobladores, de los cuales 36,6% fueron hombres y 72,5% no había oído hablar de la enfermedad de Carrión. Entre los que la conocían, la mayoría (38,7%) indicó que se contagia mediante picaduras, mientras que 26% manifestó no conocer la forma de contagio. Con respecto a las acciones que deberían tomarse en caso de presentar la enfermedad de Carrión, 69,3% de los encuestados refirieron que acudirían a un centro de salud y más de la mitad informó haber recomendado prácticas preventivas a familiares o conocidos en el pasado. CONCLUSIONES: A pesar de tratarse de comunidades históricamente afectadas por la enfermedad de Carrión, los pobladores de estas tres comunidades no mostraron un nivel adecuado de conocimientos, actitudes o prácticas para su prevención. En vista de ello, y teniendo en cuenta que este padecimiento ha presentado brotes cíclicos, se hace perentorio diseñar e implementar un programa que eduque a los habitantes de estos poblados -poniendo el foco en el papel de los usos y costumbres- sobre cómo prevenir la enfermedad de Carrión, así como el resto de las principales enfermedades endémicas de la región.Setting priorities for surveillance, prevention, and control of zoonoses in Bogotá, ColombiaS1020-498920130005000022018-01-01T00:02:00Z2018-01-01T00:02:00ZCediel, NataliaVillamil, Luis CarlosRomero, JaimeRenteria, LibardoDe Meneghi, Daniele
<em>Cediel, Natalia</em>;
<em>Villamil, Luis Carlos</em>;
<em>Romero, Jaime</em>;
<em>Renteria, Libardo</em>;
<em>De Meneghi, Daniele</em>;
<br/><br/>
OBJECTIVE: To establish priorities for zoonoses surveillance, prevention, and control in Bogotá, Colombia. METHODS: A Delphi panel of experts in veterinary and human medicine was conducted using a validated prioritization method to assess the importance of 32 selected zoonoses. This exercise was complemented by a questionnaire survey, using the knowledge, attitudes, and practices (KAP) methodology, administered in 19 districts of Bogotá from September 2009 to April 2010 to an at-risk population (workers at veterinary clinics; pet shops; butcher shops; and traditional food markets that sell poultry, meat, cheese, and eggs). A risk indicator based on level of knowledge about zoonoses was constructed using categorical principal component and logistic regression analyses. RESULTS: Twelve experts participated in the Delphi panel. The diseases scored as highest priority were: influenza A(H1N1), salmonellosis, Escherichia coli infection, leptospirosis, and rabies. The diseases scored as lowest priority were: ancylostomiasis, scabies, ringworm, and trichinellosis. A total of 535 questionnaires were collected and analyzed. Respondents claimed to have had scabies (21%), fungi (8%), brucellosis (8%), and pulicosis (8%). Workers with the most limited knowledge on zoonoses and therefore the highest health risk were those who 1) did not have a professional education, 2) had limited or no zoonoses prevention training, and 3) worked in Usme, Bosa, or Ciudad Bolívar districts. CONCLUSIONS: According to the experts, influenza A(H1N1) was the most important zoonoses. Rabies, leptospirosis, brucellosis, and toxoplasmosis were identified as priority diseases by both the experts and the exposed workers. This is the first prioritization exercise focused on zoonoses surveillance, prevention, and control in Colombia. These results could be used to guide decision-making for resource allocation in public health.Metodologia de implementação de práticas preventivas ao uso de drogas na atenção primária latino-americanaS1020-498920130005000032018-01-01T00:02:00Z2018-01-01T00:02:00ZCosta, Pedro Henrique Antunes daMota, Daniela Cristina BelchiorCruvinel, EricaPaiva, Fernando Santana deRonzani, Telmo Mota
<em>Costa, Pedro Henrique Antunes Da</em>;
<em>Mota, Daniela Cristina Belchior</em>;
<em>Cruvinel, Erica</em>;
<em>Paiva, Fernando Santana De</em>;
<em>Ronzani, Telmo Mota</em>;
<br/><br/>
OBJETIVO: Desenvolver uma metodologia para implementação de práticas de prevenção ao uso de álcool e outras drogas no âmbito da atenção primária à saúde (APS) que contribua com o debate sobre ações e políticas nos países latino-americanos. MÉTODOS: Trata-se de uma pesquisa-intervenção realizada em um município brasileiro de pequeno/médio porte. O processo foi avaliado através da observação participante, visando adequação às necessidades locais e ressaltando pontos de facilitação e dificuldade na implantação. RESULTADOS: Foi desenvolvido um modelo com seis etapas: contato inicial e planejamento, diagnóstico e mapeamento, sensibilização, capacitação, acompanhamento e devolutiva. Foram percebidos os seguintes pontos de dificuldade: insuficiência de recursos (humanos, financeiros, infraestrutura), falta de integralidade e intersetorialidade da rede assistencial, falta de participação dos médicos, formação calcada no saber médico, participação insuficiente da gestão de saúde, falta de mobilização e participação da sociedade civil, ausência de momentos onde a população fosse convidada a participar do planejamento e execução das políticas públicas. Pontos fortes foram: participação dos agentes comunitários e enfermeiros na aplicação, organização e planejamento das práticas, além da realização de práticas educacionais e preventivas nas escolas e comunidades pelas equipes de saúde. Isso indica que é possível implementar iniciativas de triagem, intervenção breve e encaminhamento para tratar (SBIRT) no contexto da APS latino-americana. CONCLUSÕES: A metodologia desenvolvida neste estudo pode ser útil para países latino-americanos desde que sejam consideradas as necessidades locais. Entretanto, os resultados serão observados apenas a médio e longo prazo, sem mudanças instantâneas.Tuberculosis patients in the Dominican Republic face severe direct and indirect costs and need social protectionS1020-498920130005000042018-01-01T00:02:00Z2018-01-01T00:02:00ZMauch, VerenaMelgen, RicardoMarcelino, BelkysAcosta, IvelisseKlinkenberg, EvelineSuarez, Pedro
<em>Mauch, Verena</em>;
<em>Melgen, Ricardo</em>;
<em>Marcelino, Belkys</em>;
<em>Acosta, Ivelisse</em>;
<em>Klinkenberg, Eveline</em>;
<em>Suarez, Pedro</em>;
<br/><br/>
OBJECTIVE: To examine direct and indirect costs incurred by new, retreatment, and multidrug-resistant (MDR) tuberculosis (TB) patients in the Dominican Republic before and during diagnosis, and during treatment, to generate an evidence base and formulate recommendations. METHODS: The "Tool to Estimate Patients' Costs" was adapted to the local setting, translated into Spanish, and pretested. Patients attending 32 randomly selected health facilities in six chosen study areas on the study days were interviewed. Responses from patients 18-65 years old who had received treatment for at least one month and provided signed informed consent were collected, entered into a database, and analyzed. RESULTS: A total of 200 patients were interviewed. For most respondents, direct and indirect costs increased while income decreased. Total costs amounted to a median of US$ 908 for new patients, US$ 432 for retreatment patients, and US$ 3 557 for MDR-TB patients. The proportion of patients without a regular income increased from 1% to 54% because of falling ill with TB. Following its review of the study results the Ministry of Health has made efforts to allocate public funds for food supplements and to include in- and outpatient TB services in the national health insurance schemes. CONCLUSIONS: Free TB diagnosis and treatment are not enough to alleviate the financial constraints experienced by vulnerable groups as a result of the illness. Health insurance covering TB in- and outpatient costs is critical to prevent TB-related financial hardship.Social class, health inequalities, and health-related behaviors of working people in ChileS1020-498920130005000052018-01-01T00:02:00Z2018-01-01T00:02:00ZRocha, Kátia BonesMuntaner, CarlesGonzález Rodríguez, María JoséBaksai, Pamela BernalesVallebuona, CleliaBorrell, CarmeSolar, Orielle
<em>Rocha, Kátia Bones</em>;
<em>Muntaner, Carles</em>;
<em>González Rodríguez, María José</em>;
<em>Baksai, Pamela Bernales</em>;
<em>Vallebuona, Clelia</em>;
<em>Borrell, Carme</em>;
<em>Solar, Orielle</em>;
<br/><br/>
OBJECTIVE: To analyze links between social class and health-related indicators and behaviors in Chilean workers, from a neo-Marxian perspective. METHODS: A cross-sectional study based on the First National Survey on Employment, Work, Health, and Quality of Life of Workers in Chile, done in 2009-2010 (n = 9 503). Dependent variables were self-perceived health status and mental health, examined using the General Health Questionnaire (GHQ-12). Health-related behavior variables included tobacco use and physical activity. The independent variable was neo-Marxian social class. Descriptive analyses of prevalence were performed and odds ratio (OR) models and 95% confidence intervals (95%CI) were estimated. RESULTS: Medium employers (between 2 and 10 employees) reported a lower prevalence of poor health (21.6% [OR 0.68; 95%CI 0.46-0.99]). Unskilled managers had the lowest mental health risk (OR 0.43; 95%CI 0.21-0.88), with differences between men and women. Large employers (more than 10 employees) reported smoking the least, while large employers, expert supervisors, and semi-skilled workers engaged in significantly more physical activity. CONCLUSIONS: Large employers and expert managers have the best health-related indicators and behaviors. Formal proletarians, informal proletarians, and unskilled supervisors, however, have the worst general health indicators, confirming that social class is a key determinant in the generation of population health inequalities.Comparing three body mass index classification systems to assess overweight and obesity in children and adolescentsS1020-498920130005000062018-01-01T00:02:00Z2018-01-01T00:02:00ZGonzalez-Casanova, InesSarmiento, Olga L.Gazmararian, Julie A.Cunningham, Solveig A.Martorell, ReynaldoPratt, MichaelStein, Aryeh D.
<em>Gonzalez-Casanova, Ines</em>;
<em>Sarmiento, Olga L.</em>;
<em>Gazmararian, Julie A.</em>;
<em>Cunningham, Solveig A.</em>;
<em>Martorell, Reynaldo</em>;
<em>Pratt, Michael</em>;
<em>Stein, Aryeh D.</em>;
<br/><br/>
OBJECTIVE: To compare the International Obesity Task Force (IOTF) 2005, Centers for Disease Control and Prevention (CDC) 2000, and World Health Organization (WHO) 2007 body mass index (BMI) classification systems in terms of prevalence estimation and association with demographic factors. METHODS: The 18 265 children and adolescents ages 5 to 18 years (mean = 11.2 years, standard deviation = 3.9 years) in the nationally representative Colombian National Nutrition Survey of 2005 were classified as overweight or obese according to IOTF, CDC, and WHO criteria. Prevalence estimates were compared according to each system and associations with age, sex, socioeconomic status, and population density were tested. RESULTS: Prevalence estimates of combined overweight and obesity differed by system (males: IOTF = 8.5%, CDC = 10.8%, WHO = 14.1%; females: IOTF = 14.6%, CDC = 13.8%, WHO = 17.1%; P < 0.001). The association between combined overweight and obesity and age and sex varied by system. The odds of having overweight and obesity in children (5 to 10 years) compared with adolescents (11 to 18 years) were: IOTF, odds ratio (OR) = 0.87 and 95% confidence interval (CI) = 0.77-0.98; CDC, OR = 1.27 and CI = 1.14-1.42; WHO, OR = 1.21 and CI = 1.08-1.35. The values for females compared with males were: IOTF, OR = 1.84 and CI = 1.6-2.10; CDC, OR = 1.33 and CI = 1.17-1.51; WHO, OR = 1.25 and CI = 1.12-1.41. CONCLUSIONS: There is a lack of consistency among the three main international systems in assessing overweight and obesity in children and adolescents. Appreciably different estimates of prevalence and associations with age and sex are obtained depending on which system is used. Future studies should assess how well each system reflects valid measures of body composition.Desenvolvimento e aplicação de um novo índice para avaliação do pré-natalS1020-498920130005000072018-01-01T00:02:00Z2018-01-01T00:02:00ZSilva, Esther Pereira daLima, Roberto TeixeiraCosta, Maria José de CarvalhoBatista Filho, Malaquias
<em>Silva, Esther Pereira Da</em>;
<em>Lima, Roberto Teixeira</em>;
<em>Costa, Maria José De Carvalho</em>;
<em>Batista Filho, Malaquias</em>;
<br/><br/>
OBJETIVO: Desenvolver e aplicar um novo instrumento para avaliar o pré-natal com base nas diretrizes do Programa de Humanização do Pré-Natal e do Nascimento do Ministério da Saúde brasileiro, inserindo elementos quanti-qualitativos distribuídos segundo a tríade avaliativa de infra-estrutura, processo de trabalho e resultados. MÉTODOS: Este estudo transversal, de natureza analítico-descritiva e abordagem quantitativa, foi desenvolvido com 238 usuárias em 44 serviços da atenção primária à saúde do Município de João Pessoa, Nordeste do Brasil, de novembro de 2010 a dezembro de 2011. Também foram entrevistados médicos e enfermeiros envolvidos no cuidado pré-natal. O instrumento elaborado pelos pesquisadores continha 23 questões relativas a infra-estrutura, processo de trabalho e resultados da assistência pré-natal. A partir das informações coletadas, o pré-natal foi classificado pelo que denominamos de Índice IPR/Pré-Natal. Para cada questão atribui-se o valor 1 para adequado, quando em conformidade com os critérios estabelecidos, e 2 para inadequado. Com base na porcentagem representada pela soma do número de questões adequadas dos três componentes em relação ao total de 23 questões, o cuidado pré-natal foi classificado em: adequado superior (100% de questões adequadas); adequado (>75%); intermediário (51 a 74%); e inadequado (<50%). As categorias de classificação do IPR/Pré-Natal foram comparadas com as dos índices de Kessner e Adequacy of Prenatal Care Utilization (APNCU). RESULTADOS: As questões referentes ao processo de trabalho foram as que contribuíram com significância estatística para que o pré-natal fosse classificado em maior proporção na categoria intermediário pelo Índice IPR/Pré-Natal. As categorias de classificação do Índice IPR/ Pré-Natal mostraram-se consistentes para detectar as variáveis prematuridade, peso insuficiente ao nascer e não realização do aleitamento materno exclusivo. CONCLUSÕES: O Índice IPR/Pré-Natal foi eficaz na incorporação de elementos quanti-qualitativos para classificação do cuidado pré-natal.Estudio epidemiológico de los casos de triquinelosis registrados en la provincia de Santa Fe, Argentina, 1998-2009S1020-498920130005000082018-01-01T00:02:00Z2018-01-01T00:02:00ZSequeira, Gabriel J.Dalla Fontana, María L.Zbrun, María V.Soto, Lorena P.Frizzo, Laureano S.Zarazaga, María del PilarSanchez, Inés C.Signorini, Marcelo L.
<em>Sequeira, Gabriel J.</em>;
<em>Dalla Fontana, María L.</em>;
<em>Zbrun, María V.</em>;
<em>Soto, Lorena P.</em>;
<em>Frizzo, Laureano S.</em>;
<em>Zarazaga, María Del Pilar</em>;
<em>Sanchez, Inés C.</em>;
<em>Signorini, Marcelo L.</em>;
<br/><br/>
OBJETIVO: Caracterizar desde los puntos de vista epidemiológico, clínico y de laboratorio los casos y brotes de triquinelosis que se registraron en la provincia de Santa Fe, Argentina, entre 1998 y 2009. MÉTODOS: Se analizaron 1 519 fichas epidemiológicas de personas que presentaron síntomas y signos compatibles con triquinelosis en la provincia de Santa Fe en el período 1998-2009. Se realizó el análisis estadístico descriptivo de la información contenida en las fichas epidemiológicas y los resultados clínicos y de laboratorio; se aplicó el análisis bifactorial para determinar las posibles asociaciones con factores epidemiológicos y ambientales. RESULTADOS: Se encontraron síntomas de triquinelosis en 1 276 casos; 372 cumplían la definición de caso clínico y 224 muestras resultaron positivas por inmunofluorescencia indirecta, independientemente de su clasificación como caso clínico. Se identificaron 27 brotes que involucraron a 1 157 casos en ocho departamentos, con mayor frecuencia en el centro y el sur de la provincia. La distribución anual de los casos asociados epidemiológicamente entre sí fue heterogénea, con una mayor frecuencia en el período 2000-2003 y en los meses de agosto a octubre. Hubo mayor probabilidad de enfermar cuando se consumieron productos de fuentes informales (OR = 3,69; P = 0,014) y en las áreas rurales (OR = 1,799; P = 0,011). El período de incubación de la enfermedad (mediana) fue de 12 días. Las personas que consumieron carne de cerdo o sus derivados tuvieron 2,06 veces más riesgo de enfermar que las que no la consumieron. CONCLUSIONES: El mayor número de brotes ocurrió en los departamentos más poblados y con mayor producción porcina. Se deben diseñar acciones específicas de prevención y control de la enfermedad en esos departamentos. Se debe considerar el análisis epidemiológico de riesgos al evaluar, gestionar y comunicar los riesgos sanitarios de triquinelosis.Zinc supplementation for treating diarrhea in children: a systematic review and meta-analysisS1020-498920130005000092018-01-01T00:02:00Z2018-01-01T00:02:00ZGalvao, Tais FreireSilva Thees, Maria Fernanda Reis ePontes, Rossana FerreiraSilva, Marcus TolentinoPereira, Mauricio Gomes
<em>Galvao, Tais Freire</em>;
<em>Silva Thees, Maria Fernanda Reis E</em>;
<em>Pontes, Rossana Ferreira</em>;
<em>Silva, Marcus Tolentino</em>;
<em>Pereira, Mauricio Gomes</em>;
<br/><br/>
OBJECTIVE: To update the available evidence about zinc use for treating diarrhea in children and to assess its effect on the malnourished population, a subgroup that has not been fully explored in previous analyses. METHODS: A systematic review was performed of randomized clinical trials that assessed children up to 5 years old with acute diarrhea who received zinc supplementation. Controls received a placebo or oral rehydration therapy. After searching the main databases, without language restrictions, two independent reviewers selected eligible studies, extracted the data, and assessed the risk of bias of included studies. Meta-analyses were calculated using Mantel-Haenszel or inverse variance random effects. RESULTS: Eighteen of 1 041 studies retrieved were included in the review (n = 7 314 children). Zinc was beneficial for reducing the duration of diarrhea in hours (mean difference [MD] = -20.12, 95% confidence interval [CI] = -29.15 to -11.09, I² = 91%). The effect was greater in malnourished children (MD = -33.17, 95% CI = -33.55 to -27.79, I² = 0%). Diarrhea prevalence on days 3, 5, and 7 was lower in the zinc group. The incidence of vomiting was significantly greater in the group that received zinc than in the control group. Included randomized controlled trials were of low risk of bias in most domains assessed. CONCLUSIONS: Oral zinc supplementation significantly decreases diarrhea duration and has a greater effect on malnourished children. Zinc supplementation seems to be an appropriate public health strategy, mainly in areas of endemic deficiencies.News reports of bullying-related fatal and nonfatal injuries in the AmericasS1020-498920130005000102018-01-01T00:02:00Z2018-01-01T00:02:00ZSrabstein, Jorge Carlos
<em>Srabstein, Jorge Carlos</em>;
<br/><br/>
Bullying is a multifaceted and injurious form of maltreatment, prevalent across social settings and around the globe. Victims and perpetrators of bullying are at significant risk of suffering from an array of morbidity and dying young due to accidental injuries, suicide, and homicide. This study reviews news reports of nonfatal and fatal injuries linked to bullying throughout the Western Hemisphere during 12 months. News reports, obtained through a Google search, of episodes of fatal and nonfatal injuries related to school bullying and violence from July 2011 through June 2012 that affected children and adolescents (ages 5 to 19 years) throughout the Americas were analyzed. News reports were found of 82 cases of bullying-related fatal and nonfatal injuries, occurring in one year, across 24 countries and dependent territories in the Western Hemisphere, which have a combined total youth population of 225.5 million children and adolescents ages 5 to 19 years. Ninety-seven percent of the victims were between 10 and 19 years old; 60% of them were below age 15, with a male/female ratio of 2:1. News reports of fatal and nonfatal injurious events related to bullying and affecting children and adolescents in the Americas in one year represent the tip of the public health iceberg composing the unknown magnitude of injuries associated with this type of maltreatment. Data on the magnitude of mortality linked to bullying, which would be of the essence in developing public health policies for its prevention, have not been documented.