Resumo em Espanhol:
La violencia en Colombia parece incontenible. A las masacres y asesinatos colectivos, de una crueldad desconcertante, se suman los secuestros y desapariciones, el maltrato de niños y ancianos y las violaciones de adolescentes. Cada día, sin tregua, los colombianos son espectadores o víctimas de atracos callejeros y de discriminación racial, sexual y socioeconómica. Sin quererlo, se convierten en agentes de agresiones en el transporte urbano, el hogar, la escuela y el trabajo. Colombia tiene las tasas de mortalidad por homicidio más altas del mundo. Independientemente de la enorme sobrecarga institucional que impone a los servicios de salud y medicina legal, la violencia constituye actualmente en Colombia el principal problema de salud pública. Para hacerle frente, el sector de la salud debe elaborar políticas y financiar acciones; crear nuevos procesos de formación de personal, poner en marcha procesos de educación pública y dedicar mayor esfuerzo y creatividad al campo de la investigación, que hasta ahora ha dado respuestas importantes pero aún insuficientes. Al reflexionar sobre la violencia, que es la sustitución de toda argumentación por la fuerza, es necesario ubicarla en el contexto de la vida y la salud. No se pretende solo racionalizarla, y menos aún sustituir la acción por la palabra o por las reflexiones, sino tratar de comprenderla a fondo con el objeto de buscarle alternativas. En el presente artículo se analiza, con esta finalidad, el tema de la violencia en Colombia, principalmente desde el punto de vista de su efecto en la salud de los colombianos y de sus implicaciones para el sector sanitario. El autor expone sus puntos de vista con plena conciencia de su subjetividad y limitaciones.Resumo em Inglês:
In Colombia, violence seems uncontrollable. Along with massacres and group killings of astonishing cruelty, there are also kidnappings and disappearances, abuse of children and the elderly, and rape of young adolescents. Every day, without respite, Colombians are witnesses or victims of street crimes as well as racial, sexual, and socioeconomic discrimination. Unwillingly, they become agents of aggression in public transport, at home, at school, and at work. Colombia has the highest rates of mortality from homicide in the world. Apart from the enormous institutional burden that violence imposes on the health services and forensic medicine, it now constitutes the principal public health problem in the country. To confront it, the health sector must develop policies and finance actions, develop innovative ways to train personnel, implement public education processes, and devote more effort and greater creativity to research, which up to now has provided some important, albeit insufficient, responses. Violence, which is the substitution of force for any type of dialogue, must be considered within the context of life and health. Doing so is not an attempt to rationalize violence, much less to substitute words or reflection for action, but rather an attempt to understand it in depth in order to search for alternatives. With that goal, this article analyzes the subject of violence in Colombia, principally from the perspective of its effect on the health of the citizens and its implications for the health sector. The author fully recognizes the subjectivity and limitations of the views he expresses herein.Resumo em Espanhol:
La garantía de calidad analítica de un laboratorio clínico se logra mediante un sistema de control de calidad interno complementado por un programa de evaluación externa. Esa garantía es la base que fundamenta la confiabilidad de los resultados obtenidos por los laboratorios y su uso en el diagnóstico y tratamiento de las enfermedades. En los países de América Latina hay muchos laboratorios que no cuentan con sistemas apropiados de evaluación y control de la calidad. Dada la importancia de los diagnósticos basados en datos hematológicos, durante el XI Congreso Latinoamericano de Bioquímica Clínica (México, 1993) la Organización Panamericana de la Salud patrocinó un curso de control de la calidad en hematología en el que participaron Argentina, Chile, Cuba, México, Paraguay, República Dominicana y Uruguay. Como parte del curso se produjeron materiales de control: solución estándar secundario de cianmetahemoglobina (HICN), solución concentrada estabilizada de hemoglobina (Hb) y sangre entera humana preservada con seudoleucocitos. Estos materiales fueron enviados a laboratorios de los siete países participantes para su uso en procedimientos analíticos, con objeto de llevar a cabo posteriormente una evaluación externa del desempeño individual y de la comparabilidad de los resultados en conjunto. Las tareas asignadas fueron: 1) determinación de hemoglobina, hematocrito, y glóbulos rojos y blancos con los métodos en uso en cada laboratorio; 2) registro de los datos obtenidos en formularios especiales para la notificación de datos y 3) envío de dichos formularios al coordinador de cada país. Los resultados fueron analizados en función de los procedimientos analíticos y de los países participantes. Los valores de referencia se establecieron por consenso general de todos los participantes después de someterse al método estadístico de truncamiento. El análisis comparado de los resultados mostró coeficientes de variación (CV) de hematocrito (4,5%), recuento de glóbulos rojos (11,0%) y recuento de glóbulos blancos (22,2%) más altos que los coeficientes obtenidos en los Estados Unidos de América y Europa. En función del procedimiento analítico, los métodos manuales arrojaron CV mayores que los métodos automatizados. Los datos discriminados por país y por procedimiento analítico, sometidos a un análisis de la varianza (ANOVA), mostraron significación estadística solo para el recuento leucocitario (P < 0,02). Se concluye que el adiestramiento en la preparación de materiales de control de calidad y su utilización posterior en encuestas piloto puede constituir la base inicial para establecer sistemas permanentes de evaluación interna y externa de la calidad en hematología que, junto con la educación continua del personal y la disponibilidad de instrumental automatizado, permitan alcanzar el objetivo de calidad óptima en el laboratorio.Resumo em Inglês:
The assurance of analytical quality in a clinical laboratory is achieved through an internal system of quality control complemented by an external evaluation program. Quality assurance provides a foundation for the confidence that is placed in laboratory results and their use in the diagnosis and treatment of diseases. Many laboratories in Latin American countries do not have appropriate systems in place to evaluate and control quality. Given the importance of diagnoses based on hematologic data, the Pan American Health Organization sponsored a course in quality control in hematology during the XI Latin American Congress of Clinical Biochemistry (Mexico, 1993), in which representatives from Argentina, Chile, Cuba, Mexico, Paraguay, Dominican Republic, and Uruguay participated. As part of the course, the following control materials were produced: secondary standard solution of cyanmethemoglobin, stabilized concentrated hemoglobin solution, and preserved human whole blood with pseudoleukocytes. These materials were sent to laboratories in the seven participating countries for use in analytical procedures, and the results were then subjected to an external evaluation to assess individual performance and the comparability of results among the group. The specific tasks carried out were: (1) determination of values for hemoglobin, hematocrit, and red and white blood cell counts by the procedures normally used in each laboratory; (2) recording of the data on special reporting forms; and (3) transmittal of those forms to the coordinator in each country. The results were analyzed with regard to both the procedure used and the participating country. Reference values were established by consensus following application of a statistical method to eliminate outlying values. Comparative analysis of the results showed the coefficients of variation (CV) of the hematocrit (4.5%), red blood cell count (11.0%), and white blood cell count (22.2%) to be higher than those reported from the United States of America and Europe. With regard to analytical procedures, the manual methods yielded larger CV than the automated methods. When analysis of variance (ANOVA) was used on data broken down by country and by procedure, the only statistically significant result was for leukocyte count (P < 0.02). It was concluded that training in the preparation of quality control materials and the subsequent use of these materials in pilot surveys could provide a starting point for establishing continuous internal and external quality assessment systems in hematology. Such systems, together with continuing education for laboratory personnel and the availablity of automated instrumentation, will lead to achievement of optimum laboratory quality.Resumo em Português:
O Estado de São Paulo, situado na região Sudeste do Brasil, apresenta esporadicamente casos autóctones de malária que se caracterizam pela presença de quadro clínico benigno com parasitemias baixas e sintomatologia branda, identificados como malária vivax. Pouco se sabe a respeito da sintomatologia e resposta imune desenvolvidas pelo ser humano para as variantes Plasmodium vivax VK247 e Plasmodium vivax-like humano. Estas variantes são transmitidas pelo mosquito Anopheles (Kerteszia) cruzii, uma das espécies mais abundantes no Sudeste brasileiro. O objetivo deste trabalho foi verificar a infecção em anofelinos desta região, através do teste imunoenzimático ELISA com utilização de anticorpos monoclonais específicos dirigidos contra as regiões repetitivas da proteína circunsporozoíta de P. vivax clássico, P. brasilianum/P. malariae e P. vivax VK247. Coletas entomológicas foram realizadas no período de 1991 a 1993 em São Vicente e Juquitiba, municípios localizados em área remanescente da Mata Atlântica do Estado de São Paulo. A Mata Atlântica é rica em plantas da família Bromeliaceae, criadouros de formas imaturas de anofelinos do subgênero Kerteszia. De um total de 1117 espécimes de An. (Ker.) cruzii capturados no Município de São Vicente, 0,179% foram positivos para P. vivax clássico. Em Juquitiba, dentre 1161 An. (Ker.) cruzii pesquisados, 0,086% foram positivos para o P. vivax VK247, o que demonstra a presença da variante na região. Embora o índice de infecção encontrado seja baixo, a alta densidade destes mosquitos e sua voracidade (picam durante as 24 h do dia) poderiam compensar a baixa porcentagem de espécimes infectados.Resumo em Inglês:
Sporadic cases of autochthonous malaria have been recorded in São Paulo State, located in the Southeast region of Brazil. These cases are characterized by their benign course, low parasitemia, and mild symptomatology and have been identified as vivax malaria. Little is known about the symptoms and immune response elicited in humans by the variants Plasmodium vivax VK247 and P. vivax-like human malaria parasites. These variants are transmitted by Anopheles (Kerteszia) cruzii, one of the most common species of mosquitoes in the Southeast of Brazil. The objective of the study described in this paper was to investigate infection in anophelines using ELISA immunoenzymatic assay with specific monoclonal antibodies directed against the repetitive regions of the circumsporozoite protein in classic P. vivax, P. brasilianum/P. malariae, and P. vivax VK247. Between 1991 and 1993, mosquitoes were collected in São Vicente and Juquitiba, municipalites located in a remnant of the Brazilian Atlantic forest in São Paulo State, an ecosystem rich in plants of the Bromeliaceae family. These plants function as nurseries for immature forms of anophelines of the subgenus Kerteszia. Of 1117 An. (Ker.) cruzii captured in São Vicente, 0.179% were positive for classic P. vivax. In Juquitiba, of 1161 An. (Ker.) cruzii, 0.086% were positive for P. vivax VK247, confirming the presence of this variant in the region. Although the infection rate is low, the high density of these mosquitoes and their voracity (they exhibit 24-h biting activity) could compensate for the low percentage of infected specimens.Resumo em Espanhol:
En mayo de 1993 se descubrió fortuitamente un brote de 14 casos de infección por virus de la inmunodeficiencia humana (VIH) en pacientes sometidos a hemodiálisis en un hospital universitario de Bucaramanga, Colombia. El brote tuvo lugar en 1992. Se usaron sueros almacenados para determinar el período de infección probable (PI) de 10 de los 14 casos y se llevó a cabo un estudio de casos y controles anidado a fin de evaluar los posibles mecanismos de transmisión. La atención de salud recibida por cada paciente positivo a VIH durante su PIP se comparó con la atención recibida por controles apareados con los casos en tiempo. Solamente los procedimientos odontológicos invasores mostraron una asociación significativa con el riesgo de infección. Los pacientes sometidos a procedimientos dentales invasores durante su PIP tuvieron un riesgo promedio de infección 8,15 veces mayor que los controles de características similares (P = 0,006), y de nueve casos de infección por VIH con un PIP conocido en 1992, siete habían sido sometidos a un procedimiento dental invasor de 1 a 6 meses antes de la seroconversión. No se detectó infección en ninguno de los miembros del personal de salud dental. A juzgar por las pruebas disponibles, es más probable que la infección haya sido transmitida de un paciente a otro por instrumentos dentales contaminados.Resumo em Inglês:
An outbreak of 14 cases of human immunodeficiency virus (HIV) infection was discovered by chance in May 1993 among hemodialysis patients at a university hospital in Bucaramanga, Colombia. The outbreak occurred in 1992. Stored sera were used to establish the probable period of infection (PPI) for 10 of the 14 cases. A nested case-control study was carried out to evaluate possible transmission mechanisms. The health care experience of each HIV-positive patient during that patients PPI was compared to the experience of time-matched controls. Only invasive dental procedures were significantly associated with the risk of infection. Patients upon whom invasive dental procedures were performed during their PPIs had an average risk of HIV infection 8.15 times greater than comparable controls (P = 0.006), and seven out of nine cases of HIV infection with known PPIs in 1992 had an invasive dental procedure performed one to six months before seroconversion. None of the dental care personnel were found to be infected. Based on the available evidence, it seems most likely that the infection was transmitted from patient to patient by contaminated dental instruments.Resumo em Inglês:
To implement an education initiative on school health in the Region, PAHO and other agencies will disseminate knowledge and experiences to schools in various countries throughout the Americas, organize meetings and workshops for the purpose of strengthening institutional capacity to identify the needs of local health education systems, and put into practice strategies to promote health and strengthen schools involvement in this area. To determine a countrys ability to set up and evaluate school health programs, the rapid assessment and analysis methodology will be used. This methodology, which arose in response to the need of governments to make decisions, formulate policies, and design programs on the basis of knowledge of the individual and collective behavior of their beneficiaries, is a useful tool for decision making and facilitates coordination mechanisms between the health and education sectors. In addition, it contributes quantitative and qualitative information for program review and analysis in an average of two months. This information is obtained through the compilation of data from secondary sources, interviews with key informants, and discussions with focal groups made up of formal and informal community leaders.Resumo em Espanhol:
El Gobierno de Bolivia ha tenido desde 1983 un programa nacional para combatir los trastornos por deficiencia de yodo (TDY), que a principios de la década de 1980 afectaban a más de la mitad de la población del país. La principal estrategia empleada de forma sostenida en la lucha contra los TDY es la yodación de toda la sal destinada para consumo humano. En 1996, el Gobierno de Bolivia invitó a un grupo de expertos a revisar, en colaboración con los integrantes del programa dentro del país, cuánto se había avanzado hacia la eliminación de los TDY de todo el territorio nacional. El equipo revisor examinó los datos recolectados mediante las encuestas más recientes sobre la disponibilidad y el uso de la sal yodada y las concentraciones de yodo excretadas por la orina. Sobre la base de criterios internacionales establecidos para estos indicadores, el equipo llegó a la conclusión de que Bolivia había eliminado los TDY como problema de salud pública de alcance nacional, pese a pruebas de que algunas comunidades aisladas de los Andes todavía carecían de una ingesta adecuada de yodo. El equipo hizo recomendaciones para mejorar el programa y garantizar su sostenibilidad. Asimismo, examinó los métodos de producción y el control de la calidad del proceso de yodación y recomendó medidas para reducir la variabilidad del contenido de yodo en la sal.Resumo em Inglês:
The leaders of 21 Ibero-American countries came to Viña del Mar (Chile) for the sixth meeting of the now-traditional Ibero-American Summits. The Declaration that resulted from the Summit reiterated the commitment of these nations to the principles of democracy, the rule of law, and political pluralism. The development of efficient and participatory systems of democratic government was one of the most important of the topics dealt with at the meeting and served as the framework for the discussion and the search for solutions to common problems, such as poverty, arms trafficking, unequal opportunity for men and women, and inappropriate government practices. The leaders also supported a series of initiatives and international programs in the technological and cultural arenas that will strengthen the ties and unite the Spanish- and Portuguese-speaking countries.