Resumo em Espanhol:

Todos los años nacen en el mundo alrededor de 13 millones de niños prematuros. La mayor parte de esos niños nacen en países en desarrollo y constituyen el componente principal de la morbilidad y la mortalidad perinatales. En el presente estudio de revisión se analizaron los datos científicamente validados sobre las intervenciones que se emplean con la intención de evitar al menos una parte de los partos pretérmino y disminuir su impacto en la salud neonatal. Se consultaron las bases de datos Biblioteca Cochrane y Medline y se estudiaron 50 trabajos de revisión y artículos de investigación relacionados con el tema del parto pretérmino en sus siguientes aspectos: factores de riesgo y detección precoz del riesgo de parto pretérmino; prevención de la amenaza de parto pretérmino; tratamiento del parto pretérmino iniciado, y prevención del síndrome de dificultad respiratoria neonatal. Se encontraron pocos medios ensayados con éxito para predecir, prevenir o detectar precozmente la amenaza de parto pretérmino. Solo el tamizaje y tratamiento de la bacteriuria asintomática pueden recomendarse para todas las embarazadas como parte del control prenatal. El tamizaje de la vaginosis bacteriana y su tratamiento ulterior y el cerclaje profiláctico reducen, respectivamente, la incidencia de nacimientos adelantados en embarazadas con antecedentes de parto prematuro y en las que tienen antecedentes de más de tres partos pretérmino. Como tratamiento del parto iniciado antes de tiempo, con o sin rotura prematura de membranas, las intervenciones que han mostrado eficacia son la administración de betamiméticos a la parturienta para prolongar por 48 horas el período de latencia del parto y de indometacina con el mismo objetivo como medicamento de segunda elección. La administración prenatal de corticoides a la embarazada puede inducir la maduración pulmonar del feto y reducir el síndrome de dificultad respiratoria y la hemorragia ventricular, reduciendo así la mortalidad neonatal. Se recomienda continuar y apoyar las investigaciones básicas y epidemiológicas sobre la prevención para adquirir más conocimientos sobre las causas y mecanismos del parto pretérmino y cómo prevenir la morbilidad y mortalidad que produce.

Resumo em Inglês:

Every year around the world some 13 million premature children are born. Most of these children are born in developing countries, and they account for the largest share of perinatal morbidity and mortality. This review study analyzed scientifically validated data on interventions to prevent at least some portion of these preterm deliveries and to lessen their impact on neonatal health. The Cochrane and MEDLINE bibliographic databases were consulted. Fifty review pieces and research articles were studied, relating to the following aspects of preterm delivery: risk factors and early detection of the risk of preterm delivery; preventing the risk of preterm delivery; treating preterm delivery once it has begun; and preventing neonatal respiratory distress syndrome. There were few successful approaches to the prediction, prevention, or early detection of the threat of preterm delivery. The only measures that can be recommended for all pregnant women are screening for and treating asymptomatic bacteriuria as a part of prenatal check-ups. Screening for bacterial vaginosis and treating it reduce the incidence of preterm births in pregnant women with a history of premature delivery. In addition, prophylactic cerclage decreases the incidence of premature births in pregnant women who have had more than three preterm births. To treat a delivery that starts early, with or without premature membrane rupture, the interventions that have proved to be effective are administering betamimetics to the parturient woman in order to delay delivery for 48 hours, and using indomethacin for the same purpose, as the second-choice drug. The prenatal administration of cortico-steroids to the pregnant woman can induce lung maturation in the fetus and reduce respiratory distress syndrome and ventricular hemorrhage, thus decreasing neonatal mortality. There is a need to continue and support basic and epidemiological research in order to develop new knowledge on the causes and mechanisms of preterm delivery and on preventing the morbidity and mortality that preterm delivery produces.

Resumo em Espanhol:

Diversos estudios muestran que la edad en sí no es un factor independiente predictor de la supervivencia de las personas mayores gravemente enfermas, pero el grupo mayor de 65 años de edad no suele tener acceso a los recursos diagnósticos y terapéuticos más complejos. Con el continuo envejecimiento de la población se hace cada vez más importante poder determinar los factores de riesgo de mortalidad que afectan a las posibilidades de supervivencia de la gente mayor hospitalizada, especialmente en condiciones de urgencia. El objetivo de este trabajo fue analizar los factores de riesgo asociados con la mortalidad de personas mayores de 65 años internadas en el Servicio de Urgencia del hospital Santa Casa de São Paulo, institución académica de nivel terciario. El estudio se basó en un análisis por regresión logística no condicional de los datos personales recogidos en el hospital en las historias clínicas respectivas y otros documentos pertenecientes a los pacientes hospitalizados durante el período de julio de 1993 a marzo de 1994, inclusive. Durante dicho período se hospitalizó a 599 pacientes -326 hombres (54,4%) y 273 mujeres (45,6%)- con una mediana de edad de 73,3 años. Las razones principales de internamiento fueron neumonía (14,4%), enfermedad cerebrovascular (11,5%) e insuficiencia cardíaca (8,2%). El total de defunciones ascendió a 160. Los pacientes que fallecieron tuvieron una estadía mediana en el hospital de 4 días (intervalo de 1 a 72), semejante a la de los que sobrevivieron (3 días; intervalo de 0 a 35 días; P = 0,29). Según el análisis multivariado, independientemente del sexo, la edad, la raza, la observancia del tratamiento, el diagnóstico inicial y otros estados patológicos presentes, la hipertensión arterial (razón de posibilidades, RP u odds ratio en inglés = 0,39, IC95%: 0,23 a 0,68), la enfermedad pulmonar obstructiva crónica (RP = 0,45; IC95%: 0,22 a 0,95) y la diabetes mellitus (RP = 0,50; IC95%: 0,27 a 0,91) fueron factores predictores de supervivencia, mientras que la presencia de infecciones extrapulmonares (RP = 2,34; IC95%: 1,13 a 4,86) y el número de enfermedades preexistentes -una (RP = 2,78; IC95%: 1,56 a 4,96), dos (RP = 4,56; IC95%: 2,28 a 9,15) y más de dos (RP= 15,88; IC95%: 6,49 a 38,85)- fueron factores de pronóstico independientes, indicadores de fallecimiento durante la hospitalización. Se concluye que el mejoramiento del diagnóstico y el tratamiento de las infecciones puede reducir la mortalidad de las personas de edad avanzada ingresadas en los servicios de urgencia. La multiplicidad de enfermedades, no la edad, fue el factor que aumentó el riesgo de muerte en este grupo de pacientes. No puede justificarse restringir el acceso de los pacientes geriátricos a los mejores recursos de diagnóstico y terapéutica, solo por la edad, si dichos recursos pueden resultar en mayor supervivencia, prevención de discapacidades o una mejor calidad de vida.

Resumo em Inglês:

Various studies show that age in itself is not an independent predictive factor for the survival of critically ill older persons. In spite of that fact, people over 65 tend not to have access to the most-sophisticated diagnostic and therapeutic resources. With the continued aging of the population, it is increasingly important to be able to determine the mortality risk factors that affect the survival possibilities of hospitalized older people, especially in emergency situations. The objective of this study was to analyze the risk factors related to mortality among people over 65 admitted to the emergency service of the Santa Casa Hospital of São Paulo, a third-level academic institution. The study was based on a nonconditional logistic regression analysis of personal data in the clinical histories and other documents of the hospitalized patients. From July 1993 through March 1994, 599 patients over 65 were hospitalized. They included 326 men (54.4%) and 273 women (45.6%), with a median age of 73.3 years. The primary reasons for admission were pneumonia (14.4%), cerebrovascular disease (11.5%), and congestive heart failure (8.2%). There were 160 deaths among the group. Those who died had a median stay in the hospital of 4 days (range, 1 to 72), which was similar to that of those who survived (median, 3 days; range, 0 to 35 days; P = 0.29). According to multivariate analysis, factors predictive of survival were hypertension (odds ratio = 0.39; 95% CI: 0.23 to 0.68), chronic obstructive pulmonary disease (OR = 0.45; 95% CI: 0.22 to 0.95), and diabetes mellitus (OR = 0.50; 95% CI: 0.27 to 0.91). This was true regardless of sex, age, race, compliance with treatment, initial diagnosis, and other pathological conditions present. On the other hand, two factors were predictive of mortality during hospitalization. They were the presence of extrapulmonary infections (OR = 2.34; 95% CI: 1.13 to 4.86) and the number of preexisting illnesses: one (OR = 2.78; 95% CI: 1.56 to 4.96), two (OR = 4.56; 95% CI: 2.28 to 9.15), and three or more (OR = 15.88; 95% CI: 6.49 to 38.85). This study shows that improving the diagnosis and treatment of infections can reduce mortality of elderly persons admitted to emergency services. Rather than age, the multiplicity of diseases was the factor that increased the risk of death among these patients. There is no justification for using age alone to limit the access that older patients have to better diagnosis and treatment resources, if these resources can result in better survival rates, fewer disabilities, or a better quality of life.

Resumo em Espanhol:

Durante los cinco años posteriores a una fumigación masiva con deltametrina realizada en 1992 y seguida de fumigaciones selectivas, se investigó la prevalencia de la infección por Trypanosoma cruzi en Triatoma infestans, Triatoma guasayana y Triatoma sordida en Amamá y otras poblaciones rurales vecinas del noroeste de Argentina. Los triatómidos fueron recogidos en los domicilios y en el área peridoméstica por los propios residentes y por personal experto. Durante el quinquenio 1993-1997, la prevalencia de T. cruzi fue de 2,4% en 664 T. infestans, de 0,7% en 268 T. guasayana y de 0,2% en 832 T. sordida. La infección por T. cruzi se detectó con mayor frecuencia en las chinches adultas y en los triatómidos recogidos en los domicilios. T. guasayana y T. sordida fueron, respectivamente, ninfas y adultos recogidos en el área peridoméstica. Durante el período de vigilancia, la prevalencia de la infección por T. cruzi en T. infestans disminuyó de 7,7% en 1993 a 1,5% en 1997, aunque este cambio no fue estadísticamente significativo. La comparación de las tasas de infección de T. infestans antes del programa de control (1992) y durante el período de vigilancia (1993-1997) reveló una disminución altamente significativa, de 49% a 4,6%, en los dormitorios y también en las áreas peridomésticas (de 6% a 1,8%). Debido a su infección por T. cruzi y a su frecuente invasión de las áreas domésticas con ataques a los humanos y a los perros, T. guasayana parecía estar implicado como vector secundario de T. cruzi en las áreas domésticas y peridomésticas durante el período de vigilancia. T. sordida fue la especie más abundante, pero estaba estrechamente asociada a los pollos y mostró escasa tendencia a invadir los dormitorios.

Resumo em Inglês:

The prevalence of Trypanosoma cruzi infection in Triatoma infestans, Triatoma guasayana, and Triatoma sordida was evaluated in Amamá and other neighboring rural villages in northwestern Argentina for five years after massive spraying with deltamethrin in 1992 and selective sprays thereafter. Local residents and expert staff collected triatomines in domiciliary and peridomestic sites. During 1993-1997, the prevalence of T. cruzi was 2.4% in 664 T. infestans, 0.7% in 268 T. guasayana, and 0.2% in 832 T. sordida. T. cruzi infection was more frequently detected in adult bugs and in triatomines collected at domiciliary sites. The infected T. guasayana and T. sordida were nymphs and adults, respectively, captured at peridomestic sites. The prevalence of T. cruzi infection in T. infestans decreased from 7.7% to 1.5% during the surveillance period, although that change was not statistically significant. Comparison of T. infestans infection rates before the control program and during surveillance showed a highly significant decrease from 49% to 4.6% in bedrooms, as well as a fall from 6% to 1.8% in peridomestic sites. Because of its infection with T. cruzi and frequent invasion of domiciliary areas and attacks on humans and dogs, T. guasayana appeared implicated as a putative secondary vector of T. cruzi in domestic and peridomestic sites during the surveillance period. T. sordida was the most abundant species, but it was strongly associated with chickens and showed little tendency to invade bedrooms.

Resumo em Português:

Milhares de crianças menores de 5 anos ainda morrem em todo o mundo devido a doenças preveníveis. As intervenções comunitárias que enfatizam cuidados primários de saúde e nutrição têm sido apontadas como uma das soluções para superar este problema. O presente trabalho descreve um estudo transversal, de base populacional, cujo objetivo foi avaliar se crianças e mães acompanhadas pela Pastoral da Criança, entidade ligada à Conferência Nacional dos Bispos do Brasil e que atua junto a comunidades carentes, apresentam melhores indicadores de saúde e conhecimento sobre as ações básicas de sobrevivência infantil do que as crianças e mães não acompanhadas. O estudo foi desenvolvido em 1996 na área urbana do município de Criciúma, estado de Santa Catarina, Brasil, com uma amostra probabilística de 2 208 crianças menores de 3 anos. A análise ajustada para possíveis fatores de confusão demonstrou que a Pastoral esteve significativamente associada ao conhecimento materno quanto à conduta alimentar durante a diarréia, à idade ideal para o aleitamento materno exclusivo, à contra-indicação do leite em pó, à interpretação da curva de crescimento e quanto ao esquema vacinal. A participação na Pastoral esteve positivamente associada à maior duração total do aleitamento materno, à introdução tardia da mamadeira, ao maior número de pesagens no trimestre imediatamente anterior à pesquisa e à posse de colher-medida para reidratação oral. Não houve associação significativa entre a vinculação à Pastoral e a duração do aleitamento materno exclusivo ou predominante nem o manejo da diarréia. A avaliação mostrou aspectos positivos da atuação da Pastoral, assim como áreas em que maiores investimentos são necessários. A Pastoral e outras entidades do mesmo tipo devem priorizar ainda mais a educação das mães quanto aos cuidados com a criança. Estas entidades devem tentar recrutar as mães ainda durante a gestação, quando o impacto das ações de educação é potencialmente maior.

Resumo em Inglês:

Thousands of children younger than 5 years of age still die all over the world as a result of preventable diseases. Community intervention measures emphasizing primary health and nutritional care have been identified as one of the solutions to this problem. This article describes a population-based cross-sectional study of the Pastoral da Criança, a Roman Catholic health support group in Brazil. The study assesses whether mothers and children assisted by the Pastoral present better health indicators and have a better knowledge of basic child survival actions than non-assisted mothers and children. The study was carried out in 1996 in an urban area of the municipality of Criciúma, in the state of Santa Catarina, in southern Brazil. The sample was composed of 2 208 children under 3 years of age. The adjusted analysis taking into consideration possible confounding factors showed that the presence of the Pastoral was significantly associated with maternal knowledge of appropriate feeding measures during diarrheal episodes, optimal duration of exclusive breast-feeding, implications of feeding powdered milk to infants, correct interpretation of the infant growth curve, and knowledge of the proper vaccination schedule for infants. Participation in the Pastoral was positively associated with longer total breast-feeding duration, later introduction of bottle-feeding, higher frequency of growth monitoring visits in the quarter before the study, and availability in the home of measuring spoons for oral rehydration. No significant association was found between participation in the Pastoral and duration of predominant or exclusive breast-feeding, or correct diarrhea management. The results showed Pastoral actions have a positive effect and also revealed areas in which greater investments are needed. It is recommended that the Pastoral, as well as other similar institutions, give priority to educating mothers on child care and to recruiting mothers early in pregnancy, when the impact of these actions is potentially greater.

Resumo em Espanhol:

El presente estudio tuvo por objetivo evaluar la calidad de los servicios de anticoncepción en la ciudad de El Alto, Bolivia. En su diseño se han contemplado cuatro elementos: 1) las relaciones entre los proveedores de servicios y sus clientes, 2) la disponibilidad de métodos anticonceptivos, 3) las condiciones de los servicios, y 4) la satisfacción de las usuarias. También se han tenido en cuenta las opiniones de los proveedores y de las usuarias y no usuarias de estos servicios, quienes se clasificaron como gubernamentales o no gubernamentales, de acuerdo con la administración de la institución a la que pertenecían. Los datos provinieron de un análisis de la situación de dichos servicios y de testimonios obtenidos de las participantes durante 1995. En cuanto a las relaciones interpersonales, se encontró que los proveedores percibían el trato del médico más favorablemente que las clientas, en tanto que las no usuarias lo percibían desfavorablemente. La percepción de un trato igualitario se correlacionó positivamente con la vestimenta que usaban las clientas. En cuanto a la disponibilidad de los métodos anticonceptivos, 15 de las 36 instituciones encuestadas no disponían de métodos modernos, a pesar de la existencia de una política nacional para proveerlos a la población. La oferta de estos servicios a parejas y a adolescentes es escasa, principalmente en las instituciones gubernamentales. El análisis de las condiciones de los servicios demostró que en algunas instituciones había problemas graves en la provisión de una atención de mínima calidad. Finalmente, este trabajo describe cómo la mayoría de estas limitaciones en la prestación de servicios de anticoncepción en El Alto pueden subsanarse mediante estrategias de costo moderado.

Resumo em Inglês:

The objective of this study was to evaluate the quality of contraception services in the city of El Alto, Bolivia. In the study design, four components were considered: 1) interpersonal relations between service providers and users, 2) the availability of various contraceptive methods, 3) conditions in the service centers, and 4) user satisfaction. The opinions of three groups were taken into account: service providers, service users, and nonusers. The service centers were classified as either governmental or nongovernmental, depending on the management of the institution to which the service center belonged. The study data came from a situation analysis of the services and from comments gathered from study participants in 1995. The study found that providers held a more favorable view than did service users of the interpersonal relations and personal treatment that physicians provided. Nonusers had an unfavorable perception of physicians treatment of users. Users perceptions of receiving egalitarian treatment correlated with their style of dress. With regard to the availability of contraceptive methods, 15 of the 36 centers surveyed did not have modern methods, despite there being a national policy to provide them to the public. The supply of contraception services for couples and for adolescents is limited, especially in the governmental institutions. The analysis of the conditions in the service centers demonstrated that some institutions had serious difficulties providing services of at least a minimum quality. Finally, the study describes how most of the service limitations in El Alto can be corrected through moderate-cost strategies.

Resumo em Inglês:

For the Pan American Health Organization (PAHO), technical cooperation (TC) is the process by which the PAHO Member States work with the Organization, as equal partners, to identify and reach their own health goals and to promote self-sufficiency in health development, through programs that respond to those countries needs and national priorities. Since 1978, PAHO has used the American Regional Planning, Programming, Monitoring, and Evaluation System (AMPES) to establish management procedures and to facilitate decision-making in health TC. As part of AMPES, PAHO uses a "logical approach to project management" to structure the work program of the Organization and to identify the expected results from TC activities and TC resource investments. This project management approach, which replaces the "functional approaches" system used to date, also helps establish a causative relationship between the programmed activities and the results that PAHO expects, and between the activities and the hoped-for outcomes in the countries. As part of an ongoing process of rethinking international health TC, several years ago PAHO began a four-phase study on the usefulness and validity of functional approaches and on the need to propose new ones or to modify existing ones. The results of the initial phase showed it was difficult to classify the activities because the functionalapproaches categories were not mutually exclusive and the TC activities were complex. Further, the expected results did not specify the product for which the PAHO Secretariat was accountable within a certain time frame nor the Secretariats level of responsibility. Thus, a new and more flexible classification of expected results was proposed, with the following categories: cooperation networks and alliances; surveillance and information systems; standards and guidelines; research and evaluation studies; plans, projects, and policies; methods, models, and technologies; training programs; promotional campaigns and advocacy; and direct support. In the second phase of the study, it was concluded that the proposed classification system made it possible to more precisely identify the products of PAHO technical cooperation projects, the Organizations degree of responsibility, and the bases for estimating needed resources. The new system could also facilitate monitoring and evaluation. In addition, the third phase of analyzing the functional approaches has begun. Its objective is to evaluate the effect of technical cooperation based on the changes incorporated in the programming of activities.