Resumo em Espanhol:

Entre los principales reservorios silvestres de Trypanosoma cruzi se encuentran las zarigüeyas del género Didelphis, ampliamente distribuidas por el continente americano. En Amamá y Trinidad, Provincia de Santiago del Estero, Argentina, Didelphis albiventris es el marsupial más frecuente. Su población se renueva cada año y normalmente hay dos períodos reproductivos: uno a principios de la primavera y otro a principios del verano. Estas dos camadas son destetadas y abandonan la bolsa marsupial para incorporarse a la población, la primera (G1) a principios del verano y la segunda (G2) a principios del otoño. Entre 1988 y 1991 se estudiaron 409 individuos distintos de D. albiventris y los xenodiagnósticos revelaron que 35% de ellos estaban infectados por T. cruzi. Se observaron ciclos de renovación anual de la infección con prevalencias que oscilaron entre 22 y 43%. La adquisición del parásito ocurría a lo largo de todo el año, desde el verano hasta la primavera. La prevalencia de la infección aumentó con la edad. Los individuos G1 tuvieron tendencia a presentar mayores prevalencias que los G2, probablemente debido a un mayor tiempo de exposición a la transmisión. En las dos primeras categorías de edad, los individuos G2 mostraron mayores prevalencias que los G1, lo cual indica un aumento significativo de la intensidad de la transmisión durante el otoño. Las zarigüeyas deberían considerarse como una fuente potencial de ingreso de T. cruzi al ciclo doméstico.

Resumo em Inglês:

The opossum of the genus Didelphis is one of the principal wild reservoirs of Trypanosoma cruzi and is widely distributed in the Western Hemisphere. Didelphis albiventris is the most common marsupial in Amamá and Trinidad, two communities in the province of Santiago del Estero, Argentina. The D. albiventris population is replaced every year, and the opossum normally has two reproductive periods, one at the beginning of the spring and another at the beginning of the summer. The two litters are weaned, and they leave the mother's marsupial pouch to join the population, the first (G1) at the beginning of the summer and the second (G2) at the beginning of the fall. Between 1988 and 1991 409 D. albiventris opossums were studied, and xenodiagnoses showed that 35% of them were infected with T. cruzi. Annual cycles of renewed infection were observed, with prevalences that ranged between 22% and 43%. The acquisition of the parasite occurred over the entire year, from the summer through the spring. The prevalence of infection increased with age. The G1 individuals tended to present higher prevalences than the G2 individuals, probably from being exposed to transmission for a longer period of time. In the first two (younger) age categories for the opossums, G2 individuals showed higher prevalences than did the G1 individuals. This indicates a significant increase in transmission intensity during the fall. Opossums should be regarded as a potential source of T. cruzi entry to the domestic transmission cycle.

Resumo em Espanhol:

Se investigó la seroprevalencia de hepatitis B en más de 12 000 sujetos en seis países de América Latina: Argentina, Brasil, Chile, México, República Dominicana y Venezuela. Cada una de las poblaciones estudiadas fue estratificada por edad, sexo y nivel socioeconómico. Se hicieron determinaciones de anticuerpos contra el antígeno nuclear del virus de la hepatitis B (anti-HBc) con el fin de detectar la infección. La seroprevalencia general más alta se encontró en la República Dominicana (21,4%), seguida del Brasil (7,9%), Venezuela (3,2%), Argentina (2,1%), México (1,4%) y Chile (0,6%). En todos los países se encontró un aumento de la seroprevalencia en personas de 16 años de edad o mayores, lo cual indica que la transmisión sexual es la principal fuente de infección. También se hallaron tasas de seroprevalencia elevadas en personas jóvenes en la República Dominicana y el Brasil, fenómeno que apunta hacia la vía de transmisión vertical.

Resumo em Inglês:

The seroprevalence of hepatitis B was investigated in over 12 000 subjects in six countries of Latin America: Argentina, Brazil, Chile, the Dominican Republic, Mexico, and Venezuela. Each study population was stratified according to age, gender, and socioeconomic status. Antibodies against hepatitis B core antigen (anti-HBc) were measured in order to determine hepatitis B infection. The highest overall seroprevalence was found in the Dominican Republic (21.4%), followed by Brazil (7.9%), Venezuela (3.2%), Argentina (2.1%), Mexico (1.4%), and Chile (0.6%). In all the countries an increase in seroprevalence was found among persons 16 years old and older, suggesting sexual transmission as the major route of infection. In addition, comparatively high seroprevalence levels were seen at an early age in the Dominican Republic and Brazil, implicating a vertical route of transmission.

Resumo em Espanhol:

Se investigó el efecto agudo de la contaminación atmosférica sobre la salud respiratoria en 114 niños de 6 a 12 años de edad residentes en la zona industrial de Puchuncaví, V Región de Chile: 57 con síntomas respiratorios crónicos y 57 asintomáticos. Durante 66 días se midieron diariamente los niveles de partículas respirables de tamaño < 10 mym (PM10) y de dióxido de azufre (SO2) en el aire. Los participantes fueron seleccionados y clasificados según su susceptibilidad a la enfermedad respiratoria crónica, para lo cual se utilizó un cuestionario de síntomas respiratorios aplicado a un total de 882 niños residentes en el área de influencia de las emisiones de una fundición de cobre y de una central termoeléctrica. Diariamente se registraron el flujo espiratorio máximo (FEM) y la incidencia de síntomas respiratorios. La asociación de los niveles de PM10 y SO2 con el FEM y la incidencia de tos, expectoración, sibilancias, disnea y uso de broncodilatadores fue estimada por modelos de regresión (ecuaciones estimativas generalizadas). En los niños inicialmente sintomáticos, un incremento de 50 myg/m³ en el nivel medio diario de SO2 dio lugar a una reducción de -1,42 L/min (intervalo de confianza de 95% (IC95%): -2,84 a -0,71) en el FEM del día siguiente, mientras que un aumento de 30 myg/m³ en la concentración acumulada de tres días de PM10 produjo una disminución de -2,84 L/min (IC95%: -4,26 a 0,00). Con respecto a los síntomas, un aumento de 30 myg/m³ en el nivel medio semanal de PM10 se relacionó con un incremento de 26% (razón de posibilidades (RP) = 1,26; IC95%: 1,01 a 1,57) en la incidencia de tos y de 23% (RP = 1,23; IC95%: 1,00 a 1,50) en la incidencia de expectoración, un aumento de 50 myg/m³ en el nivel medio de SO2 durante tres días se asoció a un incremento de 5% (RP = 1,05; IC95%: 1,00 a 1,10) en la incidencia de expectoración y un aumento de 30 (myg/m³ en el promedio diario de PM10 incrementó el uso de broncodilatadores dos días más tarde en 10% (RP = 1,10; IC95%: 1,03 a 1,18). En los niños inicialmente asintomáticos solo se registraron efectos significativos por la exposición a las PM10: tras un incremento de 30 myg/m³ en su nivel medio diario se observó una reducción de -1,34 L/min (IC95%: -2,68 a -0,67) en el FEM del día siguiente y un incremento similar en la exposición acumulada de tres días se asoció a un aumento de 9% en la incidencia de sibilancias (RP = 1,09; IC95%: 1,01 a 1,31). Se concluye que la salud respiratoria de los niños residentes en el área industrial de Puchuncaví se ve afectada por los altos niveles de PM10 y SO2.

Resumo em Inglês:

This study investigated the acute effect of air pollution on the respiratory health of children living in the industrial area of Puchuncaví, in Region V of Chile. The 114 children studied were from 6 to 12 years old; 57 of them had chronic respiratory symptoms and 57 did not. Each day for 66 days the air was checked for levels of sulfur dioxide (SO2) and of breathable particles that were < 10 µm (PM10). The children were selected and classified according to their susceptibility to chronic respiratory disease by means of a questionnaire used with 882 children living within the area of the emissions from a copper foundry and a thermoelectric plant. Each day, each studied child's peak expiratory flow (PEF) and incidence of respiratory symptoms were checked and recorded. Using regression models (generalized estimation equations), estimates were made of the association of SO2 and PM10 levels with PEF and the incidence of cough, expectoration, episodes of wheezing, dyspnea, and use of bronchodilators. Among the children who were initially symptomatic, an increase of 50 µg/m³ in the daily mean level of SO2 caused a reduction of -1.42 L/min (95% confidence interval (95% CI): -2.84 to -0.71) in the PEF of the following day. An increase of 30 µg/m³ in the cumulative concentration of PM10 over three days produced a PEF reduction of -2.84 L/min (95% CI: -4.26 to 0.00). With respect to symptoms, an increase of 30 µg/m³ in the weekly mean level of PM10 was related with a 26% increase (odds ratio (OR) = 1.26; 95% CI: 1.01 to 1.57) in the incidence of cough and of 23% (OR = 1.23; 95% CI: 1.00 to 1.50) in the incidence of expectoration. An increase of 50 µg/m³ in the mean level of SO2 for three days was associated with a 5% increase (OR = 1.05; 95% CI: 1.00 to 1.10) in the incidence of expectoration. An increase of 30 µg/m³ in the daily average of PM10 increased the use of bronchodilators two days later by 10% (OR = 1.10; 95% CI: 1.03 to 1.18). Among the initially asymptomatic children, a significant effect from PM10 exposure was found after an increase of 30 µg/m³ in the mean daily PM10 level, with a reduction of -1.34 L/min (95% CI: -2.68 to -0.67) in the PEF of the following day. A similar increase in the cumulative exposure over three days was associated with an increase of 9% in the incidence of episodes of wheezing (OR = 1.09; 95% CI: 1.01 to 1.31). It is concluded that high levels of PM10 and SO2 affect the respiratory health of children living in the industrial area of Puchuncaví.

Resumo em Espanhol:

Los dos objetivos principales de este estudio consistieron en: 1) establecer un método para determinar valores de corte de la concentración de hemoglobina que permitan estimar mejor la prevalencia de la anemia ferropénica en embarazadas residentes a gran altitud, y 2) estimar la prevalencia de la anemia en una muestra de embarazadas residentes en dos ciudades de Bolivia: La Paz (3 600 m) y El Alto (4 000 m). El método utilizado por nosotros se basó en datos ya publicados acerca de las concentraciones medias de hemoglobina en mujeres no anémicas en edad fértil residentes a diferentes altitudes, a partir de los cuales derivamos una curva de hemoglobina-altitud. Este modelo se comparó con otros dos publicados anteriormente y utilizados en la actualidad, cuyos valores de corte habían sido derivados de poblaciones de niños u hombres residentes a menos de 4 000 m y extrapolados posteriormente a las mujeres y a mayores altitudes. A partir de las historias clínicas de mujeres de La Paz y El Alto que habían dado a luz en un hospital maternal de La Paz entre enero y junio de 1996, se extrajeron los datos sobre sus concentraciones de hemoglobina, a los cuales se aplicaron los tres modelos para calcular la prevalencia de la anemia ferropénica en esta población. La curva de hemoglobina-altitud derivada en este estudio se ajustó mejor a los datos de las mujeres en edad fértil que cualquiera de los otros dos modelos. Utilizando los valores de corte de los niveles de hemoglobina determinados en este estudio, la prevalencia estimada de la anemia ferropénica en el embarazo fue mayor que las prevalencias estimadas con los otros dos métodos.

Resumo em Inglês:

This study had two primary objectives: 1) to derive a method to determine hemoglobin cutoffs that could be used to better estimate the prevalence of iron deficiency anemia in pregnancy at high altitudes and 2) to estimate the prevalence of anemia in a sample of pregnant women residing in two cities in Bolivia, La Paz (3 600 meters) and El Alto (4 000 meters). We derived a hemoglobin-altitude curve from previously published data on the mean hemoglobin concentrations of nonanemic women of childbearing age at various altitudes. In addition, we abstracted data on hemoglobin concentration during pregnancy from medical records of women from La Paz and El Alto who had given birth at a maternity hospital in La Paz between January and June of 1996. Using our approach and two other previously published, currently used methods, we calculated and compared prevalences of iron deficiency anemia in this population using hemoglobin cutoffs determined from a hemoglobin-altitude curve corrected for pregnancy. The hemoglobin-altitude curve derived in this study provided a better fit to data for women of childbearing age than the two other models. Those models used cutoffs based on non-iron-replete populations of children or men, both of which were residing below 4 000 m, and then extrapolated to women and higher altitudes. The estimated prevalences of iron deficiency anemia in pregnancy using the hemoglobin cutoffs determined in this study were higher than those estimated by the two other approaches.

Resumo em Espanhol:

En un área de salud de Provincia La Habana (n = 221) y en un servicio de un hospital pediátrico de Ciudad de La Habana (n = 200), se evaluó la influencia de distintas variables sobre los conocimientos que las madres de niños menores de 5 años poseen acerca de las infecciones respiratorias agudas (IRA), y sobre sus actitudes y prácticas ante estas. Las variables analizadas fueron el nivel educacional de la madre, su edad, lugar de residencia, ocupación laboral en servicios de salud y número de hijos, y las interacciones de estas cuatro últimas variables con la primera. Mediante un cuestionario se midieron los conocimientos, actitudes y prácticas en general (CAP) de las madres y se consideraron dos categorías de suficiencia: "Suficiente I" al obtenerse 70% o más de la máxima puntuación posible, y "Suficiente II" al alcanzarse un mínimo de 50%. Para ambos niveles de suficiencia, los CAP de las madres del área de salud fueron significativamente mayores que los obtenidos por las madres entrevistadas en el centro de atención secundaria, lo cual denota que la menor magnitud de los conocimientos sobre IRA de las madres con hijos hospitalizados y sus actitudes y prácticas menos acertadas pueden haber constituido un factor contribuyente al ingreso de estos niños. La variable más importante para la suficiencia de conocimientos fue el nivel educacional, hecho que señala la influencia primordial y positiva de este factor en los cuidados preventivos y curativos frente a las IRA que las madres proporcionan a sus hijos.

Resumo em Inglês:

An evaluation was performed on the influence of different variables on the knowledge, attitudes, and practices that mothers of children under the age of 5 have concerning acute respiratory infections (ARIs). Two groups of mothers were interviewed: 1) mothers of children seen in a polyclinic in the province of Havana (n = 221) and 2) mothers whose children were hospitalized in the respiratory unit of a pediatric hospital in the city of Havana (n = 200). The five variables analyzed were the educational level of the mother, her age, place of residence, number of children, and whether or not she was employed in the health service sector, as well as the interactions between the first variable and the other four variables. A questionnaire was used to measure the ARI knowledge, attitudes, and practices (KAP) of the mothers. Two levels of KAP sufficiency were taken into account, "Adequate I" for obtaining 70% or more of the maximum possible score and "Adequate II" for achieving at least a 50% score. For both levels of adequacy, the KAP of the mothers working in the health sector was significantly higher than that of the mothers interviewed in the secondary health care center. This suggests that the poorer knowledge, attitudes, and practices of mothers with hospitalized children may have contributed to the children's hospitalization. The most important variable associated with sufficient knowledge was educational level, which highlights the fundamental and positive influence education exerts on the preventive and curative care that mothers provide their children with ARI.

Resumo em Português:

Há uma escassez de trabalhos sobre a realidade da assistência de enfermagem nas instituições hospitalares brasileiras vinculadas ao Sistema Único de Saúde, instituído em 1988. Dessa forma, o objetivo do presente estudo foi examinar as possíveis modificações ocorridas nesta assistência desde a implantação do referido sistema. Partiu-se de entrevistas com 31 enfermeiros que atuam em um hospital universitário em Ribeirão Preto, São Paulo, admitidos pela instituição entre maio de 1980 e maio de 1987. As entrevistas, realizadas entre julho e setembro de 1995, foram examinadas a partir de análise temática e revelaram que, na opinião dos enfermeiros, os pacientes atendidos após o convênio com o Sistema Único de Saúde são mais complexos e têm melhor nível socioeconômico. Os entrevistados perceberam também um aumento na complexidade das demandas do paciente e na variedade de especialidades médicas, assim como uma diminuição no tempo de internação. Quanto às ações executadas pelo enfermeiro, 46% perceberam mudanças (por exemplo, menos proximidade com o paciente). Certas dificuldades apontadas não se relacionavam com a implantação do Sistema Único de Saúde (por exemplo, o déficit quantitativo de recursos humanos). No atual momento, é essencial que o enfermeiro reflita sobre a política nacional de saúde e que se engaje na (re)construção da prática assistencial. O enfermeiro deve compreender a realidade de sua organização e exercer um processo de gerenciamento voltado para as expectativas dos clientes e dos trabalhadores em saúde.

Resumo em Inglês:

There are few studies on the delivery of nursing services in hospitals participating in the Brazilian universal public health system (Sistema Único de Saúde), which was put in place in 1988. This study, which examined possible changes in the delivery of these services since universal health care was implemented, was based on interviews carried out between July and September 1995 with 31 nurses working at a teaching hospital in the city of Ribeirão Preto, in the state of São Paulo. The nurses had begun working at the hospital between May 1980 and May 1987. Thematic analysis was used to assess their answers. According to the nurses, patients treated after the universal system was implemented have had more complex medical needs and a higher socioeconomic status. In addition, nurses reported an increase in the complexity of patient demands and in the variety of medical specialties offered by the hospital, as well as a decrease in the length of inpatient stays. Forty-six percent of the interviewees reported a change in the work done by nursing staff (for example, nurses have less time available for each patient). Not all of the problems the nurses mentioned are related to the public health system (understaffing is one example). It is essential that nurses examine national health policy and that they engage in the (re)construction of the practice of health care delivery. Nurses ought to understand the reality of their institutions and carry out a management process geared towards the expectations of patients and of health care workers.

Resumo em Português:

O trabalho do enfermeiro, principalmente no âmbito hospitalar, está, conforme diversos estudos, entre os que mais geram estresse em seus profissionais. Dessa forma, o objetivo desta investigação foi identificar as fontes geradoras de estresse na atividade gerencial do enfermeiro que trabalha no hospital e as principais alterações que o estresse pode acarretar sobre a saúde desse profissional. Trata-se de uma pesquisa quantitativa com uma amostra de 207 enfermeiros, realizada em 1996 em um hospital universitário na cidade de Porto Alegre, RS, Brasil. Utilizou-se um questionário auto-aplicável com questões relativas às fontes de estresse e à presença de sintomas de estresse. O questionário incluiu, também, questões sobre os sentimentos dos enfermeiros em relação a determinadas condições de trabalho e levantou dados demográficos e hábitos de vida da amostra. Os participantes do estudo tinham idade média de 35,8 anos e trabalhavam, em média, há 8,5 anos nos diferentes setores do hospital. Dos respondentes, 48% estavam estressados. A sobrecarga de trabalho foi a fonte que determinou a maior estimativa de risco relativo de estresse (6,1). Em relação aos sintomas de estresse, as alterações cardiovasculares foram as que tiveram maior incidência nos auto-relatos. No entanto, as alterações gastrintestinais estiveram relacionadas com um risco maior para estresse (5,3). O gerenciamento de pessoal foi a fonte de estresse que apresentou maior número de correlações significativas com os sintomas de estresse. Por outro lado, as alterações imunitarias foram as que mais se correlacionaram com as fontes de estresse. Os resultados sugerem que o estresse gerado pela atividade gerencial do enfermeiro desencadeia alterações na saúde.

Resumo em Inglês:

According to several studies, nursing, especially in hospital settings, is one of the most stressful professions. The objective of this study was to identify the sources of stress related to the administrative tasks of nurses working in a hospital, as well as the main health changes that stress caused these professionals. The quantitative survey was carried out in 1996 with a sample of 207 nurses at a university hospital in the city of Porto Alegre, in the state of Rio Grande do Sul, Brazil. A questionnaire was used to collect data on stress sources and symptoms. The questionnaire also gathered demographic data, as well as information on the nurses' feelings about their working conditions. The average age of the study participants was 35.8 years, and the average time working at the hospital was 8.5 years. Among participants, 48% were considered to be stressed. Work overload was the stress source that best predicted relative risk of stress (6.1). In terms of stress symptoms, the most commonly reported ones were cardiovascular changes. However, gastrointestinal changes were related to a higher risk of stress (5.3). Managing other staff was the stress source that had the greatest number of significant correlations with stress symptoms. On the other hand, immunologic changes were the symptoms that had the highest correlation with stress sources. Our results suggest that stress related to administrative tasks in nursing may trigger changes in nurses' health.

Resumo em Inglês:

For the first decade of the new millennium, "Healthy People 2010" will be the official designation of the health promotion and disease prevention policy of the United States of America. The policy's work plan carries on the vision of Health for All that is promoted by the World Health Organization and the Pan American Health Organization and whose attainment will be the responsibility of each and every person on earth. Healthy People in Healthy Communities, as the approach to Healthy People 2010 will be called, will have two general objectives for the United States as a whole. One is to increase the years of healthy life, incorporating the concept of quality of life into that of healthy life expectancy. The second objective is to eliminate health disparities. Twenty-eight priority areas and more than 400 goals will be consolidated through community initiatives and close communication among the public, health authorities, and community leaders. The experience of the United States is particularly interesting because it is participatory, as shown by the creation and consolidation of alliances between numerous sectors, bipartisan political support, use of scientific tests to support decisions, and efforts to strengthen data collection processes. The broad acceptance and adoption of the objectives of Healthy People by practically all fifty states reaffirms the initiative's validity in various socioeconomic and cultural contexts. Healthy People 2010 will be launched publicly during a conference that will be held in Washington, D.C., from 24 to 28 January 2000, with support from the Healthy People Consortium and the Partnerships for Networked Consumer Health Information.

Resumo em Espanhol:

El Instituto de Nutrición de Centroamérica y Panamá (INCAP), un centro especializado de la Organización Panamericana de la Salud con sede en la ciudad de Guatemala (Guatemala), cumple este año medio siglo de trabajo dedicado a mejorar la alimentación y nutrición en Centroamérica. El Instituto ha conseguido importantes logros en diferentes áreas, que incluyen la investigación, la cooperación técnica, la formación y la diseminación de información científica y técnica.

Resumo em Inglês:

The increase in the resistance to antimicrobials has become a serious public health concern. Responding jointly to this problem, the Pan American Health Organization and the Pan American Association of Infectious Diseases, supported by the Ministry of Health and Social Welfare of Venezuela, organized the Pan American Conference on Antimicrobial Resistance, which was held in Caraballeda, Venezuela, from 2 to 4 November 1998. In this work the principal recommendations coming out of that conference are summarized for each subject addressed there: educating health professionals on the appropriate use of antibiotics, developing a Pan American network to monitor resistance, quality control and ways to achieve laboratory results that are consistent and comparable, and the appropriate and inappropriate use of antibiotics, both in hospitals and in the community.

Resumo em Inglês:

We look at the epidemiology of the most common infectious diseases that in 1998 affected the countries of Central America most seriously damaged by Hurricane Mitch: Belice, El Salvador, Guatemala, Honduras, and Nicaragua. Incidence and mortality figures and fatality rates for cholera, dengue, malaria, and leptospirosis, before and after the hurricane, come from data provided by each country's ministry of health.