Resumo em Espanhol:

El presente estudio se proyectó para un trabajo simultáneo en tres ámbitos: a) diagnóstico serológico y radiológico y tratamiento quirúrgico de la hidatidosis en la población humana asintomática; b) diagnóstico animal y tratamiento de los perros, y c) evaluación de conocimientos e intervención educativa en familias campesinas y en profesionales y técnicos en salud, agropecuaria y educación, con el fin de contribuir al control del ciclo de transmisión de la enfermedad. Se efectuaron pruebas de hemaglutinación indirecta y ELISA a 5 566 personas aparentemente sanas. Los 42 (0,8%) casos con resultados positivos en ambas pruebas (seroprevalencia de 754,6 por 100 000) fueron citados para ser sometidos a una ecografía hepática y una radiografía de tórax y, de los 26 que acudieron, 16 presentaron imágenes compatibles con quiste hidatídico. Estos 16 casos fueron enviados al hospital para ser intervenidos y en los 9 que acudieron se confirmó el diagnóstico quirúrgicamente, lo cual representa una prevalencia de 161,7 por 100 000. En 2 358 perros se procedió a la detección de la forma estrobilar de Echinococcus granulosus mediante purga con bromhidrato de arecolina y se obtuvieron resultados positivos en 11%. Los datos oficiales registrados en los mataderos revelaron la presencia de quistes hidatídicos en 13% de los bovinos, 4,4% de los ovinos y 4,2% de los porcinos sacrificados en la región. El programa educativo comprendió una evaluación de conocimientos mediante una encuesta al cabeza de familia, la intervención educativa entre las familias por un proceso participatorio activo no formal de carácter lúdico en el que participaron 1 082 familias, y la intervención educativa entre profesionales y técnicos mediante metodología a distancia y presencial. Para evaluar los resultados del programa se compararon los resultados de las pruebas de conocimientos antes y después de la intervención educativa en 200 familias que participaron en ella (casos) y en 95 que no participaron (controles). Del análisis de los conocimientos sobre equinococosis/hidatidosis, 783 familias (55%) demostraron no saber nada sobre la infección. Se observó que las técnicas participatorias lúdicas se adaptan a la forma de ser del campesino y permiten obtener cambios. Se capacitaron 276 profesionales de la salud, 201 auxiliares técnicos y 453 profesores rurales. Entre los equipos de atención primaria rural, el programa tuvo una cobertura de 100%.

Resumo em Inglês:

This study was designed to embrace three areas: a) serologic and radiologic diagnosis and surgical treatment of hydatidosis in an asymptomatic human population, b) animal diagnosis and the treatment of dogs, and c) evaluation of extent of knowledge and performance of educational interventions among rural families and health, livestock, and education professionals and technicians, in order to help control the disease transmission cycle. Indirect hemagglutination and ELISA tests were performed on 5 556 apparently healthy people. Of these, 42 (0.8%) had positive results on both tests, for a seroprevalence of 754.6 per 100 000. These 42 subjects were scheduled for liver ultrasonography and a chest x-ray; of the 26 who complied, 16 showed images compatible with a hydatid cyst. Those 16 cases were sent to the hospital for surgery. In 9 of the cases the diagnosis was confirmed surgically, for a prevalence of 161.7 per 100 000. Arecoline hydrobromide was administered as a laxative to 2 358 dogs to detect the strobilar form of Echinococcus granulosus, and positive results were found in 11% of the dogs. Official data for slaughterhouses indicated the presence of hydatid cysts in 13% of the cattle, 4.4% of the sheep, and 4.2% of the pigs slaughtered in the region. The educational program included an evaluation of the extent of knowledge by surveying heads of household; an educational intervention among families through an informal active participatory process using educational games, in which 1082 families participated; and an educational intervention with professionals and technicians using distance and inperson approaches. To evaluate the program, the results of knowledge tests before and after educational interventions with 200 families (cases) were compared with those from 95 families who did not participate (controls). Of the 1 423 heads of household initially surveyed about their knowledge of echinococcosis/hydatidosis, 783 of them (55%) said they knew nothing about the infection. It was found that the participatory educational games were well adapted to the lifestyle of people from rural areas and made change possible. Training was provided to 276 health professionals, 201 technical assistants, and 453 rural teachers. The program reached 100% of the staff members of the area's rural primary health care services.

Resumo em Português:

A utilização de medicamentos no Brasil, inclusive dos psicofármacos, tem sido considerada exacerbada e indiscriminada. Mesmo assim, é reduzido o número de trabalhos sobre a utilização destes medicamentos, principalmente entre usuários de serviços odontológicos. O estudo teve como objetivo a verificação da prevalência de consumo de psicofármacos, nos períodos de 15 dias e de 12 meses que antecederam o estudo, entre os usuários das clínicas integradas de atenção primária da Faculdade de Odontologia, Universidade Federal de Minas Gerais, Brasil. A coleta de dados utilizou formulários de entrevistas aplicados a todos os indivíduos maiores de 12 anos, atendidos nestas clínicas durante o mês de junho de 1997. O consumo de psicofármacos foi de 4% e 10%, respectivamente, para os 15 dias e 12 meses que antecederam o estudo. Os ansiolíticos foram os mais consumidos nos 12 meses antes do estudo, totalizando aproximadamente 40% do consumo global. O grupo de indivíduos com idade até 23 anos (mediana da idade) apresentou um consumo menor do que o grupo com idade superior a 23 anos (P < 0,01). Houve uma associação significativa (P < 0,05) entre o sexo feminino e o consumo destas drogas, bem como entre a profissão de dona de casa e o consumo (P < 0,03). Os usuários que relataram serem casados ou amasiados (união estável) apresentaram maior consumo de psicofármacos quando comparados com os solteiros, viúvos ou separados (união instável) (P < 0,03). Não houve associação entre a utilização de psicofármacos e a escolaridade. Apesar da importância da informação a respeito do uso de psicofármacos para o diagnóstico e planejamento integral em odontologia, apenas 40% dos alunos das clínicas integradas relataram ter anotado este dado em ficha clínica. Tal fato pode indicar que o ensino de Odontologia está sendo falho neste aspecto, devendo, então, ser repensada a importância dada à questão dos medicamentos durante a formação dos cirurgiões-dentistas.

Resumo em Inglês:

In Brazil, psychotropics and other drugs are often indiscriminately overused. Nevertheless, there are few studies regarding the use of psychotropics, especially among dental patients. The purpose of this study was to assess the prevalence of psychotropic consumption among patients of the general primary care clinic of the Dentistry School at the Minas Gerais Federal University, in Brazil. To collect data, students working in the clinic interviewed all patients over 12 years of age seen at the clinic during June 1997 and asked them about their use of psychotropics during the preceding 2-week and 12-month periods. The results showed that 4% of the patients had used psychotropic drugs in the 2 weeks before the study and that 10% of them had used psychotropics in the preceding 12 months. The drugs used most frequently in the 12-month period were anxiolytics (around 40% of total use). The median age of the patients was 23 years old. Persons under the median had used psychotropics less in comparison with older persons (P < 0.01). A significant association (P < 0.05) was found between using drugs and being female, and also between the use of drugs and being a housekeeper or a housewife (P < 0.03). Patients with a regular relationship (married or living together) used more psychotropics than patients who were single, widowed, or divorced (P < 0.03). There was no association between the use of drugs and the level of education. Even though information on the use of psychotropics is important for dental diagnosis and planning, only 40% of the students said they noted this information in their patients' charts. That fact suggests that dental student education may be lacking in this regard and that dentistry training should take into consideration the issue of patients' use of drugs.

Resumo em Espanhol:

La malaria está reapareciendo en la mayoría de los países endémicos de América del Sur. En el Ecuador, la enfermedad es endémica en la costa del Pacífico, en los valles de los Andes y en la cuenca del río Amazonas. En el Bajo Napo en el nordeste del Ecuador, la malaria se consideraba eliminada en los años setenta, pero la enfermedad ha vuelto a aparecer en años recientes. Aunque en la actualidad tres organismos participan en actividades antimaláricas en esa zona, sus actividades no están coordinadas. Este estudio se efectuó con el propósito de describir la epidemiología de la incidencia de malaria en el Bajo Napo durante el período de enero de 1992 a diciembre de 1995, así como de determinar hasta qué punto existen patrones estacionales en la transmisión en ese territorio. Para determinar la incidencia de malaria, se recogieron datos para el cuadrienio 1992-1995 a partir de los registros de los tres organismos con actividades antimaláricas: la sede del Servicio Nacional de Erradicación de la Malaria (SNEM) en Coca, el hospital de distrito de Nuevo Rocafuerte (HDNR) y una asociación de trabajadores de salud comunitarios llamada Sandi Yura. La información climatológica para el mismo período se obtuvo de la Fuerza Aérea Ecuatoriana y de las autoridades de aviación civil. Durante el período de 1992 a 1995, el SNEM diagnosticó un total de 773 casos de malaria, el HDNR 485, y Sandi Yura 859. Para el mismo cuadrienio se detectó un índice parasitario anual de 40,4 con los datos del HDNR; 35,8 con los de Sandi Yura, y 6,2 con los del SNEM. Plasmodium vivax fue el parásito hallado con mayor frecuencia en el territorio (92% de todos los casos). De las personas infectadas, 28% tenían menos de 10 años de edad. No se hallaron diferencias patentes entre los sexos, ni tampoco variaciones estacionales del número de casos. Es preciso hacer más investigaciones para confirmar estos resultados y para entender más a fondo la transmisión de la malaria en la zona. El estudio subraya la necesidad de fortalecer la coordinación entre las organizaciones que participan en la lucha antimalárica en el territorio, a fin de mejorar los conocimientos sobre la epidemiología de la malaria y de diseñar y poner en marcha estrategias de control adecuadas.

Resumo em Inglês:

Malaria is reemerging in most endemic countries of South America. In Ecuador, malaria is endemic on the Pacific coast, in the inter-Andean valleys, and in the Amazon River basin. In the Lower-Napo region of northeastern Ecuador, malaria was considered eliminated in the 1970s, but the disease has reemerged in recent years. Three organizations are involved in malaria related work in the area, but they are not coordinating their efforts. This study was designed to describe the epidemiology of malaria incidence in the Lower-Napo region for the period of January 1992 through December 1995, and to determine the extent of seasonality in transmission in the area. To determine malaria incidence, data were collected for that 4-year period from the records of the three malaria-related organizations: the office of the National Center for Malaria Eradication (NCME) in the town of Coca, the district hospital in Nuevo Rocafuerte (DHNR), and an association of community health workers called Sandi Yura. Data on climatic conditions for the same period were collected from the Ecuadorian Air Force and civil aviation authorities. During the 1992-1995 period, NCME diagnosed a total of 773 malaria cases, DHNR diagnosed 485, and Sandi Yura clinically diagnosed 859. For the 4-year period, an annual parasite index of 40.4 was found with the DHNR data, 35.8 with the Sandi Yura data, and 6.2 with the NCME data. The predominant parasite in the area was Plasmodium vivax (92% of all the cases). Twenty-eight percent of the infected persons were under 10 years old. No discernible differences between the genders were found. There was also no seasonal variation among the cases. Further research is needed in order to confirm these findings and better understand malaria transmission in the region. The study highlights the need for a closer coordination among the area's malaria-control organizations so as to have an improved understanding of malaria epidemiology and to design and implement effective control strategies.

Resumo em Português:

A disponibilidade de um serviço de genética em hospitais deveria ser uma questão de interesse público. A genética pode abreviar o período gasto na formulação de diagnósticos, reduzir o tempo médio de internação, antecipar a escolha de tratamentos adequados, impedir ou minimizar possíveis seqüelas e, desta forma, reduzir os custos. O objetivo do presente estudo foi descrever o fechamento, em 1996, do setor de genética do Hospital Infantil Menino Jesus, de São Paulo, SP, Brasil. Realizou-se uma análise retrospectiva do trabalho desenvolvido naquele setor entre 1992 e 1996, com ênfase na detecção de anormalidades cromossômicas. De todos os casos avaliados no período, 571 foram codificados em banco de dados. Alguma anormalidade cromossômica foi observada em 20% dos 350 cariótipos realizados. A presença de um serviço de genética em hospitais minimiza o surgimento de manifestações clínicas em portadores de distúrbios genéticos, melhora a qualidade de vida desses pacientes e permite que eles recebam informação sobre o risco de recorrência, além de evitar desperdícios decorrentes da realização inadequada de exames caros. Tais benefícios justificam o investimento necessário para que este tipo de serviço funcione.

Resumo em Inglês:

The availability of genetics services in hospitals should be an issue of public concern. Having genetics services helps shorten the time spent in making diagnoses and reduces the average number of inpatient days; it also helps accelerate the choice of adequate treatments, prevents or minimizes sequelae, and, ultimately, reduces costs. The objective of the present study was to describe the closing down in 1996 of the genetics division at the Menino Jesus Children's Hospital, a pediatric institution located in the city of São Paulo, SP, Brazil. A retrospective analysis was carried out of the work performed by this division between 1992 and 1996, with an emphasis on the detection of chromosomal abnormalities. Of all cases assessed during the study period, 571 were entered into a database. Some kind of chromosomal abnormality was observed in 20% of the 350 karyotypes performed. The existence of genetics services in hospitals helps minimize the appearance of clinical symptoms in carriers of genetic abnormalities, improves the quality of life of these patients, and enables them to receive information regarding risk of recurrence, while preventing the waste of resources that results from tests that are costly and unnecessary. Such benefits amply justify the investment in setting up genetics services of the type described here.

Resumo em Espanhol:

En marzo-abril de 1998 se identificó en un barrio de la ciudad de Santa Fe (Argentina) un brote de una enfermedad aguda caracterizada por fiebre, cefaleas y mialgias intensas. Se presentan los estudios realizados en relación con este brote y los intentos de identificación de la fuente y del modo de transmisión. Los hallazgos epidemiológicos, serológicos y clínicos indicaron que el agente causal fue Leptospira interrogans. Como prueba de tamizaje se aplicó la técnica de aglutinación macroscópica con antígeno termorresistente, seguida de la prueba de ELISA y, como prueba de confirmación, la aglutinación microscópica frente a 10 serovariedades de L. interrogans. Se estudiaron 32 individuos, 8 perros y 8 muestras de agua. Se registraron 12 casos confirmados, 2 probables y 18 negativos. En seis perros se demostró la existencia de infección y en las muestras de agua se detectó la presencia de espiroquetas móviles. Los sueros humanos reaccionaron con las serovariedades ballum, canicola, icterohaemorrhagiae y pyrogenes, y los caninos con ballum, canicola y pomona. La coaglutinación observada en todos los casos confirmados indica que se trató de casos agudos de leptospirosis, pero no permite identificar la serovariedad causal. Salvo en el caso índice, no se reconoció clínicamente la enfermedad. Varios hechos sugieren que la causa del brote fue la inundación pluvial de la zona estudiada. Los resultados de este estudio resaltan la necesidad de una vigilancia activa de la leptospirosis ante desastres naturales como las inundaciones.

Resumo em Inglês:

In March-April 1998 in a neighborhood in the city of Santa Fe, Argentina, there was an outbreak of an acute disease characterized by fever, headaches, and intense myalgias. This article presents the studies surrounding this outbreak and the attempts to identify the source and the mode of transmission. The epidemiological, serological, and clinical findings indicated that the causative agent was Leptospira interrogans. As a screening test, macroscopic agglutination with heat-resistant antigen was applied, followed by the ELISA test, and, as a confirmatory test, microscopic agglutination for 10 serotypes of L. interrogans. The study covered 32 persons, 8 dogs, and 8 water samples. Among the 32 persons, 12 cases were confirmed, 2 were suspicious, and 18 were negative. Six dogs were found to be infected, and motile spirochetes were found in the water samples. The human sera reacted with the ballum, canicola, icterohaemorrhagiae, and pyrogenes serotypes; the canine sera reacted with the ballum, canicola, and pomona serotypes. The coagglutination found in all the confirmed cases indicates that they were acute cases of leptospirosis, but it was impossible to identify the causal serotype. Except for the index case, the disease was not recognized clinically. Several facts suggest that the outbreak was caused by rain that had flooded the study area. The results of this study emphasize the need for active surveillance of leptospirosis when there are floods and other natural disasters.

Resumo em Espanhol:

Para poder elegir aquellas intervenciones que podrían prevenir la mortalidad materna, se necesitan datos apropiados y de calidad sobre ella. No obstante, la calidad y cantidad de la información y el alcance de los datos disponibles sobre salud y mortalidad maternas son pobres en muchos países, especialmente en el mundo en desarrollo. De enero de 1993 a diciembre de 1996 se puso en funcionamiento un programa de vigilancia sobre la mortalidad materna con la finalidad de llevar a cabo estudios de vigilancia en el departamento de Guatemala, Guatemala. Por medio de un sistema de vigilancia activa, nuestro método arrojó un cuadro más completo de la mortalidad materna e información sobre las causas específicas de dicha mortalidad. Partiendo de distintas fuentes de información, revisamos y analizamos todas las defunciones en mujeres de edad reproductiva (10 a 49 años) y cada defunción se investigó para determinar si guardaba relación con el embarazo. La razón de mortalidad materna para el período de 4 años que abarcó el estudio fue de 156,2 defunciones por 100 000 nacidos vivos. Las mujeres de 35 años de edad o mayores tuvieron un mayor riesgo de muerte por causas maternas que las mujeres de menor edad. Las mujeres de 35 a 39 años tuvieron un riesgo de muerte materna casi tres veces mayor que el de las mujeres de 20 a 24 años, y el riesgo para las mujeres de 40 años o más fue más del doble que el de este último grupo. En términos generales, las dos causas principales de muerte materna fueron la infección y la hemorragia. Los partos vaginales que fueron atendidos por personal médico mostraron la mayor tasa de mortalidad materna a raíz del parto por infección generalizada. En los partos atendidos por personal no médico, las muertes maternas por hemorragia durante el parto mostraron la mayor asociación con retención de la placenta. Los países en desarrollo deben implantar sistemas de recolección de datos continua y sistemática, a fin de que los que sientan políticas y administran el sector de la salud dispongan de información que les permita diseñar intervenciones adecuadas para salvar la vida de las mujeres.

Resumo em Inglês:

To select the proper interventions that could prevent maternal mortality, adequate and appropriate maternal mortality data are needed. Nevertheless, the quality and quantity of information and the scope of maternal health- and death-related data are inadequate in many countries, particularly in the developing world. From January 1993 to December 1996 a surveillance program in maternal mortality was developed to conduct surveillance studies in the department of Guatemala, Guatemala. With an active surveillance system, our approach gave a more complete picture of maternal death and produced information on the specific causes of maternal mortality. Using multiple sources of information, we reviewed and analyzed all deaths of women of childbearing age (10 to 49 years). Each death was investigated to determine whether it was pregnancy-related or not. The maternal mortality ratio for the four-year study period was 156.2 deaths per 100 000 live births. Women 35 and older had a higher risk of maternal death than women under that age. Women who were 35-39 years old had a maternal death risk almost three times as high as women aged 20-24. For women who were 40 or older the risk was more than double that of women 20-24 years old. Overall, the two leading causes of maternal mortality were infection and hemorrhage. Vaginal deliveries where there was medical assistance had the highest rate of delivery-related maternal death from general infection. In deliveries attended by nonmedical personnel, delivery-related maternal deaths from hemorrhage were most frequently associated with retained placenta. Developing countries are called on to implement systems that can provide continuous and systematic data collection so that policymakers and health managers have adequate information to design proper interventions to save women's lives.

Resumo em Inglês:

The aging of the population due to increasing life spans requires a reevaluation of the health care models that prevail in the countries of the Region of the Americas, given that the illnesses typical of old age make up an ever-increasing share of the morbidity burden. The countries in the Region are in an intermediate stage of demographic transition. They face the challenge of balancing priority care for the health problems characteristic of developing countries along with care for the chronic and debilitating diseases that afflict the elderly. An even greater challenge is gauging, in a timely manner, the health, social, and economic consequences of the demographic transition over the next millennium, to allow the countries to respond to these consequences through an in-depth restructuring of their health and social services. The extension of human life imposes a new vision of the health of the elderly that is oriented toward self-sufficiency, economic independence, and living life to its fullest. It will not be easy to integrate this new paradigm into the countries' health services, which are now primarily oriented toward curative care and are structured to fulfill the requirements of an epidemiological scenario that is undergoing a rapid transformation. The challenge is even greater because of the wide range of needs that the elderly have across countries with varying degrees of development. Nevertheless, sooner or later the governments of all the countries of the Region will be forced to adopt concrete measures to deal with the problems posed by the population's gradual aging.