Resumo em Português:

O presente estudo buscou identificar e descrever as ações dos senadores brasileiros, na área de saúde pública, no período de 1995 a 1996. Pretendeu-se também identificar a influência da profissão, região de origem e partido político sobre a atuação dos senadores. As ações foram divididas em três grupos: legislativas (proposição e apreciação de projetos de lei, pareceres e requerimentos), fiscalizadoras (requerimentos de informação ao Executivo e implementação de comissões parlamentares de inquérito e especiais) e parlamentares (discursos). O levantamento dos dados foi realizado em duas bases de dados mantidas pelo Senado Federal: MATE e DISC. Dos 89 parlamentares que exerceram mandato no período do estudo, 76 se envolveram com matérias de saúde. Foram estudadas 667 ações. Predominaram os discursos (43% das ações), em sua maioria respondendo a notícias veiculadas pelos meios de comunicação. Do total de ações, 60% envolveram políticas públicas (30%), drogas (9%), regulamentação das profissões de saúde (8%), controle de doenças (7%) e saúde do trabalhador (6%). A atividade fiscalizadora foi limitada (5% das ações foram requerimentos de informação). Em relação ao perfil dos senadores, predominaram os médicos, professores e jornalistas. Os parlamentares das Regiões Norte e Nordeste realizaram 62% de todas as ações e atuaram em relação a quase todos os temas. Os senadores de orientação liberal e de direita responderam por 43% de todas as ações; contudo, os de orientação socialista e trabalhista apresentaram maior participação proporcional (em termos de senadores envolvidos e de ações realizadas). É interessante notar que os senadores socialistas e trabalhistas não se envolveram com o tema "saúde do trabalhador". A predominância de discursos como ação, a proposição legislativa pontual e descontínua e, especialmente, a incipiente ação fiscalizadora, indicam a necessidade de reformular a sistemática de trabalho no âmbito das comissões técnicas e da consultoria técnica do Senado.

Resumo em Inglês:

The objective of this study was to identify and describe the actions of Brazilian senators in the field of public health in 1995 and 1996. We also sought to determine if profession, regional background, or political party influenced the senators' actions. The actions were divided into three types: legislative (proposal and review of bills and petitions); supervisory (information requests to the executive branch and the establishment of inquiry committees and other special committees); and parliamentary (speeches). The data were collected from two databases maintained by the Senate, namely MATE and DISC. Of the 89 senators who were in office during the study period, 76 were involved with public health issues. Of the total of 667 actions studied, there was a predominance of speeches (43% of all actions), most of them responding to news reported by regional or national media. Supervisory activities were limited (5% of all actions were information requests). The subjects dealt with most frequently were health policies (30%), drugs (9%), regulation of health professions (8%), disease control (7%), and worker health (6%). Concerning the professions of the senators, the most frequent categories were physicians, teachers, and journalists. The senators representing the North and Northeast regions performed 62% of the actions and were involved with almost all the health subjects. Although 43% of the actions were carried out by liberal and right-wing senators, the senators from socialist and labor parties had a stronger proportional participation (both in terms of senators involved and actions performed). It is interesting to note that socialist and labor senators showed minimal involvement in the issue of worker health. The predominance of speeches as a prevalent type of action, the limited and disjointed scope of legislative actions, and, especially, the poor monitoring and control show the need for deep changes in the work process of the Senate's technical committees and, therefore, of the Senate's technical support unit.

Resumo em Espanhol:

Se describen los principales resultados del Tercer Estudio Nacional de Consumo de Drogas realizado en Chile por el Consejo Nacional para el Control de Estupefacientes (CONACE) entre el 1 de septiembre de 1998 y el 15 de enero de 1999, que utilizó el mismo diseño metodológico de los estudios primero y segundo, realizados en 1994 y 1996, y que amplió la muestra a 31 665 individuos que representaban a una población de 6 940 727 personas de 12 a 64 años de edad, de ambos sexos y de cinco niveles socioeconómicos, residentes en zonas urbanas de 62 comunas de las 13 regiones del país. Además, se comparan los resultados proporcionados por los tres estudios. El estudio de 1998 muestra que 17,5% de los chilenos han consumido alguna vez en la vida alguna de las tres drogas ilícitas de mayor uso en el país: marihuana (16,8%), pasta base (2,3%) y clorhidrato de cocaína (4,0%). La prevalencia del consumo de cualquiera de las tres drogas durante el último año fue de 5,3% y durante el último mes de 2,2%, predominando una vez más el consumo de marihuana. Con respecto a las drogas lícitas, 28,4% de los chilenos han consumido alguna vez en su vida ansiolíticos, 84,4% alcohol y 71,9% tabaco. La mayor parte de las personas que alguna vez consumieron drogas ilegales dejaron de hacerlo: 71,6, 64,1 y 66,8% en el caso de la marihuana, de la pasta base de cocaína y del clorhidrato de cocaína, respectivamente. Para las drogas legales, estos porcentajes fueron menores: 55,5% para los ansiolíticos, 16,0% para el alcohol y 34,5% para el tabaco. El consumo de drogas lícitas e ilícitas fue varias veces mayor en los hombres que en las mujeres, excepto el de ansiolíticos, que fue tres veces mayor en el sexo femenino que en el masculino. El consumo fue más frecuente entre los 19 y 25 años de edad. El consumo de drogas ilícitas fue más frecuente en los niveles socioeconómicos más altos y el de drogas lícitas en los más bajos. El percentil 50 de la edad de inicio en el consumo de drogas se situó en los 17 años para el alcohol, en los 15 para el tabaco, en los 30 para los ansiolíticos, en los 17 para la marihuana, en los 20 para la pasta base de cocaína y en los 21 para el clorhidrato de cocaína. La comparación de los resultados de los tres estudios realizados por el CONACE muestra que, tras el aumento del consumo de drogas lícitas registrado entre 1994 y 1996, se produjo una estabilización en 1998, mientras que para el consumo de drogas ilícitas hubo un ligero aumento entre 1996 y 1998, tras la ligera disminución observada entre 1994 y 1996.

Resumo em Inglês:

The principal results are presented here from the Third National Study of the Consumption of Drugs, which was carried out in Chile by the National Board for Narcotics Control between 1 September 1998 and 15 January 1999. The 1998 study used the same methodological design as the first and second studies, which were done in 1994 and 1996. The 1998 study expanded the sample to 31 665 individuals, who were representative of a population of 6 940 727 people from 12 to 64 years old, both sexes, and five socioeconomic levels and who were residents of urban areas in 62 commune administrative divisions of the 13 regions of the country. Results from the 1998 study are compared with those from 1996 and 1994. The 1998 study shows that 17.5% of Chileans have at some time in their life used one of the three illicit drugs most popular in the country: marijuana (16.8%), coca paste (2.3%), and cocaine hydrochloride (4.0%). The prevalence of use of any of the three drugs, mainly marijuana, during the preceding year was 5.3% and during the preceding month 2.2%. With respect to licit drugs, 28.4% of Chileans have at some time in their lives used antianxiety drugs, 84.4% of them have consumed alcohol, and 71.9% have used tobacco. Most of the people who once used illegal drugs have stopped doing so: 71.6% in the case of marijuana, 64.1% with coca paste, and 66.8% with cocaine hydrochloride. For legal drugs, the percentages were lower: 55.5% for anxiolytics, 16.0% for alcohol, and 34.5% for tobacco. The consumption of licit and illicit drugs was several times greater among men than among women, except for anxiolytics, whose use was three times greater among women. Drug use was more frequent among persons between 19 and 25 years old. Consumption of illegal drugs was more frequent at higher socioeconomic levels, and use of licit drugs was more common in the lower socioeconomic levels. The 50th percentile of the age of initiating drug use was 17 years for alcohol, 15 for tobacco, 30 for antianxiety agents, 17 for marijuana, 20 for coca paste, and 21 for cocaine hydrochloride. Comparing the results of the three studies shows that, after an increase in the use of licit drugs between 1994 and 1996, there was a stabilization in 1998. With illegal drugs there was a modest increase in consumption between 1996 and 1998, following a small reduction between 1994 and 1996.

Resumo em Espanhol:

Con el fin de definir objetivos y prioridades para la prevención de las muertes en carretera en Colombia y en otros países que se encuentran en rápido proceso de urbanización, presentamos datos sobre la distribución y determinantes de las muertes y lesiones por accidentes de tráfico en Colombia. Utilizando información del Fondo de Prevención Vial Nacional y del registro nacional de defunciones, estudiamos los datos correspondientes al período comprendido entre 1991 y 1995, tanto en la totalidad del país como en sus dos principales ciudades: Santa Fe de Bogotá y Medellín. En el ámbito nacional, las muertes y lesiones por esta causa están en aumento. En relación con las muertes, 75% ocurrieron en áreas urbanas y 80% de las víctimas fueron varones, cifras que señalan la existencia de objetivos prioritarios específicos para la intervención. El subgrupo más afectado fue el de los peatones de 15 a 34 años de edad. Treinta y cuatro porciento de las muertes fueron atribuibles a exceso de velocidad o consumo de alcohol. El número de víctimas mortales fue más elevado por las noches y en los fines de semana.

Resumo em Inglês:

We report data on the distribution and determinants of road deaths and injuries for all victims in Colombia, with the aim of defining targets and priorities for highway death prevention in that country and other rapidly urbanizing nations. Using information from Colombia's Fund for the Prevention of Road Injury and the national death registry, we studied data on deaths and injuries from 1991 to 1995 for the nation as a whole and for the country's two largest cities, Santa Fe de Bogotá and Medellín. Deaths and injuries are rising in the nation as a whole. Of the deaths, 75% occur in urban areas, and 80% are in males. Pedestrians aged 15-34 are a peak subgroup. Thirty-four percent of deaths are attributable to speeding and/or alcohol consumption. Death tolls are highest at night and on weekends. Specific priority targets for intervention are indicated by the fact that 75% of road deaths in Colombia occur in urban areas and that 80% of all victims are males.

Resumo em Português:

Embora a literatura apresente dados preocupantes sobre a incidência do câncer de colo uterino entre povos indígenas, no Brasil são muito escassas as informações a respeito da ocorrência do câncer nessa população. Assim, o objetivo do presente estudo descritivo foi analisar a prevalência de câncer do colo uterino e de infecções cérvico-vaginais em 423 mulheres índias, habitantes do Parque Indígena do Xingu, Estado do Mato Grosso, com vida sexual ativa presente ou pregressa. Os dados foram coletados entre 1989 e 1996. Foram realizados exames clínico e ginecológico previamente à obtenção de esfregaço da cérvice uterina e estudo da citologia oncológica, complementados por colposcopia e biópsia nos casos positivos. Os resultados demonstraram que 1% das mulheres apresentava carcinoma invasivo e 3% apresentavam lesões pré-malignas. Além disso, evidenciou-se que 84% das mulheres apresentavam atipias celulares de natureza inflamatória, decorrentes de infecções genitais sexualmente transmitidas. Estes achados estão de acordo com a literatura internacional quanto à elevada prevalência dessas doenças em populações nativas e indicam a importância de serem estendidos aos povos indígenas do Brasil os programas de controle, tanto das doenças sexualmente transmissíveis, como de detecção e tratamento precoces do câncer do colo do útero.

Resumo em Inglês:

Although the literature presents worrisome data regarding the incidence of cervical cancer among indigenous populations, in Brazil there is very little information regarding the occurrence of this type of cancer among indigenous peoples. Therefore, the objective of the present descriptive study was to assess the prevalence of cervical cancer and of cervical and vaginal infections among 423 indigenous women living in the Xingu Indian Reservation, in the state of Mato Grosso, Brazil. These women were or had been sexually active. Data were collected between 1989 and 1996. Clinical and gynecological examinations were carried out prior to the collection of cervical specimens and to the performance of cytologic analyses. Upon detection of abnormalities, a colposcopy and a biopsy were also performed. Our results show that 1% of the women studied presented invasive carcinoma and that 3% presented premalignant lesions. In addition, 84% presented inflammatory atypia, resulting from sexually transmitted genital infections. The present findings are in accordance with the results of other international reports regarding the high prevalence of cervical conditions among indigenous populations, and they underscore the need to extend to the indigenous peoples of Brazil programs aiming at the control of sexually transmitted diseases and at the early detection and treatment of cervical cancer.

Resumo em Espanhol:

El presente estudio se diseñó con el fin de conocer las condiciones en las que se realiza el control prenatal en la ciudad fronteriza de Tijuana, Baja California, México y de estudiar las posibles asociaciones entre ese tipo de atención y el resultado neonatal en términos de peso al nacer, estado de salud del neonato y prematuridad. Se seleccionaron siete hospitales que atienden a personas de diferentes estratos socioeconómicos y entre diciembre de 1993 y marzo de 1994 se entrevistó en ellos a 279 mujeres que cursaban las primeras 24 a 48 horas del puerperio. En la entrevista se recogieron datos sobre nivel socioeconómico; conceptos, actitudes y prácticas de las madres respecto de la salud obstétrica; percepción materna de acceso a los servicios de atención prenatal; calidad de las consultas de control prenatal (evaluada según la realización de pruebas de sangre y orina y la medición de la tensión arterial y del peso); y antecedentes ginecobstétricos y de salud de la madre. Se elaboró una base de datos con el paquete estadístico SPSS y se exploraron posibles asociaciones entre la atención prenatal como variable independiente y las diferentes variables dependientes mediante tablas de contingencia y la prueba de Fisher de dos colas.

Resumo em Inglês:

This study was intended to explore the conditions under which prenatal care is delivered in the border city of Tijuana, Baja California, Mexico, and to assess the possible associations between that care and neonatal results in terms of birthweight, health of the neonate, and prematurity. Seven hospitals serving persons from different socioeconomic strata were chosen, and between December 1993 and March 1994 interviews were conducted with 279 women who were in the first 24 to 48 hours of puerperium. During the interviews data were collected on socioeconomic level; the mothers' knowledge, attitudes, and practices concerning obstetric health; the mothers' perceptions of access to prenatal care; the quality of prenatal care visits (evaluated in terms of having blood and urine tested and weight and blood pressure measured); and the gynecological and obstetric and health history of the mother. A database was created using the SPSS statistics software package. Possible associations were explored, with prenatal care as the independent variable and various dependent variables, by means of contingency tables and a two-tailed Fisher's exact test. None of the neonates was premature, ill, or had a birthweight of <= 2 500 g. For this reason it was decided to divide the variable corresponding to birthweight into two groupings, <= 3 000 g and > 3 000 g. A significant (P < 0.00038) relationship was found between a lack of prenatal care and low birthweight. In addition, a lack of prenatal care was associated with: low family income; the mother's financial dependence on the father; the mother being in an unmarried relationship; little communication with the partner; having no medical insurance; an unwanted pregnancy; and giving delivery at the General Hospital. Out of the total sample of 279 women, 15 (5.4%) had received no prenatal care. None of these 15 women reported they had encountered difficulties that prevented them from obtaining prenatal care, but only 7 of those women answered that question. The prenatal care was of good quality in 190 of the cases (68%). Both the number and the timing of the prenatal visits were adequate in 142 of the cases (50%). The mother's having worked during pregnancy or before had a positive predictive value in terms of utilization of prenatal care services. Additional studies are needed to evaluate the possible relationship between domestic violence and the lack of prenatal care or a delay in seeking such care.

Resumo em Espanhol:

Pese a su número creciente, son pocos los programas de educación sexual y prevención del embarazo que han sido evaluados en los países en desarrollo. Este estudio, realizado entre 1995 y 1997, evalúa en 945 escolares jamaiquinos de 7º grado (11 a 14 años de edad) el impacto de un programa escolar de educación sexual, el denominado "Proyecto de 7º grado", sobre la iniciación de su actividad sexual, el empleo de anticonceptivos durante el primer coito y los conocimientos y actitudes que influyen en sus comportamientos. Utilizando un diseño casi experimental, el estudio midió los efectos del proyecto al final de los nueve meses de intervención (corto plazo) y un año más tarde (largo plazo). El análisis de regresión logística multivariado reveló que el proyecto no tuvo efectos sobre la edad de inicio de la actividad sexual, aunque sí tuvo un impacto positivo a corto plazo sobre el empleo de anticonceptivos en el primer coito (P = 0,08); la probabilidad de utilizar anticonceptivos fue dos veces mayor en los adolescentes del grupo sometido a la intervención educativa. El proyecto también tuvo una influencia positiva a corto plazo sobre varios aspectos de los conocimientos y actitudes de los adolescentes hacia la sexualidad y el embarazo. El moderado impacto del proyecto es alentador, dado que los programas escolares de educación sexual de duración limitada raramente tienen impacto a largo plazo y que, además, en Jamaica existen fuerzas socioeconómicas y culturales antagónicas que alientan la sexualidad temprana y la paternidad entre los adolescentes. El empleo de métodos educativos más participatorios y la reducción del número de alumnos por clase podría fortalecer el "Proyecto de 7º grado" y aumentar su impacto.

Resumo em Inglês:

Despite their increasing numbers, few of the sexuality education and pregnancy prevention programs in developing countries have been evaluated. This study, conducted in 1995-1997, assesses the impact of a school-based sexuality education program, the Grade 7 Project, on 945 Jamaican seventh graders (aged 11-14) and their initiation of sexual activity and use of contraception at first intercourse, as well as the knowledge and attitudes that influence their behaviors. Using a quasi-experimental design, the study measured the effects of the Grade 7 Project when the nine-month intervention was completed (short term) and one year after that (long term). Multivariate logistic regression analysis indicated that the project had no effect on initiation of sexual activity, but it had a positive short-term impact on use of contraception at first intercourse (P = .08); adolescents in the intervention group were more than twice as likely to use contraception. The project also had a positive short-term influence on several aspects of the adolescents' knowledge of and attitudes about sexuality and pregnancy. The modest impact of the Grade 7 Project is encouraging, as school-based sexuality education programs of limited duration rarely have a long-term impact. Moreover, competing socioeconomic and cultural forces in Jamaica encourage early sexuality and parenthood among adolescents. The use of more participatory teaching methods and smaller class sizes might strengthen the Grade 7 Project and enhance its impact.

Resumo em Espanhol:

En este estudio se analiza la evolución de la resistencia a los antimicrobianos en 771 aislados de Shigella spp. obtenidos de un total de 9 195 coprocultivos efectuados entre 1990 y 1997 en un hospital infantil de Córdoba, Argentina. S. flexneri, responsable de 73% de las infecciones por Shigella, fue la especie más resistente. La frecuencia de la multirresistencia de S. flexneri a los tres antibacterianos más utilizados (ampicilina, trimetoprima-sulfametoxazol y cloranfenicol) aumentó de 10% en 1990 a 58% en 1997 (P < 0,001). Cuando se considera separadamente cada uno de ellos, la resistencia a la ampicilina aumentó de 60 a 100% (P < 0,001), la resistencia al cloranfenicol de 13 a 71% (P < 0,001) y la resistencia a la trimetoprima-sulfametoxazol de 79 a 84% (P = 0,22). Para S. sonnei, el aumento de la resistencia a la ampicilina (de 36% en 1990 a 54% en 1997) no fue estadísticamente significativo (P = 0,20), ni tampoco lo fue la disminución de la resistencia a la trimetoprima-sulfametoxazol, que pasó de 82% en 1990 a 55% en 1997 (P = 0,08); solo se detectaron dos aislados resistentes al cloranfenicol, uno en 1995 y otro en 1997, y dos con resistencia múltiple a los tres antibióticos. Consideramos obligatorio realizar pruebas de susceptibilidad en cada aislado clínico de Shigella, ya que permiten detectar cambios en el perfil de la resistencia y, con ello, adecuar el tratamiento empírico.

Resumo em Inglês:

This study analyzed the evolution of antimicrobial resistance in 771 isolates of Shigella spp. obtained from a total of 9 195 feces cultures done between 1990 and 1997 in a children's hospital in Córdoba, Argentina. S. flexneri, which was responsible for 73% of the Shigella infections, was the species with the greatest resistance. The frequency of S. flexneri resistance to the three antibiotics most used (ampicillin, trimethoprim-sulfamethoxazole, and chloramphenicol) increased from 10% in 1990 to 58% in 1997 (P < 0.001). Considering each of the drugs individually, the resistance to ampicillin increased from 60% to 100% (P < 0.001), the resistance to chloramphenicol from 13% to 71% (P < 0.001), and the resistance to trimethoprim-sulfamethoxazole from 79% to 84% (P = 0.22). For S. sonnei, the increase in resistance to ampicillin (from 36% in 1990 to 54% in 1997) was not statistically significant (P = 0.20), nor was the reduction in resistance to trimethoprim-sulfamethoxazole, which went from 82% in 1990 to 55% in 1997 (P = 0.08). Only two S. sonnei isolates were found that were resistant to chloramphenicol, one in 1995 and another in 1997; two S. sonnei isolates were found with resistance to all three antibiotics. We consider it essential to carry out susceptibility tests of each Shigella clinical isolate, to detect changes in the resistance profile and thus modify empiric treatment.

Resumo em Português:

Cerca de 30% dos óbitos por causas externas violentas no Brasil são decorrentes de homicídios. Tradicionalmente, a violência tem sido relacionada a problemas sociais maiores, tais como pobreza. Contudo, recentemente, tem-se observado uma correlação positiva entre maior renda e aumento das taxas de homicídio, de forma que muitos pesquisadores passaram a considerar as desigualdades sociais, mais do que a pobreza, como explicação para as epidemias de violência. O objetivo do presente trabalho foi verificar a correlação entre a urbanização, a pobreza e a desigualdade econômica e as taxas de homicídio no Estado de São Paulo, Brasil, em 1996. Para cada município do Estado foram obtidas, a partir do censo demográfico, informações sobre o tamanho, a renda mensal média dos chefes de família, a distribuição de renda e o índice de Gini. As taxas de homicídio foram calculadas para cada município a partir dos dados oficiais. Foram realizadas análises de correlação e cálculos de riscos relativos com intervalos de confiança de 95%. As taxas de homicídio apresentaram aumento diretamente proporcional ao tamanho dos municípios, variando de 6,96 (por 100 000 habitantes), em municípios com menos de 10 000 habitantes, a 55,54, em municípios com mais de um milhão de habitantes; o risco relativo variou de 1,35 a 7,98. Os resultados mostraram que apenas para o grupo de municípios com renda média mensal acima de 3,11 salários mínimos e coeficiente de Gini acima de 0,50 houve correlação significativa com o tamanho da população. A correlação entre as taxas de homicídio e a razão de rendas entre os percentis 90 e 20 da população mostrou-se forte, direta e significativa. É necessário aprofundar a análise dos determinantes macrosociais da violência, buscando identificar indicadores de desigualdade que forneçam elementos para a formulação de estratégias de saúde pública.

Resumo em Inglês:

Around 30% of the deaths due to violent causes in Brazil result from homicides. Violence has traditionally been related to larger social problems, such as poverty. Recently, however, a positive correlation has been observed between higher incomes and an increase in the homicide rate, so that some researchers have begun to consider inequality, rather than poverty, as an explanation for the epidemic of violence. The objective of this study was to investigate the correlation between urbanization, poverty, and economic inequality and homicide rates in the state of São Paulo, Brazil, in 1996. Information regarding population size, average monthly income of household heads, income distribution, and Gini index was obtained for each municipality, based on the demographic census. Homicide rates were calculated based on official data. Data were analyzed in terms of correlation and relative risk with 95% confidence intervals. Homicide rates rose in direct proportion to city population and ranged from 6.96 (per 100 000 inhabitants) in municipalities with a population smaller than 10 000 inhabitants, to 55.54 in municipalities with more than 1 million inhabitants. Relative risk ranged from 1.35 to 7.98. A significant correlation with population size was found only for incomes above 3.11 times the minimum wage and a Gini index greater than 0.50. There was a strong, direct, and significant correlation between homicide rates and the income ratio between the ninetieth and the twentieth percentiles of the population. It is necessary to probe more deeply into the macrosocial determinants of homicide rates in order to identify indicators of inequality that can generate meaningful data for developing public health strategies.

Resumo em Espanhol:

Las donaciones de medicamentos pueden desempeñar un papel esencial en la ayuda tras desastres naturales o como parte de programas de cooperación internacional para el desarrollo. No obstante, cuando son mal manejadas pueden resultar inadecuadas y causar más problemas que los que resuelven. Estas directrices revisadas y actualizadas de la Organización Mundial de la Salud describen las "prácticas de donación adecuadas" que permiten mejorar la calidad de las donaciones de medicamentos. Como base para la elaboración de directrices nacionales o institucionales, pueden ser adaptadas y puestas en práctica por los gobiernos y organizaciones que se ocupan de las donaciones de medicamentos. Las 12 directrices abordan problemas como la selección de los fármacos; la garantía de calidad y la caducidad; la presentación, envasado y etiquetado, y la información y gestión.