Resumo em Espanhol:

Objetivos. Analizar el proceso de búsqueda de atención a la tuberculosis y su influencia en la adherencia al tratamiento en Chiapas, dado que el diagnóstico temprano y la adherencia al tratamiento son los factores principales para el éxito de los programas de control de la tuberculosis. Métodos. Se realizó un estudio cualitativo mediante entrevistas grupales a 11 grupos de pacientes de las regiones Centro, Altos y Fronteriza del estado de Chiapas, México. Resultados. Se detectaron diferentes alternativas a las que los enfermos acuden para su atención. Los enfermos manifestaron un retraso importante en el diagnóstico por problemas del mismo enfermo y de la atención recibida en los servicios de salud. Las opciones de tratamiento que siguieron fueron el resultado de las percepciones que tienen sobre las causas de la enfermedad y de la diversidad de etnomedicinas legitimadas en las comunidades. Conclusiones. El poco conocimiento sobre la enfermedad propicia la elección de diferentes alternativas para su atención. El control de la tuberculosis requiere una utilización óptima de los servicios de salud en Chiapas y un programa de educación en materia de salud, tomando en cuenta la realidad social, cultural y económica en la que vive la población.

Resumo em Inglês:

Objective. To analyze the process of seeking tuberculosis care and this process's impact on treatment adherence in the Mexican state of Chiapas, given that the two primary factors in successful tuberculosis (TB) control programs are early diagnosis and adherence to TB treatment. Methods. We conducted a qualitative study using group interviews with 11 groups of patients in three of the nine socioeconomic regions of the state of the Chiapas (Altos, Centro, and Fronteriza). Results. The patients applied a variety of approaches in seeking care. The patients reported considerable delays in diagnosis due to problems that the patients themselves had and because of shortcomings in the care they received from the formal health care system. The treatment options that they followed were the result of their perceptions of the causes of TB and of the variety of traditional medical practices accepted in their communities. Conclusions. The lack of knowledge about TB encourages people to consider various alternatives for their care. Tuberculosis control in Chiapas requires an optimal utilization of the health services that exist in the state as well as a program of health education. TB control in Chiapas must take into account the social, cultural, and economic reality of the population.

Resumo em Português:

Objetivos. Avaliar a influência de práticas alimentares na incidência de anemia em lactentes a partir do estudo do perfil alimentar das crianças atendidas em um ambulatório de pediatria no Rio de Janeiro, Brasil. Métodos. Trata-se de um estudo transversal com 288 lactentes de 12 a 18 meses que compareceram ao ambulatório de janeiro a junho de 1993. As crianças foram avaliadas quanto à presença de anemia ferropriva; além disso, foi realizado um recordatório de 24 horas e um registro de freqüência de consumo de alimentos ricos em ferro junto aos responsáveis pelas crianças. Resultados. Cento e quarenta e quatro crianças apresentavam anemia (hemoglobina < 11 g/dL); destas, 38 apresentavam anemia grave (hemoglobina < 9,5 g/dL). Encontrou-se baixo consumo de ferro biodisponível, consumo de vitamina C dissociado das refeições e baixo consumo de carne. Observou-se associação significativa entre a prevalência de anemia severa e o consumo inadequado de ferro (razão de prevalência = 2,28; intervalo de confiança = 1,12-4,66; P = 0,02). O consumo de ferro biodisponível foi maior no grupo sem anemia (P = 0,04). Conclusões. Os responsáveis pelos lactentes devem ser informados sobre a composição nutricional da alimentação complementar a fim de aumentar a biodisponibilidade de ferro na dieta da criança. A estratégia da Atenção Integrada às Doenças Prevalentes na Infância pode contribuir neste sentido.

Resumo em Inglês:

Objective. To assess the influence of feeding practices on the prevalence of anemia among breast-fed children, based on the nutritional profile of children receiving care at an outpatient pediatric clinic in the city of Rio de Janeiro, Brazil. Methods. This was a cross-sectional study with 288 children between 12 and 18 months of age who were seen at the outpatient clinic between January and June 1993. The children were assessed in terms of the presence of iron-deficiency anemia. In addition, two questionnaires were done with the child's mother or the other person who had brought the child to the clinic: a 24-hour dietary recall and a record of the frequency of the consumption of iron-rich foods. Results. Of the 288 children, 144 of them had signs of anemia (hemoglobin < 11 g/ dL); of these 144, 38 of them had severe anemia (hemoglobin < 9.5 g/dL). We found low levels of bioavailable iron in the foods consumed, limited consumption of meat, and vitamin C consumption separate from meals. We found a significant association between the prevalence of severe anemia and inadequate iron intake (relative risk = 2.28; 95% confidence interval = 1.12 to 4.66; P = 0.02). The intake of bioavailable iron was higher in the group without anemia (P = 0.04). Conclusions. Individuals caring for breast-fed children should be educated concerning the nutritional contents of complementary foods so as to increase the bioavailability of iron in the children's diets. One way to achieve this objective might be through "Integrated Management of Childhood Illnesses," a strategy endorsed by a number of international organizations as a way to reduce child mortality and morbidity in developing countries.

Resumo em Espanhol:

Objetivos. Describir la síntesis y los resultados preliminares de la aplicación de un hidrogel de hidróxido de aluminio que, agregado directamente al agua, pueda lograr la eliminación total del arsénico, cualquiera que sea la naturaleza del agua y el estado de oxidación del metaloide. Métodos. Las materias primas utilizadas para obtener el hidrogel de hidróxido de aluminio fueron: sulfato de aluminio hidratado (que se utiliza para potabilizar aguas), hipoclorito de calcio en polvo, hidróxido de amonio y agua destilada (cuando el gel se preparó a escala de laboratorio) y agua de ósmosis inversa de igual o mejor calidad que el agua destilada (cuando se produjo el gel a escala piloto). El control de calidad del producto final consistió en la determinación de su capacidad para adsorber el arsénico y la realización de pruebas bacteriológicas para demostrar su esterilidad. El producto fue aplicado a muestras de agua a las que se añadió arsénico en el laboratorio y a muestras de aguas arsenicales naturales procedentes de la provincia de Tucumán, Argentina. Para el análisis del arsénico en el agua se utilizó el método colorimétrico del dietilditiocarbamato de plata. Resultados. La aplicación del hidrogel proporcionó una gran reducción del arsénico. Tanto en las aguas arsenicales naturales como en las artificiales, después del tratamiento las concentraciones de arsénico quedaron por debajo del límite de detección del método analítico utilizado (0,01 partes por millón). Las pruebas bacteriológicas del producto terminado revelaron la ausencia de bacterias viables. Conclusiones. La aplicación del hidrogel de hidróxido de aluminio proporcionó la deseada reducción de la concentración de arsénico en el agua. Este método de desarsenización es barato y fácil de utilizar en poblaciones rurales dispersas de zonas afectadas por el hidroarsenicismo que carecen de agua potable e infraestructura sanitaria y eléctrica.

Resumo em Inglês:

Objective. To describe the making of and the preliminary results from an aluminum hydroxide hydrogel that, when added directly to water, can totally eliminate arsenic, regardless of the nature of the water and the oxidation state of the metalloid. Methods. The raw materials used to make the aluminum hydroxide hydrogel were: hydrated aluminum sulfate (which is used to make water safe for drinking), calcium hypochlorite in powder form, ammonium hydroxide, and distilled water (when done at the laboratory scale), and water from inverse osmosis of the same or better quality than the distilled water (when done at a pilot scale). Quality control for the finished product consisted of determining its ability to adsorb arsenic and performing bacteriological tests to demonstrate its sterility. The product was used with water samples to which arsenic had been added in the laboratory and with water samples from the province of Tucumán, Argentina, with naturally occurring arsenic. To analyze the arsenic in the water the colorimetric silver diethyldithiocarbamate method was used. Results. Using the hydrogel greatly reduced the amount of arsenic. Treating both the natural and laboratory-produced arsenical waters yielded arsenic concentrations under the limit (0.01 parts per million) that was detectable with the analytical method used. The bacteriological tests of the finished product indicated there were no viable bacteria. Conclusions. Using the aluminum hydroxide hydrogel produced the desired reduction in the arsenic concentration in the water. This method for removing arsenic is inexpensive and easy to use in scattered rural populations in areas having high arsenic levels and lacking drinkable water, as well as an adequate sanitary and electric-power infrastructure.

Resumo em Espanhol:

Objetivo. Resumir la situación epidemiológica de la tuberculosis en Brasil y, en particular, su relación con la evolución del sector de la salud en las últimas décadas, con el proceso de reforma del sector de la salud y con las actuales propuestas del Ministerio de Salud de Brasil. Métodos. Se efectuó una revisión de los datos del Ministerio de Salud de Brasil acerca de la situación de la tuberculosis en el país durante los últimos 20 años, así como de la historia de los cambios sufridos por el sector de la salud. Resultados. En Brasil ha habido importantes cambios en la situación epidemiológica de la tuberculosis y en la estructura del sistema de salud. Conclusión. El Plan Nacional de Control de la Tuberculosis en Brasil tiene, en general, prometedoras perspectivas.

Resumo em Inglês:

Objective. To summarize the epidemiological situation of tuberculosis (TB) in Brazil, especially as it relates to the evolution of the health sector in recent decades, the process of health sector reform, and current proposals of the Brazilian Ministry of Health. Methods. A review was conducted of data from the Ministry of Health of Brazil on tuberculosis in the country over the last 20 years, as well as of the history of changes in the health sector. Results. There have been major changes in the epidemiological situation of TB and also in the structure of the health system in Brazil. Conclusions. The overall prospects are promising for Brazil's National Plan for Tuberculosis Control.

Resumo em Espanhol:

Objetivos. Determinar la eficacia de una estrategia educativa basada en juegos populares para la enseñanza de conceptos básicos de salud en niños de edad escolar que asisten a la escuela. Métodos. Estudio de intervención desarrollado en la ciudad de Durango, México, en junio de 2000, en el que se incluyeron 300 niños de 9 a 11 años de edad, asignados de manera aleatoria al grupo A, que utilizó una versión modificada del juego popular mexicano Serpientes y Escaleras, en la que se incluyeron mensajes sobre conceptos básicos de salud, o al grupo B, o grupo de control. Resultados. En condiciones basales no hubo diferencias de edad, escolaridad ni sobre conceptos básicos de salud entre los niños de ambos grupos. Después de la intervención educativa la calificación sobre conceptos básicos de salud fue de 9,3 ± 0,8 para el grupo A y de 7,5 ± 1,1 para el B (P < 0,001). Conclusiones. El uso de juegos que incluyan mensajes sobre salud e higiene puede ser una alternativa en la enseñanza de conceptos básicos de salud.

Resumo em Inglês:

Objective. To determine, for the teaching of basic health concepts to school-age children, the effectiveness of an educational strategy based on traditional children's games. Methods. Intervention study carried out in the city of Durango, Mexico, in June 2000 with 300 children from 9 to 11 years old. The children were randomly divided into two groups. The children in Group A used a modified version of a Mexican popular game called Serpientes y Escaleras (Snakes and Ladders) that included messages on basic health concepts; the children in Group B made up the control group and did not play the modified game. Results. At baseline there were no significant differences between the two groups in terms of age, grade level, or their scores on a knowledge test of basic health concepts. After the educational intervention, the health concepts test scores, out of a maximum possible of 10, were 9.3 ± 0.8 for Group A and 7.5 ± 1.1 for Group B (P < 0.001). Conclusions. Using games that include health and hygiene messages can be an alternative for teaching basic health concepts.

Resumo em Português:

Objetivo. Descrever os valores de referência para chumbo em sangue em uma população urbana do Município de Londrina, Estado do Paraná, Brasil. Métodos. A população de referência foi constituída por 520 voluntários adultos avaliados de novembro de 1994 a dezembro de 1996. Os critérios de exclusão foram: exposição ocupacional ao chumbo, exposição através de hábitos, fumar mais de 10 cigarros por dia e morar perto de indústrias ou de locais que utilizam o chumbo em seus processos produtivos. Também foram excluídos indivíduos com valores de exames clínicos e laboratoriais fora da normalidade, doenças crônicas e distúrbios cardiovasculares. Os teores de chumbo em sangue foram determinados por espectrofotometria de absorção atômica com chama de ar-acetileno. O limite de detecção obtido foi 1,23 mig/dL. Após as análises de chumbo em sangue, foram determinados valor mínimo, primeiro quartil, mediana, terceiro quartil e valor máximo; média geométrica; intervalo de confiança de 95%; intervalo experimental; e valor de referência. Resultados. Os valores de referência para plumbemia variaram de 1,20 a 13,72 mig/dL. A média geométrica foi igual a 5,5 mig/dL. Conclusões. Em geral, os valores obtidos no presente estudo são mais baixos do que aqueles obtidos em outros países. Estudos adicionais deveriam enfocar a obtenção de valores de referência em outras populações brasileiras que vivem em regiões mais industrializadas.

Resumo em Inglês:

Objective. To describe the reference values for lead in blood in an urban population in the city of Londrina, in the state of Paraná, Brazil. Materials and methods. The reference population was composed of 520 adult volunteers who were assessed from November 1994 to December 1996. Exclusion criteria were: occupational exposure to lead, exposure through personal habits or practices, smoking more than 10 cigarettes per day, and living near industrial plants or other places that use lead in their production processes. Also excluded were individuals with abnormal clinical or laboratory results or with chronic diseases or cardiovascular disorders. Lead blood levels were determined using air-acetylene flame atomic absorption spectrophotometry. The detectable limit was 1.23 mug/dL. After the analyses of lead in blood, the following values were determined: minimum value, first quartile, median, third quartile, and maximum value; geometric mean; 95% confidence interval; experimental interval; and reference value. Results. The reference values for lead in blood ranged from 1.20 mug/dL to 13.72 mug/ dL. The geometric mean was 5.5 mug/dL. Conclusions. In general, the values found in this study are lower than those that have been reported for other countries. Additional data should be gathered from Brazilian populations living in more-industrialized areas.

Resumo em Espanhol:

Movida por la rápida expansión de la epidemia de VIH/ SIDA y su impacto mundial, la Asamblea General de las Naciones Unidas convocará una reunión especial en Nueva York en junio de 2001 para examinar la situación de la enfermedad. Como parte de los preparativos para la reunión, el Secretario General de las Naciones Unidas, Kofi Annan, emitió en febrero de 2001 un documento titulado Reunión Especial de la Asamblea General para tratar el tema del VIH y el SIDA: informe del Secretario General. En el documento se examinan la propagación de la epidemia de VIH/SIDA y su impacto en términos demográficos, sociales y económicos. También se detallan las lecciones esenciales que se han aprendido sobre las características de una respuesta eficaz contra la epidemia, y sobre las dificultades de intensificar esa respuesta. He aquí algunas de las lecciones presentadas en el documento: las respuestas eficaces muestran un respeto por los derechos humanos; se puede prevenir la expansión de la epidemia; las iniciativas nacionales requieren dirección y la participación de una variedad de actores; las medidas de prevención son eficaces; la atención y el tratamiento deben ser integrales; las buenas respuestas se arraigan en el seno de la comunidad; es esencial empoderar a la juventud; las personas que viven con el VIH y el SIDA desempeñan un papel central en las medidas de respuesta, que deben tener en cuenta simultáneamente los factores de riesgo, la vulnerabilidad del paciente y el impacto de la enfermedad. Para poder incrementar el alcance y la profundidad de las respuestas que actualmente están surtiendo buenos resultados, habrá que superar una serie de dificultades, entre ellas las de proporcionar liderazgo y coordinación, mitigar el impacto social y económico de la epidemia, lanzar iniciativas internacionales, afrontar el costo de los medicamentos y destinar los recursos necesarios.

Resumo em Espanhol:

El acceso que tienen los brasileños a los medicamentos esenciales contra el VIH y el sida y otras enfermedades se ve amenazado por las acciones de las compañías farmacéuticas internacionales y por el Gobierno de Estados Unidos de América, según explica un informe reciente de la Oxfam, organización promotora internacional que ha fijado su atención en el problema de los precios de los medicamentos en países en desarrollo. El informe de la Oxfam indica que las grandes compañías farmacéuticas, con el respaldo del Gobierno estadounidense, buscan que el Brasil se vea obligado a comprarles medicamentos patentados muy costosos, en lugar de elaborar fármacos genéricos más baratos dentro del país o de adquirirlos de otros países, como la India. Además, el informe señala que las compañías farmacéuticas se resisten a fijar un techo al costo de sus medicamentos, como quisiera el Gobierno del Brasil. Gran parte del desacuerdo se centra en torno a la Ley de la Propiedad Industrial que entró en vigor en el Brasil en 1996. Tanto el Gobierno de Estados Unidos como las grandes compañías farmacéuticas sostienen que ciertas provisiones de esa ley violan el Acuerdo sobre los Aspectos Comerciales Internacionales de los Derechos de Propiedad Intelectual de la Organización Mundial del Comercio (OMC). El Gobierno de Estados Unidos le ha pedido a la OMC que convoque un panel de debate para escuchar los argumentos a favor y en contra de la ley brasileña. Si el Gobierno estadounidense gana la partida, el Brasil tendrá que enmendar la ley o enfrentar tarifas adicionales sobre los productos que exporta a Estados Unidos. Además, los 140 países que pertenecen a la OMC tendrán que cerciorarse de que sus propias leyes sean compatibles con el dictamen de la OMC.

Resumo em Inglês:

This report is based on the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, which was recently issued by the National Institutes of Health of the United States of America. Also known as the Adult Treatment Panel (ATP) III, this new report updates two earlier such reports on high cholesterol. While continuing to concentrate on treating patients with coronary heart disease, the new report advocates more intensive treatment in order to reduce low-density lipoprotein (LDL) cholesterol in specific groups of individuals, pays special attention to primary prevention among patients with multiple risk factors, and recognizes as a secondary prevention concern a cluster of heart disease risk factors known as "the metabolic syndrome." Other issues that the ATP III report covers include therapeutic lifestyle changes to reduce LDL, LDL-lowering drug therapy, and the management of specific dyslipidemias.

Resumo em Inglês:

In February 1994, a clinical trial by the Pediatrics AIDS Clinical Trials Group (PACTG 076) demonstrated, for the first time, that it was possible to reduce the risk of vertical transmission of human immunodeficiency virus type 1 (HIV-1) by nearly 70% by means of a triple therapeutic regimen: 1) oral zidovudine (ZDV) beginning anytime between the 14th and 34th week of gestation until the end of pregnancy; 2) intravenous ZDV during pregnancy, and 3) administration of oral ZDV to neonates during the first 6 weeks of life. Later, epidemiologic studies performed in the United States of America and France showed that this regimen drastically reduced perinatal transmission in clinical practice. Since then, important strides have been made, not only in terms of treatment (new drugs and highly effective therapeutic regimens) and diagnosis (tests that can measure the viral load), but also in terms of an increased understanding of the pathogenesis of perinatal transmission of HIV-1. This report contains: a) a review of special considerations to be kept in mind when administering antiretroviral agents to pregnant women; b) a current overview of the results of clinical and epidemiologic trials dealing with the prevention of perinatal transmission of HIV-1; c) a look at the use of tests for measuring HIV-1 RNA (viral load) during pregnancy; d) the most recent recommendations on the use of antiretroviral chemoprophylaxis and elective cesarean section for reducing perinatal viral transmission. These recommendations apply to the United States, and other countries may prefer to use different approaches.